Nearly One in Five New York City Children Had Posttraumatic Stress Symptoms Four Months after the Sept. 11 Terrorist Attacks

NEW YORK CITY, Nov. 18 - Nearly one in five New York City children were still experiencing severe or very severe symptoms of posttraumatic stress disorder four months after the Sept. 11, 2001 terrorist attacks, according to a study in the latest issue of the journal Ambulatory Pediatrics led by The New York Academy of Medicine.

Children who saw graphic images of the disaster on television-like an airplane hitting one of the Twin Towers, buildings collapsing, people running from a cloud of smoke, or people falling or jumping from the towers-were more likely than other children to have severe or very severe "posttraumatic stress reactions" (PTSR), as symptoms of PTSD are known. Seeing people jumping from towers was especially disturbing to the children, said lead author Gerry Fairbrother, Ph.D., Senior Scientist in the Academy's Division of Health and Science Policy. "The types of images that children saw, rather than the amount of news coverage that they watched, was related to their levels of PTSR," Fairbrother said.

Parents' stress level also had a strong affect on children's reactions, the researchers found. Children whose parents had PTSD, and children who saw their parents cry, were most likely to have severe or very severe PTSR. But this does not necessarily mean that parents should hide their stress from children.

"There are several schools of thought on whether parents should show emotion in front of their children," Fairbrother said. While that point is still debated among clinicians, the strong relationship between parents' and children's stress reactions indicates that counseling should focus on the family as a unit.

The findings are based on a random-digit dial telephone survey of 434 parents of children ages 4-17 who live in the five boroughs of New York City. The interviews were part of a larger 2,001-person survey of both parents and childless adults that the Academy conducted four months after the terrorist attack.

Overall, 18 percent of New York City children-as many as 260,000-were found to be suffering severe or very severe symptoms of post-traumatic stress disorder four months after the terrorist attacks. Nearly one-fourth of parents said that their children felt "something bad was going to happen to them" as a result of the recent attacks. Furthermore, researchers found that 66 percent of New York City children had moderate symptoms of posttraumatic stress.

Pediatricians should step in after a disaster to advise parents of the importance of limiting their children's disaster-related television viewing, said Alan R. Fleischman, M.D., Senior Vice President of the Academy and a co-author of the research paper. In an average year, 70 percent of children see their doctor, according to the Annual Report on Health Care for Children and Youth. "These findings suggest an enhanced role for primary care physicians, particularly pediatricians, for screening, treatment and referral, especially in light of the continued terrorist threats," said Fleischman, a pediatrician.

The article, entitled "Posttraumatic Stress Reactions in New York City Children After the Sept. 11, 2001 Terrorist Attacks," was also co-authored by Jennifer Stuber, Ph.D., and Sandro Galea, M.D., Dr. P.H., M.P.H., both of the Academy, and by Betty Pfefferbaum, M.D., J.D. of the Department of Psychiatry at the University of Oklahoma College of Medicine.

The New York Academy of Medicine is a non-profit institution founded in 1847 that is dedicated to enhancing the health of the public through research education and advocacy with a particular focus on urban populations, especially the disadvantaged.

Posted on November 18, 2003

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