Grief and Development: Hearing the voices of the forgotten

Lyssa Dougan
October 8th, 2018
PS 320
RUNNING HEAD: GRIEF AND DEVELOPMENT

Typically, in life, humans follow a path that traces from birth to death, and while this path may

look different for each person, the timeline remains relatively the same. A person is born, finds

the joys in discovering the world--all of its love and passions-- while surviving the heartbreak of

what it means to be humans. Loss plays a large role in the heartbreaks humans inherently

experience. Eventually, there comes a time when one must lose the people who raised them.

While still incredibly heartbreaking, for most, this happens far after they have started their own,

independent adult lives. However, for some, this incredibly impactful loss comes far sooner than

planned. In the United States alone, more than two million children and adolescents under the

age of 18 experience the death of a parent (Christ, Siegel, & Christ 2002)(1). The stress caused

by the death of a parent can impact the person’s mental wellbeing, causing mental health

problems in childhood and adulthood (Sandler et. al 2010)(2), which shows the incredible level

of devastation such a loss causes. The grief experienced by people after such a loss can be

incredibly complex and difficult to understand, especially to those not going through it. All too

often, grief is viewed through the simplistic “Five stages of Death and Dying” presented by

Kübler-Ross. However, as Massat, Moses, & Ornstein (2008)(3) point out, “the stage model of

grief espoused by Kübler-Ross is flawed. There is no evidence base to support that there are, in

fact, only five ways in a prescribed sequence that people cope with the death of a loved one.”

This prescribed idea of what grief “looks like” often causes conflict, especially when children

and adolescents are involved. Children and adolescents have ways of grieving, and “failing to

appreciate the differences...is a common source of misunderstanding between children,

adolescents, parents, and professionals” (Christ, et. al 2002). Given the drastic effects that

parental loss plays on the children and adolescent’s physical and mental well-being, it is

imperative that their grief is understood. This paper examines how exactly development plays a
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role in grief experiences, the role of gender in grief, the risk and protective factors for the

development of mental health issues after parental loss, before offering ideas on the treatment of

grief.

Grief

There are many different ways of defining grief, but the very basic definition can be traced down

to “a physical, emotional, and cognitive response to loss” (D'Antonio 2011). D’Antonio points

out that this is a definition of “normal grief”, acknowledging that there are many different types

of grief in which children and adolescents might experience. Normal grief typically is

characterized by a dynamic process that switches between focusing on the grief and avoiding it.

Restoration processes that focus on adjusting to the new way of life are also involved (Massat et.

al 2008). However, not everyone experiences normal grief. A second type, going by many

different names such as “acute”, “unresolved”, or “complicated” grief, is characterized by

somatic distress, disruption, apathy, insomnia (Johnson & Rosenblatt 1981). Unresolved grief

prolongs the grief process, often intentisfying it or obstructing the child or adolescent from fully

grieving their loved one (Lenhardt & McCourt 2000). This type of grief is correlated with

functional impairment, suicidal ideation, and increased depressive and posttraumatic stress

disorder symptoms (Sandler et. al 2010). Finally, there is maturation grief, which many children

and adolescents experience. Maturation grief is the experience of intense periods of grief that are

not a continuation of earlier grieving (Johnson & Rosenblatt 1981). Maturation grief is less

intense or pervasive than unresolved grief and often occurs with specific events or realizations

that relate in some way to the earlier loss (Johnson and Rosenblatt 1981). Most of the paper will

focus on the manifestations of normal grief, through the developmental lens. However, the risk
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and protective factors related to unresolved grief and mental health issues will be discussed later

on.

Development

The Oxford English Dictionary defines development as “the gradual growth of something so that

it becomes more advanced, stronger, etc”.

Age Differences

The age in which children and adolescents experience “grief” is highly contested, with

some arguing that adolescence must be over before one can truly “grieve” the loss of someone

close(D’Antonio 2011). However, studies have found that not only do children grieve, but that

this grief manifests different Based on the developmental stage the child or adolescent is in.

Grief is also constantly influenced by factors like age, culture, and previous exposure to loss

(D’Antonio 2011). The assumption that children or adolescents do not grieve stems from the fact

they experience shorter episodes in comparison to adults, and often return to normal activities far

sooner (Christ et. al 2002). This problematic assumption may lead to grief getting ignored or left

undealt with, which, as explained before, can have drastic and lasting mental health effects.

Understanding how grief manifests differently at each age level is vital in ensuring that children

and adolescents are given the proper attention they require for continue healthy development.

Infant. While many have claimed that infants are incapable of grief, studies theorize that

around six to eight months of age, when the infants master object permanence, they become

capable of grief (D’Antonio 2011). For infants, grief manifests through protest--otherwise

known as crying. After repeated protests with no response from the caregiver and no return,

despair develops, and eventually the child becomes detached from the world and other people

(D’Antonio 2011). Infants are described as experiencing intense feelings of abandonment, which
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not only causes extraordinary despair in the child, but may result in the disruption of their ability

to form healthy attachments to others. After experiencing detachment, these children are not

readily able to re-attach to subsequent caregivers (D’Antonio 2011). Finally, D’Antonio (2011)

explains that there have been cases in which an infant's’ grief reaction was so extreme it became

life-threatening, because the child demonstrated failure to grow and thrive.

Toddler and Preschooler. Children in this age group respond to the physical changes in

the environments and the feelings in those around them, but they have not developed a concept

of what death is (Massat et al 2008). This does not mean the child does not grieve, but it means

that their understanding behind that grief is drastically different than children just a few years

older than them. Children of this age may understand death as a person “leaving from a specific

location” and think that their return is imminent (Massat et. al 2008). They also may believe that

their bad behavior caused the death of their loved one and begin blaming themselves for the loss

(Massat et al 2008). In toddlers and preschoolers, grief manifests itself through regression, such

as thumb sucking and toilet accidents (D'Antonio 2011). These regressions may be due to the

changes in the sleep patterns of the surviving family/caregiver (Massat et. al 2008). Children

may also be cranky, display separation anxiety, clinginess, and may tantrum more than normal.

Fear of the dark and sleep disturbances have often been reported as well (Massat et al 2008,

D’Antonio 2011). Often children this age do not have the verbal language to express how they

are feeling, so the grief often comes out in physical displays. Furthermore, preschoolers, who can

verbally express they know their loved one is dead, may immediately contradict themselves in

the next sentence, because they lack the understanding that death is irreversible, the deceased is

non-functional, and death is universal (D’Antonio 2011). A child in this age group may also ask

for a “replacement parent” (D’Antonio 2011), which may seem cruel to other adults and
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caregivers, but is simply their way of understanding death. Nothing is inherently wrong with this,

but this often causes conflict and upset in the surviving caregiver.

School Age. Unlike toddlers and preschoolers, school aged children have the language

that allows them to communicate more effectively to their surviving caregivers. Despite this

access to language, they still experience psychosomatic symptoms of illness, separation anxiety,

and may worry that this could happen to them and their surviving loved ones (Massat et al 2008,

D’Antonio 2011). School-agers may continue to believe that death can be reversible and avoided

(D’Antonio 2011). Children, while more able to understand death at this age, still struggle with

fully forming the concept. At this age, children depend heavily on the surviving caregiver and

attempt to find a place like “heaven” for the deceased one to “go” (D’Antonio 2011). D’Antonio

(2011) explains further that children also “may believe that death is contagious or that the

deceased may come back as a ghost or monster”. This again shows the fact that school aged

children still do not have a fully developed sense of death, often thinking about the deceased as

“able to come back”--whether in monster form or not. However, by age nine, they will begin to

understand that death is not only unavoidable but it not a punishment, though they may continue

to be confused about the cause (Massat et al 2008). They also may hold onto the belief that they

themselves are personally immortal. By the time that school-aged children reach age twelve, they

may be able to incorporate their own cultural and spiritual beliefs into their grief, which allows

them to have heightened understanding of the emotion around them. This heightened awareness

allows them to comfort others (Massat et al 2008).

Adolescence. Adolescence, an already incredibly complicated time, is only complicated

further by the loss of a loved one--especially a parent. In fact, researchers have often referred to

adolescents as “the forgotten ones” when it comes to studying the impacts of grief, due to the
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fact that adolescent grief is often lumped in with either childhood grief manifestations or adult

grief manifestations (Lenhardt & McCourt 2000). Adolescent grief is distinctly different from

both childhood grief and adult grief, which is why it is vital that to understand the role that

development plays on grief. Adolescents are directly affected by their development, as often,

their developmental tasks clash with the increased need for assistance after the loss of a caregiver

(Christ et al, 2002). Adolescents often withdraw emotionally from their parents in order to

achieve emotional independence and be accepted by peers (Christ et al, 2002). However, when

the parent/caregiver dies, the need for help increases, meaning that the adolescent is unable to the

goals of adolescence. Later on, this may pull the adolescent in contradictory directions. A part of

them may want to leave too early, without resolving their grief, in order to avoid the pain. Other

adolescents may feel burdened by the obligations placed on the shoulders by the surviving parent

and may not leave home at all. Adolescents in the midst of grief may be reluctant to immerse

themselves in grief and may appear eager to return to school (Christ et al 2002). This reluctance

of acknowledging their grief may contribute to why their grief is lumped in with other groups

and why adults may show a lack of response to adolescent grief (Lenhardt & McCourt 2000).

Interestingly, adolescents who seem more composed about the loss of their parent or caregiver

may be at a greater risk for experiencing unresolved grief (Lenhardt & McCourt 2000). Further

manifestations of adolescent grief are characterized by excessive withdrawal, irritability, and

perfectionism (Massat et. al 2008). Adolescents are more capable of mature and thoughtful

reactions to the death of a loved one, and may also struggle with the existentialist questions they

are now faced with. On the opposite spectrum, they also may understand the inevitability of

death, but self-perceived grandiosity may compel them to engage in behaviors that are high-risk

and cheat death (D’Antonio 2011). Further, because of the complicated nature of grief, in
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combination with the complexity of adolescents, people in this age group are more at risk for

problems with eating, drinking, depression, cutting, loss of interest in friends/activities, and may

experience a decline in grades (Massatt et, al 2008)

Gender Differences

Development, as well as gender impacts the way that one grieves and what is considered

“acceptable” for each person.

Males. For men, the stereotyped idea is that they remain stoic, and research shows that

this idea seems to manifest in real life. According to Lenhardt & McCourt (2000), “men

frequently take on instrumental roles in response to grief”. Essentially, what they are saying is

that men grieve in very quiet ways. They let their heartbreak show less, focusing on what can be

done. Further, when looking at how society reacts to men who do express their grief more

openly, Lenhardt & McCourt (2000) found that “fictional male grievers who grieved more

expressively were rated more negatively by the students than were the female grievers who were

described as grieving expressively”. This response reinforces the idea that men should not show

their emotions, which made lead to young children/adolescents inhibiting their feelings and

increasing their risk for unresolved grief and mental health side effects.

Females. Lenhardt & McCourt (2000) report, “females engage in more expressive grief”,

meaning that their grief is more public, that they do not inhibit as many feelings as their male

counterparts. In comparison to males, females are in a much better position when it comes to

allowing their feelings to be heard. However, studies still show that young women are

significantly more at risk for mental health side effects. A recent study found that grieving girls

are more likely to have fears of abandonment that lead to higher emotional sensitivity to the loss

of an attachment figure, which may lead to an increased risk of mental health side effects ( Little,
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Sandler, Wolchik, Tein, & Ayers 2009). Fears of abandonment were linked to higher levels of

depression and anxiety and girls who reported higher levels of interpersonal loss and conflict

were also at risk for depressive and anxiety symptoms (Little et al, 2009). In simple terms, girls

not only report that they feel the loss more intensely, but also have a higher risk for mental health

effects and unresolved grief.

Risk and Protective Factors for Psychological Disorders

Because of the devastating effect that parental loss has on children and adolescents, they are

increasingly at risk for subsequent psychological problems. However, there are several factors

that play into whether a child will develop a mental health issue as a result. According to Christ

et. al (2002), “adaptation and recovery are moderated by the presence of additional stressors and

by the balance between risk and protective factors.

Risk Factors. Christ et al (2002) describes in their study several different risk factors that

increase the likelihood of the development of psychological problems later on in life. According

to Christ et al (2002), if a child or adolescent is exposed to concurrent stressful life events, the

risk increases, as well as having a negative and unsupportive relationship with the surviving

caregiver. If the child/adolescent is feeling unsupported in their grief, it makes the grief that

much harder to process and deal with. Further, if the child or adolescent had a poor relationship

with the deceased, low self-esteem, and external locus of control. Pre-existing mental health

problems also play a role, whether in the adolescent/child or the surviving caregiver. If the

circumstances of the death are violent or traumatic, the child as more at risk. And finally, if the

child is younger than six years old, or between the ages of twelve and fourteen, the risk increases

for them.
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Protective Factors. While losing a loved one certainly increases the risk for

psychological issues arising, Christ et al (2002) emphasizes that the certain protective factors do

exist to help decrease the risk. Their studies show that having a warm relationship with the

surviving caretaker that is characterized by open communication, warmth, and positive

experiences is vital, as it allows the grieving child/adolescent to feel supported. The surviving

caretakers ability to sustain parenting competence is important as well, as to not place too much

pressure on the child/adolescent. Acceptance from peers and other adults, higher socioeconomic

status, internal locus of control, and religiosity also protect the griever from mental health side

effects. Intellectual and social competence, as well as having the opportunity to talk about the

loss while having the emotions validated play an important role (Christ et al, 2002).

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Treating Grief/Psychological Disorders

Parents and Adults. Parents and adults play one of the most important roles in helping

the child grieve and cope with their grief. Through their guidance and acceptance, the child and

adolescent is able to process their grief and thus at less risk for psychological disorders later on.

Lenhardt & McCourt (2000) suggest acknowledge the pain and grief of the child and adolescent

can be helpful, as well as having them journal or create memory books. Through journaling, the

griever is given the space to think about and explore themes related to death and loss, thus

allowing them to process their grief more. The memory book provides the griever with physical

objects that connect them to the deceased and encourages sharing stories about their loved one.

Teaching relaxation techniques can promote feelings of peace and well being and allow the

alleviation of stress (Lenhardt & McCourt, 2000). D’Antonio (2011) suggests that parents focus

on different things depending on the developmental stage of the child. Infants are in need of

abundant love and affection, with a lot of sensorimotor stimulation. Parents should not be
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concerned about spoiling. This love in combination with consistent feedings, bathing, and

napping schedules help the infant through the grieving process (D’Antonio 2011). For children

younger than five, they need a constant and consistent caring presence from their surviving

caregiver, which can be difficult given the caregiver’s own grief. However, supporting the child

through their grief and helping them remain close to the surviving caregiver is extremely helpful

(D’Antonio, 2011). Further, encouraging the expression of their feelings through imaginary play

and creative means can be an important intervention (D’Antonio 2011), as it allows the child

process their own feelings through their available means of expression. While they may not have

the language to talk about how they feel, drawing a picture may help them alleviate that grief.

Parents should also reassure the child and adolescent, especially children, that others in their will

not die as well (D’Antonio 2011), as often this is a fear the child harbors. Using age-appropriate

literature is another excellent intervention for both children and adolescents because they can

connect their own feelings to characters in the story, as well as provide a guide for parents

(D’Antonio 2011). For adolescents, the book A Monster Calls by Patrick Ness may be a

wonderful place to start. Finally, parents need to simply allow their child to grieve and encourage

the continued bond with the deceased (Massatt et al, 2008). Giving the child or adolescent this

space ensures that their grief is acknowledged and validated, instead of ignored or put off.

Support Groups. Another way in which to help the child or adolescent cope with their

loss is through the use of support groups. As Christ et al (2002) explained, one of “the central

tasks in resolving grief is maintaining a social network in the grieving process”. Support groups

provide this outlet, both allowing for the child or adolescent to get the social acceptance they are

searching for while also being able to process their grief. Lenhardt & McCourt (2000) further

explains that “grief groups can normalize adolescents experiences, because it would allow them
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to feel less isolated from their peers. It provides them with a collaborative opportunity to

continue the developmental tasks of mourning”. These grief groups should occur with peers in

familiar contexts, such as school, because adolescents and children have shown to prefer that

(Lenhardt & McCourt, 2000). To further this point, Massat et al (2008) explains that support

groups normalize the grief process and make it into a part of the life cycle. It also allows for

adults to assist with expression of loss and help with recovery behaviors. Ultimately, having that

social backing can be extraordinarily helpful and allow for grieving children and adolescents to

truly process their own feelings.

Family Bereavement Program. Family bereavement programs (FBP) have also been

shown to help reduce the risk of psychological problems. FBP is a “14-session program designed

to promote resilient outcomes of parentally bereaved youth by strengthening family-and-child-

level variables that have been shown to relate to the multiple adaptive outcomes after parental

death” (Sandler et al 2010). The theory behind these programs was that by changing the

resilience resources, FBP would improve outcomes and reduce mental health problems,

developmental difficulties, and reduce unresolved grief (Sandler et al 2010). Studies have shown

that FBP does help reduce unresolved grief responses of parentally bereaved youths over a six

year period, and has important long-term and short-term effects to reduce unresolved grief

(Sandler et al 2010).

Conclusion

Development plays a clear and vital role on the way that children and adolescents process and

cope with their grief. Gender also plays a role, often increasing the risk for psychological issues

in young girls. Understanding the risk factors for grievers in this time period helps lead to

effective treatments that can be implemented by parents or adults in the community alike.
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However, for the best outcome for children and adolescents, adults must intervene and help them

process their grief, rather than inhibiting it. For many in the United States, this unfortunate

circumstance is their reality and all must work together to help them along this rocky path.
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D'Antonio, J. (2011). Grief and loss of a caregiver in children: A developmental perspective.

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