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Children Exposed to War/Terrorism

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Abstract

This paper reviews the prevalence of psychological morbidities in children who have been exposed to war-related traumas or terrorism as well as the diversity of war-related casualties and their associated psychological responses. The psychological responses to war-related stressors are categorized as (1) little or no reaction, (2) acute emotional and behavioral effects, and (3) long-term effects. Specific categories of war-related casualties discussed include refugee status, traumatic bereavement, effects of parental absence, and child soldiers. Psychological responses associated with terrorism and bioterrorism are presented. Lastly, mediators of the psychological response to war-related stressors are discussed, to include exposure effects, gender effects, parental, family and social factors, and child-specific factors. Children exposed to war-related stressors experience a spectrum of psychological morbidities including posttraumatic stress symptomatology, mood disorders, externalizing and disruptive behaviors, and somatic symptoms determined by exposure dose effect. Specific questions for future research are identified.

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References

  • Allwood, M. A., Bell-Dolan, D., & Husain, S. A. (2002). Children's trauma and adjustment reactions to violent and nonviolent war experiences. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 450-457.

    Google Scholar 

  • Almqvist, K., & Broberg, A. G. (1999). Mental health and social adjustment in young refugee children 3\({\frac{1}{2}}\) years after their arrival in Sweden. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 723-730.

    Google Scholar 

  • American Academy of Pediatrics Committee on Environmental Health and Infectious Diseases (2000). Chemical–biological terrorism and its impact on children: A subject review. Pediatrics, 105, 662-670.

    Google Scholar 

  • Arroyo, W., & Eth, S. (1985). Children traumatized by central American warfare. In S. Eth & R. Pynoos (Eds.), Posttraumatic stress disorder in children(pp. 103-120). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Barath, A. (2002). Psychological status of Sarajevo children after the war: 1999–2000 survey. Croatian Medical Journal, 43, 213-220.

    Google Scholar 

  • Bloch, D. A., Silber, E., & Perry, S. E. (1956). Some factors in the emotional reaction of children and disaster. American Journal of Psychiatry, 113, 416-422.

    Google Scholar 

  • Bodman, F. (1941). War conditions and the mental health of the child. BMJ, 2, 486-488.

    Google Scholar 

  • Breier, A., Kelsoe, J. R., Kirwin, P. D., Beller, S. A., Wollkowitz, O. M., & Pickar, D. (1988). Early parental loss and development of adult psychopathology. Archives of General Psychiatry, 45, 987-993.

    Google Scholar 

  • Bryce, J., Walker, N., Ghorayeb, F., & Kanj, M. (1989). Life experience, response styles, and mental health among mothers and children in Beirut, Lebanon. Social Science and Medicine, 28, 685-695.

    Google Scholar 

  • Cantor, N. F. (2001). In the wake of the Plague. New York: Free Press.

    Google Scholar 

  • Culpepper, R. C. (2000). Agents of Bioterrorism, paper presented at conference, Planning for Bioterrorism: Behaviors and Mental Health Response to Weapons of Mass Destruction and Mass Disruption, July 14–16, 2000, Center for the study of traumatic stress, Department of Psychiatry, Uniformed Services of the Health Sciences, Bethesda, Maryland, pp. 17-34.

    Google Scholar 

  • DeBellis, M. D., Baum, A. S., Birmaher, B., Keshavan, M. S., Eccard, C. H., Boring, A. M., et al. (1999). Developmental traumatology Part 1: Biological stress systems. Society of Biological Psychiatry, 45, 1259-1279.

    Google Scholar 

  • DeBellis, M. D., Keshavan, M. S., Clark, D. B., Casey, B. J., Giedd, J. N., Boring, A. M., et al. (1999). Developmental traumatology Part II: Biological stress systems. Society of Biological Psychiatry, 45, 1271-1284.

    Google Scholar 

  • De Silva, H., Hobbs, C., & Hanks, H. (2001). Conscription of children in armed conflict—A form of child abuse. Child Abuse Review, 10, 125-134.

    Google Scholar 

  • Desivilya, H., Gal, R., & Ayalon, O. (1996). Long-term effects of trauma in adolescence: Comparison between survivors of a terrorist attacks and control counterparts. Anxiety, Stress and Coping, 9, 1135-1150.

    Google Scholar 

  • Elizur, E., & Kaffman, M. (1982). Children's bereavement reactions following death of the father. Journal of the American Academy of Child and Adolescent Psychiatry, 21, 474-480.

    Google Scholar 

  • Elizur, E., & Kaffman, M. (1983). Factors influencing the severity of childhood bereavement reactions. American Journal of Othopsychiatry, 53, 668-676.

    Google Scholar 

  • Freud, A., & Burlingham, D. T. (1943). War and children (Medical war books). New York: Ernst Willard.

    Google Scholar 

  • Galea, S., Resnick, H., Ahern, J., Gold, J., Bucuvalis, M., Kilpatrick, D., et al. (2002). Posttraumatic stress disorder in Manhattan, New York City, after the September 11th terrorist attacks. Journal Urban Health, Bulletin of the New York Academy of Medicine, 79, 340-353.

    Google Scholar 

  • Garmezy, N., & Rutter, M. (1983). Stress, Coping and Development in Children. New York: McGraw Hill.

    Google Scholar 

  • Garrett, L. (2000). Betrayal of trust. New York: Hyperion.

    Google Scholar 

  • Gillespie, R. D. (1942). Psychological effects of war on citizens and soldier. New York: Norton

    Google Scholar 

  • Gleser, G. C., Green, B. L., & Winget, C. N. (1981). Prolonged psychosocial effects of disaster: A study of Buffalo Creek. New York: Academic Press.

    Google Scholar 

  • Goldin, S., Lein, L., Persson, L. A., & Hagglof, B. (2001). Stories of pre-war, war and exile: Bosnian refugee children in Sweden. Medicine, Conflict and Survival, 17, 25-47.

    Google Scholar 

  • Goldstein, R. D., Wampler, N. S., & Wise, P. H. (1997). War experiences and distress symptoms of Bosnian children. Pediatrics, 100, 873-878.

    Google Scholar 

  • Green, B. L., Grace, M. C., Vary, M. G., Kramer, T. L., Gleser, G. C., & Leonard, A. C. (1994). Children of disaster in the second decade: A 17-year follow-up of Buffalo Creek survivors. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 71-93.

    Google Scholar 

  • Green, B. L., Korol, M., Grace, M. C., Vary, M. G., Leonard, A. C., Gleser, G. C., et al. (1991). Children and disaster: age, gender and parental effects on PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 945-951.

    Google Scholar 

  • Gurvitch, R. H., Sitterle, K. A., Young, B. H., & Pfefferbaum, B. (2002). The aftermath of terrorism. In A. M. Le Greca, W. K. Silverman, E. M. Vernberg, & M. Roberts (Eds.), Helping children cope with disasters and terrorism(pp. 327-358). Washington, DC: American Psychological Association.

    Google Scholar 

  • Hadi, F. A., & Llabre, M. M. (1998). The Gulf Crisis Experience of Kuwaiti Children: Psychological and Cognitive Factors. Journal of Traumatic Stress, 11(1), 45-56.

    Google Scholar 

  • Hamilton, E. (1942). The Greek way(p. 241). New York: Modern Library.

    Google Scholar 

  • Heim, C., Meinschmidt, M. S., & Nemeroff, C. (2003). Neurobiology of early life stress. Psychiatric Annuals, 33, 18-26.

    Google Scholar 

  • Holloway, H. (1997). The threat of biological weapons: prophylaxis and mitigation of psychological and social consequences. JAMA, 278, 424-427.

    Google Scholar 

  • Jensen, P. S., & Shaw, J. (1993). Children as victims of war: Current knowledge and future research needs. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 697-708.

    Google Scholar 

  • Jensen, P. S., Martin, D., & Watanabe, H. (1996). Children's Response to Parental Separation during Operation Desert Storm. Journal of American Academic Child Adolescent Psychiarty, 35, 4 April, 433-411.

    Google Scholar 

  • Kinzie, J. D., Sack, W. H., Angell, R. H., Masson, S., & Rath, B. (1986). The psychiatric effects of massive trauma on Cambodian children. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 370-376.

    Google Scholar 

  • Klingman, A. (2002). Children under stress of war. In A. M. Le Greca, W. K. Silverman, E. M. Vernberg, & M. Roberts (Eds.), Helping children cope with disasters and terrorism(pp. 359-380). Washington, DC: American Psychological Association.

    Google Scholar 

  • Kondro, W. (2003). Humanitarian groups unprepared for Iraq war: Health survey of Iraqi children reveals shocking state of health system. Lancet Feb. 8, 361, 493.

    Google Scholar 

  • Loar, N., Wolmer, L., & Cohen, D. J. (2001). Mother functioning and children's symptoms 5 years after a SCUD missile attack. American Journal of Psychiatry, 36, 349-356.

    Google Scholar 

  • Lustig, S. L., Kia-Keating, M., Grant-Knight, W., Geltman, W. G., Ellis, H., Keane, T., et al. (2002). White paper: Child and adolescent refugee mental health. Boston, MA: National Child Traumatic Stress Network, Center for Medical and Refugee Trauma, Department of Child and Adolescent Psychiatry, Boston Medical Center.

    Google Scholar 

  • Macksoud, M., & Aber, J. (1996). The war experience and psychosocial development of children in Lebanon. Child Development, 67, 70-88.

    Google Scholar 

  • McEwen, B. S. (1998). Protective and damaging effects of stress mediator. New England Journal of Medicine, 338, 171-179.

    Google Scholar 

  • McFarlane, A. (1987). Posttraumatic phenomena in a longitudinal study of children following a natural disaster. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 764-769.

    Google Scholar 

  • Nader, K., Pynoos, R., Fairbanks, L., Ajeel, M., & Al-Asfour, A. (1993). A preliminary study of PTSD and grief among the children of Kuwait following the gulf crisis. British Journal of Clinical Psychology, 32, 407-416.

    Google Scholar 

  • North, C. S., Nixon, S. D. J., Shariat, S., Mallonee, S., McMillen, J. C., Spitznagel, E. L., et al. (1999). Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA, 282, 755-762.

    Google Scholar 

  • Pfefferbaum, B. (2001). The impact of the Oklahoma City bombing on children in the community. Military Medicine, 166(Suppl.2), 49-50.

    Google Scholar 

  • Pfefferbaum, B., Doughty, D. E., Chandrashekar, R., Patel, N., Gurwitch, R. H., Nixon, S. J., et al. (2002). Exposure and peri-traumatic response as predictors of posttraumatic stress in children following the 1995 Oklahoma City bombing. Journal of Urban Health; Bulletin of the New York Academy of Medicine, 79, 354-363.

    Google Scholar 

  • Pfefferbaum, B., Nixon, S. J., Krug, R. S., Tivis, R. D. Moore, V. L., Brown, J. M., et al. (1999). Clinical needs assessment of middle and high school students following the Oklahoma City bombing. American Journal of Psychiatry, 156, 1069-1074.

    Google Scholar 

  • Pfefferbaum, B., Nixon, S. J., Tucker, P. M., Tivis, R. D., Moore, V. L., Gurwitch, R. H., et al. (1999). Posttraumatic stress responses in bereaved children the Oklahoma City bombing. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1372-1379.

    Google Scholar 

  • Pine, D. S., & Cohen, J. A. (2002). Trauma in children and adolescents: Risk and treatment of psychiatric sequelae. Biological Psychiatry, 51, 519-531.

    Google Scholar 

  • Rolfe, Y., & Lewin, I. (1982). The effects of the war environment on dream and sleep habits. In C. D. Spielberger & N. A. Milgram (Eds.), Stress and anxiety(Vol. 8, pp. 67-80). New York: Hemisphere.

    Google Scholar 

  • Saigh, P. (1991a). Affective and behavioral parameters of traumatized and nontraumatized adolescents. Presented at the annual meeting of the Society for Traumatic Stress Studies, October, Washington, DC.

  • Saigh, P. (1991b). The development of posttraumatic stress disorder following four different types of traumatization. Behavior Research and Therapy, 29, 213-216.

    Google Scholar 

  • Schuster, M. A., Stein, B. D., Jaycox, L. H., Collins, R. L., Marshall, G. N., Elliot, M. N., et al. (2001). A national survey of stress reactions after the September 11, 2001 terrorist attacks. New England Journal of Medicine, 345, 1507-1512.

    Google Scholar 

  • Shaw, J. A. (2000). Children, adolescents and trauma. Psychiatric Quarterly, 71, 227-243.

    Google Scholar 

  • Shaw, J. A., Applegate, B., & Schorr, C. (1996). Twenty-one month follow-up study of school-age children exposed to Hurricane Andrew. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 359-364.

    Google Scholar 

  • Shaw, J., & Harris, J. J. (1994). Children of war and children at war: child victims of terrorism in Mozambique. In R. J. Ursano, B. E. McCaughey, & C. S. Fullerton (Eds.), Trauma and disaster(pp. 287-305). London: Cambridge University Press.

    Google Scholar 

  • Siegrist, D. W., & Graham, J. M. (eds). (1999). Countering Biological Terrorism in the U.S.: An understanding of Issues and Status, Dobbs, Ferry, New York, Oceana Publications.

    Google Scholar 

  • Smith, P., Perrin, A., Yule, W., & Rabe-Hesketh, S. (2001). War exposure and maternal reactions in the psychological adjustment of children from Bosnia–Hercegovina. Journal of Child Psychology and Psychiatry, 42, 395-404.

    Google Scholar 

  • Stuber, J., Fairbrother, G., Galea, S., Pfefferbaum, B., Wilson-Genderson, M., & Vlahov, D. (2002). Determinants of counseling for children in Manhattan after the September 11 attacks. Psychiatric Services, 53, 815-821.

    Google Scholar 

  • Thabet, A., & Vostanis, P. (1999). Post-traumatic stress reactions in children at war. Journal of Child Psychology and Psychiatry, 40, 385-391.

    Google Scholar 

  • Udwin, O., Boyle, S., Yule, W., Bolton, D., & O'Ryan, D. (2000). Risk factors for long term psychological effects of a disaster experienced in adolescenc: Predictors of posttraumatic stress disorder. Journal of Child Psychology and Psychiatry, 41, 969-979.

    Google Scholar 

  • UNICEF The state of the world's children 1996, New York: UNICEF 1996.

  • U.S. Department of Defense. (1990). Military operations in low intensity conflict(FM 100-20 or USAFP 3-20). Washington, DC: Author.

    Google Scholar 

  • Vizek-Vidovic, V., Kuterovac-Jagodic, G., & Arambasic, L. (2000). Posttraumatic symptomatology in children exposed to war. Scandinavian Journal of Psychology, 41, 297-306.

    Google Scholar 

  • Weine, S., Becker, D. F., McGlashan, T. H., Vojvoda, D., Hartman, S., & Robbins, J. P. (1995). Adolescent survivors of ethnic cleansing, observations on the first year in American. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1153-1159.

    Google Scholar 

  • Weller, R. A., Weller, E. B., Fristad, M. A., & Bowes, J. M. (1991). Depression in recently bereaved prepubertal children. American Journal of Psychiatry, 148, 1536-1540.

    Google Scholar 

  • Will & Ariel Durant, (1968). The Lessons of History, Simon and Schuster, New York.

    Google Scholar 

  • Yule, W. (2000). From Pogroms to “Ethnic Cleansing”: Meeting the needs of war affected children. Journal of Child Psychology and Psychiatry, 41, 695-702.

    Google Scholar 

  • Ziv, A., & Israeli, R. (1973). Effects of bombardment on the manifest anxiety level of children living in kibbutzim. Journal of Counseling and Clinical Psychology, 40, 287-291.

    Google Scholar 

  • Zuckerman-Bareli, C. (1982). Effects of border tension on the adjustment of kibbutzim and moshavim on the northern border of Israel. In C. D. Spielberger & N. A. Milgram (Eds.), Stress and anxiety(Vol. 8, pp. 81-91). New York: Hemisphere.

    Google Scholar 

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Shaw, J.A. Children Exposed to War/Terrorism. Clin Child Fam Psychol Rev 6, 237–246 (2003). https://doi.org/10.1023/B:CCFP.0000006291.10180.bd

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