Panic disorder in children

Panic disorder occurs if the child has recurrent, frequent (at least once a week) panic attacks.

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

Agoraphobia is a persistent fear of being in situations or places, from which it is not possible to easily get out without help. Diagnosis is based on anamnestic data. Treatment is carried out with benzodiazepines or SSRI, 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 of a physical nature, many children undergo a medical examination before a suspicion of panic disorder arises. This diagnosis is further complicated in children with concomitant somatic diseases, especially asthma. A panic attack can provoke an asthma attack and vice versa. Panic attacks can also develop in the context of other anxiety disorders, such as OCD or anxiety disorder caused by fear of separation.

Panic attacks usually develop spontaneously, but over time, children begin to associate them with certain situations and conditions. Children try to avoid situations that can lead to agoraphobia. Agoraphobia is diagnosed when the child's avoiding behavior is expressed to such an extent that his normal way of life is violated, for example, school attendance, walking in public places or doing any other usual activities.

In cases of panic disorder in adults, important diagnostic criteria are concern about the presence of attacks in the future, the significance of attacks, and changes in behavior. In childhood and early adolescence, there is usually a lack of understanding of what is happening and the anticipation of events necessary for the development of these additional symptoms. Behavior changes, when they arise, usually include avoiding situations and circumstances related (in the child's opinion) with a panic attack.

Diagnosis of panic disorder in children

In most cases, a medical examination should be conducted to exclude the medical causes of somatic symptoms. Careful screening should be done for other anxiety disorders, such as OCD or social phobias, since any of them may be a primary problem, and panic attacks are a secondary symptom.

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Treatment of panic disorder in children

Treatment, as a rule, includes a combination of medication and behavioral therapy. In children it is difficult even to begin behavioral therapy before panic attacks are not controlled by medication. Benzodiazepines are the most effective drugs for controlling panic attacks, but SSRI is often more preferred because benzodiazepines have a sedative effect and can significantly impair learning and memory abilities. Nevertheless, the SSRI effect develops slowly, and a short course of benzodiazepine derivatives (eg, lorazepam 0.5-2.0 mg orally 3 times a day) may be indicated before the appearance of the SSRI effect.

Behavioral therapy is especially effective in the presence of symptoms of agoraphobia. These symptoms are rarely amenable to drug treatment, as children often continue to fear panic attacks, even after long periods of absence, against the background of drug therapy.

Prognosis for panic disorder in children

The prognosis for panic disorder with or without agoraphobia in children and adolescents is favorable under the condition of treatment. Without treatment, adolescents can drop out of school, avoid society and become hermits, possibly suicidal behavior. Panic disorder is often mitigated and weakened in severity without any noticeable cause. Some patients have long periods of spontaneous remission, and many years later a relapse occurs.