All About...Generalized Anxiety Disorder

Generalized Anxiety Disorder is a common anxiety disorder in adults and/or children that involves constant and chronic worrying, nervousness, and tension.  

Defined as:

• Excessive anxiety and worry, occurring more days than not for at least 6 months, about several events or activities (such as work or school performance).  

• The person finds it difficult to control the worry.

• The anxiety and worry are associated with three or more of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months):

  1. Restlessness or feeling keyed up or on edge

  2. Being easily fatigued

  3. Difficulty concentrating or mind going blank

  4. Irritability

  5. Muscle tension

  6. Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

  
  

• 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).  

• The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).

Several parts of the brain and biological processes play a key role in fear and anxiety. In people diagnosed with Generalized Anxiety Disorder, also referred to as GAD, brain connections may be weaker from the prefrontal cortex, where the brain is processing the environment, to the hippocampus, where the brain regulates emotions.  In addition, there is a stronger connection between the hippocampus and the amygdala.  The amygdala is a pair of almond-sized bundles of nerve fibers in the middle of the brain that help process emotion, memory, and fear.  It controls our “flight or fight” response, which is a healthy part of our biology that is designed to ensure our survival and safety by preparing us to get out of dangerous situations safely, one way or another.  However, when your fight or flight response remains switched on when there is no danger, or if it gets switched on too easily, again when there is no danger, then the flight or fight response will morph into and become prolonged anxiety and anxiety disorders.

CHARACTERISTICS:

Emotional Symptoms include:

• Constant worries 

• Feeling like the anxiety is uncontrollable; there is nothing to stop the worrying

• Intrusive thoughts about things that cause anxiety

• An inability to tolerate uncertainty

• A pervasive feeling of apprehension or dread

Behavioral symptoms include:

• Inability to relax or enjoy quiet time

• Difficulty concentrating or focusing on things

• Feeling overwhelmed, which causes procrastination

• Avoiding situations that can cause anxiety

Physical symptoms include:

• Feeling tense; having muscle tightness or body aches

• Having trouble falling asleep or staying asleep 

• Feeling edgy, restless, or jumpy

• Stomach problems, nausea, diarrhea

IMPORTANT INFORMATION TO KNOW:

A child diagnosed with Generalized Anxiety Disorder is protected under the Individuals with Disabilities Education Improvement Act (IDEA) and federal special education law with regards to their education.  The diagnosis should be used in a public-school eligibility determination for special education services and when creating an Individualized Education Program (IEP) or 504 Plan.  Qualifications for eligibility fall under the IDEA category of Emotional Disturbance.  An IEP/504 represents a legal document that will hold your child’s school accountable for the delivery of accommodations and possible modifications to the curriculum to support the legal right of a Free and Appropriate Public Education (FAPE), to which your child is entitled.  The IEP/504 process can be lengthy, so be sure to organize materials and plan time to attend these important meetings at your child’s public school. 

ACADEMIC SUPPORT

Given the wide range of symptoms experienced by children and adolescents with Generalized Anxiety Disorder, it’s important to meet with your child’s school to get a baseline on your child and establish accommodations and modifications specific to your child’s needs.

The following list of suggested accommodations will help you get started:

• Extra time and warnings before transitions

• Preferential seating 

• Clearly stated and written expectations (behavioral and academic)

• Frequent check-ins for understanding

• Not requiring reading aloud or work at the board in front of the class

• Extended time for assessments.  Assessments may be administered in a separate, quiet environment (to reduce performance pressure and distraction)

• Word banks and equation sheets: These are useful for children with test anxiety, who tend to “go blank” when taking a test. Using one notecard for important facts, dates, etc. can also be helpful.

• “Cool down passes” to take a break from the classroom. This should be clearly explained to the student. Examples might include a walk down the hallway, getting water, standing outside the classroom door for a few minutes, completing coloring pages in the back of the room, or using a mindfulness app with headphones.

• Buddy system: Pair student with a peer to assist with transitions to lunch and recess (these less structured situations can trigger anxious feelings)