ruptive behaviors than nonbereaved children as well as heightened psychological and social difficulties and a higher incidence of behaviors consistent with depression and conduct disorder (Thompson et al., 1998).
From an attachment theory perspective, disruptions in a bond formed through early emotional attachment have serious implications for later social relationships and psychological adjustment (Mack, 2001). Different reactions are seen in response to permanent separation (parental death), such as sadness and depression. If children respond to parental loss with despair and sadness, in adulthood attachment-related feelings may manifest in low self-confidence or symptoms of depression.
Most research examining the impact of parental death on children has focused on long-term psychological consequences or delayed effects; only a few studies have examined the more immediate impact of parental death (within two years of loss) on the emotional well-being of bereaved children (Worden & Silverman, 1996).
Studies that examined the short-term adjustment of children have yielded mixed results. Some researchers reported that parentally bereaved children display considerable distress and significant impairments, including depressive symptoms, anxiety, aggressive and disruptive behaviors, and academic difficulties (Christ et al., 1993; Thompson et al., 1998). Other researchers have found that children who experience the death of a parent are largely indistinguishable from nonbereaved peers with regard to short-term reactions (Silverman & Worden, 1992).
About 18 months post-loss, most children are considered to be "well adjusted," particularly with regard to measures of depression and anxiety compared with nonbereaved controls (Lawrence, Jeglic, Matthews, & Pepper, 2006). However, some bereaved children do not begin to display more problems than the nonbereaved until two years after a parent's death (Worden & Silverman, 1996). Difficulties then arise, among them more anxiety and social difficulties and lower self-esteem. Children two years post-loss were also reported to be more socially withdrawn, display more aggressive behavior, experience more somatic symptoms, and report more health problems.
The mixed results in the research highlight the variability in outcomes for parentally bereaved children. This is not completely surprising considering the multitude of factors that may contribute to positive rather than negative adjustment. Sandler, Wolchik, and Ayers (2008) highlighted the notion that outcomes, both positive and negative, are not predicted by any single factor but rather by the accumulation of risk and protective factors. Most importantly, with bereaved children the developmental course of grief needs to be considered because bereavement is a process that continues over time, and throughout their lifespan these children will revisit the loss repeatedly, especially during significant life events (e.g., graduation from school, marriage, and the birth of their own children).
Factors Influencing Adjustment of Bereaved Children
Factors that may influence the adjustment of parentally bereaved children include both child-level and family-level variables (Sandler et al., 2003). Age, sex, the relationship with the deceased, the circumstances of the death, the adjustment and emotional stability of the surviving caregiver, the presence of siblings, and participation in interventions and rituals (e.g., the funeral), are consistently reported in the literature as influencing the adjustment of the parentally bereaved child (Hope & Hodge, 2006).
Specific child-level variables, such as coping efficacy and appraisal of threat, are reported to impact adjustment; in particular, fear of abandonment appears to be a salient construct for these children. Researchers have also found support for self-esteem and control beliefs as protective resources for parentally bereaved children (Haine, Ayers, Sandler, Wolchik, and Weyer, 2003).
Multiple family-level variables, such as the adjustment of the surviving caregiver and the quality of care receiv