Illness and Death of a Parent

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REVIEW OF LITERATURE

Background Characteristics

In the United States, more then million children and adolescents (.4%) younger than 18 years, have experienced death of a parent (Christ & Siegel, 0016). In Conneticut alone 8,000 children under the age of 18 have experienced death of a parent (Emswiler & Emswiler, 0005). Raveis, Siegel, and Karus (188) discovered that background characteristics of a child, the deceased parent, and family may affect the outcome of the child's grief (Raveis, Siegel, Karus, 18167). The age and gender of the child also plays a major role in the outcome of the child's grief. Younger children, under the age of five, and early adolescence, in particular, are vulnerable to poor adjustment to parental death.

According to Donna Schuurman (00) the age of the child and corresponding developmental abilities influence their understanding, memory, and their ability to cope with the death of a parent. From, birth to two years of age, known as the sensorimotor period, If the parent died at birth, or short after, there is one less "not you" to assist in building patterns and trust. The child intuitively and instinctually senses absence of another (having spent months attached to her) and in changes of those around you. This causes and interruption in the ability to trust. To generate or regain trust depends on what happens next to your family and world. From, age two to five or six years of age, known as the preoperational period, primary tasks were developing independence and initiative. When parent's death occurs it is as if "you just began to walk and the rug was pulled out from under you"(Schuurman, 007). The child may slip back to younger behaviors, such as baby talk, wetting the bed, clinging to people, crying more frequently and insisting on their own way. From age six to eleven or twelve years of age, known as the concrete operational period, most children understand death as final. Often, they also retain belief that in some way their actions, or failure to act, may have contributed to the death. During the "raging adolescence period", also known as formal operational, children begin to have more advance reasoning. They need to find and make meaning of their parent's death. Due to the loss of parent, they may have been forced to "grow up". Due to this, they may have experienced added pressures and responsibilities, as well as financial concerns or questions about the future. If the child had a conflicted relationship with the deceased parent, he/she may have carried additional guilt and unresolved issues. During each phase of life, reprocess of loss happens. The child/children must confront reality of having no parent in life while coping with new challenges, such as; friends, dating, career choices, etc (Schuurman, 007).

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According to Willis (00) understanding grief and death begins at around or 4 years of age. She distinguishes between three periods in a child's understanding of death. Between and 5 the child understands that her parent has moved and is living somewhere else. Between the ages of 5 and , the child believes that death may have been avoided entirely. Finally, between the ages of and 10, the child reaches and understands that death is permanent, inevitable, and affects all living things. The four components of children's understanding of death, such as the irreversibility factor, the finality, the inevitability, and causality all relate directly to the child's developmental level at the time of death (Willis, 00).

Some claim that girls are more vulnerable to adverse consequences, and boys have a more problematic adjustment. Others report that they believe that there is no gender difference. These inconsistent findings may be explained through investigations that have documented factors such as child's gender and deceased parent's gender. They may operate in conjunction with one another to show children at increased risk, that is, gender match of bereaved child with deceased parent for young girls, under age 11, and adolescent boys. Some other less examined background characteristics are birth order, family size, presence of siblings, and age of siblings (Raveis, Siegel, Karus, 18167).

Some of the gender differences sited in "Guiding your child through Grief" (Emswiler & Emswiler 000) are as follows boys tend to talk less and act out more, they express grief as anger and aggression. In addition, they are more prone to having concentration and learning problems in the first year after their parent's death. Girls, on the other hand, tend to talk and cry more. They show more anxiety and are concerned about their own safety and health, and that of their surviving parent. Girls may also exhibit more physical complaints and they have more frequent disagreements with other surviving family members. They tend to remain more attached to the parent who died and tend to idealize that parent more. They certainly are more likely to hold onto items that connect them to loved ones (Emswiler & Emswiler, 00050)

In "Explaining death to children", it is claimed that if a boy loses his mother he may regress to an earlier stage of development. His speech may become more babyish, he may begin to suck his thumb, whine, and demand a great deal of attention. Later in life, he may believe that all women have a tendency to hurt men, because he was "injured" by his mother. He may avoid being hurt by leaving them before they can hurt him. A mother substitute, such as a housekeeper, aunt, or older sister may be important in supporting the child and removing these later tendencies. By the same token, a small boy who loses his father may need another male figure as a substitute (Ames et al, 16716).

Factors Associated with Parent's Death

The specific cause of parental death may be an important factor in predicting the outcome of bereaved children. For example, children whose parents who died from cancer showed symptoms of depression and such psychological problems involving anxiety, behavioral problems, decreased social competence, and lower self confidence. On the other hand, children who experienced sudden or violent forms of parental death, including parental suicide showed not only symptoms of depression, but also severe anxiety and intrusive thoughts within the first year after parental death (Pfeffer et al, 0001). (Another factor that has been found to affect a child's adjustment to the loss of a parent relates to the circumstances around death.) When sudden and unexpected death occurs, there is no time to prepare the child and therefore this could result in subsequent adjustment being problematic. The length of illness, advance knowledge of near death, or degree that a child was aware of that the parent would die, may affect the child's adjustment in the postdeath period. Other factors that may affect a child in the predeath period are stress of fatal illness and changes made due to it, such as, alterations in lifestyle, absence or withdrawal of ill parent from family functions, and household economic changes. These stresses and changes can then continue into the immediate postdeath period. Even sudden or unexpected death to a child, that had had a change or loss in the predeath period, is more likely to exhibit adjustment difficulties. Circumstances where a child was prepared for the funeral, if the child was involved in it, or was allowed to see their parent's body, also affects the child's postdeath adjustment (Raveis, Siegel, Karus, 18167).

Pfeffer et al. (00) compared the depressive symptoms, social competence, and behavior problems of prepubescent children bereaved within 18 months of parental death from suicide, and whose parents died from cancer. They found that children whose parents died as a result of suicide, reported significantly more depressive symptoms than children whose parents who died from cancer, such as negative moods, interpersonal problems, lack of self esteem, and anhedonia. A major concern that may affect children's adjustment to the sudden parental death, such as suicide, is the development of these children's traumatic expectations about the world, anxiety in social situations. Long-term clinical research of children who lost their parent as a result of suicide suggest that the psychosocial adjustment of these children when they become adults may be more problematic than after other forms of death (Pfeffer et al, 00).

In "The Grieving Child", (Fitzgerald1) when death strikes without warning, such as, heart attack or accident, there is no opportunity for the child to see the physical changes in their dying parent. The surviving parent may be in a great deal of pain and may have little time to think about the special needs of the child. It is critical for other family members, as well as health care professionals to support the child in order to resolve his/her grief. The child must have an opportunity to say goodbye to the dead parent in his/her own way (Fitzgerald,11).

Attributes of the Family Environment

Most children irrespective of their age yearn and need to talk about the death of their parent. According to Emswiler & Emswiler (000) over half of the children interviewed wanted to talk to their friends about their parent's death. Fortunately, most of their friends were willing to listen and talk to them. A third of the children wanted to talk to their teachers, who were warm and caring (Emswiler & Emswiler, 0001).

Although the world has changed over the years, funamental questions children ask about death remain the same. Such as "Why do I feel sad?", "What happens after death?" or "Am I going to die too?". Adults responses regardless, must be simple honest, consistent and loving. When introducing death to a child, real-life experiences are not the best way to begin with. Newspapers and television shows are often much too frightening and may only give the child misconceptions of the topic. A good way to introduce death is through books and other visual media. This allows us to observe others from a "safe" distance. Hearing characters express their thoughts and anxieties that the grieving child experiences can be reassuring. According to Grollman (15) when children experience the uncomfortable feelings of a protagonist, they may come to realize that not all of life's mysteries can be solved and that death and grief can be avoided.

Some attributes that may effect the child are the surviving parent's own distress and adjustment to death. The child's adjustment is also subject to the quality of care provided by the existing parent. Family communication patterns about parent's death and event leading up to it affect the child as well. When issues are spoken about and discussed, the child is more likely to adapt in a normal way. If parent does not speak of the death, the child is more likely to adapt in a bad way. This can promote denial, avoidance of the finality of loss, acting out and guilt may also result if parent's failed to communicate. Daily environment and unpredictability in daily routine may also contribute (Raveis, Siegel, Karus, 18167).

The only way for people to alter the pattern of children's grief is by being truthful, open and caring. The importance of allowing children to ask questions and of confirming the reality of their parents death and of allowing them to go through the painful yet therapeutic process of grief is emphasized by Helen Fitzgerald in "The Grieving Child" (1). Her research involving young children who suffered traumatic losses, such as, parental suicide deaths and murders combined death education in a support group. The success of this type of therapy in the later adjustment of grieving children broke new ground in the mental health field (Fitzgerald, 1).

In "Explaining Death to Children", Ames et al (167) children's questions should be answered briefly and simply without a great deal of emotion. Discussions of parental death should not revolve around myths, beliefs, or religion and should be approached gently. Most of all, fairy tales about a parent's death and such lies as "Mother has gone on a long journey", are unhealthy explanations. Such stories will contribute to a child's insecurity and inability to distinguish between reality and fantasy. Dishonesty may also contribute to the bereaved child's feeling of guilt about their parent's death. Such reactions may evolve from an earlier hostility towards the surviving parent. Finally, the grieving child should not be kept away from their parents funeral irrespective of their age. This is damaging and makes the child feel isolated from the family unit(Ames ed.16751).

Recent research (Christ & Siegel 00) has also shown that in addition to family support health care professionals can play a significant role in teaching children and adolescents coping strategies and preparing their family to facilitate the child adaptive tasks posed by their parents illness, death, and aftermath.

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