This study examined pre-9/11 parenting and child temperament, as well as parental responses following the terrorist attacks of September 11, 2001, as predictors of children's PTS symptoms among children geographically distant from the events. Results may not generalize to the experiences of children who are more proximal to such events or who experience higher levels of threat to their physical well-being. Researchers have called for greater attention to prospective predictors of children’s PTS symptoms following disasters (e.g., Silverman & La Greca, 2002
). The attacks presented a unique opportunity to examine the role of prospective predictors and parenting-by-temperament interactions in post-9/11 adjustment. These types of models can help determine which children may be most susceptible to indirect exposure to traumatic events (Kraemer et al., 2008
). Research considering parenting as a prospective predictor of child PTS symptoms is limited, and this study provided information about the role that parenting and parent responses play in predicting children’s PTS symptoms. Pre-9/11 parenting. Specifically, acceptance/rejection predicted PTS symptom severity, and some 9/11-specific parent responses contributed to PTS symptoms beyond the effects of pre-9/11 parenting. Mothers’ self-focused responses following 9/11, which appeared to reflect their emotional distress, were related to greater PTS symptom severity. Our findings are also relevant to the parenting and temperament literature. Pre-9/11 parenting and temperament interacted with each other to predict PTS outcomes. For instance, maternal acceptance appeared to be more helpful for children low in negative emotionality, whereas children higher in negative emotionality demonstrated higher PTS symptoms despite levels of maternal acceptance. Also, low levels of maternal acceptance seemed to be more detrimental for children low in effortful control.
Results indicate that pre-9/11 maternal acceptance, but not consistent discipline, was related to lower levels of PTS symptoms, supporting the idea that the existing parent-child relationship contributes to children’s responses to stressful events (e.g. Grant et al., 2004
; Wolchik, Wilcox, Tein, & Sandler, 2000
). Accepting parenting may have a salient role to play in the prevention of PTS symptoms, which is supported by recent research indicating that positive parenting helps children learn how to regulate their emotions (Eisenberg et al., 2005
). In the case of an event such as 9/11, an on-going accepting and warm relationship may facilitate children’s processing and regulation of emotions. Higher levels of maternal acceptance may engender a context of security and comfort for children when major stressors occur.
Parenting responses specific to 9/11 were associated with PTS symptoms. Mother-report perceived helpfulness was associated with lower PTS symptom severity above the effects of pre-9/11 parenting, suggesting that when parents feel they are being helpful, this is likely to be accurate. Parents might be instructed to seek additional psychological help for their children when they feel their efforts to assist their children are not working. Unexpectedly, children who reported their mothers were more helpful after 9/11 reported higher levels of PTS symptoms. This likely reflects the fact that children who were more distressed required more support and recognized that their mothers were doing more to help them manage distress. It is also possible that children perceived their mothers’ extra attention as out of the ordinary, emphasizing that something was wrong, which might contribute to PTS symptoms.
Additionally, self-focused maternal responses were related to higher levels of PTS symptoms. Self-focused explanatory responses may be capturing mothers’ negative affect or distress in response to the stressful event. It might be particularly frightening for children to see their parents seemingly lacking in emotional control, further intensifying the children’s own distress. Parents might be advised that the reactions they display in their children’s presence can impact their children, and to seek help or talk privately with other adults if they are so distraught that they cannot modulate their responses around their children. This finding is also consistent with other PTS research and theory that indicates parental modeling of emotional and coping responses is important in promoting children’s natural recovery after a stressful or traumatic event (e.g., Green et al., 1991
; Pine, Costello, & Masten, 2005
). As has been suggested by other researchers, many of the changes made by parents following stressors may be adaptive (Henry, Tolan, & Gorman-Smith, 2004
). Additionally, some of the existing advice that is provided to parents, such as the advice provided by FEMA (2004)
indicating that children take their cues for how to respond from parents, is strongly supported by the findings of this study, and could be more widely disseminated. Interventions designed to train parents in media literacy and encourage positive coping have shown initial efficacy at reducing children’s perception of threat from terrorist attacks in laboratory settings (Comer, Furr, Beidas, et al., 2008
). These types of interventions hold promise for improving the positive influence of parents.
Our findings support the interactive nature of parenting and temperament (e.g., Belsky, 2005
), suggesting that these interactions play a role in the development of PTS symptoms and related functional impairment. These findings are also commensurate with disaster response models that posit child temperament makes a contribution to PTS symptoms, as temperament was correlated with PTS outcomes and moderated the effects of parenting. This work is consistent with findings in the context of other major stressors such as divorce (e.g., Lengua et al., 2000
). Our findings indicate that protective effects of maternal acceptance are most beneficial for children low in negative emotionality and not as beneficial for children high in negative emotionality. Children high in negative emotionality had higher levels of PTS symptoms regardless of maternal acceptance. These children may have difficulty focusing on positive aspects of their social context, and might have higher levels of negative affect in the face of stressful events, regardless of the level of acceptance provided by parents. Children low in negative emotionality are not likely to develop PTS symptoms unless mothers fail to provide a warm, accepting relationship, perhaps because mothers are not supporting their emotional responses. Our findings also suggest that children high in effortful control are less likely to develop PTS symptoms regardless of maternal acceptance. This is consistent with literature suggesting that children high in effortful control are likely to be able to inhibit and regulate their emotional responses in order to process negative events successfully (e.g., Salmon & Bryant, 2002
). For children low in effortful control who are less able to regulate emotions following a stressor, low levels of acceptance may further contribute to symptoms while accepting parenting may assist in regulating negative affect and stress responses (e.g., Scheeringa et al., 2004
It should be noted that the level of functional impairment was low, which was expected given the indirect exposure and nonclinical nature of the sample. Other studies of clinical and directly exposed samples have found higher levels of impairment (e.g., Foa et al., 2001
). In this sample, positive endorsement of many of the impairment items (e.g. interfering with chores or friendships) may reflect children’s general poor adjustment rather than a PTS-specific outcome. Additional research into PTS functional impairment is warranted, as the variables predicting impairment were different from those that predicted symptom severity. Impairment related to PTS symptoms appears to be less common and may be cause for additional concern and attention, particularly in the context of indirect exposure to a community-level disaster.
Functional impairment results should be interpreted with caution given their low levels in this sample. Low levels of maternal consistency were related to higher levels of functional impairment for children low in negative emotionality, whereas consistent discipline was unrelated to functional impairment for children with medium and high levels of negative emotionality. This finding was not in the expected direction, as children high in negative emotionality were expected to be more impaired in the context of less consistent parenting. This finding may be spurious, as functional impairment had a limited range and was very low in this sample and may not best represent PTS outcomes. Rather, functional impairment was related to preexisting problems in this sample, and after controlling for pre-9/11 problems, there may have been little reliable variance in impairment remaining to be predicted. In the interactions with effortful control, the relations with functional impairment were in the expected direction. The findings suggest that children who are low in effortful control are more likely to be impaired in the context of inconsistency. If functional impairment is conceptualized as a marker for general impairment, this finding is consistent with work showing that consistency is more important in the prediction of problems for children with difficulties in self-regulation (e.g. Lengua, 2008
There are several limitations to consider when interpreting findings from this study. First, no information was available about potential trauma exposure prior to 9/11 in this sample. Prior trauma experiences have been shown to increase children’s PTS symptoms in response to traumatic events (e.g., Pfefferbaum, Doughty, Gurwitch, et al., 2003
). Information about prior traumas may have explained additional variance in PTS symptom outcomes in this sample. In addition, the timeframe for post-9/11 data collection may have influenced the results. A diagnosis of PTSD requires that symptoms persist for at least a month. Children reporting symptoms related to the events over a month later may be more likely to be experiencing clinically relevant PTSD symptoms than children assessed earlier, whose responses might be reflecting normative levels of distress. However, the timing of the interview (i.e., time since 9/11) was not correlated with PTS outcomes in this sample, suggesting that the passing of time did not systematically influence symptom reporting in this sample.
Furthermore, analyses did not include a standardized measure of indirect exposure to the events of 9/11. Questionnaire measures of indirect exposure have been developed for specific types of disasters, (e.g. hurricanes; La Greca, Silverman & Wasserstein, 1998
), but further development of indirect exposure measures is needed. Factors that might be relatively easy to standardize include disruption of routines, as well as knowing people affected. Development of measures of the quantity and quality of media exposure is also crucial, as problems with these measures have been noted (Comer & Kendall, 2007
). The measure used in the current study asked parents whether they had “protected” their child from media images, which may have biased parental responses. Thus, the lack of effects of media exposure in this study may reflect problems in measurement rather than a true lack of an effect of media on children’s PTS symptoms. Another limitation is the lack of a standardized measure of 9/11-specific parenting. There may have been parenting behaviors that mothers engaged in that were not captured using the open-ended response method. Additional development of measures may be informed by this study. In particular, the level of distress that parents express in front of their children would be important to assess, as well as parental negative affect. The results of this study suggest that it is also important to assess post-disaster parenting from the perspectives of parents and children.
Additionally, sample size may have limited power to detect effects. A number of associations approached significance and may have reached significance with a larger sample size. This study is one of the first studies to examine associations between parenting and children’s responses to a disaster, and while parenting made significant contributions to children’s PTS responses, the amount of variance accounted for by the models tested in this study was relatively small. However, the magnitude of the associations between parenting and PTS outcomes in this study was similar to those reported in past studies (e.g., Green et al., 1991
). Identifying other parenting variables or family factors that may contribute to PTS responses will be an important next step in this research area. Examining potential mediators and moderators in the theoretical model will also be an important future step. For instance, it may be that parental responses have more of an impact when children have higher levels of indirect exposure, or that prior parenting is more or less helpful depending on exposure.
Implications for Research, Policy, and Practice
Studies of prospective predictors of children’s response to traumatic events or disasters are critical for several reasons. First, they enhance conceptual understanding of PTS symptoms and the development of problems following a disaster (e.g., La Greca et al., 1998
). Second, the examination of prospective predictors of children’s post-trauma responses facilitates the identification of children who are most likely to develop problems, allowing for targeted interventions aimed at those most in need. This study suggests that an existing positive parent-child relationship may reduce PTS symptoms. However, the extent to which parenting relates to stress responses depends on children’s temperament. A lack of warm parenting in the context of stress might be more of a problem for children low in negative emotionality, as they may receive less assistance with regulation of emotions during negative events. In contrast, when parents are rejecting and inconsistent, children low in effortful control may be particularly vulnerable, as stressful experiences might highlight difficulties they already have with emotion regulation, putting them at risk for developing intrusive thoughts or heightened negative affect. Third, prospective studies inform potential interventions aimed at facilitating adaptive responses to trauma (La Greca & Silverman, 2009
). Providing specific strategies for parents may increase resilience to indirect trauma exposure (Comer et al., 2008
; Pine, Costello, & Masten, 2005
). Improving parent-child interactions, assisting parents with their own responses, and building children’s effortful control skills, might be targets of future interventions.