Agoraphobia is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety. Children with generalized anxiety disorder spend a lot of time worrying about a lot of different things. Children with social anxiety disorder feel very anxious around other people, including their peers, because they are afraid of embarrassing themselves or being disliked. Children with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. Children with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like symptoms or embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. Children with a specific phobia are very afraid of one or more objects or situations, such as flying, heights, animals, or seeing blood. Children with separation anxiety disorder are afraid of being away from a certain person or people, often a parent, often because they are afraid that something bad might happen to them or the other person if they are separated. Children with selective mutism do not speak in situations where it would be socially appropriate for them to speak, such as at school.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the child is only excessively fearful of narrow range of objects or situations. In other anxiety disorders, like GAD, the child may feel anxious a great deal of the time or about a lot of different things.
Agoraphobia is a psychiatric disorder that affects less than 1% of children and roughly 3 - 4% of adolescents. Agoraphobia is characterized is characterized by fear or anxiety about two or more of the following situations:
A child or adolescent with agoraphobia fears or avoids these situations because they believe that it might be difficult to escape or because help might not be available if the child was to develop certain symptoms, such as panic-like symptoms or embarrassing symptoms (like gastrointestinal distress). For agoraphobia to be diagnosed, these fears must be out of proportion to the actual risk, the developmental level, and the sociocultural context.
A child or adolescent with agoraphobia actively avoids these situations, requires a companion such as a parent to enter these situations, or endures the situations only with intense fear or anxiety.
Agoraphobia severity can range from mild to severe. In severe cases, agoraphobia can lead to difficulty attending or performing well at school or engaging in family activities and previously-enjoyed hobbies. Children and adolescents with agoraphobia often also have other psychiatric conditions, most commonly other anxiety disorders and depression.
Agoraphobia is characterized by disruptions in the nervous system (hyperactivity of the sympathetic nervous system) and the endocrine system (disturbances in the hypothalamic-adrenal-pituitary axis), which are thought to contribute to symptoms. In addition, avoidance of feared situations and symptoms is thought to contribute to the persistence of agoraphobia. The disorder has a genetic component, although having a genetic predisposition to agoraphobia does not necessarily mean that someone will develop the disorder.
Until recently, agoraphobia was diagnosed and studied as part of panic disorder. Therefore, there are no published treatment guidelines for pediatric agoraphobia. However, published guidelines for pediatric anxiety (broadly defined) are provided by the Society of Clinical Child and Adolescent Psychology. The American Academy of Child and Adolescent Psychiatry also offers historical practice parameters (last updated in 2007); new parameters are being developed.
Currently, clinical research suggests that the following treatments are effective for pediatric anxiety:
For more information about drug prescribing in pediatric agoraphobia, click here.
Other Effective Treatments
In the event of non-response to first-line treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric anxiety:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.
Currently, clinical research suggests that the following treatments are effective for pediatric anxiety:
For more information about drug prescribing in pediatric agoraphobia, click here.
Other Effective Treatments
In the event of non-response to first-line treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric anxiety:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.