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ASD Panic Attacks Disguised As Meltdowns

Your child is majorly upset over something - but is it a meltdown, shutdown, tantrum, or full-blown panic attack?

As a parent of a child with High-Functioning Autism (HFA), you know that your child is capable of having a meltdown occasionally. We’ll describe a meltdown as “an over-reaction to environmental stimuli designed to give HFA children a sense of control when they feel that their world is out-of-control.” 

Let’s also make the distinction between a meltdown and a temper tantrum. We’ll describe tantrums as “normal acting-out behaviors designed to help children assert their independence as they learn they are separate beings from their parents.”

Having defined meltdowns and tantrums, parents need to know that there are times when their “acting-out” HFA children are having neither a meltdown nor a tantrum; rather, they are in the throes of a legitimate panic attack. Let’s describe panic attacks as “periods of intense fear and apprehension that are of sudden onset and of variable duration of hours to days.” Panic attacks usually begin abruptly, may reach a peak within 10 minutes, but may continue for much longer if the child had the attack triggered by a situation from which he or she is not able to escape. 

In panic attacks that are triggered by a situation from which the HFA child desires to escape, he or she may make frantic efforts to escape, which are often violent – especially if parents attempt to contain the child. Often, the child suffering from panic attacks will experience significant “anticipatory anxiety” in situations where attacks have previously occurred (e.g., a child having a panic attack after the neighbor’s dog jumps up on him, resulting in the child fearing ALL dogs in ALL situations after the initial incident).

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Experiencing a panic attack is one of the most intensely frightening, upsetting and uncomfortable experiences in a child’s life and may take days to initially recover from (unlike meltdowns, which usually only last a few minutes to a few hours). Repeated panic attacks are considered a symptom of panic disorder. 

Children with HFA are prone to anxiety, which in extreme situations can lead to panic attacks. Panic attacks are a terrifying experience where the body reacts as if it is in immense danger, in a situation where most children would not be afraid. A small number of HFA children will go on to develop panic disorder, whereby panic attacks are intense and occur frequently. If left untreated, panic disorder can be a debilitating condition, severely restricting the quality of life for the youngster.

In between attacks, the affected child often feels intense anxiety, worrying when and where the next one will strike. Panic attacks are accompanied by the unpleasant physical symptoms of anxiety (e.g., heart palpitations, hyperventilation, muscle pain, dizziness, sweating) along with the fear that the attack will lead to death or a total loss of control.

HFA children suffering from panic attacks need to be taught that the physical symptoms they experience with an attack are just extreme versions of normal bodily responses to danger. For example:
  • Pupils dilate for more acute vision, and this can cause difficulty with bright lights or vision distortion.
  • Blood is diverted away from non-essential areas including the stomach, brain and hands, resulting in digestive problems, dizziness and tingling or numbness in the hands.
  • Adrenaline being released into the blood stream causes the heart to beat faster and the breathing rate to increase in order to supply major muscles with more oxygen.
  • Sometimes it may appear that the walls are folding in, or in extreme cases, inanimate objects may appear to move.

During an attack, the affected child can become convinced that the symptoms are caused by a major health problem (e.g., heart attack, brain tumor) or that he or she is going crazy. This fear causes more adrenaline to be released. Thus, a worsening cycle can be generated.

Panic attacks can be accompanied by other conditions (e.g., depression), or they can give rise to the development of phobias. If, for example, the HFA child has a panic attack during his first day of school, and then associates panic attacks with “the classroom,” he or she may refuse to go to school. Some of these children’s lives become very restricted, and they avoid normal, everyday activities. Some may even refuse to leave the house unless they are accompanied by a parent (i.e., agoraphobia).




Treatment—

There are a number of treatments for panic attacks, with research showing cognitive behavioral therapy to be the best practice. Some parents may choose to combine a number of treatment options for their child, for example:

1. Relaxation techniques/meditation: These can be useful to reduce acute anxiety or to help the child cope during a panic attack. There are numerous books, CDs and DVDs which can help the child learn these techniques. 

2. Medication: Some of the anti-anxiety drugs are very potent and some produce severe side effects in some kids. While medication can give short term relief to the symptoms, it is important that other strategies are used as well, including counseling and learning more about the condition.

3. Diet and exercise: Physical fitness and a good balanced diet are essential for emotional well being. Many young people find that doing something physical helps reduced the “keyed up” feelings often associated with anxiety. For some children, high caffeine drinks and chocolate can act as a trigger to panic attacks, probably because caffeine can cause bodily changes (e.g.,  increase in heart rate), which can be misinterpreted as the start of a panic attack. The fear this causes can then trigger a real panic attack.

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4. Complementary therapies: Some parents report that the use of herbs, vitamins, and homeopathy have been effective with their child when either used alone or in conjunction with other treatments.

5. Cognitive behavioral therapy: CBT is very effective for treating panic attacks. It teaches affected children how to identify their anxiety and how to change anxiety-generating thoughts. The underlying belief with CBT is this: It is not so much “events” that are a cause of anxiety, but what the child “thinks” about the events.

6. Parental instruction: Teach your child to avoid fighting the panic. When experiencing a panic attack, affected children need to remember the following: It does not matter if they feel frightened, unreal or unsteady, because these feelings are just an exaggeration of normal bodily reactions. The feelings are unpleasant and frightening, but not dangerous. Teach your child to face the symptoms and not run from them. Tell your child to not add to his or her panic with scary thoughts about what is happening or where it might lead. Instruct your child to allow time to pass, and for the fear to fade away. He or she can use one or all of the following positive statements:
  • “I can be anxious and still deal with the situation.”
  • “I’ll just let my body do its thing. This will pass.” 
  • “This anxiety won’t hurt me, even if it doesn't feel good”.
  • “This feeling isn't comfortable or pleasant, but I can accept it.”

Symptoms of panic attacks include the following:
  • chest pain or discomfort
  • chills or hot flushes
  • depersonalization (i.e., being detached from oneself)
  • derealization (i.e., feelings of unreality)
  • fear of dying
  • fear of losing control or going crazy
  • feeling dizzy, unsteady, lightheaded, or faint
  • feeling of choking
  • nausea or abdominal distress
  • palpitations, pounding heart, or accelerated heart rate
  • paresthesias (i.e., numbness or tingling sensations)
  • sensations of shortness of breath or smothering
  • sweating
  • trembling or shaking

Many children being treated for panic attacks begin to experience “limited symptom attacks” (i.e., fewer than four bodily symptoms listed above being experienced). It is not unusual for the affected child to experience only one or two symptoms at a time (e.g., vibrations in the legs, shortness of breath, an intense wave of heat traveling up the body).

Some symptoms are sufficiently different from any normal sensation such that they clearly indicate panic disorder. Panic disorder does not require four or more symptoms listed above to all be present at the same time.

Pure “causeless” panic and the racing heart beat that panic causes are quite sufficient to indicate a panic attack. But, with proper treatment and parental-coaching/encouragement, affected children can go on to live very normal lives.

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