Panic Disorder in Children and Teens

What is panic disorder?

A child with panic disorder (PD) has sudden attacks of fear or severe anxiety. The fearful attacks happen several times over weeks or months. They may last a few minutes or they may last for hours. All children and teens feel fearful at times, however, the fear is usually brief, and goes away without causing major problems. Panic disorder is when the fearful times happen over and over, start suddenly without a clear cause, and are severe. PD interferes greatly with daily life at school and home.

Panic attacks are not caused by fear of a single thing. That is called a phobia, like being scared of dogs or the dark. The attacks are also not caused by a traumatic event, like child abuse or being in a car accident. If caused by trauma, the child may have post-traumatic stress disorder.

PD begins most often in the late teenage years into the mid-30s. It does, however, sometimes start in childhood. It begins with a few attacks that come and go. Often it never goes beyond this, but some children start having the attacks often.

What is the cause?

A stressful event, like parents divorcing or a move to a new place, may trigger the panic. But often PD begins with no identified stressful event. It is common for a child to have periods of time with attacks and then go weeks or months with few or none. What causes attacks to stop and return is often unclear.

PD runs in families. If a parent has panic disorder, children are more likely to have panic disorder, too. However, more than half of those with PD do not have a parent with a history of PD. Children who were often scared when separated from their parents are more likely to develop PD later. Other than being hereditary, the causes of PD are not certain.

What are the symptoms?

Panic attacks tend to come on suddenly. Children or teens with PD may:

• cry in fear
• tremble or shake
• be short of breath or feel like they are being smothered
• feel like they are being choked or have trouble swallowing
• sweat
• feel their heart pounding or feel like something is pressing on their chest
• feel they are going to die or that they are going crazy
• feel very helpless to stop the attacks

Along with these main symptoms, children or teens may:

• be on guard all the time or startle easily
• eat very little or become very picky eaters
• have trouble concentrating due to worry
• not do as well as they could in school
• have frequent headaches or stomachaches
• have trouble falling or staying asleep, or have nightmares
• lose interest in activities they once enjoyed
• talk about death, such as saying "I wish I were dead"

Panic attacks often happen at certain times of day, such as bedtime, or with daily events, for example, going to school. When this is the case, the child often worries as these times approach. The child feels helpless to prevent the attacks.

How is it diagnosed?

Your child's healthcare provider or a mental health therapist can tell you if your child's symptoms are caused by panic disorder. A mental health therapist who specializes in working with children and teens may be best qualified to diagnose PD. The therapist will ask about your child's behavior and symptoms, medical and family history, and any medicines your child takes. Sometimes your child may need lab tests to rule out medical problems causing symptoms like stomachaches, trouble swallowing, or difficulties breathing.

Children and teens may have other problems or disorders in addition to PD, such as:

• attention deficit/hyperactivity disorder
• bipolar disorder
• generalized anxiety disorder
• depression
• post-traumatic stress disorder
• obsessive-compulsive disorder
• substance abuse problems

How is it treated?

Cognitive behavior therapy (CBT) helps children learn what causes them to feel panic and how to control it. CBT teaches specific skills for managing the fear and the worrisome thoughts about whether an attack is coming.

Other behavioral therapies are also useful. Gradual exposure therapy teaches the child to stay relaxed while being exposed to situations associated with panic attacks.

Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel very supported when parents and siblings attend therapy with them and work as a group.

Medicines are helpful when the symptoms are severe. Medicines help reduce the frequency of attacks or how severe they are. Several types of medicines can help treat panic disorder. Medicines used to treat PD in adults may not work best for children and young teens. Your child’s healthcare provider will work with you to carefully select the best one for your child.

How long will the effects last?

Most children and teens can get over PD with good treatment and family support.

If a child has had PD once, then they are at greater risk for future PD. The mental health professional treating your child may recommend continuing treatment after your child begins to feel better. Symptoms may return since PD often comes and goes without a clear reason for stopping and starting.

What can I do to help my child?

It is very important to help your children feel supported and reassured.

• Reassure your children that their feelings are understandable and that they are not "going crazy." Let your child know that he or she is safe and protected. The support and understanding that you provide can help children deal with frightening emotions.
• Let your child talk about the scary feelings and fears of attacks if he or she feels ready. Do not force the issue if your child does not feel like sharing his or her thoughts
• Let your child make simple decisions when appropriate. Because PD often makes a child feel powerless, you can help by showing him or her that he or she has control over certain parts of his or her life. For example, you might consider letting your child decide how to spend the day, such as letting him or her pick places where they feel safest from attacks.
• Tell your child (repeatedly if necessary) that the attacks are not his or her fault.
• Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
• Do not criticize your child for acting younger than his or her age. If he or she wants to sleep with the lights on or take a favorite stuffed animal to bed, it's OK and can be soothing.
• Make sure your child gets enough sleep and exercise every day.
• Teach children and teens to avoid alcohol, caffeine, and stimulants like ephedra and guarana.
• Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed.
• Take care of yourself so that you are well equipped to help your child. You can't be supportive if you're neglecting your own emotional or physical health.
• If you suspect that your child is suicidal, get professional help immediately. Thoughts of suicide are serious at any age and require prompt attention.

When should I seek professional help?

When panic disorder seriously interferes with school, socializing with friends, or daily activities, your child needs help. If panic attacks happen more than a few times in a month, or if an attack is very severe, get professional help. The symptoms may not go away or may get worse without professional help.

Get emergency care if your child or teenager has ideas of suicide, harming him- or herself, or harming others.

For more information, contact organizations such as:

National Institute of Mental Health
Telephone: 866-615-NIMH (6464)
Web site: http://www.nimh.nih.gov

Mental Health America (formerly the National Mental Health Alliance)
Telephone: 800-969-NMHA (6642)
Web site: http://www.nmha.org