How do you help someone calm down during a panic attack?

[Tap]

My Autistic DD12 and I spent 10 hours on Sunday in Urgent Cares and 2 separate ERs for abdominal pain and what looked like related symptoms.  After 10 hours, 3 urine tests, an ultrasound and 5 doctors. They finally released her and decided that she likely has a GI bug, and part of the symptoms (that was making the situation look worse that it really was)  were actually a panic attack possibly caused by the GI bug stomach cramps.  (Shaking, nausea, heart rate, etc).  I suspect that her over sensitive brain just doesn't know what to do with the pain signals and is creating a panic attack.

Now.....what do I do to help her?  I know nothing about panic attacks. In the Er she has a full body shaking event (imagine a Grand Mal seizure if you have ever seen one) that lasted 10-15 minutes and was still mildly hyperventilating for a while after it. Any help or suggestions would be appreciated.  (BTW 2 doctors and 3 nurses all agree it isn't a seizure....she was responsive during it)

She has a new psychiatrist that we haven't seen yet. Since we haven't done an intake it is unlikely we will get help from them. They will say to go to the ER.  Her first appointment is in January with new Pdoc.  Her old psychiatrist left the practice so I don't have him to call. Her PCP tries to avoid any of DDs mental health care because she is so complex (I agree with him).   

Right now she is laying on the floor by my feet spasming. I have calm lights and music with ocean waves playing (she likes this) and have tried calming her down with strategies we use when the world overwhelms her brain. Nothing seems to be bringing her out of it. 

ETA: She is high functioning.  Mentally, she is probably about the age of NT 3-4yo when it comes to dealing with stress and controlling her body.  She can control some of it, but is easily overwhelmed and then can't really control what her body/mind is doing after it goes awry. 

Edited December 3, 2018 by Tap

[freesia]

For me, slowing my breathing helps the most as well as repeating the truth.  Ultimately, she has to access those herself, though.  The key is to catch a panic attack as it begins to escalate. When she is in a good place having her practice how mindfully counting her breath can really work would be good.  When I talked it over with my therapist she also asked me how long it took to calm down while doing it.  I told her 1-2 minutes. She said that was true of most of her clients.  I'm not sure if she did this on purpose, but it helped me see two things--one, it didn't work in 10 seconds so keep going, but also that 1-2 minutes is relatively short and if I stuck with it a little longer I'd have relief.  The app Smiling Minds helped me a lot.

I play around lightly with essential oils and my MIL just gave me Palo Santo which is suppose to help with panic attacks.  I haven't tried it yet.

I don't know how high functioning your dd is, though.  What I've suggested would have been too much for the tclassically autistic kids I used to work with, but would work with the higher functioning asperger kids I know.

[Jean in Newcastle]

With my Aspie, I have used Calms Forte - a homeopathic remedy readily available in most pharmacies. 

I also work with him on breathing - breath out to the count of four, breath in to the count of four. . .  continue to repeat. 

Or perhaps a weighted blanket? 

[Chris in VA]

I don't know if this is helpful, but I do a grounding exercise. I think of 5 things, in a category , then 5 more in another category, and so on. Usually I j7st use colors. I call it Five Red. I start w 5 red things. I have to actually visualize the object. 

[Violet Crown]

Wee Girl has them less often than she used to, but I learned to (1) as Freesia says, recognize the early stages and intervene then; (2) immediately remove her from the situation (or remove the situation from her, e.g. by saying, "No, he's wrong, you don't have to do that"; (3) tight hugs without talking until breathing and heart slowed down.

[happi duck]

34 minutes ago, Chris in VA said:

I don't know if this is helpful, but I do a grounding exercise. I think of 5 things, in a category , then 5 more in another category, and so on. Usually I j7st use colors. I call it Five Red. I start w 5 red things. I have to actually visualize the object. 

In a similar vein:

I'll ask dd: tell me five things you can see (answers) good!  Now take a good breath.  Tell me four things you can/could touch. (Answers) Good!  Take a good breath.  Tell me three things you hear/ two things you can or could smell/one thing you could taste

[happi duck]

During panic, I have experienced shaking from quivering to the intensity like from chills from a fever.

The spasms and grand mal seizure like shaking is not something I've experienced or read about.  I'd wonder what else it could be.

Just my two cents

[fairfarmhand]

Have you tried a weighted blanket?

[Carol in Cal.]

Hug, ‘You’re safe now’, ‘Your children are safe’, ‘breathe, OK, hold it, breathe again, breathe in love’, ‘I’ve got you, you are safe.’

[Ottakee]

It might be too young for her but I just saw something about a Sesame Street segment where the count is teaching Cookie Monster to calm down using the visuals of lighting candles on a birthday cake and then slowly blowing them out.

When my dd gets in that state, swinging really helps her.

[chocolate-chip chooky]

I put my daughter in front of a pedestal fan. The breeze directly on her face and the white noise are very helpful. I then stroke up and down her arms, encouraging her to breathe in time with the strokes.

I'm collating all of these ideas in this thread to have in my parenting toolbox. Panic attacks can be pretty scary.

Wishing you all the best, Tap.

[Lady Florida.]

I don't know how to help because mine never involved shaking like that. However, if you or her therapist can teach her how to recognize one before it fully comes on that would be the best thing. Once I learned to recognize the signs I could start readying myself to get through it. In my case it was slow and steady breathing. Sometimes I couldn't stop myself from pacing but while I allowed myself to pace I kept reminding myself I was not dying, just having a panic attack.

I've not heard of the seizure style shaking from a panic attack but I still think the best thing for her would be to learn to recognize one before it starts, and prepare in whatever way you all come up with as her way to handle it.

[73349]

WRT the shaking, my body does that when I have too much epinephrine/adrenaline (e.g., if injected with Novocaine at the dentist--epinephrine is usually included with it, but has its own side effect). It may have been more of a cause than an effect of her emotions.

They always think I'm really cold or something, but that's not the problem. One finally told me that I hyperreact to vasoconstrictors, and now that's on my charts.

Edited December 3, 2018 by whitehawk

[Laurie]

3 hours ago, Tap said:

  They finally released her and decided that she likely has a GI bug, and part of the symptoms (that was making the situation look worse that it really was)  were actually a panic attack possibly caused by the GI bug stomach cramps.  (Shaking, nausea, heart rate, etc).  I suspect that her over sensitive brain just doesn't know what to do with the pain signals and is creating a panic attack.

 

My daughter also has autism.   As long as I can remember, her body shakes with any episode of vomiting and she's very upset.  I  usually bundle her up in a thick terry bathrobe to keep her warm during these episodes.  Maybe the swaddling feeling helps?

I hope your daughter feels better soon and that you can find something that helps her.  

 

[BooksandBoys]

One of my autistic sons is prone to panic attacks (he’s 7).  He responds well to a large, very powerful box fan close to him, blowing on him, while he’s wrapped in a blanket. I often lay on him to give him that deep, calming pressure (he refuses to use a weighted blanket).

If I catch it early, before it’s full panic, tight hugs and deep breathing (mine...he won’t do it) makes a big difference. 

[elizadavis384]

Have you tried  organic geranium essential oil ? It is useful for reducing the anger feelings and relaxes the mind.  

[ktgrok]

First, the vagal nerve is right by the stomach so the GI bug may have stimulated that, which is what triggered the panic. Or, dehydration can trigger panic attacks. When I've had them (only twice) I was dehydrated. Drinking gatorade and taking a Benedryl helped more than all the relaxation exercises in the world because the cause was physical, not emotional. So throwing that out there. Get her hydrated, maybe give a benedryl if that is something she can have. Then yes, concentrate on having her use her rational mind, as it tends to then override the primal "fight or fight" signals. Even just moving her arms or legs VERY slowly can do that. 

And reassure her that you know she feels yucky but her body is just confused, and she's going to be okay. That you are going to stay with her, and it will get better. 

[PeterPan]

                                 Interoception Assessment Forms                            

                                 Interoception: The Eighth Sensory System                            

Kelly Mahler's new interoception curriculum should be out in January. It will address the not knowing what she's feeling piece. There's some discussion that improving interoception improves not only your conscious perception and choice but also autonomic regulation.

[happi duck]

@Tap

Hope things are getting better! (hugs)

[Suzanne in ABQ]

My daughter is much older (22), but she has pretty severe SPD, and anxiety and depression.  She takes a mild antidepressant, which helps balance her days, but she still encounters situations that push her over her threshold. For these acute anxiety attacks, she finds certain essential oils help.  She likes DoTERRA "Balance", or a blend of "Balance" and "Copaiba" diluted in a carrier oil.  (Lavender has relaxing properties as well, and it's easier to get at a health food store, but she doesn't like the scent. YMMV)

To use the pure Balance, she just opens the bottle slightly and holds it next to her nose to breathe it in.  She starts feeling better within a minute or two.

Her blend is in a roller bottle, and she applies it to her wrists. (10 drops Balance, 20 drops Copaiba, 1:1 with almond oil)  This is especially helpful if she's knows in advance that she's headed into a stressful situation.

[Tap]

Thank you for your advice everyone I really appreciate it. It has been a long and stressful week, so please forgive me for not answering everyone's comments/questions personally.

The nurses and doctors in the ER felt that it was possibly a panic attack and that they have seen them this severe before, so even though the shaking was very violent, I tend to believe it is a possibility.  (DD also has a tic disorder, so I question if it could be a full body version of a tic). She had about 4 major episodes over 3 days and has not had one for 2 days now, so I am hoping we are past the worst of them. 

After she settled down physically she was hyperventilating, and I guess that is also common with panic attacks. I have two whole new things to learn about because it was terrifying for her (and me) to have her go through this, so what ever I can do to help her prevent/stop them, the better. 

Ill try to come back and fill in some more tomorrow. I just wanted to check in to let everyone know I am reading and learning from everyone's comments and I want Thank you so much for sharing. 

~Tap

 

[geodob]

You wrote that she 'hyperventilates'.
When hyperventilating, more air is breathed out. Than is breathed in.
We breathe out CO2 carbon Dioxide. So that hyperventilating causes the levels of CO2 in the blood to drop.
The balance of CO2 and Oxygen, is what determines our PH Levels.

Though when CO2 levels drop, this causes 'Vasoconstriction'.  Where all of the blood vessels contract.  Which reduces blood-flow.
This reduced blood-flow, has a specific effect on the heart.  Which has to cope with less blood.  It also starves the brain brain of blood, and in turn of oxygen. Causing a range of symptoms. As well, the airways in the lungs contract.  To try and reduce the amount of Oxygen coming in.  Making breathing difficult. Which can add to the panic?

So that to bring the CO2 levels, back to a more level. Breathing should be focused on 'Inhalation'.   With a reduction of 'Exhalation'. An old treatment for panic attacks, is to breathe into a paper bag.  This is helpful, as CO2 that was breathed out into the paper bag. Is then inhaled.  Which helps restore the levels.

[PeterPan]

Tap, you know this, but anything (like geodob's paper bag idea) you want to have work as a strategy *in the moment* needs to have been practiced before. You might get her to do something novel with guidance, but she's probably going to do better if she has practiced the strategies ahead of time. They can also be pro-active and preventative when done regularly. If you work on her interoception, she can learn to recognize her body signals and then make the choice to use the strategies.