Paeds Cases · mental-behavioural-and-psychosomatic
Grief, bereavement and adjustment disorder in children — OSCE
OSCE communication-and-counselling station assessing a nine-year-old fourteen months after his mother's sudden death, with persistent longing, avoidance of reminders, identity disruption and functional impairment — testing the prolonged-grief-versus-adjustment distinction, the no-first-line-medication counselling, evidence-based CBT for PGD, and a suicidality conversion when a disclosure is made.
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Prompt
Noah is a nine-year-old boy brought by his father, Sam, fourteen months after his
mother died suddenly at home. Sam reports that Noah still talks about little else,
refuses to enter the room where she died, says "I don't know who I am anymore,"
and has stopped seeing his friends and dropped behind at school. Sam is exhausted,
his own grief still raw, and asks whether the GP can "start something to help him
move on," because a relative suggested an antidepressant. During the assessment
Noah becomes tearful and tells you quietly that sometimes he thinks he "should
have stopped it," and that he wonders whether it would be easier if he "wasn't
here."
Candidate information (2 minutes reading, 12 minutes station)
You are the general paediatric registrar in an outpatient clinic. Noah, aged nine, is brought by his father Sam fourteen months after his mother's sudden death. Read the presentation, then conduct the assessment and counselling. The examiner will role-play Sam. [1] [6]
References5ShowHide
- [1]Melhem NM, Moritz G, Walker M, Shear MK, Brent D Phenomenology and correlates of complicated grief in children and adolescents. J Am Acad Child Adolesc Psychiatry, 2007.PMID 17420684
- [2]Geronazzo-Alman L, Fan B, Duarte CS, Layne CM, Wicks J, Guffanti G, Musa GJ, Hoven CW The Distinctiveness of Grief, Depression, and Posttraumatic Stress: Lessons From Children After 9/11. J Am Acad Child Adolesc Psychiatry, 2019.PMID 30877043
- [6]Boelen PA, Lenferink LIM, Spuij M CBT for Prolonged Grief in Children and Adolescents: A Randomized Clinical Trial. Am J Psychiatry, 2021.PMID 33472391
- [7]Cohen JA, Mannarino AP Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Separation. Child Abuse Negl, 2019.PMID 30999167
- [12]Pelkonen M, Marttunen M, Henriksson M, Lönnqvist J Suicidality in adjustment disorder--clinical characteristics of adolescent outpatients. Eur Child Adolesc Psychiatry, 2005.PMID 15959663