Psychology
Parental death in childhood is a traumatic experience for any child. Each child handles the passing of a parent differently and the ability to experience normal grief can depend on experiences before the death. Some children need no professional help after the death and seem to handle the tragedy by the normal grief process. Others have problems with depression or anxiety in the short-term; some children ‘act out’ with inappropriate behavior. The long-term consequences of the loss of a parent in childhood can be very strong; so strong that the consequences may be carried on into adulthood.
The intensity of the impact of childhood parental death depends on the age and the developmental stage of the person experiencing symptoms. In childhood it is natural to think of the developmental stages from toddler to child to teen. Adults also are going through developmental stages as they age which also affect their grieving process.
This paper reviews both short and long term consequences of childhood parental death in order to better understand the effect age and developmental stages have on the reactions of the person who has had the experience of parental loss. The thesis is that the parent-child relationship with the surviving parent plays a part in how, as an adult the repercussions of the death show up. The study of this life changing event is important for clinicians in order to develop techniques for recognizing, understanding and treating depression and anxiety disorders in children and adults.
Childhood Reactions to Parental Death
Impacts on Childhood Grief
Silverman and Worden (1992) have pointed out there is a need for this type of research because of the large number of children living in single parent homes due to the death of the other parent; according to the 1989 census this number was 1.5 million children (p. 93). Studies in post World War II Europe demonstrated parental death was a causal factor in behavior problems and depression in children although taken as a whole there was at the time conflicting research data on the subject. (Silverman and Worden, 1992, p. 93)
Silverman and Worden (1992) designed a study with participants consisting of 70 bereaved families. Participants were from greater Boston area communities. Families were asked to participate. Those that did not wish to participate were similar to those who agreed in demographic measures. The researchers suggest the only important difference being that the families who agreed were comfortable with working through their grief by talking. One hundred and twenty-five children (65 boys and 60 girls) were in the sample population. Their ages ranged 6 to 17 years of age with a mean of 11.6 years and a standard deviation equal to 3.08. (pp. 93-94)
The results of the survey allowed Silverman and Worden (1992) to identify five areas of main interest to explore after the death of the parent. (a) The child’s reaction to the death. (b) The child’s emotional experience. (c) Efforts to maintain a link with deceased parent. (d) Their social and support systems. (e) Family routine changes after the death. (p. 97)
The above domains were most affected by the child’s age, gender, how expected (or unexpected) was the death, and the gender of the parent who died. The researchers discovered that the surviving parent needed to learn that the child may just want to talk about the past memories rather than the death per se. This reminiscing needs to be respected because it is the best way for the child to maintain a connection to the dead parent. The researchers determined that family, social and support systems are very important to include in studies in order to better understand the reactions of children. They also pointed out that although 17% of the children “displayed problem behavior” 83 percent of the children were able to cope and get on with their lives. (Silverman and Worden, 1992, p. 103)
Raveis (et al., 1999) makes the strong statement that parental death in childhood is “a profound psychological insult” (p. 165). They were interested in learning how to predict a childhood adjustment to a loss. Their methodology was an interview conducted in the homes of 83 families who agreed to participate. A parent had died of cancer up to 18 months before the interviews were done. The surviving parent and one (randomly chosen) child were individually interviewed.
The results from five important categories were used to statistically analyze the data to find any correlations that could be used to give predictive information. Those five categories were (a) child’s age, (b) child’s gender, (c) deceased parent’s gender, (d) number of days since the death, (e) illness duration, (f) how many children in the family, and (g) the way the surviving parent communicated. (Raveis et al., 1999, 169-170)
The researchers were able to demonstrate a correlation between the child’s perception of the surviving parent’s openness of communication and the child’s ability to cope in terms of depression or anxiety. When the surviving parent was able to talk openly about the deceased parent with the child the levels of depression and anxiety were shown to be low in the children. When communication is avoided by the parent, misconceptions are held by the child, for example, the child may feel responsible for the death. In the latter case the problem behaviors, depression and anxiety levels were shown to be higher for the children. They also found that girls had higher levels of depression which agrees with earlier studies (Raveis et al., 1999, 175-177)
Developmental phases of understanding death
Sood (et al., 2006) explained that time is needed for children to develop to a particular level to be able to grasp the meaning and understand emotionally the death. The researchers say that “Cognitive and emotional understanding of death and dying in children gradually evolves with age” (Sood et al., 2006, 115). Their research addressed the impact of a parent’s or sibling’s death on a child. Their purpose was to determine information useful to clinicians for understanding “risk factors for complicated grief,” warning signs of higher than normal depression and anxiety and offer some guidelines for working with young patients. (Sood et al., 2006, 115)
The warning signs include any indication of suicidal thoughts in the child, sleep problems, problems at school, illness, nightmares, changing eating habits, or behaving inappropriately for their age. Treatment interventions can include individual, family or group therapy. During individual therapy the child should be helped through three steps (a) age-appropriate understanding of the loss, (b) accepting and experiencing the pain of the loss, and (c) confirms the child’s self-awareness and enables the child to carry on normal activities. (Sood et al., 2006, 118)
Snood (et al, 2006) concluded that clinicians must work with the knowledge that children handle grief differently than adults, depending on their developmental stage. Careful observation is necessary to recognize normal versus a complicated grief. Many factors must be assessed including information about the child, the family, their social/culture experiences and the child’s relationship with the deceased parent. (Sood et al., 2006, 118)
Self-perception of identity
Schafer (2009) points out the importance of the self perception of a person’s identity. In particular their own perception of their age even if it does not reflect their chronological age is a factor that can predict health (p. 75). A self perception of a younger age than the chronological age has been shown to reflect better health and even reduces disease. Schafer’s study looked at how age perception in adults is linked to childhood parental death. (Schafer, 2009 pp. 75-76)
The study was designed as a survey, first with a phone call and then a follow-up mailed interview. The respondents were not asked directly about the deaths of their parent instead they were asked (on the phone) “if they had lived with their biological mother and father until age 16;” if the answer was ‘no’ than the clinician asked them why not. In the mail portion the question was posed as “Are your biological parents still alive?” Three categories were used, based on age of respondent when the parent died: (a) 17 to 35, (b) 36 to 60, and (c) 61 or older. The control group consisted of those respondents whose parents were still living. The results were studied using a statistical sensitivity analysis. (Schafer, 2009 p. 83)
Schafer (2009) determined that even 50 years after the childhood parental death impacts on quality of life (health and well-being) are apparent. The second important result was that “the interconnection between timing and the importance intimate social relationships” is very important even as the child grows into an adult and throughout adulthood on self-perception of identity (in particular age). (Schafer, 2009 p. 94)
Risk for adult depression or panic attacks
Jacobs and Bovasso (2009) took a closer look at the effect of childhood parental death on “adult psychopathology” (p. 24). Their study included 3481 participants, both men and women, which had been part of a 1981 Baltimore Area Catchment study which was followed through from 1994 to 1995. The methodology was an interview conducted by clinicians trained to recognize mental health problems: major depression, panic attacks and other anxiety disorders. (Jacobs and Bovasso, 2009, p. 25)
They used statistical analysis to interpret the results. The researchers found that a predictor for major depression was the loss of the father during childhood. They hypothesized that this may have been due to the financial problems that arose. They noted that the participants would have been children in the 1960s when women’s pay was much less than men’s pay. (Jacobs and Bovasso, 2009, p. 25)
Biological indicator - cortisol
Luecken (2008) studied the result of interventions with children measuring high levels of “dysregulated patterns of cortisol activity.” For the study families with a child or children between the ages of 8 to 16 were used to measure cortisol levels and the results were statistical analyzed to determine any correlations. The results showed that when interventions were undertaken in families after the loss of a parent, six years later higher cortisol levels were measured which point to better health outcomes than in children whose families had no interventions. (Luecken, 2008, pp. 397, 416)
Young children and loss
Seidenberg (1993) adds important information about the effects on young children after the loss of a parent. It is not true that children are simply younger adults; they are the most vulnerable to the changes that occur after a death. The perception of 2 to 6 years old is that the person has gone to sleep; they may have changes in eating, sleeping and bladder control. They may have tantrums. From 6 to 9 years old the children can understand more but death can be frightening. For children in both age groups the feeling of abandonment may impact them greatly. Young children have a feeling that they caused the death so communicating openly about the death is very important. Straight forward language is the best to use when talking about the death. Children should be involved in the mourning rituals if they chose to take part. Without these necessary interventions as an adult they may experience depression, illness or even panic attacks.
Limitations
The main limitation for this research is that the results can be interpreted differently because the data can be obtained only qualitatively and subjectively. It is important to use participants from the whole socio-economic spectrum. The ability of the child to communicate the emotions and thoughts can be limiting. Although Raveis (et al., 1998) used self-reporting methods in their study and felt this gave a more reliable understanding of the child’s state of mind. (p. 177)
Conclusions
The relationship between the child and the surviving parent does have a great impact on how the child handles grief and that in turn impacts their quality of live when they are an adult. The most important finding from this literature review is that honest communication with the child in language they can understand is really invaluable in aiding the child to be able to grieve normally. Children need strong support systems to nurture them while they are trying to cope with the tragedy of losing a parent. Abandonment is a constant worry for children so they need reassurance. In terms of the impact of family dynamics, continuing in the same routine is very important. Studies have found that losing a father and then being thrown into financial hardships due to the loss has the most detrimental effect on the adult even though the experience may have been long ago.
References
Jacobs, J. R. and Bovasso G. B. (2009). Re-examining the long term effects of experiencing parental death in childhood on adult psychopathology. The Journal of Nervous and Mental Disease, 197(1), 24-27.
Luecken, L. (2008). Long-term consequences of parental death in childhood: Psychological and physiological manifestations. In M.S. Stroebe, et al., Handbook of bereavement research and practice: Advances in theory and intervention, pp.397-416.Washington, DC: American Psychological Association.
Raveis,V., Siegel, K. and Karus, D. (1993). Children’s Psychological Distress Following the Death of a Parent. Journal of Youth and Adolescence, Volume 28(2), 165-180.
Schafer, M. H. (2009). Parental death and subjective age: Indelible imprints from early in the life course? Sociological Inquiry, 79(1), 75-97.
Seidenberg, H. (1993). Effects of Early Childhood Parent Loss. In T. B. Cohen, M.H. Etezady, & B. L. Pacella (Eds.), The vulnerable child (31-42). Madison, CT: International Universities Press.
Silverman, P. R. & Worden, J. W. (1992). Children’s reactions in the early months after the Death of a Parent. American Journal of Orthopsychiatry, 62(1), 93-104.
Sood, A. B., Razdan, A., Weller, E. and Weller, R. Children’s Reactions to Parental and Sibling Death. Current Psychiatry Reports, 8(1), 115-120.
