Preschoolers' exposure to terrorist attacks, other trauma linked to more severe behavioral problems

Preschool children exposed to both the World Trade Center attacks and another traumatic event were more likely to experience behavioral problems than children exposed only to one event or to none, according to a report in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Young children may be especially vulnerable to the adverse psychological consequences of trauma, according to background information in the article. However, little is known about the effect of terrorism on preschoolers.

Claude M. Chemtob, Ph.D., of the Mount Sinai School of Medicine, New York, and colleagues studied 116 preschool children (average age 3.9) directly exposed to the World Trade Center (WTC) attacks. Between March 2003 and December 2005—an average of 35 months after the attacks—the parents of children who lived or attended preschool in lower Manhattan filled out a questionnaire about their children, providing information on demographics, level of exposure to the attacks, occurrence of other traumatic events (such as the death of a family member, being in a natural disaster or seeing a serious accident) and emotional and behavioral factors.

Of the children participating, 23 percent were exposed to one or more high-intensity WTC events, meaning that they saw the towers collapse, saw injured people, saw dead bodies or saw people jumping out of buildings. Overall, these children had nearly five times the odds of having trouble sleeping and had almost three times the odds of being depressed and anxious than those who were not exposed.

These behavior problems appeared more severe among children who had also experienced another traumatic event. Compared with children who were not exposed to high-intensity WTC events or to other trauma, those who were exposed to both had 21 times the odds of having emotional problems or being anxious or depressed and 16 times the odds of having attention problems. Those who were exposed only to high-intensity WTC events and not to other traumatic events were not significantly more likely to have behavioral problems than those with only less intense exposure to the attacks.

The findings are consistent with an allostatic load theory of stress, which holds that accumulated exposure to difficult events increases the risk of psychological effects, the authors note. “Physicians seeking to assess the impact of terrorism and disaster on very young children should assess for disaster-related exposure and for other trauma,” they write. “More vigorous outreach to trauma-exposed preschool children should become a post-disaster public health policy.”

(Arch Pediatr Adolesc Med. 2008;162[2]:126-133. Available pre-embargo to the media at www.jamamedia.org.)

Editor’s Note: This study was partially supported by a grant from the National Institute of Mental Health and by grants from the New York Times Foundation’s September 11 Fund, National Philanthropic Trust/Sept. 11th Children’s Fund, United Jewish Communities, UJA Federation of New York, the UBS September 11 Fund, the Robin Hood Foundation, the Picower Foundation, an anonymous donor, the American Red Cross, Andor Capital Management and Strook, Strook and Lavan LLP. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.