Grief & Loss and the ADHD Diagnosis

Introduction

Hooyman and Kramer (2006) define grief as “the physical, psychological, and social reaction to the loss of something or someone important” (p.16). Research indicates that there are many children today who are experiencing grief due to the loss of their beloved one and this is prevalent mostly amongst military families. This loss often relates to the death of either one or both parents, death of siblings, divorce within the family, delocation or in the case of a parent being deployed for military operations and missions abroad (Walsh-Burke, 2006).Relocation pressuposes the removal by the child or family or relocation of the parent because of military deployment. In one way or another many military families in the US, have been affected especially in Central Texas. There are different types of loss which influence the emotional, psychical and physical state of children: divorce, separation, deployments, death, incarceration, moves, adoptions etc (Wolfelt, 1996, p. 34). All these factors influence the life of children and reflect in their behaviour.

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Research Statement

The purpose of this qualitative study using secondary data is to explore the perceptions and experiences of parents and guardians about the relationship between the experience of grief and loss in children and a diagnosis of AD/HD in school-aged children in a school district in Central Texas. Additionally, this paper also seeks to examine the perceptions of parents of children of the millitary families in Central Texas Schools who have been diagnosed with AD/HD.

The importance of this study is to provide the common symptoms between grief and loss and AD/HD. The awareness of symptoms helps to prevent the consequences of grief and loss. The procedure for assessing these commonalities is to explore the perceptions and experiences of parents and guardians about the relationship between the experience of grief and loss in children and AD/HD. The approach which helps students get through grief and loss increases our knowledge about childhood grief (Wolfelt, 1996, p.255).

The quantity of children suffering from AD/HD in the United States has significantly increased in recent years (Stanford, 2008). Stanfoes provides the reasons of such criteria which may be misdiagnosis/over diagnosis; the acceptance of the diagnosis; diagnostic criteria; and societal changes. (Stanford, 2008). Harris (2011) finds a significant association between the experience of childhood loss and grief and a diagnosis of AD/HD.

This study analyzes parental perceptions of parents of children in a Central Texas School District who have been diagnosed with AD/HD with particular focus on the child’s experience of loss and grief. Parents’ perceptions play a key part in the diagnosis of their child. Clinicians often make their diagnoses on information given by parents, so it is imperative that to understand parental perceptions of AD/HD (Crystal, Ostrander, Chen, &August, 2001). The research paper benefits parents, teachers, physicians, psychologists and social workers understand parents’ perceptions around this phenomenon as they meet the needs of bereaved children. One possible benefit is awareness that reduces misdiagnosis of AD/HD. The negative impact of not doing this study is to neglect the perceptions and experiences of those most aware of the impact of grief on school-aged children. Some children who are confronted with death of one of the parents are unable to recover, and may develop some symptoms of complicated grief (CG). If left untreated, CG poses serious risks for further, continual impairments in occupational and social functioning (Boelen, van den Hout, & van den Bout, 2006). Children who experience grief are at serious risk of such complications if they are not given the proper nurturing and support they need (Boelen, van den Hout, & van den Bout, 2006).

Literature Review

The aim of our research is to analyze the influences of grief and loss caused by different factors on the school-aged children, paying more attention to the cognitive factor. It should be noted that there is little attention paid to cognitive responses in the literature (Harris, 2011). Unfortunately, there are no so many researches which demonstrate the coorelation between grief and loss and the diagnose AD/HD. Hooyman and Kramer (2006) point out the difficulties in the process of study for children who have influenced some grief and provide different interventions across the life span which influence the life of children. McCue (1994) specifically highlightes problems with attention and concentration in school which may be influenced by grief and loss particularly by parent’s serious illness. Stanford (2008) demonstrates that all children experience different mental problems namely some attention and concentration problems. He stresses that the symptoms of AD/HD in children can be associated with hyperactivity, inattention and impulsivity.

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Walsh-Burke (2006) notes that these problems may be intensified in grieving children and he provides the necessary skills and theories which help professionals to solve these mental problems of children. Wolfelt (1996) points out some responses to the grief and loss such as depressed mood, distractibility, impulsivity, hyperactivity and acting out. The author makes the emphasis on that fact that all feelings and sufferings are reflected in the children behaviour. Children who have experienced grief and loss struggle with school performance. Many of them cannot concentrate or pay attention in class. Some of them may experience emotional pain, depresssion, stress or distraction. More than that, he provides different methods which help to heal these children. Webb (2004) provides the criteria of assessment and treatment of those children who have been impacted by traumetic stress and the loss in the family. The author points out the response of schools to the children suffered loss and grief. According to Potts & Mandleco (2012), AD/HD generally affects the cognitive and social development of a child and therefore any theraupetic intervention should focus on the improvement of the child’s self awareness and communication skills. They argue that there are various forms of interventions measures including individual therapy which focuses on the child’s behavour, development and psycho-social transformation (Potts & Mandleco, 2012). The other modalities include family therapy which focuses on relationships within the family relations and network while group therapy focuses on interpersonal relationship. Lastly, play therapy allows the child to identify their needs and express their feelings (Potts & Mandleco, 2012).

Meanwhile, Wolfelt (1996) provides a general overview of various therapeutic measures which can be used by professionals working with children suffering from loss and grief problems. He suggests that any therapeutic intervention strategies must connect between experiences of child grief, loss and learning patterns and behaviors. This may include anxiety, depression and school performance while Everett and Everett (2001) have outlined some of the possible methods of intervention. They believe that therapeutic process should start with an interview of the child while the parents are around so as to get the real history of the family. The second part should be done with the child in the presence of their siblings depending on their age (Walsh-Burke, 2006). The purpose of this meeting is to establish a rapport and develop trust between the healthcare professional and the child. By and large, such meeting is also used to allow the child to find his/ her own identity and promote comfort in their relationship. A therapist should also conduct an interview with parents, grandparents or guardians whom they feel can contribute to the therapeutic treatment of the child. This is very important in cases of divorce or separation.

Safran (2002) also suggests that group play and social activities has been identified as another important factor in dealing with people/ children suffering from AD/HD. Group art therapy will generally allow them to express their feelings, share ideas of what affects them and enhance their abilities to plan and organize things orderly and carefully (Buddin, Gill & Zimmer, 2001). This is so important especially in school environment where children are given group work assignments. It is also in such settings that an individual is expected to apply their cognitive, emotional and social skills as they speak and participate in implementing the tasks at hand.

As already has been said before, our qualitative study also aims at the analysis of the children from the military families diagnosed with AD/HD. Children from the military families have become the burning issues at the Committee on Health, Education, Labour, and Pensions. There is a wide range of documents and researches observing this problem. One hundred eighth Congress of 2003 devoted their first session on examining how effective the Army has been in making it easier for military families raising children and to determine what additional changes can be made to further assisst military families. The document of this session is called Understanding the needs of children and families especially during times of military deployment. One hundred fourth Congress took out on the agenda the problems of the children from military families in education. This hearing was on military connected children and impact aid. One hundren eighth congress paid attention to the issues affecting families of soldiers, sailors, airmen, and Marines in the hearings of 2003. The government is concerned with the problems of military family and it is very important to pay more attention to this problem in our research. This problem is still unsolved and it needs more detailed approach. Our study will provide the reasons of the vulnerability of children from military families to AD/HD.

Richardson (2011) observes the evidence of academic challenges and bahaviorial challenges that children face when parents deploy and recommendations. The Family Programs Branch produce special series of books for families whose parent is deployed which are called “Daddy’s Day Away: a Deployment Activity Book for Parents & Children”.

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Adler-Baeder, Pittman and Taylor paper (2005), contains survey conducted by the US Department of Defense indicating that a large number of military families are affected by divorce or marriage and many of those affected do have non- residential children. This can be attributed to the transitional nature of military service which often lives trauma to children. Harris (2011) also states that central Texas currently houses large military base with over 100, 000 military personnel compared to anywhere else in the US. Therefore, the biggest percentage of school children in Central Texas hails from the military families and so Central Texas provides the perfect setting for the study of AD/HD on Military children. A Central Texas military family therefore presents a perfect example of families in transition and children affected by cases of divorce, separation, death or military deployment. Texas is also an important place for economic activities due to the huge military presence. The area also has a big multicultural, multiethnic and Multifaith communities. There are also many schools in the region and large student population Therefore, AD/HD must target children from military family which prove to be a huge task. But generally, there is a strong correlation between AD/HD in military families. Such a research must be scaled down to specific family cases which need to be identified with the help of the schools targeted.

Barkley (2007) provides two theories of AD/HD which help to diagnose ill children. They are Wender’s theory of MBD and Douglas’s model of attention and impulses control in children. Wender’s Theory of MBD was based on six clusters of symptoms: motor behaviors; perceptual-cognitive and attentional functioning; impulse control; learning; emotion; and interpersonal relations (Barkley, 2006). Wender theorized that three primary deficits accounted for these symptoms: extroversion; a decrease in the ability to experience pleasure and pain; and, in general, a high, while poorly modulated activation level (Barkley, 2006). Douglas’s model of attention and impulse control in hyperactive children contained only four major deficits which were thought to account for the symptoms associated with AD/HD: organization, investment, and maintenance of effort and attention; lack of control over impulse control/response; the modulation of excitement levels to meet situational requests; and an unusually strong desire to seek instantaneous reinforcement (Barkley, 2006). These theories are very helpful in diagnosing AD/HD. Parents should be aware of the main symptoms to prevent the illness of their children.

Methodology

This exploratory qualitative research study analyzed secondary data to explore the perceptions and experiences of parents and guardians about the relationship between the experience of grief and loss in children and a diagnosis of AD/HD in school-aged children in a school district in Central Texas especially taken into account military families where parent’s deployment influences the children’s school performance. The study included a secondary data analysis of the survey narrative responses in a study that examined incidence of AD/HD and grief and loss in 1755 children in a Central Texas school district (Harris, 2011). The primary study included a cross-sectional survey design with parents and guardian of children in a Central Texas school district including two narrative responses (Harris, 2011). This study examined the narrative responses for themes related to parental perceptions and experiences with children with a diagnosis of AD/HD and their experiences with grief and loss.

The survey instrument from the primary study included three introductory demographic questions; five questions for each child diagnosed with AD/HD; six demographic questions and two qualitative narrative questions (Harris, 2011, p. 82). Several questions established whether or not the child had experienced a loss, when the loss occurred and whether or not the child had been diagnosed with AD/HD and when the diagnosis occurred (Harris, 2011, p. 82). For purposes of this study, the responses to the two narrative questions of parents of children in a school district in Central Texas are analyzed for themes. The two narrative questions were:

“What connection, if any, do you believe there might be between your child’s difficulties with attention and/or behavior in school and your child’s experience with separation, loss or death” (Harris, 2011, p. 179)? “What else would you like to share about your child’s experience with AD/HD and/or experience of separation or loss” (Harris, 2011, p. 180)?

Secondary data are obtained from the research database of the primary study. One hundred eighty-one responses to two narrative questions will be analyzed by coding the responses, identifying common themes and issues and considering those themes and issues in relationship to the literature on grief and loss and on attention difficulties in children including diagnosis of AD/HD. There were 181 responses, 45 of them were from military families. These responses of parents whose children are diagnosed AD/HD and children experienced AD/HD let us know what the main reasons of AD/HD are. The most mentioned reasons were separation, divorce, deployment, incarceration and death. Children who are separated from one of the parents by different reasons are more inclined to be diagnosed AD/HD. There were other different reasons mentioned in responses. They were hereditary factors and medical conditions.

Reference List

  1. Adler-Baeder, F., Pittman, J. Fl., & Taylor, L. (2005). “The prevalence of marital transitions in military families”. Journal of Divorce and Remarriage, 44, 91-106.
  2. Barkley, R. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed.). New York, N.Y.: The Guilford Press.
  3. Boelen, P., van den Hout, M., & van den Bout, J. (2006, May). A cognitive-behavioral conceptualization of complicated grief. Clinical Psychology: Science & Practice, 13(2), 109-128.
  4. Buddin, R. J., Gill, B. P., & Zimmer, R. W. (2001). Impact aid and the education of military children. Santa Monica, CA: Rand.
  5. Costa, B., Hall, L., & Stewart, J. (2007, May). Qualitative exploration of the nature of grief-related beliefs and expectations. Omega: Journal of Death and Dying, 55(1), 27-56.
  6. Crystal, D., Ostrander, R., Chen, R., & August, G. (2001, June). Multimethod assessment of psychopathology among DSM-IV subtypes of children with attention-deficit/hyperactivity disorder: Self, parent, and teacher reports. Journal of Abnormal Child Psychology, 29(3), 189.
  7. Everett, C. A., & Everett, S. V. (2001). Family therapy for ADHD: Treating children, adolescents, and adults. New York: Guilford Press.
  8. Harris, H.W. (2011). Attention deficit/hyperactivity disorder or grief: A study exploring the association between childhood loss and grief and a diagnosis of AD/HD in elementary aged children in Central Texas. Dissertation, University of Mary Hardin-Baylor, College of Education, Belton, Texas.
  9. Hooyman, N. R., & Kramer, B.J. (2006). Living through loss: Interventions across the life span. New York, NY: Columbia University Press.
  10. McCue, K. (1994). How to help children through a parent’s serious illness. NY: St. Martin’s Press.
  11. Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families. Clifton Park, NY: Delmar Cengage Learning.
  12. Richardson, A. (2011). Effects of soldiers’ deployment on children’s academic performance and behavioral health. Santa Monica, CA: Rand.
  13. Safran, D. S. (2002). Art therapy and AD/HD: Diagnostic and therapeutic approaches. London: Jessica Kingsley.
  14. Walsh-Burke, K. (2006). Grief and loss: Theories and skills for helping professionals. Boston, MA: Allyn & Bacon.
  15. Wolfelt, A. D. (1996). Healing the bereaved child: Grief gardening, growth through grief and other touchstones for caregivers. Ft. Collins, CO: Companion Press.
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