Grief often more difficult to recognize in children
Even though the grief of children and adolescents can be similar to that of adults, especially in the experience and the associated tasks of processing grief, it can differ significantly in the expression and ways of processing it. It is considered a greater challenge to talk to children and adolescents about dying and death and, moreover, to be a reliable support for them in their grief.
Elisa is eleven years old. She lives with her parents in the suburbs of a big city. Elisa grows up with the feeling that her parents do not understand each other. They argue very often. She does well in school, always trying hard to bring home good grades. She has always been more of a daddy's girl. Elisa's mother is an emotional, quick-tempered character, always trying to do everything right. For as long as Elisa can remember, her father has been the one to rely on, the one who always knows a solution to every problem. Even and especially when she does not trust herself to do something, he encourages her.
One day when she comes home from school, Elisa finds her mother crying and trembling at the kitchen table. "Dad is sick. He needs to go to the hospital."Over the next few weeks, Elisa notices that something is very wrong (full case study, see below).
Peculiarities of grief reactions in children
Many aspects of children's grief are similar to the adult experience. In terms of developmental psychology, a child's grief reaction after the death of a parent is, first of all, not only an expedient but evolutionarily absolutely necessary process of adaptation. The child's grief is difficult to recognize because it is often inaudible and not openly communicated. First, depending on the child's level of cognitive and emotional development, the child often does not have words to name what is happening inside her. Second, it has no experience to judge how it may respond and what would be helpful responses. Thirdly, the child does not have sufficient regulation possibilities of its own.
Children often withdraw into fantasy worlds during periods of grief. Comparable to adults, their feelings of grief are expressed in physical complaints (for example, breast pain if the mother had breast cancer). One misdiagnosis that can happen is attributing the behavior to attention deficit hyperactivity disorder (ADHD), even though the child is only psychologically reacting in a spectrum restlessness and/or aggressiveness.
In order to assess the extent to which the child is adequately grieving, the child's cognitive and emotional stage of development and age- and personality-specific ways of responding to the loss must be considered. The child should be informed promptly about the death of a loved one through age-appropriate, factual information and encouraged to ask questions. Saying goodbye is just as important for the child as it is for the mourning process of the adult. When things are hidden, the child gets the impression that he or she is not trusted. This can lead to a loss of trust and feelings of loneliness. If family members feel unable to talk to their child about what has happened, they can seek support.
Age-appropriate creative (painting, writing, playing, crafts) or physical offerings, participation in or to develop rituals together, help to express and live through the pain. Other support services such as grief counseling, bereavement groups, bereavement cafes, pastoral counselors, psychologists, as well as services not directly related to the complex of issues may be helpful to the child's grieving process. In order to give the deceased a new place in life, it is not wrong to remember the person and common experiences. When adapting to the new life situation, it is important that the child does not take on roles or tasks that do not suit him or her, such as household chores or responsibility for siblings.
Normal versus pathological grief in children
It is normal for the child to be sad. Persistent depression and ongoing suicidal thoughts are a clear sign of problematic grief processing. A certain degree of seclusion – depending on the character – is normal. Signs of problematic grief processing, however, would be the social withdrawal from the otherwise led life. According to the U.S. Pediatric Society, all psychological and psychosomatic reactions of the child in the first six months after the loss experience are initially to be classified as normal.
Scientific knowledge
Scientific data provide impressive evidence of what it means for a child when a parent dies. Children often suffer from this loss for years or decades. The children and young people often seem sad and lost. Their sense of being lost in the world is rarely recognized, let alone adequately addressed, as the remaining parent is understandably so consumed by their own grief processing that little or no space and attention is left for the children's grief
In all likelihood, children have an increased risk of becoming mentally ill after the death of a parent, even in the long term. There has long been a belief in clinical circles that a greater proportion of these children develop longer-term psychological abnormalities. In principle, a distinction must be made as to which type of stress is actually associated with a development risk for the children. It is undisputed that a serious illness of a parent can lead to impairments. This is expressed, for example, in lower self-esteem, not fully developed social skills or depression. The impairment of the psychological, mental and social development of a child or adolescent can be serious when a parent dies.
Determinants of grief in children
Clinical practice shows that the extent to which a child grieves or suffers in the long term depends strongly on the environment. The child normally observes closely how the deceased parent dealt with the illness and how the patient prepares himself as well as his personal environment for the impending death. The manner of death (accident, suicide or illness) also influences how much and how long a child suffers. Spiritual orientation and non-orientation also have a major influence. Offered or missing support by siblings and/or relatives as well as friends plays a role. Financial and personal resources in the mourning environment are another share.
Children and mourning: case study Elisa
Elisa is eleven years old. She lives with her parents in the suburbs of a large city. Elisa grows up feeling that her parents don't understand each other. They argue very often. She is good at school, always tries hard to bring home good grades. She has always been more of a daddy's girl. Elisa's mother is an emotional, quick-tempered character, always trying to do everything right. For as long as Elisa can remember, her father has been the one to rely on, the one who always knows a solution to every problem. Even and especially when she does not trust herself to do something, he encourages her.
One day when she comes home from school, Elisa finds her mother crying and shaking at the kitchen table. "Dad is sick. He has to go to the hospital."Over the next few weeks, Elisa notices that something is very wrong. Although no one says anything directly, but it notices that the parents are very afraid. Elisa's behavior also changes. She sticks to her father, says the mother, and the father doesn't know what to do either. The great fear that the father might die manifests itself in the guise of panic attacks, sleep disorders and nightmares. The mother has little support during this time; she is too busy trying to keep herself upright and somehow manage everyday life. Sometimes Elisa blames her mother for her father's illness.
When her father was transferred to a palliative care unit, her mother tried to prepare Elisa for her father's death. But Elisa is not ready to give up hope that everything can still be all right again. The conversations turn out to be difficult, Elisa does not want to know that she will irrevocably lose the beloved father. The mother does not have the strength to deal with the daughter. The father himself does not talk to anyone about the approaching death, also and explicitly not to Elisa. When her father dies, Elisa is shocked and doesn't know what to do. She is very distressed about the death and reacts with aggressive defense against the mother. She resents both her parents for not talking to her properly: "Why didn't Dad tell me that he was going to die?. "I don't understand it, he didn't love me at all?"
Elisa's despair does not subside. Her mother considers Elisa an imposition and devalues her. She finds no support in it and also no one else is by her side. It takes over the function of the father and takes care of everything that the mother does not manage to do. She continues to do well in school. She is hardworking so that her late father would be proud of her. Mentally, she is getting worse, suicidal thoughts are common. But she feels responsibility for the deceased father.
Also in the following years Elisa is often not well. It is difficult for her to rely on anything, as she has experienced that in case of doubt, everything can be completely different from what one thought a moment before. She realizes she just can't cope with her life. Sometimes, when nothing seems to work anymore, she thinks about whether it wouldn't be better to just be gone. Then she simply wouldn't have to deal with all the difficulties anymore.