While visiting a local nursery in July of last year, Philip Hinkle, 50, of Lorton, suffered a massive heart attack, collapsing in front of his wife and young daughter. As Chris Hinkle struggled to revive her dying husband, 4-year-old Julia had only one question: "Mommy, can I go back and play now?"

Loving children often react as Julia did, fostering the myth that the young do not grieve. "It's the most common misconception we have to deal with," reports Denise McNaught, director of the National Childhood Grief Institute in Minneapolis. "A parent dies. Minutes later the child is running around and playing. People think this means children are not affected, but they're wrong."

As Alan Wolfelt, a child psychologist and director of the Center for Loss and Transition in Denver puts it: "Any child old enough to love is old enough to mourn." While the feelings children experience in grief are similar to an adult's, their reactions are very different, and this confuses people around them. "Children grieve intermittently," says Wolfelt. "You might tell them the death news, they might cry, and 10 minutes later they're doing something else. It protects them from being overwhelmed."

According to the National Childhood Grief Institute, 1.5 million children in the United States lose one or both parents to death before the age of 15, and more than 970,000 of them are brought up by a widowed parent. Yet until recently child bereavement was little researched.

For the past two years, however, Harvard University psychologist Phyllis Silverman and her colleague, psychologist William Worden, have co-directed the Harvard Child Bereavement Study, the first major analysis of the impact of parental death on schoolchildren ages 6 to 17 years. Seventy families were followed, including 125 grieving children. The study -- which Silverman will discuss in Washington next week -- advances understanding on several fronts, according to bereavement scholars. For the first time in a major bereavement study, children were interviewed along with their parents. Before the Harvard study, nearly all research on child bereavement was retrospective, asking adults who suffered a loss in childhood to remember what it was like.

One way or another, Harvard's researchers are finding, children need to maintain a sense of connection with the parent for their own developmental purposes, a "continuity of the relationship they had before, in order to carry on," says Silverman. Julia, now an effervescent 5-year-old, reports sharing Popsicles with her dead father, and seeing his hand reach out from a cloud. "When I send a balloon up to him," she eagerly explains, "he gets it; when I throw him a big kiss, he gets it. And when I throw a hug up, he always gets it." Notes Wolfelt: "Julia is converting presence to memory. That doesn't mean she's hallucinating, or denying reality. She's just doing the work she has to do."

Silverman's data suggest that American children have an unusually well-developed sense of the afterlife. She compares the Harvard data with research on Israeli children conducted by Sara Smilansky, a psychologist at the University of Tel Aviv. "When you ask a kid in our study about the death, they admit that someone has died, but somehow life is still going on in heaven. In Smilansky's results, most Israeli kids said, "Dead is dead."

"My Daddy tells me things he likes to do better in heaven than on earth," Julia reports. "He fishes. God lets him wear anything he wants. And God gave him a new job -- helping get food ready -- so sometimes he can't visit because he has to work." Finally, for those wondering why departed loved ones visit only sporadically in their dreams, an answer: They're busy.

Like most children in Silverman's study, Julia reports her dead parent continues to watch over and advise her; Silverman theorizes that the deceased may thereby play a role in the continuing development of the superego. "My father listens a lot," says Julia, "and tells me things I should do that are good, like listening to Mom, or cleaning my room, which I do, sometimes."

Silverman believes children's bereavement is neither a time-limited nor static process, but dynamic, allowing an on-going relationship with the dead parent over the life cycle to mature as the child grows. For the very young child, she says, grief is concrete; the child relates to dead parents in terms of "what they did for them, like 'remember when Daddy brought me candy,' or 'how he threw me up in the air.' 'Remember this, remember that,' rather than the direct articulation of feelings."

Until about the age of 5, children see death as reversible; from 6 to 10 they realize its permanence. Grieving patterns, in turn, change with perceptions. In the last few months, according to her mother, "Julia seems to be realizing the finality of it. Now she cries and talks about how much she misses Daddy."

When older children lose a parent, observes Silverman, they relate to the deceased less in terms of nurturing needs, and more as one mature human being to another. At the same time, says Barry Garfinkle, chief of Child and Adolescent Psychiatry at the University of Minnesota, "adolescence is highly narcissistic, and thus not an empathetic stage of development." So adolescents to about the age of 15 may well rebel against grieving.

From ages 15 to 17, a partial identification with the adult's response emerges, though "one day they may {be} grieving, the next off on a bike ride," says Garfinkle, who is currently researching adolescent reactions to sibling suicide. Finally, from ages 17 to 21, young people tend to be "excessively philosophical and intellectual about the death, and need some help in coming back to their feelings."

Most of the unsettling behavioral and emotional changes seen in grieving children can be explained simply: fear. Helen Fitzgerald, coordinator of The Grief Program at the Mount Vernon Center, says younger children may return temporarily to bed-wetting, thumb-sucking, and baby talk "in order to revisit a safer stage."

Self-blame and fear of dying are two of the most common problems children face, according to Gretchen Lane, a social worker and consultant on child bereavement to the Montgomery Hospice Society. When Nancy Harazduk's husband died early this year, he left two boys, 5 and 8 years old. "They are afraid of losing me now," Harazduk says. "They're frightened they will die of cancer. They worry it was their fault." Children need reassurance that they are safe, that they will not get sick, and that life will go on, though things will change and people will be sad.

Many children "act out" their grief. Defiance of authority, continuous arguments and temper tantrums, says Wolfelt, should be seen as "care-eliciting behaviors," designed to "teach us about feelings they are otherwise uncomfortable or incapable of expressing."

With less concentration, many children's grades decline precipitously, but Silverman says that as distressing as such reactions may be, there is usually little cause for worry. Only where the child is totally closed off, where the surviving parent won't let the child remember the deceased (because it is too painful), or where there is a "sustained" decline in schoolwork, are long-term difficulties a concern.

There is some evidence, however, that parental loss can develop genius. "It's one of the strangest things I've ever seen," observes psychologist Harold Finklestein, who reviewed the literature on child bereavement for The Journal of Consulting and Clinical Psychology in 1988. Selecting four adults with some indicia of greatness (for example, with more than a half page biography in the Encyclopaedia Britannica), two studies found that children who had lost a parent in childhood were significantly overrepresented, in one study appearing three times more frequently than expected. "I think it's credible," says Finklestein. "The narcissistic injury of losing a parent may well spur a greater attempt to prove oneself. Combined with an unusual intellectual endowment, that's quite a package."

To insure happy children, if not geniuses, bereavement experts suggest some basic guidelines where both the parent and child are grieving:

Grieve openly and honestly in front of the child. Many parents are concerned that their grief may scare their son or daughter, or only burden them, but Silverman's work suggests that parents who try to be "strong" in front of the child only confuse them. "They think you don't care." Open grief gives children a model of how to deal with their own feelings, permitting them to cry or feel sad.

Let your child grieve. Listen to the child carefully, and ask questions when you don't understand what the child is feeling.

Be honest about the facts of death or terminal illness. The best time to talk with children about death is before it happens, when a pet dies, or even as leaves fall to the ground. Once death has struck, tell the child as much as he or she can be expected to understand. Notes Ellen Sanford, assistant coordinator of Washington Home's Caring Program, "If children are not given an explanation of what happened, they take what little they are given and construct their own story -- and their fantasies are always worse."

Encourage the child to participate in grieving rituals -- like funerals -- as much as they are willing. "Children often need this visual part to begin the grief process," says the Childhood Grief Institute's McNaught.

Prepare children for what they are going to see and hear. If there is a cremation or funeral, or visiting with a dying relative, describe ahead of time what is likely to happen.

Avoid euphemisms. Young children are very literal. A phrase like "Mommy's gone to sleep" will lead them to expect her to wake up.

Get extra support for both parent and child. Experts agree that parents need to grieve as deeply as they can. Rather than stint on their own grief to meet the child's emotional needs, they advise seeking extra support from the family or community.

Consider a bereaved children's support group. It lets children see that they are normal, that other children are going through the same thing they are, and lets them express emotions -- like anger against the surviving or dead parent -- that may be too uncomfortable to express at home.

Smilansky, the Israeli researcher, now devotes much of her time to studying and assessing bereaved children and developing support groups for them. The best adjusted children, she has found, have "parents who not only seek extra support for themselves, but in addition seek help for their children."

Concludes Silverman: "Children move through grief and go on living, and usually they do it very well. That's what we hope to understand better, and it's really the most important thing for parents to remember."


Ten Washington area bereavement-related organizations are sponsoring "Bereaved Children and Their Families," featuring Phyllis Silverman, co-principal investigator on the Harvard Child Bereavement Study, Oct. 9, at 2 p.m. (professional seminar) and 7:30 p.m. (for parents and concerned public) at the Washington Hebrew Congregation, Macomb Street and Massachusetts Avenue NW. Free. Interpreter for the deaf will be present. Call Montgomery Hospice, 301-951-9009.

Montgomery Hospice Society offers a support group for children aged 5-12. 301-951-9009.

The Hospice of Northern Virginia conducts art therapy and bereavement groups for younger children and adolescents. 703-525-7070.

The Grief Program at Mt. Vernon Center, Springfield, offers "Kids Count Too," a support group for children living with a cancer patient, and another for bereaved children. Helen Fitzgerald, 703-866-2100.

Life With Cancer, of Fairfax Hospital, has weekly support groups for children aged 5-12 and adolescents. 703-698-2841.

The St. Francis Center will conduct a workshop, "Adolescence and Loss: Helping Teenagers Cope," on Nov. 3. 202-363-8500.

The Young and Mid-Life Widowed Persons Grieving Support Groups will sponsor sessions for bereaved children and their families Thursdays, beginning Oct. 25 to Dec. 13. Psychologists Sara Smilansky and Ira Nerken will conduct the sessions. 301-365-1647. The Jewish Social Service Agency periodically runs support groups for bereaved parents and children. Suzanne Adelman, 301-881-3700.

The National Childhood Grief Institute offers materials for leading groups with children, including workbooks and curriculum.

For information and prices, write NCGI, 6200 Colonial Way, Minneapolis, Minn. 55436, or call 612-832-9286.