Grief and Loss

Breaking Bad News to Your Children

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Posted on by Freya Gardon

Breaking Bad News to children

Allied health professionals, such as psychologists, can undergo years of training and practical experience to build their communication skills to deliver difficult news sensitively. They quickly learn that, when it comes to delivering bad news to children, it is essential to be prepared.

Parents, however, may need to learn as they go. At some point, all parents will have to communicate difficult or unpleasant situations to their children. Whether it’s the death of a family pet, moving away, separation/divorce, or harder still, the passing of a loved one – children and parents will need help navigating their emotional responses and behaviours through these tough times.

Clearly, this is a daunting task for anyone as we may feel inadequate to handle such situations. Research and experience tell us that the key is to let children know you are available to answer all questions and to provide as much support as needed. 

Here are some other top tips for delivering –  and dealing with the aftermath – of delivering bad news to your children.

1# Be honest

Lay out the facts at a level that is developmentally suited to the age of the child. Younger children may need help to understand the implications of the bad news and what it means for them. For example, approaching the topic of death or loss may result in a conversation about what death really means. Use words they understand and avoid saying things in such a way that might leave children confused about what you’re really saying.  Speak clearly.

For teenagers, it is particularly important not to “sugarcoat” or limit details of the information, as this is often perceived to be dishonest or patronising. A study of young adults revealed that if they viewed their parents to be hiding something, or later found out that the parents had not been entirely truthful, the response was negative.

2# Be prepared to answer their questions

Children want their questions answered.

In fact, a survey of young adults revealed those who had access to the information they wanted from their parents in times of crisis were much more satisfied than those who were told  to ask “no questions.” It is essential to schedule a time when there is enough opportunity for children to react and to think about what they want to ask, and for you to have time to respond calmly.

Avoid having difficult conversations immediately before school or work as this may be met with stress and anxiety without the chance to address these feelings appropriately.

Additionally, be prepared for awkward or tricky questions and be ready to answer them if you can. If you can’t answer a particular question, it is okay to admit you don’t know, rather than over-complicate an explanation.

3# Respect their ability to cope with the news, and their right to hear it

Respecting children’s developmental stage and maturity is essential. No one likes to be talked down to. Children whose parents speak to them as ‘equals’ feel respected and trusted, and are likely to respond with more maturity in a problematic situation.

In a research study by Donovan, Thompson, LeFebvre, and Tollison (2017) early adult respondents who perceived that their parents discussed tough issues with them more as peers, reported higher ratings of disclosure quality and in turn, greater relational closeness following the disclosure.

4# Provide reassurance

It is an essential role of parents to provide comfort and reassurance to children in stressful or distressing times. Let them it is ok to feel whatever they are feeling (e.g. sadness, anger). Confirm that these emotions are entirely valid responses to the situation.

Reassure them that you will be available to answer any questions or talk about this situation again at any time. Reassure them that they are loved.

5# Model good self-care

Share how you feel. Experiencing difficult situations, as well as talking about it with others, can be exhausting. Taking care of your own emotional well-being is essential and being honest is part of it.

Besides, it is perfectly okay to let your kids see that you are sad, angry, upset, etc. This gives them a chance to see how emotions affect other people and to learn how to regulate them effectively.

Parents are emotional role models, especially in times of crisis, and your children will inevitably look to you to assess what is an appropriate response in these times. Be natural and talk about it.

6# Seek help for yourself and your child(ren) if needed

This all being said, it is essential to reach out for help when needed; both for yourself, and for your child.

Calling on your support network and sharing how you feel or what do you need, can help everyone to cope better.

Additionally, if you’re feeling overwhelmed or the kids seem to be having an especially hard time coping, find a child psychologist who can work with your family. Child psychologists can assist you in developing an appropriate strategy for moving forward. You can contact the  Quirky Kid.

References

Brott, A.(2014, September 29) 9 tips for breaking bad news to kids[Blog post]. Retrieved from: https://www.huffingtonpost.com/knowmore-tv/9-tips-for-breaking-bad-news-to-kids_b_5623488.html

Donovan, E. E., Thompson, C. M., LeFebvre, L., & Tollison, A. C. (2017). Emerging adult confidants’ judgments of parental openness: disclosure quality and post-disclosure relational closeness. Communication Monographs, 84(2), 179-199. doi:10.1080/03637751.2015.1119867

Levetown, M. (2008). Communicating With Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information. Pediatrics, 121(5), e1441-e1460. doi:10.1542/peds.2008-0565

Livoti, N.(2013, June 30)Honesty and reassurance is key when talking to kids about bad news[Blog post]. Retrieved from: http://www.pennlive.com/bodyandmind/index.ssf/2013/06/honesty_and_reassurance_is_key.html

Marshall, L.B.(2016, July 8). How to break bad news to your teen. Retrieved from: http://www.quickanddirtytips.com/business-career/communication/how-to-break-bad-news-to-your-teen

 

Podcast: How to Help Children Cope with Bad News

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Posted on by Leonardo Rocker (Quirky Kid Staff)

Tips to Calm a Toddler in Distress : On-air Consultation

We’d love to share our latest podcast recorded by Dr Kimberley O’Brien for a local magazine with you. This weeks topic is helping children cope with bad news.

Quirky Kid has produced a full range of creative and engaging Therapeutic Tools.


 

[00:00:00-00:00:32] Dr. Kimberley O’Brien introduces strategies for parents to help kids cope with traumatic news.

Hello Bonnie. It’s Dr. Kimberley O’Brien here. I’m auto-recording in Japan, so I hope there won’t be any background distractions. I’ll talk for five minutes on strategies to help kids cope when they’ve seen a tragedy, or had some sort of unfortunate event. I’ll have some tips for parents as well – I’ll fill you in on that towards the end of the interview.


 

[00:00:33-00:02:27] Parents shouldn’t shield children from all forms of adversity. Instead, teach them coping strategies for stressful events, since those are an inevitable part of life. 

The first thing you said was about helping kids to deal constructively with bad news, rather than sweeping it under the carpet. I agree that it’s a healthier approach, because it’s really setting them up for life. It’s giving them the skills to overcome adversity, without feeling like a parent is required to shield them from something that’s not appropriate for kids to hear.

From a young age kids are learning how to overcome physical injuries. Like toddlers grazing knees – they hop up and brush themselves off, and then life goes on. They can cope with those sorts of little incidents. And if we do shield the kids from all adversity, then they don’t learn the coping skills they need in certain situations, like if they are not good enough for a sports team, or if they’re excluded from a game at school. Teaching them coping skills is like teaching them life skills that help them to be more resilient. And it gives them confidence to be able to overcome issues moving forward. That’s part of healthy psychological development.

Imagine adults that haven’t learned to overcome adversity. They’re more likely to react negatively, perhaps need a lot more support, and need to take time off work if they haven’t learnt to cope with life’s issues that will come our way. That’s just part of life, isn’t it? Kids will have to change schools, or they may lose a pet or loved one. That stress is a part of living, so it’s something that kids need to learn to cope with.


 

[00:02:27-00:04:08] Encourage children to express their feelings in words, rather than through actions. Praise them for expressing themselves clearly, and empathise with them verbally. When something bad happens, let kids write down questions in a booklet, so you can answer those questions when you feel prepared to remain calm during the discussion. It’s a way to model good coping skills. 

The best way to do this, for parents, is to prepare for question time if it’s something that’s happened for a young person, like the loss of a pet. Have a question booklet that kids can record some questions in. And then make sure you feel prepared emotionally to answer each one of those questions. When I say prepared emotionally, I mean that children often take their cues from their parents. If parents are very emotional, kids will often follow suit and become quite emotional. So being prepared to model good coping skills as a parent is important. Say “these things happen but we will get through it”. Use words to explain those feelings.

Sometimes kids will use actions or behaviour to express their emotions. For example, they may feel disappointed, or upset that they didn’t make the sports team, and they may throw their sports bag across the room. But what we want kids to do is to use their words, and say “I feel so disappointed, I’m so jealous that my best friend was selected and I wasn’t”. Parents should then use verbal praise to say “I’m so glad to hear you express yourself so clearly, now I understand how you feel”. Parents can empathise with young people: “I’ve felt that way before, this must be hard”. Empathising is also part of helping kids to express their feelings in words, rather than in actions.


 

[00:04:08-00:05:01] When it comes to family trauma, such as a separation or a tragedy, it’s better to get professional help because they can remain objective and provide the family with support.   

Just a final point now, for parents on how to help kids through family separation. It’s good to encourage them to see a psychologist, such as someone at the Quirky Kid Clinic or a school counselor, to help them normalize those feelings. Often if parents are involved in situations, like if there’s been a tragedy or trauma within the family, it’s better to get professional help. A professional can remain objective and provide kids and parents with stats on how often these things occur, how long it may take kids to recover, and what the phases of grief and loss may be. It’s good to have an expert when dealing with family separation or similar situations.


 

[00:05:01-00:05:58] When a tragedy happens, stick to the basic facts when relaying the news to the child. Avoid delving into the causes, or exposing them to distressing images, to avoid more of an emotional response. 

And finally, a tip about how to relay the news to a child. Say it was something that happened in the world, like a tsunami. We often get rising referrals when there’s been a trauma, like a tsunami, and kids have seen it on TV. It’s best to switch off the news when there’s lots of visual, distressing images for kids to catch. Parents have more control when they’re giving the news to the young person. Stick with the facts: what happened, how it happened, when it happened. Avoid going into the whys, because that’s often going to trigger more of an emotional response.


 

[00:05:58-00:06:50] Apart from verbally expressing themselves, it can also be useful for kids to use art or visual props to talk about how they felt before, during, and after an incident. 

I’m going to wrap up now. To help kids deal and process emotions, help them to use their words to understand those feelings, or to seek help from a professional. Sometimes kids will express their feelings using art, so give them an opportunity to draw what happened. Or, they can select images, such as from our “Face It” cards, which are feelings cards with a whole bunch of different facial expressions. Children can use them to talk about what they felt before, during, and after an incident. Visual props can be very helpful.

Bonnie, it’s been a pleasure to answer your questions today, and I look forward to talking to you again in the future. I’m Dr. Kimberley O’Brien from the Quirky Kid Clinic. That’s www.quirkykid.com.au. And keep in touch. Thank you.

Grief and Loss at Christmas

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Posted on by Dr. Kimberley O'Brien

Managing Grief and Loss at Christmas

While Christmas is a time of excitement and joy for many – others would prefer to sleep through a family gatherings, avoiding triggers of grief following a particularly painful year.

People grieve for different reasons – the loss of a grandparent, the loss of a business, a string of miscarriages or a recent divorce. Christmas may be the first public airing to family about the events of the year, and the anxiety associated with the potential outpouring of emotions can stifle the Christmas joy. Knowing how to emotionally prepare for Christmas may be the difference between hiding out in the bedroom and joining your family for an afternoon of fun in the sun.

Firstly, be aware of your triggers. A family overcoming the loss of a grandparent may wish to avoid having an empty seat ‘where grandpa used to sit’. For others, the empty seat may be a symbol of respect for the missing family member. Take a quick vote among the adult family members to decide if a move outdoors may be a welcome change of scene for grieving family members. Set up a picnic rug under a tree to avoid triggers of grief and loss before Christmas lunch. While missing family members are likely to be remembered on special occasions, for the majority of people grief is best processed in the most comfortable setting available. That is, raising your glasses to grandpa in the garden may symbolize the celebration of life, while sitting in the presence of his empty chair is more aligned with sadness and loss. Being mindful of the different stages of grief impacting on others, such as denial, anger or acceptance, may also help to acknowledge the perspectives of others during sensitive discussions relating to lost loved ones.

Secondly, be aware of the discussion topics you’re exposed following a recent loss. For example, listening to people talk about their pregnancies and newborns may trigger grief for a couple overcoming a series of miscarriages. Similarly, any reference to the word, “work” may be perceived as an insult to a young entrepreneur following a failed business venture. In fact, many innocent questions or conversations can give rise to defensive responses at Christmas. Taking offense to others is one symptom of grief. At this point, consider refilling your glass of water or checking on the kids for some light-hearted relief. It is natural for family members to show an interest in the lives of each other and asking questions is part of the annual catch-up for many relatives living apart. If anyone asks a question, you’d rather not answer, it’s ok to say, “Hey, enough about me – Let’s talk about you!” or “Hang on a second, I’ll be back” and head to the bedroom to regroup (AKA “losing it”).

The following strategies have been devised to prepare you for the onslaught of questions at Christmas and to help manage common grief responses, such as crying, taking offense, getting angry or rapidly leaving the room.

  • Step 1: Be prepared – Write or draw about the topic you would most like to avoid at least 24 hrs before your family gathering to clarify the issues for yourself.

  • Step 2: Develop a plan – Find the place you feel most relaxed and settle there. Try not to make it in front of the TV. Think outdoors, think shade and comfort. Being antisocial won’t help – It will only increase your anxiety about being perceived as rude.

  • Step 3: Bring props and distractions – Photos from your holiday, a good book or some massage oil. You may give or receive a massage that will completely change your outlook on the day ahead.

  • Step 4: Share your thoughts – Like children, adults are more likely to share their thoughts and feeling when they’re relaxed. A good conversation on Christmas Day may reveal you’re not alone in your grief – Most people have experienced loss in one form or another.

  • Step 5: Be kind to yourself – If you need to have a quiet Christmas, do it. We all need time to reflect and recharge. Write a note, go for a walk…and consider leaving early. There’s always next year.

For books on grief and loss, see the Quirky Kid Shoppe.

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Talking about tragedy with children

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Posted on by Leonardo Rocker (Quirky Kid Staff)

This article as initially published by National Association of School Psychologists (USA)

Whenever a national tragedy occurs, such as terrorist attacks or natural disasters, children, like many people, may be confused or frightened. Most likely they will look to adults for information and guidance on how to react. Parents and school personnel can help children cope first and foremost by establishing a sense of safety and security. As more information becomes available, adults can continue to help children work through their emotions and perhaps even use the process as a learning experience.

All Adults Should:

  • Model calm and control. Children take their emotional cues from the significant adults in their lives. Avoid appearing anxious or frightened.
  • Reassure children that they are safe and (if true) so are the other important adults in their lives. Depending on the situation, point out factors that help insure their immediate safety and that of their community.
  • Remind them that trustworthy people are in charge. Explain that the government emergency workers, police, firefighters, doctors, and the military are helping people who are hurt and are working to ensure that no further tragedies occur.
  • Let children know that it is okay to feel upset. Explain that all feelings are okay when a tragedy like this occurs. Let children talk about their feelings and help put them into perspective. Even anger is okay, but children may need help and patience from adults to assist them in expressing these feelings appropriately.
  • Observe children’s emotional state. Depending on their age, children may not express their concerns verbally. Changes in behavior, appetite, and sleep patterns can also indicate a child’s level of grief, anxiety or discomfort. Children will express their emotions differently. There is no right or wrong way to feel or express grief.
  • Look for children at greater risk. Children who have had a past traumatic experience or personal loss, suffer from depression or other mental illness, or with special needs may be at greater risk for severe reactions than others. Be particularly observant for those who may be at risk of suicide. Seek the help of mental health professional if you are at all concerned.
  • Tell children the truth. Don’t try to pretend the event has not occurred or that it is not serious. Children are smart. They will be more worried if they think you are too afraid to tell them what is happening.
  • Stick to the facts. Don’t embellish or speculate about what has happened and what might happen. Don’t dwell on the scale or scope of the tragedy, particularly with young children.
  • Keep your explanations developmentally appropriate. Early elementary school children need brief, simple information that should be balanced with reassurances that the daily structures of their lives will not change. Upper elementary and early middle school children will be more vocal in asking questions about whether they truly are safe and what is being done at their school. They may need assistance separating reality from fantasy. Upper middle school and high school students will have strong and varying opinions about the causes of violence and threats to safety in schools and society. They will share concrete suggestions about how to make school safer and how to prevent tragedies in society. They will be more committed to doing something to help the victims and affected community. For all children, encourage them to verbalize their thoughts and feelings. Be a good listener!
  • Monitor your own stress level. Don’t ignore your own feelings of anxiety, grief, and anger. Talking to friends, family members, religious leaders, and mental health counselors can help. It is okay to let your children know that you are sad, but that you believe things will get better. You will be better able to support your children if you can express your own emotions in a productive manner. Get appropriate sleep, nutrition, and exercise.

What Parents Can Do:

  • Focus on your children over the week following the tragedy. Tell them you love them and everything will be okay. Try to help them understand what has happened, keeping in mind their developmental level.
  • Make time to talk with your children. Remember if you do not talk to your children about this incident someone else will. Take some time and determine what you wish to say.
  • Stay close to your children. Your physical presence will reassure them and give you the opportunity to monitor their reaction. Many children will want actual physical contact. Give plenty of hugs. Let them sit close to you, and make sure to take extra time at bedtime to cuddle and to reassure them that they are loved and safe.
  • Limit your child’s television viewing of these events. If they must watch, watch with them for a brief time; then turn the set off. Don’t sit mesmerized re-watching the same events over and over again.
  • Maintain a “normal” routine. To the extent possible stick to your family’s normal routine for dinner, homework, chores, bedtime, etc., but don’t be inflexible. Children may have a hard time concentrating on schoolwork or falling asleep at night.
  • Spend extra time reading or playing quiet games with your children before bed. These activities are calming, foster a sense of closeness and security, and reinforce a sense of normalcy. Spend more time tucking them in. Let them sleep with a light on if they ask for it.
  • Safeguard your children’s physical health. Stress can take a physical toll on children as well as adults. Make sure your children get appropriate sleep, exercise, and nutrition.
  • Consider praying or thinking hopeful thoughts for the victims and their families. It may be a good time to take your children to your place of worship, write a poem, or draw a picture to help your child express their feelings and feel that they are somehow supporting the victims and their families.
  • Find out what resources your school has in place to help children cope. Most schools are likely to be open and often are a good place for children to regain a sense of normalcy. Being with their friends and teachers can help. Schools should also have a plan for making counseling available to children and adults who need it.

What Schools Can Do:

  • Assure children that they are safe and that schools are well prepared to take care of all children at all times.
  • Maintain structure and stability within the schools. It would be best, however, not to have tests or major projects within the next few days.
  • Have a plan for the first few days back at school. Include school psychologists, counselors, and crisis team members in planning the school’s response.
  • Provide teachers and parents with information about what to say and do for children in school and at home.
  • Have teachers provide information directly to their students, not during the public address announcements.
  • Have school psychologists and counselors available to talk to students and staff who may need or want extra support.
  • Be aware of students who may have recently experienced a personal tragedy or a have personal connection to victims or their families. Even a child who has merely visited the affected area or community may have a strong reaction. Provide these students extra support and leniency if necessary.
  • Know what community resources are available for children who may need extra counseling. School psychologists can be very helpful in directing families to the right community resources.
  • Allow time for age appropriate classroom discussion and activities. Do not expect teachers to provide all of the answers. They should ask questions and guide the discussion, but not dominate it. Other activities can include art and writing projects, play acting, and physical games.
  • Be careful not to stereotype people or countries that might be associated with the tragedy. Children can easily generalize negative statements and develop prejudice. Talk about tolerance and justice versus vengeance. Stop any bullying or teasing of students immediately.
  • Refer children who exhibit extreme anxiety, fear or anger to mental health counselors in the school. Inform their parents.
  • Provide an outlet for students’ desire to help. Consider making get well cards or sending letters to the families and survivors of the tragedy, or writing thank you letters to doctors, nurses, and other health care professionals as well as emergency rescue workers, firefighters and police.
  • Monitor or restrict viewing scenes of the event as well as the aftermath.
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What’s in a label? Should I get a diagnosis for my child?

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Posted on by Leonardo Rocker (Quirky Kid Staff)

What’s in a label? Should I get a diagnosis for my child?

‘Labelling a child’ is the term used to describe the process where a psychologist or psychiatrist assesses a child, resulting in a diagnosis or ‘label’. The diagnosis is based on a set of criteria defined in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV).

About 10% of children and young people will have a mental health problem. The most common diagnoses for children include anxiety disorders; attention-deficit and disruptive behavior disorders; autism spectrum disorders; and eating disorders (for example, anorexia nervosa).

If you suspect your child may have a mental health condition, chances are you’ve wondered if it’s beneficial to obtain a professional opinion and perhaps a diagnosis. While professionals were traditionally hesitant to diagnose pre-adolescents with DSM-IV conditions, diagnoses have been on the rise since the 1980s, partly as a result of greater research into child mental health.

What is a diagnosis?

A reputable mental health professional will not give a diagnosis without a thorough evaluation of a person’s symptoms, behaviours, and developmental history. In the case of a child, specialists will usually consult with several other sources (for example, parents, teachers, and family doctors) before confirming a diagnosis.

What are the advantages of a diagnosis?

An accurate diagnosis will give parents and their child a clear and realistic sense of the limitations and challenges the child may face as a result of the disorder. Following a diagnosis, you should also have a good sense of what treatment plans are available, their pros and cons, and how effective they are. This knowledge can provide tremendous peace of mind for families who are struggling.

Other advantages of a diagnosis include:

  • An accurate understanding of your child’s strengths and how to best harness them.
  • Individual support from Specialists at your child’s school (for example, regular hours with a Learning Support teacher or funding for resources or appropriate training for teachers).
  • Subsidized help for the family (for example, home-based intervention such as ABA for children with autism spectrum disorders).
  • Effective collaboration between health professionals. For example, a Speech Pathologist, Occupational Therapist and Psychologist can work together to give your child comprehensive treatment.

What are the disadvantages of a diagnosis?

Most professionals agree: forming a diagnosis can be difficult. A child’s behaviour can change depending on their environment, their food intake and the people around them, which can impact the assessment process.

The disadvantages of a diagnosis may include:

  • Stigma from other parents or peers.
  • Difficulties reversing the diagnosis should behaviour change or improve.
  • Children need support when discussing a diagnosis.
  • Some families might find a thorough assessment and Diagnostic Report costly.

Finding more support:

Quirky Kid has offices in Sydney and Wollongong,

If you are concerned as to whether or not obtaining a diagnosis for your child is right for your family, you may find it helpful to talk through the decision with a professional yourself. Ask your health care provider about counselling or support services in your community or contact Quirky Kid on +61 2 9362 9297.

Parents may find useful resources at the Quirky Kid Shoppe.

Sources:

National Institute for Mental Health in England (2008). The Mental Health Act: Essential Information for Parents and Caregivers.

Harakavy-Friedman, Jill M (2009). Dimensional Approaches in Diagnostic Classification: Refining the Research Agenda for DSM-V. American Journal of Psychiatry 166, 118-119

Kimberley O’Brien (2011). Interview on the advantages, disadvantages, benefits and challenges of diagnosing children.

The Cleveland Clinic (2005-2009). “Attention Deficit Hyperactivity Disorder.” http://my.clevelandclinic.org/disorders/Attention_Deficit_Hyperactivity_Disorder/hic_Attention-Deficit-Hyperactivity_Disorder.aspx. Retrieved September 24, 2011.}

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