Generalized Anxiety in Children and Teens

Helping kids who worry about everything find calm and confidence.

What we treat

When worry takes up too much room

All children worry sometimes. Generalized anxiety disorder (GAD) is different: the worry is frequent, hard to control, and spreads across many parts of life, from schoolwork and friendships to health, family, and the future. It can wear kids out and make everyday life feel harder than it should. The good news is that anxiety in children is highly treatable.

How commonAnxiety disorders affect about 1 in 3 teens by age 18

What it looks likeConstant "what if" worries, tension, and reassurance-seeking

First-line treatmentCognitive behavioral therapy (CBT)

FormatIn person or telehealth

Understanding GAD

What generalized anxiety looks like in kids

Children with GAD are often described as little adults or perfectionists. They may be conscientious and eager to please, which means their anxiety can be easy to miss. Underneath, they are working hard to manage a steady stream of worries.

Common worries

Grades, tests, and making mistakes. Being late or breaking rules. Health and safety of themselves or family. Natural disasters, news events, or money. Whether friends are upset with them.

How it shows up

Asking "what if" questions again and again. Needing lots of reassurance. Stomachaches, headaches, or muscle tension. Trouble falling asleep. Irritability, fatigue, or trouble concentrating.

What parents notice

Long homework sessions redoing work. Avoiding new activities. Meltdowns before school or events. Seeking certainty before every plan. A child who seems tired from worrying.

When to reach out

Worry happens most days and is hard for your child to turn off
Physical complaints keep coming up without a medical cause
Sleep, schoolwork, or friendships are affected
Reassurance helps only briefly before the next worry
Your child avoids new or uncertain situations
Your family is planning around your child's anxiety

The role of parents

When a child is anxious, it is natural to reassure, answer every question, or help them avoid what feels scary. These responses come from love, but over time they can keep anxiety going.

Research shows that parents can be powerful agents of change. A parent-based program that helps families respond supportively while reducing accommodation was as effective as child CBT in a randomized trial^[4]. We include parents throughout treatment.

How we treat it

Our approach to generalized anxiety

We use cognitive behavioral therapy (CBT), the most researched treatment for childhood anxiety and a first-line recommendation of the American Academy of Child and Adolescent Psychiatry^[3]. Children learn how worry works and practice new ways to respond to it.

A thorough evaluation. We use standardized measures to understand your child's worries, what keeps them going, and how they affect daily life.
Understanding worry. Kids learn how anxiety shows up in the body, thoughts, and behavior, and that worry is not a warning sign they must obey.
Coping tools. Calm breathing, muscle relaxation, and practical problem-solving help your child feel more in control.
Catching thinking traps. Children become "worry detectives" who test catastrophic predictions and build more balanced thoughts.
Facing uncertainty. Step by step, your child practices doing things without certainty or reassurance, which is where lasting change happens.
Keeping gains. We plan for setbacks and help your child use their skills on their own.

Medication: Many children do well with CBT alone. For more severe anxiety, CBT combined with an SSRI medication has been shown to work best, and we are glad to coordinate with your child's pediatrician or psychiatrist^[1].

The evidence

What the research says

Anxiety is the most common mental health concern in young people, and it is also one of the most treatable. CBT has been tested in dozens of randomized trials with children and teens.

31.9%

of U.S. adolescents meet criteria for an anxiety disorder at some point by age 18, in a national survey of more than 10,000 teens.

Merikangas et al., 2010 [2]

60% vs 24%

of children improved significantly with CBT alone, compared with pill placebo, in a trial of 488 children with generalized, separation, or social anxiety.

Walkup et al., 2008 [1]

81%

improved when CBT was combined with medication, the strongest result in the same study.

Walkup et al., 2008 [1]

The AACAP 2020 guideline recommends CBT for children and teens ages 6 to 18 with generalized, social, or separation anxiety, specific phobia, or panic disorder^[3].
In the landmark CAMS study, CBT alone and medication alone each outperformed placebo, and combining them led to the best outcomes^[1].
A 2020 randomized trial found that SPACE, a program delivered entirely through parents, was as effective as child CBT for childhood anxiety^[4].

Research results describe averages across groups of children. Every child is different, and we track your child's progress with standardized measures throughout treatment.

Common questions

Isn't some worry normal?

Yes. Worry is a normal part of growing up. It becomes a concern when it is frequent, hard to control, and gets in the way of sleep, school, friendships, or family life.

Will my child grow out of it?

Some children do, but anxiety often continues or shifts into new forms without treatment. Getting help early can prevent years of struggle and teach skills your child will use for life.

How long does treatment take?

Many children make meaningful progress in about 12 to 20 weekly sessions. We review progress regularly and adjust the plan together.

What if my child doesn't want to talk?

That is common. We use games, examples, and hands-on practice so therapy feels active rather than like a long conversation. Parents also play an important role.

Can treatment be done over telehealth?

Yes. CBT adapts well to video sessions, and many families find it easier to fit into busy schedules.

References

Walkup, J. T., Albano, A. M., Piacentini, J., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766. View study
Merikangas, K. R., He, J. P., Burstein, M., et al. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. View study
Walter, H. J., Bukstein, O. G., Abright, A. R., et al. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. View study
Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). 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 & Adolescent Psychiatry, 59(3), 362–372. View study