BOOK REVIEWS

Children and Grief: When a Parent Dies. By j. WilliamWorden. New York: Guiljord Publications. Inc., 1996. 225 pp.•$26.95 (hardcover).

Children and Grief deals with the school-age child'sresponse to the death of a parent . It features the results of theHarvard Child Bereavement Study, which is a 2-year prospec­tive examination of bereaved children. Using results from thisstudy, the author adds depth to the mourning process andunderscores numerous factors that influence the course andoutcome of adaptation to loss.

The book begins with a brief description of the ChildBereavement Study itself. Children from 70 bereaved families(125 children) were matched with non bereaved control chil­dren by age. gender, grade in school. religion, and community.Semistructured interviews were conducted with each child aswell as the surviving parent at 4 months, 1 year, and 2 yearsafter the death occurred. In addition, three standardizedassessment instruments were completed by each child , andsix standardized instruments by each surviving parent. Des­criptions of these instruments are included in an appendix tothe book.

After the presentation of methodology, the work isorganized into three parts. Part I comprises more than halfthe length of the book and is titled "Children and TheirFamilies in Mourning." This section is divided into six chap­ters which present results, trends. and some specific children'sresponses demonstrated in the Child Bereavement Study. Theauthor attempts to integrate results from the study withmaterial that he weaves into the text, including concise the­oretical background on grief, tasks of mourning, devel­opmental theory, and numerous references to previousstudies . Descriptions of six major categories of factors thataffect the course and outcome of adaptation to loss of aparent are addressed.

A chapter titled "Children at Risk" identifies factors thatpredict future emotional or behavioral difficulties. Studyresults indicate that, in the short term , the percentage of chil­dren in the high-risk category increases over time (between 1

and 2 years) after the loss. The author terms this a "lateeffect" on the child. A screening tool to identify these high­risk children was developed using data from the study and isincluded in the book. Worden reviews research on long-termconsequences of childhood bereavement and notes that thesefindings are inconclusive. He presents reasons for these incon­clusive results that could be helpful for the design of futurestudies.

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Assistant Editor: Dean X Parmelee, M.D.

Parr II of Children and Grief is made up of two chaptersthat deal with relative losseschildren may suffer.These includethe death of a sibling and loss of a parent through divorce.The author delineates features that differentiate these lossesfrom bereavement by clear headings that are thorough andclinically useful. This section is short. clear. and, despite itsbrevity, potentially very helpful.

The final section of the work, part III, is devoted tocounseling issues. intervention models, and activities. This isalso very brief, but it is useful in its presentation of an over­view for clinicians interested in treating children and familiesafter a parent has died. The author reviews four differentmodels of intervention, includes pros and cons of eachmodel, and provides numerous references to the literaturewhich would be helpful to clinician and researcher alike. Heunderscores the need to tailor treatment to goals as well as tothe level of complication in bereavement. Dr. Worden makesan important distinction between children with serious emo­tional or behavioral difficulties and those coping adequatelywith loss. A list of "red flag" behaviors is included to identifychildren who need professional evaluation .

A special section titled "Activities for Intervention" listsactivities by category such as art, puppet play, memory books,storytelling activities, and games. The writer demonstratessensitivity to confidentiality issues and frequently reiteratesthe need to consider the developmental stage of the childwhile using such modalities.

A touching portion of the book is its two-page epilogue.Children in the study were asked to share advice they wouldgive to other children experiencing the death of a parent. Thewisdom. experience, and means of coping are relayed in theirown words. Finally, an excellent list of suggested readings,organized by topic, is included.

The author states his objectives clearly at the beginning ofeach chapter, and sometimes along the way. He recapitulateswhichever theoretical question he is considering as hepresents various information gleaned in the study. He makesuse of frequent headings and provides "Points to Remember"at the end of each chapter. Even so, the large amount ofinformation dealt with in this relatively short work, as well asthe multifactorial nature of the issues being considered, leadsto occasional loss of the reader's attention. The end-of-chap­ter summaries of specific points to remember are generallyhelpful, but in a few instances the summaries contain pointsthat were not clearly made in the chapter. In these cases, thereader is left with a feeling that something has been missed.

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BO O K REV IEWS

In summary, this book packs a tremendou s am ount ofinformation into a small package. The author's thorough styleleads to coverage of theor y, literature review, study and datapresent at ion as well as practi cal clinical suggestions for treat­ment of bereaved child ren. Although the data presentat ionbecomes uncl ear at times, it seems to reflect the mult idimen­sional na tu re of th e to pic. Material from thi s book co uldprovide a springboa rd for more in-dep th research or study inany of these areas.

T he book would be appropriate for those involved withbereavement research as well as ph ysicians an d counselor swho work with bereaved children. Agencie s could use sug­gested scre en ing p rocedu res and red flag lists to providebetter-qu ality evaluat ion of bereaved families. Wo rde n's boo kpresents a great deal of research data wh ich are not black andwh ite by nature. It is well-grounded in theor y, is clin icallyuseful, and relays the author's compassion for child ren andwillingness to hear them .

Holly Perkins, M.D.G rand Rap ids, MI

Parenting the Strong-Willed Child: The Clinically ProvenFive-Week Program for Parents of Two- to Six-Year-Olds.By Rex Forehand, Ph.D., and Nicholas Long, Ph.D. Chicago:Contemporary Books, 1996, 256 pp., $12.95 (soficover).

Strong-willed tem perament is a well-recogni zed cons tructin childhoo d development. Stro ng-willed child ren are at riskfor multiple behavioral distu rbances and psychiatr ic disorderssuch as oppositional de fiant d isorder and atte ntion-deficit /hyperactivity disorder. T hey exhaust their parents, teachers,and other care providers and may increase their own risk forabu se. Parenting the Strong-Willed Child provides a 5-week,well researched and clinically tested appro ach to th ese young­sters. T he book is geared to parents , but it is relevant to allmental health therapists and ed ucato rs working with youngchildre n.

The book is divided into four parts. Part I, "Understand ingYour Strong-Willed C hild," provides a conceptual base forunderstanding strong-willed child ren . Temperam ent is th efoundation fo r children's behavioral repertoir e, bu t sociallearning establ ishes specific behaviors. Parent s are generallyun aware of how their respo nses to their childre n's behaviorsmay ignore posit ive behaviors and reinforce negat ive ones.Parent ing skills may then mai ntain or resolve children's diffi­cult behavi ors. By developing more effective parenti ng skills,parents may then influence their ch ildren's experience andthereby their socia l learni ng.

Part II , "Addressing Strong-Willed Behavior: A Five-WeekProgram ," describes the five-step program: atte ndi ng, rewards,ignoring, giving directions, and tim e-outs. O ne behavior is

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add ressed at a tim e. Each step is practiced and mastered over1 week before the next step is practi ced. T he parent explainsthe various int erventi ons to the child, what the child shou ldex pe ct, and th e potent ial co nse q uences . These sect io nsinclude transcripts and vignettes of act ua l parent-child situ­

ation s to help the reader understand the steps in clinical andfamil y context .

Part III, "C reating a Positive Cli mate for Behavior C hange,"

nicely balan ces th e pri or emphasis on soc ial learn ing andbehavioral interventions with famil y life. Emphasis is onstrengthening th e relationship between parent and ch ildth rough FU N: friendship, unde rstanding, and nurturing.T his section aids success in the 5-week parenting program,but it also lays the founda tio n for prevent ion of furth er diffi­culties later in the chi ld 's life. Emphasis is on teach ing d fec­tive communication , social skill s, resp on sibilities, valu es,jud gment, perseverance, self-d iscipline, and self-confidence

th rou gh exper ience and example, not th rough lect ur ing. Forexample, hou sehold tasks provide an oppo rt unity to increasechildren's self-wo rth and problem-solving skills. Householdstructures and routines provide effective family fun ctioningand less nagging of the child. Family trad itions and ritu alshelp to define un iqueness of the f.lmily and to give the childa special place and meani ng. T he parents' relat ion ship isemphasized in modeling for the child. Ti me together, sharing,and confl ict resolut ion are discu ssed. One ent ire chapter is

dedicated to improving communication skills. Another helpspare nts of strong-willed children to develop more patience,an extremely imp ort ant step for parent s of strong-willed chil­d ren, who severely test their parents' pat ience and yet needtheir parents' pat ience more than the typ ical child . Lack ofpati ence int erferes with parents' ob ject ivity and ab ility tomake intelligent decisio ns. Parents arc offe red a cogni tiverestructuring approac h to recon ceptualizing their children's

behaviors, and gu idelines for what to do when they do losetheir patience. Parent s are also encouraged to man age st ress inth eir own lives.

Part IV, "So lving Some Com mon Beh avior Problems :Add itional Recommendation s," provides some help ful stepsfor dealing with such typical daily diffic ulti es as tantrums,mealt ime behaviors, car travel, bedtime, lying, and siblingrivalry.

Parenting the Strong-Willed Child describes a un iqu e, solid,em pi rically tested program for helping parents and th eiryou ng children. It provides a concep tua l base, un derstandableexp lanat io ns , and pract ical st ep s. It o ffer s opt imism to

parents who are frustrated by their st rong-willed young chil­dren . Parents not only learn parent ing strategies, but learn to

perceive their ch ildren more posit ively as the y reframe theirbehaviors and as their child ren respond to the interventi on s.Tab les in each chapter nicely extract core concepts and steps

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