Generalized anxiety disorder (GAD)
Disease Information
In-Depth
All of us are born with the instinctive “fight or flight” response that helped our ancestors escape predators and other threats. When we are afraid, concerned or stressed, the part of our brain responsible for the fight or flight response will generate the nervous, fearful sensation we call anxiety. While everyone experiences anxiety at times, people with anxiety disorders contend with excessive worrying that does not subside the way normal anxiety does.
Generalized anxiety disorder (GAD) is a type of anxiety disorder that is not tied to any single cause or reason. People with GAD worry excessively about multiple concerns and tend to feel anxious in almost any situation or setting, and are often unable to “put their worries aside” no matter how hard they try.
What do children with GAD usually worry about?
Children with GAD may worry about anything (and often worry about more than one topic at once).
Examples of common worries experienced by children with GAD include:
- future events (for example, “What’s going to happen to me when Mom and Dad die?”)
- past behaviors and incidents (“I still feel sick when I remember tripping in front of the whole class last year and how everyone laughed at me.”)
- social acceptance (“What if my friends are only pretending to like me?”)
- family matters ("Now that Kathy’s parents are getting divorced, what if mine do too?”)
- personal abilities (“Why can’t I climb the rope swing in gym class like everyone else?”)
- perceived personal shortcomings (“I’m so dumb/fat/ugly.”)
- school performance (“I’m feeling kind of confused in math class this semester. What if I fail?”)
Children with GAD often worry about the same subjects as children who do not have an anxiety disorder. The difference is that for the child with GAD, there is no “on-off” switch for the worry: it is ever-present and so extreme that it interferes with the child’s ability to relax, concentrate and enjoy activities…even favorite hobbies and interests.
Causes
What causes GAD and other anxiety disorders in children?
Anxiety disorders like GAD are linked to:
- Biological factors: The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two mportant neurotransmitters that, when disrupted, can cause feelings of anxiety and depression.
- Family factors: Anxiety and fear can be inherited. Just as a child can inherit a parent’s brown hair, green eyes and nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. For example, a child whose parent displays perfectionist tendencies may become a perfectionist, too.
- Environmental factors: A traumatic experience (such as a divorce, illness or death in the family, or major events outside of the family) may also trigger the onset of an anxiety disorder.
Signs and symptoms
What are the symptoms of GAD in children?
Unlike adults, children may not realize how intense or abnormal their feelings of anxiety have become. It can be difficult for a child to determine that something is “wrong.”
The hallmark of a child with GAD—as opposed to another type of anxiety disorder— is that they will worry about more than one topic and will experience anxiety in multiple situations and settings. If your child has GAD, she may need frequent reassurance from you or other family members, or from teachers or classmates at school.
Other symptoms of GAD often include:
- worrying about things before they happen
- a need for everything to be “perfect”
- ongoing worries about friends, school or activities
- constant thoughts and fears about safety (of self or of others, such as parents and siblings)
- reluctance or refusal to go to school
- frequent stomachaches, headaches or other physical complaints
- frequent muscle aches or tension
- trouble sleeping at home and away
- “clingy” behavior with parents
- feeling the sensation of a “lump in the throat” or “pounding in their chest”
- fatigue
- inability to concentrate
- being easily startled
- irritability
- inability to relax
Your child may be diagnosed with generalized anxiety disorder if these symptoms:
- are present for at least six months
- cause significant distress for the child
- do not subside, no matter how much the child tries to relax or stop worrying
- impaired functioning at home, at school or with peers
How can I tell if my child has GAD, or is just “going through a phase” of anxiety?
Nearly all children experience short periods of anxiety and worry in their lives. For example, very young children tend to go through phases of fearing the dark, loud noises or large animals. Older children will experience periods of anxiety when separated from their parents for the first time, taking a difficult test or giving a presentation in front of the class.
The difference between these normal feelings of anxiety and the presence of GAD or another anxiety disorder is that a child with generalized anxiety disorder will experience an extended and extensive period of worry, and the degree of anxiety and fear is notably out of proportion to the reality of the situation, and the child doesn’t respond to typical supportive measures.
As an example, let’s say your child is anxious about an impending thunderstorm. If the feeling of anxiety is minor (your child may express some nervousness or trepidation, but is comforted by asking questions and receiving reassurance), lasts for only a short time leading up to the storm and is replaced by a return to calm and a normal routine immediately afterwards, this can be interpreted as a passing bout of anxiety.
However, if your child begins to fret at the first sign of darkening clouds, is significantly distressed (to the point that she may feel physically ill, can’t focus on schoolwork or play and isn’t soothed by parents’ reassurance), this can be a warning sign of an anxiety disorder.
What if my child has been diagnosed with another mental health issue, in addition to generalized anxiety disorder?
A child with GAD often has another mental health condition, including:
- another anxiety disorder (such as obsessive-compulsive disorder or separation anxiety disorder)
- a mood disorder (such as depression or, more rarely, bipolar disorder)
- attention-deficit hyperactivity disorder (ADHD)
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