138 Grief and Loss Across the Lifespan
required to experience loss and grief; hence, some believe IWDDs are not
able to experience these emotions (Brickell & Munir, 2008; Dodd, Dowling, &
Hollins, 2005). Research has shown that this is false; children with cogni-
tive impairments do have the capacity to grieve (Brickell & Munir, 2008) and
should be assisted to express their grief (Dodd et al., 2005).
Placement of one’s child in an RCF precipitates loss for the child on
many different levels. Removal from their family of origin, relocating to a
new residential environment, interacting with a myriad of people who (at
least initially) are unfamiliar to them, and exposure to different care regimes
invoke traumatic (Clements, Focht-New, & Faulkner, 2004) and disenfran-
chised (Doka, 1989) losses and adjustment issues. Compounding and com-
plicating this situation is their inability to express emotions in conventional
manners (Clements et al., 2004). As a result, caregivers may often fail to make
the connection between certain behavioral outbursts, somatic complaints,
sleep disturbances, and aggressive or self-injurious behaviors and a grief
reaction.
For Sophie, who is blind and has hearing difficulties in addition to her
cognitive and physical impairments, a relocation of this nature was quite
traumatic. Sophie acted out behaviorally in her classroom after her residen-
tial admission. She made violent rocking movements and loud vocalizations,
oftentimes disrupting the class. In addition, her body reacted to the different
dietary regime. Having been used to smaller amounts of, and more frequent
opportunities for, fluid intake when she resided at home, her bladder capac-
ity was diminished. Sharon and Dan would come to visit and frequently find
Sophie sitting in a wet diaper. They were initially angry and frustrated as they
sought a way to work with the interdisciplinary team to understand why this
was the case and to develop a solution.
After careful investigation and several team meetings with the family, it
was determined that Sophie’s bladder was not large enough to accommodate
the regulated amount of fluids as per her dietary orders. Children at the RCF
are on strict regimens in accordance with medical and dietary specifications.
However, Sophie needed to have her fluids increased in a slow, incremental
manner until her bladder stretched and could better accommodate the volume.
Many team meetings were required and strict adherence to a more frequent
diaper check schedule were implemented until Sophie’s bladder enlarged.
Sharon and Dan also provided information about Sophie’s preferred
activities. Music, in particular country music, seemed to be a favorite. The
family was asked to supply a list of favorite country tunes along with a CD
player and head set so that Sophie could have access to her favorite music as a
reward during school for positive behaviors. This strategy was also employed
on her residential unit to provide comfort as she became more familiar with
her new living environment. Over time, her bladder size increased and disrup-
tive behaviors decreased. Sophie was able to adjust physically and emotion-
ally to the loss of her home environment.Family AdjustmentSophie’s parents appear to have a mutually supportive relationship and to
share common long-term goals and expectations for Sophie. They utilize