Generalized Anxiety Disorder

Generalized Anxiety Disorder (abbreviated as GAS, classified as F41.1 in the ICD-10) is characterized by persistent worries that extend to many areas of daily life. A child with GAS worries about school, health, friendships, the weather on field trip day, and whether their parents will come home on time. The worry jumps from one topic to the next and never seems to end.

A key characteristic is that these fears seem exaggerated and often far removed from reality. A forgotten lunch becomes a catastrophe; a cough, a serious illness. These anxieties are not tied to a single trigger, as with a fear of spiders, but accompany the child almost daily, for weeks and months on end.

According to data from the Robert Koch Institute, anxiety disorders are among the most common mental health issues in childhood and adolescence. About one in ten children is affected at some point. GAS is one of several forms of this condition and occurs more frequently in late childhood and adolescence, when children begin to think about the future, grades, and the judgment of others. Girls are affected slightly more often than boys.

Worries often remain hidden for a long time because children have a hard time putting them into words. Often, the body is the first to show signs.

• Stomachaches, headaches, or nausea—especially in the morning before school or appointments
• Trouble falling asleep, restless sleep, waking up early
• Muscle tension, teeth grinding, constant restlessness
• Irritability, crying easily, trouble concentrating

On a behavioral level, a strong need for reassurance is often noticeable: The child keeps asking whether everything will be okay, whether nothing bad will really happen. Some avoid situations that trigger anxiety and withdraw. Others appear well-adjusted on the outside and function normally in school, but carry the tension inside. Another sign is the urge to do everything perfectly, out of fear of disappointing others or making a mistake. If such signs persist for months and begin to strain school, friendships, or family life, it’s worth taking a closer look.

Fear is a natural part of development. Toddlers are shy around strangers, elementary school children are afraid of the dark, and teenagers dread exams. Such fears are age-appropriate, come and go, and can usually be alleviated with comfort. A disorder is only diagnosed when the fear is severe, persists for months, and hinders the child’s daily life.

Generalized Anxiety Disorder (GAD) differs from related conditions. With school anxiety, the worry centers on a specific place or on academic performance. With panic disorder, sudden, intense anxiety attacks occur—characterized by a racing heart and shortness of breath—that seem to come out of nowhere. Generalized anxiety disorder, on the other hand, is a persistent state characterized by many small worries without a clear focus. The boundaries are fluid, and multiple forms can occur together. This is precisely why a professional is needed to make a diagnosis.

There is no single cause. Experts believe it results from a combination of factors: an inherited tendency toward anxiety, a sensitive nervous system, stressful experiences, and an environment in which worries are given a lot of attention. Parents are not to blame for the condition. Often, several of these factors reinforce one another without a single identifiable trigger.

Cognitive behavioral therapy (CBT) is considered the treatment of choice. In CBT, children learn to recognize and contextualize anxious thoughts, and they practice, in small steps, enduring feared situations rather than avoiding them. Complementary approaches include techniques for emotion regulation and mindfulness exercises that help calm the body when it is tense. In severe cases, medication under medical supervision may be added.

At home, a calm environment is helpful: establish consistent routines, take worries seriously without exaggerating them, and gently limit constant reassurance. Small, repeated tests of courage strengthen the child more than an environment that eliminates every fear. Your own behavior also helps: When parents remain calm and do not pass their own tension on to the child, they set an example for how to deal with worries.

A good first step is to visit a pediatrician’s office. They can rule out physical causes of stomachaches or sleep problems and refer you to a specialist. Child and adolescent psychiatrists, child and adolescent psychotherapists, and child and adolescent psychiatry outpatient clinics (KJP) are responsible for the evaluation itself.

Don’t wait until your child stops going to school altogether. Persistent worries, withdrawal, or physical complaints lasting several weeks are reason enough to seek advice. A conversation with the homeroom teacher can also help if anxiety is primarily affecting the child’s daily school life. Waiting lists for therapy slots are long in many places, so it pays to inquire early.

Rückenwind “Eltern” provides coaching to guide you through this phase, helps you make sense of the situation, and supports you in your daily life. This cannot and should not replace a diagnosis or therapy. Only a medical or psychotherapeutic specialist or a child and adolescent psychiatry clinic can determine whether a child has a generalized anxiety disorder.