Grief in adultsGrief in adults

What is a Traumatic Event?What is a Traumatic Event?

Involves actual or threatened death Involves actual or threatened death or serious injury, or a threat to the or serious injury, or a threat to the person’s physical integrityperson’s physical integrity

Involves feelings of intense fear, Involves feelings of intense fear, helplessness or horror (children may helplessness or horror (children may show disorganized or agitated show disorganized or agitated behavior instead)behavior instead)

Types of TraumasTypes of Traumas

Natural disastersNatural disasters KidnappingKidnapping School violenceSchool violence Community Community

ViolenceViolence Terrorism/WarTerrorism/War HomicideHomicide Physical AbusePhysical Abuse

Sexual AbuseSexual Abuse Domestic violenceDomestic violence Medical proceduresMedical procedures Victim of crimeVictim of crime AccidentsAccidents Suicide of loved Suicide of loved

oneone Extreme NeglectExtreme Neglect

How Common are How Common are Traumatic Experiences?Traumatic Experiences?

69% of the general U.S. population report 69% of the general U.S. population report exposure to one or more life-threatening exposure to one or more life-threatening traumatic events traumatic events

14 to 43% of children report having 14 to 43% of children report having experienced a traumatic event prior to 18.experienced a traumatic event prior to 18.

Up to 91% of African American youth in Up to 91% of African American youth in urban settings report violence exposure urban settings report violence exposure

10% of children under 5 witnessed 10% of children under 5 witnessed shooting/stabbingshooting/stabbing

What What MakesMakes a Trauma a a Trauma a Trauma?Trauma?

Previous trauma exposurePrevious trauma exposure Severity of traumaSeverity of trauma Extent of exposureExtent of exposure Proximity of traumaProximity of trauma Understanding and personal significanceUnderstanding and personal significance Interpersonal violenceInterpersonal violence Parent distress, parent psychopathologyParent distress, parent psychopathology Separation from caregiverSeparation from caregiver Previous psychological functioningPrevious psychological functioning Genetic predispositionGenetic predisposition Lack of material/social resourcesLack of material/social resources

Grief cycleGrief cycle

Shock and denialShock and denialBargainingBargainingDepressionDepressionacceptanceacceptance

Reaction to griefReaction to grief

PhysicalPhysicalPsychologicalPsychological

Physical symptomsPhysical symptoms

GI symptomsGI symptomsCNS symptomsCNS symptomsPainPain

Psychological symptomsPsychological symptoms

EmotionalEmotionalCognitiveCognitiveBehavioralBehavioral

Emotional symptomsEmotional symptoms

AnxietyAnxietyAngerAngerDepressionDepressionGuilt feelingGuilt feeling

Cognitive SymptomsCognitive Symptoms

DistractibilityDistractibilityPreoccupationPreoccupationSense of unrealitySense of unrealityhelplessnesshelplessness

Behavioral symptomsBehavioral symptoms

RestlessnessRestlessnessCryingCrying IrritabilityIrritabilitySocial withdrawalSocial withdrawal

Common symptoms in Common symptoms in depression and griefdepression and grief

SadnessSadness InsomniaInsomniaDecreased appetiteDecreased appetiteDecreased weightDecreased weight

Symptoms in favor of depressionSymptoms in favor of depression

WorthlessnessWorthlessnessHallucinationHallucinationDeath preoccupationDeath preoccupationGuilt feelingGuilt feelingDisturbed functionDisturbed functionPsychomotor hypoactivityPsychomotor hypoactivity

Grief inGrief in children children

Grief in Infants and ToddlersGrief in Infants and Toddlers

Experience a sense of “goneness”Experience a sense of “goneness”Sleep/appetite disturbanceSleep/appetite disturbanceFussy, irritableFussy, irritableBowel/bladder disturbancesBowel/bladder disturbancesDifficult to comfortDifficult to comfortMay have difficulty reattaching to May have difficulty reattaching to

new caregiversnew caregivers

Grief in PreschoolersGrief in Preschoolers

Magical thinking (e.g., death is Magical thinking (e.g., death is reversible)reversible)

Regressive behaviorsRegressive behaviorsReenact death in playReenact death in playMay express desire to die as wellMay express desire to die as wellSymptoms of grief may be Symptoms of grief may be

inconsistentinconsistentAppetite/sleep disturbanceAppetite/sleep disturbance

Grief in School ChildrenGrief in School Children

More likely to show depression, sadnessMore likely to show depression, sadness May see death as something tangibleMay see death as something tangible Preoccupation with deathPreoccupation with death Begin to understand permanency of death, but Begin to understand permanency of death, but

may still behave as though deceased were still may still behave as though deceased were still alivealive

May show aggression, other behavioral May show aggression, other behavioral difficulties, concentration difficultiesdifficulties, concentration difficulties

May be anxious about wellbeing of other May be anxious about wellbeing of other family membersfamily members

Magical thinking remains prevalentMagical thinking remains prevalent

Tasks of MourningTasks of Mourning

Accept the reality of the lossAccept the reality of the loss Experience fully the pain of the lossExperience fully the pain of the loss Adjust to an environment and self-identity Adjust to an environment and self-identity

without the deceasedwithout the deceased Convert the relationship from one of live Convert the relationship from one of live

interactions to one of memoryinteractions to one of memory Find meaning in the deceased’s deathFind meaning in the deceased’s death Experience a continued supportive adult Experience a continued supportive adult

presence in the futurepresence in the future

Helping Grieving ChildrenHelping Grieving Children

Don’t be afraid to talk about the Don’t be afraid to talk about the deathdeath

Be prepared to discuss the same Be prepared to discuss the same details over and over againdetails over and over again

Be available, nurturing, reassuring Be available, nurturing, reassuring and predictableand predictable

Assist child in developing grieving Assist child in developing grieving rituals and in finding meaningrituals and in finding meaning

Help others learn how to respondHelp others learn how to respond

Talking about Death with a Talking about Death with a Young ChildYoung Child

““Died” means person is not alive Died” means person is not alive anymore. His/her body stopped anymore. His/her body stopped working. He/she can’t breathe, walk, working. He/she can’t breathe, walk, move, eat or do any of the things move, eat or do any of the things he/she could do when alive. It’s he/she could do when alive. It’s forever and he/she will never be alive forever and he/she will never be alive again. again.

Use child’s (family’s) own belief Use child’s (family’s) own belief system when discussing afterlifesystem when discussing afterlife

Talking about Death with a Talking about Death with a Young ChildYoung Child

Share memories and talk about the Share memories and talk about the person who died when appropriateperson who died when appropriate

Gently remind children ALL feelings Gently remind children ALL feelings (anger, sadness, confusion, fear, (anger, sadness, confusion, fear, relief, guilt) are okay.relief, guilt) are okay.

Use reminders like “you did not Use reminders like “you did not cause this” or “it is not your fault.”cause this” or “it is not your fault.”

When to Refer Child for When to Refer Child for Psychiatric/Psychological Psychiatric/Psychological

CareCareShowing these changes for more than 3 Showing these changes for more than 3

months after trauma…months after trauma… Behavior/Academic problems at schoolBehavior/Academic problems at school Angry outburstsAngry outbursts Withdrawal from usual activities/playWithdrawal from usual activities/play Frequent nightmares, sleep disturbanceFrequent nightmares, sleep disturbance Physical problems (nausea, headaches, Physical problems (nausea, headaches,

weight gain/loss)weight gain/loss) Depression, hopelessnessDepression, hopelessness

When to Refer Child for When to Refer Child for Psychiatric/Psychological Psychiatric/Psychological

CareCareShowing these changes for more than 3 Showing these changes for more than 3

months after traumamonths after trauma Intense anxiety or avoidance behavior Intense anxiety or avoidance behavior

triggered by trauma reminderstriggered by trauma reminders Continued worry about event (primary Continued worry about event (primary

focus) focus) Failure to attend to personal hygieneFailure to attend to personal hygiene Excessive separation difficultiesExcessive separation difficulties Continued trauma themes in playContinued trauma themes in play

When to Refer Child forWhen to Refer Child forPsychiatric/Psychological Psychiatric/Psychological

CareCare Significant ASD symptoms within first Significant ASD symptoms within first

month of traumamonth of trauma Unable to grieve/mourn because of Unable to grieve/mourn because of

trauma-related distresstrauma-related distress Inappropriate social behaviors (e.g., Inappropriate social behaviors (e.g.,

sexual)sexual) Unable to regulate emotionsUnable to regulate emotions Strong resistance to affection/support from Strong resistance to affection/support from

caregiverscaregivers Dangerous behaviors to self/othersDangerous behaviors to self/others

سوگ در كودكانسوگ در كودكان

روياهاي شخص مردهروياهاي شخص مردهتقليد رفتارهاي اوتقليد رفتارهاي او الگو قرار دادن و ايده آل الگو قرار دادن و ايده آل

نمودن رفتار و شخصيت اونمودن رفتار و شخصيت او بازگو نمودن وقايع مرگ و بازگو نمودن وقايع مرگ و

مراسم و خاطرات اومراسم و خاطرات او احساس اينكه شخص مرده احساس اينكه شخص مرده

همراه اوستهمراه اوست طرد كردن دوستان قديمي طرد كردن دوستان قديمي

و جستجوي دوستان جديد.و جستجوي دوستان جديد.

احساسات، افكار و رفتارهاي شايع در كودكان احساسات، افكار و رفتارهاي شايع در كودكان سوگوار:سوگوار:

تماس تلفني مكرر با منزل تماس تلفني مكرر با منزلبراي چك كردن سالمت براي چك كردن سالمت

والدينوالدين كاهش توجه و تمركز كاهش توجه و تمركز

روي تكاليف درسي و روي تكاليف درسي و فعاليتهاي روزمرهفعاليتهاي روزمره

گريه ناگهاني در كالس گريه ناگهاني در كالس جستجوي اطالعات جستجوي اطالعات

پزشكي در مورد متوفيپزشكي در مورد متوفي احساس نگراني راجع احساس نگراني راجع

به سالمت خود و گاهي به سالمت خود و گاهي بي توجهي به آنبي توجهي به آن

سوگ در كودكانسوگ در كودكان

.بچه ها در مراسم شركت نكنند.بچه ها در مراسم شركت نكنند جلوي كودك راجع به مرگ جلوي كودك راجع به مرگ

صحبت نكنيم.صحبت نكنيم. از صحبت راجع به مسائلي كه از صحبت راجع به مسائلي كه

كودك را به گريه مي اندازد كودك را به گريه مي اندازد اجتناب كنيم.اجتناب كنيم.

بچه هاي خردسال مفهوم سوگ بچه هاي خردسال مفهوم سوگرا نمي فهمند.را نمي فهمند.

اگر خدا مي خواست او را از ما اگر خدا مي خواست او را از مانمي گرفت.نمي گرفت.

وقتي بزرگ شوي همه چيز را وقتي بزرگ شوي همه چيز رافراموش مي كنيفراموش مي كني

او به يك مسافرت طوالني رفته او به يك مسافرت طوالني رفتهاست.است.

خدا او را از ما گرفت چون خيل خدا او را از ما گرفت چون خيلخوب بود.خوب بود.

نگرش ها و برخوردهاي غلط در مواجهه با سوگ نگرش ها و برخوردهاي غلط در مواجهه با سوگ كودكان:كودكان:

او تو را از آسمان نگاه مي كند او تو را از آسمان نگاه مي كند او به خواب رفت و ديگر او به خواب رفت و ديگر

بيدار نمي شود.بيدار نمي شود. تقصير من است كه مادرم تقصير من است كه مادرم

را از دست دادمرا از دست دادم بزرگترها قادرند توضيح بزرگترها قادرند توضيح

كافي راجع به روح و مرگ كافي راجع به روح و مرگ به كودكان بدهند.به كودكان بدهند.

سوگ بزرگترها روي كودك سوگ بزرگترها روي كودك سوگوار تاثير ندارد.سوگوار تاثير ندارد.

كودكي كه فعال و پر جنب كودكي كه فعال و پر جنب و جوش است سوگوار و جوش است سوگوار

نيستنيست اگر خيلي گريه كند دچار اگر خيلي گريه كند دچار

حمله و مشكل عصبي مي حمله و مشكل عصبي مي شود.شود.