ildren two years post-loss were also reported to be more socially withdrawn, display more aggressive behavior, experience more somatic symptoms, and report more health problems.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 received by the child after the loss, are substantially related to how children cope (Kalter, Lohnes, Chasin, Cain, Dunning, & Rowan, 2002). The surviving parent may be ill-prepared for managing his or her own reactions as well as the reactions of the child. Typical responses to the death of a spouse include feelings of guilt, anxiety, sadness, and preoccupation with thoughts of death or the deceased. Negative relations with the surviving caregiver has been shown to be more predictive of maladjustment for bereaving children than other factors; a positive adjustment of the surviving parent is necessary for a more positive adjustment of the child (Hope & Hodge, 2006).
Helping the surviving parent to implement positive parenting practices and foster a positive parent-child relationship is consistently regarded as important to the adjustment of parentally bereaved children (Sandler et al., 2008). Caregiver warmth includes displaying a positive regard toward the bereaved child, conveying acceptance, expressing affection, fostering open communication, and providing emotional support (Haine, Ayers, Sandler, & Wolchik, 2008). Additional support for both children and surviving parents (e.g., support groups, grief groups) may be beneficial to promote adjustment among grieving children and their families. The fact that bereaved children will likely experience a range of emotions like sadness, anger, guilt, and anxiety (Silverman & Worden, 1992; Worden, 1991) makes open communication imperative. More openness and frequency of communication is associated with less depression and anxiety in bereaved children (Hope & Hodge, 2006).
Adaptation to parental death can be facilitated by providing accurate information about the grief process (Corr, 1995) to decrease any maladaptive cognitions that may disrupt adjustment (e.g., feeling responsible for the death because of an argument beforehand). Educating children about death and bereavement may help reduce anxieties while also normalizing the grief process (Hope & Hodge, 2006).
Given the m