The Children of Ground Zero,

New York Post, May 12, 2005

By Sally Satel

A NEW report shows that chil dren attending school near Ground Zero at the time of the 9/11 terrorist attack were dramatically less likely to have a mental disorder than children anywhere else in New York City.
Researchers from Columbia School of Public Health published this striking finding in this month’s Archives of General Psychiatry — but it didn’t make headlines. Instead, their article, “Psychopathology Among New York City School Children Six Months After September 11,” got gloomy coverage: “9/11’s Shock Toll on Kids” (Daily News); “Terrorism Took Toll on N.Y. Kids” (Newsday).

You can’t blame reporters, though. They were following the lead of the researchers — who had just one story to tell, and it wasn’t about the remarkable sturdiness of the Ground Zero kids.

Let’s start by letting some air out of that bad news.

Six months after 9/11, the Columbia team interviewed 8,236 randomly chosen public-school children in grades 4-12. A long questionnaire asked of symptoms within the last year (E.g., “Yes or no, have you often felt very nervous in front of classmates?” Plus: “Have you had 6 or more drinks?” And “have you thought seriously about killing yourself?”).

The same questionnaire is widely used in pediatric-mental-health research — but it’s considered a screening test, not a diagnostic test. Thus, a childs’ answers typically can tell us no more than that he or she has a “probable” mental disorder.

By design, screening tests cast a wide net — that is, some number of subjects are found, on subsequent assessment to not suffer significant disorder. (Such “false positives” from the screening usually outnumber the “false negatives” — in this case, kids who need help but aren’t flagged by the test.) So the Columbia research almost certainly inflated the estimate of how many children had “probable” disorders.

Another problem: They gave us no information on what the city’s school kids were like before 9/11 — so we can’t tell how many disorders predated the attacks.

Finally, specific conditions are especially difficult to interpret. David Shaffer, a child psychiatrist (and also a professor at Columbia, though not part of the research team), says: “In some urban areas with high crime rates, when mothers don’t allow their otherwise normal kids out after school and this can give a misleadingly high rate of agoraphobia.” One can imagine mothers of exposed children — or mothers who were exposed themselves — to be somewhat more protective after the attacks.

He also points out that unless one measures how much symptoms interfere with day-to-day function — something the screening test was never designed to do — it’s tough to know whether anxiety symptoms actually reflect a mental-health condition or just the normal cares of young people growing up.

To sum up, the Columbia study found that children with higher levels of 9/11 contact were more likely to report feeling unhappy and anxious. Among them, one would expect higher levels of clinical conditions in general, as the study found — though the percentages of probable disorders are very likely exaggerated.

But let’s turn to the children who actually went to school near Ground Zero. It turns out, remarkably, that their likelihood of having any “probable” mental disorder was one-tenth of the expected rate (based on the national average) even though they were directly exposed.

Yet when the researchers mentioned these low rates, they explained it as the result of all the counseling these kids got.

It’s possible that such attention benefited some children — but I put my bets more heavily on the fact that proximity to Ground Zero united the community, providing social cohesion. Such rallying during the London Blitz, according to historians, was vital to morale. Military psychiatrists know it protects soldiers from combat stress.

One wonders, too, how the kids themselves reacted to counseling. Within weeks of 9/11, a story in The New York Times reported that even most schoolchildren in New York City were resisting counselors’ attention. “The students are saying, ‘Can’t we just do math?’ ” said Dr. Ricky Greenwald of Mt. Sinai Hospital’s Child Trauma Program.

In adults, at least, numerous studies have shown that “debriefing” sessions in which people focus on their emotional response to a disaster can actually impede emotional recovery, though for the majority it has no impact.

Unfortunately, the Columbia researchers overlooked the gold nugget they panned from the data: the resilient kids of Ground Zero. These kids smelled and saw the massive smoldering pile every day for weeks — and also saw adults coping with the horror as Lower Manhattan’s recovery swirled around them, teaching them that life, indeed, goes on.

In our trauma-conscious society, many mental-health professionals seem eager to take charge of managing the collective anxiety surrounding terrorism and its aftermath. “The challenge for psychiatrists is how to help people live in a world that is constantly under threat,” said a psychiatrist at the New York State Psychiatric Institute. Ezra Susser, one of the Columbia researchers, has pressed for “a determined [public health] effort to help the population withstand such attacks on the psyche.” With that kind of mindset, no wonder the researchers missed the real story of their study.

Sally Satel is a psychiatrist and scholar at the American Enterprise Institute. She is co-author with Christina Hoff Sommers of “One Nation Under Therapy.”