Attention Deficit Disorder – Unresolved Grief Issues?

I became interested in Attention Deficit Disorder or ADD, when my son began to get into trouble after starting secondary school. During the first parent teacher meeting, it was suggested that maybe he was suffering from ADD due to particular behaviors he was exhibiting in class, such as day dreaming and back answering teachers. I spoke with other mothers whose children were diagnosed with ADD. Many were raising these children on their own, due to separation or death of their spouse. Others were in second relationships or had been going through a very difficult patch with their spouse during the pregnancy of that child.  I wondered whether there could be a connection between ADD and the environment into which the child was born and raised, and whether the child’s behavior was a way of acting out his feelings towards that unstable environment.

Somewhere between six and twenty million men, women, and children in the USA suffer from ADD and it is thought that more than 10% of the Western world’s children are suspected of having this disorder as well (Hartman, 1999:1). ADD is described as “A person’s difficulty focusing on a single thing for any significant period of time” (Hartman, 1999: xiii).

Critics of an ADD diagnosis have suggested that the disease was invented in 1980 by the APA to boost the position of its failing profession.  Tim O’Shea, author of  “ADD: A Designer Disease” believed he was not alone in his opinion that “ADD does not exist. These children are not disordered.” (Armstrong,1996:65). He believed that the psychiatric profession needed to invent a ‘new’ disease in order to boost their lagging profession. During the late 1970’s many people were going to psychologists, social workers, therapists and priests for the ‘talking cure’ about their issues. In 1980, the APA decided to “re-medicalise”, and give up on the ‘talking-cure’, which was pushing their profession into the basement, and re-assert themselves as professionals with the right to prescribe drugs. Enter ADD. This was finally named and described in the APA.’s Bible, the Diagnostic and Statistical Manual (D.S.M 1987). The D.S.M manual is the only way for a child with ADD to be diagnosed.

There are no medical tests to confirm ADD. There are nine symptoms and, if a child has any six of them in the opinion of the doctor or teacher, that child may be diagnosed as having this condition. These are (DSM 1987):

• The child often fidgets with hands or feet or squirms in seat
• Leaves seat in classroom or in other situations, in which remaining seated is expected
• Runs about or climbs excessively in inappropriate situations
• Has difficulty playing or engaging in leisure activities quietly
• Is often ‘on the go’ or often acts if driven ‘by a motor’
• Talks excessively
• Often blurts out answers before questions have been completed,
• Has difficulty awaiting turn
• Often interrupts or intrudes on others speaking

Once the child is labeled with ADD, the drug Ritalin is usually prescribed to control the child’s behaviour.

Grief and a connection to Attention Deficit Disorder?

“When a love tie is severed, a reaction, emotional and behavioral, is set in train, which we call grief.”  (Murray Parkes, 1972: 4)

Many people, when they hear the word grief, tend to associate it with the death of a loved one. However, there are many other losses, which cause considerable grief, including major changes in family relationships resulting from separation or divorce.  Classorck and Rowling note that: “A loss reaction occurs when anything that is valued or anyone we are attached to is removed from our lives.” (1992:7). Research on the effects of grief on children and adolescents is drawn from a course called Seasons for Growth, (Australia, 1996. Companion Manual) which supports young people who have experienced loss through death, separation or divorce. In the Ireland 2002 Census, there were close to 153,900 lone parent families i.e. 11.4% of the Irish population living in a one-parent family.(Combat Poverty, 2002)

What are the effects on these children raised by one parent?  How do they deal with their grief and how can we help them in the future?  Psychologist J. William Worden conceptualizes grief work into tasks such as:

• To accept the reality of the loss
• To experience the pain of grief
• To adjust to an environment in which the significant person is no longer present
• To reinvest emotional energy  (1982: 11-16)

Many children begin grieving before they are born. No matter what is going on in the mother’s life, e.g. illness, an unstable relationship or deciding to give up her baby for adoption, will have an impact on how a baby feels about himself or herself.  Frank Lake is a pioneer, in England and other countries, on research studies on traumas in the womb, especially in the first trimester when mother finds out she is pregnant. Lake believes these traumas have a profound effect upon the foetus’s later patterns on life, their life scripts and schemas. He also believes these traumas cause negativity and disharmony in an individual, which then lead to behavioral and emotional problems in later life.  Lake’s theory is the foetus is invaded by how the mother feels about herself and the pregnancy. This is transferred through the placenta, into the umbilical and foetal circulation. (Mott (1969:196).

“Given the obvious communication problems, an unborn or newly born child cannot tell us what maternal feelings he sensed in utero or how he reacted to them.  But like the rest of us he is subject to the psychosomatic effect.  When he is happy (in the womb) he blossoms physically, when he is distraught he becomes sickly and emotionally unstable”

(Verny, 2002:36)

Children who are hospitalized or separated from their mother at a very young age can display symptoms of grief. Murray Parkes (1972:46) describes the behavior of healthy children aged between fifteen and thirty months on admission to hospital or to some residential institution.

“In this initial phase, which may last from a few hours to seven or eight days, the young child has a strong conscious need of his mother and the expectation, based on previous experience, that she will respond to his cries.  He is acutely anxious that he has lost her, is confused and frightened by unfamiliar surroundings and seeks to recapture her by the full exercise of his limited resources.  He has no comprehension of his situation and is distraught with fright and urgent desire for satisfactions only his mother can give. He will often cry loudly, shake his cot, throw himself about, and look eagerly towards any sight or sound, which might prove, to his missing mother. What are described above are not just the effects of the child losing his mother. It is also the effect of the child losing a part of himself!  (Murray Parkes, 1972: 47)

Other grief issues that can affect children are family breakdown, death/separation of a parent, parental unemployment, physical, emotional or sexual abuse or the death of a pet.

Expected and Expressed Responses children following loss

Certain reactions from children when dealing with severe loss, i.e., fear, anger, sadness, and guilt are related to their:

• Ability to understand the situation.
• Anxiety about physical and emotional well-being of others,
• A need to protect those who are living or who didn’t leave,
• Feelings of being alone, different, isolated,
• Fear about what will happen them and who will take care of them in the future

Children express their grief through behavior, emotions, physical reactions and thoughts. Typically up to age 3, these are crying, searching, a change in sleep and eating habits. In 3-5 year olds, grief is expressed through tantrums, fighting, crying, clinging and regression to earlier behaviors i.e., bedwetting, thumb sucking and nightmares. At ages 6-9, anger, denial, irritability, self-blame, mood swings, and problems at school such as not wanting to go, difficulties learning and lack of concentration are usual. At 9-12 years old, grief manifests as crying, anger, apathy, withdrawing from peers, difficulty sleeping or sleeping a lot, not showing emotion, concerns about physical health and problems at school. By adolescence, emotions intensify. Anger, shock, offensiveness, worry, risk-taking, acting-out behaviors, becoming distant to those around them and having a fear of death and physical complaints, such as stomach problems or headaches, are frequent.

Mulholland et al (1991), Brisnaire et al (1990) and Hoyt and associates (1990) found that children whose parents have divorced don’t do as well in school compared to children in intact families.  These differences were not credited to variations in social class or intellectual ability. Worden & Silverman’s Childhood Bereavement Study (1996) found that 20% of children, who were evaluated in early months following the loss of a parent, experienced some type of difficulty in concentration and were more inclined to experience learning difficulties and problems with concentration than children with a more stable home life. These results sustain the correlation acknowledged in the earlier work of Mulholland, Norman, Philpott & Sarlin (1991).

The majority of schools place huge emphasis on competitive learning and education.  Psychologists believe that continual experiences of failure breed a hopeless, helpless view of life.  Many children then find school a living hell, losing their dignity and hope.  In some cases children can develop anger for those in a position of authority. This may cause further hurt in later life because of an inability to take orders in the workplace, from managers who might remind them of a teacher in school. Schools should be the ideal place for the psychosocial education of children.  Psychosocial competence refers to a person’s ability to deal effectively with the demands and challenges of everyday life. (W.H.O., 1994).

Post Traumatic Stress Disorder (PTSD)

I feel a number of children/adolescents who have been misdiagnosed with ADD are in fact suffering from unresolved grief issues, following trauma in their childhood i.e., death/divorce in the family, abuse in the home, adoption, illness or a traumatic event. Their grief may never have been recognized. Sometimes when a child appears to be coping well, it could be because the child is in shock over what he has witnessed, such as watching his mother being beaten, or being sexually abused by a family member. However, loss rarely comes on its own. As time progresses, other losses occur, exaggerating the already unresolved primal trauma. I feel when this happens and the original loss isn’t dealt with or acknowledged, the person suffers from Post-traumatic Stress Disorder.

Children’s PTSD symptoms fall into the following categories ( DSM 1987) :

• Re-experiencing:  nightmares, scary dreams, repetitive behaviours
• Agitated behaviour:  disorganised, nervous, jumpy
• Avoidance: avoidance of thoughts, feelings, or places that remind the child of what happened
• Other behaviors: regression to earlier behavior, i.e., clinging, bedwetting, thumb-sucking, social withdrawal, excessive use of alcohol or other substances to self medicate.

The above symptoms and behavior of PTSD are identical to the behavior displayed by children suffering from grief and loss issues. There is also a correlation between the symptoms of PTSD and ADD, confirming my own hypothesis that people labeled ADD could be suffering from PTSD. Many experts (Goodman, RF, 1999) in the field of PTSD would disagree with some of my findings in relation to the impact of separation and divorce on children. They agree that divorce is stressful but argue that as divorce would not be considered a life-threatening traumatic event, the child wouldn’t be at particular risk for developing PTSD.

Has anyone asked the child how he/she felt when their parents divorced?  Many young children fear that they will lose their homes, or fear that, because Daddy or Mammy is no longer there to mind them, something terrible, like death, is going to happen to them.  I consider that to be life threatening to a child, wouldn’t you? Goodman (1999) believes that if a child’s parent or close relative dies, the child would only suffer from grief and not from PTSD. A grief response is different to a PTSD response. He reckons that grief responses may include intrusive thoughts about the person who died or sadness about activities associated with that person, but that grief responses are usually worked through with time. In many cases, the surviving parent is too taken up with their own pain to help the child deal with his pain.  Many children feel that not only did the parent who died abandon them, but also the surviving parent.

Nonetheless Goodman believes that children under the age of 11 are more vulnerable to developing PTSD.  It is more difficult to diagnose in very young children who have less developed language, as they cannot describe their internal state well or report on whether they are having intrusive thoughts or nightmares. PTSD can develop years after an event.

Psychotherapy, Schools and Society

One of the difficulties of working as a psychotherapist is trying to recognise the issues that are affecting clients’ lives. If it is accepted by society as a whole that behavioural problems could be related to unresolved trauma in one’s childhood and the person might be suffering from PTSD, then a strategy can be put in place to deal with the attendant issues.

Parents and professionals can help children by maintaining a strong physical presence, modeling and managing their own expression of feelings and coping. They can accept children’s regressed behaviors, while encouraging and supporting a return to age-appropriate behavior, allowing children to tell their story in words, play or pictures to acknowledge and normalize their experience, and maintaining a stable and familiar environment.

When a child displays behavioural problems at school, grief issues must be looked at first instead of the child being labeled with ADD. More resources, such as family therapists, psychotherapists and Loss and Grief programmes are needed. Many children don’t know how to verbalize their feelings, so they act out their feelings by getting angry and aggressive both in the home and classroom. Parents can’t cope with the children’s behavior and when the child goes to school, the teacher can’t cope either. Consequently, many children, often labeled with ADD, drop out of school early, use drink and drugs to kill their pain, and commit crimes, while fuelled with drink or drugs, to pay for their addiction.

In conclusion, I hope I leave the reader with some insight into the possible effects that unresolved and unrecognized grief and loss can have on our children, our schools and our society.

Johanna Treacy is a psychotherapist and guidance counselor working in Co. Clare; she also works in stress management, family mediation and conflict resolution, and runs courses on grief/suicide, using the “Seasons for Growth” model. 

References:

American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders. New York: American Psychiatric Press.

Goodman, RF (1993). ‘Using art as a component of grief work.’ in N.B. Webb (Ed.) Helping Bereaved Children. (Second Edition.)  NY:Guilford Press.

Hartman, T. (1999). Attention Deficit Disorder, A Different Perception. Dublin: Gill & McMillan.

Millar, A. (1987). The Drama of Being a Child. Great Britain: Virago Press

Murray Parkes, C. (1972). Bereavement – Studies of Grief in Adult Life. London: Penguin Group.

Satir, V. (1998). People Making. London: Souvenir Press Ltd.

Worden, J. (1991). Grief Counselling & Grief Therapy. New York: Springer Publishing Company.