31.19d Impact of Terrorism on Children
1323
this assessment has been determined, the next steps can be taken
to begin the road to recovery.
Perception of Safety
The notion of perceived safety is an important protective fac-
tor as well as a component of recovery for a child, adolescent,
or adult who has been exposed to terrorism. A recent report of
symptoms of PTSD, depression, and perceived safety in disaster
workers 2 weeks after the September 11
th
terrorist attacks found
that lower perceived safety was associated with increased symp-
toms of hyperarousal and intrusive fearful thoughts, but not
avoidance. An expected diminished sense of safety was found
in those individuals who had personally been in greater physical
danger, or who had worked with dead bodies compared with
others who were physically less exposed. To regain a sense of
security, reestablishment of a perception of safety is a necessary
first step.
Reestablishment or Maintenance of
Daily Routines
Although it is clearly not always possible to maintain usual daily
routines amidst war or exposure to terrorism, a study of Israeli
adolescents found that those whose families were able to main-
tain their usual activities, such as attending school and family
functions, were at lower risk for the development of posttrau-
matic reactions.
Proactive Interventions to Enhance Resilience
Perceived personal resilience has been shown to be protective
against symptoms of posttraumatic stress development. Proactive
interventions aimed at enhancing a sense of personal resilience
and an ability to cope with the stressful situation may serve to
decrease the risk of psychiatric symptoms after exposure to ter-
rorism. Interventions may include regaining a sense of perceived
safety through reestablishing routines, altruistic tasks, family pre-
paredness planning, and parental expression of security.
R
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before it crashed. While his therapist could fly the plane, he would
overpower the “hijackers” and throw them off the plane, and then
the plane would land safely in Boston. Jason continued his wish that
after landing, his father and the other passengers tell him “thank
you,” and be very happy. After expressing his wish verbally, he
appeared to be somewhat comforted and he began to recall many
positive activities with his father, and a series of happy, highly
detailed memories of his father, which then caused him to suddenly
become tearful with profound sadness at the realization that these
would be no more.
In therapy, Jason alternately expressed rage and anger and con-
fusion about the actions of “Osama Bin Laden.”Over many months,
Jason was able to remember and speak about the good things he
remembered about his father without immediately breaking down
in tears. Jason become a helpful big brother, who often tried to
care for his younger siblings, and his mother often told him how
proud she was of him. (Adapted from Robert S. Pynoos, M.D.
M.P.H., Merritt D. Schreiber, Ph.D., Alan M. Steinberg Ph.D., Betty
Pfefferbaum, M.D., and J.D.)
To respond to the mental health needs of children and ado-
lescents who have been exposed to terrorism either through
personal experience or through exposure to media depicting
world-wide terrorism, the adverse psychological reactions listed
in Table 31.19d-2 must be considered.
Components of Mechanisms for
Recovery from Exposure to Terrorism
In order to begin the process of recovery from exposure to mass
trauma, an assessment of a child’s current coping must be done.
Numerous instruments to measure coping exist. These include
COPE, a self-report questionnaire which has 52 items that can
be used with children, adolescents and adults; Children’s Cop-
ing Strategies Checklist (CCSC), a self-report questionnaire
with 45 general coping items used with children 9 to 13 years of
age; and How I Coped Under Pressure (HICIPS), which has 45
event specific questions for children in the 4
th
to 6
th
grade. Once
Table 31.19d-2
Psychological Disorders Associated with Terrorism
Acute stress disorder
PTSD
Depression
Anxiety
Separation anxiety disorder
Agoraphobia
Phobic disorders
Bereavement
Somatization
Irritability
Dissociative reactions
Sleep disturbances
Diminished self-esteem
Deterioration in school performance
Distress when exposed to traumatic reminders
Substance abuse
