Children having panic disorder may appear to be suddenly frightened or upset with no easily identified explanation. This behavior is often confusing to others. At times children having a panic disorder may incorrectly explain their symptoms as a response to an external trigger (for example,”It started when I saw a snake”). These children, particularly if they are very young, may not be able to articulate the intense fears they experience during a panic disorder. Adolescents are generally better able to describe what they experience, particularly after a panic disorder has ended.

Panic disorder is distinguished by the unpredictability of the panic attack. If a child is predictably frightened by a particular situation (such as meeting a new person) or predictably panics when seeing something he or she finds upsetting (such as a spider), the child may have a phobia rather than Panic disorder. Phobias are intense fears predictably triggered by particular situations or objects. Phobias include social phobia (associated with intense fear when exposed to new people) and specific phobia (associated with intense fear when exposed to a particular situation or object).

When left untreated, Panic disorders can lead to substantial worry or limitations in other areas of the child’s life. Peer relationships, school functioning, and family functioning may suffer, or depression may develop. In some situations, in response to extreme anxiety, social isolation, or limited activities, a child may develop thoughts of self-harm or not wanting to live. A trained therapist (such as a child psychiatrist, child psychologist or pediatric neurologist) should integrate information from home, school, and the clinical visit to make a diagnosis.

What about the home environment.

Children with Panic disorder may feel less pressure at home than at school to hide their symptoms. As a result, they may appear to have more symptoms at home, whether or not this is really the case. Symptoms may include a combination of those listed below.

- Intermittent “out of the blue” episodes of fear or physical discomfort that are brief. Typically, panic attack reach their maximum in 10 minutes.
- Intermittent episodes that are accompanied by physical symptoms, such as fast heart rate, difficulty breathing, chest discomfort, choking sensation, dizziness or faintness, trembling, sweating, nausea, or hot/cold flashes
- Intermittent episodes that may include psychological symptoms or worries such as the fear of losing control, the fear of “going nuts,” or the fear of dying. Additional symptoms include feeling detached from one’s body or feeling detached from reality.
- Persistent worry about future panic attack.
- Fear of being trapped in places or situations where escape might be difficult or embarrassing, particularly if a panic attack occurs. Such places include crowded areas, public places (shopping malls, restaurants), bridges, or enclosed spaces such as elevators, cars, or trains. Standing alone or in line may also be distressing.
- Avoidance of places where the child worries an attack may occur or where help may not be available. Some children may be able to go to these places only in the company of another person.
- Difficulty explaining unusual behavior. Children with Panic disorder may not be able to explain what their symptoms or worries are or why they feel compelled to avoid certain places.
- Feeling out of control, uncertain, and frightened by the unpredictability of panic disorder
- Low self-esteem, isolation from peers, and reluctance to participate in activities
- Experimentation with alcohol or drugs as a way to reduce suffering. Drugs and alcohol can themselves produce or worsen panic symptoms.
- Depression or thoughts of not wanting to be alive may develop when children mistakenly believe there are no interventions to reduce their panic symptoms top.

Open, collaborative communication between a child’s family, school, and treatment professionals optimizes the care and quality of life for the child with panic disorder.