Monday, January 18, 2016

Breaking Bad News in an Age-Appropriate Way

I recently had a parent approach me and ask for advice about how to talk with her 1st grade son (who happens to be on the Autism Spectrum) about his 12-year-old cousin's death. She had originally told him that she died from a bad cold that didn't get better. The truth was, she had killed herself. He didn't buy her story about the cold, and she knew he would likely find out the truth from his other cousins, so she decided to tell him.

For those of you who don't know me, I am a 4th year elementary school counselor and NOT a morning person. This conversation with his mom was happening at 7:20 in the morning, and I was at a loss for words. My best advice for new school counselors is always to find an experienced mentor (or three, in my case). I knew that this was a situation in which I needed to call upon my mentors -- my co-counselor and school-based clinician from my previous school, and a former colleague who is an expert on Autism Spectrum Disorders. I was able to reach them right away (because they are amazing, responsive, and extremely helpful), and they walked me through how to advise this mom. After collecting all of their advice, I carefully composed an email to the mother.

It was suggested that I share that email so other counselors can use the information to help parents in need. Please feel free to adapt this information to help your students. If you have been in this situation before and have other thoughts about how to help parents and children through a situation like this, please feel free to leave comments below. Thank you to my mentors for their help in this situation, and always.

Here are some thoughts to help you guide your conversation:
  • You can base the whole conversation on the questions he asks, or you can decide ahead of time that you will tell him all of this. It is sometimes better to let him guide the conversation and only get the information he is looking for by asking questions. You might want to write down talking points or phrases so you don't lose your train of thought.
  • You also should consider whether you want to have a support person there when you tell him (i.e. myself, his special educator, a family member -- but at most 2 adults total). I would also recommend practicing first and even role playing with someone (I am available to do that with you if you want), so you can practice responding to his questions. It's also important to make sure that his dad (and any other adults you have a little bit of control over) is sending the same messages you are.
  • You could also have him draw a picture to start the conversation and that might give you an idea of how much he knows already. You could ask him to draw a picture about what he's thinking about when he thinks about his cousin.
  • It is important to use the words "killed herself", not "we lost her" or "she passed away". Even if it sounds harsh, anything else can be misunderstood. We also don't use the phrase, "committed suicide" anymore because it references back to when it was a crime. It might be helpful to talk more about death and explain that death means she is not here anymore, she is not breathing or talking, her body is not a living body.
  • He might ask why -- feel free to answer this (i.e. "She felt really sad/mad/upset and she thought that it wouldn't ever get better. She hadn't learned that it always gets better, but you know that -- you know that it always gets better." You can give an example like, "Remember when you thought getting a shot at the doctor was going to be the worst thing ever? And then it was over so quick and you felt better soon. It always gets better!" This would also be a place to talk about how you wished she had talked to you about feeling so sad, because you always can find solutions to problems, and if you don't know a solution, you know who to ask for help. There is always someone to ask for help. You can have him list or draw a picture of all of the people he knows who he can ask for help or talk to. Focus on how there are lots of helpers.
  • He might ask how she killed herself -- two options: 
    • 1) You can make it a rule that he only talks to adults about this, which might prevent him finding out from his cousins. If his cousin's parents are on board, they can make this rule, and then you can give them all the language to use if a kid tries to talk to them about it -- "I am only allowed to talk about this with adults. If you need to talk about it right now, you can find an adult." And if they don't stop, he can go find an adult. If you think this will work and he won't find out about it, you can say that it's not something adults talk to 1st graders about because it will be too upsetting. The HOW is something only adults talk about. 
    • 2) If you think he will definitely hear about it from his cousins, you could use language like - "She choked herself and she stopped breathing." If he asks for more details, you can say you don't know, you weren't there and didn't see it, all you know is that she choked herself and stopped breathing. 
  • He might ask why you lied -- you can say that that was probably a mistake because you know he is so smart. You could say, "I didn't know what to say to you about it, I didn't have the words, and now I figured it out." 
  • You should talk about behaviors and feelings that might come up for him (i.e. anger, sadness, frustration, loneliness, etc.). When he has behaviors that you think might be linked to how he is feeling about this, you can point that out and talk about how your feelings affect your body, even when you don't know that is what you're feeling/thinking about. 
  • It is important to try not to glorify it by saying things like, "She is in a better place. She is happy now," etc. We don't want him to think that killing yourself is a ticket to a better place.
  • At the end of the conversation, make sure to say -- "You are going to have other questions -- come to me and ask them. If I don't have the answer, I'll find it out. You can also talk to (the people he listed above)." You can talk about how this is something private. It is not a secret, but you only talk about private things with adults. You can give the example of how if he was having something going wrong with him in the bathroom, it's not a secret, but he wouldn't walk into the classroom and tell all of his friends about it. It is private. 
I hope this is helpful. I have copied his school team on this email so we can use the same language at school if he asks about it after you have told him. If you could let us know when you tell him, that would be great.

Thanks so much for reaching out, and I am so sorry you have to go through this. Let me know what else we can do to help. I will also look into finding an outside counselor for him, as you requested.