When terrorist attacks occur, our children may witness or
learn about these events by watching TV, talking with people at
school, or over hearing adults discussing the events. For
instance, the September 11th, 2001 attacks and the Oklahoma City
bombing received widespread attention and media coverage and many
children were exposed. But how should we speak to our children
about these events when they occur? Should we shield them from
such horrors or talk openly about them? How can we help children
make sense of a tragedy that we ourselves cannot understand? How
will children react? How can we help our children recover?
Fortunately, there have been relatively few terrorist attacks.
One consequence of this is that there is little empirical
research to help us answer the above questions. Information from
related events can be used to provide answers.
How do children respond to terrorism?
There is a wide range of emotional, behavioral, and
physiological reactions that children may display following a
terrorist attack. From previous research, we know that more
severe reactions are associated with a higher degree of exposure
(i.e., life threat, physical injury, witnessing death or injury,
hearing screams, etc.), closer proximity to the disaster, a
history of prior traumas, being female, poor parental response,
and parental mental health problems.
There is some research on children from the September 11th,
2001 attacks and the Oklahoma City Bombing. In a national sample
of adults surveyed 3-5 days after the September 11th attacks, 35%
of parents reported that their children had at least one stress
symptom and almost half reported that their children were worried
about their own safety or the safety of a loved one. Two factors
related to increased stress symptoms were 1) amout of television
coverage viewed by the child, and 2) parental distress. Children
who watched the most coverage were reported to have more stress
symptoms than those who watched less coverage. Similiarly,
parents who endorsed more stress symptoms were also more likely
to report that their children were upset, indicating a
relationship between parental and child distress.
Findings from a study following the Oklahoma City bombing
indicate that more severe reactions were related to being female,
knowing someone injured or killed, and bomb-related television
viewing and media exposure.
Below are some common reactions that children and adolescents
may display.
Young Children (1-6 years)
Helplessness and passivity; lack of usual
responsiveness
Generalized fear
Heightened arousal and confusion
Cognitive confusion
Difficulty talking about event; lack of verbalization
Difficulty identifying feelings
Nightmares and other sleep disturbances
Separation fears and clinging to caregivers
Regressive symptoms (e.g., bedwetting, loss of acquired
speech and motor skills)
Inability to understand death as permanent
Anxieties about death
Grief related to abandonment by caregiver
Somatic symptoms (e.g., stomach aches, headaches)
Startle response to loud or unusual noises
"Freezing" (sudden immobility of body)
Fussiness, uncharacteristic crying, and neediness
Avoidance of or alarm response to specific trauma-related
reminders involving sights and physical sensations
School-aged Children (6-11 years)
Feelings of responsibility and guilt
Repetitious traumatic play and retelling
Feeling disturbed by reminders of the event
Nightmares and other sleep disturbances
Concerns about safety and preoccupation with danger
Aggressive behavior and angry outbursts
Fear of feelings and trauma reactions
Close attention to parents' anxieties
School avoidance
Worry and concern for others
Changes in behavior, mood, and personality
Somatic symptoms (complaints about bodily aches and
pains)
Obvious anxiety and fearfulness
Withdrawal
Specific trauma-related fears; general fearfulness
Regression (behaving like a younger child)
Separation anxiety
Loss of interest in activities
Confusion and inadequate understanding of traumatic events
(more evident in play than in discussion)
Unclear understanding of death and the causes of "bad"
events
Giving magical explanations to fill in gaps in
understanding
Loss of ability to concentrate at school, with lowering of
performance
"Spacey" or distractible behavior
Pre-adolescents and Adolescents (12-18 years)
Self-consciousness
Life-threatening reenactment
Rebellion at home or school
Abrupt shift in relationships
Depression and social withdrawal
Decline in school performance
Trauma-driven acting out, such as with sexual activity and
reckless risk taking
Effort to distance oneself from feelings of shame, guilt,
and humiliation
Excessive activity and involvement with others, or retreat
from others in order to manage inner turmoil
Accident proneness
Wish for revenge and action-oriented responses to
trauma
Increased self-focusing and withdrawal
Sleep and eating disturbances, including nightmares
Tips for talking with your children about terrorism
Create a safe environment.
One of the most important steps
you can take is to help children feel safe. If possible, children
should be placed in a familiar environment with people that they
feel close to. Keep your child's routine as regular as possible.
Children find comfort in having things be consistent and
familiar.
Provide children with reassurance and extra emotional
support.
Adults need to create an environment in which
children feel safe enough to ask questions, express feelings, or
just be by themselves. Let your children know they can ask
questions. Ask your children what they have heard and how they
feel about it. Reassure your child that they are safe and that
you will not abandon them.
Be honest with children about what happened.
Provide
accurate information, but make sure it is appropriate to their
developmental level. Very young children may be protected because
they are not old enough to be aware that something bad has
happened. School age children will need help understanding what
has happened. You might want to tell them that there has been a
terrible accident and that many people have been hurt or killed.
Adolescents will have a better idea of what has occurred. It may
be appropriate to watch selected news coverage with your
adolescent and then discuss it.
Tell children what the government is doing.
Reassure
children that the state and federal government, police, firemen,
and hospitals are doing everything possible. Explain that people
from all over the country and from other countries offer their
services in times of need.
Be aware that children will often take on the anxiety of the
adults around them.
Parents have difficulty finding a balance
between sharing their own feelings with their children and not
placing their anxiety on their children. For example, the
September 11
th attack on the United States was inconceivable. Our
sense of safety and freedom was shattered. Many parents felt
scared and fearful of another attack. Others were angry and
revengeful. Parents must deal with their own emotional reactions
before they can help children understand and label their
feelings. Parents who are frightened may want to explain that to
their child, but they should also talk about their ability to
cope and how family members can help each other.
Try to put the event in perspective.
Although you yourself
may be anxious or scared, children need to know that attacks are
rare events. They also need to know that the world is generally a
safe place.
What can parents do?
(Excerpted from Monahon)
Infancy to two and a half years:
Maintain child's routines around sleeping and eating.
Avoid unnecessary separations from important
caretakers.
Provide additional soothing activities.
Maintain calm atmosphere in child's presence.
Avoid exposing child to reminders of trauma.
Expect child's temporary regression; don't panic.
Help a verbal child to give simple names to big feelings;
talk about event in simple terms during brief chats.
Give simple play props related to the actual trauma to a
child who is trying to play out the frightening situation
(e.g., a doctor's kit, a toy ambulance).
Zero-to-Three has published excellent guidelines for parents whose very young
children (ages 0 to 3) might have been exposed to media or
conversations about the September 11
th terroristic attacks.
Two and a half to six years:
Listen to and tolerate child's retelling of the event.
Respect child's fears; give child time to cope with
fears.
Protect child from re-exposure to frightening situations
and reminders of trauma, including scary TV programs, movies,
stories, and physical or locational reminders of trauma.
Accept and help the child to name strong feelings during
brief conversations (the child cannot talk about these feelings
or the experience for long).
Expect and understand child's regression while maintaining
basic household rules.
Expect some difficult or uncharacteristic behavior.
Set firm limits on hurtful or scary play and behavior.
If child is fearful, avoid unnecessary separations from
important caretakers.
Maintain household and family routines that comfort
child.
Avoid introducing experiences that are new and challenging
for child.
Provide additional nighttime comforts when possible such as
night-lights, stuffed animals, and physical comfort after
nightmares.
Explain to child that nightmares come from the fears a
child has inside, that they aren't real, and that they will
occur less frequently over time.
Provide opportunities and props for trauma-related
play.
Try to discover what triggers sudden fearfulness or
regression.
Monitor child's coping in school and daycare by expressing
concerns and communicating with teaching staff.
Six to eleven years:
Listen to and tolerate child's retelling of the event.
Respect child's fears; give child time to cope with
fears.
Increase monitoring and awareness of child's play which may
involve secretive reenactments of trauma with peers and
siblings; set limits on scary or hurtful play.
Permit child to try out new ways of coping with fearfulness
at bedtime: extra reading time, leaving the radio on, or
listening to a tape in the middle of the night to erase the
residue of fear from a nightmare.
Reassure the older child that feelings of fear and
behaviors that feel out of control or babyish (e.g., bed
wetting) are normal after a frightening experience and that he
or she will feel better with time.
Eleven to eighteen years:
Encourage adolescents of all ages to talk about the
traumatic event with family members.
Provide opportunities for the young person to spend time
with friends who are supportive.
Reassure the young person that strong feelings-guilt,
shame, embarrassment, or a wish for revenge-are normal
following a trauma.
Help the young person find activities that offer
opportunities to experience mastery, control, and
self-esteem.
Encourage pleasurable physical activities such as sports
and dancing.
How many children develop PTSD after a terrorist attack?
The above symptoms are normal reactions to trauma and do
not necessarily mean that a child has acquired a disorder.
However, a significant minority of children will develop
posttraumatic stress symptoms after a terrorist attack.
Findings from Oklahoma City indicate that:
Children who lost a friend or relative were more likely to
report immediate symptoms of PTSD than non-bereaved
children.
Arousal and fear presenting seven weeks after the bombing
were significant predictors of PTSD.
Two years after the bombing, 16% of children who lived
approximately 100 miles away from Oklahoma City reported
significant PTSD symptoms related to the event. This is an important finding because these youths were
not directly exposed to the trauma and were not related to
people who had been killed or injured.
PTSD symptomatology was predicted by media exposure and
indirect interpersonal exposure, such as having a friend who
knew someone who was killed or injured.
No study specifically reported on rates of PTSD in children
following the bombing. However, studies have shown that as many
as 100% of children who witness a parental homicide or sexual
assault, 90% of sexually abused children, 77% of children
exposed to a school shooting, and 35% of urban youth exposed to
community violence develop PTSD.
When should you seek professional help for your child?
Many children and adolescents will display some of the
symptoms listed above as a result of terrorist attacks. Most
children will likely recover in a few weeks with social support
and the aid of their families. Many of the above suggestions will
help children recover more quickly. Other children, however, may
develop PTSD, depression, or anxiety disorders. Parents of
children with prolonged reactions or more severe reactions may
want to seek the assistance of a mental-health counselor. It is
important to find a counselor who has experience working with
children as well as with survivors of trauma. Referrals can be
obtained through the American Psychological Association at
1-800-964-2000. Also visit the website of the National Child Traumatic Stress Network
References
1.Schuster, M.A., Stein, B.D., Jaycox, L.H., Collins, R.L.,
Marshall, G.N., Elliott, M.N., et al. (2001). A National Survey
of stress reactions after the September 11, 2001 terrorist
attacks.
New England Journal Medicine, 345, 1507-1512.
2. Pfefferbaum, B., Nixon, S., Tucker, P., Tivis, R., Moore,
V., Gurwitch, R., Pynoos, R., & Geis, H. (1999).
Posttraumatic stress response in bereaved children after
Oklahoma City bombing.
Journal of the American Academy of Child and Adolescent
Psychiatry, 38, 1372-1379.
3.
Pfefferbaum, B., Seale, T.,
McDonald, N., Brandt, E., Rainwater, S., Maynard, B.,
Meierhoefer, B. & Miller, P. (2000). Posttraumatic stress
two years after the Oklahoma City bombing in youths
geographically distant from the explosion.
Psychiatry, 63, 358-370.
4.
DeWolfe, D. (2001).
Mental Health Response to Mass Violence and Terrorism: A
Training Manual for Mental Health Workers and Human Service
Workers.
5.
Pynoos,
R. & Nader, K. (1993). Issues in the treatment of
posttraumatic stress in children and adolescents. In J.P. Wilson
& B. Rapheal (Eds.),
International Handbook of Traumatic Stress Syndromes (pp.
535-549). New York: Plenum.
6.
Monahon, C. (1997).
Children and Trauma: A Guide for Parents and
Professionals. San Francisco: Jossey Bass