Children’s Disaster Reactions: the Influence of Exposure and Personal Characteristics

  • Betty Pfefferbaum
  • Anne K. Jacobs
  • Natalie Griffin
  • J. Brian Houston
Child and Family Disaster Psychiatry (B Pfefferbaum, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Child and Family Disaster Psychiatry


This paper reviews children’s reactions to disasters and the personal and situational factors that influence their reactions. Posttraumatic stress disorder (PTSD) and posttraumatic stress reactions are the most commonly studied outcomes, though other conditions also occur including anxiety, depression, behavior problems, and substance use. More recently, traumatic grief and posttraumatic growth have been explored. New research has delineated trajectories of children’s posttraumatic stress reactions and offered insight into the long-term consequences of their disaster experiences. Risk factors for adverse outcomes include pre-disaster vulnerabilities, perception of threat, and loss and life disruptions post-disaster. Areas in need of additional research include studies on the timing and course of depression and anxiety post-event and their interactions with other disorders, disaster-related functional and cognitive impairment, positive outcomes, and coping.


Adolescents Anxiety Children Coping Depression Disaster Exposure Mental health Posttraumatic growth Posttraumatic stress Posttraumatic stress disorder (PTSD) Recovery Resilience Terrorism Trauma Traumatic grief 



This work was conducted by the Terrorism and Disaster Center (TDC), at the University of Missouri and the University of Oklahoma Health Sciences Center, a partner in the National Child Traumatic Stress Network (NCTSN). TDC is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). Points of view in this document are those of the authors and do not necessarily represent the official position of HHS, NCTSN, SAMHSA, the University of Missouri, or the University of Oklahoma Health Sciences Center.

Compliance with Ethics Guidelines

Conflict of Interest

Natalie Griffin and J. Brian Houston declare that they have no conflict of interest.

Betty Pfefferbaum has received a grant from the Substance Abuse and Mental Services Administration.

Anne K. Jacobs has received consulting fees/honorarium from the University of Oklahoma Health Sciences Center and the University of Missouri, Columbia, MO.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    National Commission on Children and Disasters. 2010 Report to the President and Congress. AHRQ Publication No. 10-M037. Rockville: Agency for Health Care Research and Quality; 2010.Google Scholar
  2. 2.
    Becker-Blease KA, Turner HA, Finkelhor D. Disasters, victimization, and children’s mental health. Child Dev. 2010;81(4):1040–52.PubMedCrossRefGoogle Scholar
  3. 3.
    McLaughlin KA, Koenen KC, Hill ED, Petukhova M, Sampson NA, Zaslavsky AM, et al. Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J Am Acad Child Adolesc Psychiatry. 2013;52(8):815–30.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.••
    Pfefferbaum B, Jacobs AK, Houston JB, Griffin N. Children’s disaster reactions: the influence of family and social factors. Curr Psychiatry Rep. in press. This article examined family and social factors that influence children’s disaster reactions.Google Scholar
  5. 5.
    Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz D, Kaniasty K. 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry. 2002;65(3):207–39.PubMedGoogle Scholar
  6. 6.
    La Greca AM, Silverman WK. Treating children and adolescents affected by disasters and terrorism. In: Kendall PC, editor. Child and adolescent therapy. Third edition: cognitive-behavioral procedures. New York: The Guilford Press; 2006. p. 356–82.Google Scholar
  7. 7.
    Bonanno GA, Brewin CR, Kaniasty K, La Greca AM. Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities. Psychol Sci Public Interest. 2010;11(1):1–49.CrossRefGoogle Scholar
  8. 8.
    Alisic E, Zalta AK, van Wesel F, Larsen SE, Hafstad GS, Hassanpour K, et al. Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry. 2014;204(5):335–40.PubMedCrossRefGoogle Scholar
  9. 9.
    La Greca AM, Silverman WK. Interventions for youth following disasters and acts of terrorism. In: Kendall PC, editor. Child and adolescent therapy. Fourth edition: cognitive-behavioral procedures. New York: The Guilford Press; 2011. p. 324–44.Google Scholar
  10. 10.
    Lai BS, La Greca AM, Auslander BA, Short MB. Children’s symptoms of posttraumatic stress and depression after a natural disaster: comorbidity and risk factors. J Affect Dis. 2013;146(1):71–8.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.••
    Lai BS, Auslander BA, Fitzpatrick SL, Podkowirow V. Disasters and depressive symptoms in children. A review. Child Youth Care Forum. 2014;43(4):489–504. This paper reviewed quantitative studies of depression in children in the disaster context.PubMedCrossRefGoogle Scholar
  12. 12.•
    Tang B, Liu X, Liu Y, Xue C, Zhang L. A meta-analysis of risk factors for depression in adults and children after natural disasters. BMC Public Health. 2014;14:623. doi: 10.1186/1471-2458-14-623. This paper reported the results of a meta-analysis of observational disaster studies researching depression in children and adults after natural disasters.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.•
    La Greca AM, Lai BS, Llabre MM, Silverman WK, Vernberg EM, Prinstein MJ. Children’s postdisaster trajectories of PTS symptoms: predicting chronic stress. Child Youth Care Forum. 2013;42(4):351–69. This longitudinal study examined children’s disaster exposure, coping, and social support and identified distinct trajectories of children’s distress over the first year post disaster.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Weems CF, Pina AA, Costa NM, Watts SE, Taylor LK, Cannon MF. Predisaster trait anxiety and negative affect predict posttraumatic stress in youths after Hurricane Katrina. J Consult Clin Psychol. 2007;75(1):154–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Boer F, Smit C, Morren M, Roorda J, Yzermans J. Impact of a technological disaster on young children: a five-year postdisaster multiinformant study. J Trauma Stress. 2009;22(6):516–24.PubMedGoogle Scholar
  16. 16.
    Hoven CW, Duarte CS, Lucas CP, Wu P, Mandell DJ, Goodwin RD, et al. Psychopathology among New York City public school children 6 months after September 11. Arch Gen Psychiatry. 2005;62(5):545–52.PubMedCrossRefGoogle Scholar
  17. 17.
    Shaw JA, Applegate B, Tanner S, Perez D, Rothe E, Campo-Bowen AE, et al. Psychological effects of Hurricane Andrew on an elementary school population. J Am Acad Child Adolesc Psychiatry. 1995;34(9):1185–92.PubMedCrossRefGoogle Scholar
  18. 18.
    Stuber J, Galea S, Pfefferbaum B, Vandivere S, Moore K, Fairbrother G. Behavior problems in New York City’s children after the September 11, 2001 terrorist attacks. Am J Orthopsychiatry. 2005;75(2):190–200.PubMedCrossRefGoogle Scholar
  19. 19.
    Pat-Horenczyk R, Ziv Y, Asulin-Peretz L, Achituv M, Cohen S, Brom D. Relational trauma in times of political violence: continuous versus past traumatic stress. Peace Conflict J Peace Psychol. 2013;19(2):125–37.CrossRefGoogle Scholar
  20. 20.
    Chemtob CM, Nomura Y, Josephson L, Adams RE, Sederer L. Substance use and functional impairment among adolescents directly exposed to the 2001 world trade center attacks. Disasters. 2009;33(3):337–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Overstreet S, Salloum A, Badour C. A school-based assessment of secondary stressors and adolescent mental health 18 months post-Katrina. J School Psychol. 2010;48(5):413–31.CrossRefGoogle Scholar
  22. 22.
    Reijneveld SA, Crone MR, Verhulst FC, Verloove-Vanhorick SP. The effect of a severe disaster on the mental health of adolescents: a controlled study. Lancet. 2003;362(9385):691–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Reijneveld SA, Crone MR, Schuller AA, Verhulst FC, Verloove-Vanhorick P. The changing impact of a severe disaster on the mental health and substance misuse of adolescents: follow-up of a controlled study. Psychol Med. 2005;35(3):367–76.PubMedCrossRefGoogle Scholar
  24. 24.
    Wu P, Duarte C, Mandell DJ, Fan B, Liu X, Fuller CJ, et al. Exposure to the world trade center attack and the use of cigarettes and alcohol among New York City public high-school students. Am J Public Health. 2006;96(5):804–7.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    McFarlane AC, Van Hooff M. Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study. Br J Psychiatry. 2009;195(2):142–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Morgan L, Scourfield J, Williams D, Jasper A, Lewis G. The Aberfan disaster: 33-year follow-up of survivors. Br J Psychiatry. 2003;182(6):532–6.PubMedCrossRefGoogle Scholar
  27. 27.
    Scrimin S, Axia G, Capello F, Moscardino U, Steinberg AM, Pynoos RS. Posttraumatic reactions among injured children and their caregivers 3 months after the terrorist attack in Beslan. Psychiatry Res. 2006;141(3):333–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Scrimin S, Moscardino U, Capello F, Axia G. Attention and memory in school-age children surviving the terrorist attack in Beslan, Russia. J Clin Child Adolesc Psychol. 2009;38(3):402–14.PubMedCrossRefGoogle Scholar
  29. 29.
    Kalantari M, Vostanis P. Behavioural and emotional problems in Iranian children four years after parental death in an earthquake. Int J Soc Psychiatry. 2010;56(2):158–67.PubMedCrossRefGoogle Scholar
  30. 30.•
    Dyregrov A, Salloum A, Kristensen P, Dyregrov K. Grief and traumatic grief in children in the context of mass trauma. Curr Psychiatry Rep. in press. This paper reviewed grief in children exposed to mass trauma and described grief interventions.Google Scholar
  31. 31.
    Cohen JA, Mannarino AP, Greenberg T, Padlo S, Shipley C. Childhood traumatic grief. Concepts and controversies. Trauma Violence Abuse. 2002;3(4):307–27.CrossRefGoogle Scholar
  32. 32.
    Dyregrov K, Dyregrov A, Kristensen P. Traumatic bereavement and terror: the psychosocial impact on parents and siblings 1.5 years after the July 2011 terror killings in Norway. J Loss Trauma. 2014. doi: 10.1080/15325024.2014.957603.Google Scholar
  33. 33.
    Cryder CH, Kilmer RP, Tedeschi RG, Calhoun LG. An exploratory study of posttraumatic growth in children following a natural disaster. Am J Orthopsychiatry. 2006;76(1):65–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Williams R. The psychosocial consequences for children of mass violence, terrorism, and disasters. Int Rev Psychiatry. 2007;19(3):263–77.PubMedCrossRefGoogle Scholar
  35. 35.
    Kilmer RP, Gil-Rivas V. Exploring posttraumatic growth in children impacted by Hurricane Katrina: correlates of the phenomenon and developmental considerations. Child Dev. 2010;81(4):1211–27.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Kilmer RP, Gil-Rivas V, Tedeschi RG, Cann A, Calhoun LG, Buchanan T, et al. Use of the revised posttraumatic growth inventory for children. J Trauma Stress. 2009;22(3):248–53.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Kronenberg ME, Hansel TC, Brennan AM, Osofsky HJ, Osofsky JD, Lawrason B. Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns. Child Dev. 2010;81(4):1241–59.PubMedCrossRefGoogle Scholar
  38. 38.••
    Weems CF, Graham RA. Resilience and trajectories of posttraumatic stress among youth exposed to disaster. J Child Adolesc Psychopharmacol. 2014;24(1):2–8. This longitudinal study examined children exposed to two major natural disasters and identified outcome trajectories.PubMedCrossRefGoogle Scholar
  39. 39.
    Furr JM, Comer JS, Edmunds JM, Kendall PC. Disasters and youth: a meta-analytic examination of posttraumatic stress. J Consult Clin Psychol. 2010;78(6):765–80.PubMedCrossRefGoogle Scholar
  40. 40.••
    Masten AS, Narayan AJ. Child development in the context of disaster, war, and terrorism: pathways of risk and resilience. Ann Rev Psychol. 2012;63:227–57. This review article presented the theoretical and conceptual framework for child resilience and explored the factors that contribute to risk and resilience in children in the context of mass trauma.CrossRefGoogle Scholar
  41. 41.•
    Pfefferbaum B, Weems CF, Scott BG, Nitiéma P, Noffsinger MA, Pfefferbaum RL, et al. Research methods in child disaster studies: a review of studies generated by the September 11, 2001, terrorist attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. Child Youth Care Forum. 2013;42(4):285–337. This paper examined the methodology of child research studies of three major disasters and provided a review of the outcomes and predictors of children’s disaster reactions.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Wooding S, Raphael B. Psychological impact of disasters and terrorism on children and adolescents: experiences from Australia. Prehospital Dis Med. 2004;19(1):10–20.Google Scholar
  43. 43.
    Compas BE, Connor-Smith JK, Saltzman H, Thomsen AH, Wadsworth ME. Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull. 2001;127(1):87–127.PubMedCrossRefGoogle Scholar
  44. 44.••
    Braun-Lewensohn O. Coping and social support in children exposed to mass trauma. Curr Psychiatry Rep. in press. This review evaluated the recent literature on children’s coping with mass trauma, identified areas for future investigation, and presented a comprehensive model on children’s disaster coping.Google Scholar
  45. 45.•
    Pfefferbaum B, Noffsinger MA, Wind LH, Allen JR. Children’s coping in the context of disasters and terrorism. J Loss Trauma. 2014;19(1):78–97. This review of children’s coping in the context of mass trauma linked conceptualizations of stress and coping to empirical information about children’s disaster reactions.CrossRefGoogle Scholar
  46. 46.
    Braun-Lewensohn O. Coping resources and stress reactions among three cultural groups one year after a natural disaster. Clin Soc Work J. 2013;42(4):366–74.CrossRefGoogle Scholar
  47. 47.
    Tatar M, Amram S. Israeli adolescents’ coping strategies in relation to terrorist attacks. Br J Guid Couns. 2007;35(2):164–73.CrossRefGoogle Scholar
  48. 48.
    Zhang Y, Kong F, Wang L, Chen H, Gao X, Tan X, et al. Mental health and coping styles of children and adolescent survivors one year after the 2008 Chinese earthquake. Child Youth Serv Rev. 2010;32(10):1403–9.CrossRefGoogle Scholar
  49. 49.
    Moscardino U, Scrimin S, Capello F, Altoè G, Axia G. Psychological adjustment of adolescents 18 months after the terrorist attack in Beslan, Russia: a cross-sectional study. J Clin Psychiatry. 2008;69(5):854–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Zhang W, Liu H, Jiang X, Wu D, Tian Y. A longitudinal study of posttraumatic stress disorder symptoms and its relationship with coping skill and locus of control in adolescents after an earthquake in China. PLoS One. 2014;9(2):e88263.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Jensen TK, Ellestad A, Dyb G. Children and adolescents’ self-reported coping strategies during the Southeast Asian Tsunami. Br J Clin Psychol. 2013;52(1):92–106.PubMedCrossRefGoogle Scholar
  52. 52.
    Chen W, Wang L, Zhang XL, Shi JN. Understanding the impact of trauma exposure on posttraumatic stress symptomatology: a structural equation modeling approach. J Loss Trauma. 2012;17(1):98–110.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Betty Pfefferbaum
    • 1
    • 2
  • Anne K. Jacobs
    • 2
  • Natalie Griffin
    • 2
  • J. Brian Houston
    • 3
  1. 1.Department of Psychiatry and Behavioral Sciences, College of MedicineUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  2. 2.Terrorism and Disaster CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  3. 3.Department of CommunicationUniversity of MissouriColumbiaUSA

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