From the Guidelines
Children with generalized anxiety disorder typically exhibit excessive worry and fear that is difficult to control, occurring on most days, and manifesting as restlessness, irritability, difficulty concentrating, muscle tension, sleep disturbances, and fatigue, as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. The signs and symptoms of generalized anxiety disorder in children can be diverse and may include:
- Excessive worry about school performance, social acceptance, family issues, or health concerns
- Physical symptoms such as headaches, stomachaches, nausea, or other somatic complaints with no clear medical cause
- Perfectionism, constant reassurance-seeking, avoidance of anxiety-provoking situations, or difficulty participating in normal activities
- These symptoms typically persist for at least six months and cause significant distress or impairment in social, academic, or other important areas of functioning, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, and summarized in the guideline 1. The development of generalized anxiety disorder in children is often the result of a combination of genetic predisposition, brain chemistry, personality traits, and environmental factors, including parent/parenting factors, stressful/traumatic exposures, and insecure attachment, as discussed in the guideline 1. Early identification and intervention are crucial, as untreated anxiety can persist into adulthood and increase the risk of developing other mental health conditions, such as depression, bipolar, attention-deficit/hyperactivity disorder (ADHD), learning/language, behavior, obsessive-compulsive, eating, and substance-related disorders, as noted in the guideline 1. Treatment typically involves cognitive-behavioral therapy to help children identify and manage anxious thoughts, along with family therapy and, in some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) prescribed by a psychiatrist at appropriate pediatric dosages, as recommended in the guideline 1.
From the Research
Signs and Symptoms of General Anxiety Disorder in Children
The signs and symptoms of general anxiety disorder (GAD) in children include:
- Excessive worry and tension about everyday events that the child cannot control, expressed on most days for at least 6 months 2
- Distress or difficulty in performing day-to-day tasks 2
- Physical symptoms such as diaphoresis, palpitations, and tantrums 3
- Behavioral symptoms such as restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbances 3, 4
- Symptoms similar to those in adults, but care should be taken to distinguish them from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers 3
Diagnosis and Treatment
GAD in children can be diagnosed and managed by primary care physicians, with effective treatments including:
- Psychotherapy, often cognitive behavioral therapy (CBT) 5, 3, 6, 4
- Pharmacotherapy, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors 5, 3, 6, 4
- Combination of CBT and pharmacotherapy, which can produce greater improvement than either treatment alone 5, 6