GAD in Children: Signs and Treatment

What is generalized anxiety disorder in children?

Generalized anxiety disorder (GAD) in children is excessive, ongoing worry about many everyday things that is hard to control and gets in the way of daily life, rather than fear of one particular situation.⁠^1,5 A child with GAD worries more often or more intensely than the situation warrants.⁠²

That is often what parents mean when they ask why their child is anxious about everything: the worry moves from school to health to family to the future instead of staying with one trigger.⁠^1,2

GAD is one of several anxiety disorders that can begin in childhood, and it is treatable with cognitive behavioral therapy (CBT), medication or both.⁠^3,5

What are the signs of GAD in children?

The main sign is persistent worry that is hard to switch off, usually with physical or behavioral signs alongside it.⁠^1,2 Children may not say they are worried at all.⁠⁵

Anxiety in children often shows up in the body, as stomachaches, headaches or fatigue, and it can look like irritability or anger rather than fear.⁠⁵ NIMH suggests an evaluation for younger children who often seem fearful or worried or complain of frequent stomachaches or headaches with no known medical cause.⁠¹⁵

Anger can be a sign of fear: anxious children can have severe outbursts when forced to face something that frightens them.⁠^5,16

What do children with GAD worry about?

Many of the same things as adults, but children’s worries often center on school, activities, friendships and the future.⁠² They may struggle with uncertainty, fear making mistakes, or worry about disappointing others, and some strive for perfection to manage the anxiety.⁠²

Symptoms often get worse at times of stress, such as an illness, exams, or conflict in the family.⁠²

What does GAD look like in young children?

In young children, anxiety can look like irritability, trouble sleeping or physical complaints more than spoken worry.⁠^5,15 The USPSTF describes GAD as one of the childhood anxiety disorders that tend to appear earlier, in the preschool and early school years, though population studies find that most GAD begins in adulthood.⁠^9,17

Some fears are normal at these ages, such as wariness of strangers at 12 to 18 months or some fear of germs at 5 to 7, and they are usually short-lived.⁠¹⁸ The USPSTF found too little evidence to recommend routine anxiety screening for children 7 or younger.⁠⁹

What does GAD look like in teenagers?

Teens with GAD often worry about school, extracurriculars, friendships and the future, and may push for perfection.⁠² Signs the AAP lists include irritability, dropping grades or avoiding school, trouble sleeping or concentrating, and chronic physical complaints.⁠¹⁹

GAD is more common in teenage girls than boys: 3.0% against 1.5% in a national US survey.⁠⁷ It can occur with depression and with suicidal thoughts or behaviors, so mood changes need attention.⁠²

What are the DSM-5 criteria for GAD in children?

The DSM-5 diagnosis requires all of the following, as SAMHSA’s summary of the manual sets them out; the criteria changed very little from the DSM-IV.⁠¹

1. Excessive worry. Anxiety and worry more days than not for at least six months, about a number of events or activities, such as school performance.⁠¹
2. Hard to control. The child finds it difficult to control the worry.⁠¹
3. One symptom in children. At least one of: restlessness or feeling on edge, tiring easily, trouble concentrating, irritability, muscle tension, or disturbed sleep. Adults need three.⁠¹
4. Real impact. The anxiety, worry or physical symptoms cause significant distress or get in the way of daily life.⁠¹
5. Not a medical cause. Not due to a substance, a medication or another medical condition, such as an overactive thyroid.⁠¹
6. Not better explained. Not better explained by another disorder, such as worry about separation, social judgment or contamination in separation anxiety, social anxiety or OCD.⁠¹

Because children need only one of the six symptoms, a child whose worry shows up mainly as poor sleep or irritability can still meet the criteria, as long as the worry itself has lasted six months and is hard to control.⁠¹

Is it normal worry or generalized anxiety disorder?

All children worry at times; GAD is worry that is excessive, hard to control and lasts, and that interferes with school, home or play.⁠^1,5,15 When a child does not outgrow the fears typical of young children, or has so many worries that daily activities suffer, the CDC says an anxiety disorder may be diagnosed.⁠⁵

How is GAD different from other anxiety disorders?

GAD is defined by worry about many things; the other anxiety disorders center on one kind of fear.⁠^1,5

A child can have more than one. In a clinic study of anxious children, GAD was the most common diagnosis (68%), and most children had more than one anxiety disorder.⁠¹² See social anxiety and OCD.

Can anxiety look like ADHD?

Yes. Difficulty concentrating and restlessness are GAD symptoms, and the CDC notes that a child with anxiety might squirm or fidget often.⁠^1,20 The two can also occur together: children with ADHD are more likely than other children to develop an anxiety disorder.⁠²⁰ See ADHD.

Can a child have GAD and depression?

Yes. Depression and anxiety often occur together in children, and depression is one of the conditions that commonly co-occur with GAD.⁠^2,5 An anxiety disorder in childhood also raises the chance of later depression.⁠⁹ See childhood depression.

How common is GAD in children?

Anxiety is common in children; GAD specifically is less so. In 2023–2024, 11% of US children aged 3 to 17 had a current diagnosis of anxiety, 13% of girls and 10% of boys.⁠⁶ In a national survey of US teens aged 13 to 18 conducted from 2001 to 2004, an estimated 2.2% had had GAD, and 0.9% with severe impairment.⁠⁷

Sources differ on when GAD usually starts. NIMH says it usually starts in early adulthood, though it can occur at any age, and a 2022 meta-analysis of population studies put the median age at onset at 32, with about 9% of cases beginning by 14 and 20% by 18.⁠^2,17

The USPSTF, describing anxiety in children, says GAD tends to appear earlier in childhood, in the preschool and early school years, while social anxiety generally appears in the later school years.⁠⁹ The meta-analysis found the opposite order overall: about half of social anxiety disorder, but under a tenth of GAD, had begun by age 14.⁠¹⁷

What causes GAD in children?

No single cause. GAD runs in families, and research points to a mix of genetics, brain chemistry, biology and environment; trauma or a stressful environment may raise the risk.⁠^2,8

• Genes

  In a meta-analysis of twin studies, the heritability of GAD was 0.32: genes accounted for about a third of the variation in liability.⁠⁸

• Personality and family

  Risk factors for anxiety disorders, including GAD, include personality, attachment difficulties, conflict between parents, parental overprotection, early parental separation and child mistreatment.⁠⁹

• Stress and adversity

  Children are more likely to develop anxiety after trauma or stress, violence, abuse or neglect, or bullying and rejection.⁠⁵

• A parent’s own anxiety

  Risk rises when a child’s parents have anxiety or depression.⁠⁵

How families respond can also keep worry going. A 2017 review proposes that parents with GAD may pass on the message that the world is not safe and that uncertainty is intolerable, and that overprotection and reinforcing avoidance can maintain a child’s anxiety; the authors note these pathways still need direct research.⁠²¹

Is GAD hereditary?

Partly. GAD clusters in families, and twin studies estimate its heritability at about 0.32; experiences unique to each person also matter, while the role of shared family environment is uncertain.⁠^2,8

Can sensory over-responsivity lead to anxiety?

It may raise the risk. In a study of 917 preschoolers, 43% of those with sensory over-responsivity also had an impairing anxiety disorder, and sensory over-responsivity at ages 2 to 5 predicted more anxiety symptoms at 6.⁠¹⁰

The link was driven mainly by generalized anxiety rather than separation anxiety or social phobia, and the authors call sensory over-responsivity a risk factor for anxiety disorders.⁠¹⁰ Sensory over-responsivity or anxiety? explains how to tell them apart.

Is it anxiety, autism or sensory overload?

It can be more than one. In a meta-analysis of 31 studies, 39.6% of autistic young people had at least one anxiety disorder.⁠²² AACAP notes that autistic children can have outbursts when routines change or they are overwhelmed by loud noises or bright lights.⁠¹⁶ See autism.

How is GAD diagnosed in children?

A clinician diagnoses GAD by asking when symptoms began, how long and how often they occur and how they affect daily life, and checking them against the DSM-5 criteria.⁠^1,2 A physical exam may be done to make sure an unrelated physical problem is not causing the symptoms.⁠²

Screening questionnaires help find children who need a full assessment. The USPSTF recommends screening for anxiety from age 8 to 18, and names the SCARED among the broader screening instruments.⁠⁹

The SCARED is a child and parent questionnaire with a generalized anxiety section among its five factors.⁠²³ Pediatricians may also use general tools such as the Pediatric Symptom Checklist, and the AAP and Bright Futures recommend yearly screening for behavioral, social and emotional problems.⁠^9,19

Who can diagnose GAD?

A primary care doctor, psychiatrist, psychologist or clinical social worker.⁠² For a child, the pediatrician is usually the first stop and can refer you to a mental health professional.⁠¹⁹

Not sure where to start?Does my child need an evaluation?

How is GAD treated in children?

GAD in children is treated with cognitive behavioral therapy (CBT), medication or both. AACAP’s 2020 guideline finds that both CBT and SSRI antidepressants have considerable support as safe and effective short-term treatments for anxiety in children and teens.⁠³

CBT works well for GAD in particular. In a study of 842 children given family-based group CBT, those with GAD responded better than children with other anxiety disorders.⁠¹¹ Across trials in the USPSTF review, where GAD was one of the most common diagnoses, CBT nearly doubled the chance of a treatment response compared with usual care or a wait list (pooled relative risk 1.89).⁠⁹

What happens in CBT for a child with GAD?

CBT helps a child notice anxious thoughts, question them and change the habits that keep worry going; NIMH calls it the gold standard psychotherapy.⁠² It also involves gradually facing feared situations, which the CDC describes as helping children learn that bad things do not happen.⁠^5,19

For very young children, involving parents in treatment is key.⁠⁵ In a trial of 194 children with anxiety disorders, the full version of guided parent-delivered CBT, four face-to-face and four telephone sessions, led to recovery in 50% against 25% on a wait list; a briefer version did not do significantly better than the wait list.⁠²⁴

Can treatment work through the parents alone?

It can. In a trial of 124 children aged 7 to 14 with anxiety disorders, SPACE, a parent program with no direct therapist contact with the child, was as effective as child CBT.⁠¹⁴ Because it works entirely through the parents, the authors note it can be used even when a child is not open to treatment.⁠¹⁴

What medications are used for GAD in children?

SSRI antidepressants are the main medications, and SNRIs have some support as another option.⁠³ In a US trial of 488 children aged 7 to 17 with GAD, separation anxiety or social phobia, 80.7% improved with CBT plus medication, 59.7% with CBT alone, 54.9% with medication alone and 23.7% with placebo.⁠²⁵

These medicines can take several weeks to work, and children, teens and young adults may have an increase in suicidal thoughts or behavior, especially in the first weeks or after a dose change.⁠^2,26 In that trial, suicidal thoughts were no more frequent on medication than on placebo, and CBT caused less insomnia, fatigue and restlessness than medication.⁠²⁵ If your child talks about suicide, use the crisis lines at the top of this page.

Should you keep reassuring an anxious child?

A little reassurance is natural, but constant reassurance can become part of the problem. A child with generalized anxiety may seek constant reassurance, and answering every time is a form of family accommodation: changing your own behavior to spare the child distress.⁠¹²

Accommodation is almost universal among parents of anxious children (97.3% in one clinic study), and more of it goes with more severe anxiety, a moderate link on parent reports and a small one on children’s.⁠^12,13 Most parents in that study also found accommodating distressing.⁠¹²

Reducing it is part of treatment. In SPACE, parents learned responses that acknowledge the child’s feelings while conveying confidence that the child can cope, then reduced one accommodation at a time, with a plan explained to the child.⁠¹⁴

How does GAD affect school?

School is one of the most common worries for children with GAD, and anxiety can show up as dropping grades or avoiding school.⁠^2,19 The DSM-5 criteria give school performance as an example of what the worry can be about.⁠¹

What school accommodations help a child with GAD?

Ask the school whether accommodations such as an IEP are appropriate; examples include more time for tests or seating that reduces distraction.⁠¹⁵ A child whose anxiety substantially limits learning may qualify for a Section 504 plan.⁠²⁷

The CDC notes that the school can also be included in a child’s treatment plan.⁠⁵ How to request a school evaluation has a letter you can adapt.

How can parents help a child with GAD at home?

By staying calm and supportive while helping the child face worries in small steps, and working with their clinician.⁠^5,14

1. Listen and talk. Talk with your child about stressors, and help them keep perspective and find ways to cope.⁠¹⁹
2. Keep expectations realistic. High expectations should be realistic, and children need time to relax, play and be with friends.⁠¹⁹
3. Cut back reassurance gradually. Constant reassurance is a form of accommodation, which is tied to more severe anxiety; reduce it step by step, ideally with a therapist.⁠^12,13,14
4. Encourage small brave steps. Gradual exposure to what the child fears is part of effective treatment.⁠^5,19
5. Look after sleep and exercise. Enough sleep, exercise and less caffeine can reduce anxiety when paired with treatment, though they do not replace it.⁠²

Watch for signs that need more help: worry that keeps growing, school avoidance, low mood, or talk of self-harm.⁠^15,19

Do children recover from generalized anxiety disorder?

Many improve with treatment, but anxiety often comes and goes. In the CAMS trial, most children responded within 12 weeks, 60% to CBT alone and 81% to CBT with medication.⁠²⁵

The longer view is mixed. In a follow-up of 319 young people from that trial, originally treated for separation, social or generalized anxiety and assessed yearly for four years beginning 4 to 12 years after treatment, about 22% stayed free of anxiety disorders, 48% relapsed at some point and 30% stayed chronically ill; children who responded well to the first treatment were less likely to stay ill.⁠²⁸

So GAD is not necessarily lifelong, but it can recur, especially under stress, and childhood anxiety raises the risk of later anxiety or depression.⁠^2,9

When should you get help for a child’s anxiety?

When worry or anxiety lasts for weeks or longer, upsets your child or family, or gets in the way of school, home or friendships.⁠¹⁵ The AAP advises talking with your pediatrician if you notice signs of anxiety.⁠¹⁹

NIMH also suggests an evaluation for younger children who often seem fearful or worried, or who have frequent stomachaches or headaches with no known medical cause.⁠¹⁵

If your child’s behavior is unsafe or they talk about wanting to hurt themselves or someone else, seek help immediately, using the crisis lines at the top of this page.⁠¹⁵

Related on DrSensory

• Social anxiety in children

  Fear of being judged, and how it differs from shyness.

• OCD in children

  Obsessions and compulsions, and what helps.

• Childhood depression

  The signs, and when to worry.

• CBT for anxiety

  What cognitive behavioral therapy involves.

• Sensory over-responsivity or anxiety?

  How to tell sensory overload from anxiety.

• Autistic burnout

  What autistic burnout is, and what helps.

• Pathological demand avoidance

  Avoidance of everyday demands, and how it is understood.

• ADHD in children

  Signs, diagnosis and treatment.

• Separation anxiety strategies

  Sensory-friendly ways to ease separations.

Sources

1. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. Rockville, MD: SAMHSA; June 2016. Checked October 22, 2026.
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   Section 3.3.4 and Table 13 (DSM-5 criteria for GAD): “Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)”; “The person finds it difficult to control the worry”; “Note: Only one item is required in children”: “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 restless 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)”; “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”; GAD is “excessive anxiety and worry that is not focused on a single trigger”; “There have been very few changes made to GAD criteria in DSM-5”.
2. National Institute of Mental Health. Generalized Anxiety Disorder: What You Need to Know. Revised 2025. Checked October 22, 2026.
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   People with GAD “feel extremely worried or nervous more frequently or more intensely about these and other things”, “even when the worry is out of proportion with the situation”; “GAD develops gradually and usually starts in early adulthood, although it can occur at any age”. People may “Worry excessively about everyday things”, “Have trouble controlling their worries or feelings of nervousness”, “Feel restless or have trouble relaxing”, “Have a hard time concentrating”, “Experience pain such as headaches, muscle aches, stomachaches, or tension”. “Children and teens with GAD may worry about many of the same things as adults, but their concerns often center on school, extracurricular activities, friendships, and the future”; “They may struggle with uncertainty, fear of making mistakes, or worry about disappointing others”; “Children and teens with GAD may strive for perfection as a way to manage their anxiety”; symptoms “are often worse during times of stress”. “If anxiety doesn’t go away and begins to interfere with your daily activities, you may have an anxiety disorder”. “GAD may run in families, but the exact cause of the disorder is unknown”; “Research suggests that GAD results from a mix of genetics, brain chemistry, biology, and environment”; “experiencing a traumatic event or being in a stressful environment, may put a person at higher risk”. Diagnosis (adult rule): “difficult to control worry on most days for at least 6 months” and “at least three of these symptoms”; providers include “a primary care doctor, psychiatrist, psychologist, or clinical social worker”; “the provider may conduct a physical exam to ensure that an unrelated physical problem is not causing your symptoms”. Co-occurring: “depression, other anxiety disorders, post-traumatic stress disorder” and “suicidal thoughts or behaviors”. “CBT has been well studied and is the “gold standard” choice for psychotherapy”; SSRIs and SNRIs “may take several weeks to start working”; healthy habits “can reduce anxiety symptoms when paired with standard care”. “call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org”. “In life-threatening situations, call 911”.
3. Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, et al. Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry. 2020;59(10):1107–1124. doi:10.1016/j.jaac.2020.05.005 (PMID 32439401). Checked October 22, 2026.
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   “both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitor (SSRI) medication have considerable empirical support as safe and effective short-term treatments for anxiety in children and adolescents”; “Serotonin norepinephrine reuptake inhibitor (SNRI) medication has some empirical support as an additional treatment option”; research needs include “additional evaluation of the degree of suicide risk associated with SSRIs and SNRIs”.
4. Crisis Text Line. Crisis Text Line | Text HOME to 741741 Free, 24/7 Mental Health Support. “Text HOME to 741741 from anywhere in the United States – 24/7, free, confidential”. Checked October 22, 2026.
5. Centers for Disease Control and Prevention. Anxiety and Depression in Children. Page dated May 15, 2026 (read in the Internet Archive copy of October 9, 2026). Checked October 22, 2026.
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   “Generalized anxiety disorder: Experiencing excessive, ongoing anxiety and worry that is difficult to control and interferes with day-to-day activities, but not necessarily specific to a particular situation or context”; “When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder”; “Anxiety may present as fear or worry but can also make children irritable and angry”; “physical symptoms like fatigue, headaches, or stomach-aches”; “Some anxious children keep their worries to themselves and, thus, the symptoms can be missed”; “Depression and anxiety often co-occur”; “For very young children, involving parents in treatment is key”; “The school can also be included in the treatment plan”; “gradually exposing them to their fears to help them learn that bad things do not occur”; risk factors include “trauma or stress; violence, abuse, or neglect; being bullied or rejected by other children; or when their own parents have anxiety or depression”.
6. Centers for Disease Control and Prevention. Data and Statistics on Children’s Mental Health. Page dated August 20, 2026 (read in the Internet Archive copy of October 10, 2026). Checked October 22, 2026.
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   2023–2024: “11% of children ages 3-17 had current, diagnosed anxiety (10% of males and 13% of females)”; 2021–2023: “20% reported symptoms of anxiety in the past two weeks”.
7. National Institute of Mental Health. Generalized Anxiety Disorder (statistics). Checked October 22, 2026.
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   Ages 13–18: “An estimated 2.2% of adolescents had generalized anxiety disorder, and an estimated 0.9% had severe impairment”; “The prevalence of generalized anxiety disorder among adolescents was higher for females (3.0%) than for males (1.5%)”; the survey years: “Lifetime Prevalence of Generalized Anxiety Disorder Among Adolescents (2001-2004)”.
8. Hettema JM, Neale MC, Kendler KS. A review and meta-analysis of the genetic epidemiology of anxiety disorders. American Journal of Psychiatry. 2001;158(10):1568–1578. doi:10.1176/appi.ajp.158.10.1568 (PMID 11578982). Checked October 22, 2026.
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   Twin studies “yielded heritabilities of 0.43 for panic disorder and 0.32 for generalized anxiety disorder”; “Panic disorder, generalized anxiety disorder, phobias, and OCD all have significant familial aggregation”; “the role of family environment in generalized anxiety disorder is uncertain”; “The role of nonshared environmental experience is significant”.
9. US Preventive Services Task Force. Anxiety in Children and Adolescents: Screening. Final recommendation statement, October 11, 2022. Checked October 22, 2026.
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   “The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years”; for children 7 and younger “the current evidence is insufficient”. “Separation anxiety, selective mutism, and GAD tend to appear earlier in childhood (preschool and early school years), whereas social anxiety and specific phobias generally appear in later school years”; “Developing an anxiety disorder during childhood or adolescence increases the likelihood of a future anxiety disorder (the same disorder or another anxiety disorder) or secondary depression”; risk factors include “genetic, personality, and environmental factors, such as attachment difficulties, conflict between parents, parental overprotection, early parental separation, and child mistreatment”; broader instruments include “the Screen for Child Anxiety Related Disorders (SCARED)”; “The most common primary diagnoses in these trials were social anxiety disorder and GAD”; CBT “treatment response (pooled relative risk [RR], 1.89”; “The American Academy of Pediatrics and Bright Futures recommends annual screening for behavioral, social, and emotional problems”.
10. Carpenter KLH, Baranek GT, Copeland WE, Compton S, Zucker N, Dawson G, et al. Sensory over-responsivity: an early risk factor for anxiety and behavioral challenges in young children. Journal of Abnormal Child Psychology. 2019;47(6):1075–1088. doi:10.1007/s10802-018-0502-y (PMID 30569253; PMC6508996). Checked October 22, 2026.
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    “a community sample of 917 at 2-5 and again in 191 of these children at 6 years old”; “Forty three percent of preschool children with sensory over-responsivity also had a concurrent impairing anxiety disorder”; “Preschool sensory over-responsivity symptoms significantly and positively predicted anxiety symptoms at age six”; the relationship “was predominantly driven by children who met criteria for GAD”; “These results suggest sensory over-responsivity is a risk factor for anxiety disorders”.
11. Hudson JL, Rapee RM, Lyneham HJ, McLellan LF, Wuthrich VM, Schniering CA. Comparing outcomes for children with different anxiety disorders following cognitive behavioural therapy. Behaviour Research and Therapy. 2015;72:30–37. doi:10.1016/j.brat.2015.06.007 (PMID 26164621). “a clinical sample of 842 children and adolescents”; “Children with GAD showed better response to this broad-based intervention”. Checked October 22, 2026.
12. Lebowitz ER, Woolston J, Bar-Haim Y, Calvocoressi L, Dauser C, Warnick E, et al. Family accommodation in pediatric anxiety disorders. Depression and Anxiety. 2013;30(1):47–54. doi:10.1002/da.21998 (PMID 22965863; PMC3932435). Checked October 22, 2026.
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    “Family accommodation describes the ways in which family members, particularly parents, change their behavior so as to help a relative to diminish or avoid the distress caused by a disorder”; “a child with generalized anxiety may seek constant reassurance”; “The most common anxiety disorder was generalized anxiety disorder (68%)”; “Virtually all parents (97.3%) endorsed at least some level of family accommodation”; “Most parents also reported experiencing distress resulting from accommodation (70.7%), and negative consequences of not accommodating the child’s symptoms (85.3%)”; “Only 40% of children met criteria for a single anxiety disorder diagnosis”; “Accommodation is common across childhood anxiety disorders and associated with severity of anxiety symptoms”.
13. Iniesta-Sepúlveda M, Rodríguez-Jiménez T, Lebowitz ER, Goodman WK, Storch EA. The relationship of family accommodation with pediatric anxiety severity: meta-analytic findings and child, family and methodological moderators. Child Psychiatry and Human Development. 2021;52(1):1–14. doi:10.1007/s10578-020-00987-6 (PMID 32246361). Checked October 22, 2026.
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    “Positive moderate association was observed for measures administered to parents”; “Global effect sizes were small for measures administered to children”.
14. Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK. Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: a randomized noninferiority study of supportive parenting for anxious childhood emotions. Journal of the American Academy of Child and Adolescent Psychiatry. 2020;59(3):362–372. doi:10.1016/j.jaac.2019.02.014 (PMID 30851397; PMC6732048). Checked October 22, 2026.
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    “Participants were children with primary anxiety disorders (N=124; 7–14 years old”; SPACE had “no direct child-therapist contact”; “SPACE was noninferior, relative to CBT, on primary and secondary anxiety outcomes”; parents were “taught supportive responses to child anxiety that acknowledge the child’s experience while also conveying confidence in the child’s ability to cope”; “a target accommodation was selected for modification” and “parents were instructed in how to communicate the plan to the child”; “Because SPACE focuses entirely on parent-change, parents can implement SPACE even when a child is not amenable to treatment”.
15. National Institute of Mental Health. Children and Mental Health: Is This Just a Stage?. Checked October 22, 2026.
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    “All children are sad, anxious, irritable, or aggressive at times”; “Consider seeking help if your child’s behavior or emotions last for weeks or longer, cause distress for your child or your family, or interfere with your child’s functioning at school, at home, or with friends”; “If your child’s behavior is unsafe, or if your child talks about wanting to hurt themselves or someone else, seek help immediately”; younger children may need an evaluation if they “Often seem fearful or worried” or “Complain about frequent stomachaches or headaches with no known medical cause”; “A first step may be to ask the school whether accommodations such as an individualized education program (IEP) are appropriate for your child”; accommodations might include “allowing more time for tests, or adjusting seating in the classroom to reduce distraction”.
16. American Academy of Child and Adolescent Psychiatry. Impairing Emotional Outbursts: Parents’ Medication Guide. 2021. Checked October 22, 2026.
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    “Children who have anxiety disorders can have severe outbursts if forced to face something which frightens them and are trying to avoid”; autistic children “can have outbursts when they are upset by change in routine or environment, they are overwhelmed by loud noises or bright lights”.
17. Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry. 2022;27(1):281–295. doi:10.1038/s41380-021-01161-7 (PMID 34079068; PMC8960395). Checked October 22, 2026.
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    Table 1, generalised anxiety disorder (24 samples): peak age at onset 15.5 years; onset by age 14 in 8.6%, by 18 in 20.4%, by 25 in 33.0%; median 32. “three to four out of ten for GAD” develop the disorder before 25. Social anxiety disorder (42 samples): onset by 14 in 50.9%, median 13. GAD is in “the remaining disorders that have a median age at onset in the later adulthood”.
18. Siegel RS, Dickstein DP. Anxiety in adolescents: update on its diagnosis and treatment for primary care providers. Adolescent Health, Medicine and Therapeutics. 2012;3:1–16. doi:10.2147/AHMT.S7597 (PMID 24600282; PMC3916014). Checked October 22, 2026.
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    “it is common for infants and toddlers to be apprehensive of strangers at 12–18 months of age, known as stranger anxiety, or for school-aged children to be somewhat afraid of germs at 5–7 years”; “these normative fears are typically transient”.
19. American Academy of Pediatrics, HealthyChildren.org. Anxiety in Teens is Rising: What’s Going On?. Claire McCarthy, MD, FAAP; last updated November 20, 2019. Checked October 22, 2026.
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    Signs include “Changes in behavior, such as irritability”, “Dropping grades or school avoidance”, “Trouble sleeping or concentrating” and “Chronic physical complaints, such as fatigue, headaches, or stomachaches”; “Talk with kids about potential stressors”; “Be mindful of the expectations you set for children and teens”; “kids need time to relax, play, and be with friends”; “If you are noticing signs of anxiety in your child or are worried that something you are seeing could be related to anxiety, talk with your pediatrician”; pediatricians use “screening tools such as the Pediatric Symptom Checklist (PSC)”; “Exposure therapy, a type of CBT, focuses on increasing exposure to feared objects or activities”.
20. Centers for Disease Control and Prevention. Other Concerns and Conditions with ADHD. Read in the Internet Archive copy of October 15, 2026. “A child with anxiety might squirm or fidget often”; “Children with ADHD are more likely than those without to develop an anxiety disorder”. Checked October 22, 2026.
21. Aktar E, Nikolić M, Bögels SM. Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty. Dialogues in Clinical Neuroscience. 2017;19(2):137–147. doi:10.31887/DCNS.2017.19.2/eaktar (PMID 28867938; PMC5573558). Checked October 22, 2026.
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    “Generalized anxiety disorder (GAD) runs in families”; the review proposes that parents with GAD “may bias their children’s processing of potential threats in the environment by conveying the message that the world is not safe, that uncertainty is intolerable”; parents may maintain children’s anxiety “by showing overcontrolling or overprotective parenting, by reinforcing avoidance, by limiting exposure, and by failing to encourage approach to novelty”; “Our review highlights the need for research on specific pathways”.
22. van Steensel FJA, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clinical Child and Family Psychology Review. 2011;14(3):302–317. doi:10.1007/s10567-011-0097-0 (PMID 21735077; PMC3162631). “31 studies involving 2,121 young people (aged <18 years) with ASD”; “39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder”. Checked October 22, 2026.
23. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. Journal of the American Academy of Child and Adolescent Psychiatry. 1999;38(10):1230–1236. doi:10.1097/00004583-199910000-00011 (PMID 10517055). Checked October 22, 2026.
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    “a child and parent self-report instrument used to screen for children with anxiety disorders”; “5 factors were obtained: panic/somatic, generalized anxiety, separation anxiety, social phobia, and school phobia”.
24. Thirlwall K, Cooper PJ, Karalus J, Voysey M, Willetts L, Creswell C. Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial. British Journal of Psychiatry. 2013;203(6):436–444. doi:10.1192/bjp.bp.113.126698 (PMID 23969483). Checked October 22, 2026.
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    “A total of 194 children presenting with a current anxiety disorder”; full guided CBT was “four face-to-face and four telephone sessions”; “Full guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not”; “25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list”.
25. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine. 2008;359(26):2753–2766. doi:10.1056/NEJMoa0804633 (PMID 18974308; PMC2702984). Checked October 22, 2026.
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    “488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia”; “80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%)”; “Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group”; “There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline”.
26. National Institute of Mental Health. Mental Health Medications. Checked October 22, 2026.
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    “In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting the medication or when the dose is changed”; “People should not stop taking a prescribed medication, even if they are feeling better, without the help of a health care provider”.
27. Section 504 regulations, Electronic Code of Federal Regulations. 34 CFR § 104.3 Definitions. Paragraph (j), “Handicapped person” (the regulation’s own term for a person with a disability): “has a physical or mental impairment which substantially limits one or more major life activities”; mental impairments include “any mental or psychological disorder”; major life activities include “learning”. Checked October 22, 2026.
28. Ginsburg GS, Becker-Haimes EM, Keeton C, Kendall PC, Iyengar S, Sakolsky D, et al. Results from the Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS): primary anxiety outcomes. Journal of the American Academy of Child and Adolescent Psychiatry. 2018;57(7):471–480. doi:10.1016/j.jaac.2018.03.017 (PMID 29960692). Checked October 22, 2026.
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    “Data were from 319 youths”, followed “across a 4-year period, beginning 4 to 12 years after randomization”; “Almost 22% of youth were in stable remission, 30% were chronically ill, and 48% were relapsers”; “Acute treatment responders were less likely to be in the chronically ill group”; “treatment type was not associated with remission status across the follow-up”.

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