Certain warning signs that may indicate that a bereaved child needs professional help with his/her mourning. Before I begin, I would like to stress a couple of points. First, not all bereaved children need professional counseling regarding their grief. Children can be remarkably resilient and about two-thirds are able to adjust well within two years after the death. However, one-third of bereaved children have sufficient emotional and/or behavioral problems that counseling may be justified. The challenge is determining which children make up that one-third.

The other important point I want to make is that just because a child is acting-out after a death; it is not necessarily due to a sudden onset of disorders such as Attention Deficit/Hyperactivity Disorder (ADHD). Rather, the acting-out may be a behavior that helps the child survive during this time. A. D. Wolfelt lists six functions that acting-out may serve as:

1. A way to express insecurity;
2. A way to express feelings of abandonment, especially after the death of a parent, leading to a self-fulfilling prophecy of being unloved;
3. A way to cause the child to be disciplined so as to help feel secure;
4. A way to alienate others to prevent the pain of any future losses;
5. A way prove to themselves they are still alive, thereby counteracting their own personal death anxiety; and
6. A way of releasing internalized grief reactions that have built up to the point that the child can no longer contain them.

The ten warning signs, well described in William Worden’s book Children and Grief: When a Parent Dies, which indicate children are having trouble with their mourning are similar to warning signs that adults exhibit. As with adults, the question is normally not if the signs appear, but rather, how long they last. For children if these signs appear soon after the death and last several months or increase in intensity, it is probably time to get some professional help.

1. Persistent difficulty talking about the deceased person, especially a parent;
2. Uncharacteristic aggressive behavior;
3. Anxiety about the safety of others, especially a surviving parent - normally, this decreases during the first year after the death;
4. Physical symptoms such as stomachaches, headaches, etc. or the worsening of a previous physical condition - of course, in this last case, medical attention is called for;
5. Sleeping difficulties such as persistent nightmares and/or trouble falling asleep or staying asleep;
6. Changes in eating habits such as overeating, not eating properly, or signs of anorexia or bulimia;
7. Social withdrawal;
8. Difficulties in school, either socially or academically;
9. Persistent self-blame or guilt; and
10. Self-destructive behavior or a desire to die - a warning sign that adults should take seriously and act upon immediately!