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The psychological state of the people of the United States was altered dramatically by the attacks of September 11th. We learned that we are not protected from massive violence directed at ordinary citizens. We learned that typical experiences could be fraught with unexpected danger, so that travel, airplanes, tall buildings, and the daily mail could be deadly.

This new awareness has caused fear, anxiety, and emotional distress in New York, Washington, rural Pennsylvania and the rest of the country. The attacks created an emotional flu that was contagious, spread rapidly, and, then, gradually dissipated for most people. However it continues to affect many. Government officials and experts highlight the need to remain alert, indicating that other terrorist attacks, perhaps much smaller in scope, are likely to occur in the future.

Educators, pediatricians, and parents have been advised to be aware of symptoms of excessive distress in children who have directly or indirectly witnessed the attacks or who seem preoccupied with the war against terrorism. Based on knowledge gained after the Oklahoma City bombing and other places where terrorism or war have struck, we are aware that the likely forms of distress include heightened anxiety, avoidance of feared situations, physical symptoms indicating stress such as stomachaches, headaches, and general malaise, and, in adolescence, increased use of substances. Children who were worriers before the attacks may have had their worries intensified or confirmed. We also know the traumatic nature of a death can complicate the bereavement process for children.

Despite the potential for mental health problems, research on the capacity of children to overcome disastrous life events or living circumstances indicates that children can emerge from horrific life experiences with positive outcomes. Studies have carefully reviewed the adjustment of children in war-torn countries such as Cambodia, Bosnia, and Kosovo, areas of high terrorist activity, such as Lebanon, Israel, and the Palestinian territories, and areas of violence and poverty, such as depressed regions of the United States.

Follow-up studies of children who have lost loved ones through death and reviews of children's adjustment after they have witnessed life-threatening natural disasters provide evidence that children can do well under certain circumstances. Many children who have experienced tragedy or witnessed life-threatening events emerge with a positive outlook on life, have a good capacity to form positive, fulfilling relationships, achieve a high level of personal success, and develop effective resources for dealing with future negative events.

People caring for children and adolescents can do much to foster such positive outcomes.

Following are some suggestions for adults to help children and adolescents cope with frightening and tragic events:

  • Help children establish and maintain a close relationship with an adult: Under even the harshest circumstances, children do well when they have a relationship with at least one adult who is extremely supportive and accepting. Children who have someone who frequently spends time with them, is concerned about their welfare, and provides them with guidance, discipline, and information do much better than children without such a relationship. Most often this relationship is with parents, but others can also supply support, guidance, and affection.
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  • Be sure that children and teens know ways to calm themselves: All people manage stress better if they know some method for relieving mental and physical tension. Even in war zones, children usually find a means to play, which naturally relieves tension. Give children the opportunity to relax through play, talk, art activities, music, or physical comforting. Exercise, muscle relaxation techniques, deep breathing exercises, and using calm mental images are techniques proven to reduce stress. Teenagers should be advised to avoid unhealthy means of stress reduction such as smoking, alcohol, and drugs. Talk to a professional to learn more about these methods.
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  • Take steps to insure children's safety: Government agencies, organizations, and private citizens have all made efforts to increase surveillance and security. Be aware of recommendations from security experts to determine what steps should be taken in the future. Make sure that settings where children gather have closed any security gaps. Ask questions to determine who is able to visit settings where children spend their time. Be alert in settings where large numbers of people gather. Also, raise appropriate questions of public officials to ensure appropriate precautions are in place. Secure environments will enable children to spend their time on the main tasks of childhood: playing, learning, and growing.
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  • Help children understand the real statistical probability of tragedy and disaster: We have a tendency to believe events that have a great impact on our lives happen with greater frequency than they really do. Children easily identify with others, so they may personalize negative events and believe they could easily happen to them. This belief may lead to undue fright and persistent anxiety. Help children recognize that the awful events are very unlikely to happen to them or members of their family. Keep in mind several facts. Despite the great loss of life that occurred on September 11, many people were not physically harmed on that day. Many people on airplanes at the time of the attacks returned to the ground safely, the vast majority of people in the World Trade Center and the Pentagon were not physically harmed, and many other buildings, cities and areas throughout the United States were not physically affected. A realistic outlook should help children remain alert to dangers, but free from constant worries that they will be harmed.
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  • Watch for negative reactions and provide early assistance, or treatment, when necessary: Although it may seem that the attacks are long past, psychological reactions to the attacks are still likely. In fact, people often do not experience problematic reactions until 3 months after an event. Be on the alert for anxiety reactions manifested as chronic irritability, persistent worries about safety for themselves and others, avoidance of situations that arouse anxiety, and limited concentration on usual activities. Some older children and teens may demonstrate signs of depression such as limited investment in their futures, lack of energy, pessimistic statements, and involvement with substances. Some children may demonstrate increased aggression and anger. Behaviors that interfere with daily functioning and that last for more than a week or two should be discussed with the child's doctor or school personnel. Mental health professionals should be consulted for a full assessment so that appropriate treatment can be provided. Untreated anxiety, depression, and aggression can interfere with a child's ability to function at home, in school, with friends.
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  • Keep children informed about related events: Information filters down to children, even in preschool settings, through overheard conversations, news reports, and discussions among older children. Thus, children may get a distorted understanding that may be more frightening than the truth. The important adults in children's lives should provide an age-appropriate report of the facts which will enable the children to understand the scope of the events. Help children understand the nature of any threats to their safety and the safety of family and friends. Be careful how information is presented, however. Repeated exposure to violent images is not useful to anyone of any age, but it can be especially harmful to children. It is not helpful for children to focus on images of destruction, injury, or death, and it is harmful for them to hear recollections of gruesome details provided by witnesses and survivors. Therefore, limit news coverage and keep discussions focused on the facts as much as possible.
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  • Help children establish a set of values to guide their actions: Children who base their actions on values suffer less from depression and anxiety than others. Prosocial values help children look to the future, help them feel connected to a larger social group, and engage in more positive behavior. This is even true for children who have been first-hand witnesses of violent acts. Many witnesses become highly empathic and very concerned about the welfare of others. Even children who share the values of groups that endorse violence have better adjustment than children who have no values at all.
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  • Help children develop a positive outlook for the future: Children and youth are generally optimistic; they have a natural tendency to see the future positively and expect that their experiences will be pleasant and fulfilling. Traumatic events can shake that optimism. However, children who believe that negative events are temporary have a much more positive outcome than children who get mired in negative views of the future. It is important that caretakers help children develop a sense of self efficacy and belief in their ability to effectively deal with stress. Children who believe that they can take steps to make their future better and who believe that adults are working to create a better world have better mental health even when they experience years of traumatic events. Remember, our history contains many more positive times than negative times with great stages of growth often emerging following tragedy and conflict.
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  • Finally, take care of your own physical and mental health: Children need caretakers who are available and supportive. Make sure that you are safe, as calm as possible, appropriately rested, as healthy as possible and in good mental health so that children can develop strength in your presence. You do not need to be perfect in your demeanor, health, and adjustment, but it is important that you get support, assistance, and rest so that you have reserves available for the youth in your life.