Prolonged grief in children and adolescents: Assessment, correlates, and treatment

Approximately 6400 children and adolescents lose a parent in the Netherlands and even more children are confronted with other types of loss such as the death of a close friend or grandparent. The death of a loved one is one of the most devastating events that can occur in children’s and adolescents’ lives. There is growing recognition of a syndrome that children can develop post loss, referred to as Prolonged Grief Disorder (PGD). This dissertation project had three aims: (I) to increase our understanding of the phenomenology and correlates of PGD, (II) to enhance knowledge on the role of negative thinking in the development of PGD in children and (III) to develop an intervention for children who suffer from loss and to examine its feasibility an potential efficacy. Three studies were conducted to investigate the first aim. First we developed the Inventory of Prolonged Grief for Children (IPG-C) and the Inventory of Prolonged Grief for Adolescents (IPG-A). Findings suggest that both inventories have good internal consistency, stability and concurrent validity. Both can be used for the assessment of PGD in children and adolescents who suffer from loss and also for treatment studies among bereaved children. In a second study we found that PGD, depression and Posttraumatic Stress Disorder (PTSD) are distinct constructs in children who suffer from bereavement. Our third study suggested that avoidance symptoms of bereavement-related PTSD may better be conceived as two separate clusters of effortful avoidance and symptoms of emotional numbing. Beside those main findings we found that correlations between children’s ratings and parent-ratings on grief related feelings are moderate. This indicates that it is important that children report about their own grief instead of solely relying on their parents’ observations of the suffering following a loss. In order to understand why some children cope with loss more easily than others (our second aim), it is also important to study the role of negative thinking among bereaved children. However, no measure was available. To fill this gap, we developed the Grief Cognition Questionnaire for Children (GCQ-C). Findings suggest that it is a reliable and valid tool to examine negative grief related cognitions in children and adolescents. Despite the fact that some children suffer from grief related problems and that there is a growing recognition of PGD, hardly any effective treatments are available. We therefore developed Grief-Help, a cognitive behavioural treatment that consists of nine (weekly) sessions for the child and five separate (two-weekly) sessions for their parent(s). We tested Grief-Help in two separate pilot studies. Based on those studies the treatment appears promising enough to warrant evaluation in a controlled trial. Such a multicentre Randomised Controlled Trial therefore is currently being conducted in the Netherlands.