Home > Public Resources > Trauma Blog > 2023 - May > Terror leaves adolescents behind Terror leaves adolescents behind Strøm, Dyb, Wentzel-Larsen, Stene, Schultz, & Stensland May 19, 2023 Given the increase in mass shootings in schools in over the past decade (Irwin et al., 2021), it is imperative to pertain knowledge of how such events affect students. In particular, there is a need for early identification of survivors at high risk of having their education disrupted or terminated due to the trauma. Although there is increasing evidence that trauma in general and specifically terror attacks, negatively impact academic performance in adolescent survivors (Pfefferbaum et al., 2016; Schultz & Skarstein, 2021; Scrimin et al., 2009; Shany, 2016; Stene et al., 2019; Strøm et al., 2016), we know less about how such exposure affects survivors’ ability to stay in school over time and potential risk and protective factors that associate with disruption or termination of survivors’ educational trajectory. Such knowledge has crucial implications for interventions and will help to identify adolescents who are at particular risk and points to modifiable measures for interventions. Our study sought to examine this in survivors of the Utøya terrorist attack in Norway. The Utøya massacre took place in the summer of 2011 in Norway where 69 young people were killed and many injured. The school year started only four weeks after this massacre took place. [Note: a terrorist attack can also be a mass-shooting, like the Utøya attack, although a mass-shooting is not always a terrorist attack]. Scandinavian countries have unique educational register data that allowed us to examine a person’s educational trajectory over time. As such, interview data from the Utøya study, 4-5 months post terror, were linked to individual educational register data for 265 survivors. To examine whether the younger survivors who were still in school at the time of the terror were able to complete high school on time, the younger survivors were compared to the older survivors who had the possibility to complete high school before the terror occurred and to the national average within the same birth cohorts. As seen in figure 1, adolescents who were still in school following the Utøya terrorist attack were significantly less likely to complete high school within the normative length of study compared to the older survivors. Only about half of the younger survivors managed to finish on time, compared to over two thirds of the older survivors. The younger survivors were also significantly less likely to complete high school on time compared to the national average (see Figure 1). Figure 1. Comparing high school completion among the younger survivor(n=185), older survivors (n=80), and the national the national prevalence (n=378,913) Further, we examined peri- and posttraumatic risk and protective factors that may associate with the younger survivors’ educational trajectory and high-school completion. Factors studied were posttraumatic stress, somatic symptoms, physical injuries at the time of the attack and social support. Figure 2. Ordinal logistic regression of the associations between posttraumatic stress symptoms, somatic symptoms, social support, and the normative time frame for younger survivors (n=185) Figure 2 displays the adjusted ordinal regression analyses controlling for sociodemographic background. The big blue square is the odds ratio, while the line is the confidence interval. Values below 1 indicate lower likelihood of completing high school. With that in mind, it can be observed that young survivors injured during the massacre were less likely to complete high school, as compared to their non-injured peers. Young survivors who experienced higher levels of posttraumatic stress and somatic symptoms, in the early posttraumatic phase (4-5 months after the attack), were also less likely to complete high school within the standard time, as compared to peers with lower symptom levels. Our findings extend beyond the immediate academic impairment in the aftermath of trauma exposure, by stressing how mass shootings impact the survivor’s ability to complete high-school years after experiencing a terror attack. Survivors who sustained injuries during the terror event and who experienced early posttraumatic stress and somatic symptoms, only 4-5 months post attack are particularly vulnerable of having their education disrupted or terminated. Implications of these findings suggest that in addition to considering mental health problems, special attention needs to be directed towards injured survivors and individuals experiencing somatic symptoms, such as pain, headaches, and fatigue. A more proactive follow up of psychological and somatic symptomatology of injured survivors from the early posttraumatic phase could better equip youth to focus on their everyday developmental tasks, including their education. Our findings reinforce the need for early targeted interventions following a terror attack and encourage trauma sensitive teaching for educators to support adolescents exposed to trauma. Target Article Strøm, I. F., Dyb, G., Wentzel-Larsen, T., Stene, L. E., Schultz, J.-. H., & Stensland, S. (2023). Terror leaves adolescents behind: Identifying risk and protective factors for high-school completion among survivors of terrorism. Journal of Traumatic Stress, 00, 1– 12. https://doi.org/10.1002/jts.22935 Discussion Questions What methodological tools do teachers need to facilitate learning and academic progress for traumatized students? How can we better integrate health care services and educational adaption following trauma? How can we improve educational follow-up of traumatized students with somatic and physical health problems? About the Authors Ida Frugård Strøm, PhD is a senior researcher at the Norwegian Centre of Violence and Traumatic Stress Studies and is currently a Visiting Researcher at the University of California, Irvine (Strøm, Ida Frugård - NKVTS English). Dr. Strøm can be contacted at [email protected]. Grete Dyb, MD PhD, Research Professor at the Norwegian Centre of Violence and Traumatic Stress Studies and the University of Oslo. Tore Wentzel-Larsen, MSc is a statistician at the Norwegian Centre of Violence and Traumatic Stress Studies and Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (https://www.nkvts.no/english/employee/wentzel-larsen-tore/). Lise Eilin Stene, MD PhD is a senior researcher at the Norwegian Centre of Violence and Traumatic Stress Studies. John-Håkon Schultz, PhD, Professor UiT, The Artic University of Norway. Synne Øien Stensland, MD PhD is a pediatrician and senior researcher at the Norwegian Centre of Violence and Traumatic Stress Studies and the Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo, Norway. References Cited Irwin, V., Wang, K., Cui, J., Zhang, J., & Thompson, A. (2021). Report on indicators of school crime and safety: 2020. National Center for Education Statistics. https://nces. ed. gov/pubsearch/pubsinfo. asp. Pfefferbaum, B., Noffsinger, M. A., Jacobs, A. K., & Varma, V. (2016). Children’s Cognitive Functioning in Disasters and Terrorism. Current Psychiatry Reports, 18(5), 48. https://doi.org/10.1007/s11920-016-0685-2 Schultz, J.-H., & Skarstein, D. (2021). I’m not as bright as I used to be – pupils’ meaning-making of reduced academic performance after trauma. International Journal of School & Educational Psychology, 9(4), 265279.https://doi.org/10.1080/21683603.2020.1837698 Scrimin, S., Axia, G., Capello, F., Moscardino, U., Steinberg, A. M., & Pynoos, R. S. (2006). Posttraumatic reactions among injured children and their caregivers 3 months after the terrorist attack in Beslan. Psychiatry Research, 141(3), 333-336. https://doi.org/10.1016/j.psychres.2005.11.004 Shany, A. (2016). Too Scared for School? The effects of terrorism on Israeli student achievement. Working Paper. Hebrew University of Jerusalem. Stene, L.E., Schultz, J.H., & Dyb, G. (2019). Returning to school after a terror attack: a longitudinal study of school functioning and health in terror-exposed youth. European Child & Adolescent Psychiatry 28, 319–328. https://doi.org/10.1007/s00787-018-1196-y Strøm, I. F., Schultz, J.-H., Wentzel-Larsen, T., & Dyb, G. (2016). School performance after experiencing trauma: A longitudinal study of school functioning in survivors of the Utøya shootings in 2011. European Journal of Psychotraumatology, 7(1), 31359. https://doi.org/10.3402/ejpt.v7.31359