What is the prevalence of Generalized Anxiety Disorder (GAD) in pediatrics and adolescents?

Prevalence of Generalized Anxiety Disorder in Pediatrics and Adolescents

The lifetime prevalence of Generalized Anxiety Disorder (GAD) in adolescents aged 13-18 years is approximately 2%, making it one of the less common anxiety disorders in this population compared to specific phobias, social anxiety, and separation anxiety. 1

Epidemiology of GAD in Pediatric Populations

Overall Prevalence

• At any given time, nearly 7% of youths worldwide have an anxiety disorder of any type 1
• The estimated lifetime prevalence of anxiety disorders in the United States is approximately 20-30% among children and adolescents 1
• In pediatric primary care settings, the prevalence of mental health and behavioral disorders ranges between 12-22% 1

Specific Anxiety Disorder Prevalence

For adolescents aged 13-18 years old, lifetime prevalence rates are:

• Specific phobia: 20% 1
• Social anxiety: 9% 1
• Separation anxiety: 8% 1
• GAD: 2% 1
• Agoraphobia: 2% 1
• Panic disorder: 2% 1

GAD-Specific Epidemiology

• GAD occurs in over 10% of children and adolescents according to some studies 2
• Average age of onset for GAD is 8.5 years 2
• GAD is more frequently reported in girls than boys 2
• The median age of onset for anxiety disorders in general is approximately 11 years 1

Developmental Patterns of Anxiety Disorders

Anxiety disorders tend to emerge at specific developmental phases:

• Separation anxiety: Preschool/early school-age years
• Specific phobias: School-age years
• Social anxiety: Later school-age and early adolescent years
• GAD, panic disorder, and agoraphobia: Later adolescent/young adult years 1

Course and Comorbidity

• The course of GAD tends to be chronic, often with waxing and waning symptoms 1, 2
• GAD (especially) is highly comorbid with other anxiety disorders and psychiatric conditions 1
• Common co-occurring conditions include:
  • Separation anxiety disorder 2
  • Social phobia 2
  • Depression 1, 3
  • ADHD 1
  • Learning/language disorders 1
  • Behavior disorders 1
  • Obsessive-compulsive disorder 1
  • Eating disorders 1
  • Substance-related disorders 1

Clinical Impact and Prognosis

• Untreated child and adolescent anxiety disorders lead to significant impairments in:

  • Social functioning
  • Educational outcomes
  • Occupational achievement
  • Physical health
  • Mental health outcomes extending from childhood into adulthood 1

• Among adolescents with anxiety disorders:

  • 24% experience suicidal ideation
  • 6% make suicide attempts 1
  • GAD with comorbid depression may convey the greatest risk for suicidality 1

Treatment Considerations

Despite the availability of effective treatments for anxiety disorders:

• Less than 50% of youths needing mental health treatment receive any care
• Even fewer receive evidence-based treatments 1
• Both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy for pediatric GAD 2, 3

Clinical Pitfalls to Avoid

1. Misdiagnosis: Failing to distinguish between normal developmental fears and pathological anxiety. Normal developmental fears include separation anxiety in toddlers, fear of supernatural creatures in preschoolers, and social/existential concerns in adolescents 1.

2. Overlooking comorbidities: Given the high comorbidity rates, clinicians should screen for other anxiety disorders and depression when GAD is suspected 1, 2.

3. Delayed intervention: Early identification and treatment improve prognosis 4. Screening for anxiety disorders is recommended in children 8 years and older by the U.S. Preventive Services Task Force 4.

4. Inadequate assessment: A multi-informant, multi-method approach involving the child, parents, and school teachers is recommended for proper diagnosis 2.