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Grief in adults What is a Traumatic Event? Involves actual or threatened death or serious injury, or a threat to the person’s physical integrity Involves.

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Presentation on theme: "Grief in adults What is a Traumatic Event? Involves actual or threatened death or serious injury, or a threat to the person’s physical integrity Involves."— Presentation transcript:

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3 Grief in adults

4 What is a Traumatic Event? Involves actual or threatened death or serious injury, or a threat to the person’s physical integrity Involves actual or threatened death or serious injury, or a threat to the person’s physical integrity Involves feelings of intense fear, helplessness or horror (children may show disorganized or agitated behavior instead) Involves feelings of intense fear, helplessness or horror (children may show disorganized or agitated behavior instead)

5 Types of Traumas Natural disasters Natural disasters Kidnapping Kidnapping School violence School violence Community Violence Community Violence Terrorism/War Terrorism/War Homicide Homicide Physical Abuse Physical Abuse Sexual Abuse Sexual Abuse Domestic violence Domestic violence Medical procedures Medical procedures Victim of crime Victim of crime Accidents Accidents Suicide of loved one Suicide of loved one Extreme Neglect Extreme Neglect

6 How Common are Traumatic Experiences? 69% of the general U.S. population report exposure to one or more life-threatening traumatic events 69% of the general U.S. population report exposure to one or more life-threatening traumatic events 14 to 43% of children report having experienced a traumatic event prior to to 43% of children report having experienced a traumatic event prior to 18. Up to 91% of African American youth in urban settings report violence exposure Up to 91% of African American youth in urban settings report violence exposure 10% of children under 5 witnessed shooting/stabbing 10% of children under 5 witnessed shooting/stabbing

7 What Makes a Trauma a Trauma? Previous trauma exposure Previous trauma exposure Severity of trauma Severity of trauma Extent of exposure Extent of exposure Proximity of trauma Proximity of trauma Understanding and personal significance Understanding and personal significance Interpersonal violence Interpersonal violence Parent distress, parent psychopathology Parent distress, parent psychopathology Separation from caregiver Separation from caregiver Previous psychological functioning Previous psychological functioning Genetic predisposition Genetic predisposition Lack of material/social resources Lack of material/social resources

8 Grief cycle Shock and denial Shock and denial Bargaining Bargaining Depression Depression acceptance acceptance

9 Reaction to grief Physical Physical Psychological Psychological

10 Physical symptoms GI symptoms GI symptoms CNS symptoms CNS symptoms Pain Pain

11 Psychological symptoms Emotional Emotional Cognitive Cognitive Behavioral Behavioral

12 Emotional symptoms Anxiety Anxiety Anger Anger Depression Depression Guilt feeling Guilt feeling

13 Cognitive Symptoms Distractibility Distractibility Preoccupation Preoccupation Sense of unreality Sense of unreality helplessness helplessness

14 Behavioral symptoms Restlessness Restlessness Crying Crying Irritability Irritability Social withdrawal Social withdrawal

15 Common symptoms in depression and grief Sadness Sadness Insomnia Insomnia Decreased appetite Decreased appetite Decreased weight Decreased weight

16 Symptoms in favor of depression Worthlessness Worthlessness Hallucination Hallucination Death preoccupation Death preoccupation Guilt feeling Guilt feeling Disturbed function Disturbed function Psychomotor hypoactivity Psychomotor hypoactivity

17 Grief in children

18 Grief in Infants and Toddlers Experience a sense of “goneness” Experience a sense of “goneness” Sleep/appetite disturbance Sleep/appetite disturbance Fussy, irritable Fussy, irritable Bowel/bladder disturbances Bowel/bladder disturbances Difficult to comfort Difficult to comfort May have difficulty reattaching to new caregivers May have difficulty reattaching to new caregivers

19 Grief in Preschoolers Magical thinking (e.g., death is reversible) Magical thinking (e.g., death is reversible) Regressive behaviors Regressive behaviors Reenact death in play Reenact death in play May express desire to die as well May express desire to die as well Symptoms of grief may be inconsistent Symptoms of grief may be inconsistent Appetite/sleep disturbance Appetite/sleep disturbance

20 Grief in School Children More likely to show depression, sadness More likely to show depression, sadness May see death as something tangible May see death as something tangible Preoccupation with death Preoccupation with death Begin to understand permanency of death, but may still behave as though deceased were still alive Begin to understand permanency of death, but may still behave as though deceased were still alive May show aggression, other behavioral difficulties, concentration difficulties May show aggression, other behavioral difficulties, concentration difficulties May be anxious about wellbeing of other family members May be anxious about wellbeing of other family members Magical thinking remains prevalent Magical thinking remains prevalent

21 Tasks of Mourning Accept the reality of the loss Accept the reality of the loss Experience fully the pain of the loss Experience fully the pain of the loss Adjust to an environment and self-identity without the deceased Adjust to an environment and self-identity without the deceased Convert the relationship from one of live interactions to one of memory Convert the relationship from one of live interactions to one of memory Find meaning in the deceased’s death Find meaning in the deceased’s death Experience a continued supportive adult presence in the future Experience a continued supportive adult presence in the future

22 Helping Grieving Children Don’t be afraid to talk about the death Don’t be afraid to talk about the death Be prepared to discuss the same details over and over again Be prepared to discuss the same details over and over again Be available, nurturing, reassuring and predictable Be available, nurturing, reassuring and predictable Assist child in developing grieving rituals and in finding meaning Assist child in developing grieving rituals and in finding meaning Help others learn how to respond Help others learn how to respond

23 Talking about Death with a Young Child “Died” means person is not alive anymore. His/her body stopped working. He/she can’t breathe, walk, move, eat or do any of the things he/she could do when alive. It’s forever and he/she will never be alive again. “Died” means person is not alive anymore. His/her body stopped working. He/she can’t breathe, walk, move, eat or do any of the things he/she could do when alive. It’s forever and he/she will never be alive again. Use child’s (family’s) own belief system when discussing afterlife Use child’s (family’s) own belief system when discussing afterlife

24 Talking about Death with a Young Child Share memories and talk about the person who died when appropriate Share memories and talk about the person who died when appropriate Gently remind children ALL feelings (anger, sadness, confusion, fear, relief, guilt) are okay. Gently remind children ALL feelings (anger, sadness, confusion, fear, relief, guilt) are okay. Use reminders like “you did not cause this” or “it is not your fault.” Use reminders like “you did not cause this” or “it is not your fault.”

25 When to Refer Child for Psychiatric/Psychological Care Showing these changes for more than 3 months after trauma… Behavior/Academic problems at school Behavior/Academic problems at school Angry outbursts Angry outbursts Withdrawal from usual activities/play Withdrawal from usual activities/play Frequent nightmares, sleep disturbance Frequent nightmares, sleep disturbance Physical problems (nausea, headaches, weight gain/loss) Physical problems (nausea, headaches, weight gain/loss) Depression, hopelessness Depression, hopelessness

26 When to Refer Child for Psychiatric/Psychological Care Showing these changes for more than 3 months after trauma Intense anxiety or avoidance behavior triggered by trauma reminders Intense anxiety or avoidance behavior triggered by trauma reminders Continued worry about event (primary focus) Continued worry about event (primary focus) Failure to attend to personal hygiene Failure to attend to personal hygiene Excessive separation difficulties Excessive separation difficulties Continued trauma themes in play Continued trauma themes in play

27 When to Refer Child for Psychiatric/Psychological Care Significant ASD symptoms within first month of trauma Significant ASD symptoms within first month of trauma Unable to grieve/mourn because of trauma- related distress Unable to grieve/mourn because of trauma- related distress Inappropriate social behaviors (e.g., sexual) Inappropriate social behaviors (e.g., sexual) Unable to regulate emotions Unable to regulate emotions Strong resistance to affection/support from caregivers Strong resistance to affection/support from caregivers Dangerous behaviors to self/others Dangerous behaviors to self/others

28 سوگ در كودكان روياهاي شخص مرده روياهاي شخص مرده تقليد رفتارهاي او تقليد رفتارهاي او الگو قرار دادن و ايده آل نمودن رفتار و شخصيت او الگو قرار دادن و ايده آل نمودن رفتار و شخصيت او بازگو نمودن وقايع مرگ و مراسم و خاطرات او بازگو نمودن وقايع مرگ و مراسم و خاطرات او احساس اينكه شخص مرده همراه اوست احساس اينكه شخص مرده همراه اوست طرد كردن دوستان قديمي و جستجوي دوستان جديد. طرد كردن دوستان قديمي و جستجوي دوستان جديد. احساسات، افكار و رفتارهاي شايع در كودكان سوگوار : تماس تلفني مكرر با منزل براي چك كردن سلامت والدين تماس تلفني مكرر با منزل براي چك كردن سلامت والدين كاهش توجه و تمركز روي تكاليف درسي و فعاليتهاي روزمره كاهش توجه و تمركز روي تكاليف درسي و فعاليتهاي روزمره گريه ناگهاني در كلاس گريه ناگهاني در كلاس جستجوي اطلاعات پزشكي در مورد متوفي جستجوي اطلاعات پزشكي در مورد متوفي احساس نگراني راجع به سلامت خود و گاهي بي توجهي به آن احساس نگراني راجع به سلامت خود و گاهي بي توجهي به آن

29 سوگ در كودكان بچه ها در مراسم شركت نكنند. بچه ها در مراسم شركت نكنند. جلوي كودك راجع به مرگ صحبت نكنيم. جلوي كودك راجع به مرگ صحبت نكنيم. از صحبت راجع به مسائلي كه كودك را به گريه مي اندازد اجتناب كنيم. از صحبت راجع به مسائلي كه كودك را به گريه مي اندازد اجتناب كنيم. بچه هاي خردسال مفهوم سوگ را نمي فهمند. بچه هاي خردسال مفهوم سوگ را نمي فهمند. اگر خدا مي خواست او را از ما نمي گرفت. اگر خدا مي خواست او را از ما نمي گرفت. وقتي بزرگ شوي همه چيز را فراموش مي كني وقتي بزرگ شوي همه چيز را فراموش مي كني او به يك مسافرت طولاني رفته است. او به يك مسافرت طولاني رفته است. خدا او را از ما گرفت چون خيل خوب بود. خدا او را از ما گرفت چون خيل خوب بود. نگرش ها و برخوردهاي غلط در مواجهه با سوگ كودكان : او تو را از آسمان نگاه مي كند او تو را از آسمان نگاه مي كند او به خواب رفت و ديگر بيدار نمي شود. او به خواب رفت و ديگر بيدار نمي شود. تقصير من است كه مادرم را از دست دادم تقصير من است كه مادرم را از دست دادم بزرگترها قادرند توضيح كافي راجع به روح و مرگ به كودكان بدهند. بزرگترها قادرند توضيح كافي راجع به روح و مرگ به كودكان بدهند. سوگ بزرگترها روي كودك سوگوار تاثير ندارد. سوگ بزرگترها روي كودك سوگوار تاثير ندارد. كودكي كه فعال و پر جنب و جوش است سوگوار نيست كودكي كه فعال و پر جنب و جوش است سوگوار نيست اگر خيلي گريه كند دچار حمله و مشكل عصبي مي شود. اگر خيلي گريه كند دچار حمله و مشكل عصبي مي شود.

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