Generalized Anxiety Disorder

Anxious child looking out of the window

May 22, 2018

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Posted in: Families, Grade School, Parenting Concerns, Pre-School, Teenagers, Young Adults

Ten-year-old Joyce was always known as a bit of worrier. Even as a two-year-old, she seemed anxious from time-to-time, especially when life was a bit stressful. A new babysitter, a noisy birthday party, or a vacation could all trigger nervousness and crying spells, but these symptoms generally went away fairly quickly. 

Things changed sometime around fourth grade. The summer before fourth grade, Joyce’s best friend moved to a new town, and her mother had appendicitis that required an emergency surgery. Though Joyce’s mother recovered after a reasonable time, Joyce couldn’t stop worrying about her mother’s health. She had trouble falling asleep at night. She worried that her mother might die, that a burglar might enter the house because the doors weren’t locked, or that all of her other friends would move away.

Although she had always been a good student, her performance in school suffered. She became perfectionistic, spent far too much time completing homework and needed a lot of reassurance about her performance. The school nurse became well-acquainted with Joyce, as she frequently complained of stomach and head-aches. 

Everyone experiences anxiety. It’s part of life. In fact, some anxiety is a good thing. A little bit of anxiety keeps us motivated and excited about life. It can serve as a warning sign when we need to make changes and can protect us from entering dangerous situations. It’s even been found to be a plus in leadership because it can make us be more careful in considering the possibility of multiple outcomes, particularly risky ones.

But Joyce’s anxiety had gone beyond the level where it was a positive influence in her life. In fact, it had become quite debilitating. She was having trouble sleeping, felt anxious even when there was nothing to feel anxious about, and worried about things that would likely never happen.

Joyce had Generalized Anxiety Disorder (GAD), a disorder characterized by feelings of anxiety. These symptoms include excessive worry which interfere with a person’s ability to function at school, at home, or in social relationships.

To receive a diagnosis of GAD, a child must have:

  • Worries that are hard to control and that are experienced on most days. These worries are very upsetting, and children may exhibit symptoms such as crying, withdrawal, and tantrums
  • Worries that are accompanied by physical symptoms. These can include feelings such as restlessness, problems concentrating, muscle tension, problems sleeping, changes in appetite, stomach aches, headaches, and sweating or shaking.
  • The symptoms must be present for six months. Symptoms can occur more days than not during this six-month period. It’s important to note that experiencing anxiety just at the beginning of the school year, or after having a stressful week at school would not qualify for a diagnosis of GAD.
  • The symptoms cause significant distress and impairment in functioning. Symptoms can interfere with a child’s ability to function in every day life. For Joyce, these problems included difficulty performing in school and problems with friendships.

Joyce’s parents were concerned enough to talk to her school psychologist, who suggested she see a doctor to evaluate the possibility of an anxiety disorder. While some anxiety is normal, Joyce’s symptoms were significant enough to warrant further exploration. In general, it’s good to see a doctor when:

  • Your child’s worrying is interfering with school, friendships, or home life
  • Your child is showing frequent symptoms of depression, irritability, problems with sleeping, eating or nervousness

We don’t know what causes GAD, but it’s most likely a combination of biological and environmental factors that include:

  • Differences in brain chemistry
  • Genetics
  • Behavioral inhibition: a temperament where the child is more inclined to withdraw or become fearful in new situations   
  • A tendency to be more sensitive to feelings of anxiety, including a tendency to focus more on physical symptoms and interpret these as being harmful

Regardless of the cause of GAD, we are constantly learning more about ways to treat the symptoms. The most effective treatment for GAD is cognitive behavioral therapy (CBT), a form of therapy that focuses on the presenting symptoms, is very goal oriented, and is skills-based. Therapy starts with educating the child and entire family about GAD so that they can identify the symptoms. Once symptoms, such as worrisome thoughts, have been identified, the therapy focuses on coping skills. Coping skills can include practicing handling challenging situations (“What happens when I get anxious during a math test?”) or challenging faulty thought patterns (“I’m sure both of my parents will die,” to “There’s a pretty small chance that my parents will become sick.”). Other skills can include meditation, breathing exercises, and mindfulness. Medication can also be used to treat GAD, and for some kids both psychotherapy and medication is the best treatment option.

To know for sure if your child has GAD, you need to get a diagnosis from a professional. The best place to start is with your child’s pediatrician. If your child does get a positive diagnosis, keep in mind that GAD is very treatable. After four months of weekly CBT treatment, Joyce experienced a significant decrease in symptoms. While it’s possible that she might need booster sessions at some point in the future, the skills she learned in therapy helped her become a more confident friend and student and helped her move from a child who was generally anxious to one who was appropriately anxious.

Ellen Braaten

Ellen Braaten, Co-Director

Ellen Braaten, Ph.D. is co-director of The MGH Clay Center for Young Healthy Minds, and director of the Learning and Emotional Assessment Program (LEAP) at Massachusetts General Hospi...

To learn more about Ellen, or to contact her directly, please see Our Team.

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