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Generalized anxiety disorder in children: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Generalized anxiety disorder is a persistent condition of heightened anxiety and apprehension, characterized by excessive worry, anxiety, and fear, sometimes even terror. Physical symptoms may include tremors, hyperhidrosis, multiple somatic complaints, and weakness and exhaustion. Diagnosis is based on anamnestic data. Treatment includes behavioral therapy, sometimes combined with medication.
Generalized anxiety disorder (GAD) is diagnosed in children and adolescents with severe and disruptive anxiety symptoms that are not narrow enough to meet the criteria for a specific disorder such as social phobia or panic disorder. In addition, generalized anxiety disorder is an appropriate diagnosis for children with specific anxiety disorders who also have other severe anxiety symptoms that go beyond those of the specific disorder.
Sometimes generalized anxiety disorder can be mistaken for attention deficit hyperactivity disorder (ADHD). Children with generalized anxiety often have difficulty paying attention, and their anxiety can also lead to psychomotor agitation (i.e. hyperactivity). The key difference is that children with ADHD tend to worry no more than children without ADHD, whereas children with generalized anxiety disorder worry and have a lot of traumatic experiences.
Because of the broad spectrum of symptoms, generalized anxiety disorder is particularly difficult to treat with behavioral therapy. Relaxation techniques are often more effective in these situations. Patients with severe generalized anxiety disorder that does not respond to psychotherapeutic treatments may require anxiolytics. As with other anxiety disorders, SSRIs are usually the drugs of choice. Buspirone is a possible alternative, especially in children who cannot tolerate SSRIs; the starting dose is 5 mg orally twice daily and can be gradually increased to 30 mg twice daily (or 20 mg three times daily) depending on tolerability. GI symptoms or headache may be limiting factors in increasing the dose.
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