Children's attitudes toward death

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Children's attitudes toward death
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viii, 109 leaves : ; 28 cm.
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Engel, Bonnie Andersen, 1946-
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Children and death   ( lcsh )
Death   ( lcsh )
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Thesis:
Thesis (Ph. D.)--University of Florida, 1981.
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Includes bibliographical references (leaves 100-107).
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by Bonnie Andersen Engel.
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Typescript.
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Vita.

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CHILDREN'S ATTITUDES TOWARD DEATH


BY

BONNIE ANDERSEN ENGEL









A DISSERTATION PRESENTED TO THE GRADUATE COUNCIL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA


1981




























Copyright 1981

by

Bonnie Andersen Engel




























The energy and form of this

dissertation are dedicated to Ram.












ACKNOWLEDGMENTS


Warm appreciation is expressed

to Dr. Janet Larsen, committee chairperson,

Dr. Larry Loesch,

Dr. Michael Resnick, and

Dr. William Brievogel

for their unending support and guidance;

to Cathy, Carl, Jo Dolley, Bob A., Jim E., Henry, Geraldine, Lee,

Linda, Don, and Frank.

for their abundance of encouragement;

to my parents and professors

for providing the firm foundation of both vision and

determination;

to Mickey Singer and Amrit

for reminding me of love, perfection, and clarity of

perspective;

to the fourth and fifth grade students, their parents and teachers,

Mr. Glanzer and Mrs Marcos, assistant principals, and especially

Dr. Lee Rowell of Marion County Public Schools

for so willingly participating in this research endeavor;

to Leila Cantara

for excellence in typing services and warm sensitivity in

the fragile finalities.
















TABLE OF CONTENTS



ACKNOWLEDGMENTS . . .. iv

ABSTRACT .. . . vii

CHAPTER I

INTRODUCTION . . 1

Background . . .. .. 1.
Need for the Study . ........ 7
Purpose ... . .. 9
Rationale . . . 10
Definition of Terms . . 11

CHAPTER II

REVIEW OF RELATED LITERATURE . .. 13

Children's Concepts of Death From a Developmental View 13
The Influence of Various Factors Concerning Children's
Concepts of Death .. .......... 29
Children's Attitudes Toward Death ....... ... 34
Research Concerning Suicide and Children . 39

CHAPTER III

METHODOLOGY . . 44

Sample Selection . . .. 44
Procedure. . .. 46
Data Collection . . 47
Nature of the Data . . .. 48
Data Analysis . . 49
Validity . . . 50
Reliability . . 51
Methodological Limitations . .. 52

CHAPTER IV

RESULTS . . 53

Sampling Procedure . . .. 53










Demographic Data . .. 54
Questions Related to Children's Concepts of Death 56
Questions Related to Children's Attitudes Toward Death 59
Denial . . ... ...... .59
Fear . .... ....... .61
Anxiety . . .. 61
Acceptance . . 62
Comparison of Attitudes Within Personal Death,
Impersonal Death, and the Environment of Death 62
Differential Trends Relative to Sex, Grade, School, GPA,
and Retention . . 63
Influences of Ethnic, Social, and Familial Characteris-
tics . . . 71
Differential Trends Relative to Ownership and
Acquaintance with the Death of a Pet ... .72
Interview Closure Activities . ... 76
Clinical Impressions . .... 79

CHAPTER V

DISCUSSION . ... 82

Limitations Regarding Generalizability ... 82
Conclusions . . 83
Children's Concepts Concerning Causes of Death 83
Children's Views Concerning Conditions After Death 85
Children's Attitudes Toward Death ... 87
Implications . .... ... .88

APPENDIX A PARENT CONSENT . .... 92

B STRUCTURED INTERVIEW . ... .95

REFERENCES . . ... .. 100

BIOGRAPHICAL SKETCH . . .. 108















Abstract of Dissertation Presented to the Graduate
Council of the University of Florida in Partial Fulfillment of
the Requirements for the Degree of Doctor of Philosophy


CHILDREN'S ATTITUDES TOWARD DEATH

By

Bonnie Andersen Engel

June, 1981

Chairperson: Janet J. Larsen
Major Department: Counselor Education

The purpose of this dissertation was to assess and evaluate

normal children's concepts and attitudes toward death. The sample

for the study was composed of 35 fourth grade and 35 fifth grade

students attending one urban and one rural school. Each child

participated in individual structured interviews. Children's views

concerning the causes and events related to personal death (death

of self) and impersonal death (death of another) were explored.

There was also investigation of their attitudes of death denial,

fear, and anxiety; their acceptance regarding personal and impersonal

death; and their attitudes toward the environments of death.

The results indicated that these children viewed old age and

illness as the primary causes of death. Almost 80 percent of the

children expressed denial (i.e., aversion) regarding the environment










of death and personal. death. They also expressed anxiety concerning

impersonal death (e.g., death of a friend). Approximately half the

children expressed some fears relating to personal and impersonal

death. Psychological "acceptance" of personal and impersonal death

was expressed by approximately 65 percent of the children. A pre-

ponderance of children expressed a mixture of all the measured

attitudes of denial, fear, anxiety, and acceptance in regard to the

death of a friend. These attitudes were consistently expressed

significantly more concerning impersonal death as compared to

personal death. Forty percent expressed "acceptance" of the environ-

ment of death.

The results were also analyzed relative to sex, grade level,

urban-rural setting, grade point average, retention in grade, pet

ownership, and acquaintance with death of a pet. Approximately 15

percent more females than males consistently expressed fear and denial

of death. More rural children expressed denial of death than did

urban children. Also, significantly more urban children than rural

children expressed psychological acceptance of death. Children with

decreasing grade point averages expressed denial and anxiety of death

increasingly more often.

The results of this study indicate that normal children expressed

a wide variety of attitudes toward death. These were primarily

characterized as denial or acceptance. It was also noted that there

was relatively little fear and anxiety of death expressed by these

children.


viii















CHAPTER I

INTRODUCTION


Background


The view of children's attitudes toward death as a developmental

concept has received relatively little attention in the professional

literature. Only in the last ten years or so has the topic of

"death and dying" emerged as a significant area of research in the

scientific community and as a "visible" topic of interest in popular

literature. While there has been a rather sudden proliferation of

books and articles on death in response to the needs and interests

of adults, there has been very limited generation of material

addressing this area as it relates to children. A close scrutiny

of both professional and popular literature yields rather limited

information or guidance for parents or professionals concerning

children's concepts, views, or attitudes concerning death. Further,

little of the information has been based on scientific investigation,

as compared to the singular or collective opinions of professionals

in the varied fields of education, psychology, medicine, sociology,

anthropology, religion, and philosophy. Some authors (Fauquet, 1980;

Kubler-Ross, 1975; Moody, 1975; Wass, 1976) have asserted that the

topic of death has been characteristically ignored, denied, or evaded










in our society for a rather long period of time. However, interest in

this topic through bona fide scientific investigation has clearly

emerged. Moreover, serious researchers have become increasingly

aware of the opportunity to examine children's concepts and attitudes

toward death as a fundamental and significant area of inquiry and

clarification.

The first investigations concerning children's concepts of death

occurred approximately four decades ago. Although Schilder and

Wechsler (1934), Bender and Schilder (1937), and Anthony (1940)

presented articles mainly of case report and theoretical nature,

Maria Nagy (1948) pioneered the first comprehensive study of children's

views concerning the nature of death through individual interviews

with a large number of subjects (n = 378). Using adjusted formats

of written composition, drawing, and/or structured interviews, Nagy

assembled 484 protocols from Hungarian children 3 to 10 years of age

in Budapest, Hungary,and its environs. Nagy found evidence for

differential stages in children's understanding of death. Children

3 to 5 years of age generally denied death as a regular and final

process. They viewed it as a temporary state, with varying "degrees"

of death. The children were aware that they were alive, but they

also imagined that dead people were alive. Children 5 to 9 years of

age tended to personify death. Death was viewed as a person walking

around trying to catch people and carry them off. Children 9 to 10

years of age tended to view death as a permanent, inevitable,

irreversible, and internal process.










Rochlin (1959, 1965) later corraborated these findings with

American children 3 to 5 years of age. Rochlin (1965) theorized

that in response to their overwhelming fear of death, children

construct elaborate defenses such as the ideas of reversibility,

temporariness, and continuing existence in places like heaven or

hell.

Kastenbaum (1965) similarly interpreted the personification of

death by 5 to 9 year olds as a necessary emotional compromise. He

stated that the person or image of death is created by the children and

modified by culture in order to make death more remote or more con-

trollable. Weininger (1979) also speculated that the data obtained

from the older children in Nagy's (1948) research was strongly

affected by the cultural conditions of World War II Hungary.

On the other hand, Gartley and Bernasconi (1967), who studied

60 American Catholic children 5.1/2 to 14 years of age, did not observe

the concepts of reversibility or personification of death. These

researchers speculated that "early religious teaching and television

may acquaint the child with the facts of death earlier than was

usual in times past" (Gartley & Bernasconi, 1967, p. 85). Like the

other studies, the children's concepts of death did seem to solidify

and standardize with increasing age. McIntire, Angle, and Struempler

(1972) found no differences in children's avowed concepts of death

as related to total hours a week of television watching or type of

favorite program (aggression, fantasy, or reality). Rochlin (1965)

also commented that children's concepts of life after death or places

people go after death seem to arise spontaneously and without

necessarily any formal religious education.










Consistent with the research concerning concepts of death since

Nagy (1948), much of the recent research in the field further yielded

evidence for stages of development in children's concepts of death.

Mclntire, Angle, and Struempler (1972) attempted to measure the views

of causes, images, and finality of death in children 5 to 18 years of

age of three different religious affiliations: Catholic, Protestant,

and Jewish. Children up to the age of approximately 6 years viewed

death as reversible, and viewed dead pets or persons as having

cognizance. Seven to 9 year olds viewed death as irreversible and

considerably fewer children believed in cognizance after death. A

second drop in the percentage of children who accepted cognizance was

evident in 13 year olds. It was also noted that death was not viewed

as a total cessation of life activities until the children were 7

years old.

Weininger (1979) used the techniques of structured interview

and structured play with 4 to 9 year olds to examine the relationship

of children's concepts of death as expressed verbally and as expressed

in play. In this study, the children evidenced increasing accuracy

in their understanding of death and dying with increasing age.

However, the data indicated that corresponding continuity between

play expression and verbal expression regarding these concepts was

not evident until the children were 8 to 9 years of age.

Thus, several studies (Gartley & Bernasconi, 1967; Kastenbaum,

1965; McIntire et al., 1972; Nagy, 1948; Weininger, 1979) consistently

concluded that children's concepts of death develop in relatively

distinctive, identifiable stages. Children up to the age of 6 years






5


viewed death as reversible, temporary, and characterized by life

activities such as feeling, talking, and motion. Children 7 to 10

years of age generally accepted the concept of irreversibility,

although death was not viewed in a personal way. Some studies

(Kastenbaum, 1965; Nagy, 1948; Rochlin, 1959, 1965) suggested that

children 7 to 10 years of age viewed death as like a person who

caught people, while such personification was not evident in other

studies (Gartley & Bernasconi, 1967; Mclntire et al., 1972). At

the age of 10 or 11 years, most children tended to view death as

permanent, irreversible, and inevitable. Commensurate with the

evidence supporting developmental stages in children's views of

death, some studies (Formanek, 1974; Hansen, 1973; Koocher, 1974)

have related Piaget's theory of intellectual development to children's

emerging concepts of death. Thus, there has been general consistency

in the conclusions of researchers concerning children's concepts of

death.

However, there has been minimal research concerning children's

attitudes toward death. Most death attitudes studies have focused

on adult populations, particularly college students. Only two

assessment instruments have been developed to measure death attitudes

at the early adolescent level: the Attitude Toward Death Scale

(Hardt, 1975) and the Early Adolescent Death Attitude Scale (Fauquet,

1980).

In reviewing the literature concerning death attitudes, four

broad divisions seemed to emerge. The most frequently investigated

areas were the fear of death (Bailis & Kennedy, 1977; Bell, 1975;










Boyar, 1964; Gold, 1974; Leviton, 1974; Mueller, 1976; Nelson & Nelson, 1975)

and death anxiety (Alexander & Alderstein, 1959; Nelson &Nelson, 1975)

Rowe & Loesch, 1978; Templer, 1970). Attitudes concerning denial

of death have been investigated by Gold (1974) and Nelson and Nelson (1975).

Attitudes concerning acceptance have been studied by Kurlychek (1976).

Thus, the areas of fear, anxiety, denial, and acceptance which have

received investigation in older populations do not appear to have

been investigated in reference to young children.

There was significant information in the medical literature which

addressed the many issues of caring for the terminally ill child and

the needs of the family. In many cases, there was specificity as to

the child's particular illness, such as cancer, leukemia, or congenital

heart disease. The topic of the sudden traumatic death of children

was also addressed. However, the medical and psychiatric literature

has not yielded research on the attitudes of normal children concern-

ing death and dying.

The topic of bereavement in children has received some attention

in the literature. Stein (1974) reported that "during childhood one

out of every 20 children in the United States will lose a parent to

death and that by the age of 16, one of every five children will

have lost at least one parent." Kastenbaum (1972) stated that the

death of a parent has the "single and longest lasting" effect on

children. He further suggested that "bereavement in early childhood

has been implicated as the underlying cause of depression and suicide

attempts in later life" (Kastenbaum, 1975, p. 186). Moriarity (1967)

reported that his studies suggested that the case histories of a large










number of juvenile delinquents indicated unresolved childhood grief.

Fauquet's (1980) review of the literature revealed that "during

childhood and early adolescence bereavement reactions are similar

to those of adults: disbelief, physiological distress, guilt, fear,

anger, and panic" (p. 7).

Thus, there has been very limited research specifically investigat-

ing normal children's attitudes toward death and factors related to

them. Since there was such a scarcity of information in this area and

since children's concepts of death appeared to be relatively defined

from a developmental point of view, it seemed important to explore the

attitudes of normal children toward death. Therefore, the problem

was:: What are normal children's attitudes toward death? A related

question was: What factors relate to children's death attitudes?


Need for the Study


The increased attention to the factors, needs, and attitudes of

adults concerning death has yielded a proliferation of material,

resources, and programs in a variety of professional fields and

institutions. With increased knowledge as to the attitudes of normal

children concerning death, a number of related possibilities in the

theory, research, training, and practice of counselors and school

psychologists could result.

Increased knowledge of children's attitudes toward death and

related factors could yield further development and possible modifica-

tion in theory, particularly as it may relate to the developmental

point of view. While it appeared that children's concepts of death










emerge in stages over rather identifiable age levels, it was also

important to determine whether children's attitudes toward death

develop and mature over time. While there appeared to be various

attitudes toward death evident in the adult population, it was

important to determine whether a similar variety was manifested in

the population of normal children, or whether the attitudes were

relatively invariant. Furthermore, it seemed useful to ascertain

possible factors related to the emergence, modification, or change of

death attitudes in children. Increased information concerning

children's death attitudes would also better enable one to explore

the implications as they relate to such models as Psychoanalysis,

Piagetian theory, Behaviorism, and others. Thus, several ramifica-

tions would emerge as increased information concerning children's death

attitudes is discovered.

Increased knowledge concerning children's attitudes toward death

would also yield further implications in subsequent research. It

would be important to determine the intensity, stability, or

flexibility of children's death attitudes, and the factors related

to such dimensions. The influence of socioeconomic level, cultural,

ethnic, and religious background also merited investigation. Further

research concerning the influence of traumas on children's attitudes

toward death would need to be pursued. There also would need to be

considerable investigation of the premise that death attitudes may be

related to children's and adolescents' behaviors in such areas as

delinquency, depression, drug usage, and suicide, as suggested by some

researchers (Fauquet, 1980; Kastenbaum, 1975; Klagsbrun, 1976;










Moriarity, 1967; Orbach & Glaubman, 1978; Smith, 1976). Thus, there

are numerous implications for further research related to children's

attitudes toward death.

Increased knowledge of children's attitudes toward death also

would have significant impact on the training and practice of

counseling, school psychology, and other areas of mental health.

If such attitudes were known, it would be possible to "sensitize"

professionals to the characteristics and needs of children concerning

their attitudes toward death. Intervention and facilitation of more

healthy attitudes might also be developed by skillfully trained profes-

sionals. It might also be possible to identify some children who

may be pre-suicidal based in part on their expressed attitudes toward

death. The implementation of formal classes in death education may

also be prudently and appropriately pursued. It would be possible

to provide guidance to parents, teachers, and other caregivers con-

cerning children's attitudes toward death. On occasions when death

of a classmate or a classmate's parent or sibling is experienced, it

would be possible to facilitate an appropriate response based on valid

information regarding children's death attitudes. Thus, there are

multiple practical implications which may occur in the areas of train-

ing and practice based on further knowledge of children's death

attitudes.


Purpose

The purpose of this study was to explore normal children's

attitudes toward death. Specifically, there was investigation of










normal children's general concepts of death as initially structured

by Koocher (1974). Further, there was investigation of death

attitudes of denial, fear, anxiety, and acceptance in reference

to death of self, death of other, and the environment of death.

There was examination of the demographic factors which may relate

to children's death attitudes.


Rationale

The structured interview technique has been used with young

children consistently more than any other type of assessment. From

the early work of Nagy (1948), to the pivotal studies conducted by

Koocher (1973, 1974) and Orbach and Glaubamn (1978, 1979), the

format of self-report concerning questions about death with young

children has been most commonly used. There has been some pairing

with other tasks, such as Piaget's conservation problems, the WISC

Similarities Subtest, or structured play activities, but the indivi-

dual interview procedure seemed to be a key part of sound methodology

with young children in evaluating their concepts and attitudes about

death. Therefore, it was the method of choice for this study.

Recognition had to be given to the special sensitivity of this

topic. In that some authorities (Kubler-Ross, 1975; Moody, 1975;

Wass, 1976) asserted that there has been a tendency for people in this

society to ignore, evade, or deny the topic of death, it seemed

prudent to use a methodology which enabled maximum sensitivity, support,

and response to the child. In that many of today's elementary children

experience periods of leaving the regular classroom for various










activities such as media center instruction, group guidance, music,

speech therapy, etc., the format of individually interviewing

children away from the classroom setting seemed to permit a sense

of routine procedure to the child. Further, the individual interview

situation better enabled the establishment of rapport, privacy, and

personal attention.


Definition of Terms

To clarify the terms and concepts of this study, the following

definitions were used:

Acceptance "A willingness or openness to understand a topic;

to have particular ideas about or to consent to think about a topic"

(Fauquet, 1980, p. 5).

Anxiety A generalized "feeling of apprehension which tends to

be elicited by situations in which the individual feels threatened

. the nature of the threat may or may not be clearly perceived"

(Coleman & Hammen, 1974, p. 124).

Attitude "A relatively enduring system of affective, evaluative

reactions based upon and reflecting the evaluative concepts or beliefs

which have been learned about the characteristics of a social object

or class or social objects" (Shaw & Wright, 1967, p. 10).

Cemetery A place where people are buried.

Children Persons 8 years 6 months to 11 years 0 months of age

as of September 1, 1980.










Concept "A general meaning, an idea, or a property, that can

be predicted of two or more individual items" (English & English,

1966, p. 104).

Denial "Denial is a mental mechanism. Its function is

to dispense with a perceived danger. It is a process requiring

constant revision of facts and constant correction of perceptions.

It nullifies part of a reality and restores a state of previous

harmony" (Weisman, 1972, p. 25).

Environment of Death The setting in which the dying or dead

person is known to be present, such as a cemetery or a hospital in

which a friend or acquaintance is dying.

Fear A specific feeling that is experienced "in the face of a

present, anticipated, or imagined danger or pain. There is a real or

imaginary threat to one's well being or survival" (Wood, 1976, p. 22).

Normal Those children in regular class who are achieving

academically at an A, B, or C level, who have been retained only once

or not at all, and who are determined to exhibit adequate adjustment

in learning, behavioral, and social areas in the professional judgment

of the classroom teacher.

Suicide "The deliberate act of self-injury with the intention

that the injury should kill" (Garfinkel & Golombek, 1974, p. 1278).















CHAPTER II

REVIEW OF RELATED LITERATURE


The review of the literature pertaining to this study concerning

children's attitudes toward death provided a theoretical basis for

the study. Attention was given to research which has investigated

children's concepts of death from a developmental view, particularly

from a Piagetian and a psychoanalytic theoretical basis; research

which has investigated the effects of various factors such as

socio-economic level, race, television viewing, and experience with

death on children's concepts of death; research which has investigated

children's attitudes toward death; and relevant research which has

investigated children's perceptions of death as may be related to

suicide.


Children's Concepts of Death From a Developmental View

Since the first comprehensive study (Nagy, 1948) of children's

concepts of death, developmental stages have been evident consistently

in the literature in this area. Through individual interviews with

378 Hungarian children ages 3 to 10 years, Nagy (1948) found evidence

for differential stages in children's understanding of death.

Children 3 to 5 years of age generally denied death as a regular










and final process, death was viewed as another kind of existence

in changed circumstances. Death was also seen as temporary and in

varying "degrees." The children were aware that they were alive,

and they imagined that dead people were alive also. "Living" and

"lifeless" were not yet distinguished. Thus, a sense of animism

was attributed to the dead.

Other studies (described later) have investigated the child's

concept of animism in detail. Nagy (1948) found that children 5 to

9 years of age tended to personify death. Death was viewed as a

person walking around trying to catch people and carry them off.

Death was also viewed as an eventuality, but the children endeavored

to keep it distant from themselves. Children 9 to 10 years of age

tended to view death as a permanent, inevitable, irreversible, and

internal process. The perceptible result of death was the dissolu-

tion of bodily life. Animism and egocentrism were not characteristic

of this age group.

Rochlin (1959, 1965) corraborated Nagy's findings concerning

young children's concepts of death at the 3 to 5 year age range.

Rochlin (1965) theorized that in response to their overwhelming fear

of death, children constructed elaborate defenses such as the ideas

of reversibility, temporariness, and continuing existence in places

like heaven or hell.

Beauchamp (1974) studied the death perceptions of 3 and 5 year

olds. She found that the two groups differed significantly on the

concepts of universality, irreversibility, causality, and fear of

death. Three year old children did not view death as irreversible










or universal. They exhibited more fear of death than the five year

olds, and attributed death to such causes as anger, naughtiness,

and wishful thinking. On the other hand, the five year olds viewed

death as universal, irreversible, and due to more realistic causes.

Swain (1976) studied the concepts of death of children 2 years

to 16 years of age through a semi-structured individual interview

format. The 2 to 4 year olds viewed death as reversible rather than

final, improbably or escapable rather than inevitable, and not

personally applicable to them. Children 5 to 7 years old expressed

the belief that death was inevitable and applicable to them personally,

but at a time remote from today. Like the younger children the 5 to

7 year olds tended to emphasize the accidental and punishing nature

of death. In general, the 5 to 7 year old children also demonstrated

less magical thinking and a greater reliance on biological and social

reality.

Anthony (1940) summarized a series of investigations of children

3 to 13 years of age in England over a two year period. Anthony

found that thoughts of death were frequent in children's fantasies.

For example, approximately 50 percent of the children in a story

completion task made reference to death in completing the story even

though the concept did not appear in the story stem. Anthony (1940)

distinguished five stages in children's concepts of death from

ignorance of the meaning of the word to a clear definition in logical

or biologically essential terms. Anthony (1940) observed differen-

tial stages in children's concepts of death which generally parallelled

Piaget's theory on the development of children's understanding of

causality.










Several other studies (Hansen, 1973; Kalmbach, 1979; Kane,

1979; Koocher, 1973; Nass, 1956; White, Elsom, & Prawat, 1978)

have specifically investigated children's concepts of death in the

context of Piagetian theory of intellectual development. Children's

concepts of death seem to evolve in sequential stages generally

consistent with Piaget's stages of preoperational thought, concrete

operations, and formal operations. Hansen (1973) asserts that "the

notions of classification, conservation, time and age acquired in

the concrete operational stages seem to be necessary elements for

grasping death as a definitive and universal event" (p. 110).

Although Hansen's data was generally consistent with Piaget's

stages, other evidence suggested that 7 to 8 year olds tend to view

death as an internal process. This concept seemed to be grasped at

an age earlier than Hansen (1973) predicted and earlier than what

is stated in the literature. Formanek (1974) reported findings

similar to Hansen (1973) in his study of the responses of 300

children. On the other hand, Melear (1973) found evidence which

suggested that children do not develop a realistic view of death

until they are more nearly 10 years old.

Kalmbach (1979), Koocher (1972, 1974), and White (1977) presented

the children with conservation tasks to determine their stage of

intellectual development. The children were then presented with

various questions concerning various concepts of death in an indivi-

dual interview format. He asked 75 children ages 6 to 15 years a

group of four questions about the meaning of death and their expecta-

tions about their own death. The sample was of middle SES status,










of equal representation in sexes, and composed of 20 percent non-

white children. Koocher also sought to obtain an estimate of the

children's intellectual level by administering the Similarities

Subtest of the Wechsler Intelligence Scale for Children. In order

to classify the children according to their level of cognitive

functioning by a Piagetian model, each child was tested with three

conservation tasks (i.e., mass, number, and volume) and one task in

hypothesis formation. Koocher's criteria were the following:

If the child failed one or more of the conservation tasks,
he was placed in the "preoperational" group. If he
passed all three of those, but failed the hypothesis
formation task the child was classified as "concrete-
operational." If the child dealt with all four tasks
successfully, he was classified as "formal operational."
(p. 405)

In an individual interview format, each child was administered the

Similarities subtest, the conservation tasks, and asked the following

questions: "What makes things die?" "How do you make dead things

come back to life?" "When will you die?" "What will happen then?"

Koocher found no statistical differences attributable to race or sex.

The results did, however, reflect developmental differences across

children's ages. Koocher reported that children 7 years of age and

under generally evidenced fantasy reasoning, magical thinking, and

realistic causes of death marked by egocentric reasoning. Death was

viewed as reversible and impermanent by this age group. Children 7

to 12 years of age described the infliction of death with or without

intention, such as through weapons, poison, or assault. Children 12

years of age and older cited relatively abstract clusters of specific

possibilities of death. These included physical deterioration, often










with a recognition of death as a natural process. In response to the

question of what will happen when one dies, Koochergrouped the

responses into the following non-exclusive categories:

references to being buried alive were given by 52% of
the children; references to being judged, going to
heaven or hell, or other hints at any sort of after-
life by 21%; references to having a funeral by 19%;
specific predictions of how death would occur by 10%;
references to some aspect of sleep by 7%; references
to being remembered by others by 5%; references to
reincarnation by 4%; and references to cremation by
3%. (p. 409)

In contrast to the findings of Nagy (1948), Koocher (1974)

found no personification type responses given in reference to what

might happen at the time of death. Weininger (1979) speculated

that Nagy's (1948) findings concerning children's personification of

death perhaps had its source "in specific cultural situations--the

armies, bombs, and threat of imminent death of World War II Hungary"

(p. 397). On the other hand, Kastenbaum (1965) theorized that the

personification of death by 5 to 9 year olds was a necessary emotional

compromise. The children created a person or image of death in order

to make death more controllable.

Kane (1979) investigated the death concepts of 122 mid-America,

middle class white children, ages 3 to 12 years, through 10

components of the death concept which she described as the following:

1. Realization is the awareness of death, of the state of being

deceased, or an event which happens. Death can happen to someone,

or it can be something which makes the living die.

2. Separation deals with the location of the dead and is con-

cerned with the child's idea of where the dead are: i.e., "In the

trees," "Under the ground."










3. Immobility has to do with the child's notions concerning

the movement of the dead. The dead may be seen as totally inactive

or partially or completely active.

4. Irrevocability has to do with the child's idea of death as

permanent and irreversible, or temporary and reversible.

5. Causality is a belief of what brought about the state of

death, whether from internal causes, such as heart attacks or external

causes such as guns or a combination of the two.

6. Dysfunctionality deals with the ideas about bodily functions

other than the senses. A child could believe that the dead are totally

dysfunctional, or that they are partially or completely functional.

7. Universality deals with the child's ideas of mortality. A

child could have notions that everybody dies, or that nobody dies, or

that there are exceptions.

8. Insensivity is a consideration of mental and sensory functions

such as dreaming, feeling, thinking, and hearing. Ideas may be held

that the dead are totally insensate or partially or completely sensate.

9. Appearance is the notion of the way the dead look. Ideas

could be held that a dead person cannot or does not look as though he

were alive or, to the contrary, that he looks the same.

10. Personification is a notion of death as concretized and

reified as a person or thing.

During the course of the study it became apparent that a
child could be aware, recognize, or realize death as
having a substance. The Realization component was seen,
therefore, to include Personification, and Personifica-
tion was dropped as a separate component. (p. 144)










Kane (1979) discerned three stages in the children's concept

development. Stage One was characterized by the presence of the

components of Realization, Separation, and Immobility. Death was

mainly a description: lying down with immobility. Egocentricity

and magical thinking was evident. The children believed they could

make someone dead by their behavior, wish, or label. At Stage Two,

death was viewed as specific, concrete, and dysfunctional. The

beginnings of logical thought were evident. Besides further develop-

ment of the aforenamed components, there was inclusion and development

of the remaining components of Irrevocability, Causality, Dysfunc-

tionality, Universality, Insensitivity, and Appearance. However, the

components were not interrelated. Early in Stage Two, the children

tended to believe that death was externally caused, although internal

causes of death were recognized later. Except for violence, death

was viewed as a part of old age and very far away. At Stage Three,

the children began to interrelate the components. The children's

conceptualizations were more abstract, logical, and reality-based.

Some children considered the existential issues of life and death.

Death was a definition, an internally caused state characterized by

dysfunctionality, inactivity, and insensitivity. The stages were

shown to develop year by year. Kane (1979) further stated that the

stages were related to Piagetian preoperational, concrete operations,

and formal operations stages. The youngest children in Stage One

organized their thinking in terms of structure; those in Stage Two

thought in terms of function; those in Stage Three evidenced abstrac-

tion.










Factor analysis of children's death concepts as defined by

Kane (1979) evidenced an increasing multiplicity in the components

during the early childhood years. In general, children acquired

Realization by age 3; Separation and Immobility be age 5; Irrevoc-

ability, Causality, and Dysfunctionality, and Universality by age

6; Insensivity by age 8; and Appearance was added by age 12. Kane

(1979) emphasized that the addition of components in each cluster

was not in any particular order. Thus, a one-to-one sequence of

component acquisition could not be established.

Kane (1979) also differentiated as to whether the children

were experienced or inexperienced with death. This was established

through postinterview contacts with the parents. The following

criteria were used:

A child was considered to be experienced if, after the
age of 18 months, he had known at least one intimate such
as a parent, sibling, or close friend, or four non-
intimates who had died, or if he had seen at least one
dead person, or had gone to at least one funeral or
funeral home, or had been greatly affected by the death
of a nonintimate. A child was considered to be in-
experienced if he had encountered death before he was
18 months old or had never encountered it. (p. 145)

Kane (1979) found that the experienced 3 to 6 year olds evidenced

the presence of the death components at a significantly greater degree

than the inexperienced peers. Children 7 through 12 years of age

manifested the same concepts whether they were experienced or not.

However, the older children generally evidenced the presence of most

of the concepts anyway, and a differentiation would be more difficult

to establish, if indeed it existed. Bolduc (1972) also found that

children who have had experiences with death evidenced significant










differences in their death concepts as compared to those who had no

experiences with death.

Contrary to Nagy's (1948) results, in which the inevitability

of death occurred to children at age 9, Kane (1979) found this

belief occurring frequently in children by age 6, and consistently

in children 8 years of age and older. Also contrary to Nagy's

(1948) investigations in which personification of death was expressed,

Kane (1979) found no such form of reification. Thus, there appeared

to be some significant differences in the concepts of death as

expressed by American middle class white children in the 1970's as

compared to the concepts of death of Hungarian children of post World

War II.

In studying children in kindergarten through the fourth grade,

White, Elsom, and Prawat (1978) also found that children's concepts

of irrevocability, universality, and cessation of bodily processes

in regard to death were related to the children's age and intellectual

development. White et al. (1978), however, isolated a rather inter-

esting differentiation in their study. After determining the child's

intellectual conceptual level by presenting three conservation tasks

taken from the Concept Assessment Kit by Goldschmid and Bentler

(1968), a story was read to the children. Half of the children

heard a version in which the main character, an elderly woman who

dies, is a kind, likeable, and friendly person who always says "hello"

to children. Half of the children heard a version in which the

elderly woman is unkind, mean to her pets, and yells at children.

The researchers found that the children's understanding of death was










not affected by the story. However, the children's views concerning

the cause of death were influenced. It is reported:

Twenty two percent of the children who heard the story
about the unkind woman attributed her death to some
unkind act she committed. Some children, for example,
claimed she died because she yelled at the school
children and some because she would never laugh.
Of the children who heard the story about the nice
woman, only one subject out of 85 attributed the
woman's death to her own behavior, claiming, perhaps
whimsically, that she died because she laughed too
much. There was, then a significant relationship
between a child's perception of the attractiveness of
the story character and a child's understanding of
the cause of that character's death, x2(1) = 18.36,
p < .001. (p. 309)

Melear (1973) who interviewed 41 children 3 to 12 years of age

in Greeley, Colorado, found children's death concepts to be generally

consistent with those reported in other studies which suggested a

developmental view. Melear (1973) categorized the responses into

four stages. The first stage was characterized by relative ignorance

of the meaning of the word death as evidenced by children 3 and 4

years of age. (However, one may question the limited sample of six

children at this age range from which such a conclusion is drawn.)

In the second stage, 4 to 7 year olds viewed death as a temporary

state in which the dead can be revived, experience feelings, and

engage in biological functioning. Five to 10 year olds, in the third

stage, viewed death as final, but the dead were able to see, hear,

feel, and in other ways function biologically. (Again, Melear (1973)

reported only four children in this category, and one may question

the size of the sample.) The fourth stage was characterized by the

view that death was final with the cessation of all biological func-

tioning. In other words, a more realistic concept of death was










expressed. It was interesting to review the ages of the children

in this stage as reported by Melear (1973). Of the 21 children,

two were between 4 and 5 years of age, one was between 5 and 6

years, and the remainder were 6 years and older.

Other studies which found children's views of death to be a

developmental phenomenon were those by Anthony (1940), Blum (1976),

Childers and Wimmer (1971), Gartley and Bernasconi (1967), Hornblum

(1978), McIntire, Angle, and Struempler (1972), Nass (1956), O'Brien

(1979), Swain (1976), and Weininger (1979).

Some portion of the literature (Buhrmann, 1970; Maurer, 1966;

Plank & Plank, 1978; Schilder & Wechsler, 1934; Schnieder & Schneider,

1977) interpreted children's developmental concepts of death based

on Psychoanalytic Theory. For example, Plank and Plank (1978)

examined children's art and autobiographies to discern the process

of building up defenses, the rejection and denial of death, and

children's reactions to catastrophes. In Maturation of Concepts of

Death, Maurer (1966) outlined 12 developmental steps illustrated by

quotations from various essays. Briefly, the maturational steps

were the following:

1. Awareness. The primal terror was there, less among the

brighter and so great among the dull that they feared direct mention

of it. "When I think of death, right away I am horrified.

Sometimes when I see a dead person, they seem so unreal."

2. Denial. This may take many forms: childlike whistling in

the dark ("My grandfather ain't never going to die"); reversals

("Death is a triumph"); clinging to attributes of life ("All I want










to know is what it feels like"); or refusing to think ("I think it

is a word that should be thought only when it occurs").

3. Projection. The death of an "other" leaves one grateful

for one's own life, indeed more fully alive.

4. Curiosity. Questions do not cease and some remain silly

even in adolescence. Wrote one: "I think it is the fear of the

unknown. What's going to happen? Will I just be there with no

thoughts, then all of a sudden someone blows a horn and up I come

or will I be conscious every minute? I would like for someone to

tell me what it's like and what happens afterward? Maybe if I trust

God and be a good little girl I will not fear the answers and not ask

so many questions."

5. Personification. "Will death call your name to go?"

6. Propitation. The death of the self being too traumatic to

express, they could approach it only one step removed. "If I lost

one of my parents, death would probably be hard to accept because I

am close to both of them."

7. Dare-devilry. No mention was made of this, possibly because

it is an action language.

8. Substitution. A remnant of this appeared as: "A new life

is born each day just as an old life dies each day."

9. Contempt with laughter. "I went on a dare one time with this

friend who knows a guy who works at the, you know, morgue. He puts

his lunch right on the body in the cold room to keep it like in an ice

box. He laughed and said: 'It's all right. He won't eat much.' But

I didn't care for that too much."










10. Acceptance of inevitability. "Some people think that it

is best not to know, but I feel you can appreciate life more and get

more out of it."

11. Despair. "When I think of death I think of living. I

think about the things I should have done but didn't, the places I

wanted to see but never did. Ordinary things like I should have

treated my sister and brother better or I should have gotten better

grades in school and the little bad things I did that upset my

mother."

12. Transmutation to idealism. "Death is something most people

hate to think about, but it is also something we have to accept. What

we should do is to make the best of our lives before it is too late."

Other psychoanalytic studies and writings (Ackerly, 1967; Menninger,

1938; Pfeffer, 1978; Pfeffer, Hope, Conte, Plutchik, & Jerrett, 1979;

Ringel, 1976) interpreted concepts of death in reference to suicide.

This topic will be discussed in more detail later in this chapter.

A few studies (Bruce, 1941; Huang & Lee, 1945; Klingberg, 1957;

Klingensmith, 1953; Russell, 1939, 1940a; Safier, 1964) have examined

children's concepts of animism as it relates to their concepts of

death. Piaget (1929) described animism as the mental phenomenon.in

children in which life and consciousness is attributed to certain

inanimate objects. According to Piaget, this was partially due to

the child's view of objects as extensions of himself or herself.

Piaget identified four stages in the development of the concept of

animism. In Stage One, children up to 6 or 7 years of age attributed

life to anything that demonstrated activity in any way. For example,










a stove was alive because "it cooked." In the second stage,

children 6 to 8 years of age attributed life to anything that

moved at the time it was moving. For example, a ball was alive

while it was rolling. Clouds, cars, and bicycles were alive while

they were moving. At Stage Three, children 8 to 11 years of age

attributed life to anything that moved on its own accord, such as

the sun and moon. Mechanical devices were not considered alive

because an operator was required to move them. At Stage Four,

children 11 years of age and older attributed life and consciousness

to animals alone or to plants and animals. The age limits were some-

what indefinite, but Piaget asserted that there was definite model

development in these stages.

Safier (1964) examined the responses of three groups of boys in

San Francisco who were ages 4 to 5, 7 to 8, and 10 to 11. She

administered the following ten stimulus words: dog, ball, tree,

bike, boy, moon, mother, ocean, car, cloud. For each word presented

at random, the following questions were asked:

1. Does a live? Is it a living?

2. Does a hurt when hit?

3. Does a grow up?

4. Does a die?

In the second part of the interview, the children were asked their

rationale for their responses. Two independent judges evaluated the

tape-recorded conversations in reference to the following questions:










1. Is life or death seen as a recurrent process?
2. Does life or death come from the outside to a person
or thing (external process)? Or does it come from
the inside, and is it seen as an internal process?
3. Is there neither basis for considering life or death
either as a recurrent or irrevocable or as an
internal event. (Safier, 1964, p. 288)

Basically, Safier (1964) found a decrease in "animism" and "death"

scores with increase in age. As children's concepts of death improved,

so also did their concepts of life. Safier stated, "The judges'

conclusions seemed to support a common rationale underlying Piaget's

stages of animism and Nagy's stages of death conception" (1964, p.

294).

Another approach to clarifying children's concepts of death was

implemented by Weininger (1979) who compared children's verbalizations

about death and dying with their behavior and comments in structured

play situations. Weininger (1979) combined the four questions used by

Koocher (1973, 1974a, 1974b) with two differently structured play

situations to determine the children's perception of death. Weininger

(1979) examined the verbal and play responses of 30 boys and 30 girls

ages 4 to 9 years old living in a middle class urban area. In a

small empty classroom, there was a tape recorder, a small table and

two chairs, and the following play materials: a mother and a father

doll, a child doll, a pretend stethoscope, a pretend hypodermic

needle, candy pills, a pretend thermometer, a blanket, a pillow,

a double bed, a box with a lid, 2 inch glass of water. The play

procedure was described as follows:

the interviewer presented all the materials, saying that
"the doll is very sick and the doll is going to die."
The interviewer gave the child time, and, if necessary,
helped the child to play out the situation, encouraging










the child in a free fashion to play with the materials
and to say what was happening. Following this play,
the interviewer said, "the doll is very sick and is now
dead" and encouraged the child to play out the situation
as the child perceived it. All children were
encouraged to respond both in terms of vocalization and
in terms of play and gesture. (p. 400)

As a preface to asking Koocher's (1974) questions, the interviewer

generally stated, "I would like to find out what children think about

dying, and I wonder if you have ever thought about this." The play

procedure or the interview procedure were done in random fashion.

Weininger (1979) summarized the results as follows:

The children's play indicated increasing accuracy in their
understanding of the concepts of dying and dead. Their
answers to the questions also indicated accuracy increased
with age. There were, however, differences between their
play understanding, and their verbal expressiveness.
Children's play frequently contradicts what they say about
dying and death, sometimes indicating a more complex
understanding than verbal expression would suggest, some-
times reflecting a failure to grasp freely the concepts
they speak about. Concepts of dying and death are hard
for children to understand and accept; the data indicate
that it is not until 8 or 9 years that play and verbal
expressions come to terms with each other. (p. 395)

Thus, there were a number of studies which examined children's

concepts of death in the context of Piaget's stages of logical thinking

through the use of individual interview and structured play format. In

general, the results appeared to be relatively consistent in supporting

a developmental evolution in children's concepts of death throughout the

childhood years.


The Influence of Various Factors Concerning
Children's Concepts of Death

Some studies (Beauchamp, 1974; Bolduc, 1972; Gartley & Bernasconi,

1967; Hornblum, 1978; Mclntire, Angle, & Struempler, 1972; Plotz &










Plotz, 1979) gave attention as to whether factors such as sex, socio-

economic level, religion, and television viewing affected children's

concepts of death. The results tended to be consistent in most of

the measured factors.

Beauchamp (1974) found no differences in children's concepts of

death as a function of sex. On the other hand, Zweig (1977) found

significant sex differences in the death attitudes of children 8 to

12 years old. It was interesting to note that Chasin (1971) who

studied the death attitudes of adults did find sex differences.

Further, this factor was differentially influenced by level of educa-

tion and religious orthodoxy.

Plotz and Plotz (1979) reported that children have many miscon-

ceptions about death which are culturally induced. For example,

there may have been an overemphasis on violence. However, the

researchers suggested that this factor needs further study. Zweig

(1977) also reported some effect from cultural differences as well

as racial differences. On the other hand, Beauchamp (1974) found

no significant differences in children's concepts of death as a

function of social class. Chasin (1971), however, found that higher

income (over $10,000) populations were differentially affected in

their death attitudes as a function of religious orthodoxy. However,

the death attitudes of lower income ($10,000) populations were not

differentially influenced.

Some attention has been given to examining the effects of

children's television viewing on their concepts of death. Although

Gartley and Bernasconi (1967) speculated that television may acquaint










children with the facts of death earlier than was usual in past

times, they did not investigate this variable in their study.

Hornblum (1978) and McIntire et al. (1972) reported no differential

effects of television viewing on children's conceptions of death.

Mclntire et al. (1972) found no significant differences even when

there was factor analysis of the total number of hours of television

viewing and type of favorite program: aggression, fantasy, or

reality. On the other hand, Zweig (1977) reported that her results

indicated that children learn more about death from the media and

reading than from religious training or school.

The matter of the effects of religion on children's concepts of

death has received very little attention in the literature. Gartley

and Bernasconi (1967) speculated on possible effects due to early

religious training, although they did not investigate this factor.

Mclntire et al. (1972) investigated the death concepts of 598

children, ages 5 to 18 years, who attended youth classes at either

a Roman Catholic elementary school, a Protestant Sunday school, or

a Jewish Temple. The children's religious affiliation was found to

be a significant variable in several measured aspects of their

acquaintance and concepts of the cause, imagery, and finality of

death. When asked "Why do people die?" there were significant

differences evident in the responses of the Catholic children at

the 6 year through 11 year range. At the age of 6 years, 33 percent

of the Catholic children gave the cause as "because they are bad."

However, no children in this or any other group attributed a known

death to moral guilt. At the age of 11 years, 22 percent of the










Catholic children stated that selection by God as the reason people

die, although only 2 percent of the Protestant and Jewish children

gave this as a reason. McIntire et al. (1972) also attempted to

determine children's views of what happens after death. The children

who had lost a pet were asked, "Do you think the pet knows you miss

it?" For all children, there was a drop in this belief at 7 years

and at 13 years of age. However, some differences were noted at the

ages of 15 to 16 years. Twenty-eight percent of the Protestant

children and 12 percent of the entire group attributed cognizance

to the pet. Further, at all ages, the belief in cognizance or

awareness after death for self was much less than that attributed

to the pet. McIntire et al. reported the following:

Catholic school children, ages 11 to 12 years, for example,
93% gave the response of spiritual continuation without
cognizance to the pet. Coexistence of these two responses
was interpreted as a belief in personal spiritual continua-
tion. In all four groups, the belief in spiritual
continuation peaked at the ages of 13 to 14 years, and
then decreased in all but those interviewed at the Catholic
school. In both the Protestant and Catholic children
the 7 year old was most likely (p < .01) to accept death
as total cessation; this corresponded with the decrease in
fantasy of imagery at the same age. By the age of 8, death
as a total cessation was less acceptable with responses of
increasing belief in spiritual immortality. (p. 530)

It was further added that frequency of religious instruction within

the various church groups did not seem to have any apparent effect on

the children's avowed concepts of death. There was also some investi-

gation of the children's imagery of what happens to the body after

death. McIntire et al. (1972) reported that "the concept of dis-

integration to ashes or dust was clearly a factor of religious

education," although no more specificity in this area was given.










The investigators also found differential effects of religion regard-

ing questions on the meaning of life and on suicide ideation. These

areas are discussed later in the chapter in the section on suicide.

Blum (1976) interviewed 155 children ages 7, 9, 13, and 18

years old. Half of the children were Catholic and half were Jewish.

Half attended religious Parochial schools and half attended public

schools. Blum (1976) also found that children's concepts of death

changed with age. He further found significance in the factor of

religion. For children in the formal operations stage, Blum reports

the following:

It was Catholicism (vs. Judaism) and a parochial-school
background (vs. a public-school background) that were,
in certain circumstances, related to more abstract levels
of thinking about an after-life. Finally, regarding
belief vs. non-belief in an after-life, Jews and
Catholics were very distinguishable at all ages, with
Catholics believing significantly more than Jews.
(p. 5248)

It was interesting to note that in adult populations, religious

activity and religious beliefs seemed to affect one's attitude toward

death. For example, Swenson (1965) found that "persons engaged in

frequent religious activity or demonstrating a fundamentalistic

type of religion evidenced a very positive or forward looking death

attitude whereas those with little religious activity or interest

either evaded reference to death or feared it" (p. 109). Similar

results were reported by Chasin (1971), although there appeared to

be differential effects related to sex, level of education, and

income levels.

As discussed earlier, Kane (1979) investigated the effects of

children's experience with death on their death concepts. In general,










experienced children 3 to 6 years of age seemed to manifest more of

the measured components of death concepts than those 3 to 6 year

olds who were not experienced with death in their life. No differ-

ential effects were found in children 7 to 12 years of age. Zweig

(1977) found that experiences with death influenced the attitudes

and concepts of death of 8 to 12 year olds. Bolduc (1972), in

studying the attitudes and concepts of death in 9 to 14 year olds,

found experience with death to be an influential factor. On the

other hand, Mclntire et al. (1972) who studied the death concepts of

children 5 to 18 years of age, found no apparent effect of experience

on children's avowed concepts of death. Thus, the results in this

area were rather contradictory, although the research tended to

suggest that experiences with death did affect children's death

attitudes and death concepts.


Children's Attitudes Toward Death


There appeared to be very limited research concerning children's

attitudes toward death. The only instruments which even approached

the early adolescent level were the Attitude Toward Death Scale

(Hardt, 1975) for 13 to 26 year olds and the Early Adolescent Death

Attitude Scale (Fauquet, 1980) for children in the sixth, seventh,

and eighth grades.

In older populations, mainly college students and adults, investi-

gations of death attitudes have been approached through a variety of

models and dimensions. However, there did appear to be four broad

divisions which emerge from the literature on this topic. The most










frequently investigated areas appeared to be those of fear of death

(Bailis & Kennedy, 1977; Bell, 1975; Boyar, 1964; Gold, 1974;

Leviton, 1974; Mueller, 1976; Nelson & Nelson, 1975), and death anxiety

(Alexander & Alderstein, 1959; Nelson & Nelson, 1975; Rowe & Loesch, 1978;

Templer, 1970). Attitudes concerning denial of death have been

investigated by Gold (1974) and Nelson (1975). Attitudes concerning

the acceptance of death have been studied by Kurlychek (1976).

A few studies (Ackerly, 1967; Alexander & Adlerstein, 1959;

Beauchamp, 1974; Blake, 1969; Levinson, 1967; Rochlin, 1965) have

alluded to children's fear of death. For example, Rochlin (1965)

presented the following thesis:

children very early, perhaps around three or four, become
aware that they will die but due to their overwhelming fear
of death, they erect elaborate defenses against this
concept. Thus the young child describes death as reversible
and temporary in order to master the realization of death.
(in Ackerly, 1967)

Beauchamp (1974), who studied the death perceptions of 3 and 5

year old children in the Midwest, reported that the older children

exhibited less fear than did the younger children.

Gartley and Bernasconi (1967), who interviewed 60 children 5

to 14 years of age, concluded that "children can accept death matter-

of-factly, but acquired a fear of death by observing the behavior of

adults" (p. 85). Cox (1979) and Zeligs (1967) findings also supported

the view that children's death attitudes are affected by the parents

and adults in their environment. On the other hand, Dugan (1977),

who administered the Taylor Manifest Anxiety Scale and the Lester

Fear of Death Scale to adolescents and their parents, reported that

"fear of death in parents did not significantly influence that










attitude in children, nor was children's general anxiety score

affected" (p. 230).

Blake (1969) investigated the death attitudes of adolescents

as compared to older people as they related to the psychosocial

developmental stages proposed by Erikson (1958, 1959, 1964).

Adolescents reported more fear of death than older people. However,

the older people tended to use denial more than the adolescents.

Religious versus non-religious did not appear to be a factor. It

should also be noted that these populations were white, Protestant,

and middle-class.

O'Brien (1979) studied The Effects of Inclusion and Exclusion in

Mourning Rituals on the Development of Children's Conceptual Under-

standing and Attitudes About Death. A questionnaire was administered

to 174 children in an inner-city public school, a parochial school,

and a Sunday school in the first, third, fifth, and seventh grades.

O'Brien (1979) found that middle-class children were more likely to

view death as painful and scary. Also, older children who had

participated in mourning rites evidenced increased anxiety in regard

to death.

Although little specificity is given, Melear (1973) placed some

focus on clarifying the death anxiety of 41 children 3 to 12 years

old among other issues related to their concepts of death. Melear

(1973) reported that some degree of death anxiety was evident in 12

percent of the 3 to 7 year old children, and in 75 percent of the 5

to 12 year old children. He commented, "all of the children, except

one, who exhibited anxiety also expressed a belief in an afterlife.










Perhaps this belief is an effort to overcome anxiety produced by

the realization that death is final and universal" (p. 360).

Only one study made some investigation of children's acceptance

of death. Rutzky (1979) examined the attitudes toward death of

children who grew up in concentration camps. Like other death

concepts, the children's responses varied according to their age.

Rutzky (1979) stated the following:

It is reported that the same mechanism and reactions
are observed in those who witnessed killing and mass
murders as in American children growing up in a peace-
ful environment. Children from concentration camps
were not found to accept death more readily, even though
their environment introduced them to loss repeatedly and
might have inured them to death."(p. 101)

Anthony (1940) and Plotz and Plotz (1979) made some attempts to

discern the meanings children attribute to death on both the cognitive

and emotional level. Anthony (1940) suggested that children associated

death with "inner fears and feelings about separation, loneliness,

aggressive impulses, and birth" (p. 46). Plotz and Plotz (1979)

suggested that children's attitudes toward death may have been

associated with cultural factors.

Thus, there were relatively few studies which yielded any signi-
ficant information concerning children's attitudes toward death.

Further, many of the comments appeared to be more speculative and

interpretive than descriptive. Other writings (Anthony, 1940;

Harnik, 1930; Kotsovsky, 1939; Menninger, 1938; Osipov, 1935)

theorized about children's feelings and reactions toward deathmainly

from a psychoanalytic basis. However, little substantive investiga-

tion was offered to support the theories.










There was a body of information in the medical literature
which addressed the many issues of caring for the terminally ill

child and the needs of the family. In many cases, there was

specificity as to the child's particular illness, such as cancer,

leukemia, or congenital heart disease. The topic of the sudden

traumatic death of infants and children was also addressed. However,

the medical and psychiatric literature did not yield research on the

attitudes of normal children concerning death and dying.

The specific topic of children's bereavement has received some
attention in the literature. Stein (1974) reported that during

childhood one out of every 20 children in the United States will lose

a parent to death and that by the age of 16, one out of every five

children will have lost at least one parent. Kastenbaum (1972) stated

that the death of a parent has the "single and longest lasting" effect

on children. He further suggested that "bereavement in early child-

hood has been implicated as the underlying cause of depression and

suicide attempts in later life" (Kastenbaum, 1975, p. 186). Moriarity

(1967) reported that his studies suggested that the case histories of

a large number of juvenile delinquents indicate unresolved childhood

grief. Fauquet's (1980) review of the literature revealed that

"during childhood and early adolescence bereavement reactions are
similar to those of adults: disbelief, physiological distress,

guilt, fear, anger, and panic" (p. 7).

Miya (1972) theorized that the children's perceptions of death
and dying were influenced by the three growth processes of (a)

individual developmental levels of abstract and concrete reasoning,

(b) parental attitudes, and (c) personal experiences.










Other studies (Cox, 1979; Escamilla, 1977; Gomez-Ossorio, 1978;

Pinette, 1977; Zeligs, 1967) generally agreed that children's

emotional reactions to death were largely determined by their age

and developmental stage, their personal experiences, and the

parents' responses to death. Pinette (1977) stated that "the

limited understanding of the child is in itself a built in protec-

tion for the child against being plunged into the depressed condi-

tion that the adult might enter" (p. 6). On the other hand, Dugan

(1977) presented data which supported the contrary point of view in

regard to adolescent populations. Dugan (1977) used instruments,

including the Taylor Manifest Anxiety Scale and the Lester Fear of

Death Scale, to determine the nature of the fear of death in adoles-

cents and their parents. This researcher stated the following:

Results indicated that fear of death in parents did not
significantly influence that attitude in children, nor
was children's general anxiety score affected. It was
concluded that the nature of the fear of death in
children is extremely complex and that: (1) adolescents
do not correlate viewpoints with parents even though
they are influenced by them; (2) unconscious death fear
plays a major role in the psyche; (3) people tend not to
think or are unable to think of the reality of their
personal death even though they have confronted it in
a specific life incident; and (3) this inability to think
of or grasp the reality of personal death is especially
true of persons who are in no immenent danger of death
(adolescents). (p. 239)


Research Concerning Suicide and Children

In 1946 in The Manual of Child Psychology, Carmichael spoke of

adolescent suicide as "a rarity." In 1979 the American Association

of Suicidology reported that suicide was ranked as the second leading










cause of death among this nation's youth. The incidence has nearly

tripled over the past 20 years. Green (1978) has associated self-

destructive behaviors in children 5 to 12 years of age to factors

of child abuse. Paulson, Stone, and Sposto (1978) conducted a

three year study of 662 children, 12 years of age and under, who

were identified as self-abusive or suicidal and in treatment at the

UCLA Neuropsychiatric Institute. Pfeffer (1978) reported that over

100 suicidal children 6 to 12 years of age were treated at the Child

Psychiatry Inpatient Service at Bronx Municipal Hospital in the

previous four years. The National Clearinghouse for Poison Control

Centers (1968) and several researchers (e.g., McIntire & Angle, 1973;

Sobel, 1970; Teicher, 1970; Springthorpe, Oates, & Hayes, 1977)

reported increasing admissions of children under 12 years of age to

poison centers and/or emergency hospitals for accidents and
"accidental overdoses." The National Center for Health Statistics

reported 170 confirmed child suicides in 1975. In the State of

Florida in 1977, five suicidal deaths were reported by children in

the 5 to 14 year old range. .Schnake (1972) estimated the ratio of

suicide attempts to actual suicides is 50 to 8, while Jacobs (1971)

estimated the ratio at 50 to 7. Jacobziner (1960) estimated the

proportions at 50 to 1, while still higher ratios are cited by

Tuckman (1962) at 120 to 1. Thus, there was considerable evidence

suggesting serious and significant increase in suicidal attempts and

suicidal behavior in children.

In the last few years Orbach and Glaubman (1978, 1979a, 1979b)

produced some very interesting studies investigating the concepts of










death of normal, suicidal, and aggressive children. Zeligs (1974)

and Orbach and Glaubman (1977) have postulated that suicidal

behavior in the young could be partly attributed to the child's

concept of death. It was suggested (Orbach & Glaubman, 1977) that

suicidal children would likely evidence a more idiosyncratically

distorted view of death than would normal children or children with

other disturbances, such as problems of impulse control and aggression.

In 1978 Orbach and Glaubman individually interviewed 21 children,

ages 10 to 12, who were either suicidal, aggressive, or normal accord-

ing to school records and school services. All of the children were

of low socioeconomic status; 20 were of Middle-Eastern origin, and

one was of European origin. They lived in Ramat-Gan, Israel. The

children were also matched for cognitive functioning by their per-

formance on the Similarities subtest of the WISC. The children were

then administered structured questionnaire based on a modified

version of questions used in Koocher's (1974b) study. They were as

follows:

One set consisted of questions about impersonal death,
namely: How do things die?; What happens to things
when they die?; Can dead things come back to life?
The other set contained the same questions about per-
sonal death, namely: How do you think you will die?;
What will happen to you when you die?; Can you come
back to life after you die? (p. 405)
The responses for the first questions in the two sets were categorized

as (a) natural death, (b) aggressive or brutal death, or (c) suicide

and self-destruction. The categories for the second question were

(a) burial process, (b) cessation of life activities or life process,

(c) deterioration of the body, (d) continuation of the life process or










life activities, (e) reference to other people's reaction, or

(f) other, such as don't know or the soul going to heaven. The

third question in the two sets was classified into one of the

following: (a) no return to life, (b) return to life in any form,

or (c) other. The following results were reported:

Aggressive children, compared to the other groups, gave
significantly more frequent responses of aggression and
brutality as causes of death, and suicidal children gave
more such responses than normal children. Suicidal
children named suicide and self-destruction significantly
more than any of the other groups. Responses of old age
and illness were given mostly by normal children. The
aggressive children gave the fewest responses of old age
and illness as causes of death. The frequency of responses
of old age and illness given by the suicidal children was
intermediate between these two groups. Normal children
attributed cessation of life to the state of death to a
significantly greater degree than the other two groups.
Suicidal children, on the other hand, attributed life
qualities to the state of death significantly more than
aggressive or normal children. This difference was
significant for responses about personal death and total
responses but not for responses about impersonal death.
The data also indicate that the distortion in con-
cepts that concern death is not related to differences
in IQ because all three groups were equal in level of
intelligence as measured in this study. (p. 853-856)

In a similar study a year later, Orbach and Glaubman (1979)r

presented measures and questions to 27 suicidal, aggressive, and

normal children, ages 10 to 12 years old. The children were indivi-

dually administered the Similarities subtest of the WISC, and inter-

viewed with a modified version of questions from Koocher (1974) and

Safier's (1964) questions regarding children's concepts of animism.

Orbach and Glaubman (1979),found the following:

Suicidal children showed distortion in the death concept
more frequently than the other group, but they showed
no inferiority in their ability for abstract thinking.









The results favor the assumption that distortions in
the death concept are specific and, therefore, can
be attributed to a defensive process. "(p. 671)

Orbach and Glaubman (1978, 1979) repeatedly emphasized that a

discussion of the concepts and meaning of death must be an essential

part in the treatment of suicidal children.

McIntire et al. (1972) reported one of the more striking statistics

from their interviews with the 598 Midwestern children 5 to 18 years of

age. When asked, "Are there times when you really wished you were

dead?" 238 (40 percent) of the children replied "occasionally" and

18 (3 percent) said "frequently." Those admitting frequent death

wishes held less naturalistic views of death, evidenced more fantasy

and imagery (such as reincarnation), and were more likely to believe

in reversibility and cognizance for themselves after death. Ten of

the 18 children reported that their death wishes were most often

percipitated by family arguments or fear of punishment, and most often

characterized by anger or sadness. Fourteen of the 18 children

were Protestant. All of them were over the age of 10 years.

Thus, there was considerable evidence which suggests that suicide

has become a matter of increasing frequency and concern among children

and adolescents. Further, since very few studies have focused on the

relationship between children's concepts of death and thoughts of

suicide, continued investigation of children's concepts, thoughts,

and attitudes toward death certainly seemed warranted.















CHAPTER III

METHODOLOGY


The assessment of death attitudes among elementary school age

children occurred through structured interviews in the school

setting. Self-reports in reference to discussions of self, a

"friend," and the environment of death were used in the explora-

tion of the death attitudes of denial, fear, anxiety, and acceptance.

Each of these attitudinal dimensions were assessed in terms of

the following frames of reference (as developed by Fauquet, 1980);

death of self, death of other, and the environment of death. In

the Early Adolescent Death Attitude Scale, Fauquet (1980) further

included the frame of reference of the death ritual. However, this

aspect was omitted in this study because it was believed that children

in this study were likely to have had only limited exposure or

experience with death rituals.


Sample Selection

For the purposes of this study, normal elementary school children

were those in regular classes in the fourth and fifth grades who were

determined to exhibit adequate adjustment in learning, behavioral,

and social areas in the professional judgment of the investigator.









The age range was 7 years 6 months to 10 years 11 months, as of

September 1, 1980. Children who had been retained and who were

performing at an average level academically were included in the

sample. Average was defined as "C" or better, or 2.0 or higher on

a 4.0 scale, in the combined subjects of reading and mathematics.

However, children who had been retained or who were performing

below average academically; that is, below "C" or 1.9 on a 4.0

scale were not included. Children who were identified by the school

Child Study Team as possibly educable, trainable, or profoundly

mentally handicapped were not included. However, those who were

receiving resource room delivery of special education services, e.g.,

speech, learning disabilities, and other categories of Exceptional

Student Education were included in the sample. Children who were

known to have experienced separation or loss of a parent or close

friend, or a trauma related to death in the last two years were also

ruled out. Thus, by the criteria, all of the children were function-

ing intellectually within the dull normal range or higher, and were

not so severe in their learning, behavior, or other maladjustment

problems so as to warrant full-time special education services in a

setting other than the regular classroom.

The children were attending the public schools of Marion County,

Florida. One school was selected from a suburban area in a community

of approximately 120,000, and one school was selected from a rural

area. Both schools had a pupil population between 450 to 800.

There was selection of alternative schools in each category in case

a local principal chose not to participate in the research project.









The principal was asked to select three fourth grade classes

and three fifth grade classes in which he/she judged the receptivity

and cooperation of the teacher to the research project to be optimal.

The principal was also asked to write a cover letter to the parent

consent form expressing support for the research study (see

Appendix A). In a teachers' meeting, the nature of the study and

the criteria for selecting the children was explained. Teachers

were asked to identify eight students in their classes who met

criteria. Parent consent forms were sent home with a request for

return the next day. There were five or more consent forms returned

for each class yielding a total N of 70.



Procedure

In November of 1980, cooperation on this study was solicited

from the Director of Student Services, School Board of Marion County,

as to how to proceed further in the school system. Subsequent

contacts were made with the Supervisor of School Psychology Services,

the Supervisor of School Counseling Services, and the appropriate

school principals. The logistics were discussed in detail with the

school principals and teachers in the identified schools. A copy of

the research proposal was provided to each school. The school

personnel and researcher developed a schedule as to the time and

setting of the interviews. The structured interviews were conducted

in a private room of the school guidance and administrative area.

Each interview required approximately 20 minutes. There was insured

freedom from distractibility, privacy, and additional optimal










conditions for the interview process. (The structured interview is

recorded in Appendix B.) The interviews were conducted by the

researcher who is certified by the Department of Education as a

school psychologist, a school counselor, and an elementary teacher.

She has had nine years experience as a school psychologist mainly in

the elementary school setting.

The nature of this topic made it especially important for the

structured interview to be conducted skillfully and sensitively. It

was important that the child felt comfortable in the situation and

trusting of the interviewer. Attention was given to the adequacy and

appropriateness of the environment. It was characterized by privacy,

comfort, safety, and familiarity. It was also important that the

child develop feelings of trust, openness, and spontaniety. Thus,

the initial part of the interview was designed to emphasize the

examiner's acceptance, positive regard, and interest in the child.

The child's responses and preferences were accepted readily thereby

facilitating the development of a warm rapport. Only after rapport

was adequately developed in the judgment of the interviewer were the

questions on death attitudes asked. In the atmosphere of acceptance,

warmth, and trust, it was anticipated that the child's responses

were, therefore, relatively honest and accurate.


Data Collection

As much as possible, the demographic data on each child included
the following: date of birth, sex, ethnic origin, grade, grade










point average, and number of retentions. Further, efforts were

made to secure the following data from the structured interview

and/or the report of school personnel: number of siblings, sibling

position of the child, status of the parents or caregivers (natural

or step), and parents' vocations. Data were collected concerning any

recent events which may have been traumatic to the child in the

areas of loss or separation. Specifically, this information focused

on indication of loss of parent or significant others through death,

divorce, or separation. Reported death of one or more pets was

noted also.


Nature of the Data

The scoring concerning the six questions on concept of death has

been developed by Koocher (1974-). The exact questions and scoring

were used with the exception of one addition of an "other" category

in the first set. The first two questions were the following:

1. How do things die?

2. How do you think you will die?

The above questions were scored according to the following categories:

A. Natural Causes (e.g., old age)

B. Aggressive Causes (e.g., murdered)

C. Suicidal or Self-destructive causes (e.g., killed himself)

D. Other (e.g., I don't know)

The next two questions were the following:

3. What happens to things when they die?

4. What will happen to you when you die?










The above questions were scored in one of these categories:

A. Burial (e.g., put 'em in the ground.)

B. End of Life (e.g., It's all over.)

C. Deterioration (e.g., It gets rotten.)

D. Continuation of Life Processes (e.g., You still know

what's going on.)

E. Other (e.g., I never thought about it.)

The next questions were as follows:

5. Can dead things come back to life?

6. Can you come back to life after you die?

The responses to these questions were scored as follows:

A. No return

B. Return in Any Form (e.g., I might be an angel.)

C. Other (e.g., I really couldn't say.)

The subsequent questions which focused on death attitudes yielded

responses in one of the following categories: Yes, No, Sometimes, or

Other.


Data Analysis

Since this was basically a descriptive study, frequency distribu-

tion of the various responses to each of the questions concerning con-

cepts of death (Koocher, 1974a) was calculated. In reference to each of

the attitudinal dimensions of denial, fear, anxiety, and acceptance, a

frequency distribution was calculated for grade level, GPA, retention in a

grade, sex, ethnic origin, urban-rural setting, pet ownership, acquaintance










with death of a pet, and for the total sample. Further, responses

were analyzed by percentages.


Validity

The first six items in the death attitudes interview were

developed by Koocher (1974) in exploring children's general concep-

tual understanding of death. The 12 questions concerning death

attitudes were modified to some extent from the Early Adolescent

Death Attitude Scale (Fauquet, 1980). In developing the EADAS,

Fauquet (1980) established face validity, content validity, and

construct factoriall) validity. A rather extensive three phase

process of developing and selecting the items was completed by four

reviewers who were counseling professionals of the following

description:

a university professor who teaches a course in counseling
research, a counselor education doctoral student who has
had varied experiences with death in his role as an
instructor and as a hospital chaplain, a doctoral student
who is working in the field of gerontology, and a practic-
ing school counselor with ten years' experience working
with early adolescents. (p. 19)

Among the criteria for the items was the establishment of a

fourth grade readability level as determined by a reading specialist

through readability analysis. The EADAS was administered as a pencil

and paper test.

The children in this study, however, were not asked to read the

statements, but to listen and respond to them in a structured inter-

view procedure. Oral responses were recorded by the interviewer.










Elementary school children vary widely in their reading skills.

Therefore, the limitation of reading was eliminated as a factor

through the structured interview format.

Reliability

In order to establish inter-rater reliability, two other certified

school psychologists were asked to evaluate and categorize the

responses of three children. Comparison was made with the judgment

of the researcher regarding the categorization of the responses.

Although no reliability procedure as such was used in this study,

these modified items are based on those developed in the EADAS

(Fauquet, 1980), in which reliability was established by test-retest

procedures using the Pearson Product Moment Correlation Coefficients

and by determining the internal consistency of the instrument by

comparing split half variances using Cronbach's Alpha reliability

coefficient. The total test-retest reliability was r = .77 (p < .01).

The reliability coefficient (split-half) was r = .89 (p < .01).

It is believed that children at the pre-adolescent level are

more responsive to the structured interview approach than to a

Likert-type scale using paper and pencil. In that adequate rapport

in the interview situation was clinically established and in that

the factor of readability level was essentially eliminated the

present format was determined to be adequate for data collection

with normal children at the fourth and fifth grade levels.

It was assumed that the data indicated the attitudes of normal

elementary children toward death through self-report. The children's

responses were spontaneous, honest, and accurate because of the










structured interview design. The structured interview design

provided for an adequate environmental setting, an age appropriate

manner of administration, and a child-centered format of inter-

action.


Methodological Limitations

To some extent, one may question whether self-report fully

reflects the child's concepts and attitudes concerning death and

suicide. Also, the sample of one or two questions in each area may

seem rather limited. However, one must consider the general tendency

of children to be rather direct and honest in an accepting environ-

ment, as well as their limited attention span in task-oriented

situations.















CHAPTER IV

RESULTS


The present data were derived from the purposes of this study:

specifically, an exploration of normal children's attitudes toward

death. Normal children's general concepts of death and of the

attitudes of fear, denial, anxiety, and acceptance in reference to

death of self, death of other, and the environment of death were

investigated. There was also an examination of various demographic

variables which have sometimes been shown to be related to normal

children's death concepts and death attitudes.


Sampling Procedure

The children sampled were randomly selected according to the

previously specified criteria from three fourth grade classrooms

and three fifth grade classrooms in each of two schools. In each

of the 12 classrooms, eight parent consent forms, with supporting

letters by the school principals, were sent home. No less than five

were returned in every class. All children who returned affirmative

consent forms were initially interviewed. However, two interviews

were eventually eliminated because more careful scrutiny revealed










that the children did not meet the selection criteria. Thirty-five

fourth grade children and 35 fifth grade children yielded valid

interviews that were used in the data analysis.

A total of five parent conferences were held following the

interviews with the children. Four conferences were by parent request

and one was by the request of the researcher. In one of these cases,

it was decided to eliminate the child's interview from the sample due

to situational adjustment difficulties in the child. It should be noted

that this child's parents were already in the process of pursuing

appropriate treatment.


Demographic Data

A total of 31 male (44 percent) and 39 female (56 percent) students

were interviewed. Thirty-seven children (53 percent) were from the

urban school and 33 children (47 percent) were from the rural school.

The grade point averages of the children were as follows: 21 percent

had an A average, 63 percent had a B average, and 16 percent had a C

average. Only 9 percent of the children had ever been retained in

grade level.

The age data revealed that 16 percent of the children were in the

range 8 years 9 months to 9 years 6 months old, 54 percent of the

children were in the range 9 years 7 months to 10 years 6 months old,

and 30 percent were in the range 10 years 7 months to 11 years 1 month

of age. In terms of ethnic characteristics, 93 percent of the children

were Anglo-American, 6 percent were Afro-American, and 1 percent were

Asian American.










Because attitudes toward death might be related to religious

beliefs, inquiries of religious preference were made. The

expressed religious preferences were as follows: 34 percent were

Baptist, 13 percent were Methodist, 4 percent were Presbyterian, 11

percent were Catholic, and 24 percent expressed other preferences.

The other 13 percent reported no preference or did not attend church.

In all cases, the children were living with their biological

mothers. Also, 80 percent were living with their biological fathers.

Of those children who were from homes where the parents were divorced,

almost 60 percent of the children were three years old or younger

at the time of the divorce. In regard to siblings in the home,

approximately 10 percent of the children had no siblings, almost

60 percent had one sibling, and approximately 30 percent had three

or more siblings. This included natural, step, and half siblings

by family structure.

When asked whether they presently owned or have ever owned a pet,

84 percent of the children reported yes and 16 percent reported no.

When asked whether they had ever had a pet die, 80 percent responded

positively. In 21 percent of the cases, the children had acquaintance

with death of pets in two or more instances. Twenty percent of the

children had no such incident in their lives with pets of their own.

The employment of the parents was noted. Approximately three-

fourths of the mothers were gainfully employed outside the home.

Ninety-three percent of the fathers were employed outside the home.

The parents' occupations were categorized by the same criteria of the

five condensed categories as recorded in the Weschler Intelligence










Scale for Children Revised. The incidence of the parents occupations

is recorded in Table 1.


Table 1

Occupational Status of Mothers and Fathers


Category Mothers Fathers

1. Not employed 34% 9%

2. Professional and technical workers 7% 19%

3. Managers, officials, proprietors, 40% 30%
clerical workers, and sales workers

4. Craftsmen and foremen 1% 24%

5. Operatives, service workers, farmers, 10% 13%
and farm managers

6. Laborers, farm laborers, and farm 7
foremen 7% 6%


Questions Related to Children's Concepts of Death


The purpose of this study was to explore children's concepts of

death. Using questions initially designed by Koocher (1974), there were

analyses of the children's responses concerning personal and impersonal

death. Table 2 summarizes the analyses of the data regarding what

children viewed as causes of death. Most of the children (70 percent)

reported that the cause of death of other things (i.e., animals) was

usually due to old age, illness, or both. More importantly, nearly

90 percent of the children stated that their own deaths were expected










to be from these causes. Approximately 10 percent believed that death

was likely to occur from aggressive causes, such as a car accident or

getting shot or kidnapped. A small percentage (6 percent) believed

that death comes when "God decides." No children reported suicide as

a cause of death.


Table 2

Children's Views of the Causes of Death


Impersonal Personal
(How do (How do you think
Causes things die?) you will die?)


1. Old age 24% 61%

2. Illness, heart attack, cancer, etc. 34% 24%

3. Old age and illness 13% 3%

4. Aggressive causes (car accident, etc.) 10% 9%

5. Old age and aggressive causes 9% 1%

6. Suicidal causes 0 0

7. God decides 6% 1%

8. Other 4% 0


Table 3 summarizes the data analyses regarding children's views as

to what happens after death in reference to other things (impersonal

death) and themselves (personal death). Thirty percent of the

children stated that things and themselves would be buried after

death. Approximately 50 percent expressed a belief in some kind of










continuation of life. Most of these responses were "Go to heaven."

Twenty percent of the children reported that things deteriorate when

they die. However, only 10 percent reported that they would deteriorate

when they died. One percent or less expressed the belief that

death was the total end of life.


Table 3

Children's Views of Conditions After Death


Impersonal Personal
(What happens to (What will happen
Conditions After Death things when to you
they die?) when you die?)

1. Burial 30% 31%

2. Burial and continuation 7% 3%

3. Burial and deterioration 6% 3%

4. Continuation 41% 48%

5. Deterioration 14% 7%

6. End of life 1% 0

7. Other 0 7%


Table 4 summarizes the data analyses regarding children's views

as to whether dead things can come back to life and as to whether they

can come back to life after they die. Seventy percent of the children

reported that they believed dead things could come back to life.










Fifty-four percent stated that they could come back to life after they

died. Most of the remaining children held opinions to the contrary.


Table 4

Children's Views Concerning


Life After Death


Yes No Other

Impersonal
Can dead things come back 70% 26% 4%
to life?

Personal
Can you come back to life 54% 43% 3%
after you die?


Questions Related to Children's Attitudes Toward Death


A second purpose of this study was to investigate children's

attitudes toward death. Questions adopted from Fauquet (1980) were

modified to examine the presence of the attitudes of denial, fear,

anxiety, and acceptance in regard to death of self, death of other,

and the environment of death. Refer to Table 5 for a summary of

the data.

Denial

In examining the attitude of denial toward death in children,

most 77 percent of the children report some denial in regard to their

own death. There was considerably less denial in reference to the

death of another. Forty percent of the children reportedly experienced










Table 5
Responses Concerning Attitudes Toward Death


Yes No Sometime

Denial

1. Do you sometimes feel this way: I
don't like to think about how I will 77% 10% 13%
die? (self)

2. If a friend died, do you feel you
would ever want to talk about it 46% 40% 14%
with anybody? (other)

3. Would you ever want to go where a
friend is dead? (environment of 81% 14% 4%
death)

Fear

1. Are you afraid of dying? (self) 50% 37% 13%

2. Would the death of a friend scare % 2%
you? (other) 67% 21% 1 1
3. Are you scared to go to a cemetery?
(environment of death) 24% 60% 16%
Anxiety

1. Do you worry about dying? (self) 31% 39% (30%

2. Does the thought of a friend dying 7 9
upset you? (other) 79% 9% 12%

3. Does a cemetery make you upset?3% 4%
(environment of death) 33% 9% 18%
Acceptance

1. Does it bother you to think about 6 1
how you may die? (self) 29% 61% 10% / ,
2. Would you want to visit a dying \ 6
friend in the hospital? (other) 71% 23% 6%

3. Would you be willing to go where 7 2
a friend is dead? (environment) 71% 23% 6%










denial in regard to talking about the death of a friend. Fourteen

percent of the children expressed a willingness to discuss the

death of a friend sometimes. Forty-six percent reported a clear

willingness to do so. There appears to be even less tendency for

the children to deny the environment of death, since only 14 percent

reported denial in this area. On the other hand, 81 percent of the

children did not express denial in this area.


Fear

In reference to the attitude of fear toward death, more (67

percent) children reported a sense of fear over death of a friend

than over their own death (50 percent). Thirty-seven percent of the

children stated that they were not afraid of dying. In regard to the

environment of death, only 24 percent reported that they were afraid

to go to a cemetery. Many of these qualified their responses by

expressing the fear of doing so alone or at night. Sixty percent of

the children stated that they were not afraid to go to a cemetery.

Sixteen percent apparently experienced the fear sometimes.

Anxiety

In examining the attitude of anxiety toward death, 31 percent of

the children stated that they did worry about their own death.

Approximately one-third (30 percent) worried about dying sometimes.

Thirty-nine percent of the children reported that they do not worry

about dying. Many children (79 percent) indicated that they experienced

anxiety over the thought of a friend dying. Twelve percent reportedly

experienced such anxiety sometimes. Only 9 percent reported no anxiety










over the death of another. One third (33 percent) of the children

indicated anxiety in the environment of death. Almost half (49 per-

cent) reported experiencing no anxiety in the environment of death

(specifically a cemetery). Eighteen percent reported the experience

of such anxiety sometimes.

Acceptance

In regard to the attitude of acceptance toward death, 61 percent

of the children reported some sense of acceptance in regard to their

own deaths. Twenty-nine percent did not indicate such acceptance.

Ten percent reported acceptance sometimes. Many of the children (71

percent) reported acceptance of the death of another. Twenty-three

percent did not. Six percent expressed acceptance of the death of

another sometimes. Thirty-seven percent expressed acceptance toward

the environment of death. Twenty-eight percent did not. Five per-

cent of the children reported such acceptance of the environment of

death sometimes.


Comparison of Attitudes Within Personal Death, Impersonal
Death, and the Environment of Death

There was a range of attitudes expressed by the children concern-

ing their own death. The majority of the children (77 percent)

expressed occasional denial of personal and half expressed fear.

One-third of the children expressed anxiety and one-third expressed

acceptance of their own deaths.

In general, there was less variability of attitudes concerning

impersonal death (death of another). Approximately half of the

children expressed denial and 67 percent expressed fear concerning










the death of a friend. Four out of five children indicated anxiety

over the death of a friend. Very importantly, 71 percent of the

children also expressed acceptance of another's death.

There was some variability of attitudes concerning the environ-

ment of death. Approximately one in five children expressed denial

or fear. Only one-third of the children expressed anxiety. Almost

40 percent of the children indicated acceptance of the environment of

death.


Differential Trends Relative to Sex, Grade,
School, GPA, and Retention

Although there may be some question concerning the validity of

the chi square analyses due to the sparse number of responses in

several cells of the tables, certain trends and characteristics are

suggested. Analysis of the data indicated that the children's views

of death and death attitudes may tend to be different in some respects

relative to the demographic characteristics of sex, grade, school,

grade point average, and retention.

In regard to responses relative to sex, minor differences were

noted (refer to Table 6). For instance, more females (28 percent)

than males (19 percent) attributed the cause of their personal death

as being due to illness, heart attacks, and similar reasons. Signifi-

cantly more males (26 percent) than females (5 percent) stated that

things deteriorate after death. On the other hand, more females (46

percent) reported that things continue to exist in some manner after

death than did males (35 percent). In regard to attitudes, 77 percent










of the females and 55 percent of the males reported some fear in

regard to the death of another. Also, more females (46 percent)

than males (32 percent) expressed denial in regard to the environment

of death. Considerably more females (56 percent) than males (42

percent) also expressed fear in regard to their own death. More

females (79 percent) than males (70 percent) also tended to deny

death in regard to themselves. Table 6 summarizes the data in this

area.


Table 6

Differences in Responses Relative to Sex


Males Females

Concepts

Attribute major cause of personal death
to illness, heart attack, and similar 19% 28%
reasons ,

Report a belief that things deteriorate 2
after death .2%

Report a belief that things continue to
exist after death /'c 1 I 35% 46%

Attitudes

Express denial regarding personal death -" 70% 79%

Express denial regarding environment of( i- 32%
death 32% 46%

Express fear regarding personal death : 42% 56%

Express fear regarding impersonal death : 55% 77%









In regard to differences relative to grade, concepts and

attitudes were explored. (Refer to Table 7.) Little or very

little difference was noted between the two grades. More fourth

graders (16 percent) than fifth graders (9 percent) attributed old

age as being the major cause of death for other things. Also,

more fifth graders (20 percent) attributed aggressive causes to the

death to other things while no fourth graders named such a category.

More fourth graders (31 percent) than fifth graders (17 percent)

viewed illness and related causes to their own deaths. More fifth

graders (14 percent) than fourth graders (3 percent) also attributed

their own deaths to aggressive causes, such as car accidents. More

fourth graders (49 percent) than fifth graders (34 percent) expressed

the view of some nature of continuation of life after death. Several

fifth graders (14 percent) expressed a view of the end of life at

death while no fourth graders expressed such a view. In regard to

death attitudes, 20 percent of the fifth graders expressed denial

in regard to their own deaths while no fourth graders did so except

on the basis of "sometimes." Almost 20 percent more fifth graders

than fourth graders also expressed fear and anxiety in regard to

their own deaths. On the other hand, more fourth graders (14 percent)

expressed anxiety in regard to the death of another than did fifth

graders (3 percent). More fourth graders (80 percent) than fifth
graders (63 percent) also expressed acceptance of the environment of

death.










Table 7

Differences in Responses Relative to Grade


Fourth Fifth

Concepts

Attribute major cause of personal death to 31% 17%
illness

Attribute major cause of personal death to 3% 14%
aggressive causes

Attribute major cause of impersonal death 16% 9%
to old age

Attribute major cause of impersonal death 20%
to aggressive causes

Report a belief in continuation of life 4%
after death 49% 34%

Report a belief in end of life after death 0 14%

Attitudes

Express denial regarding personal death 0 20%

Express fear and anxiety regarding personal death

Express anxiety regarding impersonal death 14% 3%

Express acceptance regarding environment of 8%
death 80% 63%





In comparing the attitudes expressed between urban and rural

children, some differences were noted. Table 8 summarizes the data

in this area. More urban children (76 percent) believed that they

will die of old age than did rural children (45 percent) who suggested










Table 8

Differences in Responses Relative to Rural-Urban Setting


Rural


Concepts

Attribute major cause of death to old age

Attribute major cause of personal death to
illness, heart attack, and similar reasons

Report a belief that things are buried
after death

Report a belief in continuation of life
after death

Attitudes

Express denial regarding personal death

Express denial regarding impersonal death

Express denial regarding environment of death

Express anxiety regarding personal death

Express acceptance regarding personal death

Express acceptance regarding environment of
death


45%

33%


42%


30%



85%

76%

58%

39%

27%

67%


Urban


76%

16%


19%

51%



24%

49%

24%

24%

51%

76%










that cause. About twice as many more rural children than urban

children (33 percent to 16 percent) attributed the causes of their

own deaths to illness, heart attack, or other similar reasons.

Considerably more rural children (42 percent) viewed things as being

buried after death than did urban children (19 percent). On the

other hand, more urban children (51 percent) viewed a continuation

of life after death than did rural children (30 percent) who expressed

such a view. More rural children (76 percent) than urban children

(49 percent) expressed the attitude of denial in regard to another's

death. Almost twice as many rural children (58 percent) than urban

children (24 percent) expressed denial in regard to the environment

of death. Also, more rural children (39 percent) than urban children

(24 percent) reported anxiety over their own deaths. Eighty-five

percent of the rural children compared to 68 percent of the urban

children expressed the attitude of denial in regard to their own deaths.

On the other hand, 51 percent of the urban children expressed more

acceptance of their own deaths as compared to 27 percent of the rural

children. Also, more urban children (76 percent) expressed more

acceptance of the environment of death as compared to 67 percent of

the rural children.

There was some differentiation of children's attitudes relative

to their grade point averages (refer to Table 9). Children with

lower GPA's increasingly viewed illness as the cause of death of

other things. The percentages who attributed death due to illness

were 13 percent of those children with A averages, 39 percent of those

children with B averages, and 45 percent of those children with C










averages. Children with lower GPA's also increasingly viewed

themselves as able to come back to life after they die. The

percentage of children who responded positively to that concept

were as follows: 33 percent of those with A averages, 55 percent

of those with B averages, and 82 percent of those with C averages.

There was also a slight trend for children with lower GPA's to

express the attitude of denial in reference to their own deaths.

Sixty-seven percent of the A students expressed such denial; 77 per-

cent of the B students did; and 82 percent of the C students did so.

A similar trend, but less obvious, was also suggested in regard to

denial of the death of another.

A stronger trend of increasing denial toward the environment of

death was noted as children's GPA's become lower. Specifically, 27

percent of the A students reported such denial; 39 percent of the B

students did; and 64 percent of the C students stated denial of the

environment of death. More students (55 percent) with GPA's of C

seemed to experience anxiety of their own deaths more than did

students with GPA's of A (27 percent) or B (27 percent). Also, more

C students (100 percent) reported anxiety over the death of another

than did A students or B students.

There were some differences in responses among children who were

retained as compared to those who were not retained (refer to Table

10). Half of the children who were retained viewed illness as the

cause of their deaths as compared to 22 percent of those who were not

retained. Sixty-seven percent of those who were retained reported a

view of continuation of life after death as compared to approximately










Table 9

Differences in Responses Relative to Grade Point Average


A B C


Concepts

Attribute major cause of death to illness 13% 39% 45%

Report a belief in coming back to life after 33% 55% 82%
personal death

Attitudes

Express denial regarding personal death 67% 77% 82%

Express denial regarding environment of death 27% 39% 64%

Express anxiety regarding personal death 27% 27% 55%

Express anxiety regarding impersonal death 80% 77% 100%


Table 10

Differences in Responses Relative to Retention


Retention No Retention


Concepts

Attribute major cause of death to illness 50% 22%

Report a belief in continuation of life 6%
after death

Attitudes

Express fear regarding environment of death 0 27%

Express anxiety regarding personal death 17% 33%

Express acceptance regarding personal death 67% 44%

Express acceptance regarding impersonal death 100% 80%










40 percent of those who were not retained. Commensurate attitudes and

percentages were also evident in regard to the view that one could

come back to life after death. No children who were retained reported

fear of the environment of death, while 27 percent of those who had

never been retained reported such fear. Twice as many students who

were never retained (33 percent) express anxiety over their own

deaths as did students who had been retained (17 percent). All

students who had been retained reported acceptance of death in regard

to another while 80 percent of the non-retained students expressed

acceptance. Approximately two-thirds of the retained students

reported acceptance of their own death while only 44 percent of

the students who had never been retained expressed acceptance.


Influences of Ethnic, Social and Familial Characteristics


In that 93 percent of the children were Anglo-American, an

interpretation of the differential responses by ethnic group did not

seem warranted.

There were no differential trends relative to the children's

religious preference.

There appeared to be no differential trends in the children's

responses relative to the married or divorced status of the parents,

employment status of the parents, or the number of siblings in the

family. The homogeniety of the population in some characteristics

and the considerable scatter in other characteristics were perhaps

factors in the limited distribution of the data relative to these

characteristics.










Differential Trends Relative to Ownership and
Acquaintance with the Death of a Pet

There were several instances in which children who owned pets

tended to respond differently from those children who did not own

pets. Table 11 summarizes the data in this area. More children who

owned pets reported illness as a cause of death, including their own

death, as compared to such reports from only 9 percent of the children

who had never owned a pet. Forty-three percent of the children who

owned pets reported a continuation of life after things die as

compared to 27 percent of those children who had not owned pets

making such reports. Also, 17 percent of those children who had

owned pets described some kind of deterioration after death, while

none of the children in the other category did. Twice as many children

who had never owned pets (55 percent) reported that burial is what

happens to things after they die. Similar frequencies of responses

were noted between the two groups of children in regard to what

happens after personal death in the areas of burial and continuation

of life in some manner after death. In regard to attitudes, children

who owned pets tended to have less denial concerning the death of

another and in regard to the environment of death as compared to

children who did not own pets. Also children who owned pets expressed

fear of the environment of death less frequently (18 percent less) than

children who did not own pets.

There was an examination of the responses regarding children who

never had a pet die, experienced the death of one pet, or experienced

two or more deaths of pets. When asked, "What happens to things when










Table 11

Differences in Responses Relative to Pet Ownership


Own Pet No Pet


Concepts

Attribute major cause of personal and 38% 9%
impersonal death to illness

Report a belief in continuation of life 43% 27%
after impersonal death

Report a belief in deterioration after 17% 0
death

Report a belief in burial after impersonal 27% 55%
death

Attitudes

Express denial regarding impersonal 59% 73%
death

Express fear regarding environment of 22% 36%
death









they die?" 60 percent of the children who experienced multiple deaths

of pets reported continuation of life as compared to approximately 35

percent in both of the other categories. Further, only 6 percent of

the children who had experienced multiple deaths of pets reported

burial as compared to approximately 36 percent of the children in both

of the other categories. When asked, "What will happen to you when

you die?" no children who had experienced multiple deaths of pets

reported burial, while approximately 40 percent of the children in the

other two categories reported burial for themselves. In response to

the same question, 27 percent of the children who experienced

multiple deaths of pets reported deterioration, while no children

who had one pet die made such a report. Seven percent of the children

who had never experienced the death of a pet made such a report.

Attitudes of children toward death of a pet are reported in

Table 12. Children who had never experienced the death of a pet

expressed denial of the environment of death only half as often as

those children who had experienced deaths of pets (22 percent to approxi-

mately 45 percent). Children who had experienced deaths of pet(s)

fear of the death of another more frequently (17 percent to 23 percent

more) than did children who had not experienced any deaths of pets,

about half of whom expressed fear. On the other hand, children who

had experienced deaths of pets expressed fear less frequently in regard

to their own death (10 to 18 percent less frequently) than did children

who had never known the death of a pet. Children who had experienced

deaths of pets generally expressed anxiety over the death of another

more often than those who had not experienced death of a pet.

Specifically, when asked, "Does the thought of a friend dying upset










Table 12

Differences in Responses Relative to None, One,
or Multiple Deaths of Pets


None One Multiple

Concepts

Report a belief in continuation of life 3 3
after impersonal death

Report a belief in continuation of life 2% 4
after personal death 49%

Report a belief in burial after impersonal 3 3
death36% 37% 6%

Report a belief in burial after personal 36% 41% 0
death 36% 41%

Report a belief in deterioration after 0
death 7 27%

Report a belief that things do not return 4% 7
to life after death 43% 78% 73%

Attitudes

Express denial regarding environment of 2% 4
death 22% 44% 47%

Express fear regarding impersonal death 50% 73% 67%

Express anxiety regarding environment 6% 4
of death 64% 44% 47%

Express anxiety regarding impersonal 5% 8
death 57% 88% 73%










you?" 57 percent of the children who had never known the death of a

pet responded yes; 57 percent of the children who had known the

death of one pet responded yes; and 73 percent of the children who

had known multiple deaths of pets responded positively. Sixty-four

percent of the children who experienced no deaths of pets reported no

anxiety in regard to the environment of death. On the other hand,

approximately 45 percent of the children who had experienced deaths

of pets expressed no anxiety. There were no clear differentiations in

regard to the attitude of acceptance toward death.


Interview Closure Activities

At the conclusion of the specific questions investigating death

concepts and attitudes, a few open-ended questions for closure and

a drawing activity were provided. The children were asked, "Is

there anything else you would like to tell me about this?" Seventy-

three percent of the children responded negatively. The children

were also asked, "Is there anything you would like to ask me?"

Fourteen percent of the children did have questions, 86 percent of

the children did not. Table 13 summarizes the questions. When asked,

"Is there anyone else you would like to talk with more about living

and dying?", 13 of the children responded positively, mainly naming

a parent. Table 14 specifies the persons the children identified for

further discussion. Finally, the children were asked to draw a

picture of anything they would like to draw before leaving. Ninety-six

percent of the children drew pictures of themes typical of their












Table 13

Questions Children Asked the Researcher


Question


"Is it true when you die they'll burn you?"

"If a person smokes, how long 'til they die?"

"How do diseases get started?"

(Later, child expressed worry over mother
smoking.)

"Do ghosts come back to families?"

"How old do people get?"

"Can you die of a heart attack?"

"Could God bring you back to life?"

"Can you read other people's minds?"

"How can you read people's minds?"

"How do you feel about dying?"

"Why do you ask children these things?"

"Do you work here?"

"How do you feel about it?"


Child


Child

Child

Child


Child #18

Child #22






Child #24

Child #25

Child #35


Child #38












Table 14

Persons Identified by Children to Ask Further Questions


Child Identified Person


Child #2 Parents

Child #8 Neighbor (who had a recent death in
family)
Child #13 Doctor or Mother or Nurse

Child #26 Mother

Child #47 Parents

Child #49 Anyone

Child #52 Parents

Child #56 Mother

Child #58 Anyone

Child #68 Doctor










special interests, such as people, cars, scenes with trees and flowers

and other content. However, 4 percent drew pictures of a death

related scene.


Clinical Impressions


In most cases, the children were informally met at the classroom

door by the researcher and escorted to the private conference room.

On the way, the researcher identified herself as the one who had

sent the note home for the child's parents to sign the preceding day.

The children were asked if their parents had made any comments con-

cerning the consent form. The children often shrugged as though it

was a rather insignificant event. They usually stated that the

parents had asked the child whether he/she had a willingness to

participate in the interview. The researcher often asked what the

child decided and the response was commonly, "Sure" or "It's OK with

me." The mood of the children seemed to be one of willing cooperation,

relaxation, and interest, except in one case in which the data could

not be obtained.

During the structured interviews all children readily responded

to the initial activity of drawing a picture of a person. This

activity seemed to give the children opportunities to become

accustomed to the setting and to focus on a self-directed task which

did not require much interpersonal interaction. In most cases, rapport

was established with ease. The format of the structured interview

typically proceededwith a continued sense of interest and cooperation

on the part of the child. Very few asked for clarification on the










questions concerning their concepts and attitudes toward death. Most

children responded rather quickly and spontaneously. Some children

responded slowly, with apparent thoughtful deliberation. In

general, there was more hesitation and reflection on questions

concerning the death of a friend than on the questions concerning

the environment of death or personal death.

The closure activities were particularly useful. The few children

who had additional comments seemed to find the opportunity to do so

an important one. The closing remarks usually focused on more

detailing of the events surrounding the death of a relative or pet.

When given the opportunity to ask the researcher questions,

approximately 13 percent (n = 10) of the children chose to do so.

Examples of these questions are listed in Table 13. It is interesting

to note that over half the questions reflected a need for information.

Two of the nine children expressed related concerns over the possible

dangers of their parents' smoking. Several questions reflected a

healthy curiosity over the researcher's interest and activities in

this area. The two questions relating to the researcher's ability

"to read other people's minds" were apparently prompted by a classroom

teacher's remarks which stated such. These questions are viewed as

extraneous artifacts of the investigation.

It is interesting to note the persons whom the children identified

for further discussion. More than half the normal children identified

their parents. This likely reflected very healthy positive relation-

ships in the family constellation. The two identifications of

medical personnel seemed to again reflect the children's need for










accurate information relating to their concerns over health, life,

and death.

The final activity of drawing a "picture of anything you would

like" provided an opportunity for spontaneous self-expression. It

is important to note that 96 percent of the pictures were not death

related drawings. The majority of the drawings were judged to be

clinically healthy drawings with content such as trees, houses,

nature scenes, cars and other vehicles, and so forth. In those cases

of death related scenes, the researcher further examined the child's

adjustment to determine whether there was need for concern. In the

two cases in which concern was warranted, conferences with the

children's parents were scheduled. Further responsible action was

pursued.

The parent conferences were cordial. All the parents expressed

genuine interest in the healthy adjustment of their children. A few

inquired whether their child evidenced apparent difficulties in the

area of death and dying which may need special attention. In two

cases, parent awareness of their child's attitudes seemed advisable.

In one instance, a discussion regarding provision for the child's

safety in the event of the parents' deaths seemed advisable. Appro-

priate professional services were advised and scheduled in a second

case. Most parents stated that they believed the interview with their

children had been a very positive, constructive event. They expressed

strong interest regarding their children's healthy adjustment in all

areas of life, including the matters of death and dying.















CHAPTER V

DISCUSSION


Limitations Regarding Generalizability

It is important to determine appropriate limits for generalization

of the results of this study. The present results can appropriately

be generalized to normal Anglo-American children in the fourth and

fifth grade classes who reside in urban or rural settings. However,

the differential trends of these characteristics as well as the child's

sex, grade point average, retention history, ownership of a pet, and

acquaintance with death of a pet should be kept in mind.

In that 93 percent of the children were Anglo-American it is

prudent to draw conclusions from the data only as they relate to

Anglo-American children in the United States. Even though there

were minor distinctions between the responses of the children in

urban and rural settings, between fourth grade and fifth grade

children, between males and females, and among grade point averages,

there should certainly be a recognition of these factors in the

population. In that there appeared to be no clear distinctions in

the responses from children of varying social-familial descriptions,

guarded acceptance of any implications of the data as they relate

to those areas is appropriate. Further study of the possible










relevance of these factors with a large N would also be appropriate.

These many characteristics are, of course, applicable to normal

children in basically regular classroom settings.



Conclusions

Children's Concepts Concerning Causes of Death

Analyses of the data concerning children's concepts of the

causes of personal and impersonal death, conditions after personal

and impersonal death, and the finality of personal and impersonal

death reveal a significant range of responses in most of the areas

of exploration.

In regard to children's views of how other things die compared

to the causes of their own death, the view of one's own personal

death being due to old age was expressed nearly three times more

frequently than old age being the cause of death of animals. Perhaps

old age is believed to be a more acceptable and less threatening way

to die than the other possible causes such as illnesses, heart

attacks, or aggressive causes. This concept is further supported

in comparing the differences in responses concerning personal and

impersonal deaths as being due to illness, heart attacks, cancer,

and related causes. Specifically, illness was reported as the cause

of death for other things more (34 percent) than it was reported as

the cause of one's own death (24 percent).

It is important to note that approximately 10 percent of normal

children apparently attribute aggressive causes, such as car accidents,

being kidnapped or killed, to a possible actual cause of either









personal (death or self) or impersonal (death of other things) death.

In evaluating the emotional adjustment of children particularly con-

cerning death, this finding should be viewed with care.

Although not a common response, the view of aggression as a

cause of death also may not necessarily be a deviant response.

Such a view would likely need to be evaluated in the context of

additional evaluative data relative to the child's emotional adjust-

ment. It is important to compare this finding to Orbach and Glaubman

(1978) who reported that "aggressive children gave significantly

more frequent responses of aggression and brutality as a cause of

death, and suicidal children gave more such responses than normal

children" (p. 852).

It is also interesting to note that none of the children attributed

suicidal causes to either their personal deaths or to the deaths of

other things. This finding also corraborates the work of Orbach

and Glaubman (1978) who found that (normal) children seldom identified

suicide as a cause of death. However, suicidal children named

suicide and self-destruction significantly more as a cause of death.

Thus, there is the strong indication that children who suggest

suicide as a possible cause of death may indeed by pre-suicidal.

Some attention must be given to the 6 percent (four children)

who stated that other things die because "God decides." Although

the data are too sparse to draw any conclusions, perhaps there is the

implication that children accept God's decisions for the fate of

other living things more readily than for the conditions of their own

lives. Further, investigation of the conditions of the role or









relationship of religious or spiritual views in regard to children's
concepts of death seems to warrant some consideration. Blum (1976),
Chasin (1971), Gartley and Bernasconi (1967), Mclntire et al. (1972),

O'Brien (1979), and Zweig (1977) have alluded to or investigated
children's views or concepts concerning death relative to religious
training. However, mixed results are reported in the studies

yielding no clear conclusions at this time.

Children's Views Concerning Conditions After Death

Perhaps the most striking feature of these data was the rela-
tively little variability of children's responses in comparing
personal and impersonal deaths. There was no more than a 7 percent

(5 out of 70) difference in any of the seven categories describing
conditions after death. Approximately one-half of the children
reported that burial or burial with continuation or deterioration

will happen after death. A significant percentage of children
(almost half) reported the view of a continuation of life in some
manner after death. Most commonly, this was described as "go to
heaven" or "go to heaven or go down there." These views corroborate

the work of Orbach and Glaubman (1978, 1979) and Zeligs (1974) as it
relates to normal children compared to aggressive children and pre-
suicidal children.

On the other hand, do 50 percent or so children who did not
describe some type of continuation after death believe that death
is indeed final? This issue becomes more complex in viewing the

children's responses to the questions, "Can dead things come back to










life?" and "Can you come back to life after you die?" Nearly three-

fourths of the children stated that dead things come back to life

and approximately half of the children expressed such a view in regard

to themselves. Analysis by sex suggests that almost half of the

females expressed a belief in continuation of life after death as

compared to one-third of the males. Also, fourth graders tend to

express the view of continuation more often than fifth graders (49

percent to 34 percent). Further, approximately 50 percent of the

urban children expressed a view of continuation of life compared to

one-third of the rural children. Children with lower GPA's also view

continuation of life more frequently.

In contrast, Nagy (1948) found that nine to ten year olds tended

to view death as a permanent and irreversible process. Melear's (1973)

results support this finding. Kane (1979) reported that death was

viewed as irrevocable and dysfunctional by children when they are

six years of age. On the other hand, Mclntire et al. (1972) presents

data which support this study. McIntire et al. (1972) stated, "the

belief in spiritual continuation peaked at the ages of 13 to 14

years" (p. 530). The perception of continuation was as high as 93

percent in 11 to 12 year olds. Blum (1975) also found that Christian

(Catholic) children tended to believe more in after life significantly

more than Jewish children. Thus, there does not appear to be a clear

definition of children's concepts in this area. Certain demographic

variables such as age, sex, environment (urban or rural), GPA, and

religion seem to have some relationship to children's views concerning

some nature of continuation of life after death.










Children's Attitudes Toward Death

In focusing on children's attitudes concerning their own deaths,

there seems to be considerably more denial than fear in that

approximately three-fourths of the children expressed the former

and only half expressed the latter. Further, only about 30 percent

of the children reported anxiety. Perhaps the defense mechanism of

denial enables the child to control anxiety about personal death.

There seems to be the attitude of acceptance of death among the

majority of children. Six out of ten children responded negatively

when asked, "Does it bother you to think how you may die?"

There seems to be generally more intensity in all the attitudes

concerning the death of a friend. Approximately 55 percent of the

children would even want to talk about the event or want to talk about

it sometimes. A considerable number of children expressed fear (67

percent) and anxiety (79 percent) concerning the death of a friend.
Further, 71 percent of the children also expressed acceptance to the

point of visiting a dying friend in the hospital. Thus, the attitudes

toward the death of another seem to be more intense, more mixed, and

perhaps more conflicting. Overall, there seems to be more interest

in the death of another than in one's own death for fourth and fifth

graders.

A rather consistent acceptance of the environment of death was

expressed. Sixty percent of the children reported no fear or anxiety

about going to a cemetery. Forty to eighty percent of the children

indicated a willingness to go where a friend is dead. Perhaps there

is a basic acceptance of the reality of death that is tolerated more









readily by children in the context of the environment of death.

Perhaps visiting the environment, namely a cemetery or "where a

friend is dead," enables the child to process or integrate the death

event into a greater sense of reality or acceptance.


Implications

The exploration of children's concepts and attitudes toward death

has several important implications for theory, training, practice,

and research. The present study basically coraborates the develop-

mental aspect of children's concepts of death. The children's

concepts of death seem generally consistent with much of the previous

research (e.g., Anthony, 1940; Kalmbach, 1979; Koocher, 1973, 1974a,

1974b; Melear, 1973; White, 1978) that has been done using the

Piagetian model. Some aspects of the data concerning children's

attitudes toward death may be interpreted rather readily in the

framework of Psychoanalytic Theory, particularly in the context of

defense mechanisms and the dynamics of personality adjustment.

However, many questions concerning normal children's attitudes toward

death still remain for research to answer.

There needs to be further investigation regarding the development

of the concepts of death and the intensities of attitudes. This

should include a clarification of possible relationships among the

demographic variables such as ethnic and cultural background, age and

grade level, grade point average, sex, urban-rural environment,

religious training or orientation, or other aspects of the children's

lives. Because the interview process seems to be very effective with










this sensitive area, it is recommended for the control of many of

the variables of data collection.

In regard to the training of professionals in counseling,

education, and mental health, there should be significant emphasis

on understanding children's concepts and attitudes toward death.

In addition to the usual professional skills in mental health

services, there should be allocation of at least part of a course to

focus on the salient issues and related research regarding death

concepts and death attitudes. Current curricula could be evaluated

carefully to provide for the inclusion of valid information concerning

children's concepts of death and death attitudes. There needs to be

awareness of the available research and information concerning the

differential concepts and attitudes among normal aggressive, and

suicidal children in regard to their own deaths and the deaths of

others.

Self-clarification of students' perceptions and attitudes con-

cerning death should be encouraged. Appropriately structured and

supervised opportunities for such exploration should be provided.

For instance, students may be encouraged to recall their own

experiences concerning death, dialogue with their colleagues concern-

ing the emotional effects and intellectual conclusions, increase their

own awareness of sensitive or problem areas, and clarify lingering

issues concerning death of self or others.

It is important to realize that the information and voluminous

recent writings on death and dying for adult populations may have

very limited applicability to children's concepts and attitudes










concerning death and dying. The literature for adults is important

to the extent that it enables clarification of thinking and feelings

concerning death. However, such perspectives and conclusions must

be very guarded in application to children.

There is not enough research and expertise related to the

professional practice concerning many aspects of normal and abnormal

children's concepts and attitudes toward death to make very extensive

recommendations. The practitioner must, of course, be cognizant of

all the available information concerning children's concepts of

death. The practitioner must have a great deal of self-awareness in

regard to the multiplicity of death issues. Further, the practitioner

must be very selective in using commercial materials. Any structured

experiences must be conducted with considerable caution and with

detailed knowledge of children's social, emotional, and academic

adjustment. It is important for the practitioner to be especially

aware of the verbalizations, fantasies, and behaviors of disturbed

children toward death, should any significant death concerns manifest

themselves.

Children want to have their questions answered concerning death.

They need to explore their own feelings and attitudes, and to

experience support from family or other significant adults who

have a healthy clarity of their own feelings concerning death issues.

Then, the child may be provided with support and appropriate

responsiveness should a death occur. If a child seems to be

experiencing significant difficulties in areas related to death

concerns, including their own deaths, it would be prudent to refer










these children for services to a qualified counselor, therapist, or

psychologist.

This study of children's concepts and attitudes toward death

has yielded insights, questions for research, implications for

theory, and directions for training and practice. With increased

knowledge and sensitivity to the needs of children, the competent

professional will more readily and more skillfully respond to

children regarding the important matter of the universal experience

of death and dying.















APPENDIX A

PARENT CONSENT


Dear Parent:

In order to better understand and help children, it is important

to learn their thoughts and attitudes on many subjects. As you

know, there recently is more discussion about attitudes toward life

and death by adults.

I would like to ask permission for your child to participate in

a research project to explore children's attitudes concerning death.

This will be through a 20 minute individual discussion. If you agree

to let your child participate, you may withdraw your permission at any

time. Your child's identity will be known only to me and to school

persons who help arrange for your child to talk to me. I would also

like to ask permission to review your child's cumulative folder and

to check the information, such as status of the family members, with

your child.

A copy of this study is available at the school. If you have any

questions or would like to know the results, a conference can be

arranged with me through the school secretary. My phone number is

listed below, and you can feel free to call me at any time to discuss

this research. There is no monetary compensation for participation

in this project.