Understanding Generalized Anxiety Disorder: What It Is, Why It Happens, and How to Help Your Child

“What if everyone stands up and leaves when it’s my turn to sing on stage?”

“What if I trip on the playground and no one ever wants to be my friend again?”

“What if all the walls of my bedroom fall in on me?”

These may sound like normal childhood fears; every child experiences fears at some point. However, it is important to be able to spot when normal childhood fear has become overwhelming anxiety. 

Generalized anxiety disorder sounds like a scary term, but breaking it down and understanding it will give you insight into how to cope with your child’s fears. So what is generalized anxiety disorder, what triggers it, and how is it treated? Let’s dive in.

What is Generalized Anxiety Disorder?

Generalized anxiety disorder (GAD) is exactly what the name suggests. A person suffering from this disease doesn’t feel anxiety about one particular thing or situation in their life but instead feels excessive anxiety throughout their daily activities.

They are always worried about what could go wrong, but their fears seem irrational or out of proportion to the situation. The intense worry that they feel about everything often makes it difficult for them to go about their daily life in a normal way.  

Other symptoms can include:

• Difficulty making decisions

• Restlessness or trouble concentrating

• Fatigue or trouble sleeping

• Crankiness or irritability

• Muscle tensions and aches

• Stomach upset, including nausea and diarrhoea

• Headaches

 
About 2% of American adults suffer from generalized anxiety disorder; most of these individuals begin experiencing symptoms in childhood or adolescence.(2) The prevalence of GAD in children is estimated to be similar to adults at 2-4%.(4)

Worry and nervousness are a part of life. Every child will feel these emotions at some point. When the anxiety seems out of control or disproportionate to the situation is when there may be something more going on. You have the power to get them the help they need to manage their anxiety and fears.

What Triggers Child Anxiety?

Oftentimes, anxiety disorders are not caused for reason alone. The risk factors can include environmental factors, genetic influences, and biological factors. Someone with GAD may experience any number or combination of these risk factors.

Environmental factors that may trigger episodes of anxiety include:

• Parental divorce or separation

• Loss of a family member or friend

• Living with an ill or disabled family member

• Living with someone with an anxiety disorder

• Living in a volatile home

• Moving

• Changing schools

• Experiencing a traumatic event

Genes often play a role in the likelihood of a child developing an anxiety disorder. Many mental health professionals will assess the parents’ mental health when diagnosing a child, but family members beyond the parents could also be considered. Children can be predisposed to anxiety disorders if there is a history of anxiety disorders in their family.  

Biological factors can also influence childhood anxiety. Imbalances of certain chemicals in the brain, such as serotonin and dopamine, can lead to feelings of anxiety and depression.(4)

How Can I Help My Child with Generalized Anxiety Disorder?

When your child is suffering from generalized anxiety disorder, it’s easy to feel helpless. Luckily there are many things that you can do to help your child.

Use Cognitive Behavioral Therapy Strategies

Cognitive Behavioral therapy (CBT) is often the first strategy employed by mental health professionals when treating children with generalized anxiety disorder.

CBT works on helping children identify what their thought patterns are and how those thought patterns help or hurt them. They learn to recognize that how they think influences how they feel. CBT can be a useful tool to give children the power back over their anxiety.

Check Out My Upcoming Book

 
Priscillia Puppy Is Afraid of Everything! uses a specific technique in CBT, called Graded Exposure, to help your child manage their anxiety.  

Graded Exposure helps children slowly and systematically face their fears and anxieties. The end goal is to help children learn to manage their anxiety and experience reduced symptoms.

As you read this story with your child, you will see Priscilla Puppy recognize her anxiety, use Graded Exposure, and be successful in managing her fears. Your child will learn how Graded Exposure could be applied to their fears and help them manage their anxiety.

Other Treatment Options

Treatment of generalized anxiety disorder should always be overseen by a mental health professional. Mental health treatment is not one size fits all. Having a professional on your child’s side is invaluable.  

Cognitive Behavioral Therapy is the gold standard for treatment of generalized anxiety disorder. Especially, Graded Exposure Therapy, part of CBT, is a very effective treatment to reduce anxiety symptoms. CBT includes some of the following techniques and strategies: 

• Psychoeducation – Learning about their symptoms and the pattern they follow.(8)

• Somatic management skills – Progressive muscle relaxation or diaphragmatic breathing to control the physical symptoms of anxiety.(5)

• Cognitive restructuring – Learning to reshape maladaptive thoughts or cognitive distortions.(8)

 
The mental health professional will continue to use tools and methods to help your child until they find the ones that work best. Alternative treatment options for your child are Mindfulness-Based Psychotherapy or Psychodynamic Psychotherapy.(6)

Your child’s mental health professional may suggest anti-anxiety medications if all other routes have not improved their symptoms as much as is needed. SSRIs and SSNRIs can be an effective form of treatment for generalized anxiety disorder but should only be used as a last resort and under the careful watch of a psychiatrist or psychologist.(7) Oftentimes, medication will be used in tandem with therapy to give a child all the tools they need to overcome their anxiety.(6)

Generalized anxiety disorder can feel difficult to overcome as it permeates every part of a sufferer's day-to-day life. However, there are many effective treatments. Your child can learn to cope with their anxiety and live a normal life.

Pre-order Priscillia Puppy Is Afraid of Everything! here. To check out other books in the I’M AFRAID anxiety disorder series, visit: www.DrMadeleineVieira.com/books/imafraid

Would you like more information on childhood anxiety? Listen to my Genius Little Minds two-part podcast series on childhood anxiety disorders now! Click here for part 1 and click here for part 2.

And don’t forget to sign up for my monthly newsletter to stay up-to-date on the latest blogs and podcasts!

Resources

1. https://www.drmadeleinevieira.com/books/imafraid/generalizedanxietydisorder

2. https://www.webmd.com/anxiety-panic/guide/generalized-anxiety-disorder#:~:text=Generalized%20anxiety%20disorder%20

3. https://www.med.upenn.edu/ctsa/general_anxiety_symptoms.html

4. https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad

5. https://www.heretohelp.bc.ca/infosheet/strategies-for-children-with-generalized-anxiety-disorder

6. Wehry, A. M., Beesdo-Baum, K., Hennelly, M. M., Connolly, S. D., & Strawn, J. R. (2015). Assessment and treatment of anxiety disorders in children and adolescents. Current psychiatry reports, 17(7), 52. https://doi.org/10.1007/s11920-015-0591-z

7. Kodish, I., Rockhill, C., & Varley, C. (2011). Pharmacotherapy for anxiety disorders in children and adolescents. Dialogues in clinical neuroscience, 13(4), 439–452. https://doi.org/10.31887/DCNS.2011.13.4/ikodish

8. https://www.uptodate.com/contents/psychotherapy-for-anxiety-disorders-in-children-and-adolescents

3 Things to Do if You're Raising an Anxious Child

The past couple of years have been hard on all of us. But if you’re a parent, you’re a real hero. Working and parenting from home—all while tackling crippling pandemic anxiety—has become the new norm for many people.

And your children are likely feeling anxious too. They may not use the exact phrase “I’m anxious,” but the pandemic hasn’t been easy on anyone.  And they probably don’t even have the words to describe exactly what they’re feeling.

So it’s up to you to notice and tackle the issue head on.

Is the question, “Mom, what if…?” followed by the disaster of the day on repeat in your household?

No matter how many ways you assure them they’re safe—does their brain still get on an anxiety loop of worst-case scenarios?

And are you struggling to soothe them when their fear or worry becomes overwhelming?

Navigating a childhood anxiety disorder can be really taxing.

There are only so many ways you can assure your child they’re okay. When their brain gets on an anxiety loop of “what if… what if… what if…” it can feel impossible to flip the switch.

So how do you help them cope when you’re hanging on by a thread yourself?

You start with learning the signs and symptoms.

Signs of Anxiety in Children

Anxiety in children can look and sound different than anxiety in adults.

So What Does Childhood Anxiety Actually Look Like?

• Crying spells

• Frequent stomachaches and/or headaches

• Being unwilling to go to school or attend social events with peers

• Being afraid that something bad will happen to you or other loved ones

• Changes in mood, sleeping and eating habits or behavior

 
Symptoms vary from disorder to disorder. That’s why seeking professional evaluation and treatment is so necessary and important.

Should I Be Worried About My Child’s Anxiety?

It’s completely normal for children to be anxious or worried sometimes. They are human, after all! Just like you and me, sometimes they get scared or nervous when facing a new challenge, meeting new people, or being in an unfamiliar environment.

But when a child has an anxiety disorder, they feel extreme fear and worry. And the anxiety they feel is disproportionate to the situation at hand. It might feel impossible for them to relax because their worry is so pervasive. Their “fight or flight” response is activated even when there isn’t any real danger present. And they might have symptoms that show they aren’t coping with their fear and stress very well.

Your child may try to hide their anxiety from you due to shame, fear, or just not knowing what’s going on inside their own body and brain. Try to cultivate a sense of safety so they share their feelings and experiences with you.

If your child’s anxiety is so severe they feel physically ill, don’t want to go to school, have trouble focusing on schoolwork, and you’re unable to soothe them, then you may want to seek professional help.

Anxiety disorders in children and teens are actually quite common. It’s estimated that 1 in 8 children in the US (1) and between 5 and 19% of children and adolescents in the UK have an anxiety disorder. (2)

If you suspect your child has an anxiety disorder, try not to stress yourself out. “Disorder” is not a dirty word! And even if your child has a diagnosable anxiety disorder, it doesn’t mean they’re doomed.

What Causes Childhood Anxiety?

There are a number of factors that contribute to children developing anxiety disorders.

Genetics

This may be hard to hear, but just like your child might have inherited your hair and eye color, they might have also inherited your anxiety. Children of parents with an anxiety disorder can be as much as seven times more likely to develop an anxiety disorder themselves. (8)

Not all children with anxious family members will develop anxiety.

But a 2016 literature review found that panic disorder, generalized anxiety disorder and social anxiety disorder are linked to specific genes. (5)

And predispositions to neuroticism, shyness, conscientiousness and low extraversion also tend to be associated with anxiety. (6)

Most researchers will tell you that genes play a part in a child developing clinical anxiety. But remember, you’re also a hero and role model! When your child sees you coping and using healthy strategies to deal with your anxiety, they learn that anxiety is manageable. Together, you can reduce worries, implement self-care routines, and make healthy choices.

Biology and Brain Chemistry

Biology can also play a role—sometimes children’s dopamine and serotonin neurotransmitters can get out of whack. Consulting with your child’s healthcare provider can help rule out or hone in on any imbalances that need to be addressed.

Anxiety and depression often present simultaneously, so be sure to keep an eye out for depressive symptoms in your child as well. In children and teens, depression may present as irritability. (7) Stay tuned for the upcoming podcast episode with more information on childhood depression and how you can help your child overcome it.

Environmental Factors

A child’s environment also plays a role in how anxious they are. Stressful living situations, major life changes, the death of a loved one, or family problems can make a child’s anxiety skyrocket.

Life can be stressful—that’s just a reality we all have to face. But do your best to come up with a plan with your child before a stressful event so they know what to expect.

And the more you can cope with your own stress and show support as your child learns age-appropriate ways to manage their anxiety, the better.

How Can I Help My Anxious Child?

Calming an anxious child is no easy feat.

Finding a therapist who specializes in anxiety disorders can be extremely helpful. Early detection and intervention can help reduce the severity of symptoms and improve your child’s quality of life. (3)

The best thing you can do is seek out professional help sooner rather than later. Licensed mental health professionals specializing in Cognitive Behavioral Therapy (CBT) and Graded Exposure Therapy are a great place to start. They can also provide training on what you as a parent or caretaker can do to help your child take small steps toward conquering their fears.

Here are 3 steps you can take to help your anxious child today.

1.    Seek Out Professional Help

Therapy is safe and non-invasive. But it does require a medium to long-term commitment of weekly sessions. And those can range from a few months to over a year of treatment, depending on the severity of symptoms.

Cognitive Behavioral Therapy (CBT) is usually the first line of treatment for anxiety disorders, though in some cases medication is also useful. CBT is a form of talk therapy based on the idea that unhelpful thought patterns and behaviors can be changed into more realistic thoughts—which in turn has a positive effect on feelings and behavior. (4)  

Under the CBT umbrella there are two therapeutic interventions that are particularly useful for treating anxiety:

• Graded Exposure Therapy: With a stepladder approach, children are slowly and systematically exposed to the thing they fear, reducing their anxiety symptoms.

• Exposure Response Prevention Therapy: This is the CBT-based therapy of choice for Obsessive-Compulsive Disorder (OCD). It helps children with OCD face their fears while refraining from engaging in compulsive behaviors.

2.    Read Therapeutic Books Together

In addition to therapy, reading therapeutic books together can help your child understand their anxiety. Through storytelling and beautiful illustrations, your child will learn to overcome their fear-based behaviors.

The book series I’m Afraid, which is based on Graded Exposure Therapy, demonstrates that it is possible for children to manage their anxiety.

They’ll find themselves identifying with Sophia Swan Who’s Afraid of Water, Charlie Cub Who’s Afraid to Leave His Mother, or Khloe Kitten Who’s Afraid of Germs. These beautiful stories bring your child’s lived experience to the page. At the end of each story, they’ll see fears are conquerable. Pre-order my therapeutic book series about childhood anxiety disorders today!

3.    Learn More About Childhood Anxiety Disorders

By learning about what your child is going through, you’ll be better equipped to help them cope. Children often have a hard time finding the words to express their anxiety. So being cognizant of the physical signs and behaviors is so important.

Listen to my two-part Childhood Anxiety Disorders series on my podcast, Genius Little Minds, where I unpack 8 anxiety disorders and how they present in children.

Listen here:

Childhood Anxiety Disorders: Part One – My Child Cries When I Go to Work! And Other Anxious Tendencies

Childhood Anxiety Disorders: Part Two – My Child is Afraid of Messes! And Other Anxious Tendencies

And don’t forget to subscribe to stay up to date with the latest in children’s mental health!

References

1. Anxiety and Depression Association of America. Facts & Statistics. 2014. http://www​.adaa.org/about-adaa​/press-room/facts-statistics.

2. (2020, September). Anxiety Disorders in Children. NHS Inform. https://www.nhsinform.scot/illnesses-and-conditions/mental-health/anxiety-disorders-in-children

3. Generalized Anxiety Disorder. Boston Children’s Hospital. https://www.childrenshospital.org/conditions-and-treatments/conditions/g/generalized-anxiety-disorder-gad

4. (2017, July). What is Cognitive Behavioral Therapy. American Psychological Association https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

5. (2019, June). Is Anxiety Genetic? Healthline. https://www.healthline.com/health/mental-health/is-anxiety-genetic#symptoms

6. Personality Traits Associated With Anxiety. Brainsway. https://www.brainsway.com/knowledge-center/personality-traits-associated-with-anxiety/

7. The Relationship Between Anxiety and Depression. Hartgrove Behavioral Health System. https://www.hartgrovehospital.com/relationship-anxiety-depression/

8. (2020, August). Does Anxiety Run in Families? UNC Healthtalk. https://healthtalk.unchealthcare.org/does-anxiety-run-in-families/