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Therapy for Children's Grief
Psychological outcomes in children who have experienced the death of a parent are heterogeneous. One child in five is likely to develop psychiatric disorder. In the year following bereavement, children commonly display grief, distress, and dysphoria. Nonspecific emotional and behavioral difficulties among children are often reported by surviving parents and the bereaved children themselves. The highest rates of reported difficulties are found in boys. This review identifies the moderating and mediating variables that lead to some children being more vulnerable to disturbance than others following parental death. Limitations and gaps in the recent bereavement literature are identified. Theoretical and methodological advances that are necessary for a coherent account of childhood bereavement are outlined.
Early studies of bereavement in childhood document "pathological mourning'' following the death of a parent (Furman, 1974); depressed mood; phobic disorders; and school refusal (Arthur & Kemme, 1964; Black, 1974; Caplan & Douglas, 1969). However, early studies are often descriptive and based on psychoanalytic case studies (see Miller, 1971, for review), or consider children referred for psychiatric help (Black, 1978). A higher incidence of parental bereavement has been reported in child psychiatric clinic attendees compared to controls (Rutter, 1966).
In a previous review of the literature in this journal, Black (1978) concludes ``bereaved children are more likely than children from intact homes to develop psychiatric disorders both in childhood and in adult life, although the differences are small'' (p. 291). The putative association between parental loss, childhood disturbance, and later psychiatric disorder continues to receive support (Black, 1994, 1998), although the strongest evidence comes from retrospective studies of adults with mental health problems. These appear to establish a link between parental death in childhood and subsequent depression in adulthood (e.g., Birtchnell, 1972; Brown, Harris, & Copeland, 1977). But the validity of that link has been challenged. First, because a number of other studies have not found significant associations between childhood parental death and adult psychopathology. Second, because of serious methodological inadequacies, including a reliance on hospital samples, inadequate control groups and a failure to control for independent or mediating variables likely to be associated with outcome (Crook & Eliot, 1980). Tennant, Bebbington, and Hurry (1980) argue that child bereavement alone is unlikely to be related to adult psychopathology, while Brown proposes that it is not bereavement per se that leads to adult depression (T. Harris, Brown,&Bifulco, 1986). Rather, it is the factors associated with bereavement, such as the quality of parental care and the presence of other adverse social and economic sequelae following the bereavement, that influence adult outcome. Nonetheless, debate continues as to whether serious adverse sequelae do or do not follow childhood bereavement (Black, 1996; Harrington, 1996).
Child Outcome Following Parental Death
What Are the Psychological Effects upon Children of Parental Death?
The issue is further complicated as investigators have different aims and objectives. Some document the nonspecific disturbance and grief that bereaved children display, whereas others focus primarily on pathological outcomes as reflected in psychiatric diagnoses, or document the social and educational adjustment of these children. The evidence on child outcome in each of these areas is reviewed, followed by consideration of the duration of reported effects.
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