Panic attacks and children
October 25, 2022 6:12 PM Subscribe
I have an 11 year old experiencing panic attacks 2-5 times a month.At what point do I advocate for meds? What meds treat panic attacks?
In another situation with someone older, counselling and Prozac helped. We are doing weekly therapy, grounding exercises and avoiding stressful situations but school remains a highly stressful situation (the school is helpful and the child likes school but finds it very stressful due to sensory/autism issues).
In another situation with someone older, counselling and Prozac helped. We are doing weekly therapy, grounding exercises and avoiding stressful situations but school remains a highly stressful situation (the school is helpful and the child likes school but finds it very stressful due to sensory/autism issues).
My partner is autistic. She describes her experience as having a "buffer" which can absorb a certain amount of stress, but when the buffer is depleted, she needs to get herself away from the stressful situation, or else she will eventually start to panic. The most important factor is agency -- for example loud noises can be okay at things like concerts when she has the choice to experience it or not, but if she is trapped in a place in which she cannot escape a loud noise, panic will rise very fast. You can take a multi-pronged approach to increase the buffer, avoid situations that will deplete the buffer, or do things that reduce the rate of depletion.
To increase the buffer:
- Get lots of sleep
- Eat healthy, and remove sources of inflammation in diet
- Keep a regular schedule
- CBD pills
- Have lots of unstructured downtime
- Take days off to recover after severely stressful situations
- Spend time on special interests
- Generally, ensure the body and mind's needs are met
To avoid buffer depletion:
- Avoid crowds
- Avoid situations with loud noises
- Avoid situations with a lot of social pressures
- Avoid situations in which you are forced to do anything or be anywhere
- Be close to an exit / at the periphery of crowds
- Have emergency coping resources available e.g. anti-anxiety meds (she doesn't use them often, but just having them at hand greatly reduces stress, knowing they are there if needed)
- Generally, have a "way out" available
To reduce the rate of buffer depletion:
- Stimming activities -- chew toys, fidget cubes -- this evacuates tension before it becomes panic. (By the way if you try to stop an autistic person from stimming, they will eventually start to panic and the tension will have to come out some other way e.g. screaming or self-injuring)
- Earplugs to reduce noise (Loop is a good brand)
- Comfortable well-fitting clothing
- Remove any sensory irritants (hair getting in eyes, itchy clothes etc)
- Stay close to trusted friends
- Generally, try to 'soften' the environment
Something like prozac would effectually switch off her sensations so that she would be numb to the things she experience and therefore not so bothered by it, and it might be effective at preventing panic attacks, but it also seems like the nuclear option to me. Before going that road I would work with your child to gain better skills at understanding their 'buffer', what depletes it, and what restores it.
posted by PercussivePaul at 7:21 PM on October 25, 2022 [13 favorites]
To increase the buffer:
- Get lots of sleep
- Eat healthy, and remove sources of inflammation in diet
- Keep a regular schedule
- CBD pills
- Have lots of unstructured downtime
- Take days off to recover after severely stressful situations
- Spend time on special interests
- Generally, ensure the body and mind's needs are met
To avoid buffer depletion:
- Avoid crowds
- Avoid situations with loud noises
- Avoid situations with a lot of social pressures
- Avoid situations in which you are forced to do anything or be anywhere
- Be close to an exit / at the periphery of crowds
- Have emergency coping resources available e.g. anti-anxiety meds (she doesn't use them often, but just having them at hand greatly reduces stress, knowing they are there if needed)
- Generally, have a "way out" available
To reduce the rate of buffer depletion:
- Stimming activities -- chew toys, fidget cubes -- this evacuates tension before it becomes panic. (By the way if you try to stop an autistic person from stimming, they will eventually start to panic and the tension will have to come out some other way e.g. screaming or self-injuring)
- Earplugs to reduce noise (Loop is a good brand)
- Comfortable well-fitting clothing
- Remove any sensory irritants (hair getting in eyes, itchy clothes etc)
- Stay close to trusted friends
- Generally, try to 'soften' the environment
Something like prozac would effectually switch off her sensations so that she would be numb to the things she experience and therefore not so bothered by it, and it might be effective at preventing panic attacks, but it also seems like the nuclear option to me. Before going that road I would work with your child to gain better skills at understanding their 'buffer', what depletes it, and what restores it.
posted by PercussivePaul at 7:21 PM on October 25, 2022 [13 favorites]
As an adult, your child will have more agency to remove themself from overwhelming situations when they need to restore their buffer. That's hard to do when you're in class all day. I hear quiet spaces in schools for children who need it to be able to go to is becoming a thing. If it's not a thing in your child's school yet, maybe you would work with the school to give your child the option to remove themself to the bathroom as needed, or the library, or an unused space, etc.
posted by aniola at 8:00 PM on October 25, 2022 [4 favorites]
posted by aniola at 8:00 PM on October 25, 2022 [4 favorites]
Hi, I'm a person with mental health issues that got noticeably bad for the first time at age 13 and only seriously improved once I started taking medication for them (in addition to therapy and lifestyle changes). I am not a therapist or doctor. I am not your kid's therapist or doctor.
At what point do I advocate for meds?
You start advocating for meds at the point when you think non-med approaches aren't not going to be enough to stop the symptoms, unless you add meds. My instinct is to say, "That point is now." But I can't make that judgement just from an AskMetafilter question. That's something for you and your kid to decide.
A general practitioner, a psychiatrist, or your kid's therapist might be able to help you in this process. You could ask them to help you figure out if you've tried therapy and lifestyle changes for a sufficiently long time to know if they're going to be enough. You could discuss your worries about meds with them. Talk it over with your kid, and, if they agree with you, make an appointment with a doctor to talk about meds. After all, you can always walk away from the appointment without a prescription.
Things to think about:
This is something a psychiatrist will know! You don't have to come in with a list of meds to try. Just have your kid explain their symptoms, and the psychiatrist will come up with a list themself.
I know meds might seem scary, and psychiatrists might be especially reluctant to prescribe them to a child or teenager, in part because some side effects can be worse in younger people. But the right medication can make a huge difference in a kid's life. Not all meds dull a person's sensations, by the way, and your kid may even be able to find meds that don't have any side effects for them at all. If your kid does try some meds and determines the side effects are bad enough that they want to stop taking them, they can talk to their doctor about going off them, and if they want, they can try something new. Some folks have to try lots and lots of meds before they find the right ones. But it's absolutely worth it.
posted by spiderbeforesunset at 8:19 PM on October 25, 2022 [7 favorites]
At what point do I advocate for meds?
You start advocating for meds at the point when you think non-med approaches aren't not going to be enough to stop the symptoms, unless you add meds. My instinct is to say, "That point is now." But I can't make that judgement just from an AskMetafilter question. That's something for you and your kid to decide.
A general practitioner, a psychiatrist, or your kid's therapist might be able to help you in this process. You could ask them to help you figure out if you've tried therapy and lifestyle changes for a sufficiently long time to know if they're going to be enough. You could discuss your worries about meds with them. Talk it over with your kid, and, if they agree with you, make an appointment with a doctor to talk about meds. After all, you can always walk away from the appointment without a prescription.
Things to think about:
- It's looking like one of the biggest problems this kid has is that school is deeply stressful for them. Some questions you can ask yourself: If the kid is in the US, do they have an IEP? If the kid isn't in the US, do they have whatever the local equivalent is? If they have already requested accommodations, are there more accommodations they need that you can request? Can the kid change schools to a school that might be less stressful, if such a school exists? Can the kid homeschool, "unschool," or do online school? Can the kid drop some of their non-school responsibilities so that they're not juggling too many things at once? Seriously, consider and investigate drastic lifestyle changes. This kid is struggling.
- Sometimes one kind of therapy doesn't work for someone, but another kind does. Questions to consider: Does your kid like their therapist and get along with them? Does the therapist respect your kid, listen to them, and treat them with compassion? Does the therapist's modality (CBT, DBT, EDMR, etc.) and way of communicating (direct, humorous, gentle, etc.) work for your kid's issues? There are many different therapists and many different ways of doing therapy. If one doesn't work, try another.
This is something a psychiatrist will know! You don't have to come in with a list of meds to try. Just have your kid explain their symptoms, and the psychiatrist will come up with a list themself.
I know meds might seem scary, and psychiatrists might be especially reluctant to prescribe them to a child or teenager, in part because some side effects can be worse in younger people. But the right medication can make a huge difference in a kid's life. Not all meds dull a person's sensations, by the way, and your kid may even be able to find meds that don't have any side effects for them at all. If your kid does try some meds and determines the side effects are bad enough that they want to stop taking them, they can talk to their doctor about going off them, and if they want, they can try something new. Some folks have to try lots and lots of meds before they find the right ones. But it's absolutely worth it.
posted by spiderbeforesunset at 8:19 PM on October 25, 2022 [7 favorites]
Panic attacks are very treatable with exposure. A child psychologist who treats panic using behavioral approaches will be able to help.
dorothyisunderwood you probably already know what I'm about to say, but just in case:
The above advice is dangerous and harmful for autistic people.
Exposure therapy works on neurotypical people because their fear is irrational, and exposure to it makes that fact clear.
Autistic people's anxiety and overwhelm are not caused by irrational fears. They are caused by the physical and emotional pain of sensory over stimulation, which gets worse with each exposure. As well as the completely accurate realisation that we are constantly misjudging social interactions, accidentally offending others, and surrounded by a web of rules that are invisible to us, but obvious to most people.
The above is dangerous advice for neurodivergent people and I wish this fact was more widely known.
posted by Zumbador at 9:11 PM on October 25, 2022 [28 favorites]
dorothyisunderwood you probably already know what I'm about to say, but just in case:
The above advice is dangerous and harmful for autistic people.
Exposure therapy works on neurotypical people because their fear is irrational, and exposure to it makes that fact clear.
Autistic people's anxiety and overwhelm are not caused by irrational fears. They are caused by the physical and emotional pain of sensory over stimulation, which gets worse with each exposure. As well as the completely accurate realisation that we are constantly misjudging social interactions, accidentally offending others, and surrounded by a web of rules that are invisible to us, but obvious to most people.
The above is dangerous advice for neurodivergent people and I wish this fact was more widely known.
posted by Zumbador at 9:11 PM on October 25, 2022 [28 favorites]
There is a fairly recently proposed spectrum disorder centering around panic attacks that I think may be worth looking into:
posted by jamjam at 1:31 AM on October 26, 2022 [9 favorites]
A high rate of association between panic disorder and four domains of physical illness has been documented by researchers. Their new study could alter how physicians and psychiatrists view the boundaries within and between psychiatric and medical disorders.If you recognize elements of this spectrum in your child, I think you might want to look for a specialist who is conversant with this new syndrome.
...
"Patients who appear to have certain somatic disorders -- illnesses for which there is no detectable medical cause and which physicians may consider to be imagined by the patient -- may instead have a genetic propensity to develop a series of real, related illnesses," says Dr. Coplan, an expert in neuropsychopharmacology.
The researchers found a high correlation between panic disorder, bipolar disorder, and physical illness, with significantly higher prevalence of certain physical illnesses among patients with panic disorder when compared to the general population.
"Panic disorder itself may be a predictor for a number of physical conditions previously considered unrelated to mental conditions, and for which there may be no or few biological markers," explains Dr. Coplan.
In the study, published in the Journal of Neuropsychiatry and Clinical Neurosciences, the researchers proposed the existence of a spectrum syndrome comprising a core anxiety disorder and four related domains, for which they have coined the term ALPIM:
A = Anxiety disorder (mostly panic disorder);
L = Ligamentous laxity (joint hypermobility syndrome, scoliosis, double-jointedness, mitral valve prolapse, easy bruising);
P = Pain (fibromyalgia, migraine and chronic daily headache, irritable bowel syndrome, prostatitis/cystitis);
I = Immune disorders (hypothyroidism, asthma, nasal allergies, chronic fatigue syndrome); and
M = Mood disorders (major depression, Bipolar II and Bipolar III disorder, tachyphylaxis. Two thirds of patients in the study with mood disorder had diagnosable bipolar disorder and most of those patients had lost response to antidepressants).
...
For example, joint laxity was observed in 59.3% of patients in the study compared with a prevalence of approximately 10% to 15% in the general population; fibromyalgia was observed in 80.3% of the subjects compared with approximately 2.1% to 5.7% in the general population; and allergic rhinitis was observed in 71.1% of subjects, whereas its prevalence is approximately 20% in the general population. ...
posted by jamjam at 1:31 AM on October 26, 2022 [9 favorites]
Something like prozac would effectually switch off her sensations so that she would be numb to the things she experience
This is not true. It’s how some people experience SSRIs and other meds used for similar situations, but it’s not universal. For me Prozac specifically increases my emotional buffer space, as described upthread, with no downsides. People’s responses genuinely differ a lot.
posted by lokta at 1:44 AM on October 26, 2022 [16 favorites]
This is not true. It’s how some people experience SSRIs and other meds used for similar situations, but it’s not universal. For me Prozac specifically increases my emotional buffer space, as described upthread, with no downsides. People’s responses genuinely differ a lot.
posted by lokta at 1:44 AM on October 26, 2022 [16 favorites]
My mistake, I appreciate the correction.
posted by PercussivePaul at 4:56 AM on October 26, 2022 [2 favorites]
posted by PercussivePaul at 4:56 AM on October 26, 2022 [2 favorites]
they will not want to be on Prozac for the rest of their life
Kindly, this is bullshit. Many, many people are on some kind of med, including psych meds, for their entire lives. It improves their quality of life in a way that is not always replaceable with any other method.
If you can't make your own neurotransmitters, store-bought is fine.
posted by restless_nomad at 6:04 AM on October 26, 2022 [16 favorites]
Kindly, this is bullshit. Many, many people are on some kind of med, including psych meds, for their entire lives. It improves their quality of life in a way that is not always replaceable with any other method.
If you can't make your own neurotransmitters, store-bought is fine.
posted by restless_nomad at 6:04 AM on October 26, 2022 [16 favorites]
Is there any chance the source of her upset is ongoing?
- Is there any relationship in her life that’s stressful to her (bullying, teacher or childcare provider mismatch, family conflict, adult who is not a healthy presence or a person with whom she clicks “very deeply” (can be lovely or could be a sign of abuse), etc)
- Anything physical happening like a food intolerance or environmental allergy, itchy skin, stomach ache, headache, insomnia, menstrual cramps (she may be close to her first period so the monthly hormones might be starting to cycle even before actual menarche) ear infection, urinary infection, constipation, chronic pain?
I would want to be sure that physical and social causes of upset are being dealt with, since emotional and physical discomfort can of course trigger or exacerbate panic attacks.
It might be hard for her to identify what the issue is. It might help for you to discreetly keep a calendar and note her panic attack times, as well as activities, bathroom issues, and meals etc - might help you spot patterns that could be triggering the panic attacks.
posted by nouvelle-personne at 7:21 AM on October 26, 2022 [1 favorite]
- Is there any relationship in her life that’s stressful to her (bullying, teacher or childcare provider mismatch, family conflict, adult who is not a healthy presence or a person with whom she clicks “very deeply” (can be lovely or could be a sign of abuse), etc)
- Anything physical happening like a food intolerance or environmental allergy, itchy skin, stomach ache, headache, insomnia, menstrual cramps (she may be close to her first period so the monthly hormones might be starting to cycle even before actual menarche) ear infection, urinary infection, constipation, chronic pain?
I would want to be sure that physical and social causes of upset are being dealt with, since emotional and physical discomfort can of course trigger or exacerbate panic attacks.
It might be hard for her to identify what the issue is. It might help for you to discreetly keep a calendar and note her panic attack times, as well as activities, bathroom issues, and meals etc - might help you spot patterns that could be triggering the panic attacks.
posted by nouvelle-personne at 7:21 AM on October 26, 2022 [1 favorite]
first you have to figure out what is triggering these.
The list PercussivePaul gave above, of inputs that are stressful to autistic people, is very relevant not only to autistic people but to many others. And they overlap just about 100% with a standard middle school setup.
If your kid is in a typical middle school, she is surrounded by people constantly screaming, in echo-ey long hard-surfaced halls (seriously, the decibel level has to be heard to be believed); moving in unpredictable ways that often invade others' personal space; big crowds; constantly having to do what one is told, with instructions that are often complex, irrational and hard to follow. And that's before you even get to actual classes. The whole setup is UNBELIEVABLY stressful for anyone who is even mildly introverted. (My own kid, who is not at all autistic, has to sit in absolute silence for a good hour or so after getting home from middle school if we don't want a sobbing meltdown.)
I have nothing against meds, but if this were my kid, and homeschooling were any kind of option at all, I'd do that for a month before medicating her, to see if the change of environment fixes the situation. If homeschooling weren't an option I'd be looking for the smallest school possible.
posted by fingersandtoes at 7:36 AM on October 26, 2022 [4 favorites]
The list PercussivePaul gave above, of inputs that are stressful to autistic people, is very relevant not only to autistic people but to many others. And they overlap just about 100% with a standard middle school setup.
If your kid is in a typical middle school, she is surrounded by people constantly screaming, in echo-ey long hard-surfaced halls (seriously, the decibel level has to be heard to be believed); moving in unpredictable ways that often invade others' personal space; big crowds; constantly having to do what one is told, with instructions that are often complex, irrational and hard to follow. And that's before you even get to actual classes. The whole setup is UNBELIEVABLY stressful for anyone who is even mildly introverted. (My own kid, who is not at all autistic, has to sit in absolute silence for a good hour or so after getting home from middle school if we don't want a sobbing meltdown.)
I have nothing against meds, but if this were my kid, and homeschooling were any kind of option at all, I'd do that for a month before medicating her, to see if the change of environment fixes the situation. If homeschooling weren't an option I'd be looking for the smallest school possible.
posted by fingersandtoes at 7:36 AM on October 26, 2022 [4 favorites]
All the responses about identifying stressors and so on are fantastic, but as someone who had anxiety and depression from a young age, please do consider medication as well. I really only began to get a handle on my anxiety when I was finally given beta blockers, which work by switching off the 'fight or flight' response. For me, that meant I could actually identify the things that were making me anxious and manage those fears, rather than being caught up immediately in the 'I can't breathe, I'm going to faint, I'm going to die' spiral. I only took them for a year or so, and then on and off when things flared, but they were SO helpful.
Antidepressants are also perfectly useful medications, which it is absolutely normal and fine to take for long periods of time or indeed for life! I will probably take mine forever, and they absolutely don't make things 'flatter' or me less able to experience emotion. Indeed, I am more able to experience the world when my brain is not flattening everything down into 'you cannot do anything and you are terrible'. However, for me, the nice thing about beta blockers was that they didn't really change my thinking, they gave me some space to deal with the thoughts. They are definitely very different medications, and if you or your child would rather not go down one road, do consider the other separately rather than thinking of it all as either meds or no meds.
posted by In Your Shell Like at 7:53 AM on October 26, 2022 [4 favorites]
Antidepressants are also perfectly useful medications, which it is absolutely normal and fine to take for long periods of time or indeed for life! I will probably take mine forever, and they absolutely don't make things 'flatter' or me less able to experience emotion. Indeed, I am more able to experience the world when my brain is not flattening everything down into 'you cannot do anything and you are terrible'. However, for me, the nice thing about beta blockers was that they didn't really change my thinking, they gave me some space to deal with the thoughts. They are definitely very different medications, and if you or your child would rather not go down one road, do consider the other separately rather than thinking of it all as either meds or no meds.
posted by In Your Shell Like at 7:53 AM on October 26, 2022 [4 favorites]
Get thee to a pediatrician, preferably one that has specialists in adolescent mental health as part of their roster. They will talk to you, and to the teenager, and they can help you come up with a plan re: meds/no meds, therapy/no therapy, that meets HER comfort level.
posted by nkknkk at 9:19 AM on October 26, 2022 [1 favorite]
posted by nkknkk at 9:19 AM on October 26, 2022 [1 favorite]
Just to check, are you and your child familiar with "autistic meltdown" and how it is like and unlike panic attacks? Since you mention autism this will likely be important sooner or later.
Basically, an autistic meltdown is driven by external factors like PercussivePaul describes, while neurotypical panic attack is driven by internal anxiety spiraling. A person can have both more-or-less separately, and they can have responses that combine both dynamics.
Treatment for one is wrong for the other, as Zumbador said. So it's important that anyone treating your child is familiar with both and with anxiety in autism.
posted by away for regrooving at 9:44 AM on October 26, 2022 [3 favorites]
Basically, an autistic meltdown is driven by external factors like PercussivePaul describes, while neurotypical panic attack is driven by internal anxiety spiraling. A person can have both more-or-less separately, and they can have responses that combine both dynamics.
Treatment for one is wrong for the other, as Zumbador said. So it's important that anyone treating your child is familiar with both and with anxiety in autism.
posted by away for regrooving at 9:44 AM on October 26, 2022 [3 favorites]
Not to abuse the edit: and if you can't find a fully autism-aware professional (they are hard to find!) then it's important to manage the limits of their expertise.
Eleven is well old enough to get that a professional is an expert in their own field, but not in autism. And that you will listen to your child and advocate for them and support them in self-advocacy. Because they're gonna need that.
posted by away for regrooving at 9:56 AM on October 26, 2022 [1 favorite]
Eleven is well old enough to get that a professional is an expert in their own field, but not in autism. And that you will listen to your child and advocate for them and support them in self-advocacy. Because they're gonna need that.
posted by away for regrooving at 9:56 AM on October 26, 2022 [1 favorite]
My kids were given the right to withdraw from any situation and go to a low stimulation location to wait for the adults in charge to retrieve them, or to return themselves once they were feeling up to it. This created some significant problems if the adults in charge were not expecting this, or not prepared for it. - A youth group trip to the States resulted in the person temporarily in charge of the kids totally freaking out when they quietly slipped out to the stairwell and could not be immediately found. You may or may not be able to set this up with your school and at their other activities but it is very worth trying.
The location that worked best for my kids was the nearest stairwell, where they could sit on the steps and be alone. Whenever they went missing I knew exactly where to look for them. Some kids also use the bathroom because teachers seldom argue with the demand for an immediate bathroom break, at least not after a couple of instances where their pupils have puked all over the classroom floor in the middle of the argument. Another location that has worked was the deacon's bench in the school office which contained the lost and found items. It was within sight of the secretaries but in a quiet location so satisfied the authorities' need to know where the kids were and what they were up to at all times.
Alternatively when the kid is nearing meltdown at school, by pre-arrangement they may be able to retreat from the situation at their own desk by putting a notification out on their desk, such as a piece of orange construction paper with the word "RE-INTEGRATING" printed on it, putting on noise cancelling headphones and reading a book.
It helps a LOT if the kid does not have to ask permission to disappear, as getting the teacher's permission and arguing their case is likely to either be impossible when the overload is happening, or tip the kid over into the screaming abjabs.
Teacher: "But we are about to start the spelling test!"
Kid: "I need to shut down."
Teacher: "Can't you wait until after the test?"
Kid: "No, I can't"
"Teacher: "It will be just ten min....."
Kid: "AAAUIIUUUIIIIGGGHHHH...!!!!!" *flying books and uncontrollable crying.
So see if you can get it set up so that the kid has a piece of orange construction paper ready, and maybe a desk at the back of the room so that they don't need to do anything but get those headphones, the paper and the book and they are gone into their own insulated little world.
In each location where the kid is at risk of a panic attack, a predesignated method of withdrawal and location should be arranged. It is often the noisier more active classes that will tip the kid over, so they should have a designated bench in the gym to go to during gym class, and a withdrawal spot agree on with the art teacher, and a place to retreat to that has been set up with Akela at scouts. Same thing with recess. Discuss with your kid where they can go to get away from the over stimulation. At the grocery store it can be the magazine rack, as you don't want them taking off for the car through the parking lot while they are in running meltdown.
Something to chew on can help, as a hit of blood sugar can stave off the crash when the brain is shutting down, as can extra oxygen. It doesn't have to resemble candy. An apple or whole grain crackers will work also, or three K on the classroom exercise bike.
Also listen to your kid. If the tears and raging during a panic attack include swearing at their "..stupid shirt..!" or complaints about the sun, or the suddenly ripping off clothes, or holding their ears and keening, you know what some of the over stimulation triggers are. If the kid *always* has a melt down in the cafeteria, and any time they end up sitting near the trash can, you can predict that situations with strong smells are going to over load them every time.
Finally, listen to any complains about pain. "My stomach hurts" might be butterflies from anxiety, but it also might be a digestive problem, the first manifestations of Crohn's Disease or the like, and the pain be the primary source of the sensory overload, not just an unimportant symptom of it.
If your kid tends to puke and then sleep after they overload, investigate if they may be getting stomach migraines. Even if they don't complain of pain, as children's migraines often begin with only a tummy upset and no head pain, they may be having incapacitating neurological symptoms which need a different kind of attention than anti-anxiety meds or antidepressants.
posted by Jane the Brown at 10:34 AM on October 26, 2022 [8 favorites]
The location that worked best for my kids was the nearest stairwell, where they could sit on the steps and be alone. Whenever they went missing I knew exactly where to look for them. Some kids also use the bathroom because teachers seldom argue with the demand for an immediate bathroom break, at least not after a couple of instances where their pupils have puked all over the classroom floor in the middle of the argument. Another location that has worked was the deacon's bench in the school office which contained the lost and found items. It was within sight of the secretaries but in a quiet location so satisfied the authorities' need to know where the kids were and what they were up to at all times.
Alternatively when the kid is nearing meltdown at school, by pre-arrangement they may be able to retreat from the situation at their own desk by putting a notification out on their desk, such as a piece of orange construction paper with the word "RE-INTEGRATING" printed on it, putting on noise cancelling headphones and reading a book.
It helps a LOT if the kid does not have to ask permission to disappear, as getting the teacher's permission and arguing their case is likely to either be impossible when the overload is happening, or tip the kid over into the screaming abjabs.
Teacher: "But we are about to start the spelling test!"
Kid: "I need to shut down."
Teacher: "Can't you wait until after the test?"
Kid: "No, I can't"
"Teacher: "It will be just ten min....."
Kid: "AAAUIIUUUIIIIGGGHHHH...!!!!!" *flying books and uncontrollable crying.
So see if you can get it set up so that the kid has a piece of orange construction paper ready, and maybe a desk at the back of the room so that they don't need to do anything but get those headphones, the paper and the book and they are gone into their own insulated little world.
In each location where the kid is at risk of a panic attack, a predesignated method of withdrawal and location should be arranged. It is often the noisier more active classes that will tip the kid over, so they should have a designated bench in the gym to go to during gym class, and a withdrawal spot agree on with the art teacher, and a place to retreat to that has been set up with Akela at scouts. Same thing with recess. Discuss with your kid where they can go to get away from the over stimulation. At the grocery store it can be the magazine rack, as you don't want them taking off for the car through the parking lot while they are in running meltdown.
Something to chew on can help, as a hit of blood sugar can stave off the crash when the brain is shutting down, as can extra oxygen. It doesn't have to resemble candy. An apple or whole grain crackers will work also, or three K on the classroom exercise bike.
Also listen to your kid. If the tears and raging during a panic attack include swearing at their "..stupid shirt..!" or complaints about the sun, or the suddenly ripping off clothes, or holding their ears and keening, you know what some of the over stimulation triggers are. If the kid *always* has a melt down in the cafeteria, and any time they end up sitting near the trash can, you can predict that situations with strong smells are going to over load them every time.
Finally, listen to any complains about pain. "My stomach hurts" might be butterflies from anxiety, but it also might be a digestive problem, the first manifestations of Crohn's Disease or the like, and the pain be the primary source of the sensory overload, not just an unimportant symptom of it.
If your kid tends to puke and then sleep after they overload, investigate if they may be getting stomach migraines. Even if they don't complain of pain, as children's migraines often begin with only a tummy upset and no head pain, they may be having incapacitating neurological symptoms which need a different kind of attention than anti-anxiety meds or antidepressants.
posted by Jane the Brown at 10:34 AM on October 26, 2022 [8 favorites]
Response by poster: Thank you to everyone who replied here and on memail! We're working on the sensory issues, and as it's nearly school holidays, switching to home learning. I'm talking about meds with the various people involved so that's going to be something that can be trialled, and mostly - it's really good to hear she's not the only kid this has happened to, and treatment can help.
posted by dorothyisunderwood at 3:49 AM on November 5, 2022 [1 favorite]
posted by dorothyisunderwood at 3:49 AM on November 5, 2022 [1 favorite]
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posted by ThePinkSuperhero at 6:21 PM on October 25, 2022 [8 favorites]