1. Helping Children Cope with Grief Cope with Grief and Loss Presented by Christy Harpold, LSW Susan Nichter, LSW February 8 and 9, 2007

2. What we hope you will learn!   What is grief   Common behaviors of a grieving child including the physical, behavioral, emotional, academic, social, and spiritual responses   Interventions for adults and children   When is it time to get help

3. Grief is the intense emotional reaction to a loss Feelings of grief can occur when there is a:  Loss in the environment  Loss related to skills and abilities  Loss of external objects  Loss of relationships  Loss of self

4. Common Responses Physical Physical Behavioral Behavioral Emotional Emotional Academic Academic Social Social Spiritual Spiritual

5. Common Physical Responses Stomachaches, headaches, heartaches Stomachaches, headaches, heartaches Frequent accidents or injuries Frequent accidents or injuries Sleep disturbances Sleep disturbances Loss of appetite or increased eating Loss of appetite or increased eating Low energy, weakness Low energy, weakness Increased illnesses and infections Rapid heart beat Acne New habits or regression in behavior Increased psychosomatic complaints

6. Common Behavioral Responses Disruptive behaviors Disruptive behaviors Aggressive behaviors Aggressive behaviors Non-compliance Non-compliance Increase in risk taking Increase in risk taking “Hyperactive – like” behavior “Hyperactive – like” behavior Withdrawal Withdrawal Regressive behaviors Regressive behaviors Lying Separation anxiety Refusal to return to school or daycare Rage and anger High need for attention A need to check in on other loved ones

7. Common Emotional Responses Insecurity Insecurity Concern about being treated differently Concern about being treated differently “I don’t care” attitude “I don’t care” attitude Depression Depression Overly sensitive, frequently tearful Overly sensitive, frequently tearful Mood swings Mood swings Trouble concentrating Trouble concentrating Nightmares Nightmares Irritable Appears unaffected by the loss Suicidal thoughts or ideations Increase in fears Guilt, confusion, regret, anger Withdrawn or spending a lot of time alone

8. Common Academic Responses Inability to focus Inability to focus Decline in grades Decline in grades Incomplete work, or poor quality Incomplete work, or poor quality Increase in absences Increase in absences Over achievement, trying to be perfect Over achievement, trying to be perfect Inattentiveness Daydreaming Increase in behavior problems at school Lack of interest

9. Common Social Responses Withdrawal from friends Withdrawal from friends Withdrawal from activities and sports Withdrawal from activities and sports Use of drugs or alcohol Use of drugs or alcohol Changes in relationships with peers Changes in relationships with peers Change in family roles Stealing, shoplifting Difficulty being in social situations that were once comfortable Wanting to be physically close to safe adults

10. Common Spiritual Responses Anger at God Anger at God Questions of “Why me?” or “Why now?” Questions of “Why me?” or “Why now?” Questions of the meaning of life Questions of the meaning of life Confusion about what happens after death Confusion about what happens after death Doubting or questioning previous beliefs Sense of despair about the future Change in values, questioning of what is important

11. Developmental Understandings of Grief and Loss AgeUnderstanding Common Behaviors 0-2 Cannot understand death/loss. All he/she knows is that someone who cared for him/her is no longer present Needing to be held, sleep problems, stomach problems, separation anxiety, crying 3-5 “Magical thinking” leads them to believe that they somehow caused the loss, or somehow can bring the person back. They will repeatedly ask questions about the loss Regression in behavior, confusion, concerns about their own safety 6-10 If loss is due to a death, they begin to suspect that they might die. Develop interest in causes of the loss. Loss is viewed as final and inevitable. Start asking for reasons and connect what is happening to others may happen to them Anger, difficulty in paying attention and concentrating, not completing schoolwork, withdrawal 11-14 Comprehend loss as final and unavoidable. May start to show concern for future and impact on others Anger, risk-taking, lack of concentration, unpredictable ups and downs or moodiness 15-18 Essentially adult views of loss. Withdrawal for parents, pushing limits or rules, inability to focus, increased risk-taking, wanting to spend lots of time with friends

12. Important things to remember:   Children feel the pain of loss—but do not have the coping skills that adults have developed   Children often express their feelings of grief through behavior   Grieving may not “show” on the outside—the child may hide his/her sadness, deny the reality or seem unaffected   Children’s grief can be cyclical. They can not tolerate long periods of sadness.   Each child’s grief experience is unique

13. Many factors can affect the grief response of the child, including: Gender Age—Emotional and developmental Religious and ethnic customs Relationship with the person that died or involved with the loss Prior grief experiences Circumstances of the loss Support available Status of “unfinished business” Physical and mental health Personal resilience Ability to cope with the stress

14. Children experience many different thoughts and feelings when they are grieving, including: Shock and denial Disorganization and panic feelings such as scared, insecure, confused or overwhelmed Explosive emotions, such as rage, blame, terror, and jealousy Guilt Sadness Acceptance

15. Grieving children must complete four tasks for recovery. The tasks are: Acknowledging the reality of loss; Experiencing the feelings of grief and confronting the pain of loss; Adjusting to a way of life without the person who died, the lost object or the change in the family Re-entering life and becoming involved with others Grief is a natural process occurring for an unspecified period of time.

16. Words and Actions to Avoid

17. DO NOT suggest that the child has grieved DO NOT suggest that the child has grieved long enough or indicate that the child should get over it long enough or indicate that the child should get over it DO NOT act as if nothing happened DO NOT act as if nothing happened DO NOT tell a child things that she /he will later need to unlearn DO NOT tell a child things that she /he will later need to unlearn DO NOT force them to go to the funeral if they adamantly refuse to go or deny them the opportunity to go to the funeral home for the visitation or funeral DO NOT force them to go to the funeral if they adamantly refuse to go or deny them the opportunity to go to the funeral home for the visitation or funeral DO NOT rely on your child for your own emotional DO NOT rely on your child for your own emotionalsupport DO NOT burden your child with adult responsibilities DO NOT burden your child with adult responsibilities DO NOT try to protect your child from your own DO NOT try to protect your child from your own sad feelings sad feelings DO NOT say things like: DO NOT say things like: “I know how you feel.” “You’ll be stronger because of this.” “It could be worse you still have…”

18. Helpful Strategies

19. It is better for the child to learn about the loss from a parent or family member Answer questions with honesty and provide factual information Use accurate words such as died or divorced Give developmentally appropriate definitions of words Reassure that death is not “contagious” Talk about and encourage discussion of the person, or pet, using names and memories

20. Involve child in decision about attending the funeral or memorial service Prepare child for what will happen, what they will see, and how people will behave at the funeral or memorial service Model appropriate responses to loss Provide lots of hugs, holding, physical contact, and nurturing Encourage and allow fun and happy times Ask and discuss “What do you need to comfort yourself?” Create with your child a list of comfort strategies

21. Listen much and say little… Listen quietly and attentively Acknowledge their feelings with a word. “Oh…I see… Mmmmm….” Keep lines of communication open Explore your religious beliefs and explain to your child Reassure child that all emotions (sadness, anger, relief, guilt) are normal responses to loss If possible, teach your child about death

22. Give the feeling a name. “That sounds frustrating.” “You sound lonely.” “It sounds like you are worried.” Give them their wishes in fantasy. “I wish I could make make your dog come home.” “If I had a magic wand, I would change….” “I know that you wish that dad and I were still together.” Be gentle and patient Allow for expression of feelings but not in a way that hurts others, property or the child “ “I can see how angry you are about…… Tell me with words (or draw me a picture), it is not o.k. to hit.”

23. Plan a concrete activity such as plant a tree, create a memory book, or participate in the funeral Reassure child of your love and support Address child’s unspoken feelings Help your child to use their grief in a positive way. For example, help others in similar situation, contribute or raise funds for a memorial scholarship, make ribbons, etc Provide structure and routine with flexibility as needed Reassure child that he or she did not cause breakup, death, etc. Be cautious about false assurance

24. Include your child in the process of acceptance and healing Encourage drawing, reading, playing, art, music, dance, acting and/or sports Work with school to tailor workload Allow for some regressive behavior and offer comfort Expect and accept mood swings Teach your how to change their physical response. For example, deep breathing, imagery, muscle relaxation

25. Recognize and praise your child when he or she is using positive comfort strategies Books can be helpful Be proactive and inform children about changes in the routine, expectations, etc. Consistency and predictability is important whenever possible Try to ensure plenty of sleep, proper nutrition, exercise, and quiet time Provide or replace items that provide security Holidays and anniversaries can be especially painful

26. When is it time to get help?

27. Extreme changes in behavior after loss Extreme changes in behavior after loss Grieving process seems to interfere with the child’s daily functioning Grieving process seems to interfere with the child’s daily functioning If the expression of, or lack of, feelings seems too strong for what is happening or last too long If the expression of, or lack of, feelings seems too strong for what is happening or last too long Exhibits self-destructive behavior Exhibits self-destructive behavior Trouble with the law Trouble with the law Extreme belligerent, acting-out, destructive or impulsive behavior Extreme belligerent, acting-out, destructive or impulsive behavior Expresses suicidal ideation Expresses suicidal ideation

28. Appetite changes that have caused major weight gain or loss Appetite changes that have caused major weight gain or loss Upset sleep patterns that leave you unable to rest or sleep excessively Upset sleep patterns that leave you unable to rest or sleep excessively Long term withdrawal from peers or family Long term withdrawal from peers or family Inability to experience pleasure no matter what Inability to experience pleasure no matter what Feeling overwhelmed by anger, fear, or hopelessness Feeling overwhelmed by anger, fear, or hopelessness Only feeling happy with drugs and alcohol Only feeling happy with drugs and alcohol Sharp drop in school performance or refusal to attend school Sharp drop in school performance or refusal to attend school Acting much younger for an extended period Acting much younger for an extended period

29. Seek help for your child if the grief or loss becomes more than he or she can handle or if it is negatively impacting two or more areas of his or her life. Seek help for your child if the grief or loss becomes more than he or she can handle or if it is negatively impacting two or more areas of his or her life.Contact: A counseling or mental health center A counseling or mental health center Your pastor, priest, rabbi or minister Your pastor, priest, rabbi or minister A child psychiatrist or psychologist A child psychiatrist or psychologist Your child’s school Your child’s school Your family physician or pediatrician Your family physician or pediatrician A support group A support group

30. Brooke’s Place for Grieving Young People Suite 103 50 East 91 st Street Indianapolis, IN 46240 317-705-9650 Camp Healing Tree A Special Weekend Camp for grieving children and teens, ages 7 – 17 will be held August 24-26. Camp Healing Tree is FREE but space is limited. If you would like more information, or to register a young person, call 317-388-CAMP beginning April 3 or call any area hospice.

31. Websites and Resources www.dougy.org www.tlcinstitute.org www.aacap.org www.mentalhealth.org www.childgrief.org

32. “Grieving is as natural as crying when you hurt, sleeping when you are tired, eating when you are hungry, or sneezing when your nose itches. It is nature’s way of healing a broken heart.”