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
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Identify how children grieve differently than adults. Identify emotional and behavioral signs of childhood
Learn effective helping strategies for children who are
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Grief and Mourning are the same experience. There is a predictable, sequential progression in the
There is an end point to grief.
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Death is death and the nature of the loss does not
People who have suffered multiple losses experience
Crying a year or two years later following a loss
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Young children do not grieve. Children should go to funerals. Children should not go to funerals. Children get over loss quickly.
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Children will be traumatized by a significant loss and
Encouraging children to talk about their feelings of
Children are not affected by grief and mourning of the
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Approximately 4% of children (through age 18, in
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
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Physical Symptoms
Fatigue Sleep disturbances Eating disturbances Stomach or intestinal problems Confusion Irritability
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Emotional Symptoms
Shock Fear Anxiety Depression Guilt Numbness
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Have generally experienced some type of loss before Understand the finality of death. Understand broader concepts of loss (not just loss
Have better developed/refined coping skills. Small percentage experience complicated grief
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Being stuck in an intense state of mourning
Yearning for the loved one so intensely that it strips one
Preoccupation with or avoidance of anything associated
with the death.
Life has no meaning without loved one Individual experiences no joy in life.
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Children’s responses to death vary from child to child.
Influenced by:
Developmental stage Family factors Individual child factors
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Children may experience grief emotionally and/or
Children grieve in individualistic ways. Bereaved children grieve for short periods of time and
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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.)
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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
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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.
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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.
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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.
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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
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.
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Gender Relationship to the deceased Anticipated versus unanticipated death Social Support
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Depression
Dysphoria Declining school performance Sleeping/eating disturbances Withdrawal from activities and/or peers Suicidal thoughts Low energy Behavioral problems Feelings of guilt
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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.
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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
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Behavioral Problems
Anger Rage Acting out behaviors Oppositional behaviors Aggressive behavior School problems Conflict with siblings
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Parents often seek guidance on what to expect and
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.
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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?
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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?
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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?
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Questions for parents:
Coping Strategies
What has helped your child with his/her grief thus far? What supportive resources are available to your family and your
child?
How does your child respond when feeling upset or sad? How has school attendance changed since the loss? How has interactions with peers changed since the loss? What are some of the things you would like help with? What do you think your child needs help with?
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Screen for depression, anxiety, PTSD, behavioral
General appearance (dress, grooming)? Behavior (activity level, eye contact, manner of relating to
you/other adults, aggression, impulsivity, speech patterns).
Thought content (fears, worries, obsessions, delusions).
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Examine:
Thought processes (attention, concentration,
distractibility, magical thinking, flight of ideas).
Mood (depression, agitation, emotionless, inappropriate
affect for the situation).
Attitude (cooperation, opposition, adaptive capacity).
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Screen for suicidal risk. Examine:
Whether there are suicidal thoughts. Have there been previous suicide attempts? Made arrangements to give away prized possessions. Has the child taken life‐threatening risks or displayed
poor impulse control?
Feelings of hopelessness, helplessness and worthlessness.
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Explain importance of and your responsibility to break
Try to contact parents via telephone
Inform about concern Gather additional information to help with assessment Provide information about problem and available
resources
Offer help in connecting with appropriate resources
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Examine protective factors
Social support Family support No previous mental health problems
Examine risk factors
Lack of social support Lack of family support Previous mental health problems Significant family changes Significant school changes
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Be sure that the physical basis for the presenting
Determine whether the child has previously exhibited
Teachers and parents will be turning to you and school
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Find out what your school has planned, check with
Be prepared to for an increased demand for services
Identify support people and community resources who
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Be sure that all students who want or are referred for
Identify students at‐risk. This includes students with:
Pre‐existing mental health problems Exposure or witness of death Previous loss and traumatic experiences
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Relaxation Exercise for Children
Start with toes Legs Stomach Arms and Shoulders Hands and Fingers Head Finish
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Activities for Depression
Changing negative thoughts Improving relationships Increasing self‐esteem Changing behaviors Sentence completion
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Activities for Anxiety
Identify anxiety clues Relaxation exercises Teaching self‐talk Sentence completion
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Behavioral Problems
Focus on strengths Encourage parental warmth Help re‐establish structure and routine Positive reinforcement Problem‐solving skills
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Before the death:
Allow students to talk about their feelings Answer questions about the illness, disorder, or disease Create a banner/card with each class member
contributing art work or notes to the sick child
Make an audio or video recording of students’ messages
to the child and family
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Before and After the Death:
Create opportunities for service to the family Visit as appropriate When a terminally ill child dies, with the grieving
families’ permission, notify the students’ parents of the death and relevant information
Encourage parents to discuss the loss with their children
prior to coming to class
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After the Death:
Answer questions about the death truthfully Reassure students that nothing they did caused the death Continue to create opportunities for service to the family Attend the funeral Send a special note from the class on the deceased’s
birthday and/or special holidays
Hold a memorial activity at school
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Do:
Listen without judgment Follow routines Set limits. Rules still apply, set clear limits when
necessary.
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Don’t:
Suggest that the student has grieved long enough Act as if nothing happened Use clichés
“It could be worse. You still have one parent.” “I know how you feel.” “They are in a better place.”
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“Helen” is a 8 year old student at your school. You have
What would you advise the teacher? What assistance could you provide?
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“Jessica” is a 17 year‐old student at your high school. She
What would you advise the parents? What assistance could you provide?
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Over the weekend 3 students from your high school were
What would you tell the principle? What assistance could you provide?
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You have just learned that a Nathan, a 12 year old student
What suggestions do you have? Are there any special issues to consider?
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Parents/Teachers/Administrators will seek assistance
Multiple factors impact childhood grief. Screen for depression, anxiety, suicide risk ,etc. Understanding childhood reactions to grief will assist
When possible, involve parents and other adults to
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The Dougy Center http://www.dougy.org/grief‐
Child Grief Education Center
Center for Mental Health Services
National Institute of Mental Health
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The National Center for School Crises and
UCLA School Mental Health Project
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