The vast majority of American children probably were not traumatized by the Sept. 11 terrorist attacks, experts say. There are, however, clear exceptions, as research on kids in New York City shows.
A study commissioned by the New York public school system six months after the attacks found that city school kids had a higher rate of mental problems than would be expected under normal circumstances. More than 10% of the students surveyed had symptoms of posttraumatic stress disorder (PTSD). These symptoms include flashbacks to the event, feeling numbness or detachment from everyday life, irritability, angry outbursts, and trouble concentrating.
This study looked at children in grades four to 12. Another study under way aims to find out how the attacks have affected preschoolers and kindergartners. Ellen Devoe, PhD, a professor at New York's Columbia University, leads the research. "We definitely know that many of the younger kids were affected," she says. The study won't be completed for several weeks, but she says she expects results similar to those of the New York City public schools study.
Devoe says children living near Ground Zero seem to have had it worst, but it seems the experience was less traumatic for kids uptown. That would stand to reason. "As a rule, physical proximity is the most powerful predictor of emotional injury or traumatization," says Steve Brock, PhD, spokesman for the National Association of School Psychologists. The closer the kids were to the towers, the more horror they were likely to have witnessed firsthand. What's more, "One of the things that makes events more or less traumatic is duration," he says. Families in lower Manhattan were displaced from their homes for months in some cases, and they had to live with the recovery effort going on under their windows when they returned.
"It's all impressions at this point," Devoe says, but she has seen a wide range of reactions among children in the city. "I think that probably bodes well for kids in the rest of the country."
Results from the New York City schools study also show a greater impact on children who had a loved one injured or killed that day. Even those who had loved ones escape unharmed from the site were more likely to have PTSD. Many of the people at the World Trade Center that morning were from out of town, so children in those families may have suffered more trauma. Nevertheless, for the millions of kids across the nation whose only contact was via the media, the way they cope may be determined by how the adults closest to them are getting on. "Young children are especially sensitive to stress in their caregivers," Devoe says.
"You can make a relatively stressful event into a crisis if you treat it as such," Brock says. "What caregivers need to do is take their lead from the kids they're caring for." If a child seems unusually affected by what happened, special counseling may be helpful. But if the child's reaction has been sanguine, extra attention may make things worse.
The grownups who tie children's shoes and pack their lunches are not the only ones in their lives. Adults running TV stations have a major influence, too.
Robin Gurwitch, PhD, a psychologist at the University of Oklahoma Health Sciences Center, studied the effect of television on Oklahoma City middle school students after the 1995 bombing of the federal building. She and her colleagues found that kids who watched a lot of television after the explosion were more likely to have symptoms of PTSD. Though about two-thirds of the students heard or felt the blast, and one-half knew someone killed or injured, even those who had no such connection to the event showed signs of PTSD if they watched a lot of TV news coverage.
Gurwitch says it's not clear whether their symptoms were a direct result of seeing horrific images on the screen or whether they watched because they were traumatized. But the findings suggest that kids who stayed glued to the news on Sept. 11 and afterward may have been more affected than those whose viewing was limited.
On the anniversary of the attacks, parents and teachers should be mindful of their kids' media consumption, Gurwitch says. "I think you're going to see a potential increase in stress reactions." TV viewing should be "significantly limited for younger children." File footage from that morning will be shown, and "a 3-year-old might not understand that this is something replayed," she says. A very young child may think it's happening all over again. She says parents should take the opportunity to watch some of the anniversary coverage with older kids and discuss the meaning of it all.
In Years to Come
Asked whether American kids will have lifelong scars from Sept. 11, Gurwitch says, "On the whole, I think children are fairly resilient."
Brock agrees. For kids living far away who didn't have loved ones directly involved, "It won't be a serious issue," he says. "Most people do recover from these kinds of events -- even the kids in New York."
People who have survived other acts of terror against civilians attest to this. In September 1939, millions of British children were evacuated from London as attacks from Nazi Germany seemed imminent. Many children lived with strangers in the countryside during the weeks of air raids that followed, but some returned to the city because they couldn't find a suitable host family. Eddie Terry, 68, was one of the children who returned and lived through the bombing. "We had no counseling," he tells WebMD in an email. "People were killed near you and you lost school friends and neighbours but this was life and war." He maintains that the experience did not damage him permanently.
Evacuee Mara Culleton, 6 years old at the time, also returned to London during the bombing. "I may have had long-term echoes of the war," she writes. "If that is so they go unnoticed, except that when I have experienced turmoil, I have great resilience and strength of character and maybe this is my heritage."
Another evacuee, Roger Stanley, who was 4 years old in 1939, says the experience had one major impact on his character. "I have been a confirmed pacifist most of my life."
Exactly what effect the Sept. 11 attacks will have on American kids as they grow up remains to be seen. "The proper, science-based answer is, nobody knows," says Louis Cooper, MD, president of the American Academy of Pediatrics. But he urges parents and other caregivers to see it all in perspective. "Raising children is a balancing act."
Cooper's mission is to make sure the special needs of children are included in any national agenda. Knowledge of how terrorism affects American kids will help serve their needs, he says, "but knowledge that loses perspective is not helpful." Terrorism is just one among many threats to American children's mental health.