Grief can be described as a natural, intense emotional suffering brought on by a loss. People can grieve in different ways and can experience a variety of different emotions and responses. Loss is a universal experience that everyone will have, and there are many factors that contribute to a person’s reaction to loss. For some, it can be life changing. Losing a loved one is never easy, but one of the most significant and life altering events is a child’s loss of a parent. The effects can be substantial, persistent, and affect not only the immediate and future emotional state of the child, but also the child’s physical, behavioral, social, and spiritual state as well. Childhood and adolescence are times when growth and development are at their highest and are dependent on care provided. The death of a parent can lead to a sudden and dramatic disruption in positive development in many ways. There are far fewer studies about the grief reactions of very young children and adolescents after the death of a parent than there are about adult children, but one study suggests that in Western countries, 4% of children and adolescents experience the death of a parent, and approximately 1 in 20 children and adolescents in the United States experience such a loss before age 18 years old (Melhem, et al., 2011). There are several factors that need to be considered when studying the experience of children after the loss of a parent including the age of the child, the relationship between parent and child, and type of parental death (natural or unnatural).
The five stages of grief consist of denial, anger, bargaining, depression, and acceptance. The cycle of the stages of grief does not have a specific linear order, nor does it happen the same for every person. Denial is often one of the beginning stages of grief, and is crucial for the child to cope with the death of their parent, to survive to immediate impact of the lose. Such reactions consist of avoidance, disbelief, confusion, shock and fear. Anger appears once the denial and shock start to fade away, the feelings consist of frustration, and the child poses the question of “why me?”. In children, it is prevalent to not express the why me, they place the blame towards other family member or teachers. Anger is a necessary part of the grieving process, and anger is needed to move forward. They will act out in other environments such as the classroom. Bargaining is when the child tries to make a tradeoff for one thing, for the return of the parent that has passed. Children will try to make a deal with a higher power or caregiver, to get their deceased parent back. This part of the cycle is a way for the child to cling to a desperate yet false sense of hope. For example, children might say “ I promise I’ll be good if you just bring my daddy back”. Depression comes when children start to feel empty, helpless, and overwhelmed as they realize that their parent is gone. This is the stage where children can start to appear withdrawn from life activities due to the sense of not wanting to be around others, just longing for their loved one. Lastly, the final stage of grief is acceptance. It doesn’t necessarily mean that the idea of the parent died is “okay”, but rather that children have accepted the event as their new reality. This is when a child’s life will never be the same as it once was, but understand that there is indeed a life to live. This is a type of adjustment and readjustment and some days will be better than others, the good days will start to outweigh the bad days, and most importantly, hope is restored and a new life begins during this last stage.
Through literature review, reactions to a death of a parent at the micro level have shown to have a particularly significant impact on children and can be very disruptive to minor children. Parental loss can disrupt a child’s sense of security and safety. Children may have higher rates of substance abuse, PTSD, depression, anxiety, or other mental health issues, increased suicidal tendencies, behavioral and/or academic problems, poor social skills, long term physical health problems and even earlier mortality. The death or loss of a parent can increase the chance of emotional and behavioral problems, separation stress, and psychiatric disorders. Sometimes losing a parent early in life can result in financial difficulties, especially when the parent lost was a primary income earner. This loss of economic and social support can result in poorer housing conditions and nutrition, as well as educational disruptions. When reviewing the impact of a loss of a parent on a child, there are many aspects that can lead to challenges for that child. The stress and extreme emotional toll that can result can have an adverse impact on the individual that can reach into adulthood.
Childhood grief and bereavement can lead to developmental complications, including inhibiting the development of the ability to build effective interpersonal relationships. This skill begins at an early stage in life, often relying on the quality of the relationship that children have with their parents. A Social Work theory that can help explain this phenomenon is Attachment Theory. This theory states that children need to form a strong attachment to at least one primary caregiver to build a foundation that allows them to develop necessary relationship skills as they grow older. The security provided to a child of having a strong relationship to at least one primary caregiving is critical. As the child grows older, the need for a parental caregiver and attachment bond with the caregiver grows less important as new relationships are formed with friends, partners, etc. Based on this, the loss of a primary caregiver due to death has a greater impact on a young child versus an older child because a younger child has not yet had the opportunity to develop other strong relationships, and therefore is dependent upon the attachment to the parent.
The findings of one study indicate that children who lose a parent are at a higher risk for “increased mortality risk” (Rostila, et al.,2011). This is based on how the child perceived the experience, which is often unexpected and traumatic, and are then deprived of a significant attachment figure. These events then cause the child to experience severe signs of grief and loss. (Rostila, et al.,2011). The traumatic event of a child losing a parent can have significant adverse medical impact of the child. These effects are a result of the stress related to the trauma, and “raises their vulnerability to disease and illness.” (Rostila, et al.,2011) The results are due to the impact that stress can have on the sympathetic nervous system, the immune system and other systems in the body (Rostila, et al.,2011). These same children studied are then likely to be subject to structural changes that impact their material and emotional support. This is due to the significant impact of an unnatural parental death. In contrast to adult children, the rates of mortality associated with these types of events are less, since at an older age, the death of a parent is more expected and understood as natural. Therefore, adult children have a better acceptance of the loss as opposed to younger children (Rostila, et al.,2011). Some results in multiple studies have concluded that stress in childhood contribute to telomere shortening and thus enhance aging in exposed individuals. This may result in certain diseases such as cardiovascular diseases. (Smith, et al., 2014).
Sudden, accidental or suicidal death of a parent can cause unique complications to the grieving process for a child. Studies have shown that the type of parental death has an impact. For those deaths that occurred by suicide or by sudden or accidental death children are affected differently, often with symptoms of PTSD and traumatic grief which interrupt the normal grieving process, it makes it more difficult to proceed with normal bereavement. Due to the development that occurs in the early childhood years, these types of loss can have significant impacts on the mental health of children. Parental death by suicide is linked to higher rates of offspring suicide, suicide attempts and depression. It appears young children are more severely impacted than young adults (Wilcox et al., 2010). Childhood survivors of parental suicide may have increased familial risk for mental disorders, suicidal behavior, and impulsive aggressive behavior in schools or neighborhoods. This can be due to stress following the death and change in caregiver routines. (Kuramoto, et al., 2009) Unnatural or unexpected parental deaths contribute to the profound effects on children and their ability to process grief. In addition to the natural feelings of loss associated with the death of a parent, when that death is by suicide, the child’s reaction may be complicated as it may include feelings of guilt, horror, betrayal, and abandonment as well.
At the mezzo level, conditions at the micro level can cause a need for additional support in schools and communities. Certain age appropriate developmental tasks of this period would be compromised. These might include the development of close friendships or academic initiative. (Coffino, 2009). Future studies should consider the relation between the developmental timing of the loss and specific age-salient developmental tasks. Overall, this study suggests that childhood parental loss has developmental outcomes that persist into adulthood. (Coffino, 2009).
These types of losses can impact each child differently as children will respond to loss in different ways. Two children in the same family may act very similarly or very differently when handling the loss. Feelings of grief and loss may impact a child differently, immediately or over time. This may appear that grief in children lasts shorter than adults, but it may actually be longer. Adults who experience parental loss as a child may recycle this grief and loss as they approach mile markers in their lifetime such as, school, employment, marriage, or families of their own.
At the macro level there is an increased need for awareness and support of children who lose a parent. Certainly, more research is needed to evaluate how to reduce the level of hardship resulting from grief experienced by young children and adolescents after the loss of a parent. Programs designed to intervene when resulting complications from grief and bereavement arise in childhood may help to lower the rate of problems experienced in adulthood. Although every child’s individual experience and response is different, it has been shown that the grief and bereavement suffered by a child can, for some, have lifelong implications. Things like suicide prevention, mental health support, group therapies, and other intervention methods can help to address these impacts. Targeting social policies to make these types of services widely available will help to minimize the impact to children who experience the loss of a parent.
There are several intervention strategies that can be used to minimize the impacts on a child of losing a parent. They include ensuring that basic information is provided, and questions are answered, helping the child understand they are not to blame, returning the youth back to standard routines, providing support shortly after the parent’s death, and making sure there is a strong support structure in place. Loss of a parent during childhood is a hard and sometimes traumatic experience that can be associated with grief symptoms and heightened risks for social, emotional, and behavioral problems that can follow through childhood, adolescence, and adulthood (Chen & Panebianco, 2018). These interventions listed are for children around preschool age, these three consisted of attachment theory, play therapy, and trauma-focused school-based. In the research done in this article, these intervention and strategies were the most promising treatment models.
Attachment theory suggests that children react to the bereavement or loss of a parent when there is s shift in caregiver roles, thus a shift in adjustment to the loss. Developmentally, young children are sensitive to strong emotions and emotional withdrawal from others, and they need special attention to recover and manage their grief when experiencing the loss of a parent (Chen & Panebianco, 2018). The most effective way to approach this grief is for the surviving parent to understand their own grief, before the can accurately and correctly approach their child’s grief and loss. Understanding what the child is trying to communicate, whether that may be their emotions or how they are feeling, through the use of play therapy can help the caregiver understand how and what to address with the child. In the same sense, caregivers have to know how to address these emotions, or understand how to know those signs. Understanding this process is a family process, and everyone needs to work together in order to move past this stage of their grief, is crucial to the family dynamic (Chen & Panebianco, 2018).
When researching the interventions and strategies to confront grief and loss in younger children, the best models to use are family therapy, play therapy, expressive art therapy, and cognitive-behavioral therapy (CBT). Play therapy can greatly improve children’s psychological and behavioral symptoms such as sleep problems, oppositional behavior, separation anxiety, distractibility, PTSD symptoms, sleep disturbance, anxiety, bedwetting, and aggression (Chen & Panebianco, 2018). Play therapy enables children to communicate with others, expressing deep thoughts and feelings in a manner that feels comfortable with a therapist. By utilizing play therapy, this intervention can help children learn how to experience and express emotion, develop empathy and respect for thoughts and feelings of others, learn new social skills, grow more responsible for behaviors, and develop respect and acceptance of self and others (Health Chapters System, 2018). Play has been showed to be related to preschoolers psychological adjustment and social-emotional well-being. Play therapy is used to treat children dealing with parental separation and other ongoing family issues (Chen & Panebianco, 2018).
Trauma focused school based cognitive behavioral therapy practice can be extremely effective while working with a child dealing with trauma. This is because schools are well equipped with psychologists that can complete trauma informed screenings to understand the particular trauma the child has gone through. Psychologists can also understand that child’s specific triggers and find an approach in the classroom to prohibit these responses. They also can facilitate a supportive role in the family and the student’s life, while providing cognitive behavior therapy to children and nonoffending caregivers in the school setting (Fitzgerald & Cohen, 2012). There are many positives to trauma focused cognitive behavioral therapy such as, access and retention in treatment, support by school staff, tracking of behavior and progress. On the down side there are just as many challenges, such as limited amount of time with children, resources, and caregiver involvement. Ways where schools can become effective in this trauma focused therapy approach is by “educating school staff about child trauma, implementing screening protocols to recognize and refer children with trauma symptoms, and implementing effective treatment while maintaining child and family confidentiality” (Fitzgerald & Cohen, 2012).
When engaging in grief counseling with children who have undergone the death a parent in their life, there are many tools to utilize in helping a child through that time in a healthy way. Giving children an honest answer, even if it is uncomfortable and hard for the child to hear, specifically about death. When talking about the death of the parent, it is important to use the words “kill” and “died” instead of “lost” or “passed away”. (Ackerman, 2019). Going with the clients pace is important, letting them handle the grief in a guided way with the therapist will help them feel in control of how they handle the loss of their parent. (Ackerman, 2019). Another good tool is to teach parents how to talk about that deceased parent, let the child know that it is normal to have feelings and memories of that parent that they may way to focus on. (Ackerman, 2019). It is also important to note again that all children cope in different ways, whatever is working for them may not work for someone else. While working with a client at this age, it is important to not show any judgment or say how they are supposed to feel, reflecting feelings back to the child as they speak is a validation of what the client is saying, and asking questions to follow up to better understand what the client is saying. (Ackerman, 2019). Applying the principles that the mental health professional is important to share with the caregiver at home, so these ideas and practices can be in all aspects of the child’s life (Ackerman, 2019).
Spirituality, religion, and culture play an important role in the lives of many people. When dealing with a client surrounding the idea of death of a parent, it is important to take into account that all children respond differently. This being said, inquiring about their belief in God, the importance of their religion, and attendance of religious services could be a major factor in one’s recovery process. There are many different views of death to match many different cultures. Some cultures talk about death openly, and others do not, especially around the topic of suicide. This is a topic where religion can play into this as well. Suicide can be seen as a bad thing in some specific religions. For example, in Japan death is seen as liberation, and deceased family members are celebrated in a three day holiday in the month of August. During this time period, those family members who have passed away are thought to come back to the family home. During this time the graves are cleaned and fires are ignited in the preparation of their return home. “This celebration of the dead is common in cultures where ancestor worship is practiced. In these cultures, life is seen as cyclical rather than linear and the dead are believed to have powers over the living, such as the ability to bless or curse” (Death and dying: How different cultures view the end, 2019).
Losing a parent is never easy but, for a child, it can be life altering. Children and adolescents are at a vulnerable and critical stage, when the role of a parent is vital to their growth and the ability to process loss is undeveloped. It is important to continue studying the effects of parental death on children and adolescents in order to provide positive support on all levels.