Helping Parents with Grieving Children

Bereaved Children
It is essential when working with children who have experienced the death of someone close to them to be aware of the many childhood losses incurred. Often there are secondary losses for bereaved children. The death of a loved one can be the catalyst creating many secondary losses including loss of friends, home, schools, neighborhoods, self-esteem, and routines. Angela was a 7-year-old in a single parent home. She rarely saw her dad after her parent's divorce. Mom had died in a plane crash. Within a week she moved to another state to live with her dad and a stepmother and stepbrother she barely new. Angela began to do poorly in school and said she "couldn't concentrate." She told her dad that she had no energy to play soccer anymore. She felt different now that her mom had died, and she "didn't want to talk about it with anyone." Within a short time she had lost her mom, her home, her school, her friends, her neighborhood, her ability to learn, and her day-to-day life as she knew it. These are multiple childhood losses that can occur due to the death of a parent.

MHCs' awareness of the following common losses experienced by children (Goldman, 2000b) can give insight into the complexities of children's grieving process. In addition to the types of losses that come easily to mind, like the loss of a family member or friend, children experience more subtle or less obvious losses. Other relationship losses include the absence of teacher or a parent being unavailable due to substance abuse, imprisonment, or divorce. Children experience loss of external objects through robbery or favorite toys or objects being misplaced Self-related losses include loss of a physical part of the body or loss of self-esteem perhaps through physical, sexual, emotional, or derivational abuse. Many children live with loss in their environment including fire, floods, hurricanes, and other natural disasters. A primary death can often create the secondary loss of a move, change of school, change in the family structure, or family separation. Other childhood losses are loss of routines and habits and loss of skills and abilities after the death of a close loved one. Lastly, the loss of a future and the protection of the adult world are common experiences for the grieving child, causing them sometimes to exhibit a lack of motivation and an inclination to choose violence as a way of solving problems.

Children's Developmental Understanding of Death
A child's understanding of death changes as he or she develops, as explained by Piaget's (Ginsberg, & Opper, 1969) cognitive stages of development. Gaining insight into children's developmental stages allows the MHC to predict and understand age-appropriate responses. During the pre-operational stage, usually ages 2-7, magical thinking, egocentricity, reversibility, and causality characterize children's thinking. Young children developmentally live in an egocentric world, filled with the notion that their words and thoughts can magically cause a person to die. Children often feel they have caused and are responsible for everything (Ginsberg, & Opper). For instance, 5-year-old Sam screamed at his older brother, "I hate you, and I wish you were dead!" He was haunted with the idea that his words created his brother's murder the following day. Due to Sam's age-appropriate egocentrism and magical perception, he saw himself as the center of the universe, capable of creating and destroying at will the world around him. Reversibility also characterizes children's grieving. For example, Jack, a 5-year-old first grader, was very sad after his dad died in a plane crash. Age-appropriately, he perceived death as reversible and told his friends and family that his dad was coming back. Jack even wrote his dad a letter and waited and waited for the mailman to bring back a response. Alice, age 7 years, who told me that she killed her mother, exemplifies the common childhood notion of causality in the following story. She was 4 years old when her mom died. When I asked how she killed her, she responded, "My mom picked me up on the night she had her heart attack. If she hadn't picked me up, she wouldn't have died; so I killed her."

Piaget's next stage of development, concrete operations, usually includes ages 7-12 years (Ginsberg, & Opper, 1969). During this stage the child, in relation to death, is very curious and realistic and seeks information. Mary, at age 10, wanted to know everything about her mother's death. She stated that she had heard so many stories about her mom's fatal car crash that she wanted to look up the story in the newspaper to find out the facts. Jason, age 11, wondered about his friend who was killed in a sudden plane crash. "What was he thinking before the crash, was he scared, and did he suffer?" Tom age appropriately wondered at age 9 if there was an after-life and exactly where his dad was after his sudden fatal heart attack. These examples illustrate that, at this stage of development, children commonly express logical thoughts and fears about death, can conceptualize that all body functions stop, and begin to internalize the universality and permanence of death. They may ponder the facts about how the terrorists got the plane to crash, wanting to know every detail. When working with this age group, it is important to ask, "What are the facts that you would like to know?" and to assist children in finding answers through family, friends, media, and experts.

Adolescents' (age 13 and up) concept of death is often characterized in accord with Piaget's prepositional operations, implications, and logic stage of development (Ginsberg, & Opper, 1969). Many teenagers, being self-absorbed at this age, see mortality and death as a natural process that is very remote from their day-to-day life and something they cannot control. Teenagers are often preoccupied with shaping their own life and deny the possibility of their own death. Malcolm, 16 years old, expressed age-appropriate thoughts when he proclaimed, "I won't let those terrorists control my life. I'll visit the mall in Washington whenever I want. They can't hurt me!"

Children can misinterpret language at different developmental stages. The young child can misunderstand clichés associated with grieving, and these clichés can actually block the grieving process. Sammy, at age 6, began having nightmares and exhibited a fear of going to sleep after he was told that his dog Elmo died because "the vet put him to sleep." Alice was told it was "God's will" that her grandmother died because "God loved her so much." Alice questioned, "Why would God take Grandma away from me, doesn't God love me, and will God take me too?" Tom, age 9 years, continually heard the message that dad was watching over him. One day he asked the mental health clinician, "Do you really think my dad is watching over me all of the time? That would be very embarrassing."

Talking to Children About Death
Sudden or traumatic deaths, divorce and abandonment, the death of a grandparent, and the loss of a pet are a few of the many grief issues that children face (Goldman, 2000b). These losses shatter the emotional and physical equilibrium and stability a child may have had. The terror, isolation, and loneliness experienced by too many of today's children after a death leave them living in a world without a future, without protection, and without role models. Children normally and naturally assume the adult world will care for them, support them, and nurture them. When Grandpa has a sudden fatal heart attack, Dad dies in a car crash, Mom dies of suicide, or sister Mary overdoses on drugs, a child's world is shattered. "How could this have happened to me?" is the first question.
- Goldman, Linda; Counseling with children in contemporary society; Journal of Mental Health Counseling; Apr 2004; Vol. 26; Issue 2.

Personal Reflection Exercise #2
The preceding section contained information about children’s developmental understanding of death and talking about it.  Write Write three case study examples regarding how you might use the content of this section in your practice.

Update
Developmental Stages of Social
Emotional Development in Children

- Malik, F., & Marwaha, R. (2022). Developmental Stages of Social Emotional Development in Children. In StatPearls. StatPearls Publishing.

Peer-Reviewed Journal Article References:
Bellet, B. W., LeBlanc, N. J., Nizzi, M.-C., Carter, M. L., van der Does, F. H. S., Peters, J., Robinaugh, D. J., & McNally, R. J. (2020). Identity confusion in complicated grief: A closer look. Journal of Abnormal Psychology, 129(4), 397–407.

Grolnick, W. S., Schonfeld, D. J., Schreiber, M., Cohen, J., Cole, V., Jaycox, L., Lochman, J., Pfefferbaum, B., Ruggiero, K., Wells, K., Wong, M., & Zatzick, D. (2018). Improving adjustment and resilience in children following a disaster: Addressing research challenges. American Psychologist, 73(3), 215–229.

Schonfeld, D. J., & Demaria, T. P. (2018). The role of school psychologists in the support of grieving children. School Psychology Quarterly, 33(3), 361–362.

Online Continuing Education QUESTION 16
According to Goldman, why is it important to avoid using clichés associated with grieving when speaking to a child about death? Record the letter of the correct answer in the CEU Test.