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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.

Information for Researchers, Health Practitioners, and Other Professionals
(Printable Version)

Reactions to Terrorist Violence

In the immediate aftermath of a traumatic event, such as a terrorist attack, it is normal for children and youth to display a variety of reactions, including trauma-specific fears, fears of recurrence, generalized anxiety, separation anxiety, arousal, difficulties in concentration, depression, intrusive recollections associated with the event, posttraumatic play, behavioral re-enactments, regressive behaviors, somatic ills, sleep disturbances, avoidance of traumatic reminders, behavioral and school problems, and changed attitudes about the self, others and the future.[1,2] These reactions are most often normal responses to abnormal situations.

In the days following the September 11th terrorist attacks, a national survey of parents was conducted. Thirty-five percent of parents reported that their children had at least one of five stress symptoms; 47 percent reported that their children had been worrying about their own safety or the safety of loved ones.[3]

The specific reactions displayed after a traumatic event will vary with a child's age and developmental stage.[4]

Preschool children's responses are highly influenced by the emotional state and behavior of their caregivers. They may exhibit a variety of behaviors including thumb sucking, enuresis, clinging, whining, night terrors, and wanting to sleep with their parents. Crying, immobility, irritability, behavior disorders, and reenactment of the trauma in drawings, stories, and play are also common.

Elementary school-aged children may exhibit a variety of responses, including fears about their safety, worries that the disaster will recur, separation anxiety, withdrawal, regression, nightmares, irritability, disobedience, increased hostility, somatic complaints, school refusal, behavior problems, decreased school performance, poor concentration, and distractability.

Adolescents' reactions are similar to those of adults. Withdrawal and isolation, somatic complaints, depression and sadness, emotional numbing, irritability, aggressive or antisocial behavior, lack of concentration, decreased school performance, sleep disturbance, loss of interest in hobbies, increased risk-taking behavior, and substance abuse are common.[5,6,7]

While stress reactions after a traumatic event are common, the majority of children and youth recover with the support of their families. Unfortunately, some children and youth develop long-term psychiatric problems, such as posttraumatic stress disorder. Posttraumatic stress disorder (PTSD) is a mental disorder resulting from exposure to an extreme traumatic stressor. Children and youth with PTSD have three general types of symptoms:

  1. Persistent reexperiencing of the stressor (e.g., recurrent and intrusive distressing memories; repetitive play and behavioral reenactment; recurrent distressing dreams, and feeling as if the trauma were recurring);
  2. Persistent avoidance of reminders of the event and numbing of general responsiveness (e.g., efforts to avoid thoughts, feelings or conversations associated with the trauma and other reminders of the event, amnesia about important aspects of the event, diminished interest or participation in normal activities, and detachment or estrangement from others); and
  3. Persistent symptoms of arousal (e.g., sleep difficulties, irritability or angry outbursts, difficulty concentrating, hypervigilance, or an exaggerated startle response).

In order for a formal diagnosis of PTSD, symptoms from all three of these symptom clusters must be present, must cause significant distress or impairment in functioning, and must endure for more than 1 month.[8]

Children and youth who have experienced trauma are also at a heightened risk for developing other psychiatric problems, often in addition to PTSD. One commonly co-occurring disorder is major depression. Others include substance abuse, other anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder.9 Children and youth with PTSD also commonly experience deterioration in their overall health.[10]

Six months after the September 11th attacks, a survey was conducted with over 8000 New York City public school students, in grades 4-12. Based on the results of this survey, it was estimated that as many as 10.5 % of children in New York City had symptoms consistent with PTSD and 26.5% had at least one mental health problem (e.g., major depression, generalized anxiety, agoraphobia, separation anxiety, or conduct disorder) and required some form of intervention. Rates for all mental health problems were higher than one would expect in an urban population of children and youth.[11]

While the majority of children and youth recover from PTSD within a few months, for some the condition will persist for many years and may affect the rest of their lives.[12]

  1. Shaw, J.A. (2000). Children, adolescents, and trauma. Psychiatric Quarterly, 71(3), 227-243.
  2. Gurwitch, R. H., Sullivan, M.A., Long, P.J.(1998). The impact of trauma and disaster on young children. Child and Adolescent Psychiatric Clinics of North America,, 7(1), 19-32
  3. Schuster, M. A., Stein, B.D., Jaycox, L.H., Collins, R. (2001). A national survey of stress reactions after the September 11, 2001, terrorist attacks. The New England Journal of Medicine, 345(20), 1507-1512.
  4. Shaw, J.A. (2000). Children, adolescents, and trauma. Psychiatric Quarterly, 71(3), 227-243.
  5. Gurwitch, R. H., Sullivan, M.A., Long, P.J.(1998). The impact of trauma and disaster on young children.Child and Adolescent Psychiatric Clinics of North America,, 7(1), 19-32
  6. Flynn, B.W., Nelson, M.E. (1998). Understanding the needs of children following large-scale disasters and the role of government. Child and Adolescent Psychiatric Clinics of North America,, 7(1), 211- 227.
  7. Coffman, S. (1998). Children's reactions to disaster. Journal of Pediatric Nursing, 13(6), 376-382.
  8. Cohen, J. A. (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.),
  9. Hamblen, J. PTSD in Children and Adolescents. National Center for Post-Traumatic Stress Disorder, Department of Veterans Affairs.
  10. Yule, W. (2001). Posttraumatic stress disorder in the general population and in children. Journal of Clinical Psychiatry, 62(suppl 17), 23-28.
  11. Yule, W. (2001). Posttraumatic stress disorder in the general population and in children. Journal of Clinical Psychiatry, 62(suppl 17), 23-28.