The First Caregiver-Report Tool for Prolonged Grief in Children: TGI-K-CR Validation
- TGI-K-CR is the first validated caregiver-report screening tool for prolonged grief disorder (PGD) in children aged 8–18, covering both DSM-5-TR and ICD-11 criteria
- Strong internal consistency: α = 0.85 (DSM-5-TR items) and α = 0.87 (ICD-11 items) in 196 Dutch bereaved caregivers
- Confirmatory factor analysis supports two distinct but related factors for DSM-5-TR and ICD-11 PGD — the diagnostic systems capture overlapping but different constructs
- Provisional cut-offs established: ≥46 for probable DSM-5-TR PGD, ≥52 for ICD-11 PGD (sum of all 16 items)
Prolonged grief disorder is now recognized in both DSM-5-TR and ICD-11. We have validated screening tools for adults. For children — nothing that a caregiver can fill out to flag a child who needs assessment. Until now.
Why a caregiver-report tool matters
Children under 12 cannot reliably self-report complex grief symptoms. They may not have the language for yearning that disrupts functioning, identity disturbance following a loss, or the sense that life is meaningless without the deceased. But caregivers observe these behaviors daily: school refusal, regression, persistent distress around reminders, withdrawal from activities that connected to the deceased.
The TGI-K-CR (Traumatic Grief Inventory — Kids — Caregiver Report) was developed at the University of Twente and validated with 196 Dutch caregivers whose children had experienced bereavement. 44% of the children had lost a parent — the highest-risk loss type for developing PGD.
The dual-criteria approach
The tool provides separate scoring for DSM-5-TR and ICD-11 PGD — a practical necessity since the two systems define the disorder differently. The CFA confirmed that while the factor structures overlap, they capture somewhat different constructs. The DSM-5-TR cut-off (≥46) is lower than the ICD-11 cut-off (≥52), reflecting the DSM's broader criteria. For international practitioners, having both thresholds in one 16-item tool is efficient.
Known-groups validity
The validation data showed expected patterns: children scored higher on PGD when their caregivers also reported higher grief intensity, and when deaths occurred more recently. These are not surprising findings, but they confirm the tool measures what it claims to measure.
For your practice
If you see bereaved families: the TGI-K-CR fills a screening gap. It takes under 10 minutes, a caregiver completes it, and you get a preliminary signal about whether the child's grief trajectory warrants further assessment. The provisional cut-offs (≥46 DSM-5-TR, ≥52 ICD-11) are just that — provisional — but they provide a starting point for clinical decision-making. Pair with the adult TGI for the caregiver's own grief, since caregiver PGD independently predicts child PGD.
We had diagnostic criteria for prolonged grief in children but no way for caregivers to flag it. That gap is now closed.
Convenience sample of Dutch caregivers recruited through a grief information website — selection bias likely. Some factor loadings were poor. No test-retest reliability. Cut-offs are provisional and need cross-validation in clinical samples.