Generalized Anxiety Disorder (GAD) Symptoms & Causes

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What causes GAD?

As with many other mental health conditions, the exact cause of generalized anxiety disorder (GAD) is unknown but may be linked to:

Genetic Factors:
GAD may run in families. Just as a child can inherit parent’s brown hair, green eyes and nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. Current research suggests that 1/3 of the risk of experienced GAD is genetic.

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 important neurotransmitters that, when disrupted, can cause feelings of anxiety and depression. Researchers have also found that several parts of the brain are involved in fear and anxiety.

Temperament Factors:
A child whose temperament is timid or shy or who avoids anything dangerous may be more prone to generalized anxiety disorder than others are.

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. 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. 

Who is affected by GAD?

Females are believed to be twice as likely as males to experience generalized anxiety disorder (GAD). GAD begins gradually, often in childhood or adolescence, with symptoms that may worsen during times of stress. The age of onset varies but occurs more often in adolescents and older children than in younger children.

What are the symptoms of GAD?

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, children with anxiety disorders contend with excessive worrying that does not subside the way normal anxiety does. 

Children with generalized anxiety disorder (GAD) experience excessive and uncontrollable worry about a number of events or activities. They feel anxious in multiple settings and are often unable to “put their worries aside” no matter how hard they try.

Examples of common worries experienced by children with GAD include:

  • Future events (“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.”)
  • 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 a 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.

Symptoms of generalized anxiety disorder symptoms can vary. They may include:

  • Restlessness or feeling keyed up or on edge
  • Apprehensiveness
  • Being easily fatigued, especially at the end of the school day
  • Irritability
  • Trouble sleeping
  • Difficulty concentrating or the feeling that your mind "goes blank"
  • Difficulty handling uncertainty or indecisiveness
  • Expecting the worst, even when there is no apparent reason for concern

Physical signs and symptoms may include:

  • Fatigue
  • Muscle tension or muscle aches
  • Trembling
  • Twitching
  • Sweating
  • Nausea, diarrhea or irritable bowel syndrome
  • Headaches

How common is GAD?

Generalized anxiety disorder (GAD) is a relatively common disorder that is estimated to affect 6.8 million adults or 3.1% of the U.S. population. The prevalence of GAD in children and adolescents ranges from 2.9% to 4.6%.

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 generalized anxiety disorder (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.

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 apprehension, 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 is the difference between Generalized Anxiety Disorder in children and Generalized Anxiety Disorder in adults?

Adults with generalized anxiety disorder (GAD) often worry about every day circumstances such as job possibilities, health and finances, the health of their family members, well being of their children, and every day matters like chores. Children and adolescents have a tendency to worry about their competence or the quality of their performance at school and sporting events. They may also have excessive concerns about earthquakes, nuclear war or other catastrophic events. Thus, the content of an individual’s worry varies with age. A child or adolescent with GAD may also be perfectionist, overly anxious to fit in, and redo tasks because they aren't perfect the first time. Children tend to require excessive reassurance about their performance and other things they may be worry about.

Can I prevent GAD?

At this time, we do not know how to prevent generalized anxiety disorder (GAD) or other anxiety disorders. However, early detection and intervention can reduce the severity of symptoms, enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with anxiety disorders. If you notice your child is showing signs of an anxiety disorder, the best thing you can do is to seek professional help as soon as possible.

What is the long-term outlook for a child with GAD?

If left untreated, studies show that generalized anxiety disorder (GAD is often a chronic illness with symptoms that tend to wax and wane across the lifespan. Earlier age of onset is also associated with greater risk for development of other anxiety and depressive disorders later in life.

Where can I go to learn more?

Boston Children's Hale Family Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.

The Boston Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.

Boston Children's Center for Young Women's Health and Center for Young Men’s Health recognize that young men and young women have certain concerns that are specific to their genders, while other concerns are shared. These Boston Children's centers offer the latest general and gender-specific information about issues like fitness and nutrition, sexuality and reproductive health, physical development and emotional well-being.

The Advocating Success for Kids (ASK) Program at Boston Children's provides multidisciplinary evaluation, referral and advocacy services for children under 14 who are experiencing behavioral, emotional, learning or developmental problems, either at home or at school. ASK works with children who receive their primary care either at Boston's Bowdoin Street Community Health Center, Martha Eliot Health Center or Joseph M. Smith Community Health Center or at Boston Children's Primary Care Center. For more information about ASK, please call 617-355-4690.

Other Anxiety Resources

Other resources that are useful for children and families with anxiety include:

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- Sandra L. Fenwick, President and CEO

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