Generalised Anxiety Disorder

What does GAD look like in children?

The essential feature of GAD is worry, which is commonly defined as “a chain of thoughts and images, negatively affect-laden and relatively uncontrollable” (Brosschot & Verkuil, 2013). Worry is when our thoughts seem to go around in circles in our heads and we can’t seem to stop them. Importantly, worry is a form of problem-solving - an attempt to determine the outcome of an issue where the outcome is uncertain, but it includes negative possibilities. Most of the research on worry has focused on adults, but recent studies have begun to reveal that children may differ from adults in terms of how they worry and what they worry about. 

Most adults are familiar with worry thoughts being verbally expressed, such as through a string of “what if?” questions. However, the ability to represent thoughts with language is dependent on the language skills we have. Studies of primary school-aged children suggest that they spend approximately equal amounts of time worrying in words and in images (Wilson, 2020). They also associate worry more closely with fear - a feeling - than with thinking (Szabo & Carr, 2015). This differs from the way adults and adolescents worry, which is primarily in words and is differentiated from fear.

Another feature of worry is the generation of numerous possibilities. When we worry, we come up with many different outcomes to a single scenario. If a loved one is late coming home, we may worry that they got lost or were in an accident. This feature increases with age as young children often struggle to anticipate future events and may find it difficult to imagine multiple negative outcomes (Songco et al., 2020). This means that children tend to worry about things that make them feel bad and that they avoid (Szabo, 2007), while adults tend to have more abstracted worries that are less associated with negative feelings. 

Because children’s verbal and cognitive skills are still in development, GAD often looks different in children compared to adults. Children often present with more somatic issues, such as stomach complaints or headaches, than explicitly expressed anxieties (Anxiety Canada, n.d.). They tend to worry about issues that are closer to home, such as school or sporting performance (APA, 2013). Additionally, children’s capacity to express their worries depends on their level of development. As a result, some children might describe specific things that are worrying them while others might simply say that they “feel bad” or “need to get away”. 

How can I tell if my child has GAD?

GAD diagnosis in children can sometimes be tricky. Because the way children feel and show anxiety changes with age, it can be difficult to determine if an anxious child has GAD or a different anxiety disorder. In fact, it is common for children to show symptoms of multiple anxiety disorders.

Key signs of GAD can be found across several areas of cognition, behaviour and daily functioning.

Thoughts

Children with GAD worry about things that are happening in their life, things that could happen in the future and things others would consider to be minor (Anxiety Canada, n.d.). Critically, they worry more than their peers, are worried more days than not and find it hard to stop worrying.

Some typical worries can look like:

• What if I fail my maths test tomorrow?
• What if I lose my soccer game on the weekend?
• What if I don’t find a friend to play with at lunchtime?
• What if my dog gets sick and dies?
• What if we lose all our money and we can’t afford our house?
• What if the COVID-19 pandemic keeps getting worse?
  

Very young children may not be able to articulate specific worries. Instead, their experiences may be reflected in how they feel, both physically and mentally.

Physical symptoms

GAD involves frequent activation of the body’s fight-or-flight-or-freeze response. This means that children will show a range of physical feelings alongside - or in some cases, instead of - their verbal expressions of anxiety. 

These feelings can include:

• Being restless, fidgety or “keyed up”
• Irritability
• Getting tired easily
• Having headaches or stomach aches
• Muscle pain, particularly in the neck and shoulders

Emotions

As well as the obvious emotion of anxiety, children with GAD can show other feelings associated with being worried, including:

• Sadness
• Anger
• Shame
• Guilt
• Fear

Behaviours

Children with GAD often behave in ways that are related to the negative thoughts, emotions and physical feelings they are experiencing. Behaviours may be more internally focused or they may involve instances of acting out or aggression.

Common behaviours include:

• Difficulty focusing or paying attention
• Trouble falling or remaining asleep
• Seeking reassurance
• Rumination (thinking about situations over and over)
• Excessive studying
• Excessive list-making
• Procrastination
• Refusing to go to school
• Tantrums
• Snapping at others

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What are the effects of GAD?

GAD is characterised by almost constant anxiety about a multitude of things. This means children with GAD are dealing not only with worry, but also the emotional and physical symptoms of worry, on a daily basis.

As a result, GAD can have negative consequences on several areas of children’s social, emotional and educational wellbeing (Anxiety Canada, n.d.). While parents of older or very private children may struggle to identify the immediate signs of GAD, they may notice carry-on effects of their child’s anxiety which can alert them to the problem.

The effects of GAD can look like:

• Declining grades due to school refusal or difficulty paying attention in class
• Over-prioritisation of study over recreational activities or spending time with friends due to fear of failure
• Development of depressive symptoms because they are starting to withdraw from friends and family
• Reliance on unhealthy coping mechanisms to escape their anxiety, such as excessive media consumption or substance abuse

What should I do if I think my child has GAD?

If you recognise the signs of Generalised Anxiety Disorder in your child, there are a few things you can do to help:

• Talk to a professional. Speaking with your GP or the Quirky Kid Clinic is a good first step. Other options include your paediatrician or a school counsellor.
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• Try talking to your child about how they are feeling. Rather than quickly reassuring them, let them express their worries to you. Being available to listen and showing compassion while exploring what’s on their mind can be helpful. The aim is to support and help your child to self-regulate (rather than managing their anxiety for them).
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• Helping your child to reframe their negative thoughts can encourage them to look at a situation or event from a different perspective. You could team up with your child to evaluate their thoughts about an anxiety-provoking situation. Are their thoughts helpful? If not, brainstorm more accurate and helpful thoughts they could replace them with. For example, “I can’t do this, it’s too hard and I'm going to fail,” could be reframed as “Challenges are important for learning. The more I practice, the better I get!”
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• Regularly practice simple relaxation techniques. Activities such as controlled breathing, progressive muscle relaxation and mindfulness are shown to be helpful in managing generalised anxiety.
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• Check out The Quirky Kid Shop for a selection of useful anxiety resources for parents and children.

Want to speak to a professional? We’re here for you.

The Quirky Kid Clinic is a unique place for children and adolescents aged 2 to 18 years. We work from the child’s perspective to help them find their own solutions. If you suspect your child may be experiencing symptoms of Generalised Anxiety Disorder, you can:

Book an individual session with one of our experienced child psychologists.

Register for our award-winning child anxiety program - Basecamp.

Contact us for more information.