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Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt

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Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt ARTICLE Adjustment Among Area Youth After the Boston Marathon Bombing and Subsequent Manhunt AUTHORS: Jonathan S. Comer, PhD,a Annie Dantowitz, WHAT’S KNOWN ON THIS SUBJECT: Research in the aftermath of MSW,b Tommy Chou, MA,a Aubrey L. Edson, MA,b R. large-scale terrorist attacks shows that exposed children Meredith Elkins, MA,b Caroline Kerns, MA,b Bonnie Brown, experience numerous negative psychological sequelae, including RN,b and Jennifer Greif Green, PhDb increased emotional difficulties, posttraumatic stress, and aDepartment of Psychology, Florida International University, significant attack-related life disruptions. Miami, Florida; and bDepartment of Psychology, Boston University, Boston, Massachusetts WHAT THIS STUDY ADDS: Most research on terrorism-exposed KEY WORDS youth examines large-scale terrorism. Limited work examines trauma, terrorism, PTSD, mental health, disaster reactions to terrorism of the scope of the marathon attack, and ABBREVIATIONS the extraordinary manhunt and shelter-in-place warning was an — PTSD posttraumatic stress disorder unprecedented experience. Understanding adjustment after these SDQ—Strengths and Difficulties Questionnaire events is critical. Dr Comer conceptualized and designed the study, supervised participant recruitment and data collection, conducted the data analyses, drafted the initial draft of the manuscript, and revised the manuscript in response to internal suggestions; Ms Dantowitz developed the data collection infrastructure, coordinated participant recruitment efforts, helped oversee data collection, and helped prepare data for statistical analysis; abstract Mr Chou, Ms Edson, Ms Elkins, and Ms Kerns helped design the BACKGROUND: The majority of research on terrorism-exposed youth has study and develop the core study survey, helped coordinate examined large-scale terrorism with mass casualties. Limited research participant recruitment efforts, helped prepare data for statistical analysis, reviewed the initial draft of the manuscript, has examined children’s reactions to terrorism of the scope of the and provided suggestions for revision; Ms Brown coordinated Boston Marathon bombing. Furthermore, the extraordinary postattack and oversaw participant recruitment efforts and reviewed the interagency manhunt and shelter-in-place warning made for a truly initial draft of the manuscript and provided suggestions for revision; Dr Green helped design the study and develop the core unprecedented experience in its own right for families. Understanding study survey, helped coordinate participant recruitment efforts, the psychological adjustment of Boston-area youth in the aftermath of helped develop a data analytic plan, and reviewed the initial these events is critical for informing clinical efforts. draft of the manuscript and provided suggestions for revision; and all authors approved the final manuscript as submitted. METHODS: Survey of Boston-area parents/caretakers (N = 460) reporting ’ www.pediatrics.org/cgi/doi/10.1542/peds.2013-4115 on their childs experiences during the attack week, as well as fi doi:10.1542/peds.2013-4115 psychosocial functioning in the rst 6 attack months. Accepted for publication Apr 9, 2014 RESULTS: There was heterogeneity across youth in attack- and manhunt- Address correspondence to Jonathan S. Comer, PhD, Center for related experiences and clinical outcomes. The proportion of youth with Children and Families, Department of Psychology, Florida likely attack/manhunt-related posttraumatic stress disorder (PTSD) International University, 11200 Southwest 8th St, Miami, FL 33199. was roughly 6 times higher among Boston Marathon–attending youth E-mail: jocomer@fiu.edu than nonattending youth. Attack and manhunt experiences each uniquely PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). predicted 9% of PTSD symptom variance, with manhunt exposures Copyright © 2014 by the American Academy of Pediatrics more robustly associated than attack-related exposures with a FINANCIAL DISCLOSURE: The authors have indicated they have range of psychosocial outcomes, including emotional symptoms, conduct no financial relationships relevant to this article to disclose. problems, hyperactivity/inattention, and peer problems. One-fifth of youth FUNDING: Supported by the Center for Anxiety and Related . Disorders Research Fund, the Barlow Research Fund, and the watched 3 hours of televised coverage on the attack day, which was linked Department of Psychology at Boston University, as well as by the to PTSD symptoms, conduct problems, and total difficulties. Prosocial behavior National Institutes of Health (grants K23 MH090247 and K01 and positive peer functioning buffered the impact of exposure. MH085710). Funded by the National Institutes of Health (NIH). CONCLUSIONS: Clinical efforts must maintain a broadened focus beyond POTENTIAL CONFLICT OF INTEREST: The authors have indicated simply youth present at the blasts and must also include youth highly exposed they have no potential conflicts of interest to disclose. to the intense interagency pursuit and manhunt. Continued research is needed to understand the adjustment of youth after mass traumas and large-scale manhunts in residential communities. Pediatrics 2014;134:1–8 PEDIATRICS Volume 134, Number 1, July 2014 1 Downloaded from www.aappublications.org/news by guest on September 28, 2021 In recent years, there have been several suburb, during which ∼300 rounds of pathways of resilience in disaster- high-profile terrorist attacks specifically ammunition were fired, bombs and affected populations,8 as well as re- targeting civilian child and family venues grenades were thrown, a transit officer search identifying social support as a (eg, Russia’s Beslan school hostage crisis, was shot, and 1 suspect was killed. potential protective factor for disaster- Norway’sWorkers’ Youth League camp The second suspect escaped, and an affected youth,4 we also examined attack, Nairobi’s Westgate Mall attack). emergency “shelter-in-place” warning whether prosocial behavior and peer Although research has documented the was enacted for nearly 1 million Boston- functioning moderated associations be- psychological toll of terrorism on youth,1–4 area residents. Transportation and busi- tween traumatic exposure and negative the majority of such work has focused nesses were shut down as helicopters child outcomes. on attacks targeting office buildings of circled overhead and officers searched high symbolic value,3,5–7 where the pres- door-to-door for the remaining suspect. METHODS ence of families has been incidental. That evening, a Watertown resident spot- Design and Participants Much remains to be learned about the ted the suspect. Helicopters using ther- Study procedures were conducted un- reactions of children affected by terror- mal imaging then circled overhead, der approval of the Boston University fi “ ” fi ism speci cally aimed at soft targets followed by heavy gun re and the use Institutional Review Board. English- fl such as family events. Moreover, the ma- of ash bangs. The remaining suspect speaking parents and caretakers of at jority of research on terrorism-exposed was taken into custody in critical least1childagedbetween4and19years youth has examined large-scale attacks condition. After 5 days, the imminent dwelling ,25 miles of the attack site or – with mass casualties (eg, 9/11).2,3,5 7 Min- threat posed by the suspects and the Watertown were recruited between the imal research has examined children’s extraordinary show of interagency force dates of June 15, 2013 and October 15, reactions to high-profile terrorism with was over. 2013 (2–6 months postevent) to com- relatively few fatalities. Understanding the adjustment of Boston- plete an online survey assessing chil- The 2013 Boston Marathon bombing area youth after the marathon bomb- dren’s experiences during the marathon was a high-profile attack that spe- ingandsubsequentmanhuntiscritical attack week, as well as psychosocial cifically targeted a civilian family for informing clinical efforts and for functioning. Recruitment efforts in- event. Two coordinated pressure-cooker improving our understanding of the cluded (a) school-based outreach (eg, bombs were detonated near the fin- impact of high-profile terrorism on superintendents, including the Water- ish line of the heavily attended mara- “soft targets.” Moreover, unlike the town Public Schools superintendent, thon, killing 3 and injuring 264 others aftermath of previous well-studied sent letters home with children encour- (including 16 amputees). The attack and terrorist attacks, the extended imme- aging participation); (b) pediatrician- associated casualties marked the be- diate threat, the extraordinary post- based outreach (study flyers displayed ginning of a highly intense week for attack interagency show of force, the in waiting rooms); (c) community event Boston-area families. Bags abandoned violent and public manhunt, the tem- outreach (study staff attended local by fleeing spectators were treated porary shelter-in-place warning, and family-oriented events, as well as “Bos- as potential explosives, and rumors the extended disruption in daily ac- ton Strong” fundraisers/rallies to dis- spread about additional live bombs. tivities for large numbers of families tribute recruitment flyers); and (d) Transportation was shut down, and not directly exposed to the bombing media-based outreach (eg, local news- the typically bustling 15-block radius made for a truly unprecedented and papers and blogs wrote pieces en- around the attack was
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