We have read Dr Lyons' letter with interest, and considered his/her comments with great care. It is encouraging that the letter also highlights the need for further research in this area, and we are happy to say that we have new research in progress.

We acknowledge that the methodology of the published report has limitations, but that does not mean that it is flawed. Dr Lyons does little more than amplify the limitations spelled out in what was, after all, only a short research report. It is perfectly acceptable to use data from the first study as longitudinal data in the follow-up study. Furthermore, although follow-up of the original control group might have yielded some useful material, it is more probable that it would have been unreliable, because of the likelihood that these individuals would have experienced bereavements themselves in the intervening time between the first and second study.

Dr Lyons suggests that new ‘cases’ at follow up cannot be attributed to the underlying learning disability as confounding medical and life events may have played a part. One of the key points made in both 1997 and 1999 papers is that the effects of bereavement are compounded by the increase in life events experienced by the client group at such a time.

With regard to the size of the second sample, the shortfall is not excessive: as stated in the paper, three of the missing individuals were dead, and three untraceable, possibly also dead. The true followup rate could thus be more accurately described as 41 out of 44, or 93%. Furthermore, two of the remaining three carers refused to help with the follow-up interviews because bereavement was too sensitive an issue for either the relative or the person with learning disability.

Dr Lyons suggests that the results of the study are not ‘meaningful’. The original manuscript, which was cut in length at the request of the Editor, included qualitative material collected from carers at the same time as the quantitative data. This material supports the results of the quantitative data, and includes a wide range of phenomena following bereavement, including withdrawal, tearfulness, weight loss, obsession with death, health problems, increase in fits, faecal incontinence and regressive behaviour. Carers reported the continuing effects of bereavement. For example, one man, who had had a close but difficult relationship with his father, was still working through the bereavement with a psychologist, and taking psychoactive medication, some five years after his father's death. Another man, after a similar period of time, still cried out for his mother when something went wrong; Miss F is said still to break down easily, crying “ My mother's dead!”, illustrating the immediacy that a bereavement can have even after a number of years.

The work we reported adds to the growing body of evidence that bereavement can cause psychological distress and behavioural symptoms, which may well be overlooked or misinterpreted.