Death Understanding and Fear of Death in Young Children

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THE FACTS ABOUT death and dying are among the most emotional and complex .... young children evince little fear of death relative to their older peers, ...
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Death Understanding and Fear of Death in Young Children VIRGINIA SLAUGHTER & MAYA GRIFFITHS University of Queensland, Australia

A B S T R AC T The purpose of this study was to test whether the developmental acquisition of a mature concept of death, that is, understanding death as a biological event, affects young children’s fear of death. Ninety children between the ages of 4 and 8 participated in an interview study in which their understanding of death and their fear of death were both assessed. Levels of general anxiety were also measured via parent report. A regression analysis indicated that more mature death understanding was associated with lower levels of death fear, when age and general anxiety were controlled. These data provide some empirical support for the widely held belief that discussing death and dying in biological terms is the best way to alleviate fear of death in young children. K E Y WO R D S children, death anxiety, death concept, normal fear death and dying are among the most emotional and complex topics of childhood. As such, the acquisition and development of a mature death concept has been a subject of interest for decades. Research documenting how children of different ages understand death and dying has spanned the psychoanalytic, Piagetian and, recently, the intuitive theory research traditions (see Carey, 1985; Kenyon, 2001;

T H E FA C T S A B O U T

V I R G I N I A S L A U G H T E R is Associate Professor of developmental psychology and Codirector of the Early Cognitive Development Unit in the School of Psychology, University of Queensland, Australia. Her research focuses on social and cognitive development in infants and young children. C O N TA C T : Virginia Slaughter, School of Psychology, University of Queensland, Brisbane, Queensland 4072, Australia. [E-mail: [email protected]]

is a Clinical Psychologist currently working in the field of child and youth mental health. She has a Masters degree in Clinical Psychology from the University of Queensland. Maya is currently undertaking a PhD examining quality of life in children with cancer, using the qualitative methodology of Interpretative Phenomenological Analysis.

M AYA G R I F F I T H S

Clinical Child Psychology and Psychiatry Copyright © 2007 SAGE Publications Vol 12(4): 525–535. DOI: 10.1177/1359104507080980 www.sagepublications.com 525

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Slaughter, 2005). The psychoanalytic literature described children’s death concepts in order to explore their emotional responses to death, whereas the Piagetian researchers measured changes in children’s death understanding in relation to their movement through general stages of cognitive development. Most recently the intuitive theory approach has explored children’s knowledge about death in terms of their developing intuitive, or folk knowledge about the domain of biology. Each of these approaches to understanding development of the death concept has documented stages and changes in children’s understanding, and the picture is quite consistent. Children first acknowledge death in the preschool period. At this age, young children have yet to acquire specific knowledge about the biological underpinnings of life and death, and so make sense of what they know about death and dying in terms of their understanding of human behaviour. Thus preschool-aged children typically consider that death is something that happens only to some (the sick, the aged) and that it can be avoided with healthy living and avoidance of specific situations that they know can be fatal (e.g. car crashes, getting cancer). Young children tend to conceptualize death as an altered state of living, either in heaven, or under ground in the tomb, and so often assert that the dead still need oxygen or water, and that the dead can hear, dream and so on. At this age children do not understand the causes of death, other than to link dying with internal or external agents such as poison, guns or fatal illnesses. Early studies (Anthony, 1939; Nagy, 1948; Piaget, 1929; Von Hug-Helmuth, 1964) documented this developmentally immature death concept through relatively open-ended interview techniques. Later work captured the complexity of developing death understanding through analysis of specific subcomponents that contribute to a mature concept of death. The number of subcomponents of the death concept has varied across studies (Lansdown & Benjamin, 1985; Speece & Brent, 1996) but the majority of researchers recognize the importance of the following five major aspects of death understanding, which are mastered by children in a relatively fixed sequential order between the ages of 5 and 10: 1. Inevitability – the acknowledgement that living things must die eventually; 2. Universality or applicability – the understanding that death must happen to all living things; 3. Irreversibility or finality of death – the recognition that the dead cannot come back to life; 4. Cessation or nonfunctionality – the understanding that death is characterized by bodily processes ceasing to function; 5. Causation – the understanding that death is ultimately caused by a breakdown of bodily function. Not all studies have included all of these subcomponents (and others have included additional ones, such as unpredictability or personal mortality), but the majority of developmental researchers in this area operationally define the mature death concept as mastery of some or all of these subcomponents. By age 10, most children conceptualize death as a fundamentally biological event that inevitably happens to all living things and is ultimately caused by an irreversible breakdown in the functioning of the body. Studies that have investigated the progression of subcomponent acquisition have generally found that understanding the irreversibility of death occurs first, by age 5 or 6. Thus children’s earliest accurate understanding of death involves the recognition that the dead cannot come back to life. Next, the subcomponents of applicability, inevitability and cessation are acquired. In the early school years, children come to understand that death must happen to all living things, and that it is characterized by bodily 526

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processes ceasing to function. The final subcomponent to be acquired is causality. Several researchers have argued that understanding specific causal mechanisms that can result in the breakdown of bodily functioning leading to death is the most inclusive and complex subcomponent, and so is the last to be mastered. By age 7 to 10, all subcomponents are acquired. At this stage, death is conceptualized as a fundamentally biological event that inevitably happens to all living things and is ultimately caused by an irreversible breakdown in the functioning of the body. Further, this mature understanding of death has been shown to be developmentally linked to other biological concepts, namely life, such that it is contextualized as part of the natural life cycle (Safier, 1964; Slaughter, Jaakkola, & Carey, 1999). Death is recognized as a concept that carries substantial emotional impact across the lifespan. In early childhood, the most common normal fears are separation from parents, the dark, animals and imaginary creatures such as monsters (Gullone, 2000; Warren & Sroufe, 2004). Although not the primary source of fear and anxiety at this age, fear of death has been documented in children as young as age 5 (Muris, Merckelbach, Gadet, & Moulaert, 2000). Early studies assessed fear of death in young children via physiological measures and reaction times, as well as open-ended interviews. The majority of recent studies of fear in childhood have used questionnaire rating scales, most commonly the revised Fear Survey Schedule for Children (FSSC-R; Ollendick, 1983; see also Gullone & King, 1992) in which items that describe specific fearful stimuli or situations are presented, and children are asked to rate the extent to which each item provokes anxiety or fear. Due to the attention and comprehension requirements of this methodology, the FSSC-R is only considered appropriate for school-age children, but a recent version of the FSSC-R in a fully pictorial format rendered it useful for children as young as age 4 (the Koala Fear Questionnaire (KFQ); Muris et al., 2003). The fear survey schedule studies have shown that children’s fears cluster into five factors, one of which is death and danger. This factor emerged in the responses of children as young as age 4 to 6 on the KFQ, and by age 7 to 10, items loading on the death and danger factor are the most commonly endorsed fear items and they remain so through adolescence (see Gullone, 2000 for a comprehensive review). A number of authors have speculated about the developmental relation between fear of death and children’s developing death understanding. One suggestion is that very young children evince little fear of death relative to their older peers, because they do not yet understand what it means or all that it implies (Piaget, 1929). An alternative suggestion is that young children’s tendency to think about death in terms of behaviour rather than biology may exacerbate fear of death, because their immature conceptualization of death leads them to focus on unresolvable questions like, ‘why do some people I love decide to go live under ground instead? Will he or she come back soon? Isn’t it cold down there?’ Despite long-standing interest in the acquisition and development of the death concept, to date there has been no empirical investigation of how the transition to a mature understanding of death affects children’s fear of death. There have been studies that investigated whether children’s fear or anxiety about death affected acquisition of the death concept. Cotton and Range (1990) found that fear of death, as assessed with the FSSC-R, was negatively correlated with understanding the cessation subcomponent of death in a sample of children between the ages of 9 and 12 years. Orbach, Gross, Glaubman, and Berman (1986) found that 6- to 11-year-old children who scored higher than their peers on a general anxiety scale, were less likely to endorse the applicability/universality of death. In both of these studies, the negative correlation between subcomponents of death understanding and fear or anxiety was interpreted as reflecting anxious children’s tendency to defend against the notion of 527

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death, rather than as failure to acquire those subcomponents of the death concept. This interpretation is sensible given that in the majority of cognitive developmental studies, children have mastered the death subcomponents of cessation and applicability by age 7 or so. These data therefore suggest that acquisition of at least two of the subcomponents of death, applicability and cessation, may be associated with fear of death. Arguably, the development of a mature concept of death could affect children’s fear of death in either a positive or negative way. The negative prediction is that when children reach the relatively mature biological understanding of death as the inevitable and irreversible cessation of bodily function that is applicable to all living things, it might provoke fear because, among other things, they now understand that death will happen to everyone they love, and ultimately to themselves. On the positive side, the acquisition of a mature concept of death could reduce anxiety because children now understand it as a natural part of the life cycle, and no longer struggle with unanswerable questions arising from their earlier conceptualization of death as a behaviour. Documenting which of these possible developmental scenarios is more accurate has obvious and important implications for clinical and educational practice. The primary purpose of this study was therefore to investigate whether there are changes in children’s self-reported fear of death, that go along with the acquisition of a mature death concept. To achieve this, we assessed concurrent relations between death concepts and fear of death in a sample of children between the ages of 4 and 8, in whom the understanding of death could be expected to vary widely. We also assessed children’s general anxiety via parent report, in order to investigate fear of death independently of general fearfulness, which varies substantially across individuals in the preschool and early school age periods (Warren & Sroufe, 2004).

Method Participants Participants were 90 preschool and primary school children, between the ages of 4 years 4 months and 8 years 3 months (M age = 6 years, 5 months; SD = 11.7 months). The final sample was made up of 46 girls and 44 boys; approximately 90% were Caucasian. The sample was obtained from two preschools and four primary schools located in Brisbane, Australia. A letter of information detailing the study procedures plus a consent form were sent to parents. The subset of children whose parents returned the consent form were asked, prior to testing, if they wished to participate. Only those children who wanted to participate (which in fact was 100% of those asked) were included in the study. All children in the sample were in mainstream classes and none had a diagnosed childhood disorder, as reported by their parents.

Materials Two instruments were administered to the children: A standard death interview for children that assessed knowledge of five subcomponents of the death concept, and a death anxiety scale for children. Also used was a parent report questionnaire that asked whether the child had any diagnosed disorders and also assessed children’s general levels of anxiety.

Death interview for children We administered a death interview that has been widely used in previous research with this age group. The interview, included in full in Table 1, assessed children’s understanding of death as a biological event. Specific questions addressed the following subcomponents of the death concept: (a) Inevitability, assessed 528

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Table 1. Questions and scoring criteria for death interview Subcomponent

Interview question

Scoring criteria

Inevitability

1. ‘Tell me some things that die’ (if people are not named ask, ‘Do people die?’) 2. ‘Do all [entities mentioned in answer to question 1] die’?

0 points – People were not mentioned as dying, and when given question 2, people were held not to die 1 point – People were not mentioned as dying, and when given question 2, people were held not to die. Or, people were mentioned as dying but when given the forced choice, people were held not to die 2 points – People were mentioned as dying and all people were held to die

Applicability

3. ‘Tell me some things that don’t die.’

0 points – Only living things were mentioned (e.g. ‘kids, dogs, fish’) 1 point – A mixture of living and nonliving things were mentioned (e.g., ‘books, bricks, trees, old people’) 2 points – Only nonliving things were mentioned (e.g. ‘houses, fences, bricks’)

Irreversibility

4. ‘Can a dead person ever become a living person?’ 5. ‘If a person dies and they haven’t been buried in their grave for very long can they become a live person again?’

0 points – Incorrect on both questions 4 and 5 (answers yes to both questions) 1 point – One of the questions 4 or 5 correctly answered (answers ‘no’ to one question) 2 points – Both questions 4 and 5 answered correctly (answers ‘no’ to both questions)

Cessation

6. ‘When a person is dead . . . (a) Do they need food? (b) Do they need to go to the toilet? (c) Do they need air? (d) Can they move around? (e) Do they have dreams? (f) Do they need water?’

0 point – Two or fewer of items (a)–(f) correctly answered 1 point – More than 2, but fewer than 6 of items (a)–(f) correctly answered 2 points – All items (a)–(f) correctly answered

Causation

7. Can you tell me something that might happen that would make someone die? When _______ happens, why does that person really die?

0 points – External cause of death given (e.g. ‘knife because they are bad’) 1 point – Reference to the body was given but did not refer to a biological cause (e.g. ‘knife, because it cuts into your body’) 2 points – Fully explicit biological causal answer (e.g. ‘knife because it cuts your body and all your blood comes out so you die’).

with items 1 and 2; (b) applicability, assessed with item 3; (c) irreversibility, assessed with items 4 and 5; (d) cessation, assessed with item 6; and (d) causation, assessed with item 7. These interview questions and scoring criteria have been widely used in the developmental psychology literature to assess the development of death concepts in children between the ages of 4 and 10 (Koocher, 1973; Lazar & Torney-Purta, 1991; Orbach et al., 1986; Speece & Brent, 1984). Test–retest reliability for the interview was 529

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r = .61 in a sample of 30 preschoolers tested over a 2-week period as part of a larger training study (Slaughter & Lyons, 2002). Following standard procedure in the literature, a score for each of the five death subcomponents was derived from patterns of answers to the various questions on the death interview (see scoring details in Table 1). Children were given scores of 0, 1 or 2 for each of the subcomponents of the death concept. An overall death concept score was obtained by summing children’s scores on the five subcomponents, yielding a total score out of 10. Subcomponent scores as well as the summed death concept scores were used in the analyses. Initial scoring was done by the first author, then a complete blind rescoring was done by the second author. Cohen’s Kappas for each subcomponent were calculated as follows: Inevitability = .98; applicability = .95; irreversibility = .95; cessation = .95; causation = .88. To ensure consistency, in cases of disagreement the first (senior) author’s score was used in the analyses.

Death Anxiety Scale for Children

The Death Anxiety Scale for Children (DASC) developed by Schell and Seefeldt (1991) was expanded for this study. The original scale assessed children’s self-reported fear responses to three death-related words and 10 neutral words. We expanded the scale to include six death-related words (two from the original scale, plus four new words), and 12 neutral words, eight of which were retained from the original scale and four of which were life-related words, included to provide a conceptual counterpoint to the death-related words. The new scale included the following 18 items: Dead, boy, eyes, live, dying, like, funeral, years, living, death, breathing, smiled, died, life, awake, use, coffin, alive. Children were asked to judge on a Likert scale whether each word made them feel ‘not scared at all’ (scored as 0) or ‘a little scared’ (scored as 1) or ‘very scared’ (scored as 2). Death fear scores were generated by averaging scores on the six individual items related to death. A reliability analysis on the six death-related items resulted in a Cronbach’s alpha of .79, indicating good internal consistency for this measure of fear of death. This is also nearly identical to Schell and Seefeldt’s (1991) findings for internal reliability of the original DASC. Children’s responses to the neutral items were also consistent, with a Cronbach’s alpha of .71.

Parent Report Children’s Anxiety Scale To assess children’s general levels of anxiety, parents of all participating children were requested to complete the Spence Children’s Anxiety Scale (SCAS; Spence, 1998). This is a 38-item parent-report scale that assesses children’s anxiety symptoms in a variety of everyday contexts (e.g. is scared of heights, worries that he/she will do something embarrassing in front of other people). A reliability study of the SCAS demonstrated excellent internal reliability (coefficient α = .90) and a test–retest reliability of r = .60 over a 6-month period; for details see Spence (1998). For the preschool-aged participants, the slightly shorter, 28-item version for younger children (the Preschool Anxiety Scale; Spence, 1999) was given. Parents reported whether specific behaviours or feelings were characteristic of the child, on a Likert scale from 0 (‘not true at all’) to 4 (‘very often true’). Reliability for both versions of the measure was high in the current sample: Cronbach’s alphas for the SCAS and the Preschool Anxiety Scale were .86 and .81, respectively. Because two different versions of the scale were used, scores on the two questionnaires were standardized and the resulting z-scores were used in all analyses.

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Procedure Children were interviewed individually at their schools in a private area by a single female experimenter. All children were told at the start of the study that they didn’t have to answer any question they didn’t want to, that there were no right or wrong answers and that they were free to go back to their classrooms at any time. No child indicated any signs of distress when being interviewed. Presentation of the instruments was given in a fixed order with the death interview administered first and death anxiety scale for children administered second. A copy of the SCAS along with an instruction letter and a stamped return envelope was given to each child to take home to his or her parents, who then filled out the questionnaire and mailed it back to us. All questionnaires that were sent home were returned with valid data.

Results Preliminary analyses indicated that there were no significant effects of gender on any of the measured variables, so gender was not included in the analyses. A repeated-measures analysis of variance, with death subcomponent scores as the dependent variable, was computed to evaluate whether there were differences in children’s scores across the five subcomponents of the death concept, as has been documented in previous studies with similar samples of young children. There was a significant effect of subcomponent, F(4,356) = 14.97, p < .001, indicating differences in children’s 0–2 scores across the various subcomponents of death. Follow-up paired t-tests indicated that the subcomponents of irreversibility and cessation were significantly easier for children to grasp than the subcomponents of applicability and causation, all ts > 2.03, ps < .05. This pattern generally replicates previously published research (Kenyon, 2001; Koocher, 1973; Lazar & Torney-Purta, 1991; Orbach et al., 1986; Slaughter & Lyons, 2002). Mean scores for each subcomponent are provided in Table 2. We evaluated performance of the death anxiety scale by comparing mean scores on the six death-related words versus the 12 neutral words. The mean score across all deathrelated words was .99 (SD = .56) while across the neutral words the mean score was .13 (SD = .23). A paired-samples t-test indicated that the death-related words were rated as significantly more scary than the neutral words, t(89) = 14.82, p < .001. Next, we computed bivariate correlations between age (in months), general anxiety, death fear (using the sum of ratings for the death-related words) and death understanding (using the total death score that ranged from 0 to 10). The results of this analysis are presented in Table 3. A number of these intercorrelations were significant. Age was positively related to death understanding, meaning that, as expected, older children evinced a more mature concept of death. Death fear and death understanding were negatively related, meaning that children with a more mature death concept rated the Table 2. Mean scores for children’s understanding of the death concept (N = 90) Subcomponent

Mean Score (SD)

Inevitability Applicability Irreversibility Cessation Causation Summed Death Concept Score

1.12 (.67) .73 (.90) 1.44 (.75) 1.37 (.61) .99 (.81) 5.66 (2.06) 531

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Table 3. Pearson correlations between age, general anxiety, death understanding, and death fear (N = 90) Age Age General anxiety Death understanding Death fear



General anxiety

Death understanding

Death fear

–.159 –

.398* –.447* –

–.192 .199 –.357* –

* = p < .01, two-tailed.

death-related words as less scary compared to those with less mature death understanding. General anxiety was negatively correlated with death understanding, indicating the children who were less generally anxious demonstrated a more mature understanding of death. To test the hypothesis that death fear would be specifically related to the acquisition of a mature death concept, a step-wise multiple regression was computed with death fear (using the sum of ratings for the death-related words) as the dependent variable. Age (in months) and general anxiety were entered at Step 1. The resulting equation was not significant: F(2, 87) = 3.06, p = .052; Mult. R = .26, R2 = .07, Adj. R2 = .04, indicating that together, these variables just failed to predict levels of death fear in the sample. At Step 2, death understanding (using the total death score that ranged from 0 to 10) was added to the model, resulting in a significant increase in prediction of death fear: F-change = 6.60, p = .012, R2 change = .07, Adj. R2 = .10. Examination of individual Beta-weights in the final model revealed that death understanding was the only significant independent predictor of death fear: the Beta for age was –.06 (p = .58), the Beta for general anxiety was .05 (p = .66) and the Beta for death understanding was –.31 (p = .012). Thus with age and general anxiety controlled, death understanding significantly predicted death fear such that a more mature death concept was associated with relatively low fear of death.

Discussion This study investigated children’s fear of death in relation to their developing understanding of death and their general anxiety levels. The main effects we observed were generally consistent with previously published research, except for the fact that we found no significant effect of gender on any of the measures, whereas in the literature on fear and anxiety, girls generally score more highly on such measures than do boys (Gullone, 2000). We found that death understanding was positively correlated with age, and the pattern of acquisition of specific subcomponents of the death concept was as expected, based on prior research. These results confirmed that children in the current sample were beginning to acquire a biological understanding of death, and that their death concepts became more mature with age. We also found that children in the sample were more fearful of the death-related words compared to the neutral words presented on the modified DASC, replicating previous findings of death fear in preschool and school-aged children (Gullone, 2000; Muris et al., 2000). In the current sample, fear of death was not significantly related to age. This is in line with previous studies of children’s fear, which have shown that fear of death and danger typically emerges in the preschool period, and remains among the most commonly 532

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endorsed fears from age 7 onward. It is interesting to note however, that Muris et al. (2003) reported a significant increase in fear endorsements of the single specific item, ‘death’ on the Koala Fear Questionnaire between the preschool and early school age period: Only 26% of 4- to 6-year-olds endorsed this item as engendering ‘a lot of fear’, but the percentage nearly doubled by age 7 and then remained just over 50% in adolescents. This would suggest that preschoolers do not fear death as much as their older peers, in contrast to what we found. It may be that in the context of the fear survey schedule methodology, the item ‘death’ is relatively abstract and therefore benign compared to more explicit items relating to physical injury, public embarrassment and the like. It is also noted that young children endorse more specific fears than older children (Ollendick, King, & Frary, 1989) which could explain why fear responses to the relatively abstract item ‘death’ increased with age on the KFQ. In the current sample, fear of death was relatively stable across age groups, and the correlational analysis revealed that fear of death was negatively related to death understanding. General anxiety, as reported by the children’s parents, was also significantly negatively correlated with death understanding. This finding replicates earlier reports of a negative relation between anxiety and the death concept and indicates that the children who were rated as relatively anxious by their parents, were less likely to demonstrate understanding of the biological realities of death. This could be because more anxious children are avoidant of the topic of death, and so are later in acquiring knowledge about it, or alternatively, as previous authors have suggested, more anxious children may actively defend against the notion of death and so cling to their earlier, immature conceptualizations, even while recognizing, at least implicitly, the biological realities of death and dying. The central and novel outcome of the current study was that children’s levels of death understanding negatively predicted their fear of death, even after age and general anxiety were controlled. Increased death understanding represents a movement from the earliest conceptualization of death as a potentially reversible state of living in heaven or underground, to a mature recognition of death as a fundamentally biological event, part of the life cycle of all living things. Some children take longer than others to come to this understanding, and some may even defend against acquiring or acknowledging information about death leading to this mature understanding. Our results show that once children begin to conceptualize death in biological terms, in the preschool and early school age period, there is also a decrease in their fear of death. The portion of variance in children’s death fear that was uniquely predicted by children’s death understanding was small, approximately 7% (captured by the R2 change from Step 2 of the multiple regression). This means that there are additional variables, such as cognitive developmental level, cultural background, or personal experience of death, that must also influence children’s fear of death and these may moderate and/or mediate the observed relation between children’s death concepts and their fear of death (cf. Cotton & Range, 1990; Orbach et al., 1986). The overall death concept scores we measured were well below ceiling, therefore most of the children in the sample had not yet developed a fully mature understanding of death (which would be a score of 10 on our scale). It is not yet clear whether reduction of fear of death would be even more pronounced once children mastered all five subcomponents of the death concept, which usually occurs around age 10. Even when a mature understanding of death is achieved, some fear of death will remain, as indicated by the fear survey schedule research (Gullone, 2000). Indeed, some research indicates that fear of death increases in early adolescence (Warren & Sroufe, 2004) well after a mature, biological understanding of death is in place. This suggests that additional factors 533

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– cognitive, social and/or psychodynamic – influence older children’s fear of death. What our data indicate is that in the early stages of learning about death and dying, children’s initial acquisition of a biological understanding of death is accompanied by a small but significant reduction in their fear of death. As always with this sort of analysis, it is impossible to confirm the direction of causation. We suggest that learning the biological facts about death causes children to feel less afraid of death, by eliminating confusion and unanswerable questions that arise from holding an immature concept of death. It is equally plausible, however, that as children’s fear of death decreases, they become better able to assimilate new information about death, and therefore demonstrate more mature death understanding. Longitudinal and/or training studies, ideally including more comprehensive child self-report measures of fear (such as the KFQ) are necessary to decide between these two options. Based on our interpretation of the current findings, we predict that mastering the biological facts of death and dying would come first, and would cause a subsequent reduction in young children’s fear of death. It is an unfortunately reality that some young children must face the facts of death and dying at a relatively young age. Researchers and clinicians have advised adults to discuss death in truthful, concrete and unambiguous terms with children (e.g. Lansdown & Goldman, 1988; O’Halloran & Altmeier, 1996; Shapiro, 1994; Webb, 1993). This investigation provides some empirical support and further precision to that directive. In young children, understanding death as a biological event is associated with reduction of fear of death. Thus talking about death and dying in biological terms with young children, may help to reduce their fear.

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