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This research paper examines the problem of bereavement by exploring the personal, educational, and social impacts it has on children below the age of 12 years as well as the treatment approaches and modalities that are applied to mitigate the effects of grief. Bereavement entails the feelings of sorrow, which adversely impact a child. The stresses associated with the loss and the consequences of lacking parental support can cause mental health problems that can manifest as depression among others. As a result, bereaved children may indulge in risky behaviors such as substance abuse, which together with mental and physical health challenges, increases mortality risks. Educational effects of grief and the related problems manifest in the form of reduced academic performance and increased levels of school dropout majorly due to the lack of parental support and motivation. Furthermore, the social challenges involve inability to acquire and retain friends due to antisocial behaviors. Fortunately, the use of supportive counseling, group-help therapy, and complicated grief therapy can aid in mitigating most of the grief challenges. Cognitive behavioral therapy is effective in any of the three treatment approaches. An understanding of the bereavement effects in children implicates practice by forming the basis, through which the treatment approaches can be applied to achieve good health in children.
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Bereavement Experiences in Children
The death of a loved person is a traumatic experience that affects various aspects of an individual's life. Aoun et al. (2015) explain that losing a loved one is a significant stressor that impacts people across physical, emotional, behavioral, spiritual, social, and financial domains. The effects of bereavement can be compared to being robbed of someone or something that adds immense value to personal life. The depiction of bereavement among those who have lost a close person may exemplify the emotions humans feel after experiencing a tremendous loss. When compared to other forms of loss such as immigration and divorce, death is distinctive because it is irreversible and universally experienced as an important life aspect that no one can avoid (Porter, 2016). Children may sometimes not gain an actual understanding of the death of their parents or siblings because of being shielded by those who care for them during and after bereavement. Porter (2016) reiterates that, especially in the western society, discussing death with children is avoided due to the natural inclination to shelter them from death despite its common nature. However, children should understand and experience bereavement and, together with effective treatment strategies, the adverse effect of death can be mitigated.
Children under 12 years of age have not reached puberty yet and may face severe impacts of grief because of their early stages of mental development. According to Brits et al. (2014), the loss of a sibling has devastating consequences in children, especially those between seven and twelve years of age because they are at a critical juncture in their growth and development. Brits et al. (2014) further explain that bereavement experiences in children are dissimilar to that of adults because of huge variations in the intensity of grief. This is possible because the perception of death and its effects vary depending on cognitive growth and development. However, limited research has been conducted on bereavement experiences in children who have lost their parents, siblings, or close acquaintances. As a result, many aspects should be considered to understand the coping strategies and bereavement treatment approaches. A close analysis of bereavement reveals adverse personal, educational, and social impacts in children below 12 years of age, but different treatment approaches are helpful in mitigating them when applied well.
Overview of Bereavement in Children
Death is a common occurrence in the society, which means that bereavement in children is equally common. In most cases, every child has one or more siblings and the loss of any sibling results in severe effects of bereavement (Brits et al., 2014). Furthermore, the death of one or both parents can be equally traumatizing to cause adverse effects in children. Every year, at least 50,000 American children die, which translates to a death rate of 58.85 per 100,000 for infants to 14-year-old children (Fletcher et al., 2013). The mortality rate comprises 65.5 per 100,000 for infants to people below the age of 24 years (Fletcher et al., 2013). This fact reveals that the death of children and youths is high but greater in individuals with a lower age. This means that most of the deaths rob young children below the age of 12 years their close associates and age mates, which may have grave consequences during the period of bereavement.
In the United Kingdom (UK) and many other countries of the world, the death of parents is also one of the leading causes of bereavement and its effects in children. Five percent of children in the UK are bereaved of at least one parent before reaching their 16th birthday (Ellis, Dowrick, & Lloyd-Williams, 2013). Furthermore, these figures are underinflated, which means that more children experience bereavement than those that are officially declared and documented. Ellis, Dowrick, and Lloyd-Williams (2013) indicate that more than 24,000 children in the UK experience the death of at least one parent every year, but this data is underinflated. Li et al. (2014) explain that when the number of deaths of siblings is added to parental deaths, then it is evident that child bereavement is a serious commonly occurring problem in the society because of the high number of deaths of children's loved ones. This occurrence is similar in the United States (US) and the world as a whole.
Socioeconomic status and the causes of death have a significant influence on the prevalence of bereavement in children. Bolton et al. (2016) conducted a research study to examine mental disorders and the use of various treatment strategies in bereaved siblings in the general population. This study revealed significant findings on the effects of socioeconomic factors and causes of death on the prevalence of child bereavement. In7,243 siblings recruited in the survey who compromised of an almost equal number of sisters and brothers, 43% (3,102) were in the lowest income quintile (Bolton et al., 2016). This statistics shows that children from homes stricken with high levels of poverty are vulnerable to losing at least one of the beloved siblings and hence are vulnerable to being bereaved. Ellis, Dowrick, and Lloyd-Williams (2013) reiterate that poverty is a risk for encountering childhood death or being bereaved in childhood. In their study, Bolton et al. (2016) found that more than 62% of the children died when they were five or fewer years of age, with accidents being the leading cause of death. The occurrence of diseases was also a significant cause of death hence bereavement in children below the age of 12 years (Bolton et al., 2016). These problems are much rampant in people with low socioeconomic status and are the major causes of bereavement in children.
Impact of Childhood Bereavement
The death of either a parent or a sibling constitutes a potentially traumatizing event, which affects children in many different ways. Grieving has a negative impact on childhood happiness because death is associated with sorrow. Moor and Graaf (2016) conducted a research study to investigate both the short and long-term effects of a sibling or parental death on happiness in children. They found that losing at least one parent at a young age increases the probability of feeling unhappy, mainly when the death happened not more than five years ago. Additionally, the findings demonstrated that the relationship between being unhappy and the death of a parent is stronger (Moor & Graaf, 2016). This occurrence indicates that children find it difficult to overcome the death of their parents or siblings and the sorrow that comes with this death has an immense negative effect on their morale.
Death is a stressful event associated with a series of negative consequences. According to Berg et al. (2014), the loss of a parent during childhood results in stressful events that are associated with mental health problems, mortality, and health risk behaviors. Bereavement is conceptualized as a significant stressor, which produces two types of demands in the lives of children. The first are the loss oriented demands that include experiencing negative emotions related to grief and demands associated with restoration, which are life changes as consequences of death (Fletcher et al., 2013). The stress that bereaved children experience after losing at least one of their loved ones exposes them to emotional problems. For instance, these children can display feelings of depression and loneliness (Rosenberg et al., 2015). Stress may prompt such children to indulge in risky health behaviors such as substance abuse with the aim of coping with the challenging moments (Berg et al., 2014). As a result, the children may display ill health both mentally and physically.
Other problems that can increase the likelihood of developing mental health issues may include the effects of death on their lives. Once a parent dies, children may lack a source of livelihood including the basic needs and emotional support from their parents. Fletcher et al., (2013) explain that children in grief experience high levels of resource reduction in the family, which affects the supply of basic needs. For instance, the loss of a sibling or a parent can cost the family a huge fortune, which may leave it impoverished and unable to immediately return to the pre-bereavement status in the shortest time possible. Additionally, the death of a parent means that the source of family income will be lost (Rosenberg et al., 2015). This results in diminished material resources and a sibling or parental guidance for healthy living (Fletcheret al., 2013). Such problems have a great negative impact on children in grief.
Bereavement increases the likelihood of developing childhood depression and other mental health disorders. Ellis, Dowrick, and Lloyd-Williams (2013) explain that childhood bereavement is closely associated with an increased risk of emotional instability and self-isolation from the society, which is a risk factor for depression. Losing a sibling is associated with a more than seven-fold increase in clinician-diagnosed childhood depression in children below 13 years compared to the rates before bereavement (Bolton et al., 2016). The mental health effects of childhood bereavement vary with the age, at which an individual encounters this experience. In the study, Bolton et al. (2016) found that children in their early lives are most vulnerable to childhood depression compared with their colleagues of advanced ages. This phenomenon is a reality because young children depend most on their parents as they lack independence in their lives. The loss of a parent that provides much support is traumatic due to the abrupt end of the support associated with the dead.
Furthermore, the unhealthy effects of bereavement increase the likelihood of dying in children. In their research, Li et al. (2014) found that parental death in childhood and adolescence increases the risk of all-cause mortality irrespective of both the age and gender of children. The risk of mortality is high because of confounding factors associated with parental death and stress of losing a parent. Most bereaved children suffer from the lack of materials and health care resources that were initially being provided by their dead parents (Li et al., 2014). This increases the likelihood of children not acquiring basic needs, development of severe health conditions, and inability to acquire the necessary health services not only in disease prevention but also treatment. Moreover, bereavement increases the risk of substance abuse and mental health problems that, in turn, increase the risk for mortality (Rosenberg et al., 2015). Death is an inevitable consequence of having such problems.
Bereaved children experience educational problems associated with their grieving state as well as the effects of lacking parental or sibling influence. The loss of a parent has an adverse impact on household income, which, in turn, affects the level of academic performance in children (Berg et al, 2014). Due to the death of at least one parent, household income dwindles predisposing children to the lack of significant resources for educational purposes. As a result, the children may display a huge drop in their level of academic performance (Schoenfelder et al., 2015). Additionally, bereaved children are susceptible to engage in unhealthy behaviors such as crimes, all of which are associated with poor performance in school (Berg et al., 2014). Such children may also suffer from the effects of substance abuse or stressful life conditions they experience after the death of their parent, which increases the likelihood of developing mental health problems. These problems are detrimental to their academic progress.
Along with that, bereavement increases dropout rates in children. In their study, Amato and Anthony (2014) evaluated the dropout rates in 21,387 kindergarten students and followed them throughout their either grade. They found that children who had lost at least one parent registered high levels of school dropouts. These results were similar to those of Fletcher et al. (2013) who found that children who had lost their parents were more likely to drop out of school mainly due to the lack of both parental support and motivation. Dropping out of school is associated with the absence of academic resources, poor academic performance, and the lack of parental motivation (Berg et al., 2014). Fletcher et al. (2013) also found that 0.23 to 0.52 years of schooling in children are lost due to the death of one or both parents. Therefore, it is evident that children under the age of 12 years and beyond suffer from many educational challenges once they are bereaved, which imply effects that are caused by grief and the consequences of lacking a parent.
Bereaved children face many social challenges, especially those that involve interacting with their colleagues in the society. Rosenberg et al. (2015) conducted a study to examine the prevalence of risky health behaviors, social support, and psychological distress in bereaved siblings. They found that 62% of the bereaved siblings displayed depression, anxiety, and abuse of illicit substances. Poor communication and inability to make and retain friends were other major challenges that had a negative impact on their social lives (Rosenberg et al., 2015). These behavioral problems emanate not only from the stress of losing a parent or sibling but also from the lack of guidance and support.
Other studies have also found social challenges in bereaved children, which further illustrate the social problems of bereavement. For example, in their study, Hamdan et al. (2012) examined the occurrence of high-risk behaviors in children and the youths over a period of three years. Grieving children who had lost at least one of their beloved ones presented with one or more social functioning impairments (Hamdan et al., 2012). According to Barron, Dyregrov, Abdallah and Jindal-Snape (2015), young children are more repetitive in their play, which is sometimes destructive and irritable. However, the presence and influence of parents in the control of this behavior helps moderate bad social behaviors in children. Once a parent dies, this moderation disappears resulting in the display of abnormal social behaviors. Some of the high-risk behaviors are associated with parental psychopathologic factors that comprise of anti-social personality disorder that increases the risk for psychiatric impairment, violent behavior, and depression (Hamdan et al., 2012). Having such problems makes it hard for this group of people to make and retain friends.
Bereavement Treatment Approaches
Complicated Grief Therapy (CGT)
CGT is a new psychotherapeutic model that purposes at mitigation and elimination of symptoms of complicated grief in children. Wetherell (2012) explains that the therapy is drawn from the theory of attachment and has its roots in cognitive behavioral therapy (CBT) as well as the renowned interpersonal therapy (IPT); it includes techniques of prolonged exposure whereby the victim of grief tells the story of death among others. The attachment theory holds that human beings are programmed to seek, form, and sustain close relationships, and in this case, it involves the child and the deceased having links. IPT techniques focus on restoration by helping the client establish both relationships and connection with life goals while CBT targets behavioral avoidance and painful, intrusive memories in to correct loss-related processes (Wetherell, 2012). This approach is effective in dealing with the stress associated with grief as well as its symptoms.
Grief-Help Therapy (CHT)
In children, this therapy relies on the cognitive behavioral framework to postulate grief symptoms that persist and worsen to the point of impairment for individuals suffering from prolonged grief disorder (PGD). Children with PGD experience a sense of purposelessness, preoccupation with thoughts of loss, bitterness, separation distress, and difficulty in accepting and moving on with personal life without the deceased (Spuij et al., 2013). CHT is governed by three processes that include acknowledging the irreversibility of losing the loved one, propensity towards both the fear and avoidance of internal and external factors that remind death and propensity to engage in negative thinking (Spuij et al., 2013). This form of therapy targets these three processes with the use of CBT interventions.
This approach aims at treating bereaved children for grieving challenges and the treatment of posttraumatic stress disorder (PTSD), which may be associated with the death of the loved one. Children with PGD suffer from social, emotional, and practical challenges, but supportive counseling can relieve them from the emotional burden (Spuij et al., 2013). In this therapy, children are motivated to express both their feelings and thoughts about the loss and the nature of the relationship with the deceased. It is only through the expression of thoughts and feelings that children can learn to cope with the loss. Supportive counseling is divided into three sessions where the first identifies difficulties while the second entails the review of identified themes in the first stage (Spuij et al., 2013). The last step involves expressing the feelings and losses to bring about normalcy.
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Effective Treatment Modality
CBT is the most effective treatment modality applied in bereaved children. A close analysis of the three treatment approaches reveals how CBT forms the framework for their success. This modality relies on the three modalities that govern the CHT. According to Spuij, van Londen-Huiberts and Boelen (2013), the initial step of this therapy aims at promoting child integration of the loss with the existing knowledge before different interventions are applied including imagery exposure such as telling a story, visiting the scene of death, and writing a letter to the dead. Secondly, the negative cognitions are altered by the use of cognitive restructuring techniques that include Socratic questioning and behavioral experiments. Finally, the child under the guidance of the therapist replaces the maladaptive avoidance behaviors with better ways of coping (Spuij, van Londen-Huiberts, & Boelen, 2013). This modality is effective in treating PGD and PTSD in children under the age of 12 years.
Child bereavement is a common phenomenon that has adverse impacts on the lives of children despite the presence of effective treatment strategies. Bereavement predisposes children to feelings of unhappiness during and after the time of the death of their parent or sibling. Additionally, they face mental health challenges due to stressful emotions. These problems predispose them to unhealthy behaviors such as substance abuse. The lack of basic needs and other resources initially provided by the deceased increases the distress, and together with mental health problems such as depression, the risk for mortality increases. Educationally, bereavement is associated with reduced academic performance and increased dropout rates. Along with that, bereaved children face serious social challenges that emanate from poor coping techniques and stresses from the loss of their close acquaintance. However, CHT, CGT and supportive counseling can be implemented to eliminate some of these effects and enhance effective coping. The most effective treatment modality applied in all of these approaches is CBT. Understanding bereavement and its effects in young children is important in laying down a therapeutic framework, through which the treatment approaches can be implemented.