Generalized anxiety disorder is a persistent state of heightened anxiety and apprehension characterized by excessive worrying, fear, and dread. Physical symptoms can include tremor, sweating, multiple somatic complaints, and exhaustion. Diagnosis is by clinical criteria. Treatment is often with relaxation therapy, sometimes combined with drug therapy.
(See also Overview of Anxiety Disorders in Children and Adolescents and Generalized Anxiety Disorder in adults.)
Symptoms and Signs
Children with generalized anxiety disorder have multiple and diffuse worries, which are exacerbated by stress. These children often have difficulty paying attention and may be hyperactive and restless. They may sleep poorly, sweat excessively, feel exhausted, and complain of physical discomfort (eg, stomachache, muscle aches, headache).
During the COVID-19 pandemic, the abrupt and dramatic disruption in routines—such as school closure and isolation from extended family, peers, teachers, cultural and religious groups—increased anxiety in nearly all children. Living in constrained spaces with family members for weeks to months, parental job loss, and general uncertainty about the future increased stress as well (1).
Symptoms and signs reference
1. Mental Health and Coping During the Coronavirus (COVID-19) Pandemic. Centers for Disease Control and Prevention. Accessed May 12, 2023.
Diagnosis
Psychiatric assessment
Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) criteria
Generalized anxiety disorder is diagnosed in children and adolescents who have prominent and impairing anxiety symptoms that are not focused enough to meet criteria for a specific disorder such as social anxiety disorder or panic disorder. Generalized anxiety disorder is also an appropriate diagnosis for children who have a specific anxiety disorder, such as separation anxiety, but also have other significant anxiety symptoms above and beyond those of the specific anxiety disorder.
Specific criteria include the presence of each of the following:
Excessive anxiety and worry that patients have difficulty controlling
Symptoms present on more days than not for ≥ 6 months
Symptoms cause significant distress or impair functioning socially or at school
In addition, the above criteria must be accompanied by ≥ 1 of the following:
Restlessness or a keyed-up or on-edge feeling
Being easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
Occasionally, generalized anxiety disorder can be confused with attention-deficit/hyperactivity disorder (ADHD) because generalized anxiety disorder can cause difficulty paying attention and can result in psychomotor agitation (ie, hyperactivity). However, in ADHD, children also have difficulty concentrating and feel restless when they are not anxious. Some children have both ADHD and an anxiety disorder.
Treatment
Relaxation therapy
Sometimes anxiolytic medications, usually selective serotonin reuptake inhibitors (SSRIs)
Because the focus of symptoms is diffuse, generalized anxiety disorder is especially challenging to treat with behavioral therapy. Relaxation training is often more appropriate.
Patients who have severe generalized anxiety disorder or who do not respond to psychotherapeutic interventions may need anxiolytic medications. As with other anxiety disorders, SSRIs (see table Medications for Long-Term Treatment of Anxiety and Related Disorders
Key Points
Children with generalized anxiety disorder have multiple and diffuse worries, rather than a single, specific one.
Diagnose generalized anxiety disorder when symptoms cause significant distress to the child or impair social or academic functioning socially and the child has ≥ 1 specific symptoms (eg, restlessness, a keyed-up or on-edge feeling).
Relaxation therapy may help; if children have severe anxiety or do not respond to psychotherapeutic interventions, consider anxiolytic medications (preferably SSRIs).
