Posttraumatic stress symptoms in children after the World Trade Center attack: Investigating the triple vulnerability model of etiology

Research on the emotional sequelae of a traumatic event suggests that there are mediating and moderating variables that contribute to the development of posttraumatic symptoms and posttraumatic stress disorder (PTSD). The Triple Vulnerabilities model specifies a set of interacting diatheses that contribute to etiology: biological (temperamental dispositions), psychological (based on early experiences of control over salient events), and a specific psychological vulnerability where one learns to focus anxiety on specific situations. While this model has received support in the adult literature, it has not been examined in children. Within the literature on children's reactions to traumatic events, La Greca and colleagues are the only researchers who have examined a model of the development of PTSD symptoms in children. However, their model is limited because it only considers factors that influence symptom expression after an event (e.g. social support, coping, life events). The aim of this study was to examine a combined model of the development of PTSD symptoms after direct exposure to the September 11th terrorist attacks. Fifty-one 3rd and 5th graders and their parents, who attended school 3 blocks north of “ground zero,” were assessed during the 2002–2003 school year. Children were evaluated 13, 17 and 20 months post-attack. The primary hypothesis was that the combined model would predict the emergence of posttraumatic symptoms over time. In this sample of children exposed to life-threatening events during the September 11th attack greater negative affectivity 13 months after the attack, greater behavioral inhibition since first grade, more negative coping after the event and a high frequency of stressful life events since the attack was associated with greater posttraumatic stress symptoms 13 months after the attack. Those who experienced greater negative affect 13 months after the event and behavioral inhibition since 1st grade were more likely to have posttraumatic symptoms up to 20 months after the attack. Parental reports of behavioral inhibition since first grade and negative affect 13 months after the attack were the strongest predictors of PTSD over time. Results suggest that temperamental vulnerabilities contribute substantially to the development of posttraumatic symptoms following a traumatic event.