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Children’s Reaction & Adjustment to Parental Death

An Overview of Several Studies on Children’s Reaction and Adjustment to Parental Death

Esmael Darman

M.D., M.S. Clinical & Counseling Psychology

Introduction

Experiencing the death of a parent during childhood is one of the life’s most challenging and stressful events and has a tremendous impact on the physical and psychological development of the children involved. Some research suggests that a substantial number of children can continue or begin to experience psychological pain in development years after a parent dies.

Recent studies indicate that children experience their grief differently from adults, or they may not be able to express it, as their reaction is directly linked to the developmental, emotional, cultural, and social context in which they experience the loss of a family member, particularly a parent.

Children obviously suffer from losing a parent, but it is a lack of information and ineffective communication patterns among the other adult family members that lead to the misunderstanding of the children’s reactions to the loss. They may think that these mourning children can deal with or forget the loss more easily compared to other surviving family members. They may give these children some ambiguous information about the concept of death and afterlife. They may expose the children to some inappropriate scenes about dying and related issues, or they may simply criticize the children for not grieving.

The above are a few examples of an ineffective approach to the parentally bereaved children and a failure to understand their feelings and the reason behind their behaviors. Some studies support this idea, indicating that a lack of information about children’s developmental stages and the way they experience grief can cause misunderstanding and confusion. In some cases, these children are even neglected as other family members and relatives may try to help the surviving parent.

As there is a dearth of information in this field, more research on the impact of the death of a family member can help clinicians, counselors, social workers, parents, and other family members work more efficiently with bereaved children and facilitate their grief process.

Hain, Rachel A., Ayers, Tim S., Sandler, Irwin N., Wolchik, Sharlene A. (2008) Evidence-based practices for parentally bereaved children and their families. Professional Psychology: Research and Practice, 39 (2), 113-121.

The death of a parent has a traumatic impact on children and can lead to unpleasant outcomes unless proper measures are taken to deal with the bereaved children. The article reviewed some evidence-based, empirically supported practices, which suggested that these practices may help children resolve the grief process in a more effective manner. Some of the practices suggested by the article are: increasing child self-esteem through more positive self-talk; increasing child adaptive control beliefs using problem-focused coping strategies; improving child coping skills by focusing on optimism; helping children to express their feelings of sadness, guilt, anger and anxiety, and facilitating a positive parent-child relationship and effective communication between them.

The child’s developmental level and gender, the cause and type of death, the time since the death, and cultural background are the other “nonmalleable factors” that should be considered when working with parentally bereaved children, the article suggested. It also highlighted that there is a dearth of empirical work on cultural differences in children’s bereavement experiences, suggesting clinicians to take into account various reactions to the death of a family member as they may vary from one culture to another.

The article concluded that despite some evidence about clinician’s significant role in supporting parentally bereaved children through utilizing these techniques, more research was required to provide a platform for better interventions. My view is that the article is well organized and gives some detailed information about the recommended practices for bereaved children. Nevertheless, it has also put emphasis on the little work conducted so far to have a better understating of the grief process in children in general, and to shed light on the role of the culture in particular.

 

Norman, Abeles., Tara, Victor L., and Delano-Wood, Lisa. (2004). The impact of an older adult’s death on the family. Professional Psychology: Research and Practice, 35 (3), 234-239.

Taking into account the impact of the death of an older adult member in a family, this article examined the effects of such a loss on family functioning and children, and reviewed the theoretical approach to the grief process. The article opposed the classical model of the grieving process, which assumed that bereavement was time limited with predictable stages, adding that evidence shows that people may not always experience an organized grief process as their reaction is individually determined.

Family systems theory indicates that bereavement should be dealt with by awareness not only of familial context, but also of larger contexts in which the family lives, for instance the culture surrounding the death.  At the same time, attachment theorists suggest that the resolution of grief depends on the attachment status of the bereaved relative to the parent who has died. In such cases, the most frequent initial reactions included difficulties in sleeping, in working, in keeping up with normal activities, and in getting along with certain people. The most frequent residual reactions, however, included missing the parent, still feeling the need to cry, being unable to replace the parent, and feeing that things and people continued to remind them of the parent.

Considering the contexts in which the death takes place, some of the treatment options are family therapy, psychoeducation, bereavement groups, and individual or play therapy. Among other things, family therapy can help the bereaved adapt to their loss by facilitating communication and strengthening interpersonal connections in a safe environment and by encouraging parents to serve as a role models for their children. Psychoeducation can help the family to get information about the relationship between grieving and health, common physical symptoms and help them understand how to deal with the child’s feelings in line with the child’s cognitive development. In addition, bereavement groups can provide support for children to realize the loss and come to terms with their confusion about the permanence and irreversibility of death. Finally, individual and play therapy may be helpful, especially for the young children who are less likely to benefit from family treatment, by providing them with the opportunity to express their feelings.

To conclude, the article highlighted the importance of thinking of bereavement in context as it occurs at the individual level, thus it recommended that psychologists begin thinking about individual responses to grief as they relate to changes in family dynamics, structure and functioning, and the cultural context, which shapes ideas about grieving process.

The evidence-based findings about the grief as an individual experience that indicates the grief process may not follow a predictable series can help researchers collect more information about the diversity of cultures and the different reactions to the death of an older family member and its impact on children. 

Raveis, Victoria H., Siegel, Karolynn., and Karus, Daniel. (1999). Children’s psychological distress following the death of a parent. Journal of Youth and Adolescence, 28 (2), 165-180.

A study among 83 families with school-age children in which a parent had died of a cancer in the preceding 18 months has demonstrated some interesting findings. The study, which was participated by White and middle or upper class families, was predominantly focused on “normal” children, who were not referred for professional intervention due to complicated grief. The data were obtained from the interviews with surviving parent, interviews with study child, and abstraction of data from deceased parents’ medical records.

According to the article, one of the main findings was that the bereaved children’s level of distress was “highly correlated” with the child’s perception of the communication patterns in the family, particularly with the surviving parent, and whether or not the surviving parent was open to communicate about the loss. The study suggested that the more the surviving parent’s receptivity to open communication with the child, the greater the chances were for the child to adjust to the loss successfully.

The other significant coefficient in depressive symptomatology was the child’s gender, with boys reporting lower levels of depressive symptoms than girls. The article continued that the findings regarding a higher level of depression among girls suggested that girls may suffer more lingering bereavement effects than boys, relating this reaction to “innate factors”, such as a greater bereavement vulnerability.

In conclusion, the article recommended that the findings regarding children’s grief process had been inconsistent and, therefore, further large-scale analyses were needed in order to focus more on the role of gender, developmental stages, ethnic group, and the impact of the life transition following a parent’s death.

This study has provided some valuable information about the role of communication patterns among grieve-stricken families. It has also highlighted the importance of more data to clarify the nature of children’s bereavement and to provide more effective, consistent measures to help children adjust to a parental death more successfully.

 

Sally, Dunning, A.C.S.W., (2006). As a young child’s parent dies: Conceptualizing and constructing preventive interventions. Clinical Social Work Journal, 34 (4), 499-514.

The loss of a parent can present the surviving children with some major challenges, but the article challenged the assumption that a sudden death may have a stronger effect on the surviving members of the family. It argued that even though the sudden death of a parent is commonly believed to have a poignant impact on the family, the anticipated death presents a family with tough challenges and stress that can be more serious than experiencing the loss of a parent due to sudden death.

The article indicated that for the children experiencing the “too-long dying” of one of their parents, it is helpful to intervene and support them before the death in order to facilitate successful mourning. Focusing on the importance of understanding a stressful event and whether or not it can cause trauma, the article suggested three frames to help children experience grief effectively: cognitive, affective, and behavioral.

In the cognitive frame, the children are mainly given necessary information, with the language appropriate to their developmental level, about the disease, its cause, treatments, and prognosis. This framing can help children overcome the struggle with their guilt and have a better understanding of a terminal illness, which usually leads to information about death.

Using the affective frame provides the child with the opportunity to overcome their resistances and deal with their feelings of confusion, sadness, loneliness etc. To reach this goal, one of the displacement techniques, which is a simple picture depicting “before and after” the disease in the family, is used. The article mentioned a number of cases that children used drawing to express their concerns, feelings, and emotions about the impact of their parents’ illness on their lives. The third frame is behavioral, which suggests that children should not be put in a position to experience overexposure to the crisis and disturbing sights of a person dying from a terminal illness. Instead, they should be given the opportunity to learn coping behavior by acting out their feelings in a non-hurtful way.

The article, which provided several examples for the three frames, concluded that there is a dearth of guidelines which could have helped clinicians work with children experiencing anticipatory grief. It also concluded that the three domains, cognitive, affective and behavioral, can help children overcome their defenses and express their difficult feelings.  The contents of this article support the assumption that there is still a shortage of information about the grief reaction among children and, therefore, it is required to work more on understanding their experience in the social, developmental, and family contexts. 

Silverman, Phyllis R., Ph.D., Worden, J. Williams., Ph.D. (1992) Children’s reactions in the early months after the death of a parent. American Journal of Orthopsychiatry, 62 (1), 93-104

A study on reaction of a nonclinical group of 125 dependent children aged 6-17 years within four months of the death of a parent has demonstrated that there were some similarities in the way these children were experiencing and expressing their grief. Silverman et al., who had conducted among bereaved families of various socioeconomic, religious and ethnic backgrounds in the greater Boston area, interviewed both children and their surviving parents and examined their experiences, concerns and reactions through standardized measures. The measures included in the study were Child Behavior Checklist, Perceived Competence Scale for Children and Locus of Control Scale.

The article said that for the children in this study, the loss of a parent was not only stressful itself but also had a huge impact on most aspects of their lives. As for affective responses, their initial behavior included crying, insomnia, learning difficulties, and early health problems. Moreover, children with a higher level of distress were doing poorly in school. In terms of health problems, more than 70 per cent of these children reported some form of illness during this four-month period.

On the other hand, many of the children were expending a great amount of energy to stay connected to the deceased parent, by believing that they were being watched by the parents and by keeping their parents’ belongings. Regardless of their gender, the majority of the children also tended to say they were most resembled to the decreased parent. However, not all of the bereaved children in this study were speaking about the death with their teachers, peers and classmates.

To conclude, the article stated that understanding a child’s responses to the death of a parent, and the way the child copes and adapts, requires a focus on many interacting variables, particularly by looking at the child’s context of social and family system. The study also indicated that the surviving parents did not sufficiently appreciate the way the children were expressing their grief or for their conversations about the dead parent.

It appears that the findings of this study support the idea that children express their feelings and grief differently compared to adult members of their family and the surviving parents. The article’s emphasis on paying more attention to children’s social and family contexts implies the necessity for doing more to understand children’s cultural background and developmental stages.

Photo courtesy of Zubaida Akbar

Sood, Aradhana Bela., MD., Razdan, Amit, MD., Weller, Elizabeth B., MD., and Weller, Ronald A., MD. (2006). Children’s reactions to parental and sibling death.  Current Psychiatry Reports, 8, 115 – 120.

Loss of a parent or a sibling is the most commonly experienced bereavement in children while their grief process is somewhat different from the bereavement seen in adults and this indicates that their reactions and adjustment need to be understood in a developmental context.

The article first focused on the concept of death in children and the way they react to the loss of a family member. A child’s reaction to death is related to the child’s concept of death, which in turn is related to the child’s developmental stage, and the acquisition of these concepts occurs between 5 and 7 years. Four major concepts related to death that can be perceived by a child at this period are: irreversibility, finality, causality, and inevitability. However, children in the first few years of life believe that the dead person has disappeared as they have no concept of death.

It then elaborated on the main factors that should be considered in evaluating a child that has lost a parent or sibling: (1) developmental level and understanding of death, (2) differences between the grief of a child and the grief of an adult, (3) cultural considerations, (4) differentiating normal grief from pathological one, (5) family assessment, (6) factors related to the death, and (7) factors related to premorbid functioning.

The article recommended that as adult members of the families experiencing grief may not be able to provide support for children, pastoral counselors or family friends can provide appropriate support for uncomplicated grief. As for the complicated grief manifested by suicidal thoughts, somatic problems, new difficulty with schoolwork, nightmares, sleep problems, change in eating patterns, and frequent regression in behaviors, a professional intervention is needed. Several therapeutic modalities were suggested for a child needing intervention: (1) individual therapy, (2) family therapy, (3) group therapy, and (4) medications.

To conclude, the article pointed out that the experience of loss in children is qualitatively different from adults, mainly due to their developmental considerations, and that it is necessary to gain knowledge about how children’s grief process is if intervention is required.  It added that a thorough assessment of individual, family, social, and cultural factors are essential to differentiate between normal and complicated grief. The article ended by saying that further research is needed to obtain a clearer definition of the grief process in children and to develop more effective interventions.

 Although the article explains children’s grief process briefly, the way it has described and placed emphasis on the importance of children’s developmental stages and their relation to the concept of grief, as well as the children’s reaction, is valuable. The article has appropriately highlighted the significance of culture and its impact on the grief process. Its suggestion justifies the need for further research on this subject.

Closing Statement

The above summaries indicate that the studies conducted so far on children’s reaction and adjustment to a parental death have provided some useful information that helps understand children’s feelings and perception of death more effectively. However, although the data collected from dozens of such studies have helped mental health professionals gain more skills and work in a more efficient manner with bereaved children, there is still some inconsistency in this field. The discrepancy and inconsistency, and in some cases a dearth of information, simply indicate that more should be done to explain some important factors about the contexts in which children experience grief, such as the role of gender, developmental stages, culture, religion, education, and communication patterns.

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