Generalized anxiety disorder

Generalized anxiety disorder, or GAD, is a condition characterized by pervasive worry. It takes the form of undue distress about a variety of everyday things—worrying too much about everything. As one clinician puts it, “people with GAD worry that they aren’t worrying because there should be something to worry about.” In children the anxiety is often focused on performance in school or sports—Will I pass the test? What if I don’t play well? Will I get into a good college?—and may drive extreme studying or practicing. A kid with GAD is “her own tyrant,” in the words of another clinician. It can emerge in childhood as well as adolescence, and is more prevalent in girls than boys, as with all anxiety disorders. The anxiety impacts a child’s quality of life and the ability to participate in social activities and school. 

Your child might have GAD if she worries incessantly about everything, but particularly over her own performance in school or other activities, or her ability to meet expectations. Kids with GAD tend to seek reassurance in an attempt to assuage their fears and worries (Will we get there on time? What if I can’t fall asleep the night before the test?). Their anxiety can make them rigid, even irritable and restless. The stress they experience can lead to physical symptoms, including fatigue, stomachaches, and headaches.

 

The anxious thoughts of a child with GAD are exaggerated but they tend to focus on tangible, real-life issues. Unlike social anxiety disorder, they’re focused on her own perfectionism rather than what others will think of her. And unlike in adults with GAD, who realize that their pervasive anxiety is not an appropriate response to their actual situation, children with GAD may not immediately recognize that their fears are outsized. It should also be noted that many of the symptoms of GAD are also symptoms of other, more specific anxiety disorders, and differentiating them can be difficult.

The causes of GAD are not definitively known, but experts believe genes and environment play a role. Stressful and traumatic events could lead to onset, and exposure to anxious behavior combined with a genetic predisposition is a possible cause.

A diagnosis of GAD can be made when a child’s anxiety is beyond her control, causes “clinically significant distress or impairment in social, occupational, or other important areas of functioning,” and is present for an extended period. Other symptoms include a restless, on-edge feeling; fatigue; loss of focus; irritability; muscle tension; and trouble sleeping.

Treatment for GAD usually has a psychotherapeutic and a pharmacological component. In therapy, the family plays an integral role in aiding the child in her quest to control her anxiety and its effects; kids really need their parents’ help in working through the symptoms of GAD.

 

Psychotherapeutic: GAD is often treated with cognitive behavioral therapy. A therapist may expose a child to anxiety-provoking situations and teach her techniques to manage and reduce the anxiety response; this exposure therapy is very effective in cases of GAD, but difficult because of the wide range of stressors. Another technique involves teaching the child how to recognize symptoms and how her thinking contributes to anxiety, and to understand that her anxiety response is out of proportional to the things that trigger it. This is referred to in some circles as “decatastrophizing.” A course of CBT for GAD can be relatively short—10 or 20 sessions—as it quickly becomes the responsibility of the child and her family to put the skills imparted to use in the world outside the office.

 

Pharmacological: GAD often responds very well to selective serotonin reuptake inhibitors, or SSRIs. Anti-anxiety drugs are often prescribed if these do not provide the desired result. Buspirone is one which can be taken over the long term. The benzodiazepines are stronger, fast-acting sedatives that work well to curb bouts of anxiety but are prescribed sparingly, as they may be habit forming.

People with generalized anxiety disorder are more likely than the rest of the population to be diagnosed with depression, and are more likely to have problems with substance abuse. 

Can GAD be prevented?
No. Research suggests that the onset of GAD cannot be accurately predicted or prevented; still, early identification and treatment have been shown to reduce signs and symptoms later, and the sooner a child learns how to manage the disorder the better the outlook.
Are the drugs safe?
If used properly, the medications used to treat GAD are safe. The side effects of SSRIs are not particularly common or severe, and include nausea, drowsiness, and insomnia. Children on antidepressants should always follow their doctor’s orders as far as dosage and staying on their medications—abruptly stopping a course can produce damaging effects that are worse than a nuisance. Sedatives in the benzodiazepine family can be habit forming and are typically used sparingly, if at all, in the treatment of anxiety disorder. A course of medication can be as short as a few months or last for years.
Will my child grow out of GAD?
It’s possible. But even in more chronic cases, GAD can be effectively managed with cognitive behavioral therapy and medication.
How does it affect school?
As with other anxiety disorders, a child suffering with GAD may be so worried about various things at school—tests, performances, sporting events, appearance, friends, popularity—that she attempts to avoid it entirely. These things are stress-inducing for all adolescents, but with GAD can find them so crushing that her education is adversely affected; treatment is necessary so she can tolerate, even enjoy, her peers and the learning process.
What is my role in treatment?
Vital. A child with GAD needs her parents to help master and use the anxiety management skills she has learned from sessions with a clinician. The process is one of education for you as well, as you learn how to look for signs of growing anxiety, and help your child master it.
How long does treatment last?
A course of medication can last as long as it is necessary to manage the symptoms of the disorder. A course of CBT can be relatively short, perhaps 10 to 20 sessions over a period of months.