不同视角下的临终关怀学 (13).pdf

Death Understanding and Fear of Death inYoung ChildrenVIRGINIA SLAUGHTER&MAYA GRIFFITHSUniversity of Queensland,AustraliaABSTRACTThe purpose of this study was to test whether the developmental acquisition of amature concept of death,that is,understanding death as a biological event,affectsyoung childrens fear of death.Ninety children between the ages of 4 and 8 partici-pated in an interview study in which their understanding of death and their fearof death were both assessed.Levels of general anxiety were also measured viaparent report.A regression analysis indicated that more mature death under-standing was associated with lower levels of death fear,when age and generalanxiety were controlled.These data provide some empirical support for the widelyheld belief that discussing death and dying in biological terms is the best way toalleviate fear of death in young children.KEYWORDSchildren,death anxiety,death concept,normal fearTHEFACTSABOUTdeath and dying are among the most emotional and complextopics of childhood.As such,the acquisition and development of a mature death concepthas been a subject of interest for decades.Research documenting how children ofdifferent ages understand death and dying has spanned the psychoanalytic,Piagetianand,recently,the intuitive theory research traditions(see Carey,1985;Kenyon,2001;Clinical Child Psychology and Psychiatry Copyright 2007 SAGE PublicationsVol 12(4):525535.DOI:10.1177/1359104507080980 525VIRGINIASLAUGHTERis Associate Professor of developmental psychology and Co-director of the Early Cognitive Development Unit in the School of Psychology,University ofQueensland,Australia.Her research focuses on social and cognitive development in infantsand young children.CONTACT:Virginia Slaughter,School of Psychology,University of Queensland,Brisbane,Queensland 4072,Australia.E-mail:vpspsy.uq.edu.auMAYA GRIFFITHSis a Clinical Psychologist currently working in the field of child and youthmental health.She has a Masters degree in Clinical Psychology from the University ofQueensland.Maya is currently undertaking a PhD examining quality of life in children withcancer,using the qualitative methodology of Interpretative Phenomenological Analysis.04 080980 Slaughter 10/10/07 12:53 pm Page 525Slaughter,2005).The psychoanalytic literature described childrens death concepts inorder to explore their emotional responses to death,whereas the Piagetian researchersmeasured changes in childrens death understanding in relation to their movementthrough general stages of cognitive development.Most recently the intuitive theoryapproach has explored childrens knowledge about death in terms of their developingintuitive,or folk knowledge about the domain of biology.Each of these approaches tounderstanding development of the death concept has documented stages and changesin childrens understanding,and the picture is quite consistent.Children first acknowledge death in the preschool period.At this age,young childrenhave yet to acquire specific knowledge about the biological underpinnings of life anddeath,and so make sense of what they know about death and dying in terms of theirunderstanding of human behaviour.Thus preschool-aged children typically consider thatdeath is something that happens only to some(the sick,the aged)and that it can beavoided with healthy living and avoidance of specific situations that they know can befatal(e.g.car crashes,getting cancer).Young children tend to conceptualize death as analtered state of living,either in heaven,or under ground in the tomb,and so often assertthat the dead still need oxygen or water,and that the dead can hear,dream and so on.At this age children do not understand the causes of death,other than to link dying withinternal or external agents such as poison,guns or fatal illnesses.Early studies(Anthony,1939;Nagy,1948;Piaget,1929;Von Hug-Helmuth,1964)documented this develop-mentally immature death concept through relatively open-ended interview techniques.Later work captured the complexity of developing death understanding through analysisof specific subcomponents that contribute to a mature concept of death.The number of subcomponents of the death concept has varied across studies(Lansdown&Benjamin,1985;Speece&Brent,1996)but the majority of researchersrecognize the importance of the following five major aspects of death understanding,which are mastered by children in a relatively fixed sequential order between the agesof 5 and 10:1.Inevitability the acknowledgement that living things must die eventually;2.Universality or applicability the understanding that death must happen to all livingthings;3.Irreversibility or finality of death the recognition that the dead cannot come backto life;4.Cessation or nonfunctionality the understanding that death is characterized bybodily processes ceasing to function;5.Causation the understanding that death is ultimately caused by a breakdown ofbodily function.Not all studies have included all of these subcomponents(and others have includedadditional ones,such as unpredictability or personal mortality),but the majority ofdevelopmental researchers in this area operationally define the mature death concept asmastery of some or all of these subcomponents.By age 10,most children conceptualizedeath as a fundamentally biological event that inevitably happens to all living things andis ultimately caused by an irreversible breakdown in the functioning of the body.Studies that have investigated the progression of subcomponent acquisition havegenerally found that understanding the irreversibility of death occurs first,by age 5 or6.Thus childrens earliest accurate understanding of death involves the recognition thatthe dead cannot come back to life.Next,the subcomponents of applicability,inevita-bility and cessation are acquired.In the early school years,children come to understandthat death must happen to all living things,and that it is characterized by bodilyCLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(4)52604 080980 Slaughter 10/10/07 12:53 pm Page 526processes ceasing to function.The final subcomponent to be acquired is causality.Severalresearchers have argued that understanding specific causal mechanisms that can resultin the breakdown of bodily functioning leading to death is the most inclusive andcomplex subcomponent,and so is the last to be mastered.By age 7 to 10,all sub-components are acquired.At this stage,death is conceptualized as a fundamentallybiological event that inevitably happens to all living things and is ultimately caused byan irreversible breakdown in the functioning of the body.Further,this mature under-standing of death has been shown to be developmentally linked to other biologicalconcepts,namely life,such that it is contextualized as part of the natural life cycle(Safier,1964;Slaughter,Jaakkola,&Carey,1999).Death is recognized as a concept that carries substantial emotional impact across thelifespan.In early childhood,the most common normal fears are separation from parents,the dark,animals and imaginary creatures such as monsters(Gullone,2000;Warren&Sroufe,2004).Although not the primary source of fear and anxiety at this age,fear ofdeath has been documented in children as young as age 5(Muris,Merckelbach,Gadet,&Moulaert,2000).Early studies assessed fear of death in young children via physio-logical measures and reaction times,as well as open-ended interviews.The majority ofrecent studies of fear in childhood have used questionnaire rating scales,most commonlythe revised Fear Survey Schedule for Children(FSSC-R;Ollendick,1983;see alsoGullone&King,1992)in which items that describe specific fearful stimuli or situationsare presented,and children are asked to rate the extent to which each item provokesanxiety or fear.Due to the attention and comprehension requirements of this method-ology,the FSSC-R is only considered appropriate for school-age children,but a recentversion of the FSSC-R in a fully pictorial format rendered it useful for children as youngas age 4(the Koala Fear Questionnaire(KFQ);Muris et al.,2003).The fear surveyschedule studies have shown that childrens fears cluster into five factors,one of whichis death and danger.This factor emerged in the responses of children as young as age 4to 6 on the KFQ,and by age 7 to 10,items loading on the death and danger factor arethe most commonly endorsed fear items and they remain so through adolescence(seeGullone,2000 for a comprehensive review).A number of authors have speculated about the developmental relation between fearof death and childrens developing death understanding.One suggestion is that veryyoung children evince little fear of death relative to their older peers,because they donot yet understand what it means or all that it implies(Piaget,1929).An alternativesuggestion is that young childrens tendency to think about death in terms of behaviourrather than biology may exacerbate fear of death,because their immature conceptual-ization of death leads them to focus on unresolvable questions like,why do some peopleI love decide to go live under ground instead?Will he or she come back soon?Isnt itcold down there?Despite long-standing interest in the acquisition and development ofthe death concept,to date there has been no empirical investigation of how the tran-sition to a mature understanding of death affects childrens fear of death.There have been studies that investigated whether childrens fear or anxiety aboutdeath affected acquisition of the death concept.Cotton and Range(1990)found thatfear of death,as assessed with the FSSC-R,was negatively correlated with understand-ing the cessation subcomponent of death in a sample of children between the ages of 9and 12 years.Orbach,Gross,Glaubman,and Berman(1986)found that 6-to 11-year-oldchildren who scored higher than their peers on a general anxiety scale,were less likelyto endorse the applicability/universality of death.In both of these studies,the negativecorrelation between subcomponents of death understanding and fear or anxiety wasinterpreted as reflecting anxious childrens tendency to defend against the notion ofSLAUGHTER&GRIFFITHS:DEATH UNDERSTANDING AND FEAR OF DEATH52704 080980 Slaughter 10/10/07 12:53 pm Page 527death,rather than as failure to acquire those subcomponents of the death concept.Thisinterpretation is sensible given that in the majority of cognitive developmental studies,children have mastered the death subcomponents of cessation and applicability by age 7 or so.These data therefore suggest that acquisition of at least two of the sub-components of death,applicability and cessation,may be associated with fear of death.Arguably,the development of a mature concept of death could affect childrens fearof death in either a positive or negative way.The negative prediction is that whenchildren reach the relatively mature biological understanding of death as the inevitableand irreversible cessation of bodily function that is applicable to all living things,it mightprovoke fear because,among other things,they now understand that death will happento everyone they love,and ultimately to themselves.On the positive side,the acquisitionof a mature concept of death could reduce anxiety because children now understand itas a natural part of the life cycle,and no longer struggle with unanswerable questionsarising from their earlier conceptualization of death as a behaviour.Documenting whichof these possible developmental scenarios is more accurate has obvious and importantimplications for clinical and educational practice.The primary purpose of this study was therefore to investigate whether there arechanges in childrens self-reported fear of death,that go along with the acquisition of amature death concept.To achieve this,we assessed concurrent relations between deathconcepts and fear of death in a sample of children between the ages of 4 and 8,in whomthe understanding of death could be expected to vary widely.We also assessed childrensgeneral anxiety via parent report,in order to investigate fear of death independently ofgeneral fearfulness,which varies substantially across individuals in the preschool andearly school age periods(Warren&Sroufe,2004).MethodParticipantsParticipants were 90 preschool and primary school children,between the ages of 4 years4 months and 8 years 3 months(M age=6 years,5 months;SD=11.7 months).The finalsample was made up of 46 girls and 44 boys;approximately 90%were Caucasian.The sample was obtained from two preschools and four primary schools located inBrisbane,Australia.A letter of information detailing the study procedures plus a consentform were sent to parents.The subset of children whose parents returned the consentform were asked,prior to testing,if they wished to participate.Only those children whowanted to participate(which in fact was 100%of those asked)were included in the study.All children in the sample were in mainstream classes and none had a diagnosedchildhood disorder,as reported by their parents.MaterialsTwo instruments were administered to the children:A standard death interview forchildren that assessed knowledge of five subcomponents of the death concept,and adeath anxiety scale for children.Also used was a parent report questionnaire that askedwhether the child had any diagnosed disorders and also assessed childrens general levelsof anxiety.Death interview for childrenWe administered a death interview that has been widely usedin previous research with this age group.The interview,included in full in Table 1,assessed childrens understanding of death as a biological event.Specific questionsaddressed the following subcomponents of the death concept:(a)Inevitability,assessedCLINICAL CHILD PSYCHOLOGY AND PSYCHIATRY 12(4)52804 080980 Slaughter 10/10/07 12:53 pm Page 528with items 1 and 2;(b)applicability,assessed with item 3;(c)irreversibility,assessed with items 4 and 5;(d)cessation,assessed with item 6;and(d)causation,assessed withitem 7.These interview questions and scoring criteria have been widely used in thedevelopmental psychology literature to assess the development of death concepts inchildren between the ages of 4 and 10(Koocher,1973;Lazar&Torney-Purta,1991;Orbach et al.,1986;Speece&Brent,1984).Testretest reliability for the interview was SLAUGHTER&GRIFFITHS:DEATH UNDERSTANDING AND FEAR OF DEATH529Table 1.Questions and scoring criteria for death interviewSubcomponentInterview questionScoring criteriaInevitability1.Tell me some things that die 0 points People were not mentioned as(if people are not named ask,dying,and when given question 2,people Do people die?)were held not to die2.Do all entities mentioned in answer 1 point People were not mentioned as to question 1 die?dying,and when given question 2,people were held not to die.Or,people werementioned as dying but when given theforced choice,people were held not todie2 points People were mentioned asdying and all people were held to dieApplicability3.Tell me some things that dont die.0 points O