Helping a child with a panic disorder: a personal account

by: Author Unknown,

- by a mother

In last month's issue I wrote briefly about plans for a support group for adolescents. My interest in establishing such a group is not just academic. I once suffered from agoraphobia and panic attacks, as did my 10-year-old daughter. She was struck down suddenly and with much intensity about two years ago. Thankfully she has made an excellent recovery and is now training for international competition in an elite gymnastics program.
The cause

Often it's difficult to determine the underlying cause(s) in the development of an anxiety disorder. In the case of my daughter, however, a number of factors were evident. She is a very quiet and sensitive child, who in her fourth year of schooling, became a victim of bullying. Although I was aware of the problems she was experiencing at school, as was her teacher, the extent of the bullying had been grossly underestimated as it occurred mainly in a passive form. Also, at the height of the bullying, she became ill with gastroenteritis. It was during this time that her panic and fears suddenly emerged.
The panic

My daughter's panic attacks were specifically related to a fear of vomiting. The attacks were profuse and severe. Signs of the onset of an attack included frequent swallowing, rapid-irregular breathing, and jitteriness. As her panic intensified, she would walk around in a frenzied state, trembling and crying out for help. Often she would scream, 'Mummy please take me to the hospital, I can't stand it'. She couldn't go anywhere - especially school.
The long road to recoveryInitial therapy began at a large local hospital after a complete medical examination to rule out other possibilities for my daughter's condition. As I was in my fourth year of psychology at this time, I was familiar with the various cognitive-behavioural techniques recommended by the psychologist. The main technique used was graduated exposure. This technique was employed at the beginning of the new school year (1997) and involved a series of graduated steps in reintroducing my daughter back to school.
The treatment was slow and tedious and involved many setbacks, most of which were due to a lack of flexibility on the part of my daughter's school. For instance, my daughter's teacher refused to allow her to carry a small towel-something that provided comfort and security, as she frequently felt nauseated. Against this backdrop of rigidity were numerous other professionals who were not helpful: the school guidance officer who wanted to drag my daughter to school, a psychiatrist who was Prozac crazy, the school principal who said my daughter 'was just a naughty child playing on us all'.
By July 1997, things were on the decline. We were at a stalemate in our negotiations with the school. Clinicians from a school refusal program served as the interface and sessions often involved us (the parents) making suggestions that were continually rejected by the school. I remember feeling incredibly frustrated and disappointed that the clinicians could not be more persuasive with the school.
It was at this point that it had become evident that we had hit a 'brick wall'. The school had their own view of what they saw as the problem (i.e., a naughty child) and how it should be addressed (i.e., force the child to school). This was the reason why all our recommendations (e.g., a safe room &/or a safe person) had been rejected. I believe that the stalemate could have been avoided had the school been better educated.
So in the face of all of this, what did I do? I took control. I knew my daughter and knew what she needed: to feel safe and to have someone to trust to regain her confidence. She trusted me but the problem was that I was not allowed in the classroom or in any other room. Nor was she allowed a safe place or safe person where she could escape to if the need arose. In spite of this, on a freezing cold winter's day, I took my daughter to school and into her classroom and told her that I would be right outside the door if she needed me.
Soon after this, the Principal walked past and glared at me; and not long after that, the Vice-Principal came and suggested a room nearby where I could take shelter. What a turn around! Nonetheless, my efforts were short-lived as my daughter's teacher contInually undermined our efforts.
Following this, I supported my daughter's school refusal and started to workshop a way forward. I enrolled her in a recreational gymnastics program with the aim of increasing her self-confidence. Here my daughter received the understanding and support that she so desperately needed. She carried her 'sick towel' from apparatus to apparatus although, it was not long before she left her towel behind. It was also not long before I could leave her alone at the gym for brief periods which gradually became longer.
As my daughter's confidence slowly increased, I began to look for a new school. I found a school that was sympathetic to her condition and that had no problem about providing what was needed to get and keep her there (a safe place, a safe person, the ability to ring me if the need arose). We never looked back. My daughter attended school full-time from the very first day. That is not to say that we did not have a few hiccups. Within the first week, a boy in her class happened to vomit in class and consequently my daughter had a full-blown panic attack. Fortunately for my daughter (but unfortunately for the poor sick boy) the teacher rushed to the aid of my daughter providing lots of reassurance and comfort. Although somewhat anxious, my daughter did return to school the following day.
Things that helped

In retrospect, what things do I believe helped my daughter to recover? There were many things: my knowledge and understanding of the disorder, a belief that my daughter could recover given the 'right' kind of help and support, the rejection of treatment and/or advice that I felt was counterproductive, not giving up despite numerous setbacks, and a recognition that there were no quick fixes as getting 'better' takes time.
I strongly believe that 'empowerment' is of critical importance in recovering from an anxiety disorder. This can be achieved in a variety of ways. In my daughter's case, having a few things in place, such as a safe place, safe person and the ability to call me was empowering enough for her.