Generalized anxiety disorder (GAD), previously called Overanxious Disorder, is characterized by chronic, excessive worry about events or activities, such as everyday events, health, family, school performance, or world affairs. Children with GAD are described as “worrywarts.” They have been worried more days than not for at least six months. They have difficulty controlling their worry and are often consumed by worry. When they worry, they experience at least one of the following physical symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and/or difficulty sleeping. Some children with GAD also experience gastrointestinal discomfort.

Some children with GAD may exhibit a certain theme to their worry. For example, some children with GAD are very perfectionistic. They might worry excessively about being on time. They adhere to high standards for themselves in academic and performance domains and worry greatly about not meeting those standards. They fear making mistakes and may spend an excessive amount of time working on projects. Other children with GAD may worry excessively about safety concerns, such as war, crime, and natural disasters. These children may become overly distressed by stories they hear on the news and perseverate on “what if” scenarios. Other children with GAD may exhibit a “flavor of the day” worry. They often worry but the focus of the worry may shift depending on what they hear or experience in a given a day. As a coping mechanism, many children with GAD frequently seek approval or reassurance from others. However, this usually does not satisfy them, resulting in continual reassurance-seeking.

GAD occurs in approximately 3-6% of children. Typical onset occurs between the ages of 10 and 14. It is generally equally common among boys and girls, with a somewhat higher prevalence in adolescent females as compared to adolescent males. Of note, it is normal for children and adolescents to have some anxiety about things like everyday events, family and school; however, children with GAD worry about these kinds of things to such a degree that the worry causes significant impairment in their ability to function at home or at school.

In the Coping Cat Program, treatment for children with GAD has two parts. First, children  work with therapists to gain a better understanding of their anxiety. Children learn to identify  bodily arousal associated with anxiety as well as their anxious thoughts and worries. Children also learn relaxation techniques and problem-solving strategies that can be helpful in managing their worry.

The second part of treatment involves gradually exposing children with GAD to the kinds of situations that they fear and avoid. Because children with GAD worry about a wide array of things, exposures allow therapists to focus on the concerns that are most interfering for each child. For example, a child who worries excessively about performing well might participate in an exposure in which s/he fails. If failing is a high-anxiety situation, the therapist might start by having the child do an imaginal exposure. The child would think aloud about an anxiety-provoking situation, for example failing a test. Then the child would imagine each step of failing the test, from entering the testing classroom to receiving the bad grade. Once anxiety is at a manageable level during imaginal exposures, the child is ready to advance to more real-world exposures. For example, the therapist might create an impossibly difficult test for the child to take. The child would not only take the test during the session but also receive a poor grade on it, allowing him or her to experience test failure in real life.

Such real-world exposures are not possible for all worries children with GAD have. For example, some children with GAD worry about the safety of themselves and others. An exposure for this kind of worry might involve a child reading or listening to an imaginary script about his or her worst fear, like a parent dying or the world ending. The child would read or listen to this script repeatedly under the care of a therapist until his or her anxiety is reduced by half. While these kinds of exposures should be introduced during the therapy session, the child can then practice them at home.

Other children with GAD worry excessively about lots of little things. Therapists might work with their clients to create a “worry box”. Children then write their worries on a slip of paper to place in the box. They are allowed to look at them once a day for a specified amount of time. Because children with GAD fear many situations that frequently change over time, treatment can be difficult; however, GAD can often be treated successfully. For more information on GAD and treatments for GAD, please see the below references.

References

• Albano, A. M., Chorpita, B. F., & Barlow, D. H. (1996). Childhood anxiety disorders. In E.J. Marsh & R. A. Barkley (Eds.), Child Psychopathology (pp. 196-241). New York: Guilford Press.

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• Jill T. Ehreneich & Alan M. Gross (2001). Treatment of childhood generalized anxiety disorder/overanxious disorder. In Orvaschel, Helen & Faust, Jan (Eds.), Handbook of conceptualization and treatment of child psychopathology (pp 211 - 238). Amsterdam: Pergamon/Elsevier Science Inc.

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• Hudson, Jennifer L., Hughes, Alicia A., & Kendall, Philip C. (2004). Treatment of Generalized Anxiety Disorder in Children and Adolescents.In Paula M. Barrett & Thomas Ollendick (Eds.), Handbook of interventions that work with children and adolescents: Prevention and treatment (pp. 115-143). New York: John Wiley & Sons Ltd.

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• Strauss, C. C., Lease, C. A., Last, C. G., & Francis, G. (1988). Overanxious Disorder: An Examination of Developmental Differences. Journal of Abnormal Child Psychology, 16, 433-443.

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• Carl F. Weems & R. Enrique Varela (2011). Generalized Anxiety Disorder. In Dean McKay & Eric Storch (Eds.), Handbook of Child and Adolescent Anxiety Disorders (pp. 261-274). New York: Springer Science and Business Media.