Case Study of a Child with Generalised Anxiety Disorder: Signs, Struggles, and Support
Patient Information
- Age: 9
- Gender: Male
- Background: Ayan (name changed to protect confidentiality), a 9-year-old boy from Bhubaneshwar, resides in a nuclear family consisting of his working parents and a younger brother who is 5 years old. He is a student of Class 5 in a well-known ICSE school.
History or Cause:
Ayan was always a shy and sensitive kid, but in the last year, his parents saw an ever-growing shift in his behaviour. He worried excessively about exams at school, was afraid of doing something wrong, and would shy away from engaging in group work. He was not nervous in specific situations—it spread to general activities including going to birthday parties, talking to relatives, or even to the supermarket.
His parents first dismissed it as a "shy phase," but Ayan's persistent questioning, lack of sleep, refusal to go to school for petty excuses like stomach aches, and fits of emotional storms became the pattern. He cried hysterically at homework, repeatedly asked about the same piece of work to be done again, and dreaded greatly being criticised or scolded.
With time, his grades declined, he became withdrawn socially, and his eating pattern was disturbed. His parents, anxious, brought him to a paediatrician who recommended psychological intervention. After an initial evaluation, Ayan was advised to seek special treatment from Jagruti Rehabilitation Centre in Delhi.
Diagnosis :
After Jagruti Rehabilitation Centre's child psychiatrists and clinical psychologists conducted a complete psychological examination, Ayan was diagnosed with:
- Generalised Anxiety Disorder (GAD) – characterised by excessive and persistent worry in many different situations.
- Sleep Disturbance – caused by anxious ideas and mental hyperactivity.
- Mild Separation Anxiety – especially apparent while dropping off at school or in novel situations.
The underlying causes were assumed to be a mix of high educational ambitions, an introverted personality, sensitivity towards criticism, and low-key parenting pressures to perform.
The clinicians observed that Ayan's anxiety was not triggered by one single cause but was distributed across many things in his life—making it a prototype case of Generalised Anxiety Disorder in children.
Treatment :
Approach:
At Jagruti Rehabilitation Centre, a comprehensive, child-centred, non-pharmacological intervention was designed. The treatment was targeted to offer a safe, organised, and supportive setting where Ayan can voice and verbalise his thoughts and concerns, acquire coping mechanisms, and diminish his agitated behaviour with the assistance of therapy and parents.
Program:
Week 1–2: Initial Stabilisation and Rapport Building
- Child counselling sessions focused on building a non-judgemental environment.
- Parents were advised separately to gain a better insight into Ayan's anxiety and emotional cues.
- Sleep and eating habits were regulated through a regular daily schedule.
Week 3–4: Cognitive Restructuring
- Cognitive Behavioural Therapy (CBT) was initiated to enable Ayan to overcome his anxious thoughts.
- Drawing activities, storytelling, and visual aids were used. It encouraged him to recognise "worry monsters" and re-label them.
Week 5–8: Exposure and Confidence Building
- Gradual exposure methods were employed. Ayan was prompted to confront his fears in a controlled, safe environment (e.g., responding to a question during group therapy).
- Group play therapy helped in developing social confidence.
- Family therapy helped reduce pressure from parents and promoted open, supportive communication.
Week 9–12: Development of Skills and Training in Independent Living
- Relaxation skills like deep breathing, guided imagery, and progressive muscle relaxation were taught to Ayan.
- Expressive arts (clay modelling, drawing) and writing were used to regulate effect.
- Age-appropriate time management and self-soothing were conditioned to him.
Medical Interventions:
- No medication was used since Ayan's symptoms were manageable with the help of therapy and lifestyle changes.
Therapy Types:
- Cognitive Behavioural Therapy (CBT): Assisted Ayan in delearning unrealistic anxieties and substituting them with rational, soothing cognitions. He realised that errors were an integral part of learning—not failure.
- Play and Art Therapy: Equipped Ayan with non-verbal ways to communicate fear and anxiety. Art therapy also facilitated the diminution of his emotional tension.
- Family Therapy: Educated Ayan's parents concerning GAD and decreased accidental triggers such as excessive criticism or too many expectations. The parents were able to learn and validate his feelings and praise his efforts over his achievements.
- Relaxation Training: These activities such as "balloon breathing" and "visualisation of safe place" facilitated Ayan to relax whenever there was an incidence of panic or excessive thinking
Improvements/Recovery Timeline :
| Week | Key Milestones |
|---|---|
| Weeks 1–2 | Adapted to therapy. Improved sleep. Opened up during art class. |
| Weeks 3–4 | Less emotional meltdown. Did well with CBT games. Identified 3 primary fears. |
| Weeks 5–6 | He began striking up a conversation during group play. Coped with small changes well. |
| Weeks 7–8 | Presented a drawing in front of the group. He gained confidence in decision-making. |
| Weeks 9–10 | Utilised breathing techniques on his own during times of anxiety. He slept independently. |
| Weeks 11–12 | Participated in a family event without difficulty. He joined his school's story club voluntarily. |
Our Success:
Impact on Ayan's Life:
Ayan came back home with a stronger, calmer, and braver mindset. His performance at school improved over time, but more significantly, he was less afraid and happier. He became expressive, embraced ambiguities, and was able to self-monitor his anxieties.
Ayan: "I can speak up in class now. I still get frightened sometimes, but I know how to make the frightening thoughts go away. Drawing my 'worry monster' and blowing like a balloon helps me feel much better."
Family and Community Impact:
Ayan's parents also mentioned that the home atmosphere was improved in terms of happiness and communication. His little sister also gained an empathetic nature, and their parents improved their approach by being emotionally more supportive parents. His teachers noticed improvements in classroom participation and a more relaxed attitude towards exams and peer interactions.
Future Steps:
In the future, regular monthly therapy sessions over the next half-year will be necessary to observe Rishi closely for emotional and behavioural development. Ongoing counselling by the school counsellor will be required, particularly with transitions like examination periods or shifting peer relationships. The family should have a structured daily routine with frequent emotional checks at home to maintain a stable setting. If any of these signs of relapse—social withdrawal, irritability, or sleep disturbances, the child psychiatry team at Jagruti Rehabilitation Centre will be on hand for immediate intervention and support.
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