Generalized Anxiety Disorder (GAD)

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Brief description:

Children with GAD can worry about anything and everything. Always considering the "what if?," they go through a multitude questions to try to predict every possible scenario. They need to know details about all situations, may be unable to stop themselves from eavesdropping on adult conversations because they need to know what might be happening. They will often be looking over your shoulder when you are writing a check or opening the mail. While this may seem to be a game at times, where children with GAD try hard to find out the very details that you are trying to hide from them, in truth the game is no fun. They feel they need to know this information for fear the family is in dire straits.

Parents of kids with GAD may regret telling their children snippets of information (a neighbor has cancer, a relative lost a job, how lyme disease works) because they quickly turn it into days or weeks of distress about whether this might happen to them. In addition, they think about things long after they have happened (e.g. something they said to a friend which they think may have hurt his feelings). They worry a lot about whether they are good enough at school, sports, or other activities. Sometimes kids with GAD are unwilling to try new activities unless they are sure they will be good enough, or they may quit new activities if things aren't going well without giving themselves a chance to improve on or master the situation. Most times it is really difficult to get them to even try anything new. These kids often have headaches and stomachaches especially on school days, and the school nurse might know them well.

Red Flags:

Many of the following symptoms are present most of the time over a 6 month period and interfere with a child's enjoyment of or participation in normal activities:

  • Excessive, unrealistic fears about day-to-day activities
  • "What if" concerns that span far into the future
  • Uncontrollable worry about multiple situations, performance, social, academic, health, financial
  • Physical symptoms: headaches, stomachaches, inability to unwind
  • Difficulty concentrating, always thinking what's next
  • Low risk-taking; Need for reassurance and approval for small steps
  • Perfectionism, great fear of making mistakes, fear of criticism; unrealistic unfavorable assessment of their grades, abilities
  • Over-responsibility, feels that tragedies are preventable by worry, and if disaster happens that it's their fault
  • Any negative piece of news that happens to others, fears will happen to them; everything is contagious by association: divorce, illness, car accidents, food poisoning
  • Reviewing events to make sure that didn't hurt anyone's feelings or do anything wrong
  • Sleep difficulties, irritability, fatigue

Treatment focus:

Children with GAD may feel they have no choice but to worry, they are taught that there is a choice. For kids with GAD, their first thought tends to be "what's the worst thing that could happen in this situation?," retraining them to look for their second thought "what's the most likely thing I believe will happen in this situation?" will bring risky situations down to size and make them immediately more approachable. By identifying how the mind is playing tricks on them by catastrophizing, racing ahead, and bombarding them with warnings that are meant for other children who aren't so responsible, they learn how to turn down the voice of worry and turn up the volume on rational thinking. Specifically, therapists work on identification of anxious thoughts, ways to challenge these thoughts, and the generation of alternative coping thoughts. Physical symptoms of stress are addressed by teaching deep breathing and relaxation training. Then children and adolescents use these new skills to practice in situations that make them anxious (called in vivo exposures) beginning with the easiest situations and moving to the more difficult.


Brought to you by The Children's and Adult Center for OCD and Anxiety.

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