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National Youth Violence Prevention Resource Center

A Federal resource for professionals, parents and youth working to prevent violence committed by and against young people.

Responding to Terrorism and War - Information for Researchers, Health Practitioners, and Other Professionals
(Printable Version)

Reducing the Impact of Terrorism and War on Children and Youth

Because of the potential for long-term psychological harm as a result of terrorist attacks, it is crucial that strategies be implemented to reduce the impact of terrorism and war on children and youth. One approach is to foster resilience and bolster support for all children and youth so that they are more able to cope when confronted with traumatic events. A second approach is to ensure that after an attack, children, youth and their families are provided with support. Traumatized children and youth must be identified early and receive appropriate treatment in order to prevent the development of lifelong mental health problems.

Foster resilience and bolster support so children and youth are more able to cope in times of traumatic stress.

Based on our knowledge of the factors that put a child or youth at risk for serious emotional problems after traumatic events, it is possible to identify a number of strategies to increase resiliency and decrease children's vulnerability when confronted with traumatic events.

  1. Strengthen and support families. Children and youth who have the support of their parents after an attack are far more likely to recover quickly from the traumatic events. Yet some families are far more capable than others of adapting to stressful events and providing support for children. Programs that strengthen and support families and reduce their isolation may play a key role in increasing resiliency.[1,2]
  2. Strengthen the links between children and youth and other caring adults in the community. The impacts of trauma are lessened when children and youth have a strong relationship with a competent caring adult.[3] While this adult is generally a parent, relationships with other adults in the community can be crucial in instances where the family is unwilling or unable to provide the needed support and guidance. When children and youth participate in after-school, recreational, or mentoring programs run by schools, community groups, or churches, they are more likely to develop these critical relationships with adults in the community.
  3. Work to prevent child abuse, domestic violence, and violence in the community. Children and youth with previous exposure to violence are at greater risk for developing long-term emotional problems after exposure to a traumatic event.[4,5,6] An estimated 5.8 million (or 26% of adolescents) have been victims of physical and sexual violence and an estimated 8.8 million (or 39% of adolescents) have been witnesses to violence.[7] By reducing child abuse, domestic violence, and community violence, we prevent children and youth's exposure to these types of violence and the subsequent development of mental health problems that can decrease their resiliency in the face of terrorist attacks.
  4. Increase mental health screening and children and youth's access to mental health care. Children who have previously been exposed to traumatic events or who have pre-existing mental health problems are at greater risk after a terrorist attack. If these children can be identified and receive appropriate treatment before and after terrorist violence occurs, they may be less likely to develop serious emotional problems in the aftermath of terrorist violence.[8]

After a terrorist attack, provide support to children, youth and their families. Ensure that traumatized children and youth are identified early and receive treatment in order to prevent the development of lifelong psychological problems.

In the aftermath of terrorist violence, families are the first line of defense. In order for parents to be able to support their children, however, their own the needs must first be addressed. Some parents require treatment and support in order to deal with their reactions to the traumatic events and to develop the coping skills necessary to allow them to help their children.[9] All parents need information about the variety of posttraumatic symptoms and problems that may affect their children along with guidance about how best to meet their children's needs. Parents and other supportive adults must provide reassurance, re-establish a sense of security, increase caregiving in response to attachment behaviors, tolerate regression, and encourage open communication among family members. The creation of a general atmosphere of support and acceptance of posttraumatic reactions is crucial.[10]

Schools can also play an important role in supporting children after terrorist attacks. However, teachers, counselors and administrators may themselves be traumatized and need support before they can help children. While school-based prevention and treatment efforts have been shown to be effective for traumatized children or children at risk for trauma, it is important that school-based programs not supplant efforts to identify and refer children in need of more intensive individual work.[11] Because parents and teachers often underestimate the extent of children's suffering, disaster mental health efforts must systematically identify youth in need of attention.[12,13] After the Oklahoma City bombing, mental health professionals were able to use the school system as a vehicle for screening and assessing 6500 children. They found that 9% of the children were judged to be at risk, and further intervention services were made available to them.[14]

It is also important for primary care physicians to be trained to recognize signs of PTSD and to separate out symptoms associated with trauma from those associated with physical conditions. Physicians need to be provided with information about mental health resources and community groups that can provide treatment and support to children and youth suffering from PTSD.

When children require professional treatment, a number of approaches are available. Unfortunately, there is little evidence for the efficacy of the majority of these approaches in treating children and youth with PTSD. Further research is needed to assess the effectiveness of these approaches with different groups of children and youth and to identify the risks and benefits of the different approaches. A number of studies have documented the effectiveness of one approach: cognitive behavior therapy, or CBT.[15]

Despite the paucity of empirical treatment outcome studies, there is generally strong clinical consensus among experts in the field regarding essential components of appropriate treatment interventions for children and youth with PTSD. These components are direct exploration of the trauma, use of specific stress management techniques, exploration and correction of inaccurate attributions regarding the trauma, and inclusion of parents in treatment. Although few studies have examined the use of medications in children after a disaster, they are occasionally used as an adjunctive therapy when symptoms are disabling.[16]

  1. Kiser, L. J., Ostoja, E., Pruitt, D.B. (1998). Dealing with stress and trauma in families. Child and Adolescent Psychiatric Clinics of North America, 7(1) 87-103.
  2. Bell, C. C. (2001). Cultivating resiliency in youth. Journal of Adolescent Health, 29(5), 375-81.
  3. Osofsky, J.D. (1999). The impact of violence on children, The Future of Children, 9(3), 33-49.
  4. Garbarino, J., Kostelny, K., Dubrow, N. (1991). What children can tell us about living in danger. American Psychologist, 46(4): 376-83.
  5. Duncan, R.D., Saunders, B.E., Kilpatrick, D.G., Hanson, R.F., Resnick, H.S. (1996). Childhood physical assault as a risk factor for PTSD, depression, and substance abuse: findings from a national survey. American Journal of Orthopsychiatry, 66(3): 437-48.
  6. Boney-McCoy, S,, Finkelhor, D. (1995). Prior victimization: a risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Child Abuse and Neglect, 19(12): 1401-21.
  7. Kilpatrick, D., & Saunders, B. (1997). The Prevalence and Consequences of Child Victimization. Washington, DC: National Institute of Justice.
  8. Bell, C. C. (2001). Cultivating resiliency in youth. Journal of Adolescent Health, 29(5), 375-81.
  9. Kiser, L. J., Ostoja, E., Pruitt, D.B. (1998). Dealing with stress and trauma in families. Child and Adolescent Psychiatric Clinics of North America, 7(1) 87-103.
  10. Kiser, L. J., Ostoja, E., Pruitt, D.B. (1998). Dealing with stress and trauma in families. Child and Adolescent Psychiatric Clinics of North America, 7(1) 87-103.
  11. Pfefferbaum, B. (1997). Posttraumatic stress disorder in children: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36(11), 1503-1511.
  12. Handford, H. A., Mayes, S.D., Mattison, R.E. et al. (1986). Child and parent reaction to the Three Mile Island nuclear accident. Journal of the American Academy of Child Psychiatry, 25, 346-356.
  13. Yule, W., & Williams, R.M. (1990). Post-traumatic stress reactions in children. Journal of Traumatic Stress, 3, 279-295.
  14. Allen, J.R., Whittlesey, S., Pfefferbaum, B., Ondersman, M.L. (1999). Community and coping of mothers and grandmothers of children killed in a human-caused disaster. Psychiatric Annals, 29(2): 85-91.
  15. American Academy of Child and Adolescent Psychiatry. (1998). Summary of the practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (10 Supp.).
  16. American Academy of Child and Adolescent Psychiatry. (1998). Summary of the practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 37 (10 Supp.).