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Key Features

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Essentials of Diagnosis
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  • Multiple, intense, disproportionate, or irrational worries, often about future events

  • Worry is accompanied by other symptoms

  • The worry is difficult to control

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General Considerations
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  • Individuals with generalized anxiety disorder often recall a lifetime of anxiety, but community samples find GAD rarely presents before adolescence

  • Prevalence of GAD in adolescence is 0.9%

  • Potential reasons for this discrepancy include that the symptoms of anxiety may not meet full criteria for GAD at an earlier age, or symptoms may be underestimated by parents or guardians

  • Individuals in whom GAD develops at an early age are more likely to have greater impairment

  • GAD is highly heritable, overlapping with the risk for depression and neuroticism

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Clinical Findings

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  • Young children with generalized anxiety often worry about their competence or performance while older youth may worry about additional issues such as family finances or being on time

  • In addition, children with GAD experience at least one symptom of fatigue, restlessness or poor concentration, irritability, feeling on edge, or sleep disturbance

  • GAD can also be accompanied by other somatic symptoms and the pediatrician is more likely to encounter children with GAD who present with symptoms of gastrointestinal difficulties or headaches

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Diagnosis

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  • To meet criteria for GAD, the symptoms must cause significant distress or disturbance of function and be present for at least 6 months

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Treatment

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  • Psychotherapy is the first-line treatment

  • If response is insufficient, a selective serotonin reuptake inhibitor may be added

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Outcome

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Prognosis
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  • The combination of medication and therapy can be very effective for treating youth with GAD

  • Individuals with GAD are at increased risk for depression

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References

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American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA, American Psychiatric Association; 2013.
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Beesdo-Baum  K, Knappe  S: Developmental epidemiology of anxiety disorder. Child Adolesc Psychiatric Clin N Am 2012;21:457–478
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Ghandhi  B, Cheek  S, Campo  JV: Anxiety in the pediatric medical setting. Child Adolesc Psychiatric Clin N Am 2012;21:643–653
[PubMed: 22800999] .
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Ginsberg  GS, Kendall  PC, Sakolsky  D  et al: Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol 2011;(79):806–813
[PubMed: 22122292] .
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Manassis  K: Silent suffering: understanding and treating children with selective mutism. Expert Rev Neurother 2009 Feb;9(2):235–243
[PubMed: 19210197] .
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Mohatt  J, Bennett  SM, Walkup  JT: Treatment of separation, generalized and social anxiety disorders in youths. Am J Psychiatry 2014;171:741–748
[PubMed: 24874020]
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Sakolsky  D, Birmaher  B: Pediatric anxiety disorders: management in primary care. Curr Opin Pediatr 2008;20(5):538–543
[PubMed: 18781116]
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Strawn  JR, Sakolsky  DJ, Rynn ...

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