Loss and Grief for Children and Adolescents

Loss and Grief for Children and Adolescents Graham Martin OAM, MD, FRANZCP, DPM g.martin@uq.edu.au

Personal reflections

Death and Children in 2007 Children may experience meaningful loss through death of • Grandparents, Parents or Siblings • Animals • Death on Television though the News, or more likely through programs is more frequent, but may have less impact.

Acute Loss Syndrome • Psychological and Somatic Symptoms • May appear immediately, or delayed • May be exaggerated or apparently absent • May appear to be a distorted aspect of one part of the syndrome • Is amenable to support, care, but needs to run its course

Symptoms • Somatic Distress - often in waves • A sense of unreality, with increased emotional distancing • Often an intense preoccupation with the image of the dead • Feelings of responsibility or guilt • Disconcerting loss of warmth in relationship, with irritability or anger • Changes in patterns of conduct • Traits of the deceased may appear in the behaviour of the child

Death of a mother • Universally accepted as more traumatic • Shock, disbelief, denial may be followed by episodes of panic • Regression • Compensation • Clinging to a mother substitute

Death of a father • All the previous symptoms may occur • Death of a father may be more difficult for a boy

Death of a sibling • Regret or Guilt may be prominent • Profiting from extra parental attention • Struggling with the reaction of parents • A ‘replacement’ child can have special problems

Grieving in Infancy • During the first 2 years there may be no true understanding of death • However, stages of loss (Bowlby, 1958) may appear: • Protest • Despair • Detachment • There may be later problems with attachment, or an inability to trust that others will ‘always’ be there

From age 3 • May have more comprehension • May be able to discuss the death • May act out fears and fantasies • May not have concept of death as final; this may lead to anxieties over sleep • Separation anxiety is common, and dependency may be strong • Grief work through play

From about age 6 • May accept that death is final • May have resulting fears around own finiteness • Personification of Death • Grief work more verbal

From about age 10 • More emotionally mature with an understanding of the finiteness of death • Most of the intellectual tools to understand death and its context • Delayed or distorted reactions can occur

Distorted grief reactions • Overactivity with no sense of loss • Taking on traits of the deceased • A psychosomatic disorder • Alteration of relationships with friends and siblings • Hostility to certain people (eg professionals) • Withdrawal • Problems at school • Aggressive acting out • Depression with agitation

The Funeral • Whatever our core religious beliefs, some ceremony is necessary for us to celebrate a life and acknowledge the passing • All children should be present and take part in the mourning as far as they can

Loss and Grief for Children and Adolescents