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"The death of a close relative is one of the most severe stresses that a child can endure," says Dr. Cynthia Pfeffer, Professor of Psychiatry at Weill Cornell Medical College and Attending Psychiatrist at NewYork-Presbyterian Hospital's Weill Cornell Medical Center. In the World Trade Center attack of last September 11, many thousands of children—some have said as many as 15,000—suddenly lost at least one parent. Now, with the support of a Federal grant, Dr. Pfeffer, a nationally recognized authority on childhood bereavement, is leading a study to determine what kind of emotional and physiological effects this loss has had, and will have, on the children and their surviving parents.

The grant—$225,000 a year for two years, from the National Institute of Mental Health—will enable Dr. Pfeffer; her colleague, Dr. Margaret Altemus, Associate Professor of Psychiatry and an expert on neuroendocrinology; and a staff of several health professionals to follow about 50 children, aged 6 to 12, who lost a parent at the World Trade Center, through in-depth interviews at intervals of about six months. By also collecting saliva samples, the study will also measure levels of cortisol, a hormone affected by stress.

The study will also track the children's growth in height and weight. And it will measure another group of children—perhaps somewhat less than 50—who did not lose a parent on September 11, to provide what Dr. Pfeffer calls a "standard" against which the bereaved children can be compared. The study will take place mostly at NewYork-Presbyterian Hospital's Payne Whitney Clinic, in Manhattan, and Westchester Division, in White Plains, but Dr. Pfeffer says that the investigators may also travel to Staten Island and New Jersey to reach all the children and their families. The study, which has already begun, will attract participants through advertising and word-of-mouth, and it will use liaisons with the Fire Department, the Police Department, and certain World Trade Center companies, all of which suffered great losses on 9/11.

"This study will have significant advantages for the families that participate," Dr. Pfeffer says, "because the children will get very comprehensive evaluations. We will be able to provide information to the surviving parents or guardians about how their child is coping, and, if there's a need for help—for intervention—we will be able to provide that or point to where it can be obtained."

Dr. Pfeffer has long been involved with grieving children as Director of Weill Cornell's Childhood Bereavement Program, which was established with funding from the William and Mildred Lasdon Foundation. Previous research by Dr. Pfeffer received support from a fund established in The New York Community Trust by DeWitt Wallace, and the William T. Grant Foundation.

In the Childhood Bereavement Program, Dr. Pfeffer has commonly dealt with children who have lost parents to illness. When a child loses a parent in that manner, she says, "we've found that the bereavement process starts before the actual death." That is, the child sees changes in the parent—decreases in functioning—and is already suffering a loss: the parent may not be as available as before.

"What happened on September 11 was different from losing a parent to illness," Dr. Pfeffer says. After September 11, too, there has been tremendous stress and anxiety. But there is also a potential for further attacks, which causes more anxiety. "And for some of the families," Dr. Pfeffer says, "there was no body found. So the sense of definitiveness, or what happens when there is a funeral and burial—for many of the families, that hasn't occurred. Some families struggled for weeks or months before they could realize that a loved one was not coming home."

Like other psychiatrists at Weill Cornell—indeed, like other psychiatrists throughout the city—Dr. Pfeffer has already seen many effects from September 11, in families both directly affected and not directly affected. "We've seen children who, even if they haven't lost a parent, are anxious, or having trouble sleeping, or what is common is that they were having trouble separating from their parents."

Among children who have lost a parent, Dr. Pfeffer says, some don't want to talk very much about their loss, possibly because they don't want to upset their surviving parents further. "They see their parents sad, crying, maybe not coping well," she says. "They don't want to hurt their parents. We will interview the children individually, to enable them possibly to feel more comfortable talking about their feelings and concerns."

There are also children who will speak very readily about the loss, saying, "Daddy's not here," or "Mommy's not here." These children feel sad and anxious. They may draw pictures of when the parent was there. Some children, who do not want to talk much about their loss, will show non-verbal behavior expressing sadness and anxiety. And some children have demonstrated some self-destructive behaviors: they are more irritable or aggressive, or they may not take care of themselves.

"The effects of September 11 can be very variable," Dr. Pfeffer says. "We think it's very important to find out the impact of the attack on the children most severely affected, to understand the emotional and physiological changes they are going through, and to provide all the support we can to them in this difficult time."