Text of Children Coping With A Parents Terminal Illness
Downloaded from caonline.amcancersoc.org by on January 21, 2010 (American Cancer Society, Inc.) Current Approaches to Helping Children Cope with a Parents Terminal Illness Grace H. Christ and Adolph E. Christ CA Cancer J Clin 2006;56;197-212 DOI: 10.3322/canjclin.56.4.197 This information is current as of January 21, 2010 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://caonline.amcancersoc.org/cgi/content/full/56/4/197 To subscribe to the print issue of CA: A Cancer Journal for Clinicians, go to (US individuals only): http://caonline.amcancersoc.org/subscriptions/ CA: A Cancer Journal for Clinicians is published six times per year for the American Cancer Society by Wiley-Blackwell. A bimonthly publication, it has been published continuously since November 1950. CA is owned, published, and trademarked by the American Cancer Society, 250 Williams Street NW, Atlanta GA 30303. (American Cancer Society, Inc.) All rights reserved. Print ISSN: 0007-9235. Online ISSN: 1542-4863.
CA Cancer J Clin 2006;56:197212 Current Approaches to Helping Children Cope with a Parents Terminal Illness1 Grace H. Christ, MSW, DSW; Adolph E. Christ, MD, DMS Downloaded from caonline.amcancersoc.org by on January 21, 2010 (American Cancer Society, Inc.) Dr. G. Christ is Associate Profes- ABSTRACT Much has been learned about childhood bereavement in the last few decades as sor, Columbia University School of studies have increasingly focused on the direct interviewing of children about their recovery from Social Work, New York, NY. the tragic loss of a parent. It has been shown that children do indeed mourn, although differently Dr. A. Christ is Professor Emeritus, Child/Adolescent Psychiatry SUNY from adults. Important moderating and mediating variables have been identified that impact Health Science Center at Brooklyn their recovery from the loss of a parent, which can be the focus of intervention. When death is and Kings County Hospital, Brook- lyn, NY. expected, the terminal phase of an illness has been found to be particularly stressful for children, This article is available online at yet seldom investigated. Similarly, few studies have explored the impact of development on http://CAonline.AmCancerSoc.org childrens experience and expression of grief. We present research findings that clarify phases in childrens experience during the terminal illness, hospital visits, the death, and its immediate aftermath, as well as how the parent is mourned and issues in longer term reconstitution. Variations in childrens responses in these phases are described as they were experienced by 87 children from 3 different developmental groupings: 3 to 5 years, 6 to 8 years, and 9 to 11 years. Recommendations are suggested for parents and professionals about ways to understand and support children during the terminal illness, at the time of death, and during the phase of reconstitution. (CA Cancer J Clin 2006;56:197212.) American Cancer Society, Inc., 2006. INTRODUCTION For a child, the death of a parent is a highly stressful event. Research suggests that it places them at risk for adverse psychosocial consequences. However, with adequate family resources, competent substitute care, and emotional support, bereaved children are better able to return to previous levels of functioning.1 4 When death can be anticipated, as with a terminal illness, physicians and other health care professionals have an opportunity to ameliorate the impact of the loss. The experiences of adolescents who confront parent loss from illness and the ways professionals can support their coping were reviewed in an earlier article.5 Presented here is an update on current approaches to helping children (age 3 to 5, 6 to 8, and 9 to 11) cope with a parents terminal cancer illness and death. These approaches are informed by three areas of research: Y Risk and protective factors that mediate the coping of bereaved children. Y Intervention during the terminal illness. Y Developmental grouping of children to enhance specificity and accuracy of findings and interventions. Suggested are ways to better prepare families and health care professionals to facilitate childrens mastery of adaptive tasks during the terminal phase of the parents illness, at the death, and during its immediate aftermath. 1 This work was supported in part by grants from the National Institute of Mental Health (NIMH) (MH41967), the American Cancer Society (PRB-24A), the van Ameringen Foundation, the Society of Memorial Sloan-Kettering Cancer Center, and the Project on Death in America of the Open Society Institute. Volume 56 Y Number 4 Y July/August 2006 197
Helping Children Cope with a Parents Terminal Illness BACKGROUND Recent studies have also identified a broad range of risk and protective factors that con- Early research in childhood bereavement tinue to be explored, refined, and utilized in hypothesized links between unresolved child- developing interventions and service programs. hood grief and subsequent adult psychopathol- Those currently under study are summarized in ogy.6 8 While early studies appeared to Table 1. Prospective and retrospective studies establish a link,9,10 later research was able to confirm the critical role of the surviving parent control for independent, moderating, and me- or caregiver in helping children adapt to a diating variables associated with outcomes that Downloaded from caonline.amcancersoc.org by on January 21, 2010 (American Cancer Society, Inc.) parents death. The quality of the relationship suggested child bereavement alone was un- with the surviving parent or caregiver and their likely to be related to adult psychopathology.11 competence in parenting bereaved children are Rather, these studies highlighted the impor- the most consistently identified mediating vari- tance of mediating and moderating factors as- ables.3,1520 Caregiver attributes that contrib- sociated with bereavement, such as the quality ute to childrens adaptation include more active of parental care and the presence of other ad- coping, less depression, more parental warmth, verse social and psychological occurrences pre- and family cohesiveness.4,20 While the connec- ceding and following the bereavement that tion between childrens mourning experience may have more influence on adult outcomes and adaptation level has not been clearly doc- than the fact of the death.12 umented, better psychological outcomes have Studies conducted shortly after parent death, been associated with broader characteristics, in- including interviews with children, have con- cluding openness of general communication firmed that children do indeed experience with the surviving parent and sharing of infor- grief, sadness, and despair following the death mation about the parents death.21,22 Parents of a parent. As Dowdney states in her review of often find it difficult to understand and respond child bereavement research, Inconsistencies in to their childrens unique, developmentally the literature relate to rates of disorder or dis- specific expressions of grief, which may seem turbance rather than to the manner in which vague, intermittent, and at times inappropriate children manifest distress.8 The highest rates by adult standards. Adults find that children can of psychological symptoms are found in sam- even appear to be unconcerned, callous, or ples that include children referred for bereave- indifferent. ment services or those from less stable backgrounds or under-resourced family envi- Helping Children Cope During the Parents