What about the children? On and immediately after September 11, 2001, this was among the questions most-asked of WebMD about that horrific day.
Ten years later, questions persist. Here's what several experts had to say:
How did the 9/11 terrorist attacks affect U.S. children?
Remarkably little is known for sure, says child trauma expert Roxane Cohen Silver, PhD, of the University of California, Irvine.
Symptoms of trauma were most likely in children directly affected by the attacks - who witnessed the events, who lost family members, or whose family members escaped. Nevertheless, kids far from the scene of the crimes - even in nations outside the U.S. - also were traumatized by dramatic media coverage.
But even among children who lived in New York City, Silver found, "the psychological and behavioral outcomes of 9/11 often have been found to be relatively modest."
A few months after the attacks, Silver said, "very few studies found symptoms in children."
One interesting phenomenon is what happened when Osama bin Laden was killed by U.S. soldiers. There were wild celebrations in the U.S. - but the vast majority of those celebrating were college-age young adults who were 10 to 12 years old in 2011.
The son of a colleague at WebMD was among the celebrants. When she asked him about it, he explained, "Mom, bin Laden is our Hitler."
"One thing terrorist attacks can do is identify an enemy," Silver says. "The fact that young people celebrated the killing of Osama bin Laden suggests very strongly that they grew up under the shadow of 9/11."
"For those who were 8 or 10 at the time of 911 it was a defining moment in their lives," Karen Remmler, PhD, an expert in the remembrance of tragedies at Mount Holyoke College, tells WebMD. "It is a defining moment that will ground any other experiences of trauma or political attacks, even natural disasters."
On a positive note, young people are working particularly hard to understand and bring meaning to the 9/11 tragedy, says political science professor Stephen R. David, PhD, vice dean for undergraduate education at Johns Hopkins University.
"Right away it was clear students were anxious about what had happened and craving a sense of what all this was about," David told me. "One difference with this generation is their increased interest in study of terrorism and how America can protect itself. They are going deeper, with interest in studying Arabic and the countries of the Middle East. They have a desire to understand why people hate America so much. Courses on and travel to the Middle East are much more popular than they were."
How do children typically respond to trauma?
No two children will respond to trauma in exactly the same way. Their reactions depend on the degree of their exposure to the event, on their individual nature, on their age and stage of development, and on their parents' level of distress.
As child mental health expert Robin Gurwitch, PhD, notes in a news release from the American Psychological Association, children's responses to trauma fall into four categories: feelings, thoughts, actions, and physical reactions.
According to guidance issued by the American Academy of Pediatrics, these responses occur in stages:
• Immediately after a disaster, children may be afraid, disbelieving, in denial, grieving, and, if people they know have not been harmed, relieved. Interestingly, children at this stage may be very generous and are looking for ways to help others. This may be a sign that a child is particularly resilient.
• Days to weeks after a disaster, traumatized children tend to regress developmentally. They may show signs of emotional distress such as anxiety, fear, sadness and depressive symptoms, hostility and aggressive behavior, apathy, withdrawal, sleep disturbances, physical symptoms, and pessimistic thoughts about the future. Their play may act out themes related to the traumatic event.
• These symptoms are normal and should last a few weeks. Silver found that in the small number of long-term studies of children affected by 9/11, these initial distress symptoms "seemed to diminish over time."
Children with stress reactions and behavioral symptoms a month after the event are at increased risk of PTSD or violent/delinquent behavior later in life. Treatment from a mental health specialist "is appropriate and necessary" for these children, the AAP advises.
What effect will the 9/11 10th anniversary remembrances have on children?
Media coverage of the 9/11 tenth anniversary may be anxiety provoking for children with direct experience of the events of 9/11. This likely includes children whose parents are or were involved in the military response to 9/11.
The 9/11 10th anniversary is a good opportunity for parents to talk with children about what they are seeing, hearing, and feeling. It might be a good idea to watch or read some of the coverage with them.
Parents should decide is appropriate for their children - but Silver says there's no point in replaying graphic images of the violence.
"Whatever is being shown I would encourage parents to discourage children from watching graphic pictures. Parents too. I don't see any psychological advantage to repeated exposure," she says.
Instead of wallowing in the tragedy, Silver advises positive steps.
"There are age-appropriate ways to recognize the lives lost, to acknowledge the heroes of that day, to remember how our country came together," she says. "Families may choose to donate money or blood, or to make displays of patriotism such as flags in the home. These kinds of things enhance recognition of lives lost and ways in which people came together to help those who were bereaved."