10 Things you should know . . .
children coping with terrorism
We know more about how adults react to
war and disaster than we do children. But researchers are
beginning to document how children are uniquely affected,
and how they can best heal. Psychologists are increasingly
called upon for help in recovery efforts. The facts presented
below stem from a broad research base that includes wartime,
natural disasters and data from the bombing of the Alfred
Murrah Federal Building in Oklahoma City -- the most significant
terrorist act in the U.S. prior to September 11, 2001 when
the World Trade Center and the Pentagon were attacked.
- Acts of terrorism
make us all feel vulnerable and may shake our fundamental
beliefs. This is especially true for children.
Two elements of terrorism magnify
its impact for both children and adults: it was not anticipated
-- so no one is prepared -- and another human being inflicted
the harm intentionally. Although hurricanes, floods and
tornados can tear apart families and communities, research
shows that terrorism takes the biggest toll psychologically.
It violates our beliefs about human relationships. Regardless
of the situation, a child will experience intense fear in
a disaster because he does not have the tools to assess
the dangers around him. One of the ways we move beyond fear
as human beings is by putting things into context and reasoning
our way through a crisis. Children have not yet arrived
at this stage of growth. Their ability to say what is bothering
them is also limited. This is why playacting, drawing and
stories are good therapy for children.
- We used to think
that children who survived a disaster did not experience
psychological setbacks, and if they did, they would quickly
rebound. Research shows that parents may not be able to
recognize psychological distress, but it is often present.
Not every child at a disaster site
will develop a psychiatric disorder, but most will experience
some difficulties. According to research done with survivors
of the Oklahoma City bombing, parents can readily admit
their own struggles, but they may not recognize the signs
in their own children. It is common for children to be anxious,
to have fears, to become easily distracted, and to have
"baby" behaviors they've long outgrown. Mental
health professionals can assess whether these behaviors
are of concern.
look at several factors when assessing a child: the intensity
of the disaster experience, the child's age, and the resources
available in the recovery environment.
Researchers have confirmed a dose-response
effect for trauma. The psychological impact increases in
severity according to the level of violence and the degree
to which it was personal. We also know that the effects
of a disaster will intensify when communities and families
have inadequate resources.
The age of the child is a factor that researchers are still
evaluating. Some believe that the younger a child, the more
dramatic the effect. This is difficult to document because
young children have a limited ability to say what happened
to them and how they feel about it. Researchers are beginning
to show that older children and adolescents can cope with
the violence of war more effectively than their younger
siblings since they can: more realistically evaluate the
probability of personal danger; understand war in the context
of an ideology; and participate actively in helping family
members in emergencies.
- Depression and
Post Traumatic Stress Disorder (PTSD) are the most common
PTSD was formally recognized as
a psychiatric diagnosis in 1980. It is common among veterans,
but is now being studied across the civilian population,
including children. A child may be at risk when she experiences
any number of violent acts, including: kidnapping, sniper
fire, school shootings, motor vehicle accidents, severe
burns, community violence, war, sexual or physical abuse,
rape or murder of a parent.
In the context of terrorism, PTSD is most likely when: the
child experiences a threat to her life; she is injured;
she witnesses something grotesque in the disaster; someone
she loves dies or is injured. At least one-fourth of the
children who are physically harmed or lose a parent in a
disaster develop PTSD and/or depression.
- There are many
signs that a child may need help because he is suffering
from some type of post traumatic stress.
When situations remind him of the
traumatic event, a child may try to avoid them. For even
routine activities, he becomes anxious when leaving his
parents. In his playtime, he may re-enact the traumatic
event in ways that can be disturbing to the adults around
him. He may have difficulty sleeping and experience nightmares.
He may startle more easily from sounds or touch. A seriously
traumatized child may shut down emotionally and show no
feelings at all; this is typical immediately following a
disaster, but unhealthy in the long run.
- The child's
environment may be dramatically altered by a terrorist incident
and this too has a profound effect.
If a child loses a family member,
her recovery is even more difficult because PTSD may interfere
with the grieving process. A terrorist incident may shake
the stabilizing factors in a child's life. For example,
the family may experience economic hardship or loss of home.
Schools may be closed. We know that children recover most
successfully when they have immediate support from parents
and caregivers, and when they can resume normal routines,
such as going to school.
It is one thing to recover from a single incident and another
to live in a climate of fear and instability. When the threat
is ongoing, it is a challenge for the community to give
children a sense of security; this will enable them to trust
others and make plans for their future.
- PTSD symptoms
may persist for many years.
Children exposed to very severe
and prolonged trauma may have difficulties well into adulthood.
Researchers have found this is true with children who were
taken hostage or experienced terrorist violence with mass
casualties. Immediate access to mental health care is helpful,
but long-term treatment for chronic PTSD is recommended
as the best option for quality of life.
- Mental health
professionals are developing manuals and making themselves
available to communities in distress, but even when resources
are available, only a small fraction of families take advantage
This was the case in Oklahoma City.
In a study of 3,200 middle and high school students, sixty
percent heard or felt the explosion in the federal building
and 330 attended at least one funeral, yet less than seven
percent reported they had seen a counselor or clergy person
for mental health support. Less than half of the students
who lost a family member had seen a counselor.
In the Manhattan public schools, surveys six months following
the September 11 disaster show that one quarter of the children
and teens had psychiatric symptoms, but only a third of
those who needed help received it.
- TV watching
can spread and intensify the psychological impact of an
Children can develop some symptoms
of post traumatic stress even though they were not directly
involved in a disaster. The impact of TV viewing has been
documented in Oklahoma where graphic coverage lasted several
weeks and reappeared with intensity at the time of the criminal
trial 8 months later. Researchers found that middle school
children who lived 100 miles from Oklahoma City had symptoms
that affected their performance at school or home for as
long as 2 years. Among children who attended middle school
near the blast site, repeated viewing of the news may have
heightened their trauma.
The media can play a positive role in disasters by providing
continuity, guidance, and the perception of safety. In Israel,
the news media participates in a community-wide system that
prepares citizens for attacks and connects them to accurate
information following a catastrophe. Uniform messages are
released on many fronts -- via the Internet, the telephone
and print media. These messages include advice from mental
health professionals about ways to reduce anxiety and ensure
- Parents can
make the biggest difference in helping their children recover.
Young children derive their sense
of well being from parents, especially their mother. To
the degree the parent is traumatized, so the young child
will be. On the other hand, the most reliable predictor
that a child will successfully manage trauma is the adaptive
capacity of his parents. Children respond well to parents
who reassure them that they are safe, help them put events
into context, and give them immediate and ongoing emotional
Parents can limit their child's exposure to trauma by monitoring
the TV and other messages that may disrupt the child's need
for continuity and stability.
In a situation where adversity persists, parents can help
their children develop coping skills. One of the best ways
to regain health is to have a sense of mastery in a difficult
situation. Studies of older children in war-torn Israel
and Bosnia show that they benefited from active involvement
in safety preparations at home and service projects in the
neighborhood; this kind of guided activity keeps children
from falling into a victim mentality and helps them direct
their emotional energy in positive ways.
Seeking the care of professionals
is also a way that parents can help their children. Many
communities provide support to families through their local
mental health centers. Universities often make their expertise
available in psychological clinics that are designed for
children and teens. School is a good place to ask about
counselors and get information on healthful activities that
This fact sheet was written by Joy
Simpson in collaboration with Eric M. Vernberg, professor
of psychology and director of the Child and Family Services
Clinic at the University of Kansas.
Queries may be directed to the Merrill Center at
La Greca, A.M., Silverman, W.K., Vernberg,
E.M., and Roberts, M.C. (Editors) (2002). Helping
children cope with disasters and terrorism. Washington,
D.C.: American Psychological Association.
Vernberg, E.M. (2002). Psychological
science and terrorism: Making psychological issues part of
our planning and technology, pp. 79-82. In M.L. Rice (Ed.) Science at a time of national emergency. (MASC Report
No. 106). Lawrence, Kansas: University of Kansas Merrill Advanced
Vernberg, E.M. and Varela, R.E. (2001).
Posttraumatic Stress Disorder: A Developmental Perspective.
In Vasey, M.W. and Dadds, M.R. (Editors), The developmental
psychopathology of anxiety (pp. 386-406). New York: Oxford
Vernberg, E.M. and Vogel, J.M. (1993) Interventions
with children after disasters. Journal of Clinical Child
Psychology, 22, 485-498.
American Psychological Association online help center. Get
the facts: Psychology in daily life. http://helping.apa.org/daily
--see Gurwitch, R.H., Silovsky, J.F., Schultz, S., Kees, M.,
and Burlingame, S. Reactions
and guidelines for children following trauma/disaster.
American Red Cross. Materials on terrorism
and unexpected events (October 2002). www.redcross..org/pubs/dspubs/terrormat.html
National Center for PTSD. www.ptsd.va.gov
--see the fact sheet What
is Posttraumatic Stress Disorder?
National Child Traumatic Stress Network. www.nctsnet.org
--see the tip sheet Talking
to children about war and terrorism