Do children panic?

doi:10.1016/0272-7358(88)90064-5

Clinical Psychology Review

Volume 8, Issue 4, 1988, Pages 359-372

https://doi.org/10.1016/0272-7358(88)90064-5 Get rights and content

Abstract

Clinical surveys and epidemiological studies suggest that few if any children experience unexpected, uncued (spontaneous) panic attacks. Similarly, few if any children present with panic disorder. Based on emerging behavioral and emotion theory views of panic, several “requirements” seem necessary for an individual to develop panic disorder. First, the individual must experience the abrupt physiological sensations characteristic of panic. In addition, empirical evidence suggests that the individual must have the cognitive capacity to experience attributions of “losing control,” or “going crazy.” Evidence from the literature on childhood hyperventilation syndrome suggests that children may be experiencing panic attacks without the cognitive component. Data on developmental stages in children's conceptions of illness from a Piagetian viewpoint suggests that children may not have the cognitive capacity to develop panic disorder (as opposed to simple phobia). Implications of these ideas for research on childhood anxiety and panic are outlined.

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One of the intriguing distinguishing features of many mental disorders is their different associations with particular life stages. For example, panic disorder has long been seen as a disorder that is rarely seen in childhood and several early theories tried to explain this specificity (Nelles & Barlow, 1988). Yet the same consideration has been rare among other forms of psychopathology.
The adolescent developmental stage appears to be a sensitive period for the onset of several particular forms of mental disorder that are characterised by heightened emotionality and social sensitivity and are more common in females than males. We refer to these disorders (social anxiety disorder, generalised anxiety disorder, eating disorders, major depression) collectively as the social-emotional disorders. The aim of this paper is to address an important question in the understanding of social-emotional disorders – why do these disorders commonly begin during adolescence? We present a conceptual model that describes some of the key changes that occur during adolescence and that addresses some hypothesised ways in which these changes might increase risk for the development of social-emotional disorders. An overview of the extant empirical literature and some possible directions for future research are suggested. The model points to interesting links between psycho-social risk factors that should highlight potentially fruitful directions for both psychopathology research and early intervention programs.
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Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. Anxiety disorders in children and adolescents can be chronic and disabling, and they can increase the risk of comorbid disorders. Anxiety is associated with substantial negative effects on children's social, emotional and academic success. Identifying and treating children and adolescents with anxiety disorders would reduce the burden of this disorder and may help in better management of the co-morbid conditions in these patients.
Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations
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Perhaps young children do not have sufficient cognitive insight to detect weekly internalizing changes. Research has demonstrated that age is associated with increased understanding of mental illness (Fox, Buchanan-Barrow, & Barrett, 2010; Nelles & Barlow, 1988). In one study, younger children were less likely to be able to make an internal attribution of their anxiety-related physical symptoms than were older children (Muris, Mayer, Freher, Duncan, & van den Hout, 2010).
Sudden gains have been described as rapid, sizeable changes observed between treatment sessions and have been associated with improved treatment outcome in adults. The current study examined weekly sudden gains among children seeking treatment in the community mental health setting.
Participants were 161 children (age M = 10.58, SD = 1.73; 69.6% male; 47.8% Caucasian) and their parents who were randomized to one of three treatment modalities and were administered weekly and quarterly assessments throughout treatment.
When idiographic (youth- and parent-identified “top problems”) and nomothetic measures (standardized checklists) were used to calculate sudden gains (i.e., gain must be large: in absolute terms, relative to prior session, and relative to changes in prior and subsequent sessions), 20–42% of participants experienced at least one sudden gain during treatment. Most sudden gains occurred early in treatment, and session content of relaxation was associated with sudden gain presence. Using a modified Bonferonni correction, sudden gains predicted overall symptom levels at final assessment (i.e., last assessment obtained following post-treatment) even after controlling for pre-treatment symptom levels and magnitude of the overall gain from pre- to post-treatment.
Suddenness of gains may have a direct effect on long-term treatment outcome among children in the community.
Listen to your heart beat and shiver! An experimental study of anxiety-related emotional reasoning in children
2010, Journal of Anxiety Disorders
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Finally, the study relied on a sample of 9–13-year-old children. While there are indications that children of this age certainly understand anxiety-related physical symptoms (e.g., Mattis & Ollendick, 1997; Muris et al., 2007), there are also authors who have argued that pre-adolescent children still lack the cognitive skills to really display more advanced cognitive distortions such as emotional reasoning (see Nelles & Barlow, 1988). Note that this also nicely fits with the (clinical) observation that panic disorder (symptoms) become really manifest during adolescence (e.g., Ollendick et al., 2004).
The present study investigated anxiety-related emotional reasoning in 9–13-year-old children using an experimental approach. Eighty-one children completed a computerized ambiguous situations test for assessing their perception of threat under two conditions. In the experimental condition, children were attached to an apparatus that allegedly recorded their heart beat, the sound of which was presented to them via headphones. In the control condition, children listened to the sound of an African djembe drum while completing the ambiguous situations test. It was found that children in the experimental condition generally provided higher threat ratings than children in the control condition, and this difference remained significant when controlling for levels of anxiety sensitivity, panic and other anxiety symptoms. These results are in keeping with the idea that children may partially rely on internal physical sensations when evaluating the dangerousness of ambiguous events.
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2008, Journal of Behavior Therapy and Experimental Psychiatry
The present study examined developmental patterns in children's interpretation of anxiety-related physical symptoms and emotional reasoning (i.e., the tendency to infer danger on the basis of physical response information). A sample of 171 children aged between 4 and 13 years were interviewed after listening to a number of vignettes in which the presence and absence of physical symptoms was systematically varied. Results revealed the expected developmental pattern for anxiety-related interpretations of physical symptoms. More precisely, from age 7, children were increasingly capable of linking physical symptoms to the emotion of anxiety. Furthermore, support was obtained for an emotional reasoning effect. That is, children rated vignettes with physical symptoms as more dangerous than vignettes without such symptoms. While the emotional reasoning effect was present in children of all ages, this phenomenon was more salient among older children. Finally, cognitive development as measured by Piagetian conservation tasks appeared to influence children's anxiety-related interpretations of physical symptoms and emotional reasoning. Altogether, these findings are relevant for researchers who are interested in “physical symptoms-based” theories of childhood anxiety.
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Citation Excerpt :
However, it remains unclear whether such theories can be generalized to younger children. Some authors have suggested that panic disorder is less common at a young age, because children lack the cognitive ability to make the catastrophic misinterpretations of physical symptoms associated with panic (e.g., Nelles & Barlow, 1988). Although such reasoning makes sense, it is also true that few studies have actually made an attempt to examine young children's understanding and interpretation of anxiety-related physical symptoms.
The present study investigated developmental patterns in children's interpretation of anxiety-related physical symptoms and emotional reasoning, and to what extent these phenomena are influenced by children's level of cognitive development. A large sample of 4–13-year-old children (N=358) were exposed to vignettes in which the presence and absence of physical symptoms was systematically varied. In addition, children completed a series of conservation tasks and a theory-of-mind-test. Results demonstrated that from the age of 7, children were increasingly able to link physical symptoms to anxiety. Furthermore, cognitive development appeared to enhance children's ability to interpret physical symptoms as a sign of anxiety. Further, children's tendency to infer danger from vignettes with physical symptoms (i.e., emotional reasoning) was already prominent in 4–6-year-olds. The implications for physical symptom-based theories of childhood anxiety are briefly discussed.

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Do children panic?

Abstract

Behaviour Research and Therapy

Journal of Anxiety Disorders

The Journal of Pediatrics

Clinical Psychology Review

Behavior Therapy

Clinical Psychology Review

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Behaviour Research and Therapy

Comprehensive Psychiatry

Behaviour Research and Therapy

A comparison of panic disorder and generalized anxiety disorder

American Journal of Psychiatry

DSM III disorders in preadolescent children: Prevalence in a large sample from the general population

Archives of General Psychiatry

Anxiety and its disorders: The nature and treatment of anxiety and panic

Anxiety disorders and phobias: A cognitive perspective

Children's conceptions of illness

Development of concepts of self, mind, reality, and knowledge

New Directions for Child Development

A study of agoraphobic housewives

Psychological Medicine

A family study of panic disorder

Archives of General Psychiatry

Social and Personality Development

Major results of a large-scale pretreatment survey of agoraphobics

Emotional expressions in infancy

The biological basis of personality