Have you started imagining life after coronavirus? What’s our “new normal” going to look like once we’re all allowed to be together again? Even though my dreams of long-distance travel or seeing a Broadway play may still be far off, I’ve started to wonder what the near future will hold for children’s mental health. Many families that I work with are already observing big changes in their children’s behavior from being cooped up in quarantine. Oftentimes, though, we don’t really see all of the effects of a trauma experience emerge until after the stressful experience is over. As more cities start to open up, I think it’s possible we’ll be seeing more symptoms of agoraphobia in children. Here’s why.
First Of All—What Is Agoraphobia?
Agoraphobia is a type of anxiety disorder. People with agoraphobia are afraid of being in situations or places where it would be difficult to get away or get help in a crisis situation. Agoraphobia gets its name from the Greek word agora, which is a type of crowded, outdoor market often held in a town square. Many people with agoraphobia are fearful of being in this type of crowded, open space, but plenty of other situations can trigger agoraphobia fears, too. For example:
Leaving the house
Riding on public transportation, like a city bus
Enclosed spaces like elevators, movie theaters, or bathroom stalls
Anywhere with a large crowd, or where you have to wait in a line
Big, open places, like shopping malls or parking lots.
For people with agoraphobia, these kinds of situations can set off worries such as “I won’t be able to get out of here if there’s an emergency” and “What if I get sick and nobody can come to help me?” This can lead to intense anxiety, panic attacks, and even cause people to start avoiding triggering places altogether. Agoraphobia is more common in adults, but kids can have it, too.
During Quarantine, Everyone Is a Little Agoraphobic
Big shopping malls, public transit, large crowds, movie theaters…when was the last time you were in any of these places? If you’ve been practicing social distancing, it’s probably been a while, and you might not even be leaving home as much as you used to.
Just like the new rules about handwashing have made us all a little OCD, social distancing protocols that help us keep each other safe have temporarily made us all a bit agoraphobic. We’re staying home more, and we’re naturally avoiding big crowds and public spaces that might put us in contact with others. If you have found that you start to feel nervous around crowds these days due to fears about transmitting or catching coronavirus, you’re not alone.
Many of us will gradually overcome these worries as the threat of coronavirus subsides…and it will, eventually! However, the longer we stay away from something that triggers our anxiety, the more intense our anxiety response is likely to be the next time we encounter it. For kids who may already be prone to anxiety, returning to public places and crowds might be very frightening for a while.
Returning To Our “New Normal” Could Trigger Agoraphobia Anxiety for Kids
If anxious kids have been avoiding public places for a while during quarantine, they may naturally feel some nervousness about returning to business as usual. This may be especially true if your child is fearful of catching coronavirus, or is not sure how the virus is transmitted. Worries about catching coronavirus could easily morph into worries about getting sick or being unable to get help in certain places.
It’s natural for us to want to avoid scenarios that trigger anxiety, which can set off a vicious cycle for anxious kids: they avoid a feared situation, which provides temporary relief but ensures that they will feel even more anxious the next time the scenario presents itself. This can make anxiety even worse in the long run, until some places or activities feel completely off-limits.
What’s more, it seems likely that our “new normal” may not look quite the same as our old normal. Gloves, masks, and other PPE may become more commonplace. We may have to get used to spacing ourselves further apart in lines, or acclimate to having our temperature taken before boarding an airplane. This different look and feel could be really scary for kids: even if masks keep us safe, they will take some getting used to! I can imagine that this will be an additional hurdle to overcome in helping anxious kids resume life in public places.
Is Agoraphobia Common in Children?
It’s not too common. Most often, people develop agoraphobia in their teenage or young adult years. More rarely, the symptoms can start earlier in childhood. Less than 1% of U.S. kids meet all the criteria for an agoraphobia diagnosis, but it can also be a tricky form of anxiety to diagnose. Because it can be hard for kids to put their worries into words, it might be hard to tell whether a child is reluctant to leave home due to social anxiety, separation anxiety, agoraphobia, or another type of worry.
Kids are more likely to develop agoraphobia if they have already had panic attacks in the past. They may also be at increased risk of developing agoraphobia symptoms if they’ve experienced a previous trauma, or had a loved one get hurt or ill outside of the house, for example, at a movie theater or amusement park. Past experiences and a history of anxiety can both contribute to kids developing agoraphobia.
Signs and Symptoms of Agoraphobia in Children
Children may not be totally aware of what is triggering their intense anxiety, or why. For parents, this can make spotting agoraphobia a little challenging. A child’s behavior might be confusing: for example, complaining of stomach aches before a family outing, or insisting on always taking the stairs rather than riding in an elevator. Here are a few common signs and symptoms of agoraphobia in kids to keep an eye out for if you suspect this may be an issue for your child:
Reluctance or refusal to go out of the house, not just for school but for more “fun” activities as well.
Panic attacks, which might include sweating, rapid breathing, a racing heartbeat, a flushed face, or stomach upset.
A child might voice worries about getting lost and not being able to find a parent in public, getting sick or having a panic attack in a public place, or fear about something dangerous happening and not being able to escape it.
The fears happen in multiple settings, for example, in elevators, crowded stores, and the movie theater.
Experiencing some or all of these symptoms isn’t enough to diagnose your child with agoraphobia, but it can help point you in the right direction. Knowing what the likely culprit is for your child’s anxiety is a good first step in finding the right help.
How to Help a Child With Agoraphobia
Agoraphobia is a form of anxiety, so treatment involves many of the same tools that we use for kids with other forms of worry. In particular, cognitive-behavioral therapy is commonly used to help kids with all forms of anxiety, and it can be really helpful for agoraphobia, too. A big part of therapy for many kids with agoraphobia is practicing gradual exposure. When kids avoid something that scares them, it provides a temporary relief but allows their fear to grow and worsen over time. Gradual exposure helps kids slowly work up to facing their fears, so that they can break the avoidance cycle and start to shrink their anxiety back down to a manageable level.
Working with a CBT therapist, your child might come up with a list of scary places or situations and rank them from easiest to hardest to complete. With the support of a counselor (and maybe a parent as well), your child can start making small steps towards doing scary things, starting at the bottom of the list and moving up to more and more challenging situations. Most kids find that once they start exposure, their fear drops away pretty quickly. Pretty soon, even the really frightening places or situations don’t seem so overwhelming anymore.
Kids might also learn coping skills to help with anxiety, so they can help their bodies relax more effectively when their panic gets triggered. Sometimes, just learning about how anxiety works in the body can help kids feel more in control of their panic, as well.
Does Your Child Need More Help?
If you think your child could benefit from some more personalized help, I would recommend finding a counselor who specializes in treating kids with anxiety disorders. If you’re in North Carolina or New York, I use cognitive-behavioral therapy to help kids manage anxiety through video sessions. You can contact me here.
If you aren’t local to one of those states, I’d recommend getting started with Child Mind Institute’s excellent intro to agoraphobia. You can also search for child therapists in your area on Psychology Today.
