Effects of Parental Death

The Effects of Parental Death and its causes On Their Children’s Behaviors. By Tameka L. Flynt A paper presented in Partial Fulfillment Of the Requirements of CST 5006 – Survey of Research Methodology Capella University May 2010 Address: P. O. Box 1987 Griffin, GA 30223 Phone: 678-588-9932 Email: [email  protected] com Instructor: Trent Nguyen Abstract The purpose of this study is to review literature related to the effects of parental death on children. Children who experience the death of a parent is considered an at risk population for psychological, behavioral, and social problems.There are many factors relating to the way children adjust to parental death. Some of these factors include the age of the child, the gender of the child, the circumstances surrounding the death (accidental, expected, or violent death), the adjustment of the surviving caregiver, etc. Children who experience the accidental or violent death of a parent are more at risk to develop psycholog ical problems, such as depression and post-traumatic stress disorder, than those children who experience the expected death of a parent. Table of Contents Abstract2 Table of Contents3 Introduction4 The Statement of the Problem5Review of Literature5 Qualitative Research5 Quantitative Research9 Conclusion14 Annotated Bibliography15 Introduction Four percent of youth in the United States lose at least one parent by age fifteen (Samide & Stockton, 2002). The Death of a parent is a major and devastating event for a child. It can affect a child’s psychological and social development, which can lead to low academic performance and behavior problems. Everyday someone dies whether it’s from a sudden death such as a car accident, a natural disaster, and violence or an expected death such as long term illnesses.Many people that die have at least one child that live in the home under the age of eighteen. Understanding how the children are affected by parental death is importan t for developing effective prevention and interventions strategies that can be used by children counselors, social workers, and school counselors. Studies have been done to understand how these children are affected but there is room for further research. The Research questions that guided this research for the review of literature include: 1. Does the cause of death have a different effect on the way children grieve or adjust to life without their parent? . What are the most common problems children experiences after the death of a parent? 3. How are children affected by parental death? 4. What are the needs of children who experience parental death? The Statement of the Problem This research proposes to identify the different effects parental death has on children and the factors (cause of death, age of child, gender of child, gender of surviving parent, etc) that relates to the adjustment of the child to the death of a parent. Review of Literature Qualitative ResearchHope and Hat e (2006) performed a qualitative study to explore the factors that affect children’s adjustment to the death of a parent. The authors of this study reviewed literature and found that many factors contribute to the way children adjust to parental death. Previous research shows that children experience distress related to the loss of a parent. Factor that affect the way a child adjust includes the age of the child, the sex of the child, circumstances of death, relationship to the deceased parent, adjustment to the remaining caregiver, & participation in post death rituals such as funerals.Other studies have compared the adjustment of children who have lost a parent to suicide to those who have lost a parent to terminal illness. Hope and Hodge (2006) conducted this study to obtain insight from social workers who work with childhood grief. They interviewed five social workers asking questions related to the adjustment of children who lost a parent. They focused on the age of children, the sex of children, the circumstances of death (sudden or expected), and adjustment of the current caretaker. They focused on these factors because they found that these were the most common studied but the findings are the most contradictory.After interviewing the social workers Hope and Hodge (2006) found that they had observed similar patterns regarding the factors that affect the adjustment of children who lost a parent to death. Boys tend to show externalizing behaviors whereas girls tend to show internalizing behaviors due to the lost of a parent. They found that the cognitive level rather than the age of the child affects their adjustment more. Therefore younger children and preadolescents seem to have more difficulty adjusting to the death of a parent than adolescents.The results did not support earlier findings that sudden death present more difficulty adjusting than expected death. Most of the participants reported that sudden and expected death is equally traum atic to children. The participants also said that the adjustment of the caretaker is important for a positive adjustment for the children. The caretaker must be able to grieve while supporting the child’s need to grieve. This study shows that children of different ages and genders react different to the death of a parent. The authors of this study choose to perform a qualitative study because of the small number of participants.The sample was collected purposefully to focus on what social workers experienced when working with bereaved children. The methods used in this study limits generalizability. The participants all live in the same are of Virginia, therefore it is questionable if the results would be the same all over the country. It also focused on one culture so the results can be different with other cultures the authors also realized that the interviews may have been biased because of the answers that were given and the styles and opinions of the interviewer.Through this study social workers can gain a better understanding of how children adjust to the death of a parent so they can develop intervention strategies when working with these families. Children who witness the homicide of a parent are becoming more common in the United States today. There is very little research done that evaluates the children after such a traumatic event. Eth, Spencer, Pynoos, & Robert (1994) conducted a qualitative study where they performed a psychiatric evaluation of children who witness the homicide of a parent. They interviewed 55 children and adolescents between the ages of 3 to 17 in Los Angeles.They interviewed children from hours to weeks after the homicide to study the child’s immediate response. They also interviewed children who had witness the homicide years earlier to study the continued impact of the event. The purpose of this study is to contribute to our understanding of the nature of child’s experience of trauma, the influence of development phase on symptoms expression, and the interaction of grief and trauma (Eth, Spencer, Pynoos, & Robert, 1994). The results of the interviews indicate that children who witness the violent death of parent results in a variety of juvenile post-traumatic stress.The interviews also suggest that the developmental phase of the child influences the development of post-traumatic stress. These interviews suggest that witnessing a homicide impairs the child’s ability to grieve because they tend to focus on the mode of death which disrupts thoughts about the deceased. The sample in this study is small so it only represents a small population. The limitations also include the fact that the study was only performed in a specific community therefore it limits the generalizability of the study.The sample was selected purposefully because they chose to focus only on children who witness the homicide of a parent. Eppler (2008) performed a study to explore the themes of resilie ncy in children after the death of a parent. After the death of a parent many children experience difficulty grieving. They may experience feelings such as shock, guilt, and anger. They may lash out at their peers for a topic other than death. Eppler (2008) reviewed several literature related to bereaved children and their experiences. He found that children who experienced the lost of a parent display lower levels of self esteem and self efficacy.The purpose of this study was to explore qualities of resiliency in children. The research question that guided this study was â€Å"What resilience factors are identifiable in the stories of grieving children? † (Eppler, 2008). The sample included 12 bereaved children who loss a parent within the past 36 months. The children were between the ages of 9 and 12 years old. There were 7 female and 5 male participants. The sample was collected purposefully to broaden the understanding of children who experience grief. The participants we re individually interviewed after gaining the parent’s or guardian’s written consent.The children were asked questions related to life before the death, how they found out about the death, their current situations, and what they thought would happen in the future. They were asked to write their stories after answering the questions. The author analyzed the data by reading and rereading the transcripts, notes, and stories. He also increased validity by directly quoting the participants. Eppler (2008) found that sadness was the dominate theme reported when a parent dies. The children in this study also reported that they see themselves as happy, nice, helpful, normal, and fun.Most of the children reported that they had support from immediate family, extended family, school, and some peers. Children that reported a full range of emotions and a support system did not seem to focus on sadness, fear, anger, and isolation. Limitations of this study include that children from one developmental age group participated in the study. There should be studies done to examine resilient factors in adolescents and younger children. This study is also not generalizable to other ethnic groups because the majority of the sample was White. There was one participant who was African American.It is important that other studies be done to include other ethnic groups. Quantitative Research Children who experience the death of a parent may have problems adjusting to the new lifestyle. They tend to develop psychological and social problems. Children who experience the death of parent through accidental or sudden death may experience depression symptoms and post-traumatic stress disorder. A longitudinal study conducted by Brent, Melhem, Donohoe, Walker (2009) examined the effects of grief on children 21 months after parental death. A previous study was conducted by them nine months after the death of a parent.The questions that guided this study is 1) what are the predictors and pathways of depression and post traumatic stress disorder in parentally bereaved children and 2) does children of parents who died of suicide, accidents, or sudden natural death show a difference in the incidence and course of depression. Brent, Melhem, Donohoe, & Walker (2009) hypothesized that youth who lost a parent to death would continue to show a higher prevalence and symptom severity of depression and post-traumatic stress disorder than non bereaved children 21 months after the death of a parent.They also hypothesized that children who parents died by suicide would show higher prevalence of depression and that predictors would include stressful life events, negative coping, low social support, and prior history of depression. The sample consisted of 176 children of parents who died by suicide, accident, or sudden natural death and 168 children of parents who both are still alive. The participants were recruited through coroner’s reports and newspaper advertise ments. The participants were interviewed two times, once at nine months after the death and once at 21 months after the death.They were assessed on socioeconomic status and household income, psychiatric disorders, experiences surrounding the death, severity of depression, anxiety, post-traumatic stress disorder, and suicidal ideation, and family cohesion, social support, coping, and self-esteem. The results supported the hypothesis that parentally bereave children would show a higher prevalence of depression and post traumatic stress disorder than non-bereaved children. Children whose parents died by suicide and accidents showed a higher rate of major depression than the comparison group (Brent, Melhem, Donohoe, Walker, 2009).They found that the incidence of PTSD was higher in the bereaved group than the comparison groups during the first nine months but not during the 21 month follow up. The rate of incident depression was higher in the children who lost a parent to suicide than in those who lost a parent to sudden natural death which supports the second hypothesis made by the authors. One limitation of the study is that the majority of the subjects is Caucasian and does not include homicides therefore it limits the generalizability.Although the participants were randomly selected the Hawthorne effect could have took place. Participants that knew they are a part of a study could have act differently. A study conducted by Raveis, Siegel, & Karus (1998) conducted a study to examine the potential predictors of children’s psychosocial adjustment to parental death. The predictors examined include the child’s age, child’s gender, deceased parent gender, time since death, length of illness, presence of siblings, and parental communication. The authors reviewed literature related to bereaved children.They found that younger children and those in early adolescence appear to have poor adjustment to parental death. They also found some controver sy regarding the child’s gender. Ravels, Siegal, & Karus, (1998) stated that some studies reported that girls are more vulnerable to poor adjustment following the death of a parent where other studies found that boys are more vulnerable to poor adjustment. One study found no difference in gender at all and another study found that the deceased parent gender may affect the way they adjust.The sample used in this study consisted of 83 families with school age children whose parent died of cancer. They conducted interviews with the surviving parent and the child. They also had the child of the deceased parent to complete the Children’s Depression Inventory (CDI) and the State-Trait Anxiety Inventory for Youths (STAIY) if they were 12 years or older or the State-Trait Anxiety Inventory for Children (STAIC) if they were 11 years or younger. The results of this study suggested that the bereaved children whose surviving parent have an open level of communication have a lo wer level of distress.The gender of the child correlated with depression with girls reporting higher levels of symptom than boys. Anxiety correlated with the age of the child with older children reporting lower levels of anxiety than younger children. One limitation of this study is that it is solely relying on the answers provided by the surviving parent and the children which can become unreliable. Also the families participating in the study is predominantly White and middle or upper class. The socioeconomic factors may affect the children’s adjustment process differently.The last limitation is that the deceased parent died due to cancer. Other causes of death such as accidents, homicides, or other natural illness may yield different results. McClatchy, Vonk, & Palardy, (2009) conducted a study to evaluated the prevalence of childhood traumatic grief and post-traumatic stress disorder symptoms in children who have lost a parent to death. They compared the results of ch ildren who lost a parent to sudden/violent death to those who lost a parent to expected death.The questions that guided this research are 1) Do children who experience an expected death of a parent suffer from Childhood Traumatic Grief (CTG) to the same extent as those children who lose a parent to a sudden or violent death, 2) Do children who experience an expected death of a parent suffer from post-traumatic stress disorders (PTSD) symptoms to the same extent as those children who lose a parent to a sudden and/or violent death, and 3) To what extent do parentally bereaved children experience CTG and PTSD symptoms. The sample used in this study consisted of 158 parentally bereaved children ages 7-16.The children completed the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for DSM-IV to measure PTSD symptoms and the Extended Grief Inventory (EGI) to measure CTG symptoms. The results of this study showed that the incidence of PTSD and CTG was no t different in children who had experienced an expected loss of a parent compared to those who had experienced a violent or sudden death (McClatchy, Vonk, & Palardy, 2009). Children who experience both expected and unexpected losses showed signs of PTSD and CTG symptoms. African American children exhibit CTG symptoms at a higher degree than White children.This study suggested that elementary school children have higher CTG symptoms than older children. One limitation is that of generalizability because a purposive sample was used. The sample was recruited from bereavement camps therefore it is likely that those parents who were having more issues with their bereaved child were most likely to register their children up for bereavement camp. Another limitation includes the measurement tool. The EGI is a newly developed instrument and its psychometric properties have not been fully investigated (McClatchy, Vonk, & Palardy, 2009). ConclusionUnderstanding how children are affecte d by the death of a parent in essential to those professionals who work with children. Studies have shown that children are indeed affected by the loss of a parent whether it is a sudden death or expected death. Depression symptoms and post traumatic stress disorder symptoms are the most common problems that parentally bereaved children experience. They also experience behavioral problems such as aggression, acting out, lashing out at others, etc. These problems can result in academic problems in school. Parental death not only has immediate effects on children but long term effects as well.There are many factors that affect the way children adjust to parental death including age, gender, adjustment of surviving parent, circumstances of death, etc, professionals working with children needs to understand that all children react different to parental death so the needs of the children are different. Overall children need to be allowed to grieve in their own way, they need to be able t o communicate with the surviving parent about the death, and they need support from others beside family because family members are usually tending to their own grief.The needs of children who experience parental death are important for those professional to develop prevention and intervention strategies to eliminate the development of emotional and social problems. Therefore further researcher is important to develop a better understanding of parentally bereaved children. Annotated Bibliography Ayyash-Abdo, H. (2001). Childhood Bereavement: What School Psychologists Need to Know. School Psychology International , 27 (4), 417-433. This article is a review of literature on children's conception of death, factors influencing the conceptions of death, and reactions to the death of a parent.This article also provides intervention strategies including play therapy, bibliotherapy, and group therapy for school counselors to utilize when working with bereaved children. Brent, D. , Methem, N . , Donohoe, M. B. , ;amp; Walker, M. (2009). The Incidence and Course of Depression in Bereaved Youth 21 Months After the Loss of a Parent to Sucide, Accident, or Sudden Death. The American Journal of Psychiatry , 166 (7), 786-794. This study was performed to compare the incidence and course of depression between those children who lost a parent to suicide, accident, or sudden natural death.One hundred and twenty six children, ages 7-26, who experienced the death of a parent and 168 non-bereaved children were the participants in this study. Children who loss a parent to death were more vulnerable to depression and alcohol or substance abuse. Eppler, C. (2008). Exploring themes of Resiliency in Children Affte the Death of a Parent. Professional School Counseling , 11 (3), 189-196. This is a qualitative study to explore how quickly children recover after the death of a parent. Twelve children, who experienced the death of parent in the past 36 months was interviewed while the session s were recorded.They also were asked to write story about the death of their parent. Sadness was a theme that was reported by all the participants. They also had a range of emotions. Children who have helpful support systems does not focus on sadness or anger but see themselves as happy and normal. Eth, Spencer, Pynoos, ;amp; Robert. (1994). Children Who Witness the Homicide of a Parent. Psychiatry , 57 (4), 287. This article is a qualitative study that evaluated children who witness the homicide of a parent. Fifty-five children and adolescents were interviewed.This study showed that children who witness the death of a parent results in posttraumatic stress disorder symptoms. It also showed that the developmental phase of the child effects the PTSD symptoms found in these children. Hope, R. M. , ;amp; Hodge, D. M. (2006). Factors Affecting Children's Adjustment to the Death of a Parent: The Social Work Professional's Viewpoint. Child and Adolescent Social Work Journal , 23 (1), 107. This qualitative study was performed to explore the factors that affect children's adjustment to the death of a parent.The authors interviewed professional social workers with 11/2 to 22 years of experience working with bereaved children. Age, gender, circumstances of the death, and the adjustment of the caregiver are the factors that was explored. The social workers interviewed had similar observations regarding the factors that affect the adjustments of children who experience the loss of a parent. McClatchy, I. S. , Vonk, M. E. , & Palady, G. (2009). The Prevalence of Childhood Traumatic Grief- A Comparison of Violent/Sudden and Expeted Loss. Omega , 59 (4), 305-323.This study compared the prevalence of childhood traumatic grief and posttraumatic stress disorder symptoms of those children who lost a parent to violent/sudden death and those children who expected the loss of a parent. There were 158 children that participated in the study. Sixty-three children lost a parent to expected death and 60 percent of the children lost a parent to a sudden or violent death. The incidence of CTG and PTSD did not differ in children who experienced sudden/violent loss of a parent from those who experienced an expected loss. Ravels, V. , Siegal, K. , & Karus, D. (1999).Children's Psychological Distress Following the Death of a Parent. Journal of Youth and Adolescence , 28 (2), 165. This article focused on the families with children who had a parent die of cancer. The children psychological distress was examined in this article. The authors of this article focused on the attributes of the family environment and what role it plays in the distress of the child. Another factor is the circumstances surrounding the death of the parent. Eighty-three families participated in this study. The level of distress in the bereaved child was found to be affected by the way the child perceives the surviving parent.Saldinger, A. , Cain, A. , Kalter, N. , ;amp; Lohanes, K. (1999). Anticipating Parental Death in Families with Young Children. American Journal of Orthopsychiatry , 69 (1), 39-48. This article focused on the children who are losing a parent to illness and the association of mental health outcomes of these children. The sample included 41 families. The authors of the article interviewed the surviving parent and gave the children self repots to complete. Anticipating the death was associated with better mental outcomes that sudden death according to the authors.