Generalized Anxiety Disorder: The Sky is Falling!!!
What to Do When Anxiety and Worry Become a Serious Matter for Your Child or Adolescent.
by Colleen Cummings, Ph.D., Clinical Psychology Associates of North Central Florida
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Childhood or Adolescent Generalized Anxiety Disorder – What is it?
Generalized Anxiety Disorder (GAD) is a relatively common psychological disorder that occurs in approximately 3 to 10% of children and adolescents. Generalized Anxiety Disorder is characterized by excessive, uncontrollable worry that is present more days than not. It is one of several disorders classified as Anxiety Disorders. Children with Generalized Anxiety Disorder can worry about a variety of topics, such as world events, something bad happening to them or loved ones, and being good enough in school. Other worries include perfectionistic concerns (e.g., worry about meeting self-imposed, high expectations) and everyday concerns (e.g., worry about saying the wrong thing).
To relieve or reduce their worries in the moment, children with Generalized Anxiety Disorder often avoid activities and/or situations that trigger feelings of anxiety. They may engage in excessive reassurance seeking, such as asking family members or teachers questions aimed at mitigating their excessive anxious worries. Additionally, Generalized Anxiety Disorder is characterized by one or more physical symptoms of anxiety (e.g., muscle tension, restlessness, difficulty concentrating or sleeping). Typically, these worries have persisted for at least a few months and cause many problems.
Generalized Anxiety Disorder Causes and Correlates:
Researchers do not know exactly what causes GAD, but there is a fair amount of evidence that it likely arises from a combination of genetic and environmental factors. Often children are born with an anxious temperament, which may involve a tendency to worry a lot, pay a lot of attention to their worries, and stay away from things that frighten them. Children with this kind of temperament also may have many wonderful qualities: their parents often describe them as bright, loving, hard-working, sensitive, and responsible. Some of these children simply need some help managing their anxiety and worries.
Generalized Anxiety Disorder can be confused with other psychological disorders such as attention-deficit hyperactivity disorder or obsessive-compulsive disorder. Sometimes medical conditions can produce anxiety symptoms, such as a thyroid disorder or other conditions. Generalized Anxiety Disorder often co-occurs with other anxiety disorders and/or depression. Additionally, when people get older, they may self-medicate with substances such as alcohol to help manage their worries. Generalized Anxiety Disorder can cause problems at school, at home, and with friends.
What Does Treatment Look Like?
Generalized Anxiety Disorder is a moderately severe psychological disorder that usually will not go away on its own. Luckily, several evidence-based treatments are available, including pharmacotherapy and cognitive behavioral therapy (CBT). CBT is often the first choice, as families may feel reluctant to put their child on medication or be concerned that all medications have some, even if minimal, side effects.
Some, but not all, children may require medication until skills are developed, or may require a combination of medication and psychotherapy. However, the majority of children, adolescents and adults with anxiety can be successfully treated with cognitive-behavioral therapy, and many who are reliant on medication are successful in discontinuing or reducing medication with CBT.
The child or adolescent psychologist using a cognitive behavioral approach may first conduct a thorough assessment that often includes an interview, some written forms, and talking to parents and maybe teachers.
Cognitive Behavioral Therapy for Generalized Anxiety Disorder typically includes learning about anxiety, skill-building, skills practice through gradual exposure to fears, and relapse prevention. CBT is typically a goal-oriented, short-term treatment (e.g., 16 sessions or so). The therapist may work with parents and teachers so that they can reinforce the child’s effective coping in the home and at school.
Warning Signs of Generalized Anxiety Disorder in Children and Adolescents:
- Worries frequently about little things
- Fears something bad happening in the future
- Catastrophizes normal situations
- Excessive worry about upsetting or hurting others
- Perfectionistic about schoolwork, performance, etc.
- Excessive worry about failure
- Wiggles, is jittery, shaky, high strung, tense and unable to relax
- Often seeks reassurance from parents and teachers
- Physical symptoms such as stomachaches, headaches, shaking, sweating, and trouble sleeping
Common Myths about Anxiety in Children and Adolescents:
“It will just go away on its own”. Anxiety can worsen over time and can cause many problems for a child or adolescent if it is not effectively treated.
“Having anxiety is a good thing because it helps children do their best”. In small doses, anxiety can be very helpful in encouraging us to plan for the future, avoid danger, etc. However, when anxiety becomes too much, it can cause many problems in children, including decreased academic performance, trouble functioning socially, and family conflict.
“Anxious children are easy to recognize”. In fact, anxiety disorders are among the most overlooked problems in children and adolescents. Anxiety is considered an internalizing disorder, meaning that the anxious child experiences the disorder internally rather than externally. These children and adolescents suffer, but usually are not disruptive to home and classrooms. Parents and teachers may not notice that the child is having difficulties until the disorder has gotten much worse.
“Anxiety disorders always occur in response to a stressor”. Not always. While anxiety can increase in the face of change or stress, often there is no identifiable reason for its occurrence.
“If my child faces his or her fears, he or she will become traumatized from the experience”. If a child’s fears are unrealistic (e.g., concern about a class presentation), it is usually good to encourage your child not to avoid the feared object or situation. Avoiding something usually makes the anxiety worse, while helping a child face his or her fears can help alleviate anxiety the next time something similar comes up. Facing difficulty fears with the help of an experienced child psychotherapist using a patient, yet systematic approach reduces risk of further trauma.
http://www.adaa.org Anxiety and Depression Association of America
http://www.nimh.nih.gov The National Institute of Mental Health
www.childanxiety.net An award-winning website for anxious youth and their parents
Books and CDs:
What To Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner
Helping Your Anxious Child by Ron Rapee
I Can Relax! CD for Children by Donna Pincus
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About the Author:
Dr. Colleen Cummings completed her doctorate in clinical psychology with a specialty in child psychology from The Ohio State University. She completed her American Psychological Association-accredited internship training in clinical child psychology at the Children's National Medical Center in Washington, D.C. and postdoctoral research and clinical work at the Temple University Child and Adolescent Anxiety Disorders Clinic in Philadelphia, Pennsylvania. She is an expert in evidence-based treatment for childhood and adolescent anxiety disorders, incorporating cognitive-behavioral techniques in her therapy.
Dr. Cummings practiced as a licensed psychologist in the State of Pennsylvania since 2011 before becoming a licensed psychologist in Florida and joining Clinical Psychology Associates of North Central Florida. Update 11/24/14: Colleen Cummings, Ph.D. now practices as a licensed psychologist in Rockville, Maryland. Her practice website link is: http://www.alvordbaker.com/.