Grief and Mourning in Children and Adolescents

Grief is a normal, healthy expectable response of children and adolescents to the loss of a loved person, object, capacity or wish. It can involve everything from death of a grandparent, parent, sibling, pet or friend, or even the need to face a special limitation or handicap that the child is born with or suffers in the course of growing up. Grief is mediated by constitutional factors internal to the child (stage of development, temperament and attachment); adaptive strategies previously learned and history of prior losses; and the social environment, both in the family and in the community. For children this means that the grief reaction is influenced and shaped by how their parent(s) understand and accept the child’s grief, as well as how the wider community supports the child in his or her grieving. In this regard, there are other factors, such as whether the grief is solely or primarily the child’s (e.g., loss of a transitional object like a blanket or stuffie), whether it is grief shared by the entire family (e.g. loss of a grandparent), or whether it is connected to a community-wide experience (e.g. disasters resulting from natural catastrophe or war, terror attacks, or political context such as, for example, violent deaths of family and friends associated with a racist dominant culture or reactions to it).

And grief, while it can be intensely difficult, is not all bad in the sense that there is a potential that positive, enduring psychological changes can come from a significant or traumatic loss. Schoulte and colleagues at the University of Iowa in a 2012 paper “Is there growth in grief?” suggest that assessments and treatment of grief should include measures of both negative psychological adjustment and post-grief growth and development.

However, there are also complications with grief and at times it is important to understand and identify the difference between normal grief and its variants. Uncomplicated grief refers to the normal, healthy, expectable process of grieving for the loss of a significant relationship. However, one should always keep in mind that linear or stage approaches to the grieving process, such as that outlined by Kubler-Ross pioneering work in the 1970’s (On Death and Dying), have been recognized as being too narrow or constricting of individual variation. While there are often certain common steps along the way, there is no right or wrong way to mourn the loss of a loved one.

Complicated grief refers to grief where there are also symptoms of separation distress and trauma. It is often characterized by preoccupation with thoughts of the deceased, searching out and yearning for the deceased, disbelief about the death, persistent crying, being stunned by the death, and not accepting the death.

Childhood traumatic grief is marked by the presence of complicated grief, PTSD symptoms, and often depressive symptoms. It is often associated with death due to factors such as violence, motor vehicle accidents, suicide of family member or peer, natural disasters, and terrorism. It can include intense preoccupying thoughts, dreams of memories about the traumatic death, avoidance of reminders of the deceased, emotional numbness or detachment, and hyperarousal symptoms including anger or bitterness. In contrast to uncomplicated grief, childhood traumatic grief, when unresolved, leaves children at risk for serious psychiatric conditions such as depression, substance abuse, and personality disorders which can last into adulthood.

The study of grief remains in its infancy, especially for children and adolescents and particularly in regard to differentiating between normal adaptive and maladaptive or pathological reactions to grief. Although childhood bereavement does not usually reach the level of a diagnostic threshold and does not usually cause long term problems, it is important to keep in mind that complications in the grieving process can occur and that at those times it can be very useful to seek professional help.

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