Psychological Effects of Terrorism on Our Children: An Expert Perspective

Caroly Pataki, M.D.

The recent terrorist attacks shocked all of us in the United States beyond our wildest nightmares. It is not difficult to imagine the helplessness, fear, sense of loss, and distress experienced by a child after a direct trauma such as the death of a parent. Even indirect exposure to a trauma, however, such as hearing about the terrorist attack in a far away city, can evoke intense emotional responses in children.

For those of you who are parents, teachers, and clinicians, the big questions in your minds probably include:

• What do we tell our children?
• What will a child of 5, 8, 13 or 17 really understand?
• What is a "normal" reaction in a child to such an abnormal event?
• How can we help?
• What are the signs that a child may need professional help?
• How can we find out more about this topic?

The following article will address these questions.

Universal Effects of Traumatic Events on Youth

While very young children are less verbally articulate about their feelings than older children, most children of all ages will experience some of the following features after exposure to a trauma:

• Increased anxiety when separated from family members
• Re-experiencing the exposure through intrusive thoughts, nightmares or repeatedly talking about the traumatic exposure
• Increased sensitivity to sounds such as sirens, planes flying above, thunder, loud noises
• Sleep disturbance, or fear of the dark
• Increase in minor aches and pains such as stomachaches, headaches
• Poor concentration with decreased school performance in some cases
• Increased thoughts about death and dying
• Irritability and increase in worrying

Preschoolers
If you have a preschooler, or have spent some time with a child between the ages of three and six, you have probably noticed that he or she is able to identify emotions including anger, sadness, happiness, and even envy. A child of preschool age can also tell you why he or she thinks another person feels badly about something. A 5-year-old may even express concern that a peer’s feelings have been hurt.

Looking for emotional cues
When under stress, however, preschool children rely heavily on cues from important adults to help them choose emotional responses to given situations. When a crisis occurs, such as the recent terrorist attack, preschoolers will most likely check parent or teacher responses in order to regulate their own emotions.

Fear separation more than death
Preschool children are not really interested in the details of the world’s politics, nor will they demand to know the details of the death toll or devastation. They are most concerned about whether their families will be well and stay together. In general, preschool children do not understand the finality of death. They believe that death is a temporary condition, and is reversible, as in sleep. They worry much more about being separated from their parents than about dying.

When preschool children fear separation, they may have nightmares, become more aggressive, and express concern about the deaths of others in that it represents "separation". Understanding the developmental thought process of a preschool child is helpful in deciding how to talk to your child, and how much to say. The following are suggested considerations when talking to your preschooler about the recent terrorist attack:

• Reassure your child that he or she is safe
• Limit the number of details given to your child to the simplest explanations
• Be honest without sharing all of your own worries or fears
• Limit your child’s exposure to news reports and discussions of the devastating consequences of this crisis
• Continue routines that the child is familiar with, and avoid unexpected separations
• Ask your child if he or she has any worries
• Spend extra time with your child in an activity that is comforting

School-Age Children

School-age children tend to polarize even complex situations into "right" and "wrong", and most feel secure with clear-cut rules. It is evident, however, if you have ever listened to school-age siblings argue, that there is some room for negotiation, that is, some flexibility to adjust the "punishment" to the "crime".

Wanting to help
At the same time, children from ages six to eleven are developing empathy, and a sense of altruism. Thus, faced with a crisis, such as a terrorist attack, school-age children are likely to be emotionally responsive to the feelings of people directly affected by the attack, and they may also express a desire to "do something to help". This altruistic desire may take the form of an action such as collecting money, or donating clothes or toys to families who are in need.

Comprehension challenges
School-age children will ask many questions about an event such as the terrorist attack, but they may misunderstand the information they are given, so, it is extremely important for parents and teachers to check with children regarding their understanding of things. In the face of a major crisis, school-age children may incorrectly believe that they or their families are at fault, or they may fear that their school is likely to be attacked. Thus, children in this age range require a great deal of explanation, and a limited amount of information. If exposed to too much, too often, a school-age child is more likely to become confused rather than better informed.

Death through their eyes
School-age children do recognize death as final and real, and they conceptualize it as a remote event, and one that only happens to "old people". In present times, a significant proportion of video games, computer games, and fantasy play of school-age children is based on aggressive themes, and involves killing. In many games, the death and dying is personified into a "bad guy", and the "good guy" is glorified after killing the bad guy.

The following are given as suggestions for considerations when talking with school-age children about the terrorist attack:

• Answer your child’s questions without providing all the details
• Check your child’s understanding of the situation after discussions, since school-age children may misinterpret information resulting in guilt or fear
• Encourage your child to talk about his or her worries, and angry feelings as well as altruistic thoughts
• Invite participation of your child in altruistic actions such as collecting money, sending clothes, toys or other items to families in need
• Expect some repetition in the discussions about the traumatic event

Adolescents Early adolescence is a time of exploration and searching for social acceptance by peers. A sense of identity is initiated in adolescents during these years, promoted by success in their ability to function independently, while accepting nurturance and guidance from parents.
In early adolescence, the ability to apply concepts learned in one situation to another begins to develop. Logical thinking prevails, while many unrealistic notions and magical ideas still coexist.

The immortal early adolescent
By the age of thirteen, an adolescent understands the finality and inevitability of death, but that same adolescent may feel immune to the possibility of his or her own mortality. In other words, young teenagers often have a sense of omnipotence, that danger can harm others, but not them. These feelings have an impact on a young adolescent’s concept of danger, and vulnerability.

Late adolescent development
Older adolescents are able to comprehend more sophisticated world situations and are also more able than younger adolescents to separate personal fears of danger to themselves from world events.

The following are suggestions to consider when talking to adolescents regarding the terrorist attack:

• Encourage your teen to voice his or her beliefs and fears about the traumatic events
• Keep in mind that even older adolescents may revert to more concrete and immature solutions to complex problems when under stress
• Be tolerant of adolescents who may be overly idealistic under stress
• Encourage your adolescent to seek out the facts and be exposed to the news, while continuing their usual activities
• Discourage your adolescent from becoming fixated on the event to the exclusion of regular academic, social or sports activities
• Encourage your adolescent to actively participate in altruistic endeavors along with peers or family members

How Parents and Teachers Can Help

Most experts agree that in a national disaster situation such as the terrorist attacks, there are a number of steps that parents, teachers, and other adults who are in daily contact with children can take to allay fears and provide comfort to children and adolescents. The following are general guidelines:

• Reinforce to children and adolescents that they are safe
• Allow less exposure of news and other broadcasts about the trauma to younger children, and more to older children and adolescents
• Explore the worries and fears of children of all age groups especially about death
• Allow children and adolescents to express feelings of anger and let them know that they will feel better over time
• Redirect misplaced feelings of "hate"
• Maintain predictable routines
• Correct misperceptions of children who feel "at fault" or believe that they are in acute danger
• Expect some degree of distraction, decreased focus, and possible irritability
• Discourage deviation from usual activities, social life and sports games
• Provide some activities that will be comforting to children such as reading a story to young children, listening to music for older children and adolescents
• Limit the number of reminders of the event in the classroom and at home

Trauma Reactions to be Concerned About

There is no question that we have all been affected psychologically by the tragic terrorist attack on the World Trade Center and the Pentagon on September 11, 2001. Fear, anger, sadness, grief, retribution, and misery have been experienced by one and all.

Normal reactions
In my experience, young children respond acutely by worrying about their immediate safety and proximity of their parents. School-age children and young adolescents probably express more initial curiosity about the events. For many children and adolescents, after several days, a barrier seems to go up and they no longer want to discuss the sad realities in detail. Nevertheless, all children and adolescents may remain fearful, clingy, more concerned about the location of their family members, and slightly distracted. All of the above is normal and expected.

Reactions to be concerned about
How can you tell when a child is having serious psychological distress that warrants mental health intervention?

Some children will develop more enduring and significant psychiatric symptoms after exposure to a traumatic event. Children at highest risk are those who have already had psychological distress related to trauma, loss, depression and anxiety. However, some children without prior difficulties will develop significant symptoms after one exposure.

Psychiatric disorders that may occur following an exposure to trauma include depression, generalized anxiety disorder, as well as posttraumatic stress disorder. Signs that should prompt a psychiatric evaluation include the following:

• A child’s refusal to return to school for several weeks following the trauma
• A major change in the child’s overall energy level, appetite, sleep pattern or mood
• Significant withdrawal from usual family, social or sports activities
• Significant and persistent deterioration in school function
• Re-experiencing the trauma frequently through intrusive thoughts, flashbacks, or nightmares
• Exhibiting a sense of "foreshortened future", that is, a child’s belief that he or she will never live to grow up
• Any self-injurious behaviors or wish to die

Resources
The following are some resources that will provide you with more information on this topic:

American Psychological Association
Brochures available such as:

"Talk to Someone Who Can Help"

"Managing Traumatic Stress: Tips for Recovering from Disaster and Other Traumatic Events"

"Reactions and Guidelines for Children Following Traumatic Disaster." by Robin Gurwitch et al. from the Dept. of Pediatrics, University of Oklahoma.

To order these brochures, call 1-800 964-2000 Or visit the APA Web site at: www.helping.apa.org

Red Cross
The Red Cross offers disaster counseling literature on its Web site, at: http://www.redcross.org/services/disaster/keepsafe/attack.html

United States Department of Health and Human Services
The United States Department of Health and Human Services also offers literature on its Web site, at: http://www.mentalhealth.org/schoolviolence/parents.htm