It is only natural that we and our children find many things hard to - PDF document

7/25/2013 Anna Satterfield, Ph.D. 1 “It is only natural that we and our children find many things hard to talk about. But anything human is mentionable and anything mentionable can be manageable. The mentioning can be difficult, and the managing too, but both can be done if we’re surrounded by love and trust.” Fred Rogers 2 1

7/25/2013 Objectives  Identify how children grieve differently than adults.  Identify emotional and behavioral signs of childhood grief.  Learn effective helping strategies for children who are grieving. 3 True or False?  Grief and Mourning are the same experience.  There is a predictable, sequential progression in the stages of grief.  There is an end point to grief. 4 2

7/25/2013 True or False?  Death is death and the nature of the loss does not change the grieving process.  People who have suffered multiple losses experience grief the same as those who have experienced a single loss.  Crying a year or two years later following a loss indicates an abnormal grief reaction. 5 Myths About Childhood Grief  Young children do not grieve.  Children should go to funerals.  Children should not go to funerals.  Children get over loss quickly. 6 3

7/25/2013 Myths About Childhood Grief, continued  Children will be traumatized by a significant loss and will always need counseling.  Encouraging children to talk about their feelings of grief is the best way to help a child get through grief issues.  Children are not affected by grief and mourning of the adults who surround them. 7 General Statistics  Approximately 4% of children (through age 18, in Western countries) experience the death of a parent.  Many more experience the death of another loved one such as grandparent, other family member, friend, etc.  It is estimated that 20% of bereaved children are likely to have problems severe enough to require clinical interventions. 8 4

7/25/2013 Signs of Adult Grief  Physical Symptoms  Fatigue  Sleep disturbances  Eating disturbances  Stomach or intestinal problems  Confusion  Irritability 9 Signs of Adult Grief  Emotional Symptoms  Shock  Fear  Anxiety  Depression  Guilt  Numbness 10 5

7/25/2013 Adult Grief  Have generally experienced some type of loss before  Understand the finality of death.  Understand broader concepts of loss (not just loss associated with death).  Have better developed/refined coping skills.  Small percentage experience complicated grief reactions. 11 Complicated Grief Reactions  Being stuck in an intense state of mourning  Yearning for the loved one so intensely that it strips one of all other desires.  Preoccupation with or avoidance of anything associated with the death.  Life has no meaning without loved one  Individual experiences no joy in life. 12 6

7/25/2013 General Information  Children’s responses to death vary from child to child.  Influenced by:  Developmental stage  Family factors  Individual child factors 13 General Information, continued  Children may experience grief emotionally and/or behaviorally.  Children grieve in individualistic ways.  Bereaved children grieve for short periods of time and will re ‐ grieve as they reach a new developmental stage. 14 7

7/25/2013 Grief Reactions Across Developmental Stages  Infants: 0 – 2 year ‐ olds  Do not have cognitive capacity to understand death.  May exhibit reactions to loss particularly in response to changes in caregiver or caregiver’s emotional state.  Searching behaviors  Confusion  Separation anxiety  Regression to earlier behaviors (changes in sleep patterns, increased crying, etc.) 15 Grief Reactions Across Developmental Stages, continued  Toddlers and Preschoolers: 2 – 5 Year ‐ olds  Not able to understand the finality of death.  Will react most to the way the loss impacts their daily lives  Confusion about what has happened.  May repeatedly ask questions about the loved one’s location and when they are coming back.  Regressive behaviors 16 8

7/25/2013 Grief Reactions Across Developmental Stages, continued  Early School ‐ Age Children: 6 – 9 Year ‐ olds  Increased understanding of concept of death.  Questions about what happened when someone dies.  Interested/fixated on details and circumstances surrounding the death.  Regressive behaviors.  Fearful of their own death or death of caregivers. 17 Grief Reactions Across Developmental Stages, continued  Middle School ‐ Age Children: 9 – 12 Year ‐ olds  More capable of abstract thinking which allows more mature understanding of death.  Understand that death is permanent.  May feel different than their peers following loss.  Withdrawal from usual activities.  May blames themselves for the death of a loved one.  May fear their own death and/or death of others. 18 9

7/25/2013 Grief Reactions Across Developmental Stages, continued  Adolescents: 13 – 18 Year ‐ olds  Reactions are similar to adults.  Emotional distress often sadness or depression.  Consider how loss will impact sense of identify and life purpose.  Imagine the absence of loved one in future life events.  May take on increased responsibilities particularly if they suffer loss of caregiver.  Acting out behavior. 19 Impact of Family Factors on Childhood Grief Reactions  Functioning of Parent/Caregiver  Parent/Caregiver adjustment best predictor of child’s emotional adjustment following loss.  Availability of supportive/consistent caregiver crucial. When absent will see:  Increased rates of depression, anxiety, PTSD  Long ‐ term psychopathology  Complicated grief reactions 20 10

7/25/2013 Impact of Family Factors on Childhood Grief Reactions  Socioeconomic Status  Research has been mixed  More accurate predictor of future mental health problems may be decline in income  Previous Functioning of Child and Family  Limited research  Evidence of prior individual or family history of psychological/psychiatric problems increases likelihood of depressive symptoms. 21 Individual Factors Affecting Grief Reactions  Gender  Relationship to the deceased  Anticipated versus unanticipated death  Social Support 22 11

7/25/2013 Bereaved Children: Clinical Presentations  Depression  Dysphoria  Declining school performance  Sleeping/eating disturbances  Withdrawal from activities and/or peers  Suicidal thoughts  Low energy  Behavioral problems  Feelings of guilt 23 Bereaved Children: Clinical Presentations, continued  Post ‐ traumatic Stress Disorder  Re ‐ experiencing images of death, nightmares, preoccupied thoughts of thoughts about the trauma or person who died.  Avoidance of traumatic reminders of the death, including specific places, people or activities.  Hyperarousal symptoms such as irritability, anger, poor sleep, poor concentration, heightened startle response. 24 12

7/25/2013 Bereaved Children: Clinical Presentations, continued  Anxiety  Difficulty concentrating  Irritability  Sleep disturbances  Somatic complaints  Inappropriate and excessive anxiety concerning separation from home or from major attachment figures  Refusal to go to school 25 Bereaved Children: Clinical Presentations, continued  Behavioral Problems  Anger  Rage  Acting out behaviors  Oppositional behaviors  Aggressive behavior  School problems  Conflict with siblings 26 13

7/25/2013 Grieving Children: Assessing Needs  Parents often seek guidance on what to expect and how to help child deal with death.  May need assistance with specific problems  May not know how to talk about death  May be struggling with their own grief reaction  May worry that loss has permanently changed child to make he/she more vulnerable to emotional or behavioral problems. 27 Grieving Children: Assessing Needs  Questions for parents:  Nature of the death  What does the child know about the circumstances of the death?  Are there certain aspects that have not been discussed?  Was the death sudden, unanticipated?  Was the death prolonged?  Was the death the result of a suicide?  Did the child witness the death?  What does your child know or understand about what happens when someone dies? 28 14

7/25/2013 Grieving Children: Assessing Needs, continued  Questions for parents:  Rituals and Beliefs  What beliefs does your family have about death?  Describe the funeral/wake/memorial service that took place. Did your child have a role?  What type of mourning/memorial activities might take place in the future?  What role does religion/spirituality play in the family’s grieving?  Has your family’s involvement in these activities changed since the death? 29 Grieving Children: Assessing Needs, continued  Questions for parents:  On ‐ going Stressors  How has your child’s routine changed since the death?  Has the primary caregiver changed since the death? How?  How has the family responded to the death?  What reminders seem most upsetting to your child?  What future changes for the family do you expect? 30 15