Panic disorder in children

Panic disorder occurs when a child experiences recurrent, frequent (at least once a week) panic attacks.

Panic attacks are discrete episodes, lasting approximately 20 minutes, during which the child develops somatic or psychological symptoms. Panic disorder may develop with or without agoraphobia.

Agoraphobia is a persistent fear of being in situations or places from which there is no easy or unaided escape. Diagnosis is based on anamnestic data. Treatment is with benzodiazepines or SSRIs, and behavioral therapy is also used.

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Symptoms of Panic Disorder in Children

Panic disorder is rare in children before puberty. Because many panic symptoms are physical in nature, many children are evaluated by a doctor before panic disorder is suspected. The diagnosis is further complicated in children with underlying physical illnesses, especially asthma. A panic attack can trigger an asthma attack and vice versa. Panic attacks can also develop as part of other anxiety disorders, such as OCD or separation anxiety disorder.

Panic attacks usually develop spontaneously, but over time children begin to associate them with certain situations and environments. Children try to avoid situations that may lead to agoraphobia. Agoraphobia is diagnosed when a child's avoidance behavior is so severe that it significantly interferes with normal activities, such as going to school, walking in public places, or performing any other normal activities.

In cases of panic disorder in adults, important diagnostic criteria include concern about future attacks, the meaning of the attacks, and changes in behavior. In childhood and early adolescence, there is usually not enough insight and anticipation to develop these additional symptoms. Behavior changes, when they occur, typically include avoidance of situations and circumstances that the child believes are associated with the panic attack.

Diagnosis of panic disorder in children

In most cases, a medical evaluation should be performed to rule out medical causes for the physical symptoms. Careful screening should be done for other anxiety disorders such as OCD or social phobias, as any of these may be the primary problem and panic attacks may be a secondary symptom.

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Treatment of panic disorder in children

Treatment usually involves a combination of medication and behavioral therapy. In children, it is difficult to even begin behavioral therapy until panic attacks are controlled with medication. Benzodiazepines are the most effective medications for controlling panic attacks, but SSRIs are often preferred because benzodiazepines are sedating and can significantly impair learning and memory. However, the onset of SSRI effects is slow, and a short course of a benzodiazepine derivative (eg, lorazepam 0.5–2.0 mg orally 3 times daily) may be indicated until the SSRI effect occurs.

Behavioural therapy is particularly effective when agoraphobia symptoms are present. These symptoms are rarely amenable to medication, as children often continue to fear panic attacks even after a long period of absence with medication.

Prognosis for panic disorder in children

The prognosis for panic disorder with or without agoraphobia in children and adolescents is good with treatment. Without treatment, adolescents may drop out of school, withdraw from society, and become reclusive, and suicidal behavior may occur. Panic disorder often waxes and wanes in severity without any discernible cause. Some patients experience long periods of spontaneous remission, only to relapse many years later.