Panic Disorder in Children and Adolescents

Symptoms of a panic attack involve a sudden surge of intense fear, accompanied by somatic symptoms (eg, palpitations, sweating, trembling, shortness of breath or choking, chest pain, nausea, dizziness). Compared with those in adults, panic attacks in children and adolescents are often more dramatic in presentation (eg, with screaming, weeping, and hyperventilation). This display can be alarming to parents and others.

Panic attacks usually develop spontaneously, but over time, children begin to attribute them to certain situations and environments. Affected children then attempt to avoid those situations, which can lead to agoraphobia Agoraphobia in Children and Adolescents Agoraphobia is a persistent fear of being trapped in situations or places without a way to escape easily and without help. Diagnosis is by clinical criteria. Treatment is mainly with behavioral... read more . Avoidance behaviors are considered agoraphobia if they greatly impair normal functioning, such as going to school, visiting the mall, or doing other typical activities.

Panic disorder is diagnosed based on a history of recurrent panic attacks, usually after a physical examination is done to rule out physical causes of somatic symptoms. Many children undergo considerable diagnostic testing before panic disorder is suspected. The presence of other disorders, especially asthma, can also complicate the diagnosis. Thorough screening for other disorders (eg, obsessive-compulsive disorder [OCD] Obsessive-Compulsive Disorder (OCD) and Related Disorders in Children and Adolescents Obsessive-compulsive disorder is characterized by obsessions, compulsions, or both. Obsessions are irresistible, persistent ideas, images, or impulses to do something. Compulsions are pathologic... read more , social anxiety disorder Diagnosis Social anxiety disorder is a persistent fear of embarrassment, ridicule, or humiliation in social settings. Typically, affected children avoid situations that might provoke social scrutiny ... read more ) is needed because any one of these disorders may be the primary problem causing panic attacks as a symptom.

In adults, important diagnostic criteria for panic disorder include concerns about future attacks, the implications of the attacks, and changes in behavior. However, children and younger adolescents usually lack the insight and forethought needed to develop these features, except they may change behavior to avoid situations they believe are related to the panic attack.

Treatment of panic disorder is usually a combination of drug therapy and behavioral therapy. In children, it is difficult to even begin behavioral therapy until after the panic attacks have been controlled by medications.

Benzodiazepines are the most effective medications, but SSRIs are often preferred because benzodiazepines are sedating and may greatly impair learning and memory. However, SSRIs do not work quickly, and a short course of a benzodiazepine (eg, lorazepam 0.5 to 2.0 mg orally 3 times a day) may be helpful until the SSRI is effective.

Prognosis is good with treatment. Without treatment, adolescents may drop out of school, withdraw from society, and become reclusive and suicidal.

Panic disorder often waxes and wanes in severity without any discernible reason. Some patients experience long periods of spontaneous symptom remission, only to experience a relapse years later.