March/April 2015 Issue
How Children Grieve — Persistent myths may stand in the way of appropriate care and support for children.
It seems both an obvious and unassailable fact that children will suffer, sometimes acutely, from the loss of important figures in their lives; yet it wasn't long ago that such profound sorrow wasn't widely acknowledged. It wasn't until Freud—not Sigmund, but his daughter Anna—shed light on childhood grief that the subject captured the attention and validation of researchers.
According to Andy McNiel, MA, CEO of the National Alliance for Grieving Children, an organization that encourages awareness of the needs of grieving children and teens and provides resources and education, Freud observed the effects of grief when working with Jewish children orphaned during World War II. Freud's observations, McNiel explains, influenced researchers, most notably John Bowlby, who went on to study how infants were affected by separation from their primary caregivers.
"In recent years," McNiel says, "the debate over whether children actually grieve has been put to rest by such research studies as the pivotal Harvard Child Bereavement Study, conducted by William Worden and Phyllis Silverman." But despite the research, myths and misunderstandings persist, obscuring the needs of children in the wake of a significant loss.
Getting Beyond Misperceptions
The Reality of Childhood Grief
The Different Faces of Grief
Not only may children and adults grieve in dissimilar ways, but, McNiel says, "Children also grieve in different ways at different ages and stages of life. Their grief might be expressed in an array of emotions such as anger, sadness, fear, and sometimes relief, particularly when there had been long-term illness or perhaps a contentious relationship with the person who died."
It's important to remember, however, DeCristofaro says, that when it comes to grief, those developmental stages are fluid and permeable. "Sometimes you'll see a 3-year-old grappling with something existential as a teenager might."
"Grief does not happen in nice, neat stages, but is unique to the person grieving and influenced by a number of factors in addition to age, including temperament and personality, the relationship they had with the deceased, the relationship they have with the surviving caregiver, the type of death, and the reaction of the adults around them," McNiel says. Grief, he adds, is not very well structured, and all children, like all adults, grieve in their own ways.
Grief May Be Invisible
In addition, grieving is cyclical. "As kids reach new developmental levels, they're going to reintegrate aspects of the grief process using newly acquired processes and skills. Kids will regrieve these important losses at different times in their lives. For example, a girl who loses her mom may have more intense grief reactions at key points in her life such as when she starts to develop physically, when she goes out on her first date, goes to the prom, when she gets married," Thomas says.
It's not always possible for adults to accurately perceive whether or how a child is grieving. Adults may expect to gauge emotion through tears or verbal expression of emotions. And while those may be present, children will behave in different ways and often in a manner that may not outwardly appear to adults to manifest grief.
As children and teens grapple with what it means to die and struggle to comprehend death's permanence, Thomas says, they may exhibit regressive behaviors such as bedwetting, thumbsucking, separation anxiety, feelings of insecurity, and needing to sleep with parents, especially younger children. "The older they get, the more able they are to understand death and they begin to be able to express their grief more in words, but the younger they are, the more grief comes out in their behavior. Older children may exhibit anger, aggression, or risk-taking behaviors," she adds.
Silence Isn't Golden
"Adults might assume that children are better off not thinking about or talking about the person who died. They might remove pictures or avoid talking about the deceased in the presence of children," McNiel says. In response, the children will retreat in silence.
It's not uncommon for children to experience feelings of guilt following a loss (particularly when the deceased is a parent), triggered by the perception they may have somehow contributed to the death. "Because children are ego-centric and view life through a 'magical' lens, they will often feel that they somehow caused the person to die," McNiel says. They may feel that if they'd been better behaved the parent would still be alive, or that there was something they could have done to prevent the death.
This guilt may arise as well if a child had quarreled with the person before the death and concluded, "I wished him dead and it happened," Tecala says. "It's magical thinking, but it can create havoc in a child's psychological well-being."
When those around the child encourage silence and fail to allow the child the freedom to express these feelings, they may persist. They'll need a lot of reassurance, DeCristofaro says, to understand that they didn't influence events and that there was nothing they could have done to prevent a death.
It doesn't help to prevent children from discussing their feelings, but, on the other hand, it's also not helpful, McNiel says, to force children to talk about or express their grief.
Children Can Handle the Truth
Younger children may have little understanding of what death is and what it means. This confusion, says DeCristofaro, "can get compounded by the use of euphemisms such as 'we lost him,' or 'he expired.' The things we say to soften the experience can be very confusing."
Experts agree, the truth is preferable to lying, which fosters mistrust, and clear language can help a child better understand the phenomenon of death and its permanence, as well as the particulars of an individual loss. At the Dougy Center, adults are encouraged to use concrete language when discussing or explaining death to children. "It's painful for adults to share information, and they may be fearful about how the child is going to respond," DeCristofaro says. But children need to understand, when a person dies, "that the person's heart stopped, that he doesn't breathe or sleep anymore, that we won't see him again," DeCristofaro explains.
"Certainly one should consider a child's age in sharing age-appropriate details, and there is no reason to share gruesome details, but whatever is shared with a child should be built upon the truth. When the caregivers in a child's life establish open dialogue about the death, the child often will return with more specific questions as he or she clarifies his or her understanding of what happened. This is true in the case of suicide and homicide as well as other types of death," McNiel says.
Rituals Aren't for Adults Only
• Children should not be forced to participate or to talk about the person who died.
• They should be prepared about what they might see or hear when participating and then given the option of whether to participate.
• A plan for an early departure should be put in place in case the child should become overwhelmed and ask to leave.
It's important, DeCristofaro suggests, "to dismantle the terminology of 'getting over something.'" It's a process one goes through, but grief, she adds, doesn't have an end.
The Tasks of Mourning
While there may not be clearly defined stages of grief, there are additional common challenges for children in the aftermath of a death. These tasks, which are highly individual, McNiel explains, were formulated by Worden after he completed the Harvard Child Bereavement Study with his colleague Silverman and have been addressed by other scholars. They include learning to cope with emotions and other changes resulting from loss; developing a new type of relationship or attachment with the deceased based on remembrance; finding meaning from the experience of loss; and reinvesting in life, moving forward, and absorbing the experience into their lives. Even kids, says Thomas, are capable of searching for meaning from the experience of death.
"Children might struggle with concentrating in school or react in anger, demonstrating an array of problem behaviors," McNiel says. "Often the lack of concentration might be misinterpreted as ADHD or ADD. Children might misbehave at home in ways not typical of their behavior before the death, testing out their new reality," he adds. Many children and teens experience isolation after the death of a loved one and may feel that they stand out from their peers, particularly if no one else among their friends or schoolmates has had a similar experience, DeCristofaro explains. As a result, they may be at greater risk of anxiety and other mental health challenges, substance abuse, and the physical aspects of grief, such as colds, coughs, and stomachaches, she says.
When children are not helped to grieve at every stage of their development, Tecala says, they experience cumulative losses. Among the consequences may be behavior problems such as depression and drug and alcohol use.
How Social Workers Can Help
To help facilitate grief, social workers should be alert to issues and behaviors that might suggest that a child is having difficulty coping with a loss, whether or not they are seeing a patient specifically for grief. "I always say one doesn't have to look at it in terms of problems you can diagnose, but rather look at the issues the child is going through now that may be red flags," Tecala says.
Social workers can best assist families by starting with honesty and transparency, DeCristofaro says, "helping children understand who died and how they died, helping parents and adult caregivers feel confident sharing information and fielding questions, and listening—to … ask kids questions and give them choices."
McNiel observes that social workers will need to be patient, "as grief is a lifelong experience for children, and they will come in and out of their grief as they grow and develop into adults." It's helpful, he says, to offer children choices throughout the course of grieving, "from the time of a funeral and when providing support long after the death."
There's no single strategy that will ensure that a child can cope with loss, but a variety of options may be helpful, including art, play, crafts, and memory projects. "Children will move toward those activities that feel most comfortable to them," McNiel says.
Social workers can help, experts agree, by being aware of and avoiding assumptions. "Avoid projecting your own grief onto children and giving advice. Assuming that we know how they feel (even if we had a loss at their age) can highjack their grief, making it more about us than about them," says McNiel, who adds, "Let the child lead you, listen, be present, and follow them in their play."
In the end, Thomas says, children can teach social workers and other adults about their grief experience. "We know a lot as social workers, but everybody's grief experience is different." Listening and allowing children to express themselves in their own way and at their own time is key.
— Kate Jackson is an editor and freelance writer based in Milford, PA, and a frequent contributor to Social Work Today.
Other resources include the following:
• The Shared Grief Project (thesharedgriefproject.org);
• The Dougy Center (www.dougy.org); and
• The Centering Corporation (www.centering.org).