Editors

SaijaRoine

Childhood Panic Disorder

If a child has inexplicable somatic symptoms that fit those of panic disorder, consultation with a child psychiatrist is imperative.
An early as possible diagnosis is essential to prevent the child from adopting a role of illness within the family or larger social network. An early diagnosis supports the development of the child's personality.

Over 10% of children have some sort of anxiety symptoms that coincide with the criteria for anxiety disorders or subclinical phobias.
According to several studies 1.7-7.6% of school-aged children suffer from school phobias.
The occurrence of panic disorder symptoms seems to become more frequent with age.
Panic disorder is found in 3-4% of the whole population; see also Anxiety Disorder.

It is thought that panic disorder is inherited through an autosomal dominant gene.
Disorders of the amygdala are considered to play a role in the development of anxiety.
The triggering of a panic disorder is often preceded by the death of someone close, illness, or a break up with a girl or boy friend in adolescence.
Separation anxiety disorder in the childhood is considered as one of the risk factors of early-onset panic disorder.

Usual age of onset between 5 and 10 years.
Pounding heart rate
Weakness
Shaking
Feelings of dying and becoming mad
Shortness of breath
Dizziness
Tightness and pain in the chest
Prickling of fingers and face
Feeling of suffocation
Sweating
Hot and cold flushes
Blurriness of sight
Somatic examinations often sought first
As a result of an undiagnosed and untreated panic disorder, a child can develop disabling forms of avoidance behaviour, of which dropping out of school is the most common.

A diagnosis of panic disorder requires examinations by specialists, and, even more importantly, the medication should be initiated in the care of specialized personnel.
The treatments are primarily psychological. If necessary, pharmacological treatments may be used in addition..
Different forms of psychotherapies are used in psychological treatment. Cognitive-behavioral therapies are recommended for treating the secondary symptoms of panic disorder Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents. Especially information given to parents and people who care for the child has proved to be important to the success of treatment.
If pharmacological treatment is necessary, the selective serotonin reuptake inhibitors (SSRIs) are primarily to be considered. There is earlier experience also of clomipramine.

Reynolds S, Wilson C, Austin J, et al. Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 2012;32(4):251-62.[PubMed]
Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am 2009;32(3):483-524.[PubMed]