Anxiety

All children and teens have some anxiety. It's a normal part of growing up. But sometimes worries and fears don’t go away and get worse over time. They may interfere with a child’s normal activities. In these cases, an anxiety disorder may be present. 

Generalized anxiety disorder (GAD) is a mental health condition. A child with GAD has a lot of worry and fear that seems to have no real cause. The worry may be more intense than the situation calls for. Children or teens with GAD often worry about many things, such as:

• Physical appearance
• Future events
• Past behaviors
• Social acceptance
• Family matters
• Failing to meet parents' expectations
• Their personal abilities
• School performance

Causes of Anxiety Disorders

Experts believe GAD is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of two chemicals in the brain (norepinephrine and serotonin) most likely plays a part.

A child can also learn anxiety and fear from family members and others. For example, a child with a parent who is afraid of thunderstorms may learn to fear thunderstorms. A traumatic event may also cause GAD. This can include things such as the death of a parent, a divorce, or a serious family accident or illness.

Risk Factors

Children who have parents with an anxiety disorder are more likely to have GAD. Children who seem more restrained as toddlers may be at more risk for GAD.

Symptoms

Unlike adults with GAD, children and teens often don’t realize that their anxiety is more intense than the situation calls for. Children and teens with GAD often need a lot of reassurance from adults in their life.

Symptoms may be a bit different for each child. But the most common symptoms of GAD are:

• Many worries about things before they happen
• Many worries about friends, school, or activities
• Almost constant thoughts and fears about the child’s safety or the parents’ safety
• Refusal to go to school
• Frequent stomachaches, headaches, or other physical complaints
• Muscle aches or tension
• Sleep problems
• Lots of worry about sleeping away from home
• Clingy behavior with family members
• Feeling as though there is a lump in the throat
• Extreme tiredness (fatigue)
• Lack of concentration
• Being easily startled
• Being grouchy or irritated
• Inability to relax

The symptoms of GAD may seem like other health problems. Make sure your child sees their healthcare provider for a diagnosis.

Diagnosis

Before a mental health referral is made, your child's healthcare provider will want to rule out any other health problems. Once this is done, a child psychiatrist or other mental health expert can diagnose GAD. They will do a mental health assessment of your child. It may include a complete emotional and social history, interviews with you and your child, and standardized testing.

Treatment

Children and teens with GAD can’t just pull themselves together and get better. They don't choose to act or feel anxious. They often need treatment. In many cases, treatment is key to recovery. Untreated, GAD can get worse or become a long-term problem. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment for GAD may include:

• Cognitive behavioral therapy: This helps a child learn how to better manage anxiety. The goal is also to help a child master the situations that may lead to the anxiety.
• Medicines: Antidepressant or anti-anxiety medicine may help some children feel calmer.
• Family therapy: Parents play a vital role in any treatment.
• School input: A child’s school may also be included in care.

Prevention

Experts don’t know how to prevent GAD in children. If you see signs of GAD in your child, you can help by getting an evaluation as soon as possible. Remember that the symptoms are not attention seeking, but a sign of a serious problem. Early treatment can ease symptoms and enhance your child’s normal development. It can also improve their quality of life.

Living with anxiety

As a parent, you play a key role in your child’s treatment. Here are things you can do to help:

• Keep all appointments with your child’s healthcare provider. If medicine is prescribed, make sure it's taken as directed. Alert your child's provider if there are any signs of side effects.
• Reassure your child. With GAD, your child may not realize their worry is more intense than the situation calls for. Your child will need more reassurance from you and other adults.
• Listen to your child. Find out about school, activity on social media, and relationships. Bullying, both in person and on social media, is a serious problem many children face. Let your child know that they can talk to you about anything, especially if they are so anxious or sad that self-harm is being considered.
• Spend enjoyable, non-stressful time with your child. Go for a walk, dinner, or out to a movie.
• Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, teachers, and psychiatrists. Your child’s care team will depend on their needs and how serious GAD is.
• Tell others about your child’s GAD. Work with your child’s healthcare provider and school to create a treatment plan. Remind teachers that your child will need extra reassurance.

If GAD greatly interferes with your child’s ability to succeed in school, they may be eligible for specific protections and reasonable accommodations under the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act. Ask your school's principal or your child’s teacher for more information.

Reach out for support from local community services. Being in touch with other parents who have a child with GAD may be helpful.

How to build resilience in your child

Resilience is the ability to withstand challenges and bounce back with a hopeful attitude. Resilient people are able to deal with challenges that may come their way and overcome them, learning lessons that will help them in the future. Fears, worries and insecurities are a part of life, and while we can’t always control them, we can control how to respond to them. To raise children who can withstand these stressors and thrive despite them, we can help by teaching them to recognize their inner strength and build resilience.

The American Academy of Pediatrics (AAP) promotes seven “C”s of resilience, as identified by Dr. Kenneth Ginsburg, author of A Parent’s Guide to Building Resilience in Children and Teens: Giving Your Child Roots and Wings. The seven “C”s include:

• Competence – Knowing how to handle a situation.
• Confidence – Believing in your own abilities.
• Connection – Creating close interpersonal relationships with people who care about you.
• Character – Developing a guiding set of morals and beliefs.
• Contribution – Believing in the value you bring to the world.
• Coping – Managing stress and deal with challenges in a healthy way.
• Control – Understanding what is within your control and what is outside of your control.

Parents can help their children build the seven “C”s of resilience by modeling these behaviors, empowering them to make decisions, encouraging them to recognize their own strengths and value and providing a space for open, honest communication. By letting your child know that you love them and value them unconditionally, you will help build your child’s ability to face life’s challenges with confidence and hope.

When to call a healthcare provider about anxiety

Call the healthcare provider or seek medical care right away if your child:

• Feels extreme depression, fear, anxiety, or anger toward themself or others
• Feels out of control
• Hears voices that others don’t hear
• Sees things that others don’t see
• Can’t sleep or eat for three days in a row
• Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to get help

GAD may increase a child’s risk for suicide. Threats of suicide are a cry for help. Always take such statements, thoughts, behaviors, or plans very seriously. Any child who expresses thoughts of suicide should be evaluated right away.