Grief, bereavement and adjustment disorder in children — OSCE

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]

Candidate tasks

1. Take a grief-focused history from Sam and Noah — establish the trigger, the clock, the pattern of longing/avoidance/identity disruption, functional impact, and Noah's developmental understanding. [1]
2. Classify the presentation as prolonged grief disorder rather than normal grief, adjustment disorder or major depressive disorder, and explain your reasoning to Sam in plain language. [2] [6]
3. Counsel on management — psychoeducation that grief is a process, the evidence-based psychological therapy (CBT for PGD), and Sam's request for an antidepressant. [6]
4. Respond to Noah's disclosure of guilt and passive thoughts of not being here, converting to a safety assessment and plan. [12]

Marking anchors

Distinction (PASS)

• Uses the trigger, the clock and the core features to name prolonged grief disorder, and explicitly distinguishes it from normal grief, adjustment disorder (wrong trigger and clock) and MDD (wavelike with preserved affect vs pervasive anhedonia). [2] [6]
• Names CBT for PGD as the evidence-based therapy and declines the antidepressant for the grief itself while offering it only for diagnosed comorbid depression or anxiety. [6]
• Supports the father as the secure base and frames caregiver support as part of the child's plan. [1]
• Converts to a safety pathway the moment Noah discloses guilt and passive thoughts — assesses ideation, intent, plan and means, makes a same-day safety plan with Sam, and arranges crisis support rather than deferring. [12]

Borderline

• Names prolonged grief disorder but cannot clearly separate it from MDD or adjustment disorder, or recommends CBT but does not address the antidepressant request, or offers therapy but fails to convert the consultation to a safety assessment on disclosure. [2] [12]

Fail

• Diagnoses MDD and starts an antidepressant for the grief, labels Noah's presentation as normal grief to be waited out, endorses the SSRI for grief, or proceeds to "refer for grief counselling and review" despite the suicidal disclosure without a same-day safety plan. [6] [12]

Examiner prompt sequence

1. Opening (the father): "Doctor, can you start something to help him move on?" — Candidate must explain that grief is a process, name PGD, and decline the antidepressant for grief itself. [6]
2. Classification probe: "So is he depressed, then?" — Candidate must distinguish wavelike grief with preserved affect from pervasive anhedonia. [2]
3. Treatment probe: "What actually works?" — Candidate must name CBT for PGD and caregiver support. [6]
4. Disclosure twist: Noah murmurs that he thinks he "should have stopped it" and wonders if it would be easier if he "wasn't here." — Candidate must pause, validate, and convert to a direct suicide assessment and same-day safety plan. [12]