Panic Disorder in Children

A retrospective study has shown that 40% of adult Panic Disorder patients reported that their disorder began before the age of 20.[11] In an article examining the phenomenon of Panic Disorder in youth, Diler et al. (2004)[12] found that only a few past studies have examined the occurrence of juvenile Panic Disorder. They report that these studies have found that the symptoms of juvenile Panic Disorder almost replicate those found in adults – e.g. heart palpitations, sweating, trembling, hot flashes, nausea, abdominal distress, and chills.[13][14][15][16][17] The anxiety disorders co-exist with staggeringly high numbers of other mental disorders in adults.[18] The same comorbid disorders that are seen in adults are also reported in children with juvenile Panic Disorder. Last and Strauss (1989)[19] examined a sample of 17 adolescents with Panic Disorder and found high rates of comorbid anxiety disorders, major depressive disorder, and conduct disorders. Eassau et al. (1999)[20] also found a high number of comorbid disorders in a community-based sample of adolescents with panic attacks or juvenile Panic Disorder. Within the sample, adolescents were found to have the following comorbid disorders: Major Depressive Disorder (80%), Dysthymic Disorder (40%), Generalized anxiety disorder (40%), Somatoform Disorders (40%), substance abuse (40%), and specific phobia (20%). Consistent with this previous work, Diler et al. (2004) found similar results in their study in which 42 youths with juvenile Panic Disorder were examined. Compared to non-panic anxiety disordered youths, children with Panic Disorder had higher rates of comorbid Major Depressive Disorder and Bipolar Disorder.

Despite the evidence pointing to the existence of early onset Panic Disorder, the DSM-IV-TR currently only recognizes six anxiety disorders in children: Separation Anxiety Disorder, Generalized Anxiety Disorder, specific phobia, Obsessive-Compulsive Disorder, Social Anxiety Disorder (a.k.a. social phobia), and Post-traumatic Stress Disorder. Panic Disorder is notably excluded from this list.

It is also well documented that a person who experiences panic attacks during childhood increases the likelihood of experiencing other anxiety disorders and major depression later in life.[21][22][23]. Age of onset also appears to impact the occurrence of comorbid disorders.[24] In a study examining children of Panic Disorder patients, Goodwin et al. (2001) found that an early onset of Panic Disorder is associated with increased co-morbid occurrences of Obsessive-Compulsive Disorder, and Separation Anxiety Disorder. In a study conducted by Biederman, Rosenbaum, Bolduc, and Faraone (1991)[25], the authors found that parental Panic Disorder with Agoraphobia increased the risk of their children developing an anxiety disorder later in life. Interestingly, while parental Panic Disorder with Agoraphobia increased the risk of Major Depressive Disorder developing in their offspring, parental depression alone did not increase the risk of their children developing other anxiety disorders. This finding is further supported with later work done by Biederman et al. (2006)[26] in a 5-year longitudinal follow-up study. The authors suggest that the high prevalence of several anxiety disorders in children of Panic Disorder patients provides evidence for a general “anxiety proneness” that may be transmitted from parent to offspring. It was also found that Separation Anxiety Disorder, Specific Phobia and Generalized Anxiety Disorder were the most common anxiety disorders found in the children of parents with Panic Disorder, which is consistent with the findings of Lipsitz, Martin, Mannuzza, and Chapman (1994)[27], who suggested that Separation Anxiety Disorder may be a specific precursor to the development of Panic Disorder later in life. The results of Beiderman et al. (2006) show a pattern in the development of Panic Disorder in which a string of precursor disorders emerge, starting with Separation Anxiety Disorder that eventually progresses to Panic Disorder. For the children in the study, the median age for the first anxiety disorder was 4 years of age. It is clear that not only does Panic Disorder appear to occur in children, but the consequences of early onset Panic Disorder can extend beyond the disorder itself.

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