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In Schools, a Hidden Toll of Sept. 11

May 13, 2002
New York Times


KRISTEN AND ERIC LEINUNG were very close to their older
brother, Paul Battaglia, so close that Kristen's first word
was "brother," and she was furious when a teacher insisted
that she indicate he was a half brother on her family tree.

After Paul, 22, who worked for Marsh & McLennan in the
World Trade Center, died on Sept. 11, 10-year-old Eric
acted out in school, got into trouble, and was quickly sent
to therapy by his parents. But the depth of Kristen's pain
did not surface until January, when she broke down after
her Sweet 16 party. "She repressed her emotions, still
doesn't want to talk about her brother," said her mother,
Elaine Leinung, a nurse-practitioner. "She had to hit
bottom before we could reach out to her."

Eric and Kristen exemplify the findings of a newly released
study by the city's Board of Education that about 75,000 of
the more than 710,000 public school students in grades 4
through 12 are suffering symptoms of post-traumatic stress
disorder, and as many as 190,000 have mental health
problems, both related and unrelated to 9/11.

The study and the underlying reality have spurred an
intense debate about how to proceed. Psychologists who
specialize in trauma want the Board of Education to screen
students and find those with emotional problems -
especially those suffering in silence, crying themselves to
sleep, like Kristen did, or having nightmares or getting
psychosomatic aches and pains.

The board studied children anonymously, and several mental
health professionals contend that the schools should now
try to identify those who need help. Even if the numbers
are not as large as projected in the study, experience with
other disasters suggests they are considerable.

"We know children don't ask for help on their own, and we
know that parents and teachers are not particularly good at
knowing which kids are hurting when they hurt silently,"
said Claude M. Chemtob, a visiting professor of psychiatry
and pediatrics at Mount Sinai School of Medicine who
specializes in trauma. "We also know with children that
when their problems are not detected they can continue to
have problems from a disaster for more than 20 years

Dr. Chemtob, who has been working with students in some
schools near the trade center site, urges the screening of
all students, with their names coded; those whose answers
betray serious problems would be identified and offered

Dr. Spencer Eth, professor of psychiatry at New York
Medical College, agrees. "Those kids affected and untreated
will go on to have potentially lifelong difficulties
directly related to 9/11, in the form of educational
handicaps, substance abuse, antisocial behavior," he said.

After Hurricane Iniki hit the Hawaiian island of Kauai -
on Sept. 11, 1992 - a study two years later showed that
teachers had missed the symptoms of the more withdrawn
students. "The teachers had reported students who acted out
and caused disruptive trouble, but the report helped us see
those suffering quietly," said Joanne P. Nakashima, an
education specialist with the Kauai school district at the

The screening on Kauai helped school officials identify
about 200 students (out of 10,000) in need of treatment. A
similar undertaking in New York City would be ambitious and
costly, but the experts say it could be done. School
officials are unenthusiastic, however. "We don't want our
kids to be guinea pigs," said Francine Goldstein, who
oversees the schools' mental health outreach program.
"We're not totally ruling out screening, but I'm not sure
that's the route the system is going. I am more concerned
about what that might do to kids than I am about money."

Those who favor screening say that exploitative research
can be prevented, but Ms. Goldstein has other doubts. She
notes that superintendents, principals and teachers have
been instructed about the warning signs of trauma, and that
concerned parents can call several programs and consult the
board's Web site.

Several schools are providing counseling, some with help
from nonprofit groups, but the numbers of students getting
therapy is small compared with the need. And few would
contend that the system has any experience at finding
students like Kristen. Ms. Leinung said that when she
called her daughter's high school asking for help, the
school counselor said that she could not do anything until
Kristen herself asked. And both brother and sister
encountered some unfeeling teachers, Ms. Leinung said.

Today, Eric and Kristen are still hurting, but getting the
attention they need. "I just wish I had realized sooner,"
Ms. Leinung said. "I wish the teachers had been more



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