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Pediatric Panic Disorder Treatment & Management

  • Author: Jeffrey S Forrest, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Dec 07, 2015
 

Approach Considerations

Support for the use of individual and family-based cognitive-behavioral treatment approaches for childhood anxiety disorders has been demonstrated in randomized, controlled trials.[11, 12, 13, 14]

Current guidelines recommend that the clinician and family form an active alliance in the treatment of children with panic disorder.[8]

Outpatient psychotherapy may be required for a few weeks to a year or longer.

Go to Pediatric Generalized Anxiety Disorder and Pediatric Obsessive-Compulsive Disorder for complete information on these topics.

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Consultations

Consultation with a child psychologist, psychiatrist, or behavioral-developmental pediatrician is important for the evaluation and treatment of panic disorder.

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Behavioral Therapy

Behavioral techniques often discussed in association with the treatment of panic disorder include deep breathing and relaxation, development of a systematic desensitization program, prolonged and carefully monitored exposure to negatively perceived stimuli, adaptive modeling, and contingency management. These techniques seek to change the way the child acts and reduce avoidance and the subjective experience of anxiety.[15]

Complementary cognitive techniques include developing a fear hierarchy, learning to identify and monitor feelings and bodily sensations, making accurate interpretations of situations and bodily sensations, and improving problem-solving skills.

Treatment may include developing a coping regimen and practicing using this regimen in the office and/or in vivo.

The importance of parental involvement in the treatment of childhood anxiety disorders has received attention, and such involvement is a necessary component to ensure success. The family-based component in the treatment of panic disorder can include contingency management, improved communication and problem-solving skills at the family level, and encouragement of effective coping through modeling.

The Coping Cat workbook is a cognitive behavioral therapy program for children that focuses on the identification feelings and somatic symptoms, the restructuring of negative thoughts into "coping self-talk," relaxation, problem solving, and self-monitoring. Acute cognitive behavioral therapy for children with panic disorder is typically provided over 12-16 sessions, with maintenance.

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Activity

Children and adolescents with this disorder may need help learning to interpret physical reactions in response to exercise as normal and not a sign of an imminent panic attack.

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Deterrence and Prevention of Panic Disorder

A consistent, stable, supportive home environment with parenting practices that promote self-confidence, self-esteem, and effective coping skills are important preventive measures.

Minimize psychosocial stressors or traumatic events when possible and provide rapid psychological intervention.

Parents and other significant people in the child's life should model adaptive problem-solving and coping skills.

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Patient Monitoring

Follow-up care during medical treatment with a selective serotonin reuptake inhibitor (SSRI; eg, fluoxetine) includes monitoring pulse and paying particular attention to symptoms of hepatic dysfunction, seizures, and movement disorder.

Anorexia, gastrointestinal dysfunction, and headache tend to be possible transient adverse effects of SSRIs. Rashes may not be reported until they already have passed and tend to be coincidental with viral illness; thus, they should be assessed by a primary care physician familiar with the rash-producing illnesses currently occurring in the community.

For patients for whom medication is prescribed, regular follow-up care with a child and adolescent psychiatrist or developmental-behavioral pediatrician is necessary for the duration of treatment.

A diary of symptoms may be a helpful tool for a psychiatrist to monitor the progression of a child’s treatment.[8]

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Contributor Information and Disclosures
Author

Jeffrey S Forrest, MD 

Disclosure: Nothing to disclose.

Coauthor(s)

Nirupama Natarajan, MD Fellow in Child and Adolescent Psychiatry, Carilion Clinic, Virginia Tech Carilion School of Medicine

Nirupama Natarajan, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Academy of Child and Adolescent Psychiatry, American Academy of Psychiatry and the Law, American Medical Association, American Psychiatric Association, American Society for Adolescent Psychiatry, Association for Academic Psychiatry, Medical Society of Virginia, Association of Clinical Research Professionals, American Association of Physicians of Indian Origin, American Society of Clinical Psychopharmacology, American Association for Emergency Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Chet Johnson, MD Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Lene Holm Larsen, PhD Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
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  11. Barrett PM, Rapee RM, Dadds MM, Ryan SM. Family enhancement of cognitive style in anxious and aggressive children. J Abnorm Child Psychol. 1996 Apr. 24(2):187-203. [Medline].

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  14. Chavira DA, Stein MB, Golinelli D, Sherbourne CD, Craske MG, Sullivan G, et al. Predictors of clinical improvement in a randomized effectiveness trial for primary care patients with panic disorder. J Nerv Ment Dis. 2009 Oct. 197(10):715-21. [Medline].

  15. Teachman BA, Marker CD, Smith-Janik SB. Automatic associations and panic disorder: trajectories of change over the course of treatment. J Consult Clin Psychol. 2008 Dec. 76(6):988-1002. [Medline]. [Full Text].

  16. Masi G, Toni C, Mucci M, Millepiedi S, Mata B, Perugi G. Paroxetine in child and adolescent outpatients with panic disorder. J Child Adolesc Psychopharmacol. 2001 Summer. 11(2):151-7. [Medline].

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  18. Ost L, Treffers PD. Onset, course, and outcome for anxiety disorders in children. Silverman W, Treffers PD, eds. Anxiety Disorders in Children & Adolescent. 2001. 293-312.

 
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