How Can we Help Children Deal with
Sudden and Violent Death?

Karola Dillenburger

Traditional stage theories of bereavement lead to multiple bereavement counseling approaches for children. Usually we are advised to give children time to talk, to listen to them carefully, to give them physical comfort, and to try to offer security. However, time and again research tells us that loving care alone has been shown to be not enough in meeting children's needs as they face the crises of sudden trauma and death (Dillenberger, 2001).

Studies of the effects of traumatic death in Northern Ireland demonstrate that a behavioral approach to grief counseling with children and adults can do much to help them deal with loss and separation (Dillenburger, 1992; Dillenburger, 1996; Dillenburger & Keenan, 1993; Dillenburger & Keenan, 1994).

The first thing behavior analysts and grief counselors using a behavioral approach should do is help to define the behaviors in question. The term behavior refers to everything people do, and this includes publicly observable behaviors and also more private behaviors such as feelings and thoughts. Terms such as bereavement, trauma, and grief are labels used to summarize a very wide range of behaviors.

What kind of behaviors in children we can expect after traumatic events? Here are the most common ones (Gibson, 1991):

1. Sleep disturbances that are very often seen in the first few weeks, include reports of fear of the dark, bad dreams, nightmares, and can persist over many months.
2. Separation difficulties such talking about a fear of being alone, clinging to adults, and speaking of fear of losing a familiar adult.
3. Concentration difficulties can occur, with children's school performance deteriorating.
4. Difficulties remembering new material, as well as loss of former skills such as in reading or music can be experienced.
5. Intrusive thoughts and repeated talking about the incident occur, often triggered by things that remind the child of the traumatic incident.
6. Some children become mono-syllabic and no longer talk openly to parents or others.
7. Other children almost boast about their trauma and talk much more.
8. Some children appear fearful with a heightened alertness to danger and risk situations.
9. Others say that they want to live each day to the full by taking dangerous risks.
10. Children often revert to behaviors that they engaged in early childhood, such as thumb-sucking or bed wetting.

A good general rule for reacting to children who have experienced trauma is to ignore undesirable behaviors of these children, while at the same time, giving much attention to desirable behaviors displayed by them (Ashkenazi, 1977). The exact nature of desirable and undesirable behaviors obviously depends on the circumstances and culture, as well as the child and his/her parents.

More specific and practical recommendations include the following:

1. Promptly communicate important personal information to the child; don't delay it. Use plain language and keep it brief.
2. Avoid repetitive explanations as this will not increase the child's understanding of the situation. Continuous clarifications encourage constant questions possibly leading to other problematic attention seeking behaviors.
3. Focus attention on behaviors that help the child deal with trauma in the long run, and ignore those which are unhelpful. New behaviors will probably appear, or previously infrequent behaviors may become more common.
4. Aggressive or destructive behaviors should be stopped using a method that the child is used to. Be consistent in the reactions with clear defining lines between 'appropriate' and 'inappropriate' behaviors.
5. Return to normal routines as soon as possible. Do not relate to the child differently or let him/her avoid a task or chore. Do not change past habits of eating or sleeping. Praise him/her more frequently than in the past for tasks well done.
6. Do not allow the child to be showered with presents; behave as normally as possible.
7. Express your own feelings but protect the child only from extreme outbursts, as these may scare the child.

It is not the traumatic event itself that should be emphasized but the reactions of children and the significant adults in their lives. Help everyone to get 'back to normal' as soon as possible, even though this is difficult to do. But remember that even when children engage in 'normal' observable behaviors this doesn't mean that they have forgotten their suffering and are feeling fine.

Changes in feelings, emotions, and thoughts will be linked to the experiences of children as they return to normal patterns of observable behavior. Our task is to build a social environment supporting those changes. and to identify the specific ways we can selectively, immediately and positively respond to support children's return to normal behaviors. (This is what behavior analysts call contingently and positively responding to behavior. It involves our building and managing a social environment that carefully and specifically supports the positive changes in children's behavior that we want to bring about through our grief counseling.) Ashkanazi found that parents and other significant adults taking action using the above advice increase the likelihood that children will be able cope with death and traumatic loss.

In summary, the advice for parents and others who care for children who have experienced traumatic events looks like this:

• Maintain a normal point of view. Do not make the feel child different in his/her own eyes or in the eyes of other children.
• Maintain everyday routines. Do not change regular routines at home or school.
• Be as consistent as possible in your reactions to the child's behaviors.
• Be generous with praise for tasks well done.

B.F. Skinner once said,

“One can picture a good life by analyzing one's feelings, but one can only achieve it by arranging environmental contingencies” (1980, p. 127).

Clearly, he was right, even when children face the challenge of managing the most traumatic, unimaginable, and devastating events. Our challenge in grief counseling is more than our private and personal understanding of the impact of grief, for ourselves and for children. As counselors we must take action to develop a personal social environment for children that specifically, positively and immediately responds to their needs and builds a behavioral pathway for a return to normal life.

References

Ashkenazi, Z. (1977). The application of principles of operant conditioning to war widows and their children. In C.D. Spiegelberger, I.G. Sarason & N.A. Milgram. (Eds) Stress and anxiety. Washington DC: Hemisphere.

Dillenburger, K. (1992). Violent bereavement: Widows in Northern Ireland. Aldershot: Avebury.

Dillenburger, K. (1996). Helping children in care deal with trauma. Northern Ireland Journal of Multidisciplinary Child Care Practice, 4, 40-45.

Dillenburger, K. (2001). 'Discovery' and treatment of trauma. Response. In B. Hamber, D. Kulle, & R. Wilson. (Eds) Future policies for the past (pp. 65-72). Belfast: Democratic Dialogue.

Dillenburger, K. & Keenan, M. (1993). Mummy don't leave me. The management of brief separation. Practice, 1, 66-69.

Dillenburger, K .& Keenan, M. (1994). Bereavement: A behavioural process. The Irish Journal of Psychology, 15, 524-539.

Gibson, M. (1991). Order from chaos. Responding to traumatic events. Birmingham: Venture

Skinner, B.F. (1980). Notebooks. (Edited by R. Epstein). Englewood Cliffs, NJ: Prentice Hal

Karola Dillenburger is a lecturer at the School of Social Work, The Queen's University of Belfast, Northern Ireland. She is best known for her research on the adjustment and treatment of survivors of violent bereavement in Northern Ireland. She is co-author of the first multi-media CD ROM on Behavior Analysis. Contact kdillenburger@bigfoot.com

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