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The symptoms of Panic Disorder in children and teens are comparable to the symptoms of Panic Disorder in adults. The student may experience periods of super-intense fear or discomfort, along with other symptoms that can last minutes to hours. Symptoms of a panic attack may include:  

• Intense fear
• Racing or pounding heartbeat
• Dizziness or lightheadedness
• Shortness of breath or a feeling of being smothered
• Nausea
• Trembling or shaking
• Sweating or chills
• Sense of numbness or tingling in the hands
• Sense of unreality
• Fear of dying, losing control, or losing your mind  

Teenagers in the throes of a panic attack will often report that they are terrified that they are having a heart attack and/or will die.  

Note that Panic Disorder is not the same as a simple phobia. A phobia is triggered by a very specfic stimulus or trigger. In contrast, panic attacks are initially unexpected and unpredictable, although there is some tendency for them to be start during periods of high stress or shortly following a major life transition (which would include a change in school).  

Although panic attacks are initially unexpected and unpredictable, and although not every person who experiences a panic attack will have Panic Disorder, if your student has repeated panic attacks, they have a serious problem that if left untreated, will probably become even more debilitating. Panic Disorder is more common in girls than in boys, but it occurs in both.  

Panic Disorder is also more likely to be comorbid with Bipolar Disorder than are other anxiety disorders. Family factors are also significant, as adolescents with a family history of Panic Disorder are significantly more likely to develop Panic Disorder.

IMPACT OF PANIC DISORDER ON STUDENTS

Panic attacks and Panic Disorder can have severely debilitating consequences for the student: 

Some students avoid school or will refuse to go to school because of heightened anxiety that they will experience a panic attack in school. Anxiety over having a panic attack can also limit the student socially as they may become reluctant to leave home or go out into settings where they will not have support if they should experience a panic attack. Thus, children and teens with Panic Disorder may develop "situational avoidance" or phobias about certain settings. In severe cases, the student may develop agoraphobia -- a phobic response to going outdoors or out of their home. Panic Disorder is also associated with a higher risk of Major Depression. 

In school, anxiety over having a panic attack -- as well as a panic attack itself -- may significantly impair the student's ability to concentrate in class. While you are trying to talk about history or teach new skills, the student is feeling her heart racing and pounding, and may be afraid that she's about to die or have a heart attack and won't be able to get help. Panic attacks and anxiety about having a panic attack can also interfere with concentration during tests, and both may contribute to fatigue and poor stamina.  

Peers may not fully comprehend the involuntary nature of the panic attack because it's so irrational and they may respond critically to the child or teen who may be in a state of near-hysteria.

ACCOMMODATING STUDENTS WITH PANIC DISORDER

The most important thing you, as the teacher, can do is to create an emotionally safe and supportive environment for the student. By reassuring the students that you understand their problem and that you will work with them to give them accommodations and to make the class as non-anxious for them as possible, you reduce their anxiety, and that does help. Other specific accommodations or strategies to consider:  

• When the student is not having a panic attack, speak with the student and collaborate as to where the student feels safest sitting and how they can quietly leave the classroom or excuse themselves to some predetermined "safe place" if they are feeling panicky or highly anxious.
• Consider giving the student a "permanent pass" so that they can just quickly leave the classroom without having to interrupt your lesson or ask for permission.
• If a student is having a panic attack, it is probably safest for you not to try to restrain the child or to stop them from leaving the classroom. I was involved in one case where staff who had never been trained in Panic Disorder tried to stop a very hefty teenage boy from leaving the classroom when he had a panic attack. The boy, who was convinced he was going to lose consciousness, wanted to call 911 or reach his mother. His teacher tried to stop him, with predictable results: the student punched the teacher to get him out of the way, and then raced out of the building and literally ran miles through the city to get to his home. Although the student's panic attack might not have been avoidable at that point, the escalation to physical assault and having a student running through the city was avoidable.
• If the student has developed a situational avoidance or phobia of a certain setting, you may have to negotiate whether to excuse the student from that setting. If the student is in therapy for the Panic Disorder, see if you can get the therapist to advise you as to whether you'd be enabling the student by excusing them from certain settings or if the therapist feels that would be an appropriate accommodation or support.
• Do have an agreed-upon place that the student can go to if he is having a panic attack. If you decide to use the nurse's office, you may wish to pre-arrange with the nurse that she will call you to let you know when the student comes to her office.
• If the student needs to leave class or can't get to class due to a panic attack, provide hard copies of any missed notes.
• Consider flexible scheduling of important exams as well as breaks during tests and testing in a quieter location.

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