L10B_ Separation, Grief and Bereavement_PHGD_SB5 (09_04_2024).pdf

CM101: Stand-alone Subject PHGD: LOSS, SEPARATION & BEREAVEMENT Alex Dy, MD | Sept 4, 2024 TOPICS IX. Roles of Developmental Health Care I. Los...

CM101: Stand-alone Subject PHGD: LOSS, SEPARATION & BEREAVEMENT Alex Dy, MD | Sept 4, 2024 TOPICS IX. Roles of Developmental Health Care I. Loss, Separation, & Bereavement A. Support During Bereavement A. Loss B. Funeral Attendance B. Separation C. Continued Care C. Bereavement D. Educational Role II. Theories of Attachment E. Communication & Support A. Bowlby’s Attachment Theory F. Risk Factors & Further Assessment B. Ainsworth’s Strange Theory X. Treatment Approaches III. Response to Reunion A. Special Considerations for Refugee IV. Divorce Children A. Prevalence and General Impact VIII. Importance of Spiritual Support B. Parent-Child Dynamics Post Divorce A. Role of Pastoral Care Teams & C. Disrupting the Familiar Spiritual Leaders D. Emotional and Psychological Risks B. Guidance for Physicians E. Long-Term Effects on Children C. Conclusion F. Positive Outcomes with Proper IX. The Kubler-Ross Model Management X. Review Questions G. Key Factors Affecting Child Morbidity XI. References in Divorce XII. Appendix VI. Separation Because of Hospitalization A. Challenges in hospitalization B. Positive adjustments for hospitalization LOSS, SEPARATION, & BEREAVEMENT C. Conclusion VI. Duty Related Separation From LOSS ParentsMilitary Arrangements Losing someone of something insignificant A. Unique challenges B. Impact of Deployments Death of a loved one C. Support Systems End of significant relationship D. Conclusion Loss of health VII. Parental/Sibling Death SEPARATION A. Coping with Sudden Loss Divorce B. Support Systems for Grieving Relocation Children Life changes that disrupt established C. Grief/Bereavement connections D. Nature of Grief E. Role of Pediatrician BEREAVEMENT F. Impact of Terminal Illness & Sudden Period of mourning and adjustment following a Death loss, particularly after the death of a loved one. G. Support Systems Range of Emotions: H. Long Term Effects if Bereavement Sadness I. Coping with Loss from Disasters Anger J. Encouraging Healthy Grief Guilt K. Conclusion V. Measurement of Bereavement in Children Loneliness A. Core Bereavement (CBI) Relatively Brief B. Intrusive Grief Thoughts Scale (IGTS) Vacations VI. Behavioral Patterns Parental job obligations A. Persistent Complex Bereavement Natural disasters or civil unrest Disorder Parental & sibling illness requiring 1. Criterion A hospitalization 2. Criterion B 3. Criterion C Enduring and Frequent 4. Conclusion Divorce VII. Guidance for Healthcare Professionals Foster care or Immigration VIII. Developmental Perspectives on Children’s Responses to Death Permanent PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 1  LOSS, SEPARATION AND BEREAVEMENT – Week 4 Death they return, the child throws a tantrum (clings to Take into account the child's age, developmental the caregiver but also avoids it) stage, past experiences, the specific relationship Showing anxiety and uncertainty with the absent person, and the context of the A child check caregiver nearby, becomes situation. stressed when caregiver leaves, but becomes Provides insights into the development of consolable upon caregivers return emotional coping mechanisms & personal Secure Attachment growth. A child becomes upset when the caregiver leaves Note: seek help from a professional to help with coping Child is confident that caregiver provides the grief needs of the child RESPONSE TO REUNION THEORIES OF ATTACHMENT Mixed reactions: caution or wariness Initial affection may quickly turn to indifference Bowlby’s Attachment Theory Anger at being left or fear of future separation Attachment Bonds: Innate drive to form attachments “Magical thinking” may cause feelings of guilt with caregivers Restoring the Parent and Child Bond Attachment Behaviors: Crying, cinging, and seeking proximity Clingy behavior helps reestablish broken bonds Engages the returned parent more closely Influence: Usually, behaviors are temporary Social, emotional, cognitive development Impact of Recurrent Separation Relationships later in life Wary and Guarded behaviors Notes: May struggle to reconnect with the repeatedly Innate absent parent Not learned Ainsworth’s Strange Theory Note: Parents should avoid using threats of leaving Secure Attachment Threatening to leave can exacerbate a child’s Note: They feel bothered when caregivers give them fear of separation attention Encouragement of open communication and Children are better able to cope with stress reassurance is key. Develop better relationships Insecure Attachment DIVORCE Experience anxiety, uncertainty, caregiver’s availability Prevalence and General Impact Show aggression with separation and stress Approximately 40% of first marriages in the U.S. Difficulty maintaining relationships end in divorce Types: Associated with negative parental functioning 1. Insecure Avoidant Do not show much stress than when and child behavior caregiver leaves Parent-Child Dynamics Post Divorce Avoid/Indifferent when guardian leaves Increased noncompliance and emotional When caregiver leaves then returns, withdrawal in children children becomes avoidant Decreased parent-child communication and 2. Insecure Ambivalent/Resistant affection When caregiver returns, children Disrupting the Familiar become resistant to them Altered routines Shows anxiety, uncertainty Changes in living arrangements 3. Insecure Disorganized Separation from extended family members Lack of clear attachment behavior Emotional and Psychological Risks Reflecting most insecurity Exposure to parental conflict Example: Risk of depression, anxiety, and low self-esteem A child is in the room, with a caregiver present. if they Range of emotions from sadness and guilt to leave, children show little stress. anger and confusion Long-Term Effects on Children Emotional issues may persist for up to 5 years; Upon return: academic or social problems even 10 years later Insecure Avoidant Long term adult relationships may be affected Child avoids eye contact -> remains emotionally (difficulties in trust, commitment issues) distant Positive Outcomes with Proper Management Insecure Ambivalent/Resistant Minimal conflict and ongoing involvement from A child frequently checks if a caregiver is nearby. both parents lead to better adjustment They feel upset if the caregiver leaves, but when PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 2  LOSS, SEPARATION AND BEREAVEMENT – Week 4 Joint custody arrangements may help but can also burden children Conclusion Key Factors Affecting Child Morbidity in Divorce Preparing children for hospitalization requires a Parental Psychopathology Morbidity: condition of suffering from a disease or medical condition comprehensive approach that addresses their Mental health issues (Depression, anxiety, psychological, emotional, & educational needs. substance abuse) By implementing these strategies, we can make Compromises a parent’s ability to provide a hospital stay as comfortable and reassuring as emotional support and stability possible for both children and their families. Increased anxiety, behavioral problems or DUTY RELATED SEPARATION FROM emotional distress PARENTS/MILITARY ARRANGEMENTS DISRUPTIVE PARENTING BEFORE THE SEPARATION Unique challenges Breakdown in the quality parenting that occur Frequent relocations & overseas assignments. before the actual separation. Separations due to duty & wartime deployments Children may not receive stability and security to Impact of Deployments: feel supported. Emotional & psychological effects of repeated Causes children to feel insecure, confused and deployments. anxious. Risks associated with parental loss during Role of Healthcare service. Advising on different reactions and managing Support Systems: child adjustment. Military focus on enhancing family coping Importance of minimal conflict & active mechanisms during deployments involvement from both parents. increased risk of child maltreatment with young Reassure the child that the divorce is not the military family fault of the child. Conclusion Conclusion While children in military families often develop Careful management & supportive parenting can remarkable resilience, they face significant mitigate the negative impacts of divorce on challenges that demand careful attention from children. both military & community support systems. Divorcing parents & healthcare providers to work It's crucial that these supports are robust & together to support children through this sensitive to the unique needs of military families. transition. PARENTAL/ SIBLING DEATH Involvement in parens Avoiding conflicts: create a more healthy Coping with Sudden Loss environment for the child. Increased anxiety & fear from unexpected SEPARATION BECAUSE OF HOSPITALIZATION deaths, accident, suicide, etc Need for clear explanations to help children Challenges in hospitalization cope with uncertainty. Separation anxiety, adapting to new Support Systems for Grieving Children: environments, & multiple caregivers. Ensuring children receive consistent care & Exposure to intensive care, anesthesia, & attention surgery. Supporting children's grief & maintaining stability Positive adjustments for hospitalization in their relationships.. Pre-admission Preparation: Grief/bereavement ○ Importance of preadmission visits to Dealing with the death of a parent or sibling is familiarize with hospital staff & one of the most difficult experiences a child can environment. endure. ○ encourage questions to ease anxiety As caregivers, educators, & community and clarify procedures members, it is our responsibility to provide the Parental Involvement:Rooming-in: laging nasa side ang magulang/kasama lagi understanding & support these children need to ○ Rooming-in policies for children under 6. navigate their grief & continue to thrive. ○ Benefits of having family members Nature of Grief present for emotional support. Emotional responses include sadness, anger, Supportive Activities and Resources: guilt, fear, & sometimes relief. ○ Engagement with child life specialists. Emphasis on the normality of these reactions. ○ Use of dolls or mannequins to simulate mourning procedures. grief - unfolds overtime and can vary ○ Liberal visiting hours and sibling visits. Educational Continuity: Role of Pediatrician ○ Provision of school assignments & Supportive care in uncomplicated & traumatic tutoring to keep up with education. grief. Role of Healthcare Providers provide support ○ Need for sensitive & empathetic approach: active and proactive interaction. Importance of honest communication & ○ continuity of care and communication appropriate pain management. about discomfort PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 3  LOSS, SEPARATION AND BEREAVEMENT – Week 4 Impact of Terminal Illness & Sudden Death How often did you find yourself thinking how Anxiety & changes in routine during terminal unfair it is that your loved one died, even though illness. you didn't want to think about it Increased anxiety & isolation from sudden, How often did you have trouble falling asleep unexpected deaths. because you were thinking about your loved Support Systems one's death? Integration of hospice, clergy, nursing, & social How often have you had bad dreams related to work your loved one's death? The necessity of open communication about the How often did you have trouble doing things you child's condition & treatment. like because you were worrying about how you Long Term Effects of Bereavement and your family will get along? Possible regressive behaviors & physical Response options: Several times a day; About symptoms that mirror the deceased. once a day: Once or twice a week; Less than Importance of secure & stable adult presence in once a week; Not at all managing grief BEHAVIORAL PATTERNS Coping with Loss from Disasters PERSISTENT COMPLEX BEREAVEMENT Complicated grief interwoven with posttraumatic stress. DISORDER The role of media in children's exposure to trauma. A. CRITERION A Encouraging Healthy Grief Child has experienced the death of a loved one Importance of discussing grief & not isolating from children. B. CRITERION B validate the feelings that bereavement is normal B1: Persistent yearning or longing for the and allow expression of feelings deceased Ensuring children have opportunities to express B2: Intense sorrow or emotional pain. grief & receive support. B3: Preoccupation with the person who died. Conclusion C. CRITERION C Underständing & supporting grief in children C3: Difficulties reminiscing about the deceased. requires a nuanced & compassionate approach. By ensuring honest communication, stable C4: Bitterness or anger related to the loss. reflect a general negative view of support systems, & opportunities for emotional C5: Maladaptive self-appraisals. oneself, hopelessness, and catastrophic thoughts about one's emotional reactions expression, we can help children heal & find a C6: Avoidance of reminders. new sense of normalcy after a loss. C7: Suicidal ideation or desire to be with the MEASUREMENT BEREAVEMENT IN CHILDREN deceased. C8: Difficulty trusting others. CORE BEREAVEMENT (CBI) Co: Feelings of alienation or detachment. Do you experience images of the events surrounding your loved one's death? = Cio: Feeling that life is meaningless. Do thoughts of your loved one make you feel Cu: Confusion about role in life or diminished distressed? sense of identity. Do you find yourself pining for/yearning for your D. CONCLUSION loved one? Persistent Complex Bereavement Disorder manifests Do reminders of your loved one such as photos, through a range of intense and prolonged emotional & situations, music, places, etc., cause you to feel behavioral reactions. loneliness? Do reminders of your loved one such as photos, GUIDANCE FOR HEALTHCARE PROFESSIONALS situations, music, places, etc. cause you to cry about your loved one? death? Recognizing Individual Grief Patterns Do you experience images of the events Emphasize that there is no correct way to surrounding your loved one's grieve. Each child's grief is unique. Do thoughts of your loved one make you feel Differences Between Child & Adult Grief distressed? Child grief is distinct from adult grief. Do you find yourself pining for/yearning for your loved one? Children experience and cope with death in Do reminders of your loved one such as photos, different ways situations, music, Places, etc., cause you to feel Impact of Death Circumstances loneliness? Circumstances of death affect children's grief Do reminders of your loved one such as photos, reactions. situations, music, places, etc. cause you to cry Deaths by homicide or suicide may need more about your loved one? Response options: A lot of the time; Quite a bit intensive mental health care. of the time; A little bit of the time; Never Empowering Caregivers INTRUSIVE GRIEF THOUGHTS SCALE (IGTS) Caregivers play a crucial role in facilitating During the past 4 wk How often did you think adaptive grief. about the death of your loved one? PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 4  LOSS, SEPARATION AND BEREAVEMENT – Week 4 Provide empathy, reassurance, & open reassure preschool children that their discussions about the deceased. thoughts had nothing to do with the outcome. Using Accessible Language Children of this age are often frightened by prolonged, powerful expressions of grief by Let children ask questions and provide clear, others. honest answers Children conceptualize events in the context of Providing Accurate Information their own experiential reality, and therefore Address preoccupations about the cause of consider death in terms of: death. ○ sleep ○ separation Validating Children’s Grief ○ injury. Bear witness to the child's grief. Young children express grief intermittently and Normalize and validate their reactions by show marked affective shifts over brief periods. allowing them to express their feelings. YOUNGER SCHOOL-AGE CHILDREN Conclusion Think concretely, recognize that death is By doing all of these as healthcare irreversible, but believe it will not happen to them or affect them, and begin to understand professionals, we can offer the support these biologic processes of the human body children need to navigate their loss. → “You’ll die if your body stops working” DEVELOPMENTAL PERSPECTIVES ON Information gathered from the media, peers, and CHILDREN’S RESPONSES TO DEATH parents form lasting impressions Children’s responses to death reflect the family’s Consequently, they may ask candid questions current culture, their past heritage, their about death that adults will have difficulty experiences, and the sociopolitical environment. addressing Personal experience with terminal illness and → “He must have been blown to pieces, huh?” dying may also facilitate children’s CHILDREN APPROXIMATELY 9 YEARS AND comprehension of death and familiarity with OLDER mourning. Understand that death is irreversible and that Developmental differences exist in children’s it may involve them or their families efforts to make sense of and master the concept These children tend to experience: and reality of death and profoundly influence ○ more anxiety their grief reactions. ○ overt symptoms of depression CHILDREN YOUNGER THAN 3 YEARS ○ somatic complaints than do younger Have little or no understanding of the children. concept of death. Are often left with anger focused on the loved Despair, separation anxiety, and detachment one, those who could not save the deceased, or may occur at the withdrawal of nurturing those presumed responsible for the death caretakers. Contact with the pediatrician may provide great Young children may respond in reaction to reassurance, especially for the child with observing distress in others, such as a parent or somatic symptoms, and particularly when the sibling who is crying, withdrawn, or angry. death followed a medical illness.results significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that in major distress and/or problems functioning. Young children also express signs and School and learning problems may also occur, symptoms of grief in their emotional states, such often → linked to difficulty concentrating or as irritability or lethargy, and in severe cases, preoccupation with death. mutism. Close collaboration with the child’s school may If the reaction is severe, failure to thrive may provide important diagnostic information and occur. offer opportunities to mobilize intervention or PRESCHOOL CHILDREN support. In the preoperational cognitive stage 12 TO 14 YEARS OF AGE → communication takes place through play and Begin to use fantasy ○ use symbolic thinking Do not show well-established cause-and-effect ○ reason abstractly reasoning ○ analyze hypothetical, or “what if,” Feel that death is reversible, analogous to scenarios systematically someone going away Death and the end of life become concepts Frequently ask unrelenting, repeated questions rather than events. having mixed feelings or contradictory ideas about something or someone. about when the person who died will be Teenagers are often ambivalent about returning dependence and independence and may Typically express magical explanations of death withdraw emotionally from surviving family events, sometimes resulting in guilt and members, only to mourn in isolation. self-blame Adolescents begin to understand complex → e.g., “He died because I wouldn’t play with physiologic systems in relation to death. him Often egocentric → may be more concerned → “She died because I was mad at her” about the impact of the death on themselves Parents and primary care providers → need to than about the deceased or other family be aware of magical thinking and must members PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 5  LOSS, SEPARATION AND BEREAVEMENT – Week 4 Fascination with dramatic, sensational, or FUNERAL ATTENDANCE romantic death sometimes occurs Sends a strong message that the family and May find expression in: their child are important, respected by the ○ copycat behavior, such as cluster healthcare provider suicides group of suicides, suicide attempts, or self-harm events that occur closer together in time and space than would Can also help the pediatric healthcare provider ○ competitive behavior normally be expected in a given community. to grieve and reach personal closure about the → e.g., “He was my best friend” death Somatic expression of grief may revolve around CONTINUED CARE the ff: A family meeting 1-3 months later ○ eating disorders → may be helpful because parents may ○ conversion reactions not be able to formulate their questions at the ○ symptoms limited to the more immediate time of death. perceptions (stomachaches) → allows them to have continued Quality of life takes on meaning, and the support teenager develops a focus on the future. → can be used to determine how the Depression, resentment, mood swings, rage, mourning process is progressing, detect and risk-taking behaviors can emerge as the evidence of marital discord, and evaluate how adolescent seeks answers to questions of well surviving siblings are coping values, safety, evil, and fairness. → also an opportunity to evaluate Alternately, adolescents may seek philosophic or whether referrals to support groups or mental spiritual explanations (“being at peace”) to ease health providers may be of benefit their sense of loss. Addressing mourning progress and family The death of a peer may be especially traumatic. dynamics Families often struggle with how to inform their Recognizing the deceased on special dates children of the death of a family member. The EDUCATIONAL ROLE answer depends on the child’s developmental level. It is best to avoid misleading euphemisms TREATMENT APPROACHES and metaphors. A child who is told that the relative who died “went to sleep” → may become frightened of falling asleep, resulting in sleep problems or SPECIAL CONSIDERATIONS FOR REFUGEE nightmares. CHILDREN Children can be told that the person is “no longer living” or “no longer moving or feeling.” IMPORTANCE OF SPIRITUAL SUPPORT Using examples of pets that have died Comforting patients & families during tragedies. sometimes can help children gain a more Role of Pastoral Care Teams & Spiritual Leaders: realistic idea of the meaning of death. Acknowledging Beliefs and Hope Parents who have religious beliefs may comfort Validating beliefs & needs for hope in end-of-life their children with explanations, such as, “Your care. sister’s soul is in heaven,” or “Grandfather Guidelines for Physicians: is now with God,” provided those beliefs are Respecting the patient's beliefs. honestly held. Following the patient's lead in spiritual If these are not religious beliefs that the parents discussions. share, children will sense the insincerity and Acknowledging limits of expertise in spirituality. experience anxiety rather than the hoped-for Maintaining Integrity: reassurance. Avoid imposing personal beliefs. Children’s books about death can provide an Listening respectfully & responding to spiritual important source of information, and when read needs together, these books may help the parent to Conclusion: find the right words while addressing the child’s Incorporating spiritual support into grief & needs. bereavement care is vital. ROLES OF DEVELOPMENTAL HEALTHCARE OR THE KUBLER ROSS MODEL: THE FIVE STAGES PEDIATRIC HEALTHCARE PROVIDERS IN GRIEF OF GRIEF SUPPORT DURING BEREAVEMENT Denial Presence during diagnosis disclosure, death, Buffer against the immediate shock of the loss and funerals Feel numb or in disbelief Availability for followup and ongoing support Anger Being available to the family by phone during the Irritation, frustration, or resentment bereavement period Direct their anger towards themselves, others, or Sending a sympathy card, attending the funeral, to the situation Helps individuals emotionally and scheduling a follow-up visit. separate themselves from their loss Bargaining Making deals with a higher power PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 6  LOSS, SEPARATION AND BEREAVEMENT – Week 4 "What if?".. "If only I had done" A. THE DEVELOPMENT OF COGNITIVE SKILLS IN Depression EARLY CHILDHOOD State of hopelessness B. THE NATURE OF THE BOND BETWEEN Acceptance INFANTS AND THEIR PRIMARY CAREGIVERS Have come to term with the new reality C. THE ROLE OF PLAY IN COGNITIVE AND Allows to find some peace, enabling them to SOCIAL DEVELOPMENT move forward in their lives D. THE IMPACT OF CULTURAL DIFFERENCES ON CHILD DEVELOPMENT REVIEW QUESTIONS 8. WHICH OF THE FOLLOWING IS A SYMPTOM CRITERION FOR PERSISTENT COMPLEX 1. WHAT TYPE OF INSECURE ATTACHMENT LACKS CLEAR ATTACHMENT BEHAVIOR? BEREAVEMENT DISORDER? A. SECURE ATTACHMENT A. PERSISTENT YEARNING OR LONGING FOR THE DECEASED B. AMBIVALENT ATTACHMENT C. INSECURE AVOIDANT B. INTENSE FEELING OF GUILT ABOUT THE DECEASED’S DEATH D. INSECURE DISORGANIZED C. FREQUENT MOOD SWINGS UNRELATED TO THE BEREAVEMENT 2. THE FOLLOWING ARE THE TYPES OF A CHILD’S EMOTIONAL REACTIONS TO LOSS AND SEPARATION EXCEPT: D. SIGNIFICANT CHANGES IN APPETITE AND SLEEP A. CRYING TYPE A. TANTRUMS TYPE B. ANGRY TYPE 9. WHICH OF THE STAGES OF GRIEF INVOLVES THE INDIVIDUAL EXPERIENCING INTENSE C. PROTESTING TYPE FEELINGS OF FRUSTRATION AND OUTRAGE, OFTEN DIRECTED TOWARDS THEMSELVES, 3. WHAT IS THE APPROXIMATE PERCENTAGE OF MARRIAGES IN OTHERS, OR THE DECEASED? THE US THAT END IN DIVORCE? A. 40% A. DENIAL A. 50% B. ACCEPTANCE A. 60% C. BARGAINING A. 70% D. ANGER 4. SHOULD A PARENT USE EUPHEMISM OR METAPHOR WHEN 10. WHAT IS ONE WAY THAT DIVORCED PARENTS CAN HELP THEIR CHILDREN MAINTAIN A EXPLAINING A LOVED ONE’S DEATH TO A CHILD? POSITIVE RELATIONSHIP WITH BOTH PARENTS? A. YES, BECAUSE THAT WOULD ALLEVIATE THE CHILD'S GRIEF. A. ENCOURAGE THE CHILD TO CHOOSE ONE PARENT OVER THE OTHER A. YES, BECAUSE THE CHILD MAY NOT BE ABLE TO OVERCOME SADNESS IF NOT USED. B. SPEAK NEGATIVELY ABOUT THE OTHER PARENT TO THE CHILD A. NO, BECAUSE IT MIGHT CAUSE CONFUSION TO THE CHILD. C. SUPPORT THE CHILD’S RELATIONSHIP WITH BOTH PARENTS AND AVOID INVOLVING THEM A. NO, BECAUSE THE CHILD IS TOO YOUNG TO IN CONFLICTS UNDERSTAND THE EXPLANATION. D. LIMIT THE CHILD’S CONTACT WITH THE NON-CUSTODIAL PARENT 5. UNDER PARENTAL PSYCHOPATHOLOGY, WHICH AMONG THE STATEMENTS BELOW IS NOT A KEY FACTOR THAT AFFECTS CHILD MORBIDITY IN DIVORCE? ANSWERS: REFER TO APPENDIX SECTION A. MENTAL HEALTH ISSUES A. COMPROMISES AS A PARENT’S ABILITY TO PROVIDE EMOTIONAL SUPPORT AND STABILITY REFERENCE A. INCREASED ANXIETY A. NEW CULTURE AND LANGUAGE Nelson, W.E. (2019) Nelson Textbook of Pediatrics. 21st Edition, Elsevier, Amsterdam. 6. HOW DOES AN INFANT WITH A SECURE ATTACHMENT Dr. Alex Dy’s lecture presentation (“Loss, TYPICALLY BEHAVE WHEN REUNITED WITH THEIR CAREGIVER Separation, and Bereavement” STRANGE THEORY? AFTER A SEPARATION IN THE A. THE INFANT AVOIDS THE CAREGIVER AND CONTINUES TO PLAY APPENDIX B. THE INFANT BECOMES EXTREMELY UPSET AND ANSWERS TO QUESTIONS RESISTS COMFORT FROM THE CAREGIVER C. THE INFANT IS DISTRESSED DURING SEPARATION BUT S Item Answer Explanation QUICKLY COMFORTED AND RESUMES PLAYING D. THE INFANT REMAINS INDIFFERENT AND SHOWS NO 1 B. Insecure Insecure disorganized it NOTICEABLE REACTION Disorganized characterized by a lack of attachment behavior. 7. WHAT IS THE PRIMARY FOCUS OF BOWLBY’S ATTACHMENT THEORY? 2 A. Angry The fourth type is the quieter type and sadder type.. PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 7  LOSS, SEPARATION AND BEREAVEMENT – Week 4 3 A.40% 40% of marriages in the US lead to divorce. 4 C. No, Additional input from Doc Dy because it might cause confusion to the child 5 D. New New culture and language are culture and more of a key factor for language migrant children. 6 C. The infant Infants with secure attachment is distressed are generally upset when their during caregiver leaves but are easily separation comforted upon the but is quickly caregiver’s return and quickly comforted return to exploring. and resumes playing 7 B. The Bowlby’s attachment theory nature of the centers on the emotional bond bond between infants and their between primary caregivers and how infants and this bond affects the child’s their primary development and future caregivers. relationships. 8 A. Persistent Persistent yearning or longing yearning or for the deceased is a key longing for symptom of Persistent the Complex Bereavement deceased Disorder, reflecting the intense and prolonged nature of the bereavement. 9 D. Anger Anger is the stage where individuals may experience frustration and rage. This anger can be directed towards themselves, others, or the deceased, and is a common reaction to feeling powerless or unfairly treated by the loss. 10 C. Support Supporting the child’s the child’s relationship with both parents relationship and keeping them out of with both parental conflicts can help parents and maintain a positive avoid relationship with each parent involving and support the child’s them in emotional well-being. conflicts. PREPARED BY G. GUMAL, JESALVA, LLANETA, MILANO, ORIARTE, RAMOS, REVERENTE, SERINA, SILVA, STA. RITA, TAN, TIBOR, VILLANIA, YALUNG (YL1-B5) 8