Up to 12% of ninth graders have had a panic attack. About 1-2% of all adults have multiple panic attacks. If you look at adults with panic disorder, 20% had their first panic attack before age 10. The first question is, What is a panic attack? Here are the official criteria:

Panic Attack

A discrete period of intense fear or discomfort, in which four (or more) of the following symptoms developed abruptly and reach a peak within 10 minutes:

• 1. palpitations, pounding heart, or accelerated heart rate
• 2. Sweating
• 3. Trembling or shaking
• 4. Sensations of shortness of breath or smothering
• 5. feeling of choking
• 6. chest pain or discomfort
• 7. nausea or abdominal distress
• 8. feeling dizzy, unsteady, lightheaded, or faint
• 9. derealization (feelings of unreality) or depersonalization (being detached from oneself)
• 10. fear of losing control or going crazy
• 11. fear of dying
• 12. parasthesia (numbness or tingling sensation)
• 13. chills or hot flushes

In children and teenagers, panic attacks can take on many different disguises. Here are a few of the presentations.

The Classic - At age 10 Ted walked into the school and felt his heart race, skip, and all of a sudden he could not breathe well. His chest hurt and he called out to his friend to get the principal. By the time the principal came Ted was sitting on a chair and his face was very red. He was breathing very fast. He said everything was spinning. He told the principal he was afraid he was dying, and to call an ambulance. By the time the ambulance arrived and brought Ted to outpatients, Ted was scared, but all of the other symptoms were gone. Routine medical tests showed nothing.

The Nausea disguise - Sheryl is 14. Even though the bus goes right by her house, her Dad takes her to school. The reason is that every time she gets on the bus she feels very, very nauseated. She is afraid she will vomit right on the bus. If she stays on the bus, she gets more and more restless, her heart races and she starts shaking. She had this for one entire bus ride, and she told her mother she would never risk that again in her life.

The anger disguise - Jean, age 12, was sitting in math class. All of a sudden he felt like he had to run out of there or he was going to go nuts or hurt someone. He felt a rush of adrenaline surge through his body. He started breathing hard, felt his heart race and was trembling. He raised his hand to tell Mr. D'entremont he had to leave. Mr. D'entremont said no. Jean started screaming that he was going anyway and knocked over his desk and then slammed the door so hard they could hear it upstairs. By the time he ended up in the vice-principal's office, it was over and he was sorry, but he ended up with a lot of detention.

The family doctor's new child - Cody, age 9, has been to the family doctor six times in the last two weeks. He has insisted that his mother take him ever since he had a spell when he was dizzy, felt like his stomach was turning inside out, and couldn't breathe. He thought he was going to die. The family doctor couldn't find anything. But Cody wonders every time he feels a little bit wrong if maybe the family doctor missed something and maybe if he went now they could find out what it is. On the way home from doctor visit number 7, Cody told his mom that sometimes he wishes that he could just live at his family doctor's house in case there ever was another spell.

What causes Panic attacks?

Most researchers have found that they are caused by an abnormality in the part of the brain which tells the brain how much Carbon Dioxide (CO2) is in the blood. If your brain finds there is getting to be too much CO2, it usually means that you are not breathing fast enough, or there is too much CO2 in the air (for example, in a room with no ventilation or a cave). So your body sends all sorts of signals to increase breathing and a rush of adrenaline to help you get out of wherever you are in a hurry. This is a great thing if you are in a fire, for example.

It is thought that in Panic attacks this Carbon Dioxide sensor is too sensitive, and tells the brain there is not enough Carbon Dioxide when there is just plenty. So a person could be just sitting quietly and then BOOM, this rush of adrenaline and fast breathing appears out of nowhere. Since there is no reason outside the body to be worried, most people will start thinking there is something horribly wrong with their own body.

Beyond this brain problem, Panic Attacks are inherited. If a parent has an anxiety disorder, their children are much more likely to have an anxiety disorder, too. Part of this heredity is expressed through something called Behavioral Inhibition.

Behavioral Inhibition is a tendency to react negatively to new situations or things. Some infants and children will be very happy and curious about new people and things. However, roughly 15% of children will be shy, withdrawn, and irritable when they are in a new situation or with new people or things. Often these children and irritable as infants, shy and fearful as toddlers, and cautious, quiet, and introverted at school age. Children who are consistently this way are much more likely to have biological parents with anxiety disorders. The children themselves are much more likely to develop anxiety disorders. On the other hand 5-10 percent of children with Behavioral inhibition will never develop anxiety disorders. At the moment it is thought that the majority of the genetic predisposition to anxiety disorders is expressed through behavioral inhibition. Often there is a combination of an inherited predisposition plus a stress In the environment. Deaths in the family, divorce, and abuse will make panic attacks much more likely.

How can you be sure that what happened was a Panic Attack and not some other medical problem?

Panic attacks in children can be confused with many things. Common imitators are ulcers, irritable bowel syndrome, thyroid disease, some prescription drugs, migraines, epilepsy, diabetes, drug abuse, and other psychiatric disorders. There are some research tests which look at the brain which will show certain abnormalities in panic attacks. However, for a variety of reasons these are not in regular clinical use. The main principle is to rule out other problems using a careful medical history, a physical exam, and often certain lab or x-ray examinations. If the history and exam looks like panic attacks and no other cause is found, then a physician assumes it is a panic attack.

In females, stomach aches and headaches together are very, very common. In fact, recent studies have shown that when these two are found together in the same child, 69% had an anxiety disorder.

You have been talking about panic attacks as if it only happens once. My son has them all the time.

One Panic attack is bad enough, but recurrent panic attacks can be devastating. If a child or adolescent has recurrent panic attacks and the following, it is called Panic Disorder.

• 1. recurrent unexpected Panic Attacks
• 2. At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:
• a. Persistent concern about having additional attacks
• b. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")
• c. a significant change in behavior related to the attacks.

Panic disorder in children is a very disabling condition. It will often affect a child's school performance. It almost always impairs them socially, and can lead to a lot of other problems. It is not a common illness in children. While perhaps 10% of children will have a panic attack, about 1-2% will develop Panic disorder. Of those that do develop Panic disorder, 10-35% will recover and remain well the rest of their lives. At least 50% will be mildly affected years later, and the rest will have chronic Panic disorder for years. If you follow-up children with panic disorder, about 25% will still have it years later. Of those who continue to have Panic disorder as they go into adulthood, many will develop other psychiatric difficulties. About 50% will develop agoraphobia, 20% will make suicide attempts, 27% will develop alcohol abuse, 60% will develop depression, 35% will believe they are unhealthy, 27% will not be financially independent, 28% will make frequent outpatients visits, and 50% will be show significant social impairment.

With my daughter, the panic attacks are nothing compared to her fears of having one. She is terrified she will panic when she goes out with us to the mall.

The most common fear or phobia in the context of Panic disorder is Agoraphobia. Here is the official definition of Agoraphobia.

• A. Anxiety about being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of having an unexpected panic attack or panic-like symptoms. Agoraphobic fears typically involve characteristic clusters of situations that include being outside the home alone, being in a crowd or standing in line, being on a bridge, and traveling in a bus, train, automobile, or plane.
• B. The situations are avoided (e.g., travel is restricted) or else are endured with marked distress or with anxiety about having a Panic Attack or Panic-like symptoms, or require the presence of a companion.
• C. This is not due to social phobia, Obsessive-compulsive disorder, Post traumatic Stress Disorder, or Separation Anxiety Disorder.

The usual pattern I find with children is not that different than with adults. Panic attacks will set in process a slow restricting of peoples lives. Slowly the stop doing all sorts of things they used to and stop going all sorts of places. Lots of times, especially with children, they have some excuse (other than fear of panic) for not going which seems fairly reasonable at first. Often they play at their home without problems, but if they have to go there is always a reason they aren't going. Sometimes it is because the child says he doesn't want to (even though you know he would love to do this before) other times it is because all of a sudden her stomach is hurting, she feels weak and tired, her eyes hurt, or she needs to go use the bathroom.

This Article has been submitted by the Jeremy's Prophecy Dot Com team for informational and educational purposes. Jeremy's Prophecy Dot Com is a website dedicated to telling the story of Jeremy Jacobs, a character in the novel, Jeremy's Prophecy Dot Com.