Generalized Anxiety Disorder in a child

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Generalized anxiety disorder (GAD) is one of the most common mental health issues in childhood. It’s important to treat because it often predicts adult mental health problems and later life difficulties. Its presence is frequently missed by both professionals and parents and children can suffer for many years without any help.

Early identification and treatment is important. Many adults who have GAD report they have had it for all of their lives. Early treatment can help your child develop lifelong skills to manage their anxiety. GAD in a child can be very debilitating and seriously impact their ability to be happy and successful. As an adult, GAD is strongly correlated with drug alcohol and nicotine dependence. Children with GAD may also have other diagnoses. 75 percent of people who suffer from GAD have another mental health diagnosis. GAD is very frequently accompanied by a depressive disorder diagnosis and/or a second diagnosis of anxiety such as separation anxiety or panic disorder.

Generalized anxiety disorder in a child is defined as: 

Excessive anxiety or worry

Difficulty controlling the worry

One or more of the following symptoms being present for most days and for more than 6 months:        

  • Restlessness 
  • Easily tired
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance

These symptoms must also be causing your child trouble in their life, must not be due to a medical condition or medication, and must not be due to another mental health or medical disorder. 

What are some other  symptoms of Generalized Anxiety Disorder in a Child?

Children with Generalized anxiety disorder (GAD) may spend hours doing and redoing homework or other tasks that peers complete quickly. School is very often a place where there anxiety is evident. They may put pressure on themselves to perform or appear perfectionist.

They may also excessively worry about social interactions, the safety and health of their family, world events, and natural disasters such as hurricanes and tsunamis.

They may exhibit behavioral symptoms such as tantrumming. Anxious children may display outbursts of anger with little provocation. To others this appears unprovoked, but this is may be because they are desperately trying to avoid something that might trigger their anxiety. Of course, adults around them are more likely to focus on these issues as behavioral problems, and to miss that it is anxiety that underlies the outbursts. 

Much of their anxiety may manifest as physical symptoms. They may complain of constant headaches, stomachaches or other ailments that seem psychosomatic. Anxiety will often manifest itself in this manner, and children don't always know how to verbally express themselves. 

Other issues you may see in your child with Generalized anxiety disorder include feelings of self doubt and requests for reassurance about their fears. Generalized anxiety disorder in a child may cause them to feel hopeless or out of control, because the worrying takes over their lives, and they are unable to control it. Although we want to make our children feel comfortable and safe, too much reassurance can reinforce the anxiety and discourage healthy independence.  

Is it my Fault my Child has Generalized Anxiety Disorder?

No it’s not your fault! There are many things that contribute to Generalized anxiety disorder in a child. Research has taught us some traits of parents of children with anxiety disorders. For example, parents of anxious kids are more likely to have anxiety themselves. Parents who are more anxious may reinforce anxiety behaviors in their children and may also model that behavior. Research also shows that parents of children with Generalized anxiety disorder are more likely to be overprotective of their child or exhibit unnecessarily cautious behavior. We also know GAD in a child can be reinforced by a parent who does not have confidence in their child. Parents who encourage children to make choices, be independent and learn self control are less likely to have anxious kids.

Parenting Tips to Help your Child

If you think you are seeing signs of generalized anxiety in your child get your child in therapy.

Do you have confidence in your child's ability to be successful and handle their anxiety? If not, you may be limiting your child. How you can replace those limiting beliefs about your child with more positive ones? How do you handle anxiety? Does your child see you avoiding activities because you are anxious? Does she hear you talk about worries that are unrealistic?

  • If this is the case, get some help for your own anxiety.
  • Limit your child's exposure to phone calls or conversations where she may hear you worrying or may be exposed to adult anxiety.
  • Model a positive attitude about problem solving. Generalized anxiety in a child can cause them to feel like their problems are insurmountable. They need to see you solving problems with a curious and positive attitude.
  • View problems as opportunities to learn.
  • Teach problem solving skills to your child. Identify problems, brainstorm solutions, examine the solutions, make a decision and evaluate the outcome.
  • With the help of your child's therapist, explore how you may be reinforcing the anxious behaviors your child is displaying and perpetuating their anxiety. Overprotecting your child is not good parenting, its enabling anxiety to control their life

Anxiety Treatment for Generalized Anxiety Disorder in Children

The best researched anxiety  treatment for children and adults  is cognitive behavioral in nature. Cognitive behavioral therapy aims to address the different components that contribute to and perpetuate the anxiety. Very young children with anxiety require the therapist to be creative with interventions because of their limited ability to process verbally. Below are some of the main components of treatment for children.

What does a therapist do at first?

Everyone wonders what  going on when they first bring their child to a therapist. What are they doing and why are they doing it? 

I hope this page can explain some of it for you.

When you first go to therapy a therapist should be trying to figure out a plan to help you and your child. You should be a big part of that plan. The younger your child is the more you should be participating in therapy


Very recent studies show that comparing parent training programs with child therapy for anxiety are just as effective in absence of the child. A child with anxiety should never be helped without your participation. You can check out the paper in press here on the SPACE program for parent training. This is pretty new and exciting research as of 2019


Assessment

Assessment of generalized anxiety in children focuses on determining where the worry is coming from, what the worries are, what happens during the worries and what helps with the worries.

Assessment will also explore family issues and dynamics that need to be addressed in therapy. For example, parents may be reinforcing anxiety by helping their child engage in avoidance, by predicting that they will fail or by modeling anxiety themselves.

Assessment helps the therapist and family to strategize how to approach the child’s anxiety. After the assessment period, which could last from four to eight weeks, the child, family and therapist come up with a treatment plan which outlines goals and some strategies to meet those goals.


Pyschoeducation

Psycho education is just education about the psychology of something, in this case, anxiety. Generalized anxiety disorder treatment must focus on the different components of a child’s anxiety. These consist of physical symptoms, worry thoughts, and behaviors associated with that anxiety. Worry thoughts are often accompanied by physical symptoms and lead to the anxiety behaviors. For example, in one child, the symptoms may be sick to my stomach, the worry thought “if I go to school everyone will laugh at me", and the behavior crying and avoiding the school bus. Psycho education would help the child and family understand the components of this particular sequence and others.

Parents are Cotherapists

When your child is in therapy you should be used as a co therapist.  You  can help coach a child through anxious times, process their daily anxiety level, and assist their child with their therapy homework assignments. Therapy can  can consist of joint sessions with parents or split sessions ( half child alone, half parent and child). Parents may be included in the entire therapy session or part of the therapy session depending on what works best for that particular child or family.


 Family and Parent Work

Anxiety therapy  for children must include  family work. In fact as I mentioned earlier, research is showing even if the therapist never works with the child, family work alone can make as many changes as having the child in therapy. If your child is anxious, you  need assistance with managing the anxiety.  You probably need  help managing your  own anxiety. Most parents are worried about why their child is anxious, want to learn what to do and how to fix it.  Some family work occurs in joint sessions, while some work must occur in separate sessions with the parents depending on the particularity situation. .

What happens with kids? 

Play Therapy

Play therapy is a very useful component of generalized anxiety disorder treatment. Most young children are unable to benefit from traditional talk therapy, so creative ideas must be employed to assist them in communicating their anxieties and learning techniques to manage them. Art, doll houses and puppet play are great ways to illustrate ideas of anxiety to a child and also to suggest coping skills and new ways to think about the anxiety. Play is also a great way to assess anxiety. For example a six year old child may be much more likely to show us through doll house play that they are afraid of a dog then to actually verbalize it. This should always be done collaboratively with parent work. 

Assessing the Fears with a Fear Hierarchy

Because generalized anxiety disorder in a child often consists of many fears about different things a fear hierarchy is great tool. Children are asked to rank their fears and then the therapist addresses those fears one by one. Children can create this as an art project and cut out each individual fear ranking it by gluing in on the paper from the least anxiety provoking to the worst or from he worst to the least.


Exposing the Child to Those Fears

In therapy, we can expose the child gradually to thoughts of the things they fear, beginning with the one that is least anxiety provoking. We can then pair more neutral thoughts and images with that thing they fear in the office, and often will assign homework designed to help the child slowly face that fear. generalized anxiety disorder treatment is different from other anxiety treatments because the child’s worries are so numerous and diverse. This kind of strategy may need to be used many times.

Reinforcing New Behavior

Generalized anxiety disorder treatment teaches parents how to effectively reward the brave behavior. The reward helps to reinforce the new brave behavior. Anxiety is reinforced by avoidance. Its power decreases once the fear is faced and the child realizes it isn’t nearly as bad as they thought.

Physical Components

Physical symptoms of anxiety can be managed with techniques such as progressive muscle relaxation (learning to tense and relax individual sets of muscles), deep breathing and guided imagery (thinking of peaceful and relaxing thoughts and images). Children can be taught these techniques in therapy and asked to practice them while thinking about anxiety provoking situations. Later, they can be instructed to use these techniques as coping skills outside of the therapy session when they become overwhelmed. Kids love this!


Negative and Anxious Thoughts

Restructuring thoughts is a primary focus of Generalized Anxiety Disorder treatment for children. In therapy children and parents are taught to challenge the thoughts that accompany the anxious behavior until the child experiences less anxiety. There are many ways to do this with younger children. A scenario can be created with puppets and one could be and anxious puppet, expressing worried thoughts. A child could create a comic book where the main character is anxious and is verbalizing their worry thoughts.

A Team Effort and a Positive Attitude

It is very important for parents and therapists to take the attitude that the child is capable of conquering their anxiety. The attitude that they can do it, lots of confidence and positive reinforcement for the child will go a long way in reducing their anxiety. It is also important that the child knows that everyone is rooting for them, and that there are a team of people who know that they can conquer their anxiety.

Imran, N., Haider, I. I., & Azeem, M. W. (2017). Generalized anxiety disorder in children and adolescents: An update. Psychiatric Annals, 47(10), 497-501. doi:http://dx.doi.org/10.3928/00485713-20170913-01