What is generalized anxiety disorder in children and teens?

Generalized anxiety disorder (GAD) is a mental health problem. A child with GAD has a lot of worry and fear that seems to have no real cause. There may be more worry than is called for. Children or teens with GAD often worry about things like:

• How they look.

• Future events.

• Past mistakes.

• Fitting in with others.

• Family matters.

• Not meeting parents' standards.

• Their own abilities.

• How they're doing in school.

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

What causes GAD in a child or teen?

Experts believe GAD is caused by both family factors and environment. A child may inherit a tendency to be anxious. An imbalance of chemicals in the brain 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. Trauma may also cause GAD. It may be the death of a parent, a divorce, or a serious family accident or illness.

Which children and teens are at risk for GAD?

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.

What are the symptoms of GAD in a child or teen?

Children and teens often don’t see that their anxiety is more intense than the situation calls for. They often need a lot of reassurance from the adults in their life.

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

• Many worries about things before they happen.

• Many worries about friends, school, or activities.

• Frequent thoughts and fears about their safety or their parents’ safety.

• Refusal to go to school.

• Frequent stomach aches, 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 like there's a lump in the throat.

• Feeling very tired (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 doctor for a diagnosis.

How is GAD diagnosed in a child or teen?

Before a mental health referral is made, your child's doctor will rule out other health problems. Then a child psychiatrist or other mental health expert can diagnose GAD. They will do a mental health exam. It may include an emotional and social history, interviews with you and your child, and testing.

How is GAD treated in a child or teen?

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. 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 bad the condition is.

Treatment for GAD may include:

• Cognitive behavioral therapy. This helps a child learn how to 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.

How can I help prevent GAD in my child or teen?

Experts don’t know how to prevent GAD. If you see signs of GAD in your child, get them examined as soon as possible. The symptoms are not attention-seeking. They are a sign of a serious problem. Early treatment can ease symptoms. It can also improve your child’s normal development. It can improve their quality of life.

How can I help my child or teen live with GAD?

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 doctor. If your child gets medicine, give it as directed. Tell the doctor if there are any side effects.

• Reassure your child. Your child may not see that their worry is bigger than the situation calls for. Your child will need more comforting 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 they're thinking about self-harm.

• Spend some fun, stress-free time with your child. Go for a walk, dinner, or out to a movie.

• Find out about other providers who will be included in your child’s care. The care team may include counselors, therapists, social workers, psychologists, teachers, and psychiatrists. It will depend on your child's needs and how serious GAD is.

• Tell others about your child’s GAD. Work with your child’s doctor 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 some protections and accommodations under the Americans with Disabilities Act 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.

When to contact your child’s doctor

Contact the doctor or get 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 3 days in a row.

• Shows behavior that concerns friends, family, or teachers. Or if others are concerned 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 is thinking of suicide should be evaluated right away.

Key points about GAD in children and teens

• Generalized anxiety disorder (GAD) is a serious mental health problem. A child with GAD has a lot of worry and fear that seems to have no real cause.

• A child with GAD may worry about things such as future events, past behaviors, and family matters.

• The child may not realize their worry is more intense than the situation calls for.

• GAD is caused by both biological and environmental factors.

• A mental health evaluation is needed to diagnose GAD.

• Treatment includes therapy and medicines.

• Untreated, chronic anxiety can lead to other serious problems such as depression, substance abuse, and self-harm.

• Treatment and family involvement can help reduce GAD symptoms. They can improve your child's quality of life.

Next steps

Tips to help you get the most from a visit to your child’s doctor:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s doctor after office hours and on weekends. This is important if your child becomes ill and you have questions or need advice.