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.
- Before you go on: Brainstorm a list of at least 10 euphemisms (i.e., common expressions)
adults use to refer to death when we talk about death with children. Post
them in question 1 on the Class Discussion on Oncourse.
- As you read the literature on child and adolescent bereavement, be sure to look at the context and source of the information. You should ask yourself the standard questions about research findings: If the author is reporting on research findings, what type of sample did s/he use? Was it drawn from the general population or from a clinical sub-sample? Is the author writing as a researcher or as a clinician? Of particular importance for this unit is the way in which the author defines terms related to development: What ages and/or developmental stages are they writing about? What do they mean by the terms they use (e.g., if they write about children, do they include infants and adolescents? If they refer to adolescents, what age range do they include?) It will help you to retain perspective on how you might apply the findings and on a sense of how generalizable the findings are.
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.
Van Reken, R. E. (1988). Letters Never Sent. Indianapolis, IN: "Letters."
(chapters 1-7, pp 1-48).
How Do Adult Attitudes Affect a Child's Grief Process?, written by a former student in this class,
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"
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
- Infants do not appear to grieve in the same sense as adults and older children do. Some
scholars view infants as experiencing a disruption of their environment rather than genuine
grief. Others propose that infants experience grief and have an emotional response that is
consistent with their level of cognitive development.
- Infants are highly organized and engage in their level of meaning making in a social context,
that is they coordinate their sensory impressions and motor activity with others.
- Throughout infancy, they build foundations for later conceptions of the world (e.g.,
trustworthy vs. not)
- The grief of adult caregivers can trigger a response from an infant, because of the disruption of
the child's social environment.
- The loss of a significant other will be experienced as separation or abandonment and it should
not be assumed that the infant's youth will protect him/her from loss.
- Response to loss: May exhibit anxiety and the most effective approach is to provide consistent
care in a stable environment.
Early Childhood -- approximately 2 through 6 -- Preoperational
- Have a better understanding of the reality of death/separation, but is confused.
- See being dead as not being alive but see it as reversible. May express concern about how long
it will be before they are reunited with the deceased.
- See death as avoidable.
- Interpret events in the context of their own understanding, because they are not able to take on
the "role of the other."
- Concrete thinkers, so what you say is what they hear. They take the words of adults as
- Magical thinking is common at this stage (e.g., may believe him/herself to be responsible
for a death or other losses because he/she wished it to be so or acted in some way).
- Fear death is a form of punishment.
- Believe death is contagious.
- Because of their need for stability and control, they may contain their public expression of grief
(and their questions) when they see it to be distressing to adults (especially to parents).
- May also ask many questions over an extended period or go through episodes of asking
questions. May ask the same questions over and over as a test of reality.
- May do any of the following:
- become curious, confused, ask body-oriented questions.
- become irritable and exhibit discipline problems.
- cry, become angry, regress.
- not display emotions at all.
- develop fear of separation, abandonment, or vulnerability.
- incorporate death and/or loss, separation, etc. in play as a way of working out anxieties
in a safe setting. Remember, play is the work of children, so if they are playing, they may
be working through issues of loss, even when their play seems not to be related to loss
at all. Also they may be using play as adults use work--as a distraction.
- experience sleep problems (e.g., night terrors, nightmares, fear of sleeping and/or the
dark, enuresis [bed-wetting])
- Need adults to discuss concretely and accurately and to provide reassurances that the child is
not responsible for the death and will be cared for.
- Stories about dead pets and other animals helpful.
Middle Childhood -- approximately 6-12 -- Concrete Operational
- Gender begins to become a factor.
- Can distinguish between self and others and can understand others' experiences that take place
independent of self.
- Logic is used to learn and solve problems. Facts become more usable, but not in the abstract
- Death is now real, irreversible, universal, with specific causes
- More avoidant of talking about their grief than earlier or younger stages.
- May talk on and on about the loss -- but not necessarily to parents.
- May experience an internal sense of turmoil, feel guilt over any real or imagined fault.
- Feel that if they can act normal, things will be normal. This may result in adults thinking they
are fine because they look it, isolating the child.
- Begins to deal with own mortality.
- May develop an interest in artifacts of death (skeletons, caskets, ghost stories, etc.)
- May be angry, "act out,"
- May act as if nothing has happened.
- May use play to work through feelings.
Adolescence -- approximately 12 and over -- Formal Operational
- Their grief is similar, in some ways, to adult grief -- depression, emptiness, crying, headaches,
insomnia, digestive upsets, exhaustion
- Grief can evidence itself in confusion, crying, depression, feelings of emptiness and/or
loneliness, disturbances in patterns of sleep and eating, and exhaustion.
- Factors in the intensity of adolescent grief include:
- the type and quality of relationship with the deceased.
- the closeness in relationship (closer the relationship, the greater the intensity).
- ambivalence in relationship (the more ambivalence, the greater the intensity).
- Adolescents have a tendency to idealize the deceased.
- Their grief is enduring -- even though they may hide it. They may be concerned about being
seen as different/odd by valued peers. They may also hide their grief from adults in order to
maintain a sense of separateness from them.
- Losses are slowly resolved. Their grief is both intermittent and continuous (i.e., episodes of
intense grief with an underlying sense of loss that seems almost to be "background noise").
Because they are less likely to resolve their grief, it extends over a long period of time.
- Adolescents may think they are experiencing grief that is unique and has never been
experienced before, that their suffering is unique ("No one can ever understand what I'm
feeling. I'm all alone in this."). This view may put them at risk.
- Their expression of emotions may be limited to brief outbursts or may be actively suppressed
because they fear loss of emotional control and because they fear looking odd, wary about how
things appear to others.
- May have particularly intense displays of emotions (almost for dramatic effect) or may be stoic
(don't want to let on).
- May refuse support.
- May feel a need to protect their parents.
- There may be conflict between the adolescent and parents in terms of the adolescent's coping
mechanisms (loud music, strange art, etc.). The adolescent may act out her/his suppressed
emotions through means adult doesn't approve of (e.g., sexual acting out or delinquent or other
socially unacceptable behavior). Behavior may be an attempt to purge their anger associated
with the grief. The adolescent may become the scapegoat for the family, serve as the "safety
valve" for the family. They can then focus on the "out of control" adolescent rather than
dealing with other, tougher issues.
- Sexual acting out may be an effort to be comforted and consoled or it may be an attempt to
deal with emotions of grief. It may reduce some of the emotional pain, discharge tension and
provide physical comfort. A pregnancy that results may be an effort to replace the absent
person or to create someone who will love the bereaved adolescent.
- The grief of adolescents may be disenfranchised, not recognized by others as legitimate or
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
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
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.
- Experience and express, outside of oneself, the reality of the death.
- Move toward the pain and loss while being nurtured.
- Learn to convert the relationship with the person who has died from one of interactive
presence to one of appropriate memory.
- Rebuild an identity based on the life without the person who has died.
- Relate the experience of the death to a context of meaning.
- Get and maintain a supportive and stable adult relationship.
- Early tasks begin as soon as the child learns of the loss and take place in the context of their
cognitive limitations and abilities.
- Gain understanding of what has happened, while employing self-protective mechanisms
to guard against the full emotional impact of the loss
- Focus on understanding the facts of the loss, protecting themselves, their bodies and
- Numbness may be a self-protective response
- Middle tasks focus on accepting and reworking the loss and coping with the intense
psychological pain that results.
- Accept and emotionally acknowledge the reality of the loss.
- Explore and reevaluate their relation to the deceased.
- Face and bear the psychological pain that accompanies the realization of the loss
- 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
- Late tasks focusing on consolidating the child's identity and resuming progress on
age-appropriate developmental issues.
- 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
- Form new relationships without excessive fear of loss and without a constant need to
compare the new to the old
- Form a new relationship with the deceased that will evolve over time and become a
sustaining inner presence for child.
- Return to age appropriate developmental tasks and activities
- Be able to cope with resurgences of painful emotions (e.g., at anniversaries and
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
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.
- A painful event becomes real when it is made explicit in language. Frightening elements,
possibly experienced as amorphous sensations or disjointed images, can become less
frightening when organized in the narrative structure of a personal story. Those involved tell
their story of grief by drawing from their experience and matching them against stories they
already know. These help them to construct their own framework in order to conceptualize
- One way both children and adolescents begin to understand and process a loss experience is to
tell their story of loss and grief. It is critical for them to tell their grief story so that they can
make sense of their grief experience. Hearing oneself tell the story to a willing audience, or
writing it down, give it order. In this, they bring order to the chaos and put their thoughts and
feelings into the form of a narrative (attempting to give it a structure with a beginning, middle,
and end). Working with a caring, trusted adult to tell their story gives them a sense of power
and control in their lives.
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
Questions for Discussion
Post your response to the following questions on the Class Discussion.
- 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?
- 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
- 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?
- 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
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