31.19d Impact of Terrorism on Children
1321
effectiveness of Boston’s medical and law enforcement teams
in response to the terrorist bombings may have promoted some
degree of resilience in the population.
A unique aspect of exposure to terrorist-related trauma,
as well as school shootings, is the psychological effects of
knowing that the trauma was both consciously and purposely
perpetrated, and yet also random. The random nature of ter-
rorist attacks appears to lead to especially adverse reactions in
children. School shootings are among the most tragic of trau-
matic events involving youth. On December 14, 2012, in the
village of Sandy Hook, in Newtown, Connecticut, a 20-year-
old male in black clothing carrying his mother’s rifle, shot his
way through a glass window at the front of the Sandy Hook
Elementary School, rampaged the school, shooting and killing
20 first-grade students from multiple classrooms and 6 school
personnel, and then shot and killed himself. He had shot and
killed his mother before arriving at the school. The psychologi-
cal impact of this massacre on children who survived is mod-
erated by age, gender, and family reactions. Younger children
appear to be at higher risk for posttraumatic stress disorder,
somatic symptoms, depression, and distress than older chil-
dren and adolescents. Gender also has been found to influence
behavioral symptoms after exposure to severe trauma or ter-
rorism, with girls experiencing higher levels of posttraumatic
stress syndromes and depression, while boys exhibit more
external behavior problems.
Although the United States has launched a series of initia-
tives in response to the threats and consequences of terrorism
in the form of an act of Congress in 2002 called the Public
Health Security and Bioterrorism Preparedness and Response
Act, children and adolescents continue to view media exposure
to terrorist events throughout the world that reinforces a sense
of danger.
The concept of terrorist acts is characterized by three distinct
features: (1) They produce a societal atmosphere of extreme
danger and fear, (2) they inflict significant personal harm and
destruction, and (3) they undermine the expectation of citizens
that the state is able to protect them.
Child and adolescent reactions to exposure to terrorism are
mediated by numerous factors, including personal appraisal
of persisting danger, the likelihood of recurrent attack, and
the perception of the relative safety of one’s family and close
friends. Children’s responses to terrorist exposure are influ-
enced by how their parents cope with the trauma and resulting
turmoil and how well they understand the situation. PTSD has
been studied in adolescents, with and without learning disabili-
ties, who have been exposed to terror attacks. Findings from
this study revealed that personal exposure to terror, past per-
sonal life-threatening events, and history of anxiety all con-
tributed to the development of posttraumatic stress reactions.
In addition, adolescents with learning disabilities who had dif-
ficulties in cognitively processing the traumatic events were at
higher risk of developing PTSD when this was combined with
the other high risk factors, such as being personally exposed to
the traumatic events.
Table 31.19d-1 identifies the relationship between objective
features of danger and subjective features related to exposure to
terrorist acts.
The following summarizes data collected after the terrorist
attack of the World Trade Center on September 11, 2001.
September 11, 2001 Attacks
The U.S. Department of Education, through Project SERV, sup-
ported the New York City Board of Education in conducting a
needs assessment of New York City schoolchildren. A total of
8,000 randomly selected students were surveyed 6 months after
the September 11, 2001 attacks. Striking differences were seen
among students in the vicinity of Ground Zero as compared
with students in the rest of the city, in exposure to smoke and
dust, fleeing for safety, problems getting home, and smelling
smoke in the days and weeks after September 11. Approxi-
mately 70 percent of all children, however, were exposed to one
of these factors. Interpersonal exposure through direct victim-
ization of a family member was greater among children attend-
ing schools outside the Ground Zero vicinity as compared
with those attending school in this area. Media exposure was
extensive and prolonged. Signs of heightened security were
visible throughout the city. The study used several scales of
the
Diagnostic Interview Schedule for Children
(DISC). Three
sets of findings stand out from this study. First a significant
degree of persistent separation anxiety was seen, especially
among school-age children, but also among adolescents. Sec-
ond, reflecting an age-related vulnerability to incident-specific
new fears (e.g., subways and buses) and avoidant behavior of
school-age children, a nearly 25 percent rate of agoraphobia
was reported among 4
th
- and 5
th
-graders. Care must be taken,
however, not to misrepresent
incident-specific new fears
as
agoraphobia, because the course of recovery and intervention
strategies may differ. Third, an enormous reservoir of prior trau-
matic experiences (more than one half of the total sample) was
Table 31.19d-1
Experience of Danger Consequent to Terrorist Acts
Objective Features
Subjective Features
Actualized threat
Realistic threats
False alarms
Hoaxes
Official risk
communication,
media coverage, and
personal exchanges of
information
Heightened security
Mobilization of prevention
and response
capabilities
Attribution of
responsibility
Evacuation and rescue
efforts
Military mobilization
War
Additional dangers,
terrorist acts, and
personal tragedies
Disruption of protective shield
Appraisals of threat
Fears of recurrence
Living with uncertainty
Ongoing worries about significant
others
Modulation of information
exposure
Safety and protective behaviors
Anxious and restrictive behaviors
Aggressive and reckless behaviors
Categorization over
discrimination of threat—risk of
intolerance
Themes of heroism and patriotism
Political ideology
—
Changes in spiritual schema
Parental demoralization
(Courtesy of Robert S. Pynoos, M.D. M.P.H., Merritt D. Schreiber, Ph.D.,
Alan M. Steinberg Ph.D., and Betty Pfefferbaum, M.D., J.D.)
