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Pediatric Generalized Anxiety Disorder

By: Kim Maryniak, PhD, RNC-NIC, NEA-BC
Pediatric Anxiety

Pediatric generalized anxiety disorder (GAD) is characterized by unrealistic worry and anxiety that isn’t focused a particular situation or object. These children worry more often and more intensely than other children about a variety of issues. Children with GAD may experience anxiety with activities, performance, safety of self or family, natural disasters, and possible future events. Excessive worrying impairs the ability to perform, concentrate, process information, and engage in activities. Insecurity and feelings of the need for perfection are common. Children with GAD may conform easily and are self-critical (Nutter, 2017).

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has specific criteria for generalized anxiety disorder (American Psychological Association, 2013) which includes:
  •   excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six 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 six 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).

Children with GAD are at higher risk for other co-morbidities such as depression, withdrawal from social activities, difficulty with relationships, substance abuse (particularly in adolescence), and family disruption. Patient therapy strategies include cognitive-behavioral approaches, behavioral therapy, and psychodynamic therapy. Exercise and relaxation practices are also helpful. Minimizing social stressors, family therapy, school-based interventions, parental practices, psychoeducation, and adaptive problem-solving and coping skills are other interventions used with pediatric GAD (Nutter, 2017).

As a nurse make sure you are prepared by taking the course Identification and care of Patients with Mental Health Disorders and PTSD: Caring for Patients and their Families.



References
American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Association.

Nutter, D. (2017). Pediatric generalized anxiety disorder. Retrieved from https://emedicine.medscape.com/article/916933-overview


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