icult this will be depends on what the relationship between the child and lost parent was and the amount of disruption in daily life the child experiences due to the loss. The opportunity for a child's personal growth is perhaps most clearly seen in this part of the grief work.
Finally, the child must convert the relationship with the deceased from one based on continuing interactions to one based on memories. Children gradually withdraw emotional energy from the loved one and focus on establishing new relationships with others. The work of this task has been described as being able to say a final farewell to the dead person. This does not mean giving up memories; rather, this farewell releases a central attachment to the dead person so that more room and energy are available for engaging in life in the present.
Ultimately, the process outlined in this model is characterized by reconciliation, which is defined as the "process that occurs as the bereaved child works to integrate the new reality of moving forward in life without the physical presence of the person who died" (Cohen, Mannarino, Greenberg, Padlo, & Shipley, 2002, p. 309). Although most children are able to cope with the normative grieving process without complications (Boelen, van den Hout, & van den Bout, 2006; Bonanno, 2004), some who cannot successfully address these tasks may suffer complicated grief.
PARENTAL BEREAVEMENT IN CHILDHOOD
A review of the literature consistently indicates that bereavement in children is significantly related to depressive symptoms, withdrawal, and academic problems (Wolchik et al., 2006). Parental death involves a series of stressors that may affect numerous aspects of the life and functioning of children, such as a decrease in economic resources, changes in residence, loss of contact with peers, increased expectations and responsibilities, loss of time with the surviving parent, and a change in caretakers and the family system (Wolchik et al., 2006). As a result, bereaved youth report more depressive, anxious, and disruptive 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. Ch