Unit 4 -- Developmental Issues #1
Infancy through Early Adolescence

Grief in a Family Context --HPER F460/F560

Goals for this Unit

In this unit, we look at the grief of children and adolescents (up to age 18), persons still actively involved in basic tasks of human development and in developing a sense of self, independent of their parents.

Preliminaries

Readings

Anthology

McClanahan, R. (1998). Children writing grief. The Southern Review, 34, 125-140.

Prong, L. L. (1995). Childhood bereavement among Cambodians: Cultural considerations. The Hospice Journal, 10, 51-64.

Wolfert, A. (1983). Children's understanding and response to death (with caregiver behavior). In A. Wolfert, Helping children cope with grief (19-50), Bristol, PA: Accelerated Development.

Also

Van Reken, R. E. (1988). Letters Never Sent. Indianapolis, IN: "Letters." (chapters 1-7, pp 1-48).

Web Resources

How Do Adult Attitudes Affect a Child's Grief Process?, written by a former student in this class, Peggy Bruno.

"Lecture"

The Nature of Children's and Adolescents' Grief

The focus of grieving for children and adolescents, as it is for adults, is on making sense of reality, reconstructing normal, organizing the chaos. Grief is seen as the response to the loss of meaning dependent on a relationship and, as the child or adolescent grieves, s/he is seen as reconstructing of a sense of a new "normal." What was "normal" is not normal anymore. There is a need for a stable reality (predictability and control) that has meaning and is understandable.

Grief is especially complicated for children and adolescents. As a normal part of their development, they are actively involved in the process of making meaning in their lives, a process that is tied to individual development and experience. They are working to establish their sense of self while also existing in a state of dependence. Thus, the disruption of meaning tied to the loss can be particularly devastating for them.

Adults especially like to look at childhood as a time of carefree happiness and security. In fact, many children experience it as a time of insecurity and unhappiness with grief as a part of their lives. The common belief is that this does not take place until adolescence. In addition to loss to death, children may experience loss of a secure attachment or a "wished-for" secure attachment. They are acutely aware of their dependence on others and their inability to control their lives. Children may experience loss in many ways not seen as terribly difficult by adults (particularly if the adults feel they can protect the child from the reality of loss): the death of a pet, a family move, the loss of a friend because he/she moves away, the end of a friendship or "first love" relationship.

Children are more likely than adults to experience fragmented recollection and a distorted understanding of the loss experience. You might want to look at the lists of euphemisms I asked students in the class to send to famgrief now and think of what a child might think when s/he is told, upon seeing a beloved grandfather in a coffin, that "Grandpa is sleeping." Both children and adolescents need an environment that is facilitative of their developing a coherent grief story, one that incorporates the recognition and acceptance of their emotions.

At the same time they are coping with their own situation, children and adolescents must also cope with grieving adults, something that may frighten or unnerve them. Adults are the ones who are supposed to take care of and be available to them, not the other way around. Adolescents and children, especially older children, may feel that they need to take care of the adults. They may feel a desperate need for adults to "get back to normal" and "stop being weird and scary."

Children and adolescents need to share their thoughts and feelings with others when they experience a loss, yet the ways in which they come to understand the loss and their techniques for grieving often are not understood or respected by adults. Their feelings may be overwhelming and frightening to them and to the adults.

Younger children are especially likely to want to talk and talk and talk, asking question after adults don't want to hear them anymore, as a way of testing reality. These questions may not make sense to adults, but they do make sense to the child asking them and they should be treated as such. On the other hand, these children may turn away from the loss and information about it. This may be because of a short attention span or a temporary defense against the overwhelming nature of the loss.

Developmental Variations in Grief

It is important to remember, as we start to consider the developmental context of grief, that the ages cited as when children move through different stages are only approximations. There is a great deal of variation among children and a large number of factors influencing development. In addition to normal variation, children under stress (as when they experience a loss) may regress to an earlier level of development. Adolescents may do the same, as, incidentally, may adults. They may adopt a variety of coping techniques that are developmentally appropriate but are, nevertheless, distressing to adults and/or may lead to later problems in relationships with others.

Because of the mass of literature on child and adolescent development, and because of the breadth of coverage in this course, we will not be able to go in any depth on normative child development (we could spend an entire semester on infancy alone!). What follows here is a brief list of grief characteristics drawn from your readings and others on developmental variation in grief.


Very Young Child -- roughly from birth to age 2 -- Sensorimotor


Early Childhood -- approximately 2 through 6 -- Preoperational


Middle Childhood -- approximately 6-12 -- Concrete Operational


Adolescence -- approximately 12 and over -- Formal Operational

The Re-cycling of Grief from Childhood and Adolescence

Losing someone early in life has an expansive impact simply because of timing. Events that take place earlier in life, when one's world view is first being formed, help to "set" that world view and impact on later interpretations of life as it is experienced.

A loss and related grief are not contained in one developmental stage; they become part of who a person is and affects him/her throughout life. The loss will be addressed again and again as he/she moves through new developmental stages, transitions from one status to another, and experiences new situations. With each re-working, new resources will be used and a new appreciation for the loss will be developed. This is an important thing to remember, particularly when working with children and adolescents, particularly those who are seen as "high risk." It may be the losses, and their struggle to deal (or not to deal) with the reality of their unresolved losses that trigger their antisocial behavior.

The experience of a loss can be positive as well as negative. In a study done by Martinson and Campos (1991), for adolescents whose sibling had died of cancer seven to nine years before, good communication in the family, the ability to share the death experience with others, expression of pleasure in the sibling's company, and reliance on family for emotional support were related to a more positive long-term outlook. A more negative outlook was related to withdrawal from family interaction, inability to use the family as a source of support, and difficulty in discussing their experience with others.

Tasks of Grief

Several authors have addressed the issue of necessary tasks of children's grief. If they are unable to resolve these tasks, the authors propose, complications will result. Two examples:

Wolfert proposed six tasks of childhood mourning (Note that these tasks do not need to be completed sequentially).

  1. Experience and express, outside of oneself, the reality of the death.
  2. Move toward the pain and loss while being nurtured.
  3. Learn to convert the relationship with the person who has died from one of interactive presence to one of appropriate memory.
  4. Rebuild an identity based on the life without the person who has died.
  5. Relate the experience of the death to a context of meaning.
  6. Get and maintain a supportive and stable adult relationship.
Baker, Sedney and Gross (1992) presented a process model of grieving tasks, which is made up of a series of tasks that must be accomplished over time. These tasks change as time goes on.
  1. Early tasks begin as soon as the child learns of the loss and take place in the context of their cognitive limitations and abilities.
    1. Gain understanding of what has happened, while employing self-protective mechanisms to guard against the full emotional impact of the loss
    2. Focus on understanding the facts of the loss, protecting themselves, their bodies and significant others
    3. Numbness may be a self-protective response
  2. Middle tasks focus on accepting and reworking the loss and coping with the intense psychological pain that results.
    1. Accept and emotionally acknowledge the reality of the loss.
    2. Explore and reevaluate their relation to the deceased.
    3. Face and bear the psychological pain that accompanies the realization of the loss
    4. Rework the relationship (this is not detachment) -- the ability to maintain an internal attachment to the lost person may be a sign of a healthy recovery
  3. Late tasks focusing on consolidating the child's identity and resuming progress on age-appropriate developmental issues.
    1. Develop a new sense of personal identity that includes experience of loss and some identification with the deceased so they can engage in new and unrelated experiences and activities.
    2. Form new relationships without excessive fear of loss and without a constant need to compare the new to the old
    3. Form a new relationship with the deceased that will evolve over time and become a sustaining inner presence for child.
    4. Return to age appropriate developmental tasks and activities
    5. Be able to cope with resurgences of painful emotions (e.g., at anniversaries and transitions)

Helping Children and Adolescents with Grief

Young people, regardless of their age, need an adult they can trust to help them understand what is going on and to help them feel secure. At the same time, parents and other adults, possibly overwhelmed by their own loss or fear of loss, yet unnerved by their child's grieving behavior, may be the persons least able to legitimize the new meaning the child is constructing. The younger person may even find him/herself placed in a role of confirming the revised view of reality that the adult is testing out. This can overwhelm his/her resources.

Parents and other caring adults need to speak the truth, in terms appropriate to the age of the child. In order to effectively communicate with them about their grief, it is important to take the lead from the children, respond to their questions in language meaningful to them, and to avoid euphemisms and incomplete information (they may end up more confused than comforted). It is better for the adult to admit he/she doesn't know than to give partial or confusing information.

It is also a good idea for the adult to be certain about what the child actually is interested in and how much he/she knows. I find an effective means of answering a child's questions is to, first, ask the child "What do you think?" This allows the adult to clarify what the child wants to know, how much the child already knows, and how accurate and/or inaccurate that is. This is also true when communicating with an adolescent, whom adults may assume to know more than he/she does. Communicating with adolescents may be made more difficult by normal developmental forces, and it may be necessary to encourage the adolescent to talk with another trusted, neutral adult.

When a loss has taken place, parents may themselves be overwhelmed by the loss, a loss that directly affects them and indirectly affects them through its impacts on others, including their children. It may be best (and wisest) to take advantage of others to help their children with grief. If they are unable to help their child, they can create opportunities for their children to speak with others. This can be with professionals or with more informal contacts (e.g., friends, family members).

A concern of many parents is whether or not their child should be allowed or required to go to a funeral. In general, the child should be able to decide for him/herself whether or not to go to the funeral. If children decide to go, they should be forewarned about what they can expect, in clear language. If a funeral is not available to the child (possibly because of distance, the child may have decided not to attend one, if one is not held), they should attend some other ritual for saying good-bye to the deceased. We will discuss this more when we talk about Ceremonies and Rituals for Connection and Closure

Play is the "work of children" and they may use it the same way that adults use work--to distract themselves from their thoughts and feelings. They also may use it to work through loss issues. Death themes in games they play may distress adults, however, and they need to be aware of the importance of children being able to use play for this purpose.

Because they are formal operational, adolescents can discuss loss, death and grief from a more abstract perspective. The parent they turn to for this purpose, surprisingly, may not be the best one for that purpose. Hogan and Balk (1990) found that even though adolescents usually turn to mothers for understanding after a loss, fathers actually were found to have a more accurate picture of the grief experience of the adolescent.

When responding to the grief of adolescents, one must "walk a tightrope" between encouraging the adolescent to talk about his/her feelings while also respecting his/her privacy. Rather than an adult talking with the adolescent, another adolescent (via support groups or peer counseling) may be the person the adolescent will be willing to talk to.

Using Stories and Storytelling to Help

A variety of creative approaches have been suggested for helping children and adolescents: the use of art, movement (dance), and writing are included among the suggestions. One approach that can be used is to collaboratively create stories with them. The rationale follows: The reading by McClanahan shows us several examples of her students' use of poetry and prose to deal with their losses. I found it difficult to read what these children wrote without feeling tenderness and admiration for how they dealt with their difficult separations and losses.

General Conclusions

The grief of children and adolescents is far more complex than many adults assume. Among the factors that contribute to this complexity is the simple fact that children and adolescents go through a grief experience that is limited by their developmental level. In order to help them, adults need to appreciate the characteristics of grief at their developmental stage.

It is important to remember that just because children and adolescents are not telling their stories, it does not mean that a loss has been integrated and that they have "moved on." It may well mean that they have learned that adults can not handle hearing what they have to say and that they should shield the adult from the reality of their pain.

Adults, in general, and parents, in particular, need to recognize their own need for their children to be innocent and protected from harm. They also need to recognize how this can be harmful to their child, especially if it means they must be dishonest or require their child to be dishonest with their child to protect that "innocent" image.

Children and adolescents will re-experience the effects of a loss throughout their lives. Attempting to avoid the reality of their grief will not make it "go away." Rather, it will simply be sealed over to be exposed again, possibly with greater intensity, since it has not been dealt with at an earlier time.

Questions for Discussion

Post your response to the following questions on the Class Discussion.

  1. Euphemisms--why do we have these? What is it about death and dying that causes us to use terms that often confuse and frighten children (for example, "he's gone to sleep")? What sorts of euphemisms do you know about? What is their purpose in using them with children?
  2. In the "lecture" above, you read about a list of necessary tasks in children's grief. What are your thoughts about these tasks? After reading Prong, do you see any possibilities that the expectations of "necessary" tasks may be culturally based?
  3. What is the role of adults in helping children to deal with a loss?  Many feel that it is best to protect children from the reality of death and loss, even after a loss has occurred. What are your thoughts on this?
  4. Ruth Van Reken addresses a variety of losses in her book, only some of which are death losses. Using the material from this class, using her as a model, discuss how adults might best assist children experiencing both public and hidden losses.

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