Article

Impact of Conjoined Exposure to the World Trade Center Attacks and to Other Traumatic Events on the Behavioral Problems of Preschool Children

Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L Levy Place, Campus Box 1230, New York, NY 10029, USA.
JAMA Pediatrics (Impact Factor: 5.73). 03/2008; 162(2):126-33. DOI: 10.1001/archpediatrics.2007.36
Source: PubMed

ABSTRACT

To examine the long-term behavioral consequences of exposure to the World Trade Center (WTC) attacks in preschool children and to evaluate whether conjoined exposure to disaster and to other traumatic events has additive effects.
Retrospective cohort study.
Lower Manhattan, New York.
A total of 116 preschool children directly exposed to the WTC attacks. Main Exposures High-intensity WTC attack-related trauma exposure indexed by the child experiencing 1 or more of the following: seeing people jumping out of the towers, seeing dead bodies, seeing injured people, witnessing the towers collapsing, and lifetime history of other trauma exposure. Main Outcome Measure Clinically significant behavioral problems as measured using the Child Behavioral Checklist.
Preschool children exposed to high-intensity WTC attack-related events were at increased risk for the sleep problems and anxious/depressed behavioral symptom clusters. Conjoined exposure to high-intensity WTC attack-related events and to other trauma was associated with clinically significant emotionally reactive, anxious/depressed, and sleep-related behavioral problems. Children without a conjoined lifetime history of other trauma did not differ from nonexposed children. Risk of emotionally reactive, anxious/depressed, and attention problems in preschool children exposed to conjoined high-intensity WTC attack-related events and other trauma increased synergistically.
Conjoined other trauma exposure seems to amplify the impact of high-intensity WTC attack-related events on behavioral problems. Preschool children exposed to high-intensity events who had no other trauma exposure did not have increased clinically significant behavioral problems. The additive effects of trauma exposure are consistent with an allostatic load hypothesis of stress. More vigorous outreach to trauma-exposed preschool children should become a postdisaster public health priority.

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    • "After a disaster, posttraumatic stress disorder (PTSD) is the psychiatric diagnosis that should be considered most carefully[11], [21], [22]. However, traumatic symptoms tend to spontaneously heal over time; therefore, the morbidity of PTSD is dependent on the time, subjects, and methods used in the survey[12], [14], [23]–[29]. "
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    ABSTRACT: On March 11, 2011, Japan was struck by a massive earthquake and tsunami. The tsunami caused tremendous damage and traumatized a number of people, including children. This study aimed to compare traumatic symptoms and daily life activity among children 20 months after the 2011 Great East Japan Earthquake and Tsunami with those observed after 8 months. The study comprised two groups. The first comprised 12,524 kindergarten, elementary school, and junior high school children in Ishinomaki City, Miyagi Prefecture, Japan, who were evaluated 8 months after the disaster. The second comprised 10,597 children from the same place who were evaluated 20 months after the disaster. The Post Traumatic Stress Symptoms for Children 15 items (PTSSC-15), a self-completion questionnaire on traumatic symptoms, and a questionnaire on children's daily life were distributed to the children. An effective response was obtained from 11,639 (92.9%, 8 months after) and 10,597 (86.9%, 20 months after) children. The PTSSC-15 score was significantly higher in junior high school girls than in boys. The PTSSC-15 score was significantly higher in 4th-6th grade girls than in boys after 8 months. Elementary and junior high school children evaluated after 20 months had a significantly lower PTSSC-15 score than those evaluated after 8 months. The number of children having breakfast was significantly higher after 8 months than that after 20 months. In both the groups, children of all grades who had breakfast had a significantly lower PTSSC-15 score than those who did not have breakfast. We conclude that traumatic symptoms and daily life activity of children who survived the earthquake and tsunami improved over time.
    Full-text · Article · Feb 2014 · PLoS ONE
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    • "It is estimated that millions of the world's children are growing up amid political violence, continuous war, tribal and racial terrorism, genocide, military attacks on civilian locations, or guerrilla warfare (Belsky, 2008; Masten & Narayan, 2012). Others, such as children of combat soldiers in the United States, experience the aftermath of war-related trauma through a parent (McFarlane, 2009), while still others are exposed to a single act of terrorism, for instance, the September 11 attack (Chemtob, Nomura, & Abramovitz, 2008) or the Oklahoma City bombing (Pfefferbaum et al., 1999). Although systematic research is often difficult in zones of war, several studies have described children's response to war and terrorism across the globe, including Lebanon (Bryce, Walker, Ghorayeb, & Kanj, 1989), Gaza (Qouta, Punamaki , & El Sarraj, 2003), Israel (Laor, Wolmer, & Cohen, 2001), Kosovo (Lopes Cardozo, Kaiser, Gotway, & Agani, 2003), Bosnia–Hercegovina (Smith, Perrin, Yule, & Rabe- Hesketh, 2001), and Rwanda (Schaal, Jacob, Dusingizemungu, & Elbert, 2010). "
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    ABSTRACT: The current study examined biomarkers of stress in war-exposed young children and addressed maternal and child factors that may correlate with children's stress response. Participants were 232 Israeli children aged 1.5-5 years, including 148 children exposed to continuous war. Similarly, 56 were diagnosed with posttraumatic stress disorder (PTSD) and 92 were defined as exposed-no-PTSD. Child cortisol (CT) and salivary alpha amylase (sAA), biomarkers of the hypothalamic-pituitary-adrenal and sympathetic-adrenal-medullary arms of the stress response, were measured at baseline, following challenge, and at recovery. Maternal CT and sAA, PTSD symptoms, and reciprocal parenting, and child negative emotionality and regulatory strategies were assessed. Differences between war-exposed children and controls emerged, but these were related to child PTSD status. Children with PTSD exhibited consistently low CT and sAA, exposed-no-PTSD displayed consistently high CT and sAA, and controls showed increase in CT following challenge and decrease at recovery and low sAA. Exposed children showed higher negative emotionality; however, whereas exposed-no-PTSD children employed comfort-seeking strategies, children with PTSD used withdrawal. Predictors of child CT included maternal CT, PTSD symptoms, low reciprocity, and negative emotionality. Findings suggest that high physiological arousal combined with approach strategies may be associated with greater resilience in the context of early trauma.
    Full-text · Article · Nov 2013 · Development and Psychopathology
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    • "After any disaster, posttraumatic stress disorder (PTSD) is the psychiatric diagnosis that should be considered most carefully [7], [18]–[21]. However, traumatic symptoms tend to heal spontaneously over time, and so the morbidity of PTSD is dependent on time, the subjects, and the methods used in the survey [6], [8], [14], [18], [19], [22]–[25]. "
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    ABSTRACT: To evaluate relationships between traumatic symptoms and environmental damage conditions among children who survived the 2011 Great East Japan Earthquake and Tsunami. The subjects were 12,524 children in kindergartens, elementary schools, and junior high schools in Ishinomaki City, Miyagi Prefecture, Japan. The Post Traumatic Stress Symptoms for Children 15 items (PTSSC-15), a self-completion questionnaire on traumatic symptoms, was distributed to the children and a questionnaire regarding environmental damage conditions affecting the children was distributed to their teachers. Of 12,524 questionnaires distributed, an effective response was obtained from 11,692 (93.3%). The PTSSC-15 score was significantly higher in females than in males among 4(th) to 6(th) grade students in elementary schools and among junior high school students. In terms of traumatic symptoms and environmental damage conditions, with the exception of kindergartners, children who had their houses damaged or experienced separation from family members had a significantly higher PTSSC-15 score than children who did not experience environmental damage. Except for kindergartners and 4(th)- to 6(th)-grade elementary school students, children who experienced evacuation had a significantly higher PTSSC-15 score. This study demonstrated relationships between traumatic symptoms and environmental damage conditions in children who had suffered from the disaster. Factors examined in studying the relationship between environmental damage conditions and traumatic symptoms were gender, age, house damage, evacuation experience, and bereavement experience. It was critical not only to examine the traumatic symptoms of the children but also to collect accurate information about environmental damage conditions.
    Full-text · Article · Nov 2012 · PLoS ONE
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