The worst effect for teenagers after trauma is that the future, which most are optimistic about, seems now very unappealing. This is a premature rupture in their sense of the world as a basically good and reasonable place where you can be happy and successful. This can lead to premature disillusionment, pessimism, and hopelessness. I don't think this will happen on a large scale but again some adolescents will be vulnerable to the worst case and all will be marked by the unexpected and overwhelming quality of the event.
Linda J. Alpert-Gillis, associate professor of psychiatry, pediatrics, and clinical nursing, University of Rochester School of Medicine and Dentistry:
Preschoolers will often react with confusion, fearfulness, separation fears, and acting younger. Concerns about separating from parents is often a major issue which is seen in children not wanting to go to child care, not wanting parents to go to work, and wanting parents to sleep with them.
School-age children may also show anxiety and fearfulness. They may have trouble separating and act younger. They are more likely to evidence physical complaints such as headaches and stomachaches. They may be quieter than usual, be more irritable, or want to talk a lot about the tragedy.
8. Should I keep my children at home with the family if they seem abnormally upset?
Charles K. West, professor of Family and Consumer Sciences, University of Mississippi:
While keeping a child at home may be OK as a very temporary solution, the grieving child can benefit by facing his or her fears in the company of other children. We all need our allies, people we can talk to, grieve with, and who can help us normalize our feelings.
Activities that provide constructive ways of self-expression also are therapeutic. Children usually express themselves best through playful activities, which may include games, singing, drawing — anything engaging.
9. How do I know if my child needs professional help?
Dr. Boris Birmaher, University of Pittsburgh:
First, you have to talk to your child about what happened and prompt them to talk about their feelings and worries. Let them know that you are also concerned, but the situation is under control and the government is taking the necessary steps to prevent tragedies like this from happening again.
Let them know parents are there for them. It is also important, that these issues be discussed at school. Some schools have been avoiding talking about what happened. Kids have been watching the TV and pictures on the Web and newspapers and need clarification of what is going on.
It is normal for a kid, in particular young children, to have nightmares, be afraid and apprehensive the first days. However, if a child continues to have anxiety, sadness, problems with concentration or behavioral problems and these symptoms are affecting their functioning at school and home, parents should consult a professional.
Children who lost relatives or close friends are at higher risk to develop emotional problems and need more reassurance and support. If they develop persistent symptoms of anxiety, depression, or nightmares they need to be seen by a professional.
10. How do I answer my child's question, "What happened to the people in the planes and the buildings?"
Carmel Mahan, child life manager, University of Maryland Children's Hospital: