The development of children's understanding of death: cognitive and psychodynamic considerations.
The cognitive and emotional development of children and adolescents follows a biologically driven, environmentally mediated, and predictable but not entirely invariate sequence. Piagetian, psychoanalytic, and other schools of thought inform an understanding of child development; some of the theories are empirically validated, some not. This framework enables clinicians and parents to approach their children, ill or well, from a developmentally informed perspective. At the same time, as Spinetta's [17] case-controlled study of 6 to 10-year-old children hospitalized either with cancer or non-life limiting illness demonstrated, serious illness itself accelerates cognitive development in often unpredicted ways: "To equate awareness of death with the ability to conceptualize it and express the concept in an adult man-ner denies the possibility of an awareness of death at a less cognitive level. If it is true that the perception of death can be engraved at some level that precedes a child's ability to talk about it, then a child might well understand that he is going to die long before he can say so." In the following articles,the editors invite a critical reading of the empiric and descriptive literature of pediatric palliative medicine that allows an informed and individualized approach to these extraordinary children and their families.
Poltorak
Dunya Yaldoo
DY
Section of Behavioral Medicine, Children's Hospital, Cleveland Clinic, 9500 Euclid Avenue A120, Cleveland, OH 44195, USA. yaldood@ccf.org
Glazer
John P
JP
D000293:Adolescent; D001293:Attitude to Death; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D003210:Concept Formation; D006801:Humans; D007223:Infant; D011582:Psychological Theory; D011584:Psychology