Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

to fellow runners who were bleeding, or to use them as tour- niquets. Boston’s emergency response medical teams worked quickly, efficiently, and tirelessly to transport injured runners to hospitals and into operating rooms in order to save limbs, and stop bleeding. The fact that almost all the injured were saved is a tribute to the emergency preparedness and collabo- ration of law enforcement, medical, and surgical teams car- rying out an emergency plan that they had previously been briefed on, as a matter of course. Additional situations in which youth are exposed to severe trauma and terror involve armed conflict around the world, mul- tiple mass school shootings that have taken place across the United States in recent years, and hurricanes, devastating storms, and tsunamis. Of course, more than a decade ago, the youth in the United States experienced the large-scale domestic terrorist attack on September 11, 2001, on the World Trade Center in NewYork City and the Pentagon in Washington, DC. There is an increasing body of literature on the impact of ter- rorism on children as well as a variety of other forms of trauma. One predominant and near universal symptom in children in response to these stimuli is anxiety. Young children may cling excessively to their parents, whereas older children may become preoccupied with fear about unrelated issues. Some youth express overt anger, and others experience a sense of hopeless- ness, lack of control, and/or depression. Severe traumas, such as experiencing a terrorist event, may be more likely to result in posttraumatic stress syndromes among exposed youth, com- pared to less severe forms of trauma. The number of traumas experienced by a child, degree of family support provided after the exposure, and the reactions of parents are all important fac- tors in a child’s reaction. According to a national survey after the terrorist attack of September 11th, stress reactions to that disaster were increased by watching repeated media coverage of those events. A similar study evaluating the impact of media versus direct exposure to collective trauma, on acute stress response was undertaken 2 to 4 weeks after the Boston Marathon bombings through surveying 846 people from Boston, 941 people from New York City, and 2,888 people through Internet means. Direct exposure, defined as being at or near the bombings, was compared to media exposure, including footage on television and bombing related stories on the radio, in print, online, and other social media cov- erage. Because acute stress responses appear within weeks of a traumatic event, this study was able to capture acute stress difference between the two groups. The study found that trauma related to media exposure was associated with acute stress reac- tions in people from all over the United States who were not directly exposed to the event in Boston. Furthermore, respon- dents reporting exposure to media coverage of the bombings for six or more hours daily in the week following the bombings were nine times more likely to report high acute stress than those who had minimal exposure to media coverage of the events. In fact, the group who engaged in extensive media coverage had higher levels of acute stress than respondents who had direct exposure in Boston, but who had minimal exposure to media coverage of the bombings. These findings suggest that prolonged media exposure to collective traumatic events may have a strong negative impact on psychological symptoms and acute stress syndromes. However, the study noted substantial resilience in the surveyed population. Researchers have suggested that the

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