Mental Health Guide

Generalized Anxiety Disorder

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What is it?

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 beyond the scope of more specific anxieties and phobias. In children the anxiety is often focused on performance in school or sports and may drive extreme studying or practicing. A key distinguishing factor in GAD is that the anxiety is focused not on exterior triggers like social interaction or contamination, but internally.

 

These anxieties may make a child with GAD feel restless, fatigued, tense, or irritiable, and she may have trouble concentrating or sleeping. GAD rarely emerges before adolescence, and is more prevalent in girls than boys. The anxiety impacts a child’s quality of life and the ability to participate in social activities and school. 

What to look for

A 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. Children 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.

Risk Factors

There are some genetic factors in developing generalized anxiety disorder. Children who develop the disorder are more likely to be avoidant and have inhibited behaviors and negative temperaments. Girls are also more at risk.

Diagnosis

A diagnosis of GAD can be made when a child’s anxiety is beyond her control, is focused on a number of different activities, causes significant distress or impairment, and is present "for more days than not" for at least 6 months.

 

GAD is distinguished from typical worry in its excessiveness, longer duration, lack of precipitating events, and occurence even when the performance or activity is not being evaluated.

 

To be diagnosed, a child must also have one of these symptoms: restless, on-edge feeling, fatigue, loss of focus, irritability, muscle tension, or trouble sleeping.

Treatment

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. Exposure therapy, in which a therapist exposes a child to stressors in gradual increments and teachs her techniques to manage the anxiety response, can be effective for 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 proportion 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—with the child and her family practicing learned skills  in the world outside the office.

 

Pharmacological: GAD often responds very well to the group of antidepressant medications called 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.

Other disorders to look out for

People with generalized anxiety disorder are more likely than the rest of the population to be diagnosed with depression.

Frequently Asked Questions
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.
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