Non-verbal methods for assessing grief and mental health in children and individuals with additional communication needs: A scoping review

Introduction:
Bereavement affects individuals in diverse ways, and the support they require can vary significantly. For grief to be effectively recognised and addressed in both clinical and research settings, appropriate and validated assessment tools are essential. However, there is a notable gap in child-specific tools, particularly those that use non-verbal approaches to support young children and individuals with Special Educational Needs (SEN), who may have limited verbal communication.

Aims:
This scoping review aims to explore and map existing evidence on grief and mental health assessment tools that incorporate non-verbal methods. The focus is on tools used with children aged 11 and under, and with older children or adults who have additional learning or communication needs, in therapeutic and research contexts.

Methods:
We conducted a scoping review using Arksey and O’Malley’s five-stage framework. Searches were carried out across five databases – CINAHL, Medline, PsycINFO, Cochrane Library and Scopus – from their inception to 7 December 2023. Data from eligible studies were analysed using descriptive statistics and content analysis.

Findings:
From 1498 screened papers, 22 articles were included. Most described mental health tools rather than grief-specific assessments. Five key themes emerged: tool development processes; language and item selection; use of visual imagery; response format design and psychometric properties, including feasibility and utility. These features illustrate how non-verbal methods can support communication and engagement in assessment.

Conclusion:
This review highlights current approaches to assessing grief and mental health in children and individuals with SEN using combinations of verbal and non-verbal methods. It provides a foundation for future development of accessible, structured grief assessment tools tailored to these populations and underscores the urgent need for such resources in practice.