A theoretical model of continuity in anxiety and links to academic achievement in disaster-exposed school children

Abstract

This study tested a theoretical model of continuity in anxious emotion and its links to academic achievement in disaster-exposed youth. An urban school based sample of youths (n = 191; Grades 4-8) exposed to Hurricane Katrina were assessed at 24 months (Time 1) and then again at 30 months (Time 2) postdisaster. Academic achievement was assessed through end of the school year standardized test scores (~31 months after Katrina). The results suggest that the association of traumatic stress to academic achievement was indirect via linkages from earlier (Time 1) posttraumatic stress disorder symptoms that predicted later (Time 2) test anxiety. Time 2 test anxiety was then negatively associated with academic achievement. Age and gender invariance testing suggested strong consistency across gender and minor developmental variation in the age range examined. The model presented advances the developmental understanding of the expression of anxious emotion and its links to student achievement among disaster-exposed urban school children. The findings highlight the importance of identifying heterotypic continuity in anxiety and suggest potential applied and policy directions for disaster-exposed youth. Avenues for future theoretical refinement are also discussed.

Full text

Achievement 1
Running Head: ACHIEVEMENT
A Theoretical Model of Continuity in Anxiety and Links to Academic Achievement in
Disaster Exposed School Children
Carl F. Weems, Brandon G. Scott, Leslie K. Taylor, & Melinda F. Cannon
Department of Psychology, University of New Orleans
Dawn M. Romano
Private Practice, New Orleans
Andre M. Perry
Department of Education, University of New Orleans
In press (accepted for publication 2-29-2012): Development and Psychopathology
Correspondence concerning this article should be addressed to Carl Weems, Department of
Psychology, University of New Orleans, New Orleans, LA 70148. Electronic mail may be sent
via Internet to cweems@uno.edu. Phone: (504) 280-6772; Fax: (504) 280-6049
Author Notes:
This research was supported in part by a grant from the New Orleans Institute of Mental Hygiene
(IMH) to Carl Weems. The authors would like to acknowledge Vera Triplett, Reshelle C.
Marino, and Shannon L. Verrett for their help with data collection and thank Robert Laird for his
insightful comments on the paper.

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Abstract
This study tested a theoretical model of continuity in anxious emotion and its links to academic
achievement in disaster exposed youth. An urban school based sample of youth (n = 191; grades
4 to 8) exposed to Hurricane Katrina were assessed at 24 months (Time 1) and then again at 30
months (Time 2) post-disaster. Academic achievement was assessed through end of the school
year standardized test scores (approximately 31 months post Katrina). Results suggest that the
association of traumatic stress to academic achievement was indirect via linkages from earlier
(Time 1) Posttraumatic stress disorder (PTSD) symptoms which predicted later (Time 2) test
anxiety. Time 2 test anxiety was then negatively associated with academic achievement. Age and
gender invariance testing suggested strong consistency across gender and minor developmental
variation in the age range examined. The model presented advances the developmental
understanding of the expression of anxious emotion and its links to student achievement among
disaster exposed urban school children. The findings highlight the importance of identifying
heterotypic continuity in anxiety and suggest potential applied and policy directions for disaster
exposed youth. Avenues for future theoretical refinement are also discussed.
Key Words: posttraumatic stress, trauma, disaster, test anxiety, academic achievement

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A Theoretical Model of Continuity in Anxiety and Links to Academic Achievement in
Disaster Exposed School Children
There are a number of developmental differences in the expression of anxious emotion
(Weems, 2008). As theory suggests, research has identified age differences in the predominant
expression of the symptoms of childhood anxiety and phobic disorders (Warren & Sroufe, 2004;
Westenberg, Siebelink, & Treffers, 2001; Weems & Costa, 2005; see Weems, 2008 for review).
While there may be considerable continuity in anxious emotion over time, its manifestation may
often be heterotypic. Heterotypic continuity refers to the idea that there may be differences in the
expression or manifestation of a construct over time or at different ages. In addition to age
related normative influences, there are also a number of atypical situations in which identifying
heterotypic continuity of anxious emotion over time can help to elucidate the more subtle effects
of a particular risk. For example, research suggests that exposure to natural disasters is associated
with anxious emotion. The most salient and well researched emotional responses to a disaster are
symptoms of posttraumatic stress disorder (PTSD e.g., Lonigan, Shannon, Taylor, Finch, &
Sallee, 1994; La Greca, Silverman, Vernberg, & Prinstein, 1996; Vernberg, La Greca, Silverman,
& Prinstein, 1996; Silverman & La Greca, 2002; Yule et al., 2000); however, other forms of
emotional problems have also been found (e.g., Marsee, 2008; Hensley & Varela, 2008).
Youth with more severe and intense traumatic experiences during a disaster are more
likely to have more severe symptoms in the immediate aftermath (La Greca, Silverman, &
Wasserstein, 1998; Weems, Pina et al., 2007). Traumatic stress has typically been defined in the
literature by drawing from the Diagnostic and Statistical Manual of Mental disorders (e.g., the
DSM-IV, APA, 1994). The two domains that define a traumatic event in criteria A of PTSD in
the DSM are exposure events (A1) and distress at the exposure events (A2). Research has
indicated that the more traumatic events (e.g., physical harm, witnessing harm, damage to home)
youth experience, the more likely they are to have elevated symptoms of PTSD (La Greca et al.,
1996; 1998). While PTSD symptoms appear to be relatively stable over time, some evidence
does suggest that they may decline as time since the disaster passes (La Greca et al., 1996). The
extant research suggests that there are a number of factors that may influence change and
remission of symptoms may be less evident in certain circumstances and contexts (Weems et al.,
2010; Yule et al., 2000). Moreover, even if a decrease in PTSD symptoms occurs, there may be
lasting effects that are more insidious in nature. Drawing from the concept of heterotypic
continuity, research is needed that examines the indirect manifestations of traumatic stress
related emotional and cognitive difficulties over time.
Cognitive difficulties (e.g., inability to recall aspects of the event, intrusive recollections)
are core features of the diagnosis of PTSD (APA, 1994) and traumatic stress exposure has been
linked to problems in several intellectual domains, including deficits in sustained attention,
concentration, mental manipulation, and memory (Gil, Calev, Greenberg, Kugelmass, & Lerer,
1990; Gilbertson, Gurvits, Lasko, Orr & Pitman, 2001; McNally & Shin, 1995; Vasterling,

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Brailey, Constans, & Sutker, 1998; Vasterling et al., 2002). These deficits have been shown in
youth who have experienced childhood maltreatment and interpersonal traumatic exposure (e.g.,
Beers & De Bellis, 2002). However, while the effects of childhood maltreatment and
interpersonal traumatic exposure (e.g., physical and sexual abuse) on intellectual and emotional
domains have been relatively well demonstrated, less is known about the effects of natural
disaster related traumatic stress on broader cognitive domains such as scholastic achievement (La
Greca, Silverman, Vernberg, & Roberts, 2002).
The studies that have examined the effects of disaster related traumatic stress on
academic problems point to possible difficulties arising amongst war/violence exposed youth
(Saigh, Mroueh, & Bremner, 1997), as well as pre-hurricane related disaster academic ability
predicting post disaster response (La Greca et al., 1998). While the extant literature suggests
linkages between traumatic stress exposure and academic difficulties, it appears that the effect of
exposure may be largely a function of emotional disorder symptoms (such as PTSD) and not a
direct effect of the traumatic stress (see Saigh et al., 1997). This is in line with the idea that when
controlling for negative outcomes, traumatic stress can sometimes be associated with positive
outcomes (Calhoun & Tedeschi, 2006; Kilmer & Gil-Rivas, 2010). To our knowledge no studies
have examined possible indirect linkages from disaster related traumatic stress exposure to
student academic achievement in exposed youth. There is critical need for a solid developmental
understanding of the potentially insidious effects of disaster exposure on anxious emotion and
student achievement. Drawing from the extant research base, this paper tests a theoretical model
of continuity in anxious emotion and of the indirect effects of disaster exposure on academic
achievement.
The model is outlined in Figure 1 and suggests that the association of disaster related
traumatic stress to academic achievement is indirect via linkages to PTSD symptoms.
Posttraumatic stress symptoms involve anxious emotion and foster other aspects of anxious
emotion (e.g., worrying about future safety, specific fears of rain). Over time anxious emotion
may be manifested in evaluative academic settings as test anxiety. Therefore, test anxiety may be
a more proximal manifestation of anxious emotion interfering with the assessment (student
testing) of academic achievement as indexed by standardized student evaluation. The theoretical
basis for possible indirect effects on anxious arousal generally and test anxiety more specifically
is derived from a number of related research findings (Barlow, 2002; La Greca et al., 1998;
Weems, Pina et al., 2007; Weems, 2008). In this view, anxiety is part of a normative response
system that prepares the individual to anticipate danger and fosters preparation for either freezing
to avoid impending punishment or escaping as part of the fight/flight response (Barlow, 2002;
Gray, 1982; Gray & McNaughton, 2000). A core defining feature of anxiety problems is
dysregulation of this normal response system (Barlow, 2002; Watson, 2005; Weems, 2008).
Research has highlighted the importance of general emotional dysregulation such as negative
affect and trait anxiety in disaster exposed youth (see La Greca et al., 1998; Weems, Pina et al.,

Achievement 5
2007). Thus, it is likely that, to the extent that disaster related traumatic stress exposure is related
to dysregulation of the normal anxiety response system (e.g., PTSD symptoms) it will also
impact related anxious arousal (e.g., test anxiety) but this link may be indirect.
Evidence for the importance of indirect effects is also suggested more specifically by the
disaster literature. Hurricane Katrina was an intensely traumatic event for many youth and has
had a substantial effect on the mental health of many survivors (Kessler et al., 2008; Weems,
Watts et al., 2007). Contextual analyses of the Katrina disaster (see Weems & Overstreet, 2008)
suggest that the pervasiveness of the disaster and the lingering effects (communities remained in
serious disrepair over 3 years later) may have substantial and broad effects on youth
development. Research from Katrina exposed samples of youth suggests that disaster exposure is
not just related to PTSD symptoms but may be related to many different forms of emotional
dysregulation (Hensley & Varela, 2008; Spell et al., 2008). For example, Marsee (2008) showed
that aggressive behavior may also follow disaster exposure in youth but that these reactions may
be the indirect results of stress exposure on PTSD symptoms and general emotional
dysregulation.
Extending an understanding of the long term impact of traumatic stress on important
indicators of youth functioning such as academic achievement to minority samples is also critical
to developing a comprehensive picture of disaster related emotional problems (Rabalais,
Ruggiero, & Scotti, 2002). There is some evidence to suggest that the remission of symptoms is
less evident in ethnic minorities (La Greca et al., 1996) and ethnic minorities also may be less
likely to seek community treatment and perceive less potential benefit from clinic based
treatment (Chavira, Stein, Bailey, & Stein, 2003; Mojtabai, & Olfson, 2006). In this study, we
therefore focused on a sample of minority youth from a high impact area within New Orleans.
Based on the theoretical model outlined above, we predicted that the association between
traumatic stress and academic achievement would be indirect via linkages to PTSD symptoms
and more specifically via PTSD’s relation to later test anxiety. We examined cross lag
associations to identify if potential heterotypic continuity was important to consider in terms of
the effects of posttraumatic stress being indirect via their relation to later test anxiety, which in
turn was predicted to be negatively associated with academic achievement. The predictions in
Figure 1 were tested using structural equation modeling and the specificity of test anxiety as an
indirect link to academic achievement was explored by testing a separate structural model with
depression symptoms substituted in the place of test anxiety. Depressive symptoms are another
common reaction to disaster exposure (Weems, Pina et al., 2007) that may interfere with
academic achievement.
Model invariance across age and sex was also tested. While the differences in the link
between exposure and PTSD symptoms across age groups have been mixed (Hoven et al., 2005;
La Greca et al., 1998; Weems, Pina et al., 2007) there is evidence to suggest that younger
children exposed to Katrina may be at increased risk (Scheeringa & Zeanah, 2008) and

Achievement 6
theoretically there may be developmental variation in the hypothesized linkages implied by the
model from a cognitive developmental standpoint (Weems & Overstreet, 2008). In general, mean
levels of anxiety and fear are lower in older age groups and tend to decrease longitudinally over
time in community samples (Gullone & King, 1997; Gullone, King, & Ollendick, 2001; Weems
& Costa, 2005; Westenberg, Gullone, Bokhorst, Heyne, & King, 2007). In addition, female sex
has been consistently associated with relatively increased PTSD symptoms (Hoven et al., 2005;
Weems, Watts et al., 2007; Weems, Pina et al., 2007) and girls tend to report relatively higher
levels of anxiety and fear than boys (Ollendick, Langley, Jones, & Kephart, 2001; Silverman &
Carter, 2006; Weems & Costa, 2005). Thus, although the model should theoretically have equal
relevance for both males and females few studies have examined the role of gender in the
linkages between exposure and academic achievement and so empirical evidence for gender
invariance of the hypothesized model is needed.

Achievement 7
Method
Participants
This study utilized a prospective design with a sample of 202 school children from New
Orleans. One hundred and ninety-one youth completed the Time 2 assessments and written
informed parental consent was obtained. These youth represented 4
th
through 8
th
graders
attending school in a New Orleans neighborhood that received massive damage, almost total
flooding, and continues to have a significant proportion of the community in disrepair
(participants reported an average of 7 exposure experiences, Table 1). Common disaster related
events reported included: thought someone might die (79%), clothes or toys ruined (78%), home
badly damaged or destroyed (65%), witnessed others hurt during the storm (45%), pet hurt or
died (41%), thought they might die during the storm (38%), had trouble getting food and water
(20%).
The sample was screened for exposure to traumatic experiences and distress related to
Hurricane Katrina and PTSD symptoms at 24 months (Time 1; early Fall semester) and then
again at 30 months (Time 2; late Spring) as part of a school-based initiative. Academic
achievement was assessed via end of the school year (approximately 31 months post Katrina)
standardized test scores. The sample was aged 8-15 years (median age = 11.5 years) and was
55% male. Youth reported their ethnicities as 97% African American (n = 196), 2% ‘mixed
African-American/other’ (n = 4), 1 as Caribbean-American, and 1 as Euro-American. The school
serves youth predominantly from low income families (school data indicate that 97% of the
students receive free lunch, 2% are on a reduced payment, and 1% pays for lunch). Comparison
of the youth who completed both the Time 1 and Time 2 assessments versus the youth who only
completed the Time 1 assessment revealed no statistically significant differences on Time 1
study variables of age, sex, ethnicity, exposure experiences, academic achievement, test anxiety,
and PTSD symptoms.
Measures
Symptoms of PTSD were measured using a modified version of the Posttraumatic Stress
Reaction Index for Children (PTSD-RI; Frederick, Pynoos, & Nadar, 1992). The PTSD-RI is one
of the most widely used instruments to assess post-traumatic stress reactions and thus allows
easy comparison amongst studies. As done in previous research (Hensley & Varela, 2008;
Vernberg et al.,1996; LaGreca et al.,1996) the PTSD-RI used in this study contains 20 items,
with answer choices modified for ease of administration from the original five options to three
options (none of the time, some of the time, most of the time – coded as 0, 2, and 4,
respectively). Total PTSD-RI scores thus range from 0 to 80. Internal consistency for the present
sample was good (alpha Time 1 = .90, Time 2 = .89).
Test anxiety symptoms were assessed using a shortened version of the Test Anxiety Scale
for Children (TASC; Sarason, Davidson, Lighthall, & Waite, 1958). The TASC is a 30-item
measure that has been used primarily in previous research for assessing test anxiety among

Achievement 8
school-aged children and adolescents (King, Mietz, Tinney, & Ollendick, 1995; McDonald,
2001). This modified version of the TASC consists of 18-items and was designed to measure
test anxiety in school-aged children and adolescents using a Yes (1) or No (0) response format,
with youth being asked to report the presence/absence of test anxiety symptoms (e.g., “Do you
worry a lot before you take a test?”). Total scores of test anxiety symptoms are derived from
summing all the items with total scores ranging from 0 to 18. Previous research has reported
good internal consistency (alpha = .87) for assessing test anxiety symptoms in a predominately
African American sample, as in the current study, using the 30-item version of the TASC
(Carter, Williams, & Silverman, 2008). The internal consistency estimates (i.e., alpha
coefficient) for total test anxiety scores of this modified version and with this particular sample
were also good (alpha time 1 = .85, time 2 = .83).
The Depression subscale of the Revised Child Anxiety and Depression scales (RCADS;
Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000; Spence, 1997) was used to assess symptoms
of depression. The RCADS depression scale has 10 items that assesses symptoms of depression
based on DSM-IV criteria. The scale is scored 1 “Never”, 2 “Sometimes”, 3 “Often”, and 4
“Always”. The RCADS is an adaptation of the Spence Anxiety Scales (Spence, 1997). Chorpita
et al. (2000) modified the Spence scales for the DSM-IV by adding the depression subscale and
evaluated the RCADS by examining the measure's factorial validity in a school sample of 1641
children and adolescents (aged 6.2 to 18.9 years) and its reliability and validity in an independent
sample of 246 children and adolescents (aged 8.3 to 18.3 years). The results suggested an item
set and factor definitions that were consistent with DSM-IV symptoms. Moreover, the RCADS
demonstrated convergent validity with existing measures of childhood depression (Chorpita et
al., 2000). The internal consistency estimates (i.e., alpha coefficient) in this sample were also
good (alpha Time 1 = .85, Time 2 = .81).
Academic achievement was constructed as a latent variable derived from scores of
standardized test results. Specifically, the Louisiana Educational Assessment Program (LEAP--
grades 4 and 8 and iLEAP--grades 5, 6, 7) were obtained from school records. The LEAP
assesses four areas of academic achievement: English Language Arts, Mathematics, Science, and
Social Studies competence (details are available on the web at
www.doe.state.la.us/lde/saa/2273.html). The four scores (English Language Arts, Mathematics,
Science, and Social Studies) were used as observed variables to compose a latent construct of
academic achievement. There are five achievement levels a student can earn on the LEAP and
iLEAP : 1. Advanced- superior performance beyond the level of mastery; 2. Mastery-
demonstrated competency over challenging subject matter and is well prepared for the next level
of schooling; 3. Basic- demonstrated only the fundamental knowledge and skills needed for the
next level of schooling; 4. Approaching Basic- has only partially demonstrated the fundamental
knowledge and skills needed for the next level of schooling; 5. Unsatisfactory-the student has not
demonstrated the fundamental knowledge and skills. The average scores in this sample (Table 1)
are in the published “Unsatisfactory” and “Approaching basic” range and are similar to most

Achievement 9
public schools in the area (http://www.doe.state.la.us/topics/interpreting_scores_leap.html).
Students must score Basic or higher in either English or Math and Approaching Basic or higher
in the other subject on the LEAP (Louisiana Educational Assessment Program) to advance to the
next grade.
Traumatic stress was assessed from the two domains that define traumatic stress in the
DSM-IV (APA, 1994). These two domains are delineated as criteria A in the DSM as exposure
events (A1) and distress at the exposure events (A2). Exposure experiences (A1) and hurricane-
related distress (A2) were assessed via a 16 item survey of exposure to the hurricane and its
aftermath that was based on the work of La Greca and colleagues (La Greca et al., 1998;
Vernberg et al., 1996). Common experiences were outlined above under “Participants” and
sample items include: “Did you get hurt during the hurricane?” “Was your home damaged badly
or destroyed by the hurricane?” Respondents indicated Yes (1) or No (0) to whether they were
exposed to each event and these were summed to make an exposure events (A1) score. To
measure distress (A2), the survey also included two global assessments of the level of distress
experienced during the storm and directly after the storm as for many youth the greatest distress
was the flooding and related events which ensued after Katrina’s landfall. These questions were:
“Overall how scared or upset were you during the hurricane?” “Overall how scared or upset were
you after the hurricane?” and these were scored from 0 “not at all” to 3 “a whole lot”.
Procedures
Data collection was conducted as part of the school’s counseling curriculum and written
informed consent for the use of the data in research was obtained from the parent (> 90%
response rate). Oral assent was obtained from the child (children were not required to fill in the
questionnaires or to participate), however, no youth declined. The IRB reviewed the procedures
and approval was obtained for the use of the de-identified data. The longitudinal data base was
created to help track and identify youth in need of school services; however, identifying
information was removed from the data set for use in this study. Youth completed the measures
in a group classroom setting and were assisted by trained staff. Younger children were read the
instructions and each item by a staff member and trained staff helped individual children as
necessary as done in previous research (La Greca et al., 1996; Vernberg et al., 1996).
Results
Preliminary examination of the scores’ ranges and skew indicated acceptable levels for
the planned analyses. Pearson’s correlations, means, and standard deviations for all the variables
are presented in Table 1. In general, the pattern of correlations suggested significant associations
among the distress, exposure, PTSD, and test anxiety variables with less strong and mostly non-
significant associations with the individual indicators of academic achievement. However, there
was a high degree of association among the academic achievement indicators. As shown in Table
1, exposure events (A1) and distress (A2) were both significantly related to initial (Time 1)
PTSD symptoms and test anxiety. However, exposure events and distress were not significantly
related to test anxiety at Time 1 controlling for Time 1 PTSD symptoms (exposure semi-partial

Achievement 10
r-squared = .01, p > .1; distress semi-partial r-squared = .003, p > .1), whereas both were
significantly related to Time 1 PTSD symptoms controlling for Time 1 test anxiety (exposure
semi-partial r-squared = .05, p < .001; distress semi-partial r-squared = .10, p < .001). A similar
pattern emerged for depression. Exposure events and distress were not significantly related to
Depression at Time 1 controlling for Time 1 PTSD symptoms (exposure semi-partial r-squared <
.001, p >.1; distress semi-partial r-squared = .001, p > .1), whereas both were significantly
related to Time 1 PTSD symptoms controlling for Time 1 depression (exposure semi-partial r-
squared = .04, p < .001; distress semi-partial r-squared = .05, p < .001).
In order to test the hypothesized model (see Figure 1) and test invariance across age and
gender, structural equation modeling was conducted using AMOS 19.0 (Arbuckle, 1983-2010).
In analyzing the fit statistics for model testing, multiple measures of fit were utilized (Kline,
2006). The chi-square statistic tests the hypothesis of perfect fit; that is, it evaluates whether
there is any discrepancy between the observed data and the theoretical model and so a non-
significant chi-square is desired. The chi-square test is substantially affected by sample size, thus
in a large sample a small discrepancy can lead to a significant chi-square. Consequently, both the
Root-Mean-Square-Error of Approximation (RMSEA) and the Comparative Fit Index (CFI)
were also used to evaluate fit of the models. The CFI ranges from 0 to 1, with 0 indicating
variation with no relation to the proposed factors and 1 indicating a perfect fit. The RMSEA also
ranges from 0 to 1 and includes both a discrete value and a 90% confidence interval. The
RMSEA denotes a perfect fit with 0.
The results of the path analysis of the theoretical model are presented in Figure 2 and
Table 2. Results suggested that the model provided very good fit to the data. The chi-square for
the model was not statistically significant (χ
2
= 29.43, df = 26, p > .1) and the fit indices
indicated a good fit of the model to the data (CFI = .995, RMSEA = .026; 90% CI = 0 to .065).
Standardized estimates are presented in Figure 2 and un-standardized estimates with standard
errors and significance tests for the structural paths are presented in Table 2. The pattern of
significant associations suggests that exposure was significantly associated with both PTSD
symptoms and test anxiety at Time 1 (with a stronger association being found for PTSD
symptoms). In contrast, only Time 1 PTSD symptoms were associated with distress. Time 1
PTSD was also associated with Time 2 test anxiety and the link between distress/exposure and
PTSD with academic achievement was indirect through their association with test anxiety at
Time 2 consistent with model predictions. Following Hatzenbuehler, McLaughlin, and Nolen-
Hoeksema (2008) one tailed Sobel testing (Sobel, 1982) suggests a significant indirect effect of
PTSD at Time 1 on academic achievement via Time 2 test anxiety (z = 1.73, p < .05, one tailed),
but not via time 2 PTSD (z = 0.23, p > .1, one tailed). There were also significant indirect effects
from exposure events and distress to Time 2 test anxiety via time 1 PTSD symptoms (z = 3.05, p
< .01 and z = 3.13, p < .01, respectively).
To test specificity of test anxiety in the theoretical model’s prediction of achievement,
depression symptoms at Time 1 and 2 were substituted for test anxiety at Time 1 and Time 2 and

Achievement 11
the analysis was re-calculated. Results suggested that the model again provided very good fit to
the data (e.g., χ
2
= 27.49, df = 26, p > .1 with similar fit indices; CFI = .998, RMSEA = .017;
90% CI = 0 to .061). The pattern of significant paths (see Table 3) was quite similar to the model
with test anxiety in terms of relations to PTSD and traumatic stress; however, the path from
distress to depression at Time 1 (standardized estimate = .27; p < .001) was significant and the
path from depression at Time 2 to academic achievement was not significant (standardized
estimate = -.11; p > .1).
Next, gender and age variation in the fit of the test anxiety model was examined by
testing invariance across boys and girls and across youth in grammar school, grades 4-6 with
youth in middle/junior high school, grades 7-8 (similar analyses using age 12 as the cut point
produced similar results and identical conclusions). The chi-square difference test for boys and
girls indicated that there was not a significant difference in the fully constrained model and one
with the constraints removed (Δχ
2
(12) = 8.73, p > .1) suggesting gender invariance. The chi-
square difference test for grammar school age and middle school age youth indicated that there
was a significant difference in the fully constrained model and one with the constraints removed
[Δχ
2
(12) = 39.11, p < .01]. Following the recommendations of Byrne (2001), we constrained one
path at a time to identify grade level related differences in the paths. This process identified 1
path that varied across the younger and older groups [i.e., in Figure 2 this is the path from test
anxiety at Time 1 to test anxiety at Time 2). Allowing this path to vary (not constraining across
younger and older youth) produced a non- significant chi-square difference [Δχ
2
(11) = 17.85, p
> .05] and fit was good (CFI = .98, RMSEA = .037; 90% CI = 0 to .06). The path from test
anxiety at Time 1 to test anxiety at Time 2 was larger in the older youth (standardized beta’s =
.67, p < .001) than in the younger youth (standardized beta’s = .25, p < .01).
Discussion
This study advances an understanding of the potentially insidious effects of disaster
exposure on student achievement. Results were consistent with hypotheses derived from the
theoretical model. Findings suggest that the association between traumatic stress and academic
achievement was indirect via linkages to PTSD symptoms and test anxiety. Such findings are
consistent with the idea that disaster related traumatic stress exposure is related to general
dysregulation (Marsee, 2008) and that this dysregulation may lead to a number of indirect
effects. Theoretically, the model tested in this study posits that part of the dysregulation
experienced by youth exposed to disaster related stress may be alteration of the normal anxiety
response system in the form of PTSD symptoms (this finding is consistent with a large body of
research see e.g., Weems & Overstreet, 2008 for review). This study adds unique findings
consistent with the idea that disaster related stress and PTSD symptoms may in turn impact
anxious arousal in the form of test anxiety. Results further suggest that the model fit the data
equally well for boys and girls and while there did appear to be some developmental variation
(grade level differences in the stability of test anxiety symptoms), the paths from PTSD

Achievement 12
symptoms at Time 1 to test anxiety at Time 2 and from test anxiety at Time 2 to academic
achievement did not vary across grade level groupings.
The extant literature has suggested linkages between traumatic stress exposure and
academic difficulties, suggesting that the effect of exposure is largely a function of PTSD
symptoms and not a direct effect of the traumatic stress (e.g., Saigh et al., 1997). This study adds
to this understanding in a sample of disaster exposed youth and helps to show that the effect of
disasters on academic achievement in the long term may sometimes be subtle and insidious
rather than always clear and direct. Findings showing that the linkage from traumatic stress to
academic achievement scores were a function of test anxiety rather than linking directly to PTSD
symptoms (i.e., Time 2 test anxiety carried the effect of any relation between PTSD at Time 2
and achievement) highlight that what might be considered a relatively benign form of anxious
emotion (test anxiety) should not be overlooked following disaster. Fortunately, research
suggests that test anxiety interventions can be effectively administered in disaster exposed youth
reducing test anxiety and potentially improving student grades (Weems et al., 2009). While
interventions for test anxiety should not be considered an intervention of choice for severe
emotional reactions to disaster such as PTSD, school based programs and public policy for youth
in the long term aftermath of disaster might benefit from attention to a broad array of potentially
negative emotional symptoms. While replication of this study’s findings is warranted before
drawing firm policy implications, results also highlight that the effect of disaster may be very
long term (Yule et al., 2000) and the evaluation of students and school success might usefully be
couched in light of the potential indirect impact of disaster related stress on academic evaluation.
The findings should be considered in light of the study’s limitations but the study’s
limitations should also be viewed in context. Broadly, the goal of the study was not to examine
predictors of school achievement in a traumatized group. The goal was to show the insidious link
between trauma and school achievement (via trauma links to PTSD symptoms and later test
anxiety) that may be otherwise overlooked (or unidentified) in direct models of the impact of
disaster related trauma. It is important to note that PTSD symptoms and test anxiety are not the
sole reasons for negative school attainment and findings should not be evaluated in terms of an
attempt to identify the best predictors of school achievement. Thus, by its nature the study is
limited in that there are a number of factors not assessed in this study that could also be
interfering with achievement. While no single study can hope to capture all the potential
influences a disaster may bring, future research is needed to further clarify the effects of natural
disaster exposure on cognitive functioning.
The specificity to test anxiety was examined by testing a model that substituted
depression. While depression’s relation to traumatic stress and PTSD symptoms were similar to
that of test anxiety, depression did not link to academic achievement in the same manner as test
anxiety. However, this study did not address the possibility of other mechanisms of poor
achievement (such as cognitive) and the question “Are there more proximal mediators of the link
between emotional difficulties and academic outcomes?” is left unanswered. For example,

Achievement 13
Sprung (2008) found that intrusive thoughts were very common among a sample of youth (n =
145 aged 5 to 8 years) exposed to the Hurricane Katrina disaster. Sprung also found that a salient
reminder (hurricane wind and rain sounds) altered the attention of youth who experienced major
loss/disruption from the storm but not the attention of youth with little or no disruption.
Reminders of a disaster may serve to focus attention away from neutral/positive cognitions and
thus foster the salience of negative intrusive thoughts, thereby, acting as an impairment to testing
success.
It is also quite possible that students’ test anxiety may have preceded the disaster and
their PTSD symptoms and pre-existing test anxiety symptoms may be a vulnerability factor for
PTSD symptoms (as have been found with trait anxiety Weems, Pina et al., 2007). The same
may be true for academic achievement. Thus, although the present study highlights the
importance of potential emotional mechanisms of interference, additional work on the cognitive
aspects of exposure to disaster is still needed. The study also relied on youth’s self-reports for
exposure, test anxiety, depression, and PTSD symptoms. It might be the case that reports from
other sources (such as parents) would have resulted in different findings. However, youth have
been consistently found to be valid reporters and sometimes better reporters of their own
internalizing distress (see e.g., Weems, Zakem, Costa, Cannon, & Watts, 2005). Finding that self
reports were linked to academic achievement does suggest the usefulness of asking youth about
their emotional symptoms in the wake of disaster. The need and utility of school based mental
health related screenings for anxiety related problems has been suggested as a cutting edge step
in prevention (see Fox, Halpern, & Forsyth, 2008) and the present results are consistent with this
notion. Another limitation of the present study concerns the timing of the assessments. The
impact of PTSD symptoms may be more direct at earlier time points following disaster and we
were not able to assess this possibility. Given that most schools in New Orleans did not reopen
(0% of New Orleans public schools reopened immediately, 16% by Jan, 2006, 62% by Nov
2007; Liu & Plyer, 2007) this appears to be an inherent limitation of school based research in the
wake of a severe disaster like Katrina. The infrastructure of normal school conditions for data
collection should not be assumed because the extent of disasters radically alters the context and
so this kind of data is incredibly difficult to obtain (likely the reason for so few published studies
on this topic in major natural disasters to date). Finally, a limitation to generalizing results to
other populations is that the study sample was composed of predominantly ethnic minority
youth. While this is a positive feature in that it extends the literature to a population that has been
relatively understudied (Rabalais et al., 2002), inference to ethnic majority youth is less clear
from this sample.

Achievement 14
References
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4th Edition (DSM-
IV). Washington, DC: Author.
Arbuckle, J. L. (1983-2010). Amos Version 19.0. Meadville, PA: AMOS Development Corporation.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic. 2nd edition. New
York: The Guilford Press.
Beers, S. R., & De Bellis, M. D. (2002). Neuropsychological function in children with maltreatment-related
posttraumatic stress disorder. American Journal of Psychiatry, 159, 483-486.
Byrne, B. M. (2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming.
Mahwah, NJ: Lawrence Erlbaum Associates.
Calhoun, L.G., & Tedeschi, R.G. (2006). Handbook of posttraumatic growth. Mahwah, NJ: Lawrence Erlbaum
Associates.
Carter, R., Williams, S., & Silverman, W.K. (2008). Cognitive and emotional facets of test anxiety in African
American school children. Cognition and Emotion, 22, 539-551.
Chavira, D.A., Stein, M.B., Bailey, K., & Stein, M.T. (2003). Parental opinions regarding treatment for Social
Anxiety Disorder in youth. Journal of Developmental & Behavioral Pediatrics, 24, 315-322.
Chorpita, B. F., Yim, L., Moffitt, C., Umemoto, L. A., & Francis, S. E. (2000). Assessment of symptoms of DSM-
IV anxiety and depression in children: A revised child anxiety and depression scale. Behaviour Research
and Therapy, 38, 835-855.
Fox, J., Halpern, L., & Forsyth, J. (2008). Mental health checkups for children and adolescents: A means to identify,
prevent, and minimize suffering associated with anxiety and mood disorders. Clinical Psychology: Science
and Practice, 15, 182-211.
Frederick, C.J., Pynoos, R.S., & Nadar, K. (1992). Reaction Index to Psychic Trauma Form C (Child). Author:
University of California, Los Angeles.
Gil, T., Calev, A., Greenberg, D., Kugelmass, S., & Lerer, B. (1990). Cognitive functioning in posttraumatic stress
disorder. Journal of Traumatic Stress, 3, 29-45.
Gilbertson, M. W., Gurvits, T. V., Lasko, N. B., Orr, S. P., & Pitman, R. K. (2001). Multivariate assessment of
explicit memory function in combat veterans with posttraumatic stress disorder. Journal of Traumatic
Stress, 14, 413-432.
Gray, J. A. (1982). Neuropsychological theory of anxiety: An investigation of the septal-hippocampal system.
Cambridge: Cambridge University Press.
Gray, J. A., & McNaughton, N. (2000). The neuropsychology of anxiety (2nd ed.). New York: Oxford University
Press.
Gullone, E., & King, N.J. (1997). Three year follow-up of normal fear in children and adolescents aged 7 to 18
years. British Journal of Developmental Psychology, 15, 97-111.
Gullone, E., King, N.J., & Ollendick, T.H. (2001). Self-reported anxiety in children and adolescents: A three-year
study. The Journal of Genetic Psychology, 162, 5-19.
Hatzenbuehler, M. L., McLaughlin, K. A., & Nolen-Hoeksema, S. (2008). Emotion regulation and internalizing
symptoms in a longitudinal study of sexual minority and heterosexual adolescents. Journal of Child
Psychology and Psychiatry, 49, 1270–1278.
Hensley, L., & Varela, R.E. (2008). PTSD symptoms and somatic complaints following Hurricane Katrina: The role
of trait anxiety and anxiety sensitivity. Journal of Clinical Child and Adolescent Psychology, 37, 542-552.
Hoven, C. W., Duarte, C. S., Lucas, C. P., Wu, P., Mandell, D. J., Goodwin, R. D., et al. (2005).
Psychopathology among New York City public school children 6 months after September 11. Archives of
General Psychiatry, 62, 545–552.
Kessler, R. C., Galea, S., Gruber, M. J., Sampson, N.A., Ursano, R. J., & Wessely, S. (2008). Trends in mental
illness and suicidality after Hurricane Katrina. Molecular Psychiatry, 13, 374 – 384.
Kilmer, R. P. & Gil-Rivas, V. (2010). Exploring posttraumatic growth in children impacted by Hurricane Katrina:
Correlates of the phenomenon and developmental considerations. Child Development, 81, 1211–1227.
King , N.J., Mietz, A., Tinney, L., & Ollendick, T.H. (1995). Psychopathology and cognition in adolescents
experiencing severe test anxiety. Journal of Clinical Child Psychology, 24, 49-54.
Kline, R. B. (2006). Principles and practices of structural equation modeling (2nd ed.). New York: Guilford.
La Greca, A. M., Silverman, W. K., & Wasserstein, S.B. (1998). Children’s predisaster functioning as a predictor of
posttraumatic stress following Hurricane Andrew. Journal
of Consulting and Clinical Psychology, 66, 883-892.

Achievement 15
La Greca, A.M., Silverman, W.K., Vernberg, E.M., & Prinstein, M. (1996). Symptoms of posttraumatic stress after
Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64, 712-723.
La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Roberts, M. C. (Eds.) (2002). Helping Children Cope with
Disasters and Terrorism. Washington, DC: American Psychological Association.
Liu, A., & Plyer, A. (2007). Executive summary: November 2007. www.brookings.edu/
~/media/Files/rc/reports/2007/08neworleansindex/200711_katrinaES.pdf. Retrieved 10-6-2010.
Lonigan, C. J., Shannon, M. P., Taylor, C. M., Finch, A. J., & Sallee, F.R. (1994). Children exposed to disaster: II.
Risk factors for the development of post-traumatic symptomatology. Journal of the American Academy of
Child and Adolescent Psychiatry, 33, 94-105.
Marsee, M. A. (2008). Reactive aggression and posttraumatic stress in adolescents affected by Hurricane Katrina.
Journal of Clinical Child and Adolescent Psychology, 39, 519-529.
McDonald, A.S. (2001). The prevalence and effects of test anxiety in school children. Educational Psychology, 21,
89-101.
McNally, R. J. & Shin, L. M. (1995). Association of intelligence with severity of posttraumatic stress disorder
symptoms in Vietnam combat veterans. American Journal of Psychiatry, 152, 936-938.
Mojtabai, R., & Olfson, M. (2006). Treatment seeking for depression in Canada and the United States. Psychiatric
Services, 57, 631-639.
Ollendick, T. H., Langley, A. K., Jones, R. T., & Kephart, C. (2001). Fear in children and adolescents: Relations
with negative life events, attributional style, and avoidant coping. Journal of Child Psychology and
Psychiatry, 42, 1029-1034.
Rabalais, A.E., Ruggiero, K.J., & Scotti, J.R. (2002). Multicultural issues in the response of children to disasters. In
A.M. La Greca, W.K. Silverman, E.M. Vernberg, & M.C. Roberts (Eds.), Helping children cope with
disasters and terrorism (pp. 73-99). Washington, DC: American Psychological Association.
Saigh, P.A., Mroueh, M., & Bremner, J.D. (1997). Scholastic impairments among traumatized adolescents.
Behaviour Research and Therapy, 35, 429-436.
Sarason, S.B., Davidson, K., Lighthall, F., & Waite, R. (1958). A test anxiety scale for children. Child Development,
29, 105-113.
Scheeringa, M.S., & Zeanah, C.H. (2008). Reconsideration of harm's way: Onsets and comorbidity patterns of
disorders in preschool children and their caregivers following Hurricane Katrina. Journal of Clinical Child
and Adolescent Psychology, 37, 508-518.
Silverman, W. K. & Carter, R. (2006). Anxiety disturbance in girls and women. In J. Worell & C. Goodheart (Eds.)
Handbook of girls’ and women’s psychological health. (pp. 60-68). New York: Oxford University Press.
Silverman, W. K., & La Greca, A. M. (2002). Children experiencing disasters: Definitions, reactions, and predictors
of outcomes. In A. M. La Greca, W. K. Silverman, E. M. Vernberg, & M. C. Roberts (Eds.), Helping
children cope with disasters (pp. 11-34). Washington, DC: American Psychological Association.
Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.),
Sociological methodology 1982 (pp.290-312). San Francisco: Jossey-Bass.
Spell, A. W., Kelley, M. L., Self-Brown, S., Davidson, K., Pellegrin, A., Palcic, J., Meyer, K., Paasch, V. &
Baumeister, A. (2008). The moderating effects of maternal psychopathology on children’s adjustment post-
Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37, 553-563.
Spence, S. H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal
of Abnormal Psychology, 106, 280-297.
Sprung, M. (2008). Unwanted intrusive thoughts and cognitive functioning and young elementary school children
following Hurricane Katrina. Journal of Clinical Child and Adolescent Psychology, 37, 575-587.
Vasterling, J. J., Brailey, K., Constans, J. I., & Sutker, P. B. (1998). Attention and memory dysfunction in
posttraumatic stress disorder. Neuropsychology, 12, 125-133.
Vasterling, J. J., Duke, L. M., Brailey, K., Constans, J. I., Allain, A. N., & Sutker, P. B. (2002). Attention, learning,
and memory performances and intellectual resources in Vietnam veterans: PTSD and no disorder
comparisons. Neuropsychology, 16, 5-14.
Vernberg, E.M., La Greca, A.M., Silverman, W.K., & Prinstein, M. (1996). Predictors of children’s post-disaster
functioning following Hurricane Andrew. Journal of Abnormal Psychology, 105, 237-248.
Warren, S. L. & Sroufe, L. A. (2004). Developmental issues. In Ollendick, T. H. & March, J. S. (Eds). Phobic and
Anxiety Disorders in Children and Adolescents: A Clinician's Guide to Effective Psychosocial and
Pharmacological Interventions (pp. 92-115). New York: Oxford University Press.
Watson, D. (2005). Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.
Journal of Abnormal Psychology, 114, 522-536.

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Weems, C. F. (2008). Developmental trajectories of childhood anxiety: Identifying continuity and change in anxious
emotion. Developmental Review, 28, 488-502.
Weems, C. F., & Costa, N. M. (2005). Developmental differences in the expression of childhood anxiety symptoms
and fears. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 656-663.
Weems, C.F., & Overstreet, S. (2008). Child and adolescent mental health research in the context of Hurricane
Katrina: An ecological needs-based perspective and introduction to the special section. Journal of Clinical
Child and Adolescent Psychology, 37, 487-494.
Weems, C.F., Piña, A.A., Costa, N.M., Watts, S.E., Taylor, L.K., & Cannon, M.F. (2007). Pre-disaster trait anxiety
and negative affect predict posttraumatic stress in youth after Hurricane Katrina. Journal of Consulting and
Clinical Psychology, 75, 154-159.
Weems, C.F., Taylor, L.K., Costa, N.M., Marks, A.B., Romano, D.M., Verrett, S.L., & Brown, D.M. (2009). Effect
of a school-based test anxiety intervention in ethnic minority youth exposed to Hurricane Katrina. Journal
of Applied Developmental Psychology, 30, 218-226.
Weems C.F., Watts, S.E., Marsee, M.A., Taylor, L.K., Costa, N.M., Cannon, M.F., Carrion, V.G., & Pina, A.A.
(2007). The psychosocial impact of Hurricane Katrina: Contextual differences in psychological symptoms,
social support, and discrimination. Behaviour Research and Therapy, 45, 2295-2306.
Weems, C.F., Zakem, A., Costa, N.M., Cannon M.F., & Watts, S.E. (2005). Physiological response and childhood
anxiety: Association with symptoms of anxiety disorders and cognitive bias. Journal of Clinical Child and
Adolescent Psychology, 34, 712-723.
Weems, C. F., Taylor, L. K., Cannon, M. F., Marino, R., Romano, D. M., Scott, B. G., Perry A. M., & Triplett, V.
(2010). Posttraumatic stress, context, and the lingering effects of the Hurricane Katrina disaster among
ethnic minority youth. Journal of Abnormal Child Psychology, 38, 49-56.
Westenberg, P. M., Gullone, E., Bokhorst, C. L., Heyne, D. A., & King, N. J. (2007). Social evaluation fear in
childhood and adolescence: Normative developmental course and continuity of individual differences.
British Journal of Developmental Psychology, 25, 471-483.
Westenberg, P. M., Siebelink, B. M., & Treffers, P. D. A. (2001). Psychosocial developmental theory in relation to
anxiety and its disorders. In Silverman, W. K., Treffers, P. D. A. (Eds.), Anxiety disorders in children and
adolescents: Research, assessment and intervention (pp. 72-89). Cambridge, UK: Cambridge University
Press.
Yule, W., Bolton, D., Udwin, O., Boyle, S., O’Ryan, D., & Nurrish, J. (2000). The long-term psychological effects
of a disaster experienced in adolescence: I. The incidence and course of PTSD. Journal of Child
Psychology and Psychiatry, 41, 503-512.

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Table 1.Means, Standard Deviations, and Correlations among Study Variables
1
2
3
4
5
6
7
8
9
10
11
Mean
SD
1. Exposure
7.10
2.83
2. Distress
.41**
3.68
1.94
3. PTSD T1
.49**
.51**
24.34
17.10
4. PTSD T2
.43**
.27**
.58**
23.57
15.40
5. TA T1
.31**
.21**
.50**
.46**
9.08
4.77
6. TA T2
.33**
.25**
.49**
.55**
.59**
8.39
4.27
7. Science
.01
.08
-.06
-.07
-.09
-.12
266.63
50.00
8. Social Science
.06
.05
-.03
-.03
-.01
-.08
.62**
266.24
54.82
9. English
.04
.14
.01
.03
-.10
-.06
.63**
.57**
266.09
56.83
10. Math
.01
.09
.00
-.03
-.12
-.15
.57**
.56**
.69**
275.71
66.13
11. Depression T1
.31**
.37**
.63**
.46**
.55**
.45**
-.08
-.07
-.08
-.08
7.49
6.17
12. Depression T2
.29**
.20**
.45**
.67**
.40**
.61**
-.09
-.02
-.04
-.07
.50**
7.06
5.48
Notes: *Correlation is significant at the 0.05 level; **Correlation is significant at the 0.01 level (2-tailed); PTSD= Posttraumatic stress
disorder symptoms, TA = Test Anxiety

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Table 2. Summary of Estimates for Test Anxiety Model
Estimate S.E. C.R.
Test Anxiety T1

Exposure 7.16 2.05 3.49**
PTSD T1

Exposure 33.15 6.16 5.38**
Test Anxiety T1

Distress .26 .19 1.37
PTSD T1

Distress 3.26 .56 5.81**
Test Anxiety T2

PTSD T1 .06 .02 3.71**
PTSD T2

Test Anxiety T1 .69 .22 3.08**
Test Anxiety T2

Test Anxiety T1 .41 .06 6.59**
PTSD T2

PTSD T1 .43 .06 6.96**
Achievement

Test Anxiety T2 -1.76 .89 -1.97*
Achievement

PTSD T2 .06 .25 .23
Achievement

Exposure 5.15 19.22 .27
Achievement

Distress 3.21 1.76 1.83
Social

Achievement 1.00
Science

Achievement .97 .10 9.63**
English

Achievement 1.20 .12 10.35**
Math

Achievement 1.33 .13 9.99**
Distress

Exposure
.14
.03
5.06**
PTSD T1

Test Anxiety T1 25.20 4.89 5.16**
PTSD T2

Test Anxiety T2
12.87
3.21
4.01**
Notes: * p < .05; ** p < .01; S. E. = Standard Error; C.R. = Critical Ratio.

Achievement 19
Table 3. Summary of Estimates for Depression Model
Estimate S.E. C.R.
Depression T1

Exposure 7.24 2.61 2.78**
PTSD T1

Exposure 33.04 6.16 5.37**
Depression T1

Distress .86 .24 3.60**
PTSD T1

Distress 3.28 .56 5.84**
Depression T2

PTSD T1 .07 .03 2.78**
PTSD T2

Depression T1 .39 .20 1.93**
Depression T2

Depression T1 .32 .07 4.34**
PTSD T2

PTSD T1 .44 .07 6.19**
Achievement

Depression T2 -.82 .77 -1.07
Achievement

PTSD T2 .02 .28 .07
Achievement

Exposure 1.59 19.15 .08
Achievement

Distress 2.94 1.77 1.66
Social

Achievement 1.00
Science

Achievement .97 .10 9.61**
English

Achievement 1.20 .12 10.33**
Math

Achievement 1.33 .13 9.93**
Distress

Exposure
.14
.03
5.06**
PTSD T1

Depression T1 40.32 6.47 6.23**
PTSD T2

Depression T2 31.56 4.87 6.48**
Notes: ** p < .01; S. E. = Standard Error; C.R. = Critical Ratio.

Achievement 20
Figure 1
Theoretical Model of the Indirect Effect of Traumatic Stress on Academic Achievement

Achievement 21
Figure 2
Structural Equation Model of the Indirect Effect of Traumatic Stress on Academic Achievement with Standardized Path Coefficients
Caption: * indicates a significant path.