Childhood and Adolescent Grieving Process

Introduction

Grieving is a process. The typical stages of grief among children and adolescents are
similar to that experienced by adults. Nevertheless, the timeframe for grieving is usually shorter
in children and adolescents compared to adults. Bereavement can be complicated, simple, or
traumatizing, depending on the relationship between the departed and grieving individuals.
Shortly after the death of a loved one, the grieving person returns to normal functioning because
life has to move on regardless. However, other people cannot move on from the phases of
grieving and end up developing mental health conditions. Traumatic grieving is experienced
when one witnesses the death of a loved one which results in posttraumatic stress disorder. This
paper explores the differences between the typical grieving process in childhood and adolescence
and stressor-related disorders, such as PTSD and acute stress disorder; evaluates the differences
between traumatic, complicated, and uncomplicate grief; identifies an assessment method that
would help in screening for these conditions; and analyzes the impact of traumatic grief on
childhood and adolescent development.
The Difference Between the Typical Grieving Process of Children and Adolescents and

Bereavement, PTSD, and Acute Stress Disorder

The grieving process in children and adolescents follows five essential stages. The first
stage is denial or shock. This stage is deceptive; children and adolescents appear calm and show
little or no evidence of distress or emotional shock. The shock causes the grieving individual to
shut down emotionally, and children become disconnected and act as if the loss had little
significance (Revet et al., 2020). However, shock is a numbing reaction and serves as an

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emotional defense against the pain of separation. At this phase, children and adolescents deny the
impact of loss and avoid talking about their families hoping that the situation will be reversed.
The second phase of grief is characterized by anger or protest. At this stage, the shock
wears off, and the grieving person can no longer deny the loss. Therefore, emotions tend to
resurface. The first response is anger, which can be directionless or directed towards someone or
something they think caused the death of a loved one. In most cases, the anger is displaced and
tends to target people or things that are less threatening. For instance, a child can direct their
anger toward God, whom they believe could have prevented the death (Revet et al., 2020).
Behaviors associated with anger, such as protests and accusations, are common in this phase.
Then there is the third phase, known as bargaining. This stage marks the child’s final attempt to
regain control over their life. Children and adolescents tend to believe that if they behave in a
given way, they can reverse the situation and prevent the losses from becoming final (Revet et
al., 2020). Therefore, they resolve to behave extra friendly and careful to people they believe are
in a position to save the situation, such as the caseworkers and foster parents.
The fourth phase of grieving in adolescents and children is depression. At this phase, the
person acknowledges that eternal separation from a loved one is real. Therefore, they experience
the emotional impact of the loss and express futility and despair (Revet et al., 2020). Children
withdraw and show little or no interest in people and their environment. Besides, they experience
episodes of fear and panic, which have devastating consequences. Depression is the longest stage
of grieving and the most difficult to overcome in the whole process. The last stage is resolution.
Depression is emotionally draining, and most people cannot remain in that stage for extended
periods. Sometime after the loss, the grieving person naturally refocuses on their life and invests

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energy towards strengthening relationships (Revet et al., 2020). The phase is completed when
people stop to focus on the past and get actively involved in their present relationships.
However, if children and adolescents cannot go through the resolution stage, they will
likely remain in the depression phase. The stage tends to have serious consequences,
significantly if prolonged, due to a lack of stress coping strategies. Individuals can develop
trauma and stressor-related disorders such as acute stress disorder (ASD) and PTSD (Geronazzo-
Alman et al., 2019). Acute stress disorder begins immediately after a traumatic event in children
and adolescents. It lasts for three days to one month, as described in the DSM-5—the
continuation of acute stress disorder graduates to posttraumatic stress disorder. DSM-5 classifies
posttraumatic stress disorder as F43.10 and is characterized by the development of specific
symptoms such as extreme fear, horror, and helplessness after the child or adolescent
experiences a traumatic event (Bruno et al., 2019). Unlike in the grieving process, the stressor
condition can last long by recurring in a given pattern. For instance, the child can keep
remembering the events that happened during the death of a loved one, and flashbacks can act as
a trigger. The unsuccessful resolution phase is a precursor to trauma and stressor conditions.
Such can be addressed through therapies and providing a support system to the affected persons.
Difference Between Uncomplicated, Complicated, and Traumatic grief.
It is usually challenging to determine how long grieving can last. Everyone has a
different experience of loss. In the uncomplicated grief process, the painful experiences are
intertwined with positive emotions like happiness and peace, which emerge after a loss of a
loved one (Sanghvi, 2020). The positive emotions tend to elicit the negative feelings of guilt and
protest associated with grief. If the positive feelings last for more than six months following the
death of a loved one, it is an indicator of good long-term outcomes. The uncomplicated grief

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starts with acute grief in the early aftermath of a death. It is characterized by unusual behaviors
like intense sadness and crying, mainly because of a deceased person’s memories. The acute
grieving transit to integrated grief, whereby the wounds begin healing, and the grieving person
returns to their routine and fulfilling lives. At this stage, the loss becomes integrated into their
everyday lives, but they do not forget the deceased.
Complicated grief occurs when the bereaved individual fails to transit from acute to
integrated grief. Acute grief prolongs, resulting in recurrent painful emotions, traumatic distress,
and intrusive thoughts related to death. People experiencing complicated grief have difficulty
accepting the loss and find themselves in a loop of intense yearning and inevitable anxiety. A
child or adolescent experiencing complicated grief may believe their life is over and that the
intense pain will never end. Others may prolong the grieving because they feel it is the only thing
remaining in their relationship with the deceased. Preoccupation with the deceased may result in
maladaptive behavior, such as sitting at the cemetery and daydreaming (Sanghvi, 2020). Other
times, the grieving person may avoid activities that remind them of the deceased, leading to
estranging people they used to be close to.
Children and adolescents face the reality of leading their lives without a loved one. In
traumatic grief, children whose loved ones die under traumatic conditions develop trauma
symptoms that weaken their ability to go through the typical grieving process. The children and
adolescents get stuck on the traumatic aspects of death. The grievers remember their loved ones
and memories of the horrifying way the person died to take them back to the acute grieving
stage. The children begin to avoid people, activities, and objects that trigger memories of their
loved ones. Unlike normal bereavement, traumatic grief often happens when the nature of death
is unexpected, tragic, or violent (Sanghvi, 2020). Sudden medical conditions such as heart

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attacks can also lead to traumatic grief. However, in children especially, chronic medical
conditions can be traumatic because they may not have anticipated that their loved ones might
die soon. Therefore, according to them, death can be unexpected and sudden. Traumatic grief in
children and adolescents is characterized by the development of severe posttraumatic stress
disorder symptoms, including sleep loss.

Assessment Tools that Would Assist in Assessing These Conditions
There are a variety of screening techniques for assessing trauma and stressor-related
disorders like PTSD, acute stress disorder, and the three types of grief/bereavement in children
and adolescents. One of these tools is the Child and Adolescent Trauma Assessment Scale. This
tool is based on the DSM-5 and measures possible traumatic events and posttraumatic stress
symptoms (Eklund et al., 2018). It can be administered as a self-report or an interview, and the
technique is suitable for preschoolers, children, and adolescents. The Prolonged Grief Disorder
Scale also assesses symptoms of complicated grieving in children and adolescents.
Impact of Traumatic Grief on Childhood and Adolescent Development
Traumatic grief has a significant impact on childhood and adolescent development. The
grievers experience intense physiological responses or psychological distress in reaction to
reminders of the traumatic death of a loved one. Besides, they develop PTSD symptoms due to
recurrent intrusive thoughts of traumatic events that lead to the death of a loved one (Pastrana et
al., 2020). The children and adolescents’ social lives are also affected as they try to avoid things
and places that remind them of the loss. Also, they experience diminished interest in usual
activities and become emotionally detached from others. Children also develop hyperarousal
symptoms, including sleep disturbance, decreased concentration, and hypervigilance which
further affects their development. Adolescents depict some degree of functional impairment,

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which is manifested through anti-social behaviors and declining academic performance. Children
face additional challenges, mainly when the death is associated with circumstances that society
attaches a stigma to, such as homicide (Pastrana et al., 2020). Such children and adolescents do
not receive public sympathy or financial support, and the negative community judgment can
contribute to developing other mental health conditions that affect their development.

Conclusion

The childhood and adolescent grieving process differ from other trauma and stressor-
related disorders. Children and adults experience grief similar to adults, and their typical grieving
process follows five basic steps: denial, anger, bargaining, depression, and resolution. The
grieving period can be short or prolonged depending on an individual’s coping strategy and
relationship with the deceased. The unsuccessful resolution phase means that there will be
prolonged depression resulting in devastating consequences on the griever—the inability to
transition from acute to integrate grief result in complicated grief characterized by traumatic
experiences. A person can experience traumatic grief when the death of a loved one is sudden.
Trauma and stressor-related disorders develop when an individual fails to cope with the loss and
remains in the grieving process for a long. Such people require therapies and medical attention.
The conditions are assessed using various techniques, such as the Child and Adolescent Trauma
Assessment Scale. Assessing the condition allows the social workers to determine the severity of
the condition and possible intervention measures.

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