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Studies of the impact of and interaction between the sex of the deceased parent and that of the child have produced interesting but somewhat contradictory results. Kliman 81 , 82 has observed that from about age three onward, while yearning for the dead parent tends to be more overt when the opposite-sex parent dies, special anxieties may develop when the same-sex parent dies, especially if the child begins to fear that he or she must in some way become the "new daddy" or "new mommy" of the family. In clinical samples, Fast and Cain 48 found that boys who lost fathers felt threatened by and therefore tried to avoid positive feelings toward their mothers, while Arthur and Kemme 7 found that girls showed a greater tendency to idealize dead fathers.

Retrospective studies of the association between early parental loss and adult-life depression in community samples 31 and studies of women psychiatric patients 14 , 15 , 17 suggest that girls are more vulnerable than boys to parental bereavement in general and more vulnerable to loss of a father during adolescence.

Contrary to the findings cited above, however, Kaffman and Elizur 78 found few differences between boys and girls who lost a father, and although Rutter found significantly higher levels of depression in adolescent boys who lost fathers, he concluded that, in general, "there is nothing to suggest that psychiatric disorder was more related to the death of the mother than father or vice versa. As discussed throughout this report, social support is a modifying variable that can soften trauma. Unfortunately, children's primary source of support is usually the surviving parent, who also has been traumatically affected by the death of a spouse or child.

Widows, usually sad and anxious following conjugal bereavement, often express impatience and irritation with children who simultaneously have special needs.

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Rather than the atmosphere of stability and consistency necessary for a better outcome, 53 the common situation following a parental death may be considerable chaos, disorganization, and a sense of insecurity. The level of trauma associated with the loss of a parent will depend in large part on relationships within the home prior to the parental death and upon the maintenance or reestablishment of the home after the death occurs. Hilgard et al. Comparing well-adjusted subjects in the community with selected patients in a mental hospital who had suffered childhood parental losses, they identified one protective factor in father loss as being the presence of a reality-oriented, strong mother who worked and kept the home intact, instilling strength in her children both through her example and through her expectations of their performance.

Elizur and Kaffman 46 agree that in the case of paternal death, the mother's assertiveness in coping with the loss and the availability of a surrogate father figure influence the course of a child's responses in the years thereafter. Other protective factors include the presence of a mother who can use a network of support outside the home, prebereavement years spent in a home with two compatible parents who had well-defined roles so that early identifications were good, and parental attitudes that fostered independence and a tolerance for separation.

In addition to the role of the surviving parent following a death in the immediate family, it would seem that grandparents, aunts and uncles, and perhaps close family friends, could step in to assist the bereaved child. The impact of nonparent figures on the course of children's bereavement reactions has not been documented. In a controlled retrospective study of women in a community whose mothers died before they reached age 11, Birtchnell 18 found that only those who experienced poor relationships with mother replacements emerged with major psychological problems.

These women tended to manifest neurotic depressions of moderate intensity and were more prone to severe and chronic anxiety symptoms than bereaved women not characterized by such relationships. Fast and Cain 48 identified the reluctance of the bereaved child to accept discipline or punishment from the stepparent, competition between the same-sex parent and child for the stepparent, and unfavorable comparisons of the stepparent with the deceased parent as possible sources of difficulty. They speculate that women this age who have young children have fewer choices of marital partners and may make unsatisfactory compromises.

On the other hand, some of the same situations already described as difficult seem to be associated with a parent's failure to remarry. For example, it seems likely that postbereavement bed-sharing, reported by Kliman, 80 and the emotional dependency that Hilgard et al. Although it has been suggested that cultural factors, such as ethnic background, social class, and religion, play a role in determining the child's understanding of and response to loss, this is an area in which very little research has been done. Based on child interview data, Tallmer et al.

In their studies comparing bereaved kibbutz and urban children in Israel, Kaffman and Elizur 45 , 78 found that differences in child-rearing methods, family functioning style, and social setting influenced the type of problems that became prominent following paternal death. The type of death experienced—e.

Erna Furman 53 comments that there are no peaceful deaths for parents of young children, and each type of death is associated with particular anxieties; the kinds and sources of anxiety vary with the child and his situation. It is generally agreed that an anticipated death is easier for children to cope with than sudden loss—just as it is for adults—because forewarning seems to provide an opportunity to prepare at least cognitively. If a parent is ill for a prolonged period of time, however, the child often has to deal with knowledge of a series of surgical and medical interventions that may be interpreted as bodily assaults.

As discussed in Chapter 4 , suicide is generally considered the most difficult type of death to accept. For children, the suicide of a parent or sibling not only presents immediate difficulties, but is thought by many observers to result in life-long vulnerability to mental health problems. Pynoos and his colleagues , have reported on children's immediate reactions to witnessing suicide attempts and homicides. Regardless of what has been told to children, it is clear that they know fundamentally what has transpired and that they promptly institute defensive adaptive measures, including denial in fantasy and reworking of the facts in accord with stage-related concerns.

In a partially controlled study, Shepherd and Barraclough followed 36 children ages years five to seven years after the suicide of a parent and found greater psychiatric morbidity among the suicide survivors than among a comparison group. They also noted that prebereavement home life was abnormal for these subjects because of the stresses of living with a parent who was mentally ill. In fact, for a few of the children, the suicide was experienced as a relief from a previously "insupportable situation. In their assessment of 45 disturbed children four years after the suicide of one parent, Cain and Fast 34 found a broad range of psychological symptoms, including psychosomatic disorders, obesity, running away, delinquency, fetishism, lack of bowel control, character problems, and neurosis.

Compared with other childhood bereavement cases, there was a much higher incidence of psychosis 24 percent versus 9 percent.

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Common disturbed reactions among this group included a very intense sense of guilt and distortions of communication. As they often receive the message that they should not know or tell about the suicide, these children frequently are in conflict about learning and knowing in general, with resultant learning disabilities, speech inhibitions, and reality sense disturbances. Parental suicide also appears to be linked with serious long-term negative consequences.

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For example, Dorpat, 43 examining the case material of 17 adult psychiatric patients who were seen an average of 16 years after the parent's death, found guilt over the suicide, depression, morbid preoccupation with suicide, self-destructive behavior, absence of grief, and arrests of certain aspects of ego, superego, and libidinal development.

Clinical data amassed by Cain and Fast 35 on adolescents and adults whose parents committed suicide when they were children suggest that some ongoing ideas and processes in these bereaved children can cause difficulty, including direct identification with the parent in his suicidal act, conviction that they too will die by suicide, and fear of their own suicidal impulses. According to the data of Blachley et al. A review of the clinical and research data suggests that the following factors increase the risk of psychological morbidity following the death of a parent or sibling during childhood years:.

Adults often become uneasy when called upon to deal with children on topics of conception, birth, or death. Clinical and research findings suggest that parents often fail to inform their children when a loved one dies, or they do so in an inappropriate or upsetting way, thereby increasing the likelihood of further distressing youngsters who are incapable of seeking out the truth for themselves. Although there are no systematic studies assessing the safety and efficacy of different intervention strategies, psychological theory and clinical experience do suggest an approach.

When a parent is terminally ill, Erna Furman 53 recommends maintenance of personal contact between child and parent for as long as the parent is not drastically altered in appearance or in the ability to communicate with feeling. She notes that visits should not become an unbearable burden nor should they force the child to discontinue other activities.

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There is some research evidence that short-term professional ''preventive therapy" with children of fatally ill parents may also decrease the likelihood of subsequent pathology after a parent dies. In a controlled study of normal, randomly assigned children, ages , Rosenheim and Ichilov found that brief treatment 10 to 12 weekly home visits made a significant difference in terms of the anxiety level and social and scholastic adjustment of children who were anticipating parental death.

Sessions focused on the child's perception of the parent's illness and his or her reactions to it, the factual life situation at home present, past, and anticipated future , the child's feelings toward his parents, and his or her self-concept.

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An opportunity was provided for catharsis while therapists helped supply realistic perspectives about in ner and outer realities e. The most important preventive intervention may be how parents and others deal with children who have been bereaved. In the interests of helping parents to provide their children with a supportive, understanding environment, this section offers some specific suggestions based on information in the literature and on the best judgment of the committee. Providing optimal support to grieving children may be difficult, not only because the parents themselves are extremely upset, but also because they may be uncertain of what to expect from a child.

Thus, it is important that parents learn about the grieving process in children so they will know what to expect and will not become alarmed about the differences between childhood and adult grieving. Knowing that the child may ask distressing questions, such as when will there be a new parent or sibling to replace the one who was lost, may eliminate surprise and hurt.

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Such questions do not indicate a shallow attachment to the deceased, but rather the manner in which young children typically respond to loss. Children may confront strangers with news of the death to test reactions and gauge their own responses.

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Tolerance toward homosexuals Parentally bereaved subjects were more likely to experience psychotic-rather than neurotic-level depression. The End of Automobile Dependence:. Brussels Sprouts. But during its period of governance, neo-liberal New Labour left behind many ordinary Britons and the party — and many British citizens — suffers today because of this. Economic growth The extent of human progress over the past two centuries is astonishing. Political views Share of US adults. They may play "funeral or "undertaker" games for a few days following the death of a family member in order to master the situation.

Children may manifest a superficially milder reaction to the loss because of the strong defenses that protect them from becoming flooded with overwhelming emotions.

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As noted earlier, troubling emotions or behaviors emerging months or years after the death may be related to the bereavement, because children give up their attachment to the deceased much more slowly than adults usually do. Providing concrete recollections of the deceased parent or sibling may also be helpful. Most authors agree that there is preventive value in educating children about death when they are young, long before death is likely to enter their lives in an emotionally threatening way. As Reed points out, children begin asking questions about death at an early age.

They are naturally curious about such phenomena and provide adults with opportunities to intervene. Various educational tools have been suggested. Chaloner, 39 Ema Furman, 54 and Koocher 85 recommend using the death of a child's pet or other naturally occurring teaching moment to introduce the concept. Opportunities such as driving past a cemetery or coming across a dead animal while on a nature walk can also be used to provide awareness and understanding, especially that the deceased animal or person will never return.

Moreover, it will provide the child with the reassurance that death is not a topic to be avoided with adults. Other means to help children gain awareness about death include children's books see Goldreich 60 for a list and formal death education classes.