Children, Grief, And Attachment Theory
When a child, age 7 to 11, experiences the death of a nuclear or extended family member, the experi-ence generates subsequent grief reaction/s. During the mixed methods study, the researcher investigates ways attachment theory may positively compliment grief reaction/s and concerns challenging the grieving child that may include feelings which include, but not limited to anger, confusion, fear, and self-blame. When not addressed, these reactions may link to the child experiencing ensuing health and/or mental health problems in his/her later life. The study also relates a number of ways to help to confront bereavement issues that children experience.
Relating to Death
Addressing “Something Else”
Statement of the Problem
Purpose of Study
Significance of Study
Scope of Study
Rationale of Study
Overview of Study
Key Word Definitions
Review of Related Literature
Chapter III: Methodology
Description of the Study Approach
Chapter IV: Analysis
Chapter V: Discussion, Conclusion, and Recommendations
KEY WORD DEFINITIONS
Adolescent: For the purpose of the dissertation, the term, adolescent, refers to a teen or juvenile before the beginning of puberty and maturity, typically beginning at the age of 13 and ending at the age of 19 (Princeton University, 2010).
Attachment: Attachment depicts a sense or feeling of affection or fondness for an individual or a place (Princeton University, 2010).
Bereaved and Bereavement: The phrases, bereaved and bereavement, reflect a phase or frame of mind of sorrow over the loss or death of a loved one (Princeton University, 2010).
Bereavement Behavior: Bereavement behavior/s may include, anger, agitation, guilt, loneliness, numbness and shock, after the loss of a loved one (Twain, 2009).
Child: For the purposes of the dissertation, the term, child, refers to a young person of either sex, between the ages of seven to 11 (Princeton University, 2010).
Grief: Grief may be defined as passionate, all consuming, sorrow caused by the loss of a loved one (Princeton University, 2010).
Irreversibility: Irreversibility depicts the condition of being permanently gone or not reversible, without the possibility of being changed (Princeton University, 2010).
Nonfunctionality: Nonfunctionality consists of irreversible changes within an individual; the process of each cell and tissue ceasing to function; causing death (Laureys, Schiff & Owens, 2009).
Unresolved Grief: Unresolved grief depicts unsettled, deep sorrow over an extended period of time; typically brought on by the non-acceptance or non-closure over the loss of a loved one. Related personal pain of the grief may be buried deep within an individual and not allow him/her to experience real grief and experience closure (Hunt, 2009).
“Whilst especially evident during early childhood, attachment behaviour is held to characterize human beings
from the cradle to the grave”
– John Bowlby (1979, p. 129).
Relating to Death
In contemporary America as well as in numerous other societies, some people may deliberately avoid verbalizing words like dead, death, and dying. Instead of using direct language, some individuals may use euphemisms, like “passed away” or “departed.” In the book, Death and Dying, Life and Living, Charles A. Corr, prominent teacher and writer in the field of death, dying and bereavement, Clyde M. Nabe, Episcopal priest and instructor at Southern Illinois University Edwardsville, and Donna M. Corr (2008), retired nursing professor from St. Louis Community College in St. Louis, Missouri, explain that using an euphemism to try to “prettify’ language about death to make it appear more delicate, ‘nice,’ or socially acceptable and to avoid seeming disagreeable, impolite, or nasty” (p. 84) does not change the fundamental truth about death.
By the age of ten, two-thirds of children have experienced the death of a friend, grandparent, parent or sibling. In the journal article, “Expert shares tips on supporting children’s grief: Ask the families of patients to keep you informed about all important events that affect their children,” Doug Brunk (2007), San Diego Bureau reports that “5% of children experience the death of a parent by the time they turn 16” (Â¶ 1). Although mental health professionals throughout the world routinely utilize a myriad of studies to help family members and adolescents understand and deal with grief during the death of a close relative or friend, determining the best psychometric tools, psychological tests, and interventions in addressing adolescent grief and/or adolescent depression proves challenging. According to Nancy Boyd Webb, consulting editor for the Journal of Child and Adolescent Trauma, and Kenneth J. Doka. (2010), co-author, in the book, Helping Bereaved Childrenâ€¦, A Handbook for Practitioner, many children realize the truth about death even when adults may try to shield them; that it is “irreversible, inevitable, and universal” (p. 4). For the child or adolescent experiencing grief, however, the lack of opportunities to communicate thoughts and feelings with others about death-related concerns does not have to be universal, inevitable, and irreversible.
The path for healing from grief for a child or adolescent may be reconciled with emotional and intellectual maturity. Children and adolescents grieve in different ways, particularly at different ages, Donna M. Burns (2010) explains in the book, When kids are grieving: Addressing grief and loss in school. Table 1 depicts the different age groups and how a child or teen may address or perceive grief during this period in his/her life.
Table 1: Children and Teens during Grieving Process (adapted from Burns, 2010).
During their preschool years, children may not view death as a formal event and may even consider that death can be changeable or reversible. A preschooler may think of death as only a short separation, not a lasting condition. Preschoolers may also link specific events and “magical” thinking as contributing to the cause of death. One example may be the tragedy of the World Trade Center. Preschool-aged children may think if one enters into a tall building, he/she may die.
Early Elementary School Age
Children five to nine years old begin to understand that death is final. They may also comprehend that specific circumstances may cause one to die. Again, relating to the World Trade Center, children early elementary school age children understand that when a plane crashes into a building the people in the building as well as those in the plane will die. Early elementary school age children, however, may not be able to differentiate between what they see on TV or in a movie and what they see at home. They also see death as something that happens to other people; not to anyone in their own family.
Children in the middle school age range possess the intellectual ability to understand death is final; that the dead person’s bodily functions cease. Some middle school age children, nevertheless, may not completely grasp the conceptions adults discuss. At middle school age, youth may also “act out” and experience a barrage of various emotions; at times feeling especially angry, depressed and revengeful.
Teens in the high school age completely understand the meaning of death as well as circumstances surrounding it; whether the loss involved a car accident or illness. Some bereaved teens may seek friends or family members to help console and comfort them during the grieving process. Others may completely withdraw from peers, friends and/or family. Adolescents experiencing other issues, like chemical dependency, depression, or suicidal thoughts are at higher risks for prolonged grief. During the grief process, they may need constant attention.
Addressing “Something Else”
“My father got shot by an officer. He died four days before my birthday,” Heather, age 11, recounted during a group session held at The Dougy Center, a “safe place” where she and children like her share thoughts relating to the death of a nuclear or extended family member.
To help keep memories alive, at times, the children bring in and share something the deceased person loved. Rachel brought in a doll her mother played with when a girl. During the 20/20 episode, “The Dougy Center, Saying Goodbye Forever,” when John Stossel (2010) interviewed Rachel about her mother’s doll, Rachel said: “This doll belonged to my mom. She had it when she was a child.” In another poignant scene, a girl hugs her late sister’s dog.
When a child or an adult experiences the death of a nuclear or extended family member, in time, the acute state of mourning following the death subsides. John Bowlby (1979), a British psychiatrist who lived from 1907 to 1990, considered the father of attachment theory, stressed in the book, The making & breaking of affectional bonds, that the individual “shall remain inconsolable and will never find a substitute. No matter what may fill the gap, even if it be filled completely, it nevertheless remains something else” (p. 88). Addressing that “something else,” albeit, reflects a contemporary challenge, counselors regularly counter when working with children experiencing grief. During the dissertation, the researcher addresses a number of concerns challenging children, ages 7 to 11, like Heather and Rachel, who often need help with a number of things, following the death of a nuclear or extended family member. The researcher also considers ways attachment theory may serve as a positive, practical process to compliment curative counseling. Figure 1 portrays three of the scenes 20/20 presented March 15, 2010.
Figure 1: Heather, Rachel, and Unnamed Girl in 20/20 Program (adapted from Stossel, 2010).
Statement of the Problem
For any individual, the death of a family member, friend, parent or sibling may often be overwhelming. For adolescents, the death of person close to them may prove much more traumatic as it can disrupt adolescent development. Diana Mahoney (2008), with the New England Bureau, reports in the journal article, “Navigating adolescent grief,” that Erik H. Erikson created a seminal model of psychosocial development that classified adolescent years as a time period when teens form their personality. These trying teen times typically may be defined by the opposing extremes of integration and separation. Mahoney (2008) asserts that as adolescents struggle to belong and strive to be accepted by others, particularly their peers; they simultaneously struggle to become individuals. For the adolescent to successfully pass through this developmental stage, he must achieve a delicate balance. When teens experience grief, they may consider themselves to be “different” or cut off from their peers. They frequently find it difficult to fit into a certain group or crowd, yet they may also struggle with conflicting feelings they experience relating to their grief.
In the journal article, “Dimensions of adolescent alcohol involvement as predictors of young-adult major depression,” W. A Mason, et al. (2008), recounts a number of significant concerns regarding depression, particularly Major Depressive Disorder (MDD). MDD, Mason, et al. explain depicts a prevalent psychiatric condition many adolescents experience. “In the United States, the lifetime and past-year prevalences of MDD among adults have been estimated to be 17% and 7%, respectively. Depression, which here refers to clinical diagnoses of MDD, is a serious public health concern” (Mason, et al., 2008, Â¶ 2). Depression, which increases risk for some illness as well as health-compromising behaviors, including suicide, may evolve from grief and/or denote depression that began in an adult’s adolescence.
Purpose of Study
During the dissertation, the researcher aims to examine grief reactions the grieving child experiences that need to be addressed to counter potential links to ensuing health and/or mental health problems in the bereaved child’s later life. The primary research question serves to guide the study: How may one best address concerns challenging the grieving child that, when not addressed, may link to the child experiencing ensuing health and/or mental health problems in his/her later life?
The researcher’s primary reason/s for choosing to focus on psychometric tools and/or psychological tests mental health professionals may utilize to measure adolescent grief and/or adolescent depression relates to the researcher’s desire to help guide the treatment of adolescents experiencing grief as well as and youth suffering from depression. The researcher also expects that the study will proffer additional therapeutic interventions clinicians may incorporate or draw from to augment their work with grieving and/or depressed adolescents.
Approximately 50% of children experiencing the death of a parent experience complications functioning in ordinary everyday activities. During the first year after the death of a parent, one in five of grieving children will need help from a specialist. One in five bereaved children will not display any evidence of difficulty during the weeks immediately after the death of a significant person. Two years later, however, the child may confuse individuals around him by evidencing problems (Cranwell, 2010). Following the loss of a significant person in their lives, some children will experience emotional and/or physical issues. Some bereaved children will not be able to concentrate as they usually do. When they do not obtain the help they need, some grieving children will display behavioral problems.
The researcher’s current career choice involves work with children who have experienced the death of a nuclear or extended family member. Poignant responses like those portrayed in the 20/20 episode, noted at the start of the study, regularly remind the researcher of the critical need for capable counselors to invest time in enhancing their counseling skills; to educate themselves regarding relevant research in their field; to empower themselves to more effectively help children with hurting hearts heal.
Significance of Study
During the study, the researcher investigates ways one may best address concerns and communicate support to help facilitate the healing process in children and/or adolescents when they experience grief after a death or loss. Amanda L. Williams and Michael J. Merten (2009), both with Oklahoma State University, examine, how one of the newer communication venues, interactions on social networking sites online, assist in the grieving process after the death of a loved one or friend. In the study, “Adolescents’ Online Social Networking Following the Death of a Peer,” Williams and Merten explain:
The ability to share thoughts and feelings with others about grief and loss has been linked with positive coping outcomes vs. internalized emotional responses such as ruminating about loneliness or fear of deathâ€¦. Adolescents often seek to minimize emotional damage from grief through wishful thinking, denial, and disengagement…; however, negative outcomes such as health problems, interpersonal conflict, depression, anxiety, and somatic problems may arise if individuals excessively ruminate vs. discussing their emotions with othersâ€¦. Teenagers, especially girls, may talk about their feelings, turn to religion, look for any positive outcomes from the stressor, and vent; boys are more likely to use humor or to disengage via substance useâ€¦ (Williams & Merten, 2009, pp. 68- 69).
Following the loss or death of a loved one, a child or an adolescent experiences, like the adult, experiences grief. The grief experience for the child or adolescent replicates the adult response in some ways yet dramatically differs in others. While the child or adolescent struggles with the ensuring emotions accompanying the grief process, those who care for them need to not only communicate truths regarding the experience, but also empower the young person to talk about how/what they feel. The study proves significant as it confronts readers with contemporary issues as well as credible information to counter current concerns regarding tools, tests and interventions to address adolescent grief and/or adolescent depression.
The primary research question which serves to guide the study queries: In what ways may attachment theory serve as a positive, practical process to compliment curative counseling with grieving children ages 7 to 11 who have experienced the death of a nuclear or extended family member?
To address the study’s primary research question, the researcher investigates the following three sub-research questions:
1. What grief experiences may a grieving child, age 7 to 11, encounter following the death of a nuclear or extended family member?
2. How does loss/death relate to attachment theory?
3. What benefits may consideration of attachment theory proffer that could positively contribute to counseling a grieving child, age 7 to 11?
Overview of Study
The organization of the mixed methods study includes five chapters as the following depicts:
Chapter I: The “Introduction” chapter for the study introduces the mixed methods study, Children, Grief, and Attachment Theory, as well as relates information regarding its primary area of focus, attachment theory. The first chapter presents the problem statement, rationale, significance, and an overview of the study as well as presents the primary research question and three sub-research questions.
Chapter II: The Literature Review, the study’s second chapter a presents a credible contemporary compilation of relevant literature to address the primary research question and the three sub-research question. An Junghyun (2001) stresses: “A critical literature review within a specific field or interest of research is one of the most essential, but also complex activities in the process of research” (Â¶ 1). The literature review aims to relate the most relevant, significant sources the reader needs to understand the research relating to study’s focus examining a specific phenomenon. The dissertation uses the thematic design; utilizes the following three sub-headings from the study’s research questions for themes.
1. Grief Encounters Children Experience
2. Loss/death Relating to Attachment Theory
3. Consideration of Attachment Theory
Chapter III: The Methodology chapter explains that the mixed-methods methodology, a compilation of qualitative and quantitative research methods mixed methods practice qualifies ad both “old” yet “emergent” research.
To conduct the mixed methods study, based on a historical-comparative analysis of contemporary research, the researcher implements a mixed methods study.
Need to answer: Will methodology includes population and sample, procedures and measures, hypotheses, level of significance, and statistical tests? Will study include interviews or a survey?
Chapter IV: During the Analysis, the fourth chapter, the researcher combines key information accessed during the literature review with data retrieved from the study tools to relate primary findings.
Need to determine whether interviews or survey will be used.
Chapter V: During the final chapter, Discussion, Conclusion, and Recommendations, the researcher recounts findings the research reveals through the study venture regarding the investigation of ways attachment theory may serve as a positive, practical process to compliment curative counseling when a child age7 to 11 experiences the death of a nuclear or extended family member. The researcher also shares conclusions regarding the study effort and makes recommendations relating to attachment theory and counseling bereaved children, ages 7 to 11, as well as recommendations for future researchers to consider.
Aims and Objectives
May want to add these with timeline.
During the next chapter, the Literature Review, the researcher, similar to Stossel (2010) as he sought to draw out and share concerns of the hearts of children at The Dougy Center, searches through the heart of contemporary literature to reveal concerns relating to attachment theory and counseling children, ages 7 to 11, who experience the death of a nuclear or extended family member. Even though nothing can ever fill the gap the death of an individual leaves and though “even if it be filled completely, it nevertheless remains something else,” (Bowlby, 1979, p. 88), the researcher asserts that information regarding individuals “from the cradle to the grave” (Ibid., p. 129), needs to be regularly updated. The information the study relates for those who counsel bereaved children can not only the children through their grief, it can also help the children experiencing grief help keep memories alive that will help them in their own lives.
In addition, the researcher ultimately develops an informational pamphlet to present to clinicians to help counsel children, ages 7 to 11, as they experience grief.
Enhancing the reader’s understanding of psychometric tools and/or psychological tests mental health professionals may utilize to measure adolescent grief and/or adolescent depression proves particularly significant to those professionals who treat children experiencing grief and/or depression. The researcher hopes that in addition to providing fresh insights to clinicians and grief counselors, albeit, the study will also empower and encourage families of grieving and depressed adolescents.
Key Word Definitions
Adolescent: For the purpose of the dissertation, this term, adolescent, refers to a teen or juvenile before the beginning of puberty and maturity, typically beginning at the age of 13 and ending at the age of 19 (Princeton University, 2010).
Attachment: Attachment depicts a sense or feeling of affection or fondness for an individual or a place (Princeton University, 2010).
Bereaved and Bereavement: The phrases, bereaved and bereavement, reflect a phase or frame of mind of sorrow over the loss or death of a loved one (Princeton University, 2010).
Bereavement Behavior: Defined by researchers as a grief cycle, bereavement behavior/s may include, anger, agitation, guilt, loneliness, numbness and shock, after the loss of a loved one (Twain, 2009, Â¶ 1).
Child: For the purposes of the dissertation, the term, child, refers to a young person of either sex, between the ages of seven to 11 (Princeton University, 2010).
Delinquent Child/Juvenile Delinquent: The term/s, delinquent child/juvenile delinquent, portrays an extensive, common term that may include various forms of antisocial behavior by an adolescent or child. In many states, juvenile delinquency may be defined as behavior that violates the state’s criminal codes by an underage individual (Regoli, Hewitt & DeLisi, 2010, p. 20).
Grief: Grief may be defined as passionate, all consuming, sorrow caused by the loss of a loved one (Princeton University, 2010).
Irreversibility: The term, irreversibility, may be defined as the condition of being permanently gone or not reversible, without the possibility of being changed (Princeton University, 2010).
Nonfunctionality: Nonfunctionality may be defined as irreversible changing of an individual, the process of each cell and tissue, within a person ceases to function causing death (Laureys, Schiff & Owens, 2009, p. 24).
Unresolved Grief: Unresolved grief comprises chronic may be defined as unresolved, deep sorrow over an extended period of time; typically brought on by the non-acceptance or non-closure over the loss of a loved one. Hunt (2009) asserts that the personal pain of this grief may be buried deep within an individual and not allow him/her to experience real grief and experience closure (p. 192).
“Adults sometimes view children as ‘not understanding or comprehending’ the loss and may assume wrongly that their children’s grief is minimal”
(Videbeck, 2010, p. 213).
In the December 6, 1984 lecture, “Attachments across the Life Span,” Mary D. Salter Ainsworth (1985) confirms her support of Bowlby’s perception of attachment. Instead of attenuating for a time but then ultimately disappearing, as some assert, this view asserts that the individual’s attachment to his parents likely persists all through his life. Ainsworth also deems it likely that one may characterize various types of later affectional as either containing attachment components or at least adhering to some criteria that distinguish attachments from other bonds. Ainsworth explains that an “attachment” depicts an affectional bond and:
Hence attachment figures are never wholly interchangeable with or replaceable by another, even though there be another to whom one is also attached. Other criteria of attachments are also shared by affectional bonds — a desire to maintain closeness to the partner as well as a need to keep proximity to him. Even though in older children and adults that closeness can to some extent be sustained over time and distance, nevertheless there is at least an intermittent desire to reestab-lish proximity and interaction and pleasure, indeed often joy, in reunion. There is a third criterion of attachment that is clearly characteristic of some bonds, notably those of children to parents, which some consider to be es-sential and to distinguish attachments from other affectional bonds. This is the experience of comfort and security in relationship to the other and yet the ability to move off from this secure base with confidence to engage in other activities, but since not all attachments are secure this should be modi-fied to imply seeking to find comfort and security in the other. (Ainsworth, 1985, pp. 799-800)
Bowlby (1979) explains that attachment behavior basically constitutes any form of behavior that consequence ends with a response where an individual attains or sustains closeness to some other distinguished and favored individual, generally perceived to be stronger and/or wiser. Any of the following experiences, albeit, according to Bowlby, can contribute to a child as well as an adolescent or adult experiencing ongoing anxiety and potentially losing his attachment figure.
1. One or both parents being persistently unresponsive to the child’s care-eliciting behavior and/or actively disparaging and rejecting him;
2. discontinuities of parenting, occurring more or less frequently, including periods in hospital or institution;
3. persistent threats my parents not to love a child, used as a means of controlling him;
4. threats by parents to abandon the family, use either as a method of disciplining the child or as a way of coercing a spouse;
5. threats by one parent to dessert or even to kill the other or else to commit suicide (each of them more common than might be supposed);
6. inducing a child to feel guilty by claiming that his behavior is or will be responsible for the parent’s illness or death. (Bowlby, 1979, p. 137)
The ensuing anxiety from one of the above experiences can cause the child, adolescent, or adult to experience anxious attachment; which denotes that the person possess a low threshold for manifesting attachment behavior.
Attachment theory basically proposes that biology predisposes human infants to bond with their primary parents and/or other primary caregivers as well as to bond with other emotionally significant individuals like mentors and romantic partners when they mature into adulthood. Even when the child becomes an adult, he experiences distress when experiencing an unexpected separation from his attachment figure or he becomes ill, fatigued, or stressed, fatigued. According to Heather L. Servaty-Seib (2004), an assistant professor, Counseling and Development, Purdue University, West Lafayette, Indiana, in the article, “Connections between Counseling Theories and Current Theories of Grief and Mourning,” the relationship the infant experiences with his primary caregivers whether they prove dependable or undependable) affects how the individual will develop, sustain, and resign his future relationships.
Each individual develops a somewhat stable style of attachment, characterized as one of the following three types:
2. avoidant, or
3. anxious/ambivalent (Servaty-Seib, 2004, Â¶ 1).
Servaty-Seib (2004) asserts that linking attachment style concepts with its internal working model and mourning following death loss significantly associates to understanding the make-up of grief and mourning. In the thanatological literature, attachment styles can be perceived parallel “to the grief reactions described; & #8230;such that persons with particular attachment patterns may be more vulnerable to particular grief-related difficulties” (Servaty-Seib, Â¶ 2). Servaty-Seib explains:
More specifically, individuals with an anxious-ambivalent attachment style, who have a preoccupied, clingy, and anxious orientation to relationships, may be more likely to experience chronic or extended grief. In direct contrast, those with an avoidant style, who tend to guard against investing in relationships, may be more likely to experience inhibited or absent grief. Persons with a disorganized style who lack trust in themselves and others, often exhibit signs of learned helplessness in the face of death lossâ€¦. [O]ne would expect securely attached individuals to respond emotionally to the death of an important person, without becoming overwhelmed by the experience. (Servaty-Seib, 2004, Â¶ 2).
In the article, “Total social isolation in monkeys,” Harry F. Harlow, Robert O. Dodsworth, and Margaret H. Harlow (1965) relate findings relating to their research regarding the overwhelming effects of social deprivation in rhesus monkeys. Due to the fact variables are innumerable and intractable to experimental control and/or manipulation and control, scientific study of the impacts produced by culturally pro-duced social isolation at the human level proves impossible. Nevertheless, Harlow, Dodsworth, and Harlow stress, human social isolation depicts a significant problem. “Its effects are deleterious to personal adjustment, normal heterosexual development, and control of aggressive and delinquent behaviors” (Harlow, Dodsworth, & Harlow, p. 90). Isolation, which typically evolves from breakdowns in family structures, results in illegitimate children, orphaned or semi-orphaned children, who, for various reasons, including the death of a parent, may grow up in institutions, deficient foster homes, or, sporadically, in abnormal residences, living with relatives.
Findings from the diverse semi-isolation and total-isolation studies of six monkeys indicated that enduring and severe and early isolation reduces the monkeys to a social-emotional level with their principal social responsiveness reflecting fear. Harlow, Dodsworth, and Harlow (1965) report:
On the follow-up tests, the 12-month isolates were highly fearful and showed almost no positive social behavior and no aggression. Except in sexual behavior, the 6-month early and late isolates were highly similar, as groups, in their social responses. One member of each group showed essentially normal play behavior, and two of each group showed little or no play. Two members of each group showed suicidal aggression toward adults, and five of the six members of the combined groups showed the abnormal phenomenon of aggressing against infants. (Harlow, Dodsworth, & Harlow, 1965, p. 100)
The total social isolation of the monkeys for 12 appeared adequate to consistently achieve the above result in rhesus monkeys. Short periods of total social isolation, albeit, do not contribute to permanent deficits in potential capabilities or social adjustment. None of the six monkeys in the study evolved as a socially normal animal. Even two of the monkeys that played with the test animals demonstrated hostility to infants. If the monkeys were placed in a free-living situation, the other monkeys would drive most of the test animals away or eliminate them. They would refuse to give the socially isolated monkeys an opportunity to learn to adjust to the group. None of the six tested monkeys demonstrated adequate sex behavior. If a human were subjected to identical deprivation conditions, Harlow, Dodsworth, and Harlow (1965) assert, he could appear as “commonly fearful or fearless, commonly hostile or without aggression, or selectively fearful or selectively hostile” (Harlow, Dodsworth, & Harlow, p. 100).
In the article, “The Origins of Attachment Theory: John Bowlby and Mary Ainsworth,” Inge Bretherton (1992) asserts that attachment theory, the joint work of Bowlby and Ainsworth draws from concepts that include cybernetics, ethology, and information processing as well as developmental psychology, and psychoanalysts Bretherton asserts that as Bowlby devised the primary tenets of the attachment theory, he transformed perceptions regarding the child’s tie to his mother and the ensuring disruption that evolves from separation and deprivation as well as bereavement. Ainsworth’s novel methodology, Bretherton contends, enabled one to empirically test a number of ideas Bowlby proposed. Ainsworth’s contributions included the conception that the attachment figure comprises a secure base where the infant can reach out to explore his world. She also constructed the theory regarding maternal sensitivity to infant signals and the role it contributes to infant-mother attachment patterns. The research Ainsworth completed significantly contributed to the expansion of the attachment theory.
Bretherton (1992) contends that a number of theories propose that an individual’s social network and/or his social sup-port system prove significant in determining propensity to physical disease, emotional disorder and/or social status. Although valid theories, Bretherton argues, these concepts comprise a gross oversimplification. Relationships that constitute affectional bonds; particularly those relationship possessing attachment components, provide a sense of security and depict the most significant elements in social networks and social support sys-tems.
When children and adolescents grieve, they may experience and express similar emotions as adults. Caroline S. Clauss-Ehlers (2009), Assistant Professor of Counseling Psychology at the Graduate School of Education, Rutgers, New Jersey, explains in the book, Encyclopedia of Cross-Cultural School Psychology, however, that the youth “do so in a way appropriate for stage of development during their life” (p. 487). During the time following their loss, children and adolescents need someone to clearly communicate concrete information about the loss or death; including causes, circumstances and consequences.
In the journal article, “Reducing depression among adolescents dealing with grief and loss: A program evaluation report,” Paulette Walker, LSW, director, Indianapolis Grief & Loss Consulting & Educational Services, Avon, Indiana and Michelle Shaffer, LCSW, (2007), clinical therapist, Cummins Behavioral Health, Inc., Indianapolis Juvenile Correctional Facility explain, the experience of grief wears many faces for children and adolescents. The death of a loved one from a shooting or stabbing, sexual abuse, physical abuse, abandonment, pregnancy loss, or an incarcerated parent often leaves a teen struggling to cope with life. The feelings and emotions experienced from these losses can be intense and frightening, frequently resulting in depression, destructive behaviors, drug and alcohol use, self-mutilation, and eating disorders. When teens experience severe emotional pain, they are tempted to “numb out” to avoid the painful and unfamiliar emotions (Â¶ 1).
Walker and Shaffer (2007) explain that The Growing Through Loss program, a seven-year project, developed out of the recognition that many youths entering the Indiana correctional system had experienced multiple losses prior to incarceration. Using collected data, surveys from participants, trial and error, and feedback from counselors and facilitators, we found it crucial to address the core issues of grief rather than treating the symptoms of the destructive behaviors we were observing. We believed it was important to create a treatment program that would provide a supportive, enriching learning experience and empower those we serve with healthy coping skills (Developing anâ€¦ Section, Â¶ 1).
Walker and Shaffer (2007) assert that Growing Through Loss was created with defined goals, objectives, and session activities. The program contains information that covers antisocial attitudes, values, beliefs, interpersonal skills, dangers of alcohol and drugs, and dealing with adverse family circumstances. The 12-session curriculum uses several strategies, such as role playing and hands-on activities that have consistently proven to be effective in teaching prosocial skills. It combines sessions on grief and loss, forgiveness, attitudes, friendship, developing a healthy conscience, life mapping, and leadership (Developing anâ€¦ Section, Â¶ 2).
Walker and Shaffer (2007) further assert that The Growing Through Loss student workbook provides the educational component of the program and has served well in teaching youths about the various stages of the grieving process. Workbooks provide language, concepts, and activities that assist in promoting the healing process. Art therapy is the creative component of the program that allows participants to create a memorial wreath, which communicates that the loss is a real and permanent aspect of the person’s life history. Family genogram activities also provide an opportunity for participants to identify destructive family patterns or behaviors (Developing anâ€¦ Section, Â¶ 3).
Walker and Shaffer (2007) conclude that since the inception of the Growing Through Loss program, approximately 5,000 adolescents have completed the program in correctional facilities, alternative and traditional schools, and residential treatment centers and community centers. The following are documented program outcomes achieved by participants:
Ninety percent of program participants demonstrated and reported an understanding of the correlation between grief and loss and maladaptive behaviors.
Eighty-eight percent of incarcerated adolescent girls showed a reduction in levels of depression as measured by the Beck Depression Inventory; 87.5% of adolescent boys showed a reduction.
Ninety-eight percent of program participants wrote a personal mission statement, created a symbol of loss, maintained a personal journal, and created a family genogram.
Ninety-eight percent of participants completed 90 worksheets from the Growing Through Loss student workbook (Program outcomes Section, Â¶ 1-6).
The American Academy of Child & Adolescent Psychiatry (2010) warns that when a child struggling with grief continues to display one or more of these symptoms, he may need professional help:
An extended period of depression in which the child loses interest in daily activities and events inability to sleep, loss of appetite, prolonged fear of being alone acting much younger for an extended period excessively imitating the dead person repeated statements of wanting to join the dead person withdrawal from friends, or sharp drop in school performance or refusal to attend school (American Academyâ€¦,
2010, Â¶ 8).
As a child experiencing grief attempts to cope with his/her losses and grief reactions, he generally looks both backward to the event of death or loss as well as to the future to try to understand what the events will mean. Charles A. Corr, Professor Emeritus at Southern Illinois, and David E. Balk (2010), Professor at Brooklyn College of the City University of New York stress: “Children experience and express grief in many ways, some & #8230;are distinctive of their developmental situations” (p. 14). Each child likely copes in his own way and in different means at various times in life. Frequently, the child’s efforts to maintain an ongoing connection to the individual, who died or no longer comprises one of the child’s significant others, aids him/her in his/her coping processes. The child’s connections, which include con-tinuing bonds entailing an internal representation of the deceased individual, comfort, placate, and support him as well as help him start to re-engage in constructive living. As the bereaved child experiences new, altered relationships with the deceased, that individual continues to be transformed, yet remains an ongoing presence in bereaved child’s life.
The grief children and adolescents experience may possess behavioral, physical, psychological (emotional or cognitive), social, and spiritual dimensions which he/she displays in various ways. Sometimes, the child or adolescent experiencing grief may feel fa-tigued and turn within him/her self. Other times, he/she may feel agitated or irritable for no apparent reason and lash out at those around (Corr & Balk, 2010; Clauss-Ehlers, 2009). During the grief experience, a child may experience one of more of the three following common concerns:
1. Did I cause it [death or some form of loss] to happen?
2. Is it going to happen to me?
3. Who is going to take care of me? (Corr, Nape, & Corr, 2008, p. 340).
The bereaved child my unwittingly regularly get into trouble. A child experiencing grief may regress to wetting his/her bed and/or sucking his/her thumb. he/she may display attention-seeking behaviors and/or experience difficulty sleeping. “Some bereaved children lose interest in favorite activities or experience a decline in school performance, whereas others strive to be the so-called perfect child, suppress-ing their grief and trying to take care of others in their families” (Corr & Balk, 2010, p. 14). Frequently, the bereaved child may perceive him/herself as alienated of different from the other children. he/she may think no one understands how he/she feels.
Dennis (2008) explains that the death of a parent affects children under five-years-old and adolescents more than other ages. “Most children who lose a parent to death experience sadness, grief and despair. Some children exhibit stronger symptoms, such as anxiety, depression, angry outbursts, and developmental regression” (Dennis, p. 88). Children already experiencing emotional problems usually regress developmentally the most. Other factors potentially affecting the grief process of the child or adolescent include, but may not be limited to:
The cause of the loss;
the mental status of the one lost;
socioeconomic status (Dennis, 2008).
Whether or not the child or adolescent anticipated their loss does not appear to factor into his/her recovery or healing from grief (Dennis, 2008). The bereaved child or adolescent may at times experience a confusing myriad of roller coaster emotions; as Figure 2 depicts.
Figure 2: Emotions the Grieving Child May Experience (adapted from Corr & Balk, 2010).
The grief a child experiences may evolve from a loss due to death of a nurturing parental figure or perhaps a loss due to divorce or some other family dysfunction like abuse or alcoholism. Sometimes, although the loss significantly impacts the child, it may not be acknowledged. In the book, Psychiatric-Mental Health Nursing, Sheila L. Videbeck (2010) recounts the following examples of losses related to particular needs, recognized in Abraham Maslow’s hierarchy of human needs.
Physiologic losses: These losses include the amputation of a person’s limb, a hysterectomy or a mastectomy or the loss of mobility.
Safety loss: These losses involve an individual being in an unsafe environment like child abuse, domestic violence, or public violence.
Loss of security and a sense of belonging: These type of losses include change/s in a relationship like birth, death, if divorce, illness, and marriage. During these losses, an individual may lose his/her particular role within a group or family.
Loss of self-esteem: these losses include change/s in the way a person is valued in the relationship/s or at work as well as by him/herself as this may threaten the individual’s self-esteem.
Loss related to self-actualization: These losses involve an individual experiencing an internal or external crisis that inhibits our blocks him/her pursuing fulfillment; potentially threatening his/her personal goals (Videbeck, 2010).
Kathryn Patricelli (2010), MA, explains in the article, “Grief,” that although the following stages prove typical, each individual does not always experience the stages in the exact order depicted.
1. Outcry: A person frequently becomes extremely upset when he/she initially realizes he/she has lost someone significant in life. he/she may cry, scream and yell as well as collapse. he/she may at times keep their distress inside him/herself; not sharing their grief with anyone else. Sometimes, a person may suppress outcry feelings to decrease the intensity of the feelings, while at other times; he/she may uncontrollably display his/her emotions. As maintaining the initial outcry mandates excessive amounts of energy, it usually only lasts for brief period of time.
2. Denial and Intrusion: As a person transitions past the initial outcry stage, he/she frequently enters a stage where he/she transitions between denial and intrusion. At times, the individual may engage in a myriad of distracting activities so that he/she does not think about the loss (denial). Other times, albeit, the individual feels the loss so strongly, it seems almost as intense as the initial outcry stage (intrusion). A person may transition repeatedly to/from denial and intrusion. he/she may also experience guilt when the denial portion of the phase occurs; fearing that by not staying faithful to his/her loved one, he/she may be betraying him/her. Denial helps decrease the intense grief feelings; making them a bit less overwhelming and more manageable. Denial does not denote betrayal but reflects a sign that the bereaved person has begun to experience healing of his/her emotional wound.
3. Working Through. As time passes, the movement between denial and intrusion decreases and appears less pronounced. The individual spends less time focusing on the loss and does not feel as overwhelmed by it. During this stage, the individual begins to discover ways to he/she can exist without the lost relationship. During this period, the individual’s goals and plans may include developing new relationships and/or friendships as well as strengthening existing ones, engaging in new activities and projects.
4. Completion: At some particular point, the individual complete or determines that he/she has completed enough grieving. In turn, he/she begins to feel normal again. The person retains memories the person or object he/she lost, however, the feeling attached to the loss proves less painful as it does not interfere with the individual’s life as often. The individual may experience temporary recurrences of grief feelings on particular anniversaries. These upwelling hurt feelings, nevertheless, do not linger (Patricelli, 2010; Videbeck, 2010).
Elizabeth Kubler-Ross developed a model of five stages to reflect what an individual experiences as he/she grieves and mourns a loss. Kubler-Ross’ model currently serves as a prototype for care providers to help them better understand and aid individuals experiencing the grieving process (Videbeck, 2010).
1. Denial is shock and disbelief regarding the loss.
2. Anger may be expressed toward God, relatives, friends, or healthcare providers.
3. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss.
4. Depression results when awareness of the loss becomes acute.
5. Acceptance occurs when the person shows evidence of coming to terms with death. (Videbeck, 2010, p. 217)
Although grief various theories differ in approach and perhaps in the order of the stages, each model indicates the grieving process cannot be rushed. Grief starts with an extremely painful emotional adjustment which requires time and cannot be hurried along (Patricelli, 2010). Dennis (2008) explains that questions like the following often arise relating to children and death.
“Is a child prepared for the funeral experience?
“Should a child be involved in the wake or funeral?
“Should a child be permitted to view his or her parent’s body?” (Dennis, 2008, p. 89).
Melissa Allen Heath, Associate Professor at Brigham Young University, with Deon Leavy, Kristina Hansen, Katherine Ryan, Amy Gerritsen Sonntag, and Lacey Lawrence (2008), all students at Brigham Young University, assert in the journal article, “Coping With Grief: Guidelines and Resources for Assisting Children,” explain grieving as personal feelings and perceptions linked with loss. Even though grief typically relates to loved one’s death, it also associates “with the disruption of familiar comfort and security, including divorce, family financial difficulties, frequent moves, and loss of friendships. Of a more personal nature, children may suffer violations of trust, abuse, and neglect” (Heath, et al., p. 259). On the a continuum of severity of children’s grief, the loss a child experiences include a blend of emotions. The grief response may relate to something as uncomplicated as losing a toy to being overwhelmed by losing a parent after gradually witnessing him/her die from a terminal illness.
Dr. Dixie Dennis (2008), Austin Peay University, explains in the book, Living, Dying, Grieving, that even when a child or adolescent appears to have adjusted to a loss or death of a loved one, he/she can still experience problems or trouble later. Significant family life events that occur later, particularly after the death of a parent, can generate delayed grief and the child or adolescent can experience renewed challenges in adjusting. At times, as the grief accompanying the loss the child or adolescent experiences may demand unfamiliar, stressful cognitive emotional and coping strategies, unaddressed concerns can strain his/her normal developmental processes.
James William Worden (2009), Fellow of the American Psychological Association, stresses in the book, Grief counseling and grief therapy: A handbook for the mental health practitioner, that some grief behaviors portend later difficulty for the bereaved child in terms of not only mental health but health problems as well. Among the myriad of loses children experience, almost 5% of children and adolescents in the United States (U.S.) experience a significant loss due to death before they reach the age of 15. In the article reviewing 13 controlled outcome studies, “The effectiveness of bereavement interventions with children a meta-analytic review of controlled outcome research,” Joseph M. Currier, Jason M. Holland, and Robert A. Neimeyer (2007), all with the Department of Psychology, University of Memphis, stress:
As with grief phenomena in adults, complica-tions in the grieving process for children are asso-ciated with greater vulnerability to a variety of psychological disturbances & #8230;. Research suggests that the detrimental effects on children’s acute and medium-term somatic complaintsâ€¦, dif-ficulties learning and concentrating in schoolâ€¦, and an inability to maintain healthy levels of self-esteem or a sense of connectedness to their remaining social networkâ€¦. Despite the encour-aging fact that findings from the Child Bereavement Studyâ€¦ indicate that most bereaved children (e.g., 80%) will show resilience in adjusting to loss, a sizable contingent (e.g., 15%-20%) is still expected to display significant emotional and beha-vior difficulties even at 2 years post-loss. (Currier, Holland & Neimeyer, 2007, p. 253)
A number of potent problems potentially challenge children ages 7 to 11 following the death of a nuclear or extended family member that may also adversely affect them in the future. Consequently, a critical need exists for expanded knowledge regarding ways to best help these children cope with a number of things, including finding places for the deceased in their on-going lives.
In the book, Where’s My Mum Now?: Children’s Perspectives on Helps and Hindrances to Their Grief, Brian Cranwell (2010) asserts that understanding what a child or adolescent needs and the best ways to respond to them will help him/her heal through grief. When a child or adolescent loses a significant person in his/her life, he/she will experience emotional and/or physical problems. In addition, some will not be able to concentrate as they did prior to their loss. Frequently, when the grieving child or adolescent does not receive the help he/she needs, he/she will display behavioral problems. Research indicates:
Approximately 50% of children who have experienced the death of a parent find it difficult to function in ordinary everyday activities. During the first year after the death of a parent, one in five of grieving children will need help from a specialist.
Even after one year following the death of a significant person in their lives, compared with 6% of non-bereaved children, 16% of bereaved children continue to experience concentration problems.
During the weeks immediately following the death of a significant person, one in five bereaved children will not display any evidence of difficulty. Two years later, however, the child may confuse individuals around him by evidencing problems
In regard to the physical health of bereaved children:
They consult general practitioners more often prior to and following the death of sick parent, and frequently for treatment of symptoms with no determined medical basis.
Some grieving children present physical complaints like bed wetting, headaches, decreased appetite, increased infections, sore muscles, and upset stomach.
Some children may even display symptoms similar to the ones the deceased experienced prior to his/her death (Cranwell, 2010).
Not addressing the extensive behavioral as well as emotional grief reactions children and adolescents experience may contribute to these youth more likely growing into adults with health and mental health problems. Addressing concerns and communicating support to those children and adolescents who experience grief proves critical to help ensure that in the future they become adults without a barrage of health and mental health problems.
In the journal article, “Group Therapy for Children after Homicide and Violence: A Pilot Study,” Alison Salloum (2008), University of South Florida, employed a secondary data analysis of 117 participants in 21 group interventions (pretest/posttest differences) to assess a group intervention designed to decrease posttraumatic stress among youth following a homicide and/or violent act. Findings indicate that child witnesses as well as older girls experience more difficulties relating to grief. In urban areas, Salloum recommends, social workers need to effectively identify child survivors who not only may need grief therapy but may also need enhanced mental health intervention related to PTSD as well as homicide and violence.
In regard to the youth’s pos-death adjustment, Dennis (2008) proffers the following recommendations for parents who want to help their children understand death:
Allow children to attend the funeral of a person they loved. Prepare them for the experience, and recognize that sometimes a child who is innocent about life might actually be wiser and better able to heal than someone with more life experience.
Do not lie or tell half-truths. People, in general, and children, specifically, can usually cope with what they know; it is trying to handle what they do not know can be a problem.
Many people think that children should reach a particular age before being told anything about death. Actually, no such age exists. Children are never too young to experience loss, be it the loss of a friend who moves away or the death of a pet.
Children typically would rather have adults they trust talk about the experience with them than go through it all alone. (Dennis, 2008, p. 89)
Caregivers and counselors should encourage youth to ask question about death as they are naturally curious about it. When the family and/or caregiver shares information with the child or adolescent and plainly expresses feelings about the one who died, the child or adolescent will more likely more easily adapt to their loss . When the child or adolescent does not receive information about the loss, however, he/she will more likely act out, deny, suffer, or experience guilt about causing the death. Dennis (2008) stresses a loss not only depicts the loss of that person from a life, it also reflects the loss of potential future events that would have included the youth. As Clauss-Ehlers (2009) explains, to circumvent feeling different from their peers, adolescents often try to repress their feelings related to their loss. When the bereaved child or adolescent expresses personal feelings, however, this may help circumvent additional grief complications. Even though the child or adolescent experiencing grief usually adjusts over time, he/she spends the rest of his/her life missing the one he/she lost. As the adage asserts, death may end a person’s life, but the relationship he/she shared with others lives on.
Contemporary discussions debate whether attachment styles actually relate to the individual’s active mourning process. Before Bowlby completed his attachment work, Freud proposed that a bereaved individual needed to de-invest libidinal energy not only from the deceased but also from relationship to effectively mourn. This would allegedly free the individual to invest in new relationships. Basically, according to Servaty-Seib (2004), every individual “constructs a “working model of relationships between the self and others” (Â¶ 1). Complimenting this contention and as a direct response to Freud’s disengagement idea, “recent work suggests that it is normative and adaptive for bereaved individuals to accommodate to loss through maintaining a dynamic connection to the deceased through a ‘continuing bond'” (Servaty-Seib, 2004, Â¶ 3). In coping with loss, Bowlby (1980) allocates for both disconnection and maintained connection. Nevertheless, in the book, Loss: Sadness and depression, he warns, that the grieving individual can experience complications with either pole.
Neglecting to address the considerable emotional and behavioral grief reactions/complications of children who experience the death of a nuclear or extended family member could contribute to these children more likely growing into adults who experience health and mental health problems. The encyclopedia entry, “Attachment Theory” (2008) notes that attachment theory and research are now “integrated into the diagnosis and treatment of children with reactive attachment disorder, a set of seriously aberrant and problematic attachment behaviors typically associated with parental maltreatment or disruptions in early caregiving relationships” (Â¶ 1). The study proves significant as it investigates attachment theory and specifically addresses concerns of children ages 7 to 11 who experience grief as well as considers constructive ways to counter potentially harmful issues and promote the child’s healing during the grieving process. In time, an emotionally healthy child most likely matures into an adult who can not only live a productive live, but by example and actions, encourage others to do likewise.
Statistics from Columbia University in 2007 assert that adolescent depression throughout the general population in the United States ranges from three to nine percent. Major depression among adolescents may lead to inability to psychosocial functioning with family members, friends and even at school. Dr. Anat Brunstein-Klomek, Dr. Gil Zalsman, and Dr. Laura Mufson (2007), all with the Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, express in the journal article, “Interpersonal Psychotherapy for Depressed Adolescents (IPT-A),” adolescent depression has been recognized as one of the chief risk factors for suicidal thoughts, to suicide attempts and sadly suicide. Several studies that have followed teens who were depressed during adolescent years typically have found those same individuals depressed in adulthood also.
Depression, a harmful mental state, has numerous health related consequences including academic problems, substance and tobacco abuse and suicide attempts. Jennifer Wisdom and Katherine Riley, both with the Department of Public Health and Preventive Medicine, Oregon Health & Science University in Portland, Oregon and Amanda Rees and Teresa R. Weis (2007), both with the Department of Counseling Psychology at Lewis and Clark College in Portland, Oregon, assert in the journal article, “Adolescents’ perceptions of the gendered context of depression: “Tough” boys and objectified girls,” depression in adolescent years can also forebode illness in later years. Depression may also be a result of influences from the environment, such as problems in a family or stressful events in life.
Adolescents of both genders and all cultures have different ideas and visions of what their peers and the world perceive to be beautiful. In today’s society, the media portrays images of teen idols, beautiful, thin young women, on countless magazines and television shows, many teen girls find it hard to measure up to these young women. Wisdom, Riley, Rees and Weis (2007) explain that “if a girl thought that she did not measure up to these images of perfection, she could feel frustrated, hopeless, and, ultimately, depressed” (Societal Expectationsâ€¦ Section, Â¶ 1). Teen boys also have teen idols they feel they have to live up to and look like, which can also cause these young men to feel as if they cannot compare to what their peers consider to be perfect.
Mental health professionals and educators alike have fears and concerns relating to teens mental health, especially depression, in today’s society. John McCarthy, associate professor in the Department of Counseling at Indiana University of Pennsylvania, Edward J. Downes, an associate professor in the College of Communication at Boston University and Christine A. Sherman (2008), Indiana University of Pennsylvania Department of Counseling, purport in the journal article, “Looking back at adolescent depression: A qualitative study,” a survey conducted by the Annenberg Pubic Policy Center, including 1400 mental health professionals who work in public high schools, asserted that depression and substance abuse were two of the most crucial issues for teen today. More so, two-thirds of these health professionals cited that depression was an enormous problem, getting a higher percentage of concern even over violence.
Adolescent depression, according to professionals simulates many of the same signs and symptoms of adult depression. McCarthy, Downes and Sherman (2008) explain that The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision) (DSM-IV-TR), “does not differentiate between adolescent and adult depression; in both cases, five or more symptoms must be present during the same two-week period and mark a change from the level of previous functioning” (Â¶ 5). Although there are nine symptoms listed in the DSM-IV-TR, only one specifically acknowledges adolescents, under “depressed mood most of the day,” a note below asserts that for adolescents, it may be perceived as an “irritable mood.”
McCarthy, Downes and Sherman (2008) explain that Brent and Birmaher (2002) noted that depression in both children and adolescents is not always featured by sadness, but rather takes the form of irritability, boredom, and the inability to find pleasure. Symptoms of depression may also vary depending upon the stage of adolescence. Younger adolescents may show more anxiety-related symptoms — clinging behaviors, unexplained fears, and physical symptoms — while older adolescents may experience a greater loss of interest and pleasure and also have more morbid thinking. Lewinsohn, Rhode, and Seeley (1998) found that nearly 89% of depressed adolescents reported disturbances in sleep. Other symptoms that were frequently reported included a disturbance in weight/appetite (79.5%) and anhedonia (77.3%) (Â¶ 6).
McCarthy, Downes and Sherman (2008) explain that though the signs of depression are fairly clear, identifying an adolescent with depression can be difficult. Though only using the word “child” in discussing child and adolescent depression, the National Institute of Mental Health (n.d.) noted that the challenge lies in determining whether the youth is experiencing a temporary phase or truly suffering from depression. Two factors can enter this determination, the first of which separates an adolescent who is dispirited from an adolescent who is demoralized. Being dispirited could surface from an adolescent’s not being allowed to go to a movie or on a date, while demoralization could result from rejection from a romantic partner. In the case of demoralization, the adolescent could show signs of rising above the feelings and thoughts of rejection, though only momentarily and temporarily. The second point focuses on the time element, as the change in mood must be significant and last for weeks rather than days (Â¶ 7).
Vanya Hamrin, an Associate Professor, Psychiatric Mental Health Nursing, Yale University School of Nursing, New Haven, Connecticut and Michelle Magorno (2010), an Instructor of Clinical Nursing and a Pediatric Nurse Practitioner, Naomi Berrie Diabetes Center, Columbia School of Nursing, New York, express in the journal article, “Assessment of adolescents for depression in the pediatric primary care setting,” depressive disorders appear to run in families; 2% to 50% of youth who experience depression in early childhood or adolescence have a family history of depression or other mental health problems. Luby, Belden, and Spitznagel (2006) found that both family history of mood disorders and stressful life events predicted depression scores six months later, and stressful life events mediated the relationship between family history in children ages 3 to 4 years old with depression. These results suggest that individuals at high genetic risk seem to be more susceptible to negative life events and environmental factors than others (Genetic riskâ€¦ Section, Â¶ 2).
Hamrin and Magorno (2010) explain that cognitive risk factors for depression in adolescents include elevated levels of anxiety, low self-esteem, high self-criticism, cognitive distortions, poor school performance, and social skill deficits. Adolescents with negative cognitive styles have a distorted view of themselves, the world, and the future, resulting in risk for MDD. They tend to feel responsible for any negative events in their life, resulting in hopelessness and depression during negative life events, such as rejection, perceived failure, or personal loss (Cognitive risk factors Section, Â¶ 1).
Brunstein-Klomek, Zalsman and Mufson (2007) explain that Mufson and colleagues were the first to adapt IPT for use in adolescents with major depression (IPT-A). IPT — A is a manualized treatment, designed to be used once per week for 12 weeks. The goals of the treatment are to reduce depressive symptoms and to address the interpersonal problems associated with the onset of the depression. The objectives of treatment take into account the adolescent’s developmental tasks including individuation, establishment of autonomy, development of romantic partners, coping with initial experiences of loss and death and managing peer pressure. IPT — A focuses largely on current interpersonal issues that are likely to be areas of the greatest concerns and importance to adolescents (IPT — A inâ€¦ Section, Â¶ 1).
Brunstein-Klomek, Zalsman and Mufson (2007) explain that the treatment manual of the therapy is clear and user friendly. It is organized as a step-by-step description of the therapeutic tasks of treatment and includes clinical vignettes to help guide the reader in the implementation of IPT-A. The manual also provides a brief overview of adolescent depression (including diagnosis, assessment, clinical course and other treatments) and efficacy data from clinical trials conducted using IPT-A. The manual has a section on special issues that arise when working with adolescents and how they can be addressed while staying within the IPT — A treatment framework (IPT — A inâ€¦ Section, Â¶ 2).
Brunstein-Klomek, Zalsman and Mufson (2007) explain that the treatment is divided into three phases: initial phase, middle phase and termination phase. The initial phase focuses on depression diagnosis, psychoeducation about the illness and limited sick role, exploration of the patient’s significant interpersonal relations, and the identification of the problem area that will be the focus of the entire treatment (Phase ofâ€¦ Section, Â¶ 1).
Brunstein-Klomek, Zalsman and Mufson (2007) explain that in the initial phase, the therapist conducts the “Interpersonal Inventory,” which is a detailed review of the patient’s significant relationships, both current and past. Examples of questions from the inventory are: Who in your family do you feel you confide in and go to help for? What are the positive and negative aspects of your relationship with X? Are there things you would like to change about this relationship? Was there a time when you felt differently about your relationship with X? This inventory is the focus of the initial phase of treatment as it provides the necessary interpersonal data to select one of the four problem areas for focus in the middle phase (Phase ofâ€¦ Section, Â¶ 2).
Brunstein-Klomek, Zalsman and Mufson (2007) explain that to conduct the Interpersonal Inventory, it is helpful for the therapist to use the “Closeness Circle.” This is a series of circles, one within the other with an ? In the center, which represents the patient. The goal is to place the adolescent’s significant relationships within the appropriate circles of closeness/importance in the teenager’s life. The result is a picture of the significant people orbiting the adolescent’s life and the emotional valence associated with their position in the adolescent’s life (Phase ofâ€¦ Section, Â¶ 3).
Cate Bearsley-Smith (2007), School of Psychology, Psychiatry and Psychological Medicine, Monash University, Traralgon, Victoria, Australia, et al., assert in the journal article, “Does Interpersonal Psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial,” the immediate and long-term individual, interpersonal and societal costs of depression are substantial. Up to one in five people will have suffered the effects of major depression before the age of 18 years. Despite limited research regarding depression amongst rural adolescents, we know that rural young men are at particularly high risk of suicide compared to their metropolitan peers (Â¶ 1).
Cate Bearsley-Smith, et al. (2007) explain that questions remain regarding the most effective community treatment for adolescents with depression. Antidepressant medication continues to be associated with controversy regarding its efficacy and safety in use with adolescents. Structured psychological interventions, particularly Cognitive Behaviour Therapy (CBT) and Interpersonal Psychotherapy (IPT), have demonstrated efficacy for the treatment of adolescent depression. These psychotherapies are also used as treatments alongside medication, or in the maintenance of post depressive episodes (Â¶ 2).
Cate Bearsley-Smith, et al. (2007) explain that The available evidence suggests IPT is an efficacious treatment for depression which can be easily learned by Australian mental health professionals and other novice therapists. IPT is based on the formulation that relationships are inherently inter-related with emotional well-being. The therapy aims to decrease depressive symptomatology and improve the relational functioning of clients. The treatment focuses on a key interpersonal problem area identified for the individual (e.g. grief, interpersonal role disputes, interpersonal role transitions). IPT is manual-based and time-limited and can be administered effectively with or without medication (Â¶ 4).
Dr. Van Pelt (2009), member of the National Headache Foundation and the Victor Frankl Institute of Logotherapy, asserts in the journal article, “Where is the hurt? How do we help?,” in recent years, we’ve seen an increase in reports of medically treated anxiety, depression, and somatic comorbidity disorders in adults and children, and in adolescents in particular. The medical literature often mentions the benefits of functional magnetic resonance imaging (fMRI), that is, visual images showing the unbalanced emotional arousal states of regions of the CNS. Still missing, however, is medical professional awareness and acknowledgement of the impact of emotional CNS arousal on organic function. Anxiety, depression, and somatic complaints such as headache, irritable bowel syndrome, or even nonorganic chest pain are symptoms of a hyperaroused CNS, not an illness (Â¶ 1).
Pelt (2009) explains that not only have fMRIs shed light on the negative excitation of the CNS, but they have also helped demystify the placebo effect by depicting how positive expectation will calm emotional hyperarousal. However, given the rise in medical costs, we should consider how we might best take advantage of this imaging breakthrough that is capable of “visualizing” the psychosomatic interplay (Â¶ 2).
Patrick Clinton (2007), Editor-in-chief, expresses in the journal article, “Second thoughts,” a new study finds that antidepressants do more good than harm. That’s good news. The bad news is how much damage may have been done in the name of protecting kids from SSRIs (Â¶ 1). A day or two after the shootings at Virginia Tech, the newspapers carried an account of an important new study in the Journal of the American Medical Association. It was a week of shock, grief, and not a little morbid fascination, and I suspect that not many readers took notice. That’s too bad, because the JAMA study and the coverage of Seung-Hui Cho cast genuinely useful light on each other (Â¶ 2).
Clinton (2007) explains that the study, conducted by a team led by Jeffrey Bridge, associate professor of pediatrics at Ohio State University and an investigator at the Columbus Children’s Research Institute, was a review of 27 published and unpublished trials of second-generation antidepressants (including selective serotonin reuptake inhibitors, or SSRIs) in patients younger than 19. Their findings-no real surprise-were that the drugs were effective in treating anxiety and obsessive-compulsive disorder in young patients, and modestly effective in treating major depression. And though they caused an increase in suicidal thoughts, it happened to only about one patient in 100, half the rate FDA had previously estimated. The benefits, it appeared, outweighed the risks (Â¶ 3). Overall, Bridge told a reporter from the Web site Foodconsumer.org, “Our findings mean that antidepressants should be considered as a first-line treatment option for pediatric depression and anxiety disorders.” (Â¶ 4).
Bowlby (1980) asserts that in regard to the attachment perspective during the grief process, for the individual to recover in a healthy way, he needs to acknowledge that the attachment figure can no longer personally/physically provide care and/or comfort, yes simultaneously discover a way to sustain a secure bond with the person. During the dissertation, as the researcher investigates grief reactions the bereaved child, age 7 to 11, experiences that need to be addressed to counter potential links to ensuing health and/or mental health problems in life, the study also correlates concepts from attachment theory with considerations for counseling these children. The venture, the researcher asserts, will concurrently enhance the reader’s knowledge of ways to help children who experience the death of a nuclear or extended family member as well as serve to stimulate the counselor’s interest in considering what benefits the investment of drawing from attachment theory may proffer.
Cristiane Seixas Duarte, Genevieve Rachel Green, and Christina W. Hoven, all with the Division of Child and Adolescent Psychiatry, New York, and Isabel Altenfelder Santos Bordi (2009), with the Setor de Psiquiatria Social, Departamento de Psiquiatria, Escola Paulista de Medicina, Unifesp, purport in the journal article, Measuring child exposure to violence and mental health reactions in epidemiological studies: Challenges and current issues,” the assessment of children’s behaviors and emotions after they had been exposed to extreme violence poses unique challenges compared to the assessment of adults. First, developmental stages need to be considered, as measurement strategies will most likely differ when assessing children in varying stages of development. As a general rule, the younger the child, the more limited are our options to appropriately evaluate her or his mental health. Second, when the goal is to learn about children’s reactions, different informants may be required. The choice of the optimal informant may depend on the type of reactions of interest (internalizing or externalizing behaviors?), the age range (early childhood or adolescence?) and logistics (is it feasible to interview parents and children?) (Â¶ 2).
The challenges inherent to the assessment of youth populations are combined with the challenges pertaining to the epidemiological measurement of psychopathology related to exposure to violence. As we know, this type of evaluation is a two-step process; including both a detailed characterization of the person’s exposure as well as of the reactions possibly related to such exposure. This paper, rather than aiming to describe a large number of measures used in post-disaster contexts, focus on a few selected measures which can be used to assess both exposure to traumatic events and symptoms in children which could be related to the traumatic exposure. The measures included were used recently in key studies addressing the impact of violence and the development of child psychopathology (Duarte, Green, Hoven & Bordi, 2009, Â¶ 3).
Dr. Daniel L. O’Donoghue and Dr. Gilbert A. Boissonneault (2009), explain in the journal article, “Major depression: Screening and treatment,” major depressive disorder (MDD) can complicate the care of patients in any clinical setting and is an issue for any PA practicing in primary care, as well as for those working in many specialty settings where depression may be common but poorly recognized. As many as 6% of pediatric patients and 16% of adult patients will meet the diagnostic criteria for MDD. Screening may be as simple as asking two questions and can provide a basis for improving the outcomes from this debilitating disorder (Â¶ 1).
1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?
2. During the past month, have you been bothered by having little interest or pleasure in doing things? (O’Donoghue & Boissonneault, 2009, Â¶ 3).
Children can experience depressive symptoms similar to those in adults, including feelings of hopelessness and loss of pleasure or interest in activities. Children may become anxious and exhibit turmoil in their lives. The prevalence of depression increases from 3% among children to 6% in adolescents, with up to a 20% lifetime MDD prevalence among adolescents. Depression affects a child’s cognitive, physical, and behavioral function and manifests as feelings of isolation and helplessness; these can lead to a sense of guilt, preoccupation with death, or thoughts of suicide (O’Donoghue & Boissonneault, 2009, Â¶ 5).
Children and adolescents, like adults, may demonstrate changes in eating or sleeping behaviors. They may appear sluggish, easily agitated, or fidgety. The history should include questions about the child’s withdrawal from daily activities and whether the child is clinging, more demanding, or more dependent on others. Children may also appear out of control or engage in excessive or reckless behaviors, including activities that produce harm or pain. Comorbid substance abuse should be considered in childhood depression, particularly in adolescence. Preoccupation with morbid thoughts and impulsive, angry, or irritable behavior can all be warning signs (O’Donoghue & Boissonneault, 2009, Â¶ 6).
Duarte, Green, Hoven and Bordi (2009) explain that instruments measuring child exposure to traumatic contexts have also been developed. Such instruments, although obviously context-dependent, can be used across different studies. In many instances, however, supplementation with questions unique to each particular context may be desirable. Examples are instruments addressing children’s exposure to war or community violence (Assessment of childâ€¦Section, Â¶ 3).
Duarte, Green, Hoven and Bordi (2009) further explain that systematic assessment of certain types or domains of potentially traumatic events experienced by children is also frequently carried out. Children can be physically or emotionally abused or neglected. Sexual abuse is another type of child traumatic exposure. These experiences may occur as part of a specific event or context (war-related rape). They may be a one-time event, but in many cases abuse and neglect become part of day-to-day lives of children. The Childhood Trauma Questionnaire is an example of a self-administered retrospective instrument used with children as young as 12 years. Another example is the Conflict Tactics Scale (CTSPC), which can be used to gather parental and child reports of intrafamily conflict or violence involving a child (Assessment of childâ€¦Section, Â¶ 4).
Duarte, Green, Hoven and Bordi (2009) assert that the use of screening measures to assess child psychiatric disorders can abbreviate the time taken to conduct assessments permitting a wider range of possible reactions to trauma to be considered. The Child Behavior Checklist (CBCL) is the most utilized instrument to identify mental health problems in children and adolescents worldwide. The Child Behavior Checklist — CBCL 6-18 is a standardized parent-report screening questionnaire with 118 items to identify emotional/behavioral problems in children and adolescents at a clinical or borderline level. Data on content and construct validity, and test-retest and inter-interviewer reliability revealed adequate psychometric properties of the instrument. It allows the identification of empirically-based, cross-culturally reproducible syndromes, which can be related to the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification (Child mental healthâ€¦Section, Â¶ 1).
Duarte, Green, Hoven and Bordi (2009) further assert that the Strengths and Difficulties Questionnaire (SDQ) is another general psychopathology measure, conceptually derived from the DSM classification, and originated from the Rutter Questionnaires. The SDQ is a brief questionnaire used as a screening for mental health problems in children aged 4 to 16 years, and shows adequate psychometric properties. Its 25 items are distributed across five scales: anxiety and/or depression, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior, with the sum of the four first scales representing total difficulties. Cutoff points determine three categories (clinical, borderline, and normal) for each of the scales. There are versions for parents/caretakers, children aged 11-18 years, and teachers (Child mental healthâ€¦Section, Â¶ 3).
Duarte, Green, Hoven and Bordi (2009) explain that to assess probable mental disorders in children, another option is the DISC Predictive Scales — DPS, a screening measure derived from the National Institute of Mental Health’s Diagnostic Interview Schedule for Children, Version IV (DISC-IV) a structured diagnostic interview (described above). Items in the DPS were derived by secondary analysis of large data sets from studies containing DISC symptom and diagnostic information. The DPS includes only the DISC items that are most predictive of DSM-IV DISC diagnoses. Besides the most prevalent psychiatric disorders, including Post Traumatic Stress Disorder (PTSD), the DPS also contains a measure of children’s impairment (7 global questions derived from the DISC), consistent with DSM-IV criteria. A measure of impairment is optimally obtained in epidemiological assessments of childhood psychiatric disorders and combined with symptoms to define a probable case.
Duarte, Green, Hoven and Bordi (2009) explain that depending on the specific nature of the traumatic situation, it may be important to include specific reactions as part of the evaluation. We now know that having a family member exposed to a traumatic situation has an impact on child mental health. Such impact may vary widely; and it may be particularly intense if the family member dies as a result of such exposure. Traumatic grief is a possible reaction to the sudden death of a loved one. Traumatic grief is not a recognized disorder in the DSM-IV, and therefore has no widely shared agreed upon definition of symptoms and it is often confused with another newly developing diagnosis, complicated grief. While these two psychiatric problems are similar, they are also distinct from one another (Traumatic griefâ€¦Section, Â¶ 1).
Duarte, Green, Hoven and Bordi (2009) further explain that childhood traumatic grief refers to a psychiatric condition in which a child or adolescent is unable to go through the normal grieving process following an objectively traumatic death. Similar to PTSD, children with childhood traumatic grief will experience hyperarousal and reexperiencing of the traumatic event related to the loved one’s death. Reexperiencing is usually triggered by trauma reminders (places, people or events that remind the child or the deceased). This indicates that the trauma of the death is taking priority over bereavement of the death itself. According to available data, without treatment, traumatic grief could linger or worsen over time, possibly posing a serious threat for persistent impairment in social functioning (Traumatic griefâ€¦Section, Â¶ 2).
Duarte, Green, Hoven and Bordi (2009) assert that children and adolescents suffering from traumatic grief can be assessed by the Inventory of Traumatic Grief (ITG). While there have been numerous attempts to quantify grieving, this measure has been developed specifically to measure pathologically maladaptive symptoms of grief (such as separation distress and traumatic distress). The ITG is a 30-item, self-report questionnaire originally designed for adults. The respondent’s rate the degree in which their symptoms affected them within the last month on a 5-point scale (ranging from almost never to always). Other items refer to the intensity of the symptoms (ranging from no sense of bitterness to overwhelming sense of bitterness) (Traumatic griefâ€¦Section, Â¶ 3).
Duarte, Green, Hoven and Bordi (2009) assert that interest in grief disorders are growing. Diagnostic tools have been developed attempting to separate normal (uncomplicated) grief symptoms from the unique symptoms of traumatic grief. As with many psychiatric disorders, child and adolescent populations are not being studied as thoroughly as the adult populace and this is clearly an area which deserves more attention (Traumatic griefâ€¦Section, Â¶ 4).
Duarte, Green, Hoven and Bordi (2009) conclude that the assessment of exposure to violence and psychopathology can be done with different levels of details and specificity. It is important that investigators have the goals of the research project clearly established so that the best measurement strategy can be determined. The selection of instruments for the assessment of exposure to violence and psychopathology in children will have to take into account a broad range of issues, such as disorder(s) to be measured, instrument’s psychometric properties, cultural appropriateness for the specific context, length, mode of administration, possibility of drawing useful comparisons based on existing data, among others. In this paper, we provided commentaries and a description of instruments which can be valuable resources, according to our research experience, knowledge of the literature, and evidence from recent studies (Final comments Section, Â¶ 2).
Adel Gabriel, with the University of Calgary and Calgary Health region, Calgary, Canada and Claudio Violato (2009), with the Department Community Health Sciences, Faculty of Medicine, University of Calgary, Canada, purport in the journal article, “The development of a knowledge test of depression and its treatment for patients suffering from non-psychotic depression: A psychometric assessment,” many people who have personal experience with depression cannot recognize it in vignettes, can’t differentiate depression from normal sadness, their knowledge about its causes is distorted and over half of the subjects who have major depression (MD) do not seek treatment for the episode. Moreover, only 40% consider antidepressants to be helpful, few recommend treatment from a counselor, telephone service or psychologist, and many consider a psychiatrist as harmful. There is, however, emerging evidence to suggest that mental health literacy can be improved with educational interventions (Background Section, Â¶ 1).
Gabriel and Violato (2009) explain that many people are not able to identify depression correctly in community surveys or structured interviews of both adolescents and adults. In these studies, respondents were also misinformed about the causes of depression, were not able to differentiate major depression from normal sadness, and were unlikely to seek professional help for depression. In a vignette depicting a depressed person, for example, only 39% of respondents (n = 1 010) correctly identified the case as depression. Moreover, only 51% rated a psychiatrist as helpful from a list of various professionals that could be either helpful or harmful for the person described in the vignette. Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, and admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments (increased physical or social activity, relaxation and stress management, reading about people with similar problems) were rated as more helpful (Recognition of Depressionâ€¦Section, Â¶ 1).
McCarthy, Downes and Sherman (2008) explain that the purpose of this study was to increase the understanding of adolescent depression by interviewing formerly depressed young adults regarding their adolescent experiences with depressive symptoms, the help-seeking process, and treatment for this disorder. Specifically, we sought to identify emerging themes in qualitative interviews to supplement quantitative research findings on such items as the person’s sources of assistance, helpful and unhelpful elements of treatment, possible concerns about subsequent relapses, and advice for currently depressed teens as well as for the mental health professionals working with this clientele. Through this design, it was hoped that themes connected to crucial issues and prior research could also be identified (Â¶ 13).
McCarthy, Downes and Sherman (2008) explain that after obtaining institutional review board approval, potential participants were sought solely through four display-sized advertisements in a student newspaper of a university during the fall 2005 semester. The text of the advertisement was: “Participants sought for a study on adolescent depression. Students must be 20-23 years of age, have been diagnosed with and treated for adolescent depression between the ages of 15-18, and must be currently depression-free. Participants will receive compensation for approximately 60-90 minutes of their time” (Method Section, Â¶ 1).
McCarthy, Downes and Sherman (2008) explain that to ensure that prospective participants were not currently depressed, two screening tools were utilized in this study: a questionnaire that reflected the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text Revision) (DSM-IV-TR) criteria for major depressive disorder and the Beck Depression Inventory-II (BDI-II). The first instrument, a nine-item questionnaire created for this study and consisting of closed-ended questions reflective of DSM-IV-TR criteria, was administered orally to potential participants by the primary author. Since the questionnaire lacked psychometric support, it served as a preliminary screening tool only. The second tool, the BDI-II, was then completed by the potential participant while alone in the interview room. To be eligible for the study, potential participants had to score 19 or below on the BDI-II (Data Collection Section, Â¶ 3).
McCarthy, Downes and Sherman (2008) explain that the interviews were analyzed without the use of a qualitative data analysis (QDA) program. Recognizing that “(s)oftware programs (can) facilitate data storage, coding, retrieval, comparing and linking — but human beings do the analysis,” the we chose to physically analyze the data through inscribing and revising notes written on the physical transcripts. While software programs can assist in analyzing qualitative data, especially for data sets larger than the one in this particular study, computer-aided analysis “is not a requisite for qualitative inquiry” (Data Analysis Section, Â¶ 1).
McCarthy, Downes and Sherman (2008) explain that five themes emerged from the data: (a) talking was helpful; (b) relief was obtained in their work with counselors; (c) parental (and adult) partnerships were significant; (d) friends were most often helpful; and (e) a realistic optimism was present when looking back at their experiences. It should also be noted that, although participants worked with a variety of mental health professionals, the word “counselor” is used predominantly in this article. More specific identifications were made when participants spoke about the type of mental health professional they saw (Findings Section, Â¶ 1).
Mona Basker and Prabhakar D. Moses, both with Department of Child Health, Christian Medical College, India, Sushila Russell and Paul Swamidhas Sudhakar Russell (2007), both with Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College, Vellore, India, assert in the journal article, “The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India,” Beck Depression Inventory (BDI) has excellent psychometric properties across clinical and non-clinical populations in other countries. BDI has also been extensively validated among the adolescent population elsewhere. Therefore this study was conducted to document the psychometric properties of BDI in a primary-care setting in India while being used by pediatricians (Â¶ 2).
Basker, Moses, Russell and Russell (2007) explain that participants were recruited from three schools at Vellore that represent the higher (Private ICSC board school), middle (Private matriculation board school), lower socio-economic (Public state board school) backgrounds and they represent the literate young adolescent population in India. All adolescents were included in the study if they were in the 11 grade (to avoid the symptoms of depression due to educational stress of appearing for board examination in the 10th as well as the 12th grades), and able to read and write English at least at sixth grade level (Methods Section, Â¶ 1).
Basker, Moses, Russell and Russell (2007) explain that Beck Depression Inventory (BDI) is a 21 item, self rated inventory with each item rated with a set of four possible answer choices of increasing intensity. When the test is scored, a value of 0 to 3 is assigned for each answer and then the total score is compared to a key to determine the depression’s severity. It can be administered for adolescents above 14 years as the reading level of the measure is only at sixth grade level and can be completed in about 10 minutes (Measures Section, Â¶ 1).
Basker, Moses, Russell and Russell (2007) explain that of the 181 adolescents interviewed, sample full data was available for only 178 participants. The mean (sd) age of the adolescents was 15.6(0.6) with a range of 14 to 17 years. There was a mild over representation of boys (N = 105) than girls (N = 73) in the sample. The mean (sd) BDI score was 13.4(8.3) with a range of 0 to 42 and CDRS-R score was 27.5(8.2) with a range of 17 to 54. Among the participants identified as having a depressive disorder (N = 11), the most prevalent diagnostic group had mild, moderate or severe depression depressive episode with somatic symptoms (N = 5), followed by Brief depressive reaction (N = 3), Mixed anxiety-depression (N = 2) and finally grief (N = 1) (Results Section, Â¶ 1).
Basker, Moses, Russell and Russell (2007) explain that in conclusion, despite these limitations, this study has demonstrated that the BDI has sound psychometric properties in a primary care setting among adolescents while being used by paediatricians. Our study further supports the Beck Depression Inventory as a viable and reliable measure for identifying probable cases of Depressive disorders among adolescents (Conclusion Section, Â¶ 1).
Joe A Buckby, Alison R. Yung, Elizabeth M. Cosgrave and Eoin J. Killackey (2007), all with the ORYGEN Research Centre, Melbourne, Australia, purport in the journal article, “Clinical utility of the Mood and Anxiety Symptom Questionnaire (MASQ) in a sample of young help-seekers,” the MASQ, a 77-item self-report questionnaire, assesses depressive, anxious and mixed symptomatology. Three scales measure General Distress: depressive symptoms (12 items), anxious symptoms (11 items) and mixed symptoms (15 items). There is also an anxiety-specific (Anxious Arousal, 17 items) and depression-specific scale (Anhedonic Depression, 22 items). Higher scores reflect greater levels of symptomatology. The reported internal consistency for each scale is excellent with coefficient alphas ranging from 0.78 to 0.92 (Mood and Anxiety Symptom Questionnaire Section, Â¶ 1).
Wisdom, Riley, Rees and Weis (2007) explain that the purpose of this study was to explore adolescents’ perspectives on the impact of sex and gender role on depression and its symptoms. We refer to sex as one’s biological sex (male/female), while gender role is considered socially constructed expectations based on sex (such as expectations for females’ passivity). Eliciting this information directly from adolescents in an open format is an important early step in theory development and testing in order to design effective gender-specific treatments (Â¶ 6).
Wisdom, Riley, Rees and Weis (2007) explain that to understand adolescents’ perspectives of depression and gender role expectations, we used a modified grounded theory approach, based on the work of Strauss and Corbin (1998). Grounded theory is a qualitative methodology that allows participants to present their experience in their own words. The methodology has as its aim the development of theory that is grounded in the participants’ experiences. Grounded theory methodology has several key components: The use of theoretical sampling, to seek a sample of individuals that is diverse in experiences related to the topic of investigation; Concurrent data collection and analysis, a method that instructs the researchers to analyze data throughout the data collection process, and actively modify data collection techniques in order to obtain the broadest and most inclusive data (Method Section, Â¶ 1).
Wisdom, Riley, Rees and Weis (2007) explain that twenty-two adolescents (13 girls, 9 boys) discussed their views on depression related to gender. The average age was 15.86 (standard deviation 1.32). Two interviewees were Hispanic, and the rest were European-American (non-Hispanic) (Sample selectionâ€¦ Section, Â¶ 1).
Wisdom, Riley, Rees and Weis (2007) explain that the interview guides included questions about participants’ views of depression related to gender. Questions included (a) Do you think the causes of depression are different for girls and boys? (b) Do you think the experience of depression is different for girls and boys? And (c) What is your perception of the role of biology or hormones in depression for boys and for girls? Interview guides were modified slightly for individual vs. focus group administration. Copies of the interview guide can be obtained by contacting the first author (Interview guides Section, Â¶ 1).
Wisdom, Riley, Rees and Weis (2007) explain that although most adolescents provided responses to questions on gender, girls and older adolescents (i.e., 16 and older) tended to provide more detailed responses. Two younger boys (14 and 15 years old) reported no opinion or comment (e.g., “I don’t know; I’m not a girl.”). Adolescents presented relatively consistent views regarding the influence of gender on the causes of depression. We found evidence for the following three themes: (a) depression in adolescents was partially attributed to challenges related to societal expectations and cultural messages; (b) pubertal changes were perceived as contributing to depression for girls but not boys; and (c) loneliness and rejection were perceived by both boys and girls as being associated with depression (Results Section, Â¶ 1).
Benedetto Vitiello (2009), National Institute of Mental Health, Bethesda, Maryland, asserts in the journal article, “Combined cognitive-behavioural therapy and pharmacotherapy for adolescent depression: Does it improve outcomes compared with monotherapy?,” adolescent depression can be effectively treated with selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, or with specific forms of psychotherapy, such as cognitive-behavioural therapy (CBT) and interpersonal therapy. A single course of any of these treatments, however, leaves between one-third and one-half of patients insufficiently improved and still depressed. In an effort to increase effectiveness, medication and CBT have been combined (COMB). A few controlled clinical trials have recently compared COMB with monotherapy. TADS (Treatment for Adolescents with Depression Study) randomly assigned 439 adolescents with major depressive disorder to fluoxetine, CBT, COMB or clinical management with placebo. After 12 weeks of treatment, both fluoxetine and COMB reduced depression more than CBT or placebo did, but only COMB was effective in inducing remission, achieving functional recovery and reducing suicidal ideation. After 36 weeks of treatment, there was no difference in improvement among treatments, but more suicidal events occurred in the medication only group than in the CBT only group (Â¶ 1).
Mary Ellen Schneider (2009), feature writer, asserts in the journal article, “USPSTF recommends depression screening for all teens,” most depression screening tools are questionnaires that can be filled out in the waiting room and quickly scored by the physician. Although this requires practices to invest time, and energy in ensuring that screening occurs, the bigger challenge may be what to do when the screen raises a red flag. Currently, there are not enough adolescent psychiatrists to meet the demand. One option is to reach out to local psychologists to provide the psychotherapy component, of treatment, Dr. Epperly said. president of the American Academy of Family Physicians (Â¶ 12).
Dr. William Golden, professor of medicine and public health and Dr. Robert Hopkins (2008), program director for the internal medicine/pediatrics combined residency program at the University of Arkansas, Little Rock, purport in the journal article, “Adolescent depression,” the diagnosis and management of adolescents with depression is a common issue for primary care physicians. Evidence-based guidelines and tools to assist clinicians in the evaluation and treatment of major depression in 10-to 21-year-olds have recently been published (Â¶ 1).
Golden and Hopkins (2008) assert that up to 9% of teens meet the criteria for major depression at any one time, and 20% of young adults have had depression at some point in their adolescence (Â¶ 2). The nine diagnostic criteria for major depression in the DSM-IV include symptoms of negative mood, anhedonia, and vegetative signs; the symptoms often run in families (Â¶ 3). Depression severity can be classified based on the number of criteria present, the degree of impairment, and the presence of suicidal thoughts and/or psychotic symptoms. The presence of four or five criteria and little impairment in functioning would be classified as mild depression; the presence of all nine criteria, active suicidal thoughts, or severe functional impairment would be classified as severe depression (Â¶ 4).
In the article, “Scientific evidence about grief in Illinois wrongful death cases,” Timothy J. Reuland, practicing attorney who represents plaintiffs in wrongful death cases and Dr. Shirley A. Murphy (2009), professor emeritus at the University of Washington, Seattle, also review a number of the legal issues involved in admitting Scientific evidence of grief and mental suffering
Reuland and Murphy (2009) assert that the problems with “grief.” Measuring grief per se can be a challenge for several reasons.
First, the concept of grief overlaps with those of mourning, sorrow, depression, and the like. That weakens the scientific identity of grief. The terms “grief” and “bereavement” are sometimes used interchangeably, though they are not the same thing.
Bereavement is the period following the death of a significant other and may be regulated by social, cultural, and religious norms. (10) Being bereaved is a state of experiencing a complex set of reactions, including major life changes, grief, and mental suffering. The terms “complicated mourning,” “pathological grief,” and “traumatic grief” found in the bereavement literature have contributed to the lack of conceptual clarity surrounding grief.
Second, some thanatologists (experts in dying, death, and bereavement) believe that the phenomenon of grief has had inadequate theoretical development. (11) Some grief counselors believe that grief occurs in stages despite the lack of empirical evidence.
Third, instruments used to measure grief vary considerably in their scope and specificity. 11 Some instruments have over 100 items, making them too lengthy for persons in distress to complete. Other instruments are composed of items that can be answered only “yes” or “no,” thereby limiting the value of the information obtained. The reliability and validity of these instruments can be called into question. (Reuland & Murphy, 2009, Scientific evidence of grief and mental suffering Section, Â¶ 12
Symptoms of PTSD can be measured based on criteria set forth in the DSM-N, the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association and commonly used by mental health professionals.
The symptoms of depression, anxiety, hostility, cognitive dysfunction, and interpersonal sensitivity can be measured by the Brief Symptom Inventory (BSI), (13) which defines each symptom dimension. The BSI yields an overall measure of mental distress as well as scores on individual subscale items measured by interval-level scales (as opposed to nominal “yes/no” scales). (Reuland & Murphy, 2009, Scientific evidence of grief and mental suffering Section, Â¶ 18).
Crick Lund (2008), Department of Psychiatry and Mental Health, University of Cape Town, et al., assert in the journal article, “Mental health is integral to public health: A call to scale up evidence-based services and develop mental health research,” global Burden of Disease studies predict that, by 2030, unipolar depression will be the world’s second most disabling health condition (Lund, et al., 2008, Â¶ 1). A review of existing studies revealed that 17% of children and adolescents suffer from mental disorders. (6) Mental illness affects people of all ages, and there are no differences between socially defined racial or cultural groups in mental disorder prevalence (Lund, et al., 2008, Â¶ 2)
Patel et al. assessed the evidence of interventions to prevent and treat selected mental health conditions and, among other findings, they concluded that depression can be treated effectively with low-cost antidepressants or psychotherapy; antipsychotic drugs are cost-effective interventions for people with schizophrenia; hazardous alcohol abuse can be dealt with effectively by providing brief interventions by trained primary care workers; and, for adults and children with chronic mental disabilities, community-based rehabilitative models provide low-cost care (Lund, et al., 2008, Â¶ 6).
The grieving processes, for adults, are typically defined, for adolescents however, this process can be difficult and confusing. Teens who are grieving have the added challenge of coping not only affectively, but behaviorally and cognitively as well. Mahoney (2008) explains that Dr. Stephen Fleming and Dr. Reba Adolph, researchers in ego-development of adolescents, assert that adolescents have “certain core issues as their development proceeds from one level to the next, which often means reliving and readapting to their loss at each developmental phase (Â¶ 6). Other research, specifically a Harvard Child Bereavement Study by Dr. William Worden and Dr. Phyllis Silverman in 1987, analyzed and interviewed 125 children and teens. The adolescents, ages six-17 years old, who had lost a parent, along with the surviving parent, were interviewed at four months, one year and two years after the death.
Mahoney (2008) purports that in the Harvard study, Worden and Silverman found that when compared to other adolescents who were not grieving, grieving adolescents felt anxious and fearful. They also considered themselves substandard academically and behaviorally, found it difficult to get along with their peers and had feelings of not belonging. Mahoney (2008) further explains that “the findings persisted over time, with the grieving teens exhibiting more withdrawn behavior, as well as more anxiety, depression, and social problems as assessed on the Child Behavior checklist” (Mahoney, 2008, Â¶ 8). One of the key factors that also affected the way adolescents adjusted to the death of their parents was how the surviving parent coped and responded to the death.
Mahoney (2008) explains that the Harvard study found other factors that increased the risk for behavioral and emotional difficulties in grieving adolescents, included changes and family stressors. The grieving adolescents also had a much more difficult time coping during the grieving process if the surviving parent was depressed and had insufficient coping skills to deal with their grief. Mahoney (2008) explains that “compared with community controls, bereaved children and adolescents experienced significantly more psychiatric problems in the first 2 years after death, particularly among youth of depressed parents and those from families of lower socioeconomic status” (Â¶ 12). The findings from this Harvard study contend that preventive efforts such as screening adolescents for the risk factors mentioned above along with careful support and monitoring of the teen and surviving parent will better assist these families in dealing with grief.
Mahoney (2008) further expresses that although grief is not preventable, the adverse aftereffects may be lessened by supporting grieving teens during this difficult time. Donna Schuurman, National Director for the Dougy Center for Grieving children in Portland, Oregon, asserts that grief is not a disease or illness that needs to be cured, “It’s not a task with definable, sequential steps. It’s not a bridge to cross, a burden to bear, or an experience to recover from. It is a normal, healthy, and predictable response to loss” (Schuurman, as cited in Mahoney, 2008, Â¶ 13). Mental health professionals agree that adolescents dealing with grief should also recognize and understand what stage of adolescents the teen is in during the grieving process and keep conversations and support at the appropriate level for that particular age group in order for the teen to grow into a healthy, happy adult.
In the book, Research design: Qualitative, quantitative, and mixed methods approaches, John W. Creswell (2009), Professor of Educational Psychology at Teachers College, University of Nebraska-Lincoln, advises the researcher to clarify the bias that he/she brings to the study. “Good qualitative research contains comments by the researchers about how their interpretation of the findings is shaped by their background, such as their gender, culture, history and socioeconomic origin” (p. 192). When the researcher shares his/her self-reflection, this contributes to helping the researcher create an honest, open narrative and better relate to the reader.
As noted at the study’s stare, the Methodology chapter explains that the mixed-methods methodology, a compilation of qualitative and quantitative research methods mixed methods practice qualifies ad both “old” yet “emergent” research. The fact that the field of mixed methods includes an historical legacy of practice, albeit, primarily retaining an invisible stance, marks it as old. Initially, social science research practice utilized mixed methods data. The earliest social research projects included “studies of poverty within families conducted in the 1800s in Europe by researchers such as Frederic LePlay (1855) and Charles Booth (1891) . . . research practices included the use of demographic analysis, participant surveys and observations, and social mapping tech-niques” (Hesse-Biber, as cited in Hesse-Biber, 2010, p. 415). By the start of the 20th century in the United States, a number of researchers had strategically planted mixed methods practices into a number of investigative fields.
Points for Developing Original Paper from TEMPLATE
BUILDING THE CONCEPTUAL FRAMEWORK
What is research? What is a research proposal? How do the two relate to each other? For the social scientist or researcher in applied fields, research is a process of trying to gain a better understanding of the complexi-ties of human experience and, in some genres of research, to take action based on that understanding. Through systematic and sometimes collaborative strategies, the researcher gathers information about actions and interactions, reflects on their meaning, arrives at and evaluates conclusions, and eventually puts forward an interpretation, most frequently in written form. Quite unlike its pristine and logical presentation in journal articles — “the reconstructed logic of science” (Kaplan, 1964) — real research is often confusing, messy, intensely frustrating, and fundamentally nonlinear. In critiquing the way journal articles display research as a supremely sequential and objective endeavor, Bargar and Duncan (1982) describe how, “through such highly standardized reporting practices, scientists inadvertently hide from view the real inner drama of their work, with its intuitive base, its halting time-line, and its extensive recycling of concepts and perspectives” (p. 2).
The researcher begins with interesting, curious, or anomalous phenomena that he observes, discovers, or stumbles across. Not unlike the detective work of Sherlock Holmes or the best traditions in investigative reporting, research seeks to explain, describe, or explore the phenomenon chosen for study. Emancipatory genres, such as those represented by some critical, feminist, or postmodern work, also make explicit their intent to act to change oppressive circumstances. The research proposal is a plan for engaging in systematic inquiry to bring about a better understanding of the phenomenon and, increas-ingly, to change problematic social circumstances. As discussed in Chapter 1, the finished proposal should demonstrate that (a) the research is worth doing, (b) the researcher is competent to conduct the study, and (c) the study is carefully planned and can be executed successfully.
A proposal for the conduct of any research represents decisions the re-searcher has made that a particular theoretical framework, design, and meth-odology will generate data appropriate for responding to the research ques-tions. These decisions emerge through intuition, complex reasoning, and weighing a number of possible research questions, possible conceptual frame-works, and alternative designs and strategies for gathering data. Throughout, the researcher considers the should-do-ability, do-ability, and want-to-do-ability of the proposed project (discussed in Chapter 1). This is the complex, dialectic process of designing a qualitative study. This chapter demonstrates how, in qualitative design, you are deciding among possible research ques-tions, frameworks, approaches, sites, and data collection methods. Building the research proposal demands that the researcher consider all elements of the proposal at the same time. But how to begin? This is often the most challeng-ing aspect of developing a solid proposal.
Sections of the Proposal
Proposals for qualitative research vary in format but typically include the following three sections: (a) the introduction, which includes an overview of the proposal, a discussion of the topic or focus of the inquiry and the general research questions, the study’s purpose and potential significance, and its limitations; (b) a discussion of related literature, which situates the study in the ongoing discourse about the topic and develops the specific intellectual traditions to which the study links; and (c) the research design and methods, which details the overall design, the site or population of interest, the specific methods for gathering data, a preliminary discussion of strategies for analyz-ing the data, how the study’s trustworthiness will be ensured, the personal biography of the researcher, and ethical and political issues that may arise in the conduct of the study. In all research, these sections are interrelated, each one building on the others. These sections are listed in Table 2.1. In qualitative inquiry, the proposal should reserve some flexibility in research questions and design because these are likely to change during the research process. The next section provides some strategies for building a clear conceptual frame-work while retaining the flexibility to allow the unanticipated to emerge.
Building the Conceptual Framework:
Topic, Purpose, and Significance
The purposes of this section of the proposal are (a) to describe the substan-tive focus of the research — the topic — and its purpose; (b) to frame it in larger theoretical, policy, social, or practical domains and thereby develop its sig-nificance; (c) to pose initial research questions; (d) to forecast the literature to be discussed in the review of related literature; and (e) to discuss the limitations of the study. The proposal writer should organize the information so that a reader can clearly ascertain the essence of the research study. This section, along with the review of related literature, forms the conceptual framework of the study and tells the reader the study’s substantive focus and purpose. The design section then describes how the study will be conducted and displays the writer’s ability to conduct the study.
Although separated into discrete sections through convention, the narrative of the first two sections — the introduction and the review of related litera-ture — is derived from a thorough familiarity with literature on relevant theory, empirical studies, reviews of research, and informed essays by knowledgeable experts. A careful reading of related literature serves two purposes. First, it establishes evidence for the significance of the study for practice and policy and as a contribution to the ongoing discourse about the topic (often re-ferred to as contributing to “knowledge”). Second, it identifies the important intellectual traditions that guide the study, thereby developing a conceptual framework and refining an important and viable research question.
Table 2.1 Sections of a Qualitative Research Proposal
Topic and purpose
Framework and general research questions
Review of Related Literature Theoretical traditions
Essays by informed experts Related research
Design and Methodology Overall approach and rationale Site or population selection Data-gathering methods
Data analysis procedures Trustworthiness
Ethical and political considerations
Because of the interrelatedness of the sections and because writing is a developmental, recursive task, the writer may find it necessary to rewrite the research questions or problem statement after reviewing the literature or to refocus the significance after the research design is developed. Bargar and Duncan’s (1982) description of “extensive recycling of concepts and perspec-tives” (p. 2), quoted earlier, captures this dialectic process. Our advice is that the writer be sensitive to the need for change and flexibility and not rush to closure too soon. Sound ideas for research may come in a moment of inspiration, but the hard work comes next as the idea, the intellectual traditions that surround the idea, and the methods for exploring it are developed, refined, and polished.
The first section of the proposal provides an overview of the study for the reader. It introduces the topic or problem and purpose of the study, the general research questions, and design of the study. This section should be crisply written, engage the reader’s interest, and forecast the sections to follow. First, the topic or problem that the study will address is introduced, linking this to practice, policy, social issues, and/or theory, and forecasting the study’s significance. Next, the broad areas of theory and related research to be discussed in the literature review are outlined. Then the design of the study is sketched in which the particular approach, major data collection techniques, and unique features of the design are noted. Finally, the introduction provides a transition to a more detailed discussion of the topic, the study’s significance, and the research questions.
In qualitative inquiry, initial curiosities for research often come from real-world observations, emerging from the interplay of the researcher’s direct experience, tacit theories, political commitments, interests in practice, and growing scholarly interests. At other times, the topic of interest derives from theoretical traditions and their attendant empirical research. Beginning re-searchers should examine reviews of literature found in journals specifically committed to publishing extensive review articles (e.g., Review of Educa-tional Research), peruse policy-oriented publications to learn about current or emerging issues in their fields, and talk with experts for their judgments about crucial issues. They might also reflect on the intersection of their personal, professional, and political interests to ascertain what particular topics or issues capture their imaginations.
Figure 2.1 provides a schematic description of the dialectic relationship between theory, practice, research questions, and personal experience. We call this the cycle of inquiry; the figure suggests that a research project may begin at any point in this complex process. For example, as a focus for the study emerges (the general topic), possible research questions, potential sites, and individuals or groups to invite to participate in the research may be considered. Imagining potential sites or groups of people to work with may, in turn, reshape the focus of the study. Thinking about sites or people for the study also encourages the researcher to think about her role in the setting and possible strategies for gathering data. Alternatively, the researcher may know of a site where intriguing issues of practice capture her imagination. Thinking about this site and the issues and people in it will foster analysis about what research questions are likely to be significant for practice. The research questions then shape decisions about gathering data. Developing the research
Crabtree and Miller (1992) offer refinements of this generic cycle of inquiry. They argue that the process of much qualitative research can be captured by “Shiva’s circle of constructivist inquiry” (p. 10) — Shiva is the Hindu god of dance and death (see Figure 2.2). The researcher enters this cycle of interpretation with exquisite sensitivity to context, seeking no ultimate truths. She must be faithful to the dance, but she also stands apart from it, discovering and interpreting the “symbolic communication and meaning .. . that helps us maintain cultural life” (p. 10). A more radical inquiry process is captured in Figure 2.3, which expresses critical, feminist, and some postmod-ern perspectives. These two. models depict the researcher looking critically at experience and the larger social forces that shape it. She searches for expres-sions of domination, oppression, and power in daily life. Her goal is to unmask this “false consciousness” and create “a more empowered and emancipated consciousness by reducing the illusions” of experience (pp. 10-11). Figures 2.2 and 2.3 provide alternative conceptualizations of the cycle of inquiry; note, however, that each entails question posing, design, data collection, analysis, and interpretation.
Especially in applied fields, such as management, nursing, community development, education, and clinical psychology, a strong autobiographical element often drives the research interest. For example, a doctoral student in family counseling psychology studied bereaved mothers because of her own experience with the loss of a teenaged son (Oliver, 1990). A student in social psychology, deeply committed to the protection of the environment, studied environmental attitudes from an adult development theoretical perspective (Greenwald, 1992). A student in organizational development investigated male and female physicians’ espoused moral principles of care and justice in compensation issues, as a way of exploring Gilligan’s (1982b) theory, because of her deep commitment to ethical practice (Cormier, 1993). A student in international development education studied Indonesian farmers’ views on land use because of her political commitment to indigenous peoples (Campbell-Nelson, 1997).
The qualitative researcher’s challenge is to demonstrate that this personal interest will not bias the study. A sensitive awareness of the methodological literature about the self in conducting inquiry, interpreting data, and construct-ing the final narrative helps, as does knowledge of the epistemological debate about what constitutes knowledge and knowledge claims, especially the critique of power and dominance in traditional research (see the discussion in Chapter 1 about critical ethnography, feminist research, action research, and postmodern perspectives). If direct experience stimulates the initial curiosity, moreover, the researcher needs to link that curiosity to general research questions. The large end of the conceptual funnel, if you will, contains the general, or “grand tour,” questions that the study will explore; the small end depicts the specific focus for the proposed study.
Figure 2.4 illustrates this funnel metaphor, drawing from the study by Benbow (1994) about the development of commitment to social action. The large end of the funnel represents the general conceptual focus — the issue of social activism and its role in ameliorating oppressive circumstances. Midway down the funnel, the focus narrows to a concern with individuals who have demonstrated and lived an intense commitment to social causes. An alternative choice at this point would have been to focus on social movements as group phenomena rather than on individuals whose lived experiences embody social consciousness. The small end of the conceptual funnel focuses even more closely on a research question (or set of questions) about how life experiences helped shape and develop a lifelong, intensive commitment to social activism.
People develop personal theories (theories-in-use or tacit theories; Argyris & Schon, 1974) about events as ways of reducing ambiguity and explaining paradox. When they decide to conduct inquiry, however, they should be guided by systematic considerations, such as existing theory and empirical research. Tacit theory (one’s personal understanding) and formal theory (from a litera-ture review) help to bring the question, the curious phenomenon, or the problematic issue into focus and raise it to a more general level. The potential research moves from a troubling or intriguing real-world observation (e.g., these kids won’t volunteer in class no matter how much it’s rewarded!), to personal theory (these kids care more about what other kids think than they do about grades), to formal theory, concepts, and models from literature (students’ behavior is a function of the formal classroom expectations as mediated by the informal expectations of the student subculture). These coalesce to frame a focus for the study in the form of a research question: What are the expectations of the student subculture vis-a-vis class participation?
Purpose of the Study
The researcher should also describe her intent in conducting the research — its purpose. Generally embedded in the discussion of the topic (often only a sentence or two but nonetheless important), a statement of the purpose of the Table 2.2 Matching Research Questions and Purpose
Purpose of the Study
General Research Questions
To investigate little-understood phenomena
To identify or discover important categories of meaning
To generate hypotheses for further research
To explain the patterns related to the phenomenon in question
To identify plausible relationships shaping the phenomenon
To document and describe the phenomenon of interest
To create opportunities and the will to engage in social action
What is happening in this social program?
What are the salient themes, patterns, or categories of meaning for participants? How are these patterns linked with one another?
What events, beliefs, attitudes, or policies shape this phenomenon?
How do these forces interact to result in the phenomenon?
What are the salient actions, events, beliefs, attitudes, and social structures and processes occurring in this phenomenon?
How do participants problematize their circumstances and take positive social action?
study tells the reader what the results of the research are likely to accomplish. Historically, qualitative methodologists have described three major purposes for research: to explore, explain, or describe the phenomenon of interest. Synonyms for these terms could include to understand, to develop, or to discover. Many qualitative studies are descriptive and exploratory: They build rich descriptions of complex circumstances that are unexplored in the litera-ture. Others are explicitly explanatory: These studies show relationships (frequently as perceived by the participants in the study) between events and the meaning these relationships have. These traditional discussions of purpose, however, do not mention action, advocacy, empowerment, or emancipation — the purposes often found in studies grounded in critical, feminist, or postmod-ern assumptions. The researcher can assert taking action as part of the intention of the proposed study, as in action research. He can assert empow-erment (the goal of participatory action research) as a goal — although he can, at best, discuss how the inquiry may create opportunities for empowerment.
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This type dynamic bond
When a child age7 to 11 experiences the death of a nuclear or extended family member, the loss comprises much more than a simple loss
How to survive after you lose one you love.
Helping children, ages 7 to 11, In what ways may attachment theory serve as a positive, practical process to compliment curative counseling with grieving children ages 7 to 11 who have experienced the death of a nuclear or extended family member?
Heather and other children participating in a Allowing Children to mourn.
Never put pictures away.
People are wrong when they tell you ‘you have to forget about his. I’m not going to figet no matter what others say
Hope and healing
John Stossel ABC News The Dougy Center, Saying Goodbye Forever
Keeping Memories Alive
Few times a day my mom I pretty much I remember her life. That’s pretty much how you keep memories alive. Remembering Someone to take care of them
“I will never forget,” one boy said during a 20/20 interview held at The Dougy Center in Portland, Ohio, focusing on how children deal with grief. hen a teacher told him he had to go on after his mom had died. Anytime I hear someone say the word, Mom, I think about my mom. I remember her laugh. Remembering how she laughed keeps her memory alive.
Letting Go yet Staying Involved
My father got shot by an officer and he died four days before my birthday.
To keep memories alive bring in and talk about something they would love
Talk about their loss
In what ways may attachment theory serve as a positive, practical process to compliment curative counseling with grieving children ages 7 to 11 who have experienced the death of a nuclear or extended family member?
received international recognition for his research and relating to child psychiatry
During the study, the researcher investigates demonstrate that the health resolution of grief enables one to maintain a continuing bond with the deceased. Despite cultural disapproval and lack of validation by professionals, survivors find places for the dead in their on-going lives and even in their communities. Such bonds are not denial: the deceased can provide resources for enriched functioning in the present. Dennis Klass, Phyllis R. Silverman, Steven L. Nickman Continuing bonds: new understandings of grief
Photographs or other mementoes serve as linking objects to continue the child’s bonds with his/her lost loved one. This helps the child keep the “lost” person’s memory as well as his/her legacy alive. ” (Corr & Balk, 2010, p. 16).
In what ways may attachment theory serve as a positive, practical process to compliment curative counseling with grieving children ages 7 to 11 who have experienced the death of a nuclear or extended family member?
Concerns Challenging the Bereaved Child
The link between childhood bereavement mental health problems in later life Corr and Balk (2010)â€¦ adding thoughts here
1) I would encourage you at the outset to think about focusing on children or adolescents. My initial reaction to the first paper is that you would need to cover both and that might end up being a huge undertaking.
2) You define attachment and use a definition from — .was it Princeton? The current date is nice though I am wondering if you throw attachment out there if you your definition ought to be from Bowlby, Ainsworth, Harlow — these are the classic theorists and maybe at least mentioning their definition might be good. I know what you sent is rough and that you were considering this, I just want you to get a feel for how this back and forth thing might work.
3) For the dissertation always find the original source of works cited. You have one “as cited in” and at this point in the game you will need to find the original citation for what you want to include.
4) You ask about the possibility of including some personal information to help elaborate and fill a section — .I want to think on this a bit and this may be driven by whether you end up with a quant or qual study. Qual you would be okay with, quant maybe not, at least in the beginning. Usually the personal anecdotal stuff doesn’t play out until the discussion section.
5) If you choose the instrument design then you will need to become an expert in psychometrics as well. I, of course, love the idea. And I think the idea fits really nicely with measuring traumatic grief.
6) I like the idea of connecting loss/death with attachment theory, that is one of my interests so that would be fun.
7) Let’s focus on the prospectus and get that done along with the committee formation, etc. If we tackle what is required for the course then we can grade you when it is complete — ..we will need to trust that they have it organized in a way that will result in this thing being completed.
The prospectus outlines the proposed investigation in a paper less than 15 pages that is used to explain the candidate’s research to other students, potential committee members, and the Program Chair. A copy of the prospectus must be attached to the Dissertation Committee Petition. This enables the Program Chair or the Chair’s designee to make recommendations about finalizing committee members. Prospectus meetings may be scheduled between the candidate and the committee to discuss the details of the prospectus development. Students should check with their program or dissertation chair for such meeting requirements.
The prospectus begins with a cover sheet (Appendix D) and should provide enough information to help prospective committee members decide if their interests and backgrounds would be appropriate for serving on the committee. The components of this narrative should include (a) the problem to be addressed, the significance of the problem, the purpose of the proposed study; (b) an initial review of the literature related to the selected research topic, sufficient to inform the candidate of what is, and is not, known about the topic; (c) an initial set of research question(s) and hypotheses as appropriate,
(d) anticipated research methodology which includes population and sample, procedures and measures, hypotheses, level of significance, and statistical tests; (e) a short reference list of key articles, books, etc., related to the research area; (f) identification of possible databases and keywords to be used in the literature search; (g) the candidate’s timeline goals for completing the four dissertation courses. Questions regarding this prospectus should be addressed to the Program Chair or the Chair’s designee.
As a result of their satisfactory completion of 9001, candidates will:
1. Define a topic for a dissertation or research project that addresses an issue,
concept, problem, course of action, or question relevant to their program outcomes and/or their profession.
2. Develop a prospectus
3. Submit a prospectus for approval
4. Form a dissertation or research project committee
5. Develop the initial sections of a proposal that include: a concise statement of the issue, concept, problem, course of action, or question to be addressed; key terms and operational definitions; research questions, hypotheses, goals and objectives; and the rationale or purpose of the proposed research.
6. Research the background of the selected topic area so that findings can be
evaluated in the context of the wider body of knowledge and practice
7. Critically evaluate prior research that serves as a foundation for the proposed research
8. Conduct a review of literature and information sources related to the proposed research
9. Compile a reference list related to the proposed research
10. Complete a working draft of an introduction to the dissertation or research project
The Dissertation Organization
The organization of the dissertation is type dependent and may be divided into the following chapters or sections:
Chapter 1: Introduction – The Topic to be Studied, Definitions, Significance of the Study, Overview of the Sections of the Dissertation
Chapter 2: Review of Literature
Chapter 3: Methodology
Chapter 4: Results or Findings (may include more than one chapter)
Chapter 4 or 5: Analysis
Chapter 5 or 6: Conclusions (or instead of Analysis and Conclusions, it may be the Discussion Section)
Appendixes (e.g., Survey Instruments, Interview Guides, Consent Forms)
The Prospectus Continued
The prospectus outlines the proposed investigation (a 5-15-page paper that is used to explain the candidate’s research to other students, potential committee members, and the Program Chair). A copy of the prospectus must be attached to the Dissertation
Committee Petition to allow the Program Chair to make informed decisions about assigning committee members to the project.
The candidate begins the formal prospectus with a cover sheet (Appendix C) and then should provide enough information to help prospective committee members decide if their interests and backgrounds would be appropriate for serving on the committee.
The components of this narrative should include (a) the problem to be addressed, the significance of the problem, the purpose of the proposed study; (b) an initial review of the literature related to the selected research topic, sufficient to inform the candidate of what is, and is not, known about the topic; (c) an initial set of research question(s) and hypotheses as appropriate, (d) anticipated research methodology which includes population and sample, procedures and measures, hypotheses, level of significance, and statistical tests; (e) a short reference list of key articles, books, etc., related to the research area; (f) identification of possible databases and keywords to be used in the literature search; (g) the candidate’s timeline goals for completing the four dissertation blocks.
Questions regarding this prospectus should be addressed to the Program Chair.
Currently, 28 centers like The Dougy Center, located in Portland Oregon work with grieving children throughout the United States.
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What discipline/subjects do you deal in?
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Are your writers competent enough to handle my paper?
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
What if I don’t like the paper?
There is a very low likelihood that you won’t like the paper.
- When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
- We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.
In the event that you don’t like your paper:
- The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
- We will have a different writer write the paper from scratch.
- Last resort, if the above does not work, we will refund your money.
Will the professor find out I didn’t write the paper myself?
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
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We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
When will I get my paper?
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
Will anyone find out that I used your services?
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
How our Assignment Help Service Works
1. Place an order
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
2. Pay for the order
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
3. Track the progress
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
4. Download the paper
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
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