When a loved one dies, everybody grieves, a process that helps people to adjust to their loss.
“Charlie Brown was right,” said Christopher Layne, a psychologist and researcher at the Semel Institute for Neuroscience and Human Behavior at UCLA. “There is good grief.”
However, for some people bereavement becomes a problem. Grieving children and young people can develop persistent complex bereavement disorder, which can affect their social and academic performance.
“It’s difficult to think about a future career or who you’re going to be if you don’t see yourself having a good life without the deceased,” said Layne, who is a program director at the UCLA/Duke National Center for Child Traumatic Stress. Layne joined with Julie Kaplow, a clinical child psychologist at the The University of Texas Health Science Center at Houston for the development of a psychological tool to assess bereaved youth.
The “Persistent Complex Bereavement Disorder Checklist — Youth Version” included 39 items and aims to help identify kids and adolescents whose grief may have taken a wrong turn and aims to detect their symptom severity.
“For children and adults, having an age-appropriate checklist to assess symptoms is a critical first step in identifying bereaved youth who may need specialized support,” said Kaplow, an associate professor of psychiatry and behavioral sciences at the University of Texas Health Sciences Center at Houston and director of its Trauma and Grief Center for Youth. She noted that maladaptive grief characteristics include emotional numbness, bitterness or anger and excessive efforts to avoid reminders of the loss and difficulty in accepting the death of a loved one.
According to Layne, people with bereavement disorder are at increased risk for conditions such as hypertension, cardiac disease, immune disorders and cancer. Importantly, these individuals are also at increased risk post-traumatic stress, depression, and substance abuse, which are all psychiatric conditions that can mask maladaptive grief.
Until now the only available grief assessment tools have been designed for adults — particularly widows. The new tools easily understandable for bereaved youth aged from 8 to 18 years. The youth version of the tool takes into account symptoms that are clinically relevant when they have persisted for more than six months, in contrast with adult versions of the tool where symptoms are considered problematic only when they last for more than a year.
“One year is simply too long a period of time for a child to suffer because of the risk for lost developmental opportunities,” Layne said.
The new tool accounts for the maladaptive grief features of the child.
“Children can be crying and grieving over the death of their mom or dad and then two minutes later be running around and laughing and playing with their friends,” said Layne, who is the director of education in evidence-based practice at UCLA/Duke National Center for Child Traumatic Stress. “Adults might incorrectly assume that the problem is something children are able to shrug off because they are not despondent for days on end like you might expect with an adult.”
This new psychological assessment measure is developed at a time were there is an increasing interest in Persistent Complex Bereavement Disorder, which was added to the recent American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The users of the new checklist can participate in an ongoing data collection that is going to be used for future refinement of the condition in the manual.
For the development of the new tool, the researchers used interviews that data retrieved from assessment of over 230 bereaved children and young people. The assessment tool was also reviewed and rated by a panel of 10 grief international experts. The final psychological assessment measure takes five to eight minutes to complete.
Health professionals and educators can tailor an individual treatment plan, which involves helping the children to develop coping skills to manage grief reactions, helping children to identify their personal loss reminders, put into words feelings or thoughts or feelings, and find strategies to help children to accept their loss while feeling connected to the deceased.
“What has been inspiring to us,” said Kaplow, “is that children often react to the test by saying, ‘So other kids feel this way, too? I thought it was just me.'”