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Pediatric Generalized Anxiety Disorder

Background

Generalized anxiety disorder (GAD) is associated with persistent, excessive, and unrealistic worry that is not focused on a specific object or situation.

Children with GAD worry more often and more intensely than other children in the same circumstances. They may worry excessively about their performance and competence at school or in sporting events, about personal safety and the safety of family members, or about natural disasters and future events.

The focus of worry may shift, but the inability to control the worry persists. Because children with GAD have a hard time “turning off” the worrying, their ability to concentrate, process information, and engage successfully in various activities may be impaired. In addition, problems with insecurity that often result in frequent seeking of reassurance may interfere with their personal growth and social relationships. Further, children with GAD often seem overly conforming, perfectionistic, and self-critical. They may insist on redoing even fairly insignificant tasks several times to get them “just right.” This excessive structuring of one’s life is used as a defense against the generalized anxiety related to the concern about the individual’s overall and specific performance. (See Treatment.)

Little empiric data are available regarding the physiologic indicators of anxiety in children.
The high cost, lack of normative data, idiosyncratic patterns, and high sensitivity of cardiovascular and electrodermal measures in children contribute to the difficulties in physiologic assessment of anxiety in children.
(See Differentials.)

Diagnostic criteria (DSM-5)

The specific DSM-5 criteria for generalized anxiety disorder are as follows
:

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

The individual finds it difficult to control the worry.

For children, the anxiety and worry are associated with one (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Restlessness or feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance (difficulty falling or staying asleep, or restlessness, unsatisfying sleep)

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

The disturbance is not better explained by another mental disorder.

Complications

Potential complications of GAD include the following (see Prognosis):

Comorbid depression and other comorbid conditions

School truancy and withdrawal from other age-appropriate activities

Strained family relationships when the child’s anxiety contributes to irritability, noncompliance, demanding behavior, and/or chronic reassurance seeking

“Self-medication” leading to substance abuse by adolescents

Parents’ inability to help in the child’s treatment or to model adaptive coping/anxiety management because of their own untreated anxiety (or other psychiatric condition)

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