Many people across the Washington region have developed new routines to reduce their chances of becoming targets of a sniper,but with those changes have come higher stress levels, constant worry and fears of leaving home, specialists say.

While the daily routine for many is unchanged, others approach walking down the street, pumping gasoline or loading groceries into a parked car as potentially lethal activities that require alertness and caution. Mental health experts say such fear, combined with the relentless drumbeat of television and radio chatter about the sniper,is stoking personal anxieties.

"We have a significant portion of people who are fearful of actually going outside," said Jane MacLean, director of the District's mental health hotline.

The first signs of widespread stress typically emerge in patients already coping with depression, anxiety or post-traumatic stress disorders. That occurred last fall with the terrorist attacks on the Pentagon and World Trade Center, followed soon by the anthrax scares.

James F. Dee, a Mount Vernon psychiatrist and past president of the Washington Psychiatric Society, said sniper fears have become prominent in his practice.

"I've had one hospitalization directly from the stress related to this," he said, adding that the patient had several disorders already. "I've also had a number of cancellations of patients afraid to go out of their homes."

Calls to mental health hotlines and crisis lines are up. "If you set up concentric circles from Montgomery County out through the region, you find that there's a ripple effect where that fear is going out in a wider and wider area the longer this goes on," said Brian Hepburn, Maryland's interim director of mental hygiene.

"This is touching us because we're so fearful of anything happening to our loved ones," he said. Altering routines, he said, minimizes the sense of powerlessness.

But Hepburn said people should not view fear as something to be avoided at all costs. "Fear is not evidence of illness," he said. "Fear can often be very positive, and it helps you go into a protective mode to decrease risk. It's when the fear becomes incapacitating that you need additional support."

At many public schools, where children scurry between vehicles and buildings -- shielded by parents and under the watchful gaze of police -- older students have increasingly responded to daily invitations to talk to guidance counselors, officials said. Some elementary students have become clingy and weepy or have complained of nightmares, they said.

Guidance counselors and psychologists at 26 Montgomery middle and high schools reported that 15 to 25 students at each school have sought out crisis counseling, although youngsters seem to be more outwardly calm this week than last.

This school week, the third since the shootings began, students have continued to go without outdoor recess and sports programs.

"This change in routine has made them feel a little bit vulnerable, and that leads to losing some sense of control," said Matt Kamins, supervisor of psychological services for the Montgomery schools.

High school athletes are particularly frustrated because dreams of varsity glory and college scholarships are in danger of vaporizing unless schedules are restored.

At all levels, "kids are quicker to get upset, more easily frustrated, a little less tolerant of one another," said Judy Madden, supervisor of guidance for Montgomery's 190 public schools.

Middle school children have complained that parents are keeping closer tabs on them than they like, and that's the age group where stress is most likely to manifest itself as a physical ailment, Madden said.

Karen McAndrews, 40, of Greenbelt said her 11-year-old daughter was absent from school in the first week of the shootings with complaints of a stomachache and headache, but has since bounced back. McAndrews doesn't know whether the cause was stress or a physical malady.

Teachers have shown signs of physical and emotional exhaustion from all the extra work at school, as well as from concern for their own safety and that of their families.

"What everybody's trying to do is keep the lid on," said Mark Simon, president of the 11,000-member Montgomery County teachers union. "The stress on kids and the teaching staff and parents is tremendous."

Some educators say that even if the sniper is caught soon, things may never be the same.

"There is the potential of going to war with Iraq and other threats," said Fairfax County School Superintendent Daniel A. Domenech. "We are already subjected to inconveniences we never had before, such as waiting two to three hours to get on a plane because of increased security.

"Things are different in our schools . . . and I daresay, they may never go back to the old days," he said.

The sniper has awakened deep fears for some with painful memories. "It's synergistic," said Dee, the Mount Vernon psychiatrist. "It multiplies. Particularly with the military veterans, they're having a hard time of it. . . . People who have been traumatized before are a little bit more fearful."

Michael Biernoff, medical director of the District's outpatient mental health services, said that pattern has become evident in the city.

"Some of our consumers have been experiencing increased symptoms, sleep difficulties, anxiety, increased fearfulness and difficulty being comfortable," he said.

Calls to the District's mental health hotline have increased from 106 to 128 a day since Oct. 2. That has prompted the city's Department of Mental Health to urge people to turn off their televisions for a while and stop thinking about the sniper attacks.

With all the national media coverage, the personal anxieties are no longer restricted to the Washington area.

David J. Markowitz, president of the Psychiatric Society of Virginia, practices in Richmond and said the fears have reached his area. This week, he and colleagues noted a surge in patients' fears about thesniper, and he said his children told him that their classmates were discussing their fears.

"I think the concern is escalated here because these things occurred on I-95 and headed south, and this would be the next stop," he said.

Of course, not everyone is worried. Tyissha Smith, 18, who lives in Southwest Washington, said she feels insulated from stress.

"We can't live our lives in fear," she said. "We can't duck and hide and pump gas at the same time. It's all up to the Lord. He'll decide when it's time to take us."