Abstract
This article reviews the impact of direct and indirect exposure to war and terrorism on children’s mental health. Although both direct and indirect exposure place children at risk of adjustment problems, the literature also provides evidence of children’s remarkable resilience in the face of the life-threatening events. An examination of factors that influence children’s responses to war and terrorism indicates an array of internal and external factors that protect or put children at risk of suffering from mental health problems. Such factors include the child’s developmental stage, gender, the intensity and duration of exposure, the extent of life disruption, the availability of parental support, and the surrounding culture. An examination of interventions for children exposed to war and terrorism emphasizes the importance of providing children with safety and a sense of security, as well as addressing basic needs and establishing trust with the child. Once these aims have been achieved, mental health interventions can be implemented to address posttraumatic symptoms. A variety of interventions have been used to help children exposed to war and terrorism, including relaxation techniques, art therapy, cognitive-behavioral therapy, and supportive therapy. Although cognitive-behavioral therapy has received the most empirical support, other techniques are commonly used.
Similar content being viewed by others
References
Achenbach, T. M., & Edelbrock, C. S. (1981). Behavioral problems and competencies reported by parents of normal and disturbed children aged four through sixteen. Monographs of the Society for Research in Child Development, 46(1, Serial No. 188), 1–82.
Alkhatib, A., Regan, J., & Barrett, D. (2007). The silent victims: Effects of war and terrorism on child development. Psychiatric Annals, 37, 586–589.
Aronson, S. (2005). “A war that had come right to them”: Group work with traumatized adolescents following September 11. International Journal of Group Psychotherapy, 55, 375–390.
Arvidson, J., Kinniburgh, K., Howard, K., Spinazzola, J., Strothers, H., Evans, M., et al. (2011). Treatment of complex trauma in young children: Developmental and cultural considerations in application of the ARC intervention model. Journal of Child and Adolescent Trauma, 4(1), 34–51.
Barath, A. (2002). Psychological status of Sarajevo children after war: 1999–2000 survey. Croatian Medical Journal, 43, 213–220.
Barenbaum, J., Ruchkin, V., & Schwab-Stone, M. (2004). The psychological aspects of children exposed to war: Practice and policy initiatives. Journal of Child Psychology and Psychiatry, 45, 41–62.
Berger, R., Pat-Horenczyk, R., & Gelkopf, M. (2007). School-based intervention for prevention and treatment of elementary students’ terror-related distress in Israel: A quasi-randomized controlled trial. Journal of Traumatic Stress, 20, 541–551.
Betancourt, T. S., Speelman, L., Onyango, G., & Bolton, P. (2009). A qualitative study of mental health problems among children displaced by war in Northern Uganda. Transcultural Psychiatry, 46, 238–256.
Betancourt, T. S., & Williams, T. (2008). Building an evidence base on mental health interventions for children affected by armed conflict. Intervention (Amstelveen), 6, 39–56.
Brown, E. J., & Bobrow, A. L. (2004). School entry after a community-wide trauma: Challenges and lessons learned from September 11th, 2001. Clinical Child and Family Psychology Review, 7, 211–221.
Bryant, R. A. (2000). Cognitive behavioral therapy of violence-related posttraumatic stress disorder. Aggression and Violent Behavior, 5, 79–97.
Burnham, J. J. (2007). Children’s fears: A pre-9/11 and post-9/11 comparison using the American Fear Survey Schedule for children. Journal of Counseling and Development, 85, 461–466.
Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditationrelaxation in North-East Sri Lanka. BMC Psychiatry, 9, 22–32.
Chimienti, G., Nasr, J. A., & Khalifeh, I. (1989). Children’s reactions to war related stress: Affective symptoms and behavior problems. Social Psychiatry and Psychiatric Epidemiology, 24, 282–287.
Cohen, M., & Eid, J. (2007). The effect of constant threat of terror on Israeli Jewish and Arab adolescents. Anxiety, Stress, and Coping, 20, 47–60.
Comer, J. S., Furr, J. M., Beidas, R. S., Weiner, C. L., & Kendall, P. C. (2008). Children and terrorism related news: Training parents in coping and media literacy. Journal of Counseling and Clinical Psychology, 76, 568–578.
Comer, J. S., & Kendall, P. C. (2007). Terrorism: The psychological impact on youth. Clinical Psychology: Science and Practice, 14, 179–212.
Crenshaw, D. A., & Hardy, K. V. (2007). The crucial role of empathy in breaking the silence of traumatized children in play therapy. International Journal of Play Therapy, 16, 160–175.
De Jong, J. T. V. M. (Ed.). (2002). Trauma, war, and violence: Public mental health in socio-cultural context. New York, NY: Kluwer Academic/Plenum.
Driessnack, M. (2005). Children’s drawings as facilitators of communication: A meta-analysis. Journal of Pediatric Nursing, 20, 415–423.
Dubow, E. F., Huesmann, L. R., & Boxer, P. (2009). A social-cognitive-ecological framework for understanding the impact of exposure to persistent ethnic-political violence on children’s psychosocial adjustment. Clinical Child Family Psychology Review, 12, 113–126.
Dybdahl, R. (2001). Children and mothers in war: An outcome study of a psychosocial intervention program. Child Development, 72, 1214–1230.
Ehntholt, K. A., & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war-related trauma. Journal of Child Psychology and Psychiatry, 47, 1197–1210.
Elbert, T., Schauer, M., Schauer, E., Huschka, B., Hirth, M., & Neuner, F. (2009). Trauma-related impairment in children—A survey in Sri Lankan provinces affected by armed conflict. Child Abuse & Neglect, 33, 238–246.
Ellis, B. H., Miller, A. B., Baldwin, H., & Abdi, S. (2011). New directions in refugee youth mental health services: Overcoming barriers to engagement. Journal of Child and Adolescent Trauma, 4(1), 69–85.
Espié, E., Gaboulaud, V., Baubet, T., Casas, G., Mouchenik, Y., Yun, O., et al. (2009). Trauma-related psychological disorders among Palestinian children and adults in Gaza and West Bank, 2005–2008. International Journal of Mental Health Systems, 3, 21–25.
Farhi, E., Lauden, A., Ifergan, G., & Fariger, M. D. (2008). Impact of continuous terrorism missile attacks on the emotional and physical strength of the local population in Sderot, Israel. Epidemiology, 19, S106–S107.
Freud, S. (1915). Thoughts for the times on war and death. Retrieved from http://www.panarchy.org/freud/war.1915.html
Freud, A. (1966) The ego and the mechanisms of defense. Madison, CT: International Universities Press.
Freud, A. (1974). Infants without families and reports on the Hampstead Nurseries, 1939–1945. London, England: Hogarth Press: Institute of Psychoanalysis.
Gammonley, D., & Dziegielewski, S. F. (2006). Crisis intervention responses to children victimized by terrorism: Children are not little adults. Brief Treatment and Crisis Intervention, 6, 22–35.
Garmezy, N., Maston, A., & Tellegen, A. (1984). The study of stress and competence in children: A building block of developmental psychopathology. Child Development, 55, 97–111.
Gelkopf, M., & Berger, R. (2009). A school-based, teacher-mediated prevention program (ERASE-Stress) for reducing terror-related traumatic reactions in Israeli youth: A quasi-randomized controlled trial. Journal of Child Psychology and Psychiatry, 50, 962–971.
Haen, C. (2005). Rebuilding security: Group therapy with children affected by September 11. International Journal of Group Psychotherapy, 55, 391–414.
Hanney, L., & Kozlowska, K. (2002). Healing traumatized children: Creating illustrated storybooks in family therapy. Family Process, 41, 37–65.
Hendricks, C., & Bornstein, M. H. (2007). Ecological analysis of early adolescents’ stress responses to 9/11 in the Washington, DC, area. Applied Developmental Science, 11, 71–88.
Henrich, C. C., & Shahar, G. (2008). Social support buffers the effects of terrorism on adolescent depression: Findings from Sderot, Israel. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1073–1076.
Hoven, C. W., Duarte, C. S., Lucas, C. P., Wu, P., Mandell, D. J., Goodwin, R. D., et al. (2005). Psychopathology among New York City public school children 6 months after September 11. Archives of General Psychiatry, 62, 545–552.
Israel State Comptroller. (2007). Home front preparation and functioning during the second Lebanon war-the complete report. Retrieved from http://www.mevaker.gov.il/serve/contentTree.asp?bookid=493&id=188&contentid=&parentcid=undefined&sw=1280&hw=954
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.
Joshi, P. T., & O’Donnell, D. A. (2003). Consequences of child exposure to war and terrorism. Clinical Child and Family Psychology Review, 6, 275–292.
Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100–110.
Kimhi, S., Eshel, Y., & Zysberg, L. (2010). Post-traumatic growth and symptoms of stress among adolescents. In F. Azaiza, N. Nachmias, & M. Cohen (Eds.), Health, education, and welfare services in times of crisis: Lessons learned from the Second Lebanon War (pp.145–163). Haifa, Israel: Pardes Publications.
Klein, M. (1946). Note on some schizoid mechanism. International Journal of Psychoanalysis, 27, 99–110.
Klien, T. P., Devoe, E. R., Miranda-Julian, C., & Linas, K. (2009). Young children’s response to September 11th: The New York City experience. Infant Mental Health Journal, 30, 1–22.
Kos, A. M., & Derviskadic-Jovanovic, S. (1998). What can we do to support children who have been through war? Forced Migration Review, 3, 4–7.
Kuterovac-Jagodic, G. (2003). Posttraumatic stress symptoms in Croatian children exposed to war: A prospective study. Journal of Clinical Psychology, 59, 9–25.
La Greca, A. M., & Silverman, W. K. (2009). Treatment and prevention of posttraumatic stress reactions in children and adolescents exposed to disasters and terrorism: What is the evidence? Child Development Perspectives, 3, 4–10.
Lahad, M. (2006). Fantastic reality. Kiryat Tivon, Israel: Nord.
Laor, N., Wolmer, L., Alon, M., Siev, J., Samuel, E., & Toren, P. (2006). Risk and protective factors mediating psychological symptoms and ideological commitment of adolescents facing continuous terrorism. The Journal of Nervous and Mental Disease, 194, 279–286.
Llabre, M. M., & Hadi, F. (2009). War-related exposure and psychological distress as predictors of health and sleep: A longitudinal study of Kuwaiti children. Psychosomatic Medicine, 71, 776–783.
Lowry, C. (2000). Mental health interventions for war affected children: Taking into account children’s resilience and coping in armed conflict. Children in Adversity. Retrieved from http://www.childreninadversity.org/DocumentCentre.html
Machel, G. (1996). Impact of armed conflict on children (Report of the Expert of the Secretary General of the United Nations). New York, NY: United Nations.
Machel, G. (2001). The impact of war on children. London, England: Hurst.
Malekoff, A. (2008). Transforming trauma and empowering children and adolescents in the aftermath of disaster through group work. Social Work with Groups, 31, 29–52.
McNamee, A., & Mercurio, M. L. (2006). Picture books: Can they help caregivers create an “illusion of safety” for children in unsafe times? Perspectives on Urban Education, 4, 1–13.
Moin, V., Sharlin, S. A., & Yahav, R. (2007). Multifaceted fears: Reactions of children and adolescents to terrorist attacks in Israel. Tel Aviv, Israel: Alpha Print.
Moscardino, U., Scrimin, S., Capello, F., & Altoè, G. (2010). Social support, sense of community, collectivist values, and depressive symptoms in adolescent survivors of the 2004 Beslan terrorist attack. Social Science & Medicine, 70, 27–34.
Moscardino, U., Scrimin, S., Capello, F., Altoè, G., & Axia, G. (2008). Psychological adjustment of adolescents 18 months after the terrorist attack in Beslan, Russia: A cross-sectional study. Journal of Clinical Psychiatry, 69, 854–859.
Overstreet, S., Salloum, A., Burch, B., & West, J. (2011). Challenges associated with childhood exposure to severe natural disasters: Research review and clinical implications. Journal of Child and Adolescent Trauma, 4(1), 52–68.
Panter-Brick, C., Eggerman, M., Gonzalez, V., & Safdar, S. (2009). Violence, suffering, and mental health in Afghanistan: A school-based survey. The Lancet, 9692, 807–816.
Pat-Horenczyk, R., Peled, O., Miron, T., Brom, D., Villa, Y., & Chemtob, C. M. (2007). Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: Provoking danger under continuous threat. American Journal of Psychiatry, 164, 66–72.
Perrin, S., Smith, P., & Yule, W. (2000). The assessment and treatment of post-traumatic stress disorder in children and adolescents. Journal of Child Psychology and Psychiatry, 41, 277–289.
Pine, D. S., Costello, J., & Masten, A. (2005). Trauma, proximity, and developmental psychopathology: The effects of war and terrorism on children. Neuropsychopharmacology, 30, 1781–1792.
Punamaki, R. J. (2002). The uninvited guest of war enters childhood: Developmental and personality aspects of war and military violence. Traumatology, 8, 45–63.
Punamaki, R. J., Qouta, S., & El-Sarraj, E. (2001). Resiliency factors predicting psychological adjustment after political violence among Palestinian children. International Journal of Behavioral Development, 25, 256–267.
Pynoos, R. S., & Eth, S. (1986). Witness to violence: The child interview. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 306–319.
Rahe, R. H., Looney, J. G., Ward, H. W., Tung, T. M., & Liu, W. T. (1978). Psychiatric consultation in a Vietnamese refugee camp. American Journal of Psychiatry, 135, 185–190.
Sagi-Schwartz, A. (2008). The well-being of children living in chronic war zones: The Palestinian-Israeli case. International Journal of Behavioral Development, 32, 322–336.
Sharlin, S. A., Moin, W., & Yahav, R. (2006). When disaster becomes commonplace. Social Work in Health Care, 43, 95–114.
Shaw, J. A. (2003). Children exposed to war/terrorism. Clinical Child and Family Psychology Review, 6, 237–246.
Silverman, W. K., Ortiz, C. D., Viswesvaran, C., Burns, B. J., Kolko, D. J., Putnam, F. W., et al. (2008). Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 37, 156–183.
Stuber, J., Galea, S., Pfefferbaum, B., Vandivere, S., Moore, K., Fairbrother, G., et al. (2005). Behavior problems in New York City’s children after the September 11, 2001, terrorist attacks. American Journal of Orthopsychiatry, 75, 190–200.
Terr, L. C. (1983). Children of Chowchilla, a study of psychic trauma four years after a school-bus kidnapping. American Journal of Psychiatry, 140, 1542–1550.
Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Macy, R. D., & de Jong, J. T. V. M. (2008). School-based mental health intervention for children affected by political violence in Indonesia: A cluster randomized trial. Journal of the American Medical Association, 300, 655–662.
Wexler, I. D., Branski, D., & Kerem, E. (2006). War and children. Journal of the American Medical Association, 296, 579–581.
Williams, R. (2007). The psychological consequences for children of mass violence, terrorism and disasters. International Review of Psychiatry, 19, 263–277.
Yahav, R., & Cohen, M. (2007). Symptoms of acute stress in Jewish and Arab Israeli citizens during the second Lebanon war. Social Psychiatry and Psychiatric Epidemiology, 42, 830–836.
Yule, W. (2002). Alleviating the effects of war and displacement on children. Traumatology, 8, 25–43.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Yahav, R. Exposure of Children to War and Terrorism: A Review. Journ Child Adol Trauma 4, 90–108 (2011). https://doi.org/10.1080/19361521.2011.577395
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1080/19361521.2011.577395