Definition

Generalized anxiety disorder (GAD) is a mental disorder in which a child is often worried or anxious about many things and finds it hard to control this anxiety.

Alternative Names

GAD - children; Anxiety disorder - children

Causes

The cause of GAD is unknown. Genes may play a role. Children with family members who have an anxiety disorder also may be more likely to have one. Stress may be a factor in developing GAD.

Things in a child's life that can cause stress and anxiety include:

• Loss, such as death of a loved one or parents' divorce
• Big life changes, such as moving to a new town
• A history of abuse
• Living with family with members who are fearful, anxious, or violent

GAD is a common condition, affecting about 2% to 6% of children. GAD usually does not occur until puberty. It is more often seen in girls than in boys.

Symptoms

The main symptom is frequent worry or tension for at least 6 months, even with little or no clear cause. Worries seem to float from one problem to another. Children with anxiety commonly focus their worries on:

• Doing well at school and sports. They may have the feeling that they need to perform perfectly or otherwise feel they are not doing well.
• The safety of themselves or their family. They may feel intense fear of natural calamities such as earthquakes, tornados, or home break-ins.
• Illness in themselves or their family. They may worry excessively over minor illnesses they have or be fearful of developing new illnesses.

Even when the child is aware that worries or fears are excessive, a child with GAD still has difficulty controlling them. The child often needs reassurance.

Other symptoms of GAD include:

• Problems concentrating, or the mind going blank
• Fatigue
• Irritability
• Problems falling or staying asleep, or sleep that is restless and unsatisfying
• Restlessness when awake
• Not eating enough or overeating
• Outbursts of anger
• A pattern of being disobedient, hostile, and defiant

Expecting the worst, even when there is no apparent reason for concern.

Your child may also have other physical symptoms such as:

• Muscle tension
• Upset stomach
• Sweating
• Difficulty breathing
• Headaches

Anxiety symptoms can affect a child's daily life. They can make it hard for the child to sleep, eat, and perform well in school.

Exams and Tests

Your child's health care provider will ask about your child's symptoms. GAD is diagnosed based on your and your child's answers to these questions.

You and your child will also be asked about their mental and physical health, problems at school, or behavior with friends and family. A physical exam or lab tests may be done to rule out other conditions that can cause similar symptoms.

Treatment

The goal of treatment is to help your child feel better and function well in daily life. In less severe cases, talk therapy or medicine alone can be helpful. In more severe cases, a combination of these may work best.

TALK THERAPY

Many types of talk therapy may be helpful for GAD. One common and effective type of talk therapy is cognitive-behavioral therapy (CBT). CBT can help your child understand the relationship between their thoughts, behaviors, and symptoms. CBT often involves a set number of visits. During CBT, your child can learn how to:

• Understand and gain control of distorted views of stressors, such as life events or other people's behavior
• Recognize and replace panic-causing thoughts to help them feel more in control
• Manage stress and relax when symptoms occur
• Avoid thinking that minor problems will develop into terrible ones

MEDICINES

Sometimes, medicines are used to help control anxiety in children. Commonly prescribed medicines for GAD include antidepressants and sedatives. These may be used short-term or long-term. Talk with the provider to learn about your child's medicine, including possible side effects and interactions. Be sure your child takes any medicine as prescribed.

Outlook (Prognosis)

How well a child does depends on how severe the condition is. In some cases, GAD is long-term and is difficult to treat. However, most children get better with medicine, talk therapy, or both.

Possible Complications

Having an anxiety disorder can put a child at risk for depression and substance abuse.

When to Contact a Medical Professional

Contact your child's provider if your child frequently worries or feels anxious, and it interferes with their daily activities.

References

Bostic JQ, Prince JB, Buxton DC. Child and adolescent psychiatric disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 69.

Calkins AW, Bui E, Taylor CT, Pollack MH, LeBeau RT, Simon NM. Anxiety disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 32.

Marcdante KJ, Kliegman RM, Schuh AM. Anxiety and phobias. In: Marcdante KJ, Kliegman RM, Schuh AM, eds. Nelson Essentials of Pediatrics. 9th ed. Philadelphia, PA: Elsevier; 2023:chap 17.

Rosenberg DR, Chiriboga JA. Anxiety disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 38.