Clinical Child and Family Psychology Review

, Volume 6, Issue 4, pp 237–246 | Cite as

Children Exposed to War/Terrorism

  • Jon A. Shaw


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.

children effects of war terrorism traumatic stressors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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
  2. 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
  3. 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
  4. 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
  5. Barath, A. (2002). Psychological status of Sarajevo children after the war: 1999–2000 survey. Croatian Medical Journal, 43, 213-220.Google Scholar
  6. 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
  7. Bodman, F. (1941). War conditions and the mental health of the child. BMJ, 2, 486-488.Google Scholar
  8. 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
  9. 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
  10. Cantor, N. F. (2001). In the wake of the Plague. New York: Free Press.Google Scholar
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. Elizur, E., & Kaffman, M. (1983). Factors influencing the severity of childhood bereavement reactions. American Journal of Othopsychiatry, 53, 668-676.Google Scholar
  18. Freud, A., & Burlingham, D. T. (1943). War and children (Medical war books). New York: Ernst Willard.Google Scholar
  19. 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
  20. Garmezy, N., & Rutter, M. (1983). Stress, Coping and Development in Children. New York: McGraw Hill.Google Scholar
  21. Garrett, L. (2000). Betrayal of trust. New York: Hyperion.Google Scholar
  22. Gillespie, R. D. (1942). Psychological effects of war on citizens and soldier. New York: NortonGoogle Scholar
  23. 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
  24. 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
  25. Goldstein, R. D., Wampler, N. S., & Wise, P. H. (1997). War experiences and distress symptoms of Bosnian children. Pediatrics, 100, 873-878.Google Scholar
  26. 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
  27. 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
  28. 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
  29. 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
  30. Hamilton, E. (1942). The Greek way(p. 241). New York: Modern Library.Google Scholar
  31. Heim, C., Meinschmidt, M. S., & Nemeroff, C. (2003). Neurobiology of early life stress. Psychiatric Annuals, 33, 18-26.Google Scholar
  32. Holloway, H. (1997). The threat of biological weapons: prophylaxis and mitigation of psychological and social consequences. JAMA, 278, 424-427.Google Scholar
  33. 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
  34. 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
  35. 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
  36. 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
  37. 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
  38. 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
  39. 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
  40. Macksoud, M., & Aber, J. (1996). The war experience and psychosocial development of children in Lebanon. Child Development, 67, 70-88.Google Scholar
  41. McEwen, B. S. (1998). Protective and damaging effects of stress mediator. New England Journal of Medicine, 338, 171-179.Google Scholar
  42. 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
  43. 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
  44. 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
  45. Pfefferbaum, B. (2001). The impact of the Oklahoma City bombing on children in the community. Military Medicine, 166(Suppl.2), 49-50.Google Scholar
  46. 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
  47. 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
  48. 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
  49. 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
  50. 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
  51. 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.Google Scholar
  52. Saigh, P. (1991b). The development of posttraumatic stress disorder following four different types of traumatization. Behavior Research and Therapy, 29, 213-216.Google Scholar
  53. 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
  54. Shaw, J. A. (2000). Children, adolescents and trauma. Psychiatric Quarterly, 71, 227-243.Google Scholar
  55. 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
  56. 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
  57. 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
  58. 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
  59. 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
  60. Thabet, A., & Vostanis, P. (1999). Post-traumatic stress reactions in children at war. Journal of Child Psychology and Psychiatry, 40, 385-391.Google Scholar
  61. 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
  62. UNICEF The state of the world's children 1996, New York: UNICEF 1996.Google Scholar
  63. U.S. Department of Defense. (1990). Military operations in low intensity conflict(FM 100-20 or USAFP 3-20). Washington, DC: Author.Google Scholar
  64. 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
  65. 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
  66. 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
  67. Will & Ariel Durant, (1968). The Lessons of History, Simon and Schuster, New York.Google Scholar
  68. 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
  69. 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
  70. 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

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Jon A. Shaw
    • 1
  1. 1.Division of Child and Adolescent Psychiatry and Behavioral Science, Department of Psychiatry (D-29), School of MedicineUniversity of MiamiMiami

Personalised recommendations