Child and adolescent mental health

Generalised anxiety disorder

What is generalised anxiety disorder?

Generalised anxiety disorder - or GAD - is when a child/young person (or adult) feels anxious or worries about different things most of the time for no obvious reason. It can make concentrating at school or having fun with their friends and family extremely difficult. They may be restless, feel on edge or act over-sensitively a lot of the time. 

Symptoms of generalised anxiety disorder in childhood

  • Difficulties sleeping or other sleep disturbances

  • Easily tired/fatigued

  • Constantly ruminating about ‘what if'

  • The need for repeated reassurance

  • Irritability/flying off the handle easily

  • Uncontrollable worry about different situations

  • Unrealistic fears about day to day activities

  • Forever worrying about future events - later today, tomorrow, next week or even years down the line

  • Perfectionism with school work

  • Feeling responsible for lots of things that are completely out of their control - at home, school or even the world at large

  • Difficulties concentrating on tasks at home or at school or their mind keeps going blank

  • Not wanting to leave the home or even their own bedroom

  • Physical complaints such as headaches, stomach aches, muscle tension and general aches and pains; nausea or even vomiting; or feeling generally unwell

NB Symptoms must be present for at least six months for a diagnosis of GAD to be made. However, it is not necessary for a child/young person to have all or even most of these symptoms for a diagnosis of GAD. Also, the symptoms above can be indicative of another mental health condition or even a physical problem, so it is important to see a GP if there are any concerns about a child or young person.

Case studies

This article presents a case study of an anxious child, and highlights some common symptoms for parents and teachers to be watchful for. Hannah (not a real person) is a 10-year-old girl from a close, supportive family who was described as 'anxious from birth'. She shows a number of symptoms indicative of generalised anxiety disorder. Questions at the end of the case study address the main thoughts, behaviours and feelings related to anxiety seen in children. BMJ article.

This paper presents the first known case reports of very young children with GAD to examine these developmental challenges at the item level. Three children, five-to-six years of age, were assessed. One case appeared to show attenuation of the worries but not when followed over two years. The other two cases showed stability of the full complement of diagnostic criteria. The cases were useful for demonstrating that the current diagnostic criteria appear adequate for this developmental period.The challenges of accurateassessment of young children that might cause missed diagnoses are discussed. Future research on the underlying dysregulation of negative emotionality and long-term follow-ups are needed to better understand the aetiology, treatment, and course of GAD in this age group. Case Reports in Psychiatry paper.

When Erik came for therapy he was 12 years old and in the 5th grade. He lived with his parents and his younger brother, aged 9 in a neighbourhood where most families had a cultural background different from his. Erik’s problems became apparent when he changed school in the beginning of second grade. Erik was diagnosed with OCD and GAD by a child psychiatrist. His parents thought that Erik needed more help and did not feel they could handle their child’s anxiety problems alone. Erik was seen in a group setting, with five younger children, for a 10-week course of CBT. Erik had a positive outcome in the therapy.  A primary aim of this case study was to investigate the mechanisms of change leading to success, focusing on the role of parental inclusion in therapy and necessary accommodations made for the child’s cognitive developmental level.  A Pragmatic Case Studies in Psychotherapy paper.  

Websites and web pages

Anxiety Canada™ is a leader in developing free online, self-help, and evidence-based resources on anxiety and anxiety disorders and promotes understanding about anxiety and anxiety disorders  in children, young people and adults. They have a page dedicated to GAD in children and adolescents, including an animated video about symptoms and strategies.

The Child Mind Institute is an American, independent, national non-profit organisation dedicated to transforming the lives of children and families struggling with mental health and learning disorders. They explain what to look for if a child might have GAD; risk factors; diagnosis; and treatment.

The University of Rochester Medical Center (URMC) is one of America’s leading academic medical centers. It forms the centerpiece of the University of Rochester’s health research, teaching and patient care missions. Although some of the information given here may not be applicable to the UK, it gives a comprehensive overview of what GAD is and how it presents in children and teens; possible causes; diagnosis; ttreatment; and how parents can help their children.

Canadian mental health website for teens and young people creating, developing and deliveing  nationally and internationally recognized research, education and clinical programs by collaborating with health care providers, policymakers, schools, the business community, non-profit organizations and the general public. They explain what GAD is and how it differs from normal anxiety; causes and risk factors; how to help someone with GAD; and treatment available.

Diagnostic criteria

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