130 Chapter 13
As a group, bereaved children have higher rates of psychopathology
than control children for the year following the loss. In a sense, bereave-
ment reactions are an inevitable corollary of attachment relationships.
However, when there are long-term harmful sequelae, they usually arise
not because of the psychological impact of the loss, but because there has
also been disruption of good quality emotional and general care, loss of
activities, change of schooling, poorer living conditions, and so on. Psychi-
atric assessment may be indicated where children are under 10 years old,
have intellectual disabilities, have suffered previous losses, where there is a
personal or family history of psychiatric disorder, where death is sudden or
otherwise traumatic, where there are multiple adversities; and where the
surviving parent is failing in the care of their child. Intervention includes
supporting the parent to look after their child sensitively, and helping
the child or adolescent to understand the loss, visit the grave and mark
anniversaries, thus sharing the mourning. Trials of such interventions
show they reduce psychopathology and improve functioning.
Subject review
Black D. (2002) Bereavement. In: Rutter M, Taylor E (eds)Child and
Adolescent Psychiatry. 4th edn. Blackwell Science, Oxford, pp. 299–308.
(This masterly summary has no equivalent in the 5th edition and is still
well worth reading for its clinical wisdom.)
Yule W, Smith P. (2008) Post-traumatic stress disorder.In: Rutter Met al.
(eds)Rutter’s Child and Adolescent Psychiatry, 5th edn. Wiley-Blackwell,
Chichester, pp. 686–697.
Further reading
Ertl Vet al. (2011) Community-implemented trauma therapy for former
child soldiers in Northern Uganda: A randomized controlled trial.JAMA
306 , 503–512.
King NJet al. (2000) Treating sexually abused children with post-traumatic
stress symptoms: A randomised clinical trial.Journal of the American
Academy of Child and Adolescent Psychiatry 39 , 1347–1355.
Smith Pet al. (2009)Post Traumatic Stress Disorder. Routledge, London. (In
series on CBT with Children, Adolescents and Families.)
Yule Wet al. (2000) The long-term psychological effects of a disaster
experienced in adolescence.Journal of Child Psychology and Psychiatry 41 ,
503–511.