Johnny peaked around the corner and listened intensely to the man on the news talking about war. His heart did that fast-thumping thing, he felt cold all of the sudden, a drop of cold sweat hit the ground. He was the only kid at home because he felt sick to his stomach, his mom thought it was something he ate, but he knew better. All of his friends were at a beach party. He worried about all the dangers of the ocean and had nightmares as he thought of undercurrents and rip tides. He is ten years old and most of his time is spent worrying about the man on the news, the dangers in the world, and other scenarios he plays out in his head. He is grounded most of the time because he throws tantrums when his mom drops him off at school. He feels like nobody understands, and he is correct, nobody has even taken the time to ask him if he is okay. He worries in silence.
Johnny’s mom finally asked his doctor for ideas to calm him as he was beginning to isolate and reported poor sleep habits. After a referral to a specialist, Johnny was diagnosed with General Anxiety Disorder. His clingy behaviors, concerning tantrums, and increased symptoms meant a change was necessary, as Johnny needed to learn to navigate his GAD over the course of his lifetime.
“Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. Individuals with GAD find it difficult to control their worry. They may worry more than seems warranted about actual events or may expect the worst even when there is no apparent reason for concern.” 
GAD in children is more difficult to diagnose and its symptoms more diverse. Children’s brains are still developing and when hormones are introduced, their battle with GAD can become more intense. According to the Mayo clinic, symptoms of GAD include:
- Feeling overly anxious to fit in, but also retreating from social events at the last minute.
- Feeling overly critical, strives for perfection.
- Feeling the need to repeat tasks because they aren’t perfect the first time.
- Feeling the need to spend excessive time doing homework
- Feeling an extreme lack confidence
- Feeling the need for approval
- Feeling the need for a lot of reassurance about performance
- Feeling the need to remain at home because of frequent stomach aches or other physical complaints
- Feeling the need to avoid social situations.
The Mayo clinic also reports physical symptoms of GAD in an attempt to help parents, as addressing early is an important component in treating and managing the disorder. If children are in a state of “fight or flight”—which is a term we use when a portion of the brain goes “off-line”—they can not rest or digest. Therefore, it is imperative for parents to listen to the silence, let their symptoms tell the story.
- Digestive or bowel problems, such as irritable bowel syndrome or ulcers
- Headaches and migraines
- Chronic pain and illness
- Sleep problems and insomnia
- Heart-health issues
Chronically ill children, especially those that report stomach aches should be evaluated for GAD. GAD is often accompanied by other mental health issues including:
- Panic disorder
- Post-traumatic stress disorder (PTSD)
- Obsessive-compulsive disorder (OCD)
- Suicidal thoughts or suicide
- Substance abuse
All of these disorders need professional intervention.
The causes of GAD are not known, though a number of factors are in play, including genetics, familial status, trauma, and other factors outside of human control. While there is not a way to prevent your child from GAD, there is hope in treatment and educating the child on their diagnosis. It is important to verbalize thoughts and concerns to your child’s doctor. It is also important to ensure that your child does not feel broken. It is vital to remove shame and confusion by helping them accept their diagnosis just as they would accept a broken arm diagnosis. When we remove the stigma for them, we set them up to live a happy and productive life. It is important for us to teach them skills to live with GAD. There are tricks and tips to help children when they are in a hyper reactive state and when GAD has commandeered their brains.
When a child (or any person for that matter) is in a state of reactivity, the prefrontal cortex literally stops working. The PFC is where a lot of executive functions, impulse control, and short- term memory occurs. When the PFC is “offline”, the brain loops continuous and largely unhelpful thoughts. When this happens, there are some tricks to bring the PFC online, and thereby calming the nervous systems.
- Body movement is an excellent way to “change the narrative”. I often encourage parents to ask their activated child to go complete a task that would require them to move their body. Parents can use this trick to instill self confidence and make them feel appreciated for helping. As children enter adolescence, organized sports or any activity that gets them socializing and physically moving their bodies (a part time job they enjoy is a great example) can diminish their GAD symptoms.
- Physical touch is a proven way to help bring the pre-fontal cortex online. Though some children may not receive this from a parent, self- soothing techniques also work. These include washing hands with cold water or any other activity where there is a physical change or touch to the skin.
- Memorizing a list, affirmation, or prayer and then reciting also brings the pre-frontal cortex online. Parents can use this technique using questions about something they love that would require them to recall a list or an event. This literally shifts the brain out of fight or flight, even if only for a short time.
GAD in children can also be treated with medication, but it is important to add counseling into the treatment arsenal. Unless their brain “grows out of it”, it is likely your child will need to navigate their diagnosis over the course of their entire lives. Educating yourself and your child will go a long way to making their diagnosis manageable. Since substance abuse is prominent in this subset of people, it’s important for parents to dialogue openly with their children from the beginning. Also, if trauma is present, other disorders like PTSD offer more symptoms and different treatment.
As with all mental illnesses, Generalized Anxiety Disorder in children must be top of mind, we must stay aware, we must remain proactive, and we must advocate for them. Awareness is everything and when coupled with Hope, children can live full lives with GAD.
Parents, it’s your job to get them to the promised land of hope and healing, and oftentimes that comes from merely paying attention and then using every tool at your disposal to help them
Because their mental health matters.