Making Sense of Your Child's Grief, Part 3: Creating a Safe Environment

by Chris Shaw, MAMFT

Without safety, vulnerability is difficult. For both children and adults to truly grieve, they need to feel freedom to express the emotions that attend pain. Let's take a moment and think about what safety is. A secure child does not fear external threats because there is a strong defensive wall outside of them ensuring their protection. Safety is environmental in nature. When we lose something or someone we value, we experience a loss of personal security and control. Our world is invaded and forever changed. In response to this, it is not uncommon for children to build a wall for themselves to protect their emotions. By doing this, they are trying to take back the control they had in their lives that was taken from them. No longer will they allow anything to hurt them.

Parents have a tremendous opportunity to free their children from having to build their own protective walls. An immediate step in building this safe atmosphere is being a safe resource figure. Parents exemplifying a sense of peace, calmness and hope provide a solid foundation for a grieving child. Respect their need for privacy by not forcing by not forcing them talk about what is going on. Is it okay for them to be sad? We cannot force another person to feel happy. Our heads and hearts can be in two different places. We want to feel joy, but our hearts are not there during grief. Allowing others to be where they are emotionally lets them know that they are free to feel the sadness that is there and let down their defenses when they feel safe. Being forced to speak about their experiences can increase defensiveness, but just being present with them in the midst of their suffering assures them that you know they are hurting and that their pain matters. When the environment feels safe to them, children will often open up, but it may take time and that's okay.

If possible, minimize additional stressors for them. The more things that we have to deal with the greater the difficulty there is in dealing with each one. Also, the more you are able to establish a routine at home, the more predictable and secure life becomes for children. Children thrive in an environment of structure and consistency. Some may try to give a false sense of security to their child by telling half-truths about what happened or by making promises that are impossible to guarantee keeping. Saying “everything will be okay,” or “it will all turn out for the best,” may or may not be true. While the intentions are good (it usually is aimed at bringing happiness to the one in suffering), the security ends up being false, and it tends to belittle the grief. However, the most difficult aspect of providing security for children may come when a parent is suffering from a loss also or are undergoing significant life stressors themselves.

Making Sense of Your Child's Grief, Part 2: Does My Child Need to Grieve?

by Chris Shaw, MAMFT


What constitutes a loss is different for each individual since we are created with individual desires and interests.  Not only hard times, but even what seem to be happy life events can be losses for children.   Life changes of any sort are stressful and may be processed by a child as a loss of normalcy.  Beginning school, moving into a new larger home, divorce, the death of loved one or pet, the addition of a younger sibling, a new job for mom or dad; all of these can pose a threat to stability and safety for a child.  When we experience loss, whether young or old, we are forced to accept things that lie beyond our own control.  Getting to that place of acceptance is the difficult part.  Grief is a God-given means of coping with things that we cannot change.  It reinforces our helplessness as we are confronted by our own humanity.  The difficult process of grieving, though, is actually necessary for healing to take place.

Many have identified the stages of grief as 1) denial 2) bargaining 3) anger 4) depression 5) acceptance.  Children may experience grief differently in conjunction with their developmental stage.  Because they often lack a framework to understand why they are experiencing these emotions, children try to make the incomprehensible understandable within their existing cognitive framework.  They may think that something is wrong with them for feeling the way they do, or try to accept blame for the loss as though it were their fault.  “If only I had said or done things differently, then things wouldn't have turned out this way.”  In addition, children may try to suppress their emotions because of the discomfort of them, yet what often follows is a spectrum of coping unhealthy mechanisms: outbursts of anger, decreased participation in activities, loss of focus in school, isolation, substance abuse, defiance, or harm to self and others.  Children need to know that it is okay to feel sadness, anger and the entire tangled web of emotions that arise from loss, and that it is important to understand and have good outlets for those emotions.  Normalizing emotions for a child who needs to grieve can help to reduce the shame often associated with grieving.  Children take grieving cues from the adults around them.  When a loss is a family felt issue, modeling grieving for your children can help them to accept and understand the emotions that they are feeling.  Talking through the difficult situations in life openly, as a family, with the goal of understanding one another's emotional pain allows pain to be shared and healing to take place.  A safe environment is essential for grieving to take place.  The task for the parent becomes: how can I make my home a safe place for emotions?

Making Sense of Your Child's Grief, Part 1

by Chris Shaw, MAMFT

The stoics of ancient Greece attempted to brace themselves from all suffering. They taught that emotions must be overcome by accepting whatever happens in life. Peace and happiness are found in taking whatever life gives you, whether good or bad, with indifference. We have learned through time that repression of emotions is an unhealthy means of coping with pain, yet too often this stoic attitude shows up in our own culture today, praising fortitude in the face of hardship while belittling  weakness.

In an ideal world, there would be no sadness, anger, pain or loss. Suffering, though is the horrible reality that we all share in. The nature of grief is such that no two people exhibit the exact same range of symptoms when handling crises. Children who experience situations which are beyond their control, often respond in a different manner than adults. Several variables which play a role in the child's grief response include:

• intensity of the experience
• duration of the experience
• age of the child
• personality and uniqueness of the child
• responses of adults around them to the situation

  

From a very young age children can have experiential memories embedded in their minds. These recurring images can produce lasting noticeable effects in their behavior. Others, however, may display little or no noticeable difference in the aftermath of a traumatic event or loss. Still others may initially show no signs, but only months later may exhibit symptoms. Such a wide range of responses can often leave a parent wondering: “What is going on with my child?” Especially in situations of delayed grief, it is much harder to pinpoint the cause of emotional distress.

Grief is a process and manifests itself as a range of emotions, thoughts and behaviors. The younger the child, the less likely they will be to cognitively grasp the reality of a situation. It is important for parents to realize that their children see the world through a different set of eyes. Children do not inherently know how to respond to grief, thus parents can help their children by maintaining curiosity about how their specific child sees the world and showing active interest in the things they value.

 

Because children have fewer emotional categories from which to operate, when difficult circumstances arise, they lack the ability to fully process what is taking place not only with external events, but also within their internal self. This inability to process can result in emotional frustrations and behavioral changes as a child loses a sense of control through the experience of loss. Parents can help their children by explicitly affirming those losses that their child experiences, rather than avoiding or minimizing their child's pain. Parents can also help to normalize grief for their child by showing genuine value for their loss. Moving away from stoicism to embracing and understanding human emotions helps us to in guiding children to make sense of their world and recover from their loss.

ADHD Resources

by Emily Suggs, LPC

In conclusion of this month’s blog on ADHD, the following books and websites have been provided as resources for families and professionals.

Books

Taking Charge of ADHD by Russell Barkley

ADHD and the Nature of Self-Control by Russell Barkley

Simon Says Pay Attention: Help for Children with ADHD by Daniel Yeager

ADHD: What Every Parent Needs to Know by Michael Reiff

Websites

www.ADHDSupport.com

www.chadd.org

www.add.org

www.addwarehouse.com (list of books and videos)

www.freeprintablebehaviorcharts.com (behavior management, behavior charts, and chore charts)

www.myadhd.com

OTHER HELPFUL RESOURCES:

• To help your child with homework organization, go to www.ADHDSupport.com/homework and download the Homework Planner PDF.
• Looking for a support program, go to www.ADHDSupport.com/join to enroll in free ADHD email support program.
• Do you think your child may have ADHD? Schedule an appointment with your doctor or a therapist. To help clarify concerns, complete the Child Symptom Checklist at www.ADHDSupport.com/child and share with your doctor/therapist.

Discipline and ADHD

by Emily Suggs, LPC

“Fathers, do not exasperate, but bring them up in the training and teaching of the Lord.” Eph. 6:4

Last week I shared the roles parents play in the life of their child with ADHD. This week let’s discuss discipline. There are different viewpoints on how children should be disciplined.  This blog is not a debate regarding which form of discipline is correct; rather, it is focused on understanding how to distinguish normal childhood misbehavior from ADHD symptoms.

When working with parents whose child has been diagnosed with ADHD, the most common questions I receive have to do with discipline. Discipline is a true balancing act when it comes to children with ADHD. It is often difficult for parents to know the best means of discipline as well as what behaviors to discipline. To help distinguish misbehavior from ADHD symptoms, I am going to take a moment to share about misbehavior. Rudolph Dreikurs, a child psychiatrist, proposed that children misbehave for four reasons: 1) to gain attention, 2) to gain power and control, 3) to gain revenge, and 4) to display feelings of inadequacy.  Misbehavior is a normal part of childhood development. Children are learning which behaviors are acceptable and which behaviors are not.

When thinking about what behaviors to discipline, it is important to distinguish between ADHD symptoms and misbehavior.  Often parents feel guilty when they discipline their child for behaviors that are truly connected to ADHD, such as hyperactivity, poor attention span, and impulsive behavior. Misbehaviors that generally fall outside the realm of ADHD symptoms are behaviors such as defiance towards authority, disrespect, anger outburst, and manipulative/testing tactics. Although these behaviors can be a result of a child’s emotions or frustrations in dealing with the symptoms of ADHD, sometimes their misbehavior is trying to accomplish one of the four goals mentioned previously.  Often it is next to impossible to determine ADHD behaviors from misbehavior. When trying to determine what is taking place, analyze the goal your child was trying to accomplish. Was he trying to get revenge on his brother or was it an impulsive decision, or was it both? Once the purpose of the misbehavior is determined, then parents will know better how to discipline.

If the purpose of your child’s behavior is due to one of the goals of misbehavior, then it is important to address how you can teach them better ways to accomplish these goals.  Setting limits and following through with discipline is essential. Children with ADHD quickly learn what they can and cannot get by with when it comes to misbehavior.  John’s mom tells him to go to his room, put on his pajamas, and get in bed. Thirty minutes later John has done none of these three. John’s mom is furious….but what is John’s misbehavior due to? The more John’s mom understands about misbehavior and the symptoms of ADHD then she will be able to determine a solution to such a problem.  Children usually cannot communicate the purpose or goal of their behavior. However the more you learn about how ADHD affects your child’s behavior, the more effectively you will be able to discipline. Children with ADHD have difficulty following multiple tasks (go to room, put on pajamas, and get in bed), staying on task, not getting side-tracked, and completing more than one task at a time. But if John shares his purpose was because he did not want to go to bed then you are dealing with misbehavior (power/control). It is also important to know the personality of your child. If your child is strong-willed then you may have a harder time distinguishing between ADHD symptoms and misbehavior. But if your child is normally cooperative but easily gets side tracked or has trouble completing task, then you know his true intention is not to misbehave.

Because a child with ADHD already struggles with low self-esteem, it is important to handle discipline in a respectful manner.  Embarrassing your child by disciplining them in a public sector only increases the internal struggle they face. It is also hurtful to discuss your child’s misbehavior in front of them with others like teachers, therapists, doctors, or family. Children have reported they feel shamed and embarrassed when parents communicate in this manner.  However it is necessary to be consistent with discipline and to follow through with discipline strategies. Otherwise it is only an empty threat and behaviors will usually increase.  Establish a routine of what is expected when in public situations, such as the grocery store or a restaurant and the consequences following if misbehavior becomes a problem.  Be realistic about what to expect when in specific situations. Children with ADHD can become over stimulated by loud noises, bright colors, upbeat music, and large crowds. When taking your child to an environment that includes one or all of these, be realistic about what you can expect from your child. The same is true with environments that require your child’s undivided attention.  When at home, establish rules and guidelines regarding your expectations. Use strategies to like discussed in week 2 to help your child complete tasks in a timely manner as well as to hold them accountable for staying on task. Bedtime is a difficult time. Allow extra time to help your child wind down and relax at bedtime. Use books, music, or talk time to help them slow down their little brains.

Addressing Misbehavior:

1. Gaining Attention: Ignore attention seeking behaviors and direct your child to alternative ways of gaining positive attention. Children with ADHD sometimes struggle with social situations. They have trouble reading social cues and respecting personal boundaries/space. In social situations, your child might resort to misbehavior (also known as “the class clown”) to get attention and acceptance from peers. Equip your child with positive ways to make friends and get accepted by peers.
2. Gaining Power and Control: Avoid power struggles! We have all heard the statement “pick your battles wisely.” When addressing power and control issues, be very wise, especially since conflict can easily escalate and in the end who usually ends up angry and agitated- the parent! There are multiple reasons children attempt to gain power and control, but in the end, the key is to not allow them to pull you in a power struggle.
   
3. Revenge: At the root of revenge is hurt. Like power and control, do not engage in a battle that will end only end in anger and frustration. Even though children with ADHD tend to get in trouble over and over for the same behaviors, it does not change the fact that they are very sensitive to criticism. This hurt can lead to them acting out to get revenge.
4. Inadequacy or Helplessness: Children with ADHD have shared with me that they feel different than their peers because the symptoms keep them in trouble. They know when teachers and parents are frustrated because they cannot complete their school work or stop talking during class. Due to these feelings, children feel discouraged or helpless. Children with ADHD need lots of encouragement and empowering to accomplish tasks.

The best way to discipline is to be proactive. If you establish guidelines and communicate these clearly, it will address not only the misbehavior but also the ADHD symptoms that often frustrate parents. Unfortunately there is not a magic solution to solving the discipline dilemma when it comes to ADHD. It takes patience, understanding, and consistency to help alleviate behaviors that can easily get out of control. The following are some guidelines to establish in your home.

1. Provide Consistency and Structure: Keep things simple and do not over explain. Children with ADHD find arguing stimulating therefore they will thrive when you try to engage in an argument or to explain reasoning.  A great discipline approach for children with ADHD is 1-2-3 Magic by Thomas Phelan. He addresses this very issue and gives clear approaches to addressing misbehavior.
2. Establish Clear Standards and Rules: Parents who have children with ADHD often let them get away with misbehavior because they think they cannot control it. This is not true. Let your “No” mean no and your “Yes” mean yes.  If they think they can persuade you otherwise, they will continue to badger you.
3. Have High Expectations: This means you as the parent have to work harder to equip your child to be prepared for whatever challenge comes their way. This does not mean you give up on what your child can accomplish because they have been diagnosed ADHD.
4. Teach Your Child to Behave: Positive reinforcement teaches positive behaviors. Children with ADHD have to worker harder to learn impulse and self control. It will not happen overnight, but if they are taught right from wrong then as they mature they will learn to be successful in life.

ADHD: What Every Parent Needs to Know by Michael Reiff, MD

“Making Child Therapy Work” by Robin Walker, MFT

“Training Lions and Tigers: Discipline and Children with Disabilities” by Pete Wright, Esq.

Parenting Your ADHD Child

by Emily Suggs, LPC

Your role as the parent to a child with ADHD

1. Advocate: Every child needs an advocate! A child’s best advocates are the people who know him best, his  parents.  If your child had a physical disability, I imagine you would do everything possible to let teachers, school counselor, and other school personnel know your child’s specific needs and desired accommodations. When it comes to ADHD, there are needs and accommodations that need to be considered. As your child’s advocate, it is important to understand the rights and laws that are in place to help your child. Since ADHD is a spectrum disorder where the symptoms range from mild to severe, parents have to communicate the specific needs of their child to the school, and many times parents have to fight in order to get the accommodations their child needs. For more information about the rights for children with ADHD, go to www.help4adhd.org. This website represents the National Resource Center on ADHD and provides educational resources to ensure your child gets the educational help needed.
2. Coach: Rather than viewing your role as a punitive disciplinarian, think of yourself as your child’s coach. A coach’s role is to equip and encourage. During practice a coach spends his energy equipping or teaching the player strategies, skills, and techniques so that when game day approaches, the players know how to play the game. Then during the game the coach’s role shifts to that of an encourager or a motivator. The coach cannot play the game for his players. His role is to remind them of what they have learned and to encourage them to do their best. At home you are equipping your child with ADHD with the skills and strategies to succeed when he is at school. You cannot go to school for your child, but you can encourage him to remember what you have equipped him with and encourage him to do his best.
3. Empower: If you are a nurturer, then empowering your child may take practice. Nurturing personalities tend to attempt to “help” or “fix” problems when they arise for their children. For a child with ADHD, unfortunately you cannot “fix” the struggles he will face. You can advocate and coach but many of the challenges are lifelong obstacles that individuals with ADHD have to learn to address. By empowering your child, you are communicating that you BELIEVE in them. Empowerment places the responsibility and power back on the child to solve the problem while also recognizing the child’s ability to learn and grow. Statements such as, “You did it! You worked hard to clean your room all by yourself.” Or “I noticed you stayed on green today. That took a lot of hard work and self-control. I bet you are proud of yourself.” When you empower, it focuses on what the child accomplished and what the child is feeling.  Children with ADHD have reported to me feeling different and not accepted by the outside world. They struggle with meeting the expectations of others. When empowered, they learn to look within for strength and acceptance.

Parenting is a difficult task whether you are parenting a child with ADHD or not.  Every child is created differently and what works for one child may not work for another. As a parent, it is your responsibility to think outside the box of tradition to search for what is best for your child to succeed and prosper spiritually, mentally, and emotionally.

The Importance of Executive Function with ADHD

by Emily Suggs, LPC

When thinking about ADHD, it is essential to recognize the importance executive function plays in our day-to-day functioning. First you may be wondering what is executive function?

“Executive Function is a set of mental processes that helps connect past experiences with present action. People use it to perform activities such as planning, organizing, strategizing, paying attention to and remembering details and managing time and space”  (CHADD ATTENTION magazine, February 2002).

As adults we use executive function all day long to help remember tasks and responsibilities. We make list to carry to the grocery store (planning/strategic thinking). We don’t answer a phone call when we are trying to get kids out the door to school because we don’t want them to be late to school (interference control). After working all day we come home and cook supper (initiating task). We make list of things we need to remember to accomplish during the day (planning). We set three alarm clocks so we don’t oversleep (sense of time).

These are examples of how the different mental processes guide us through our day-to-day functions. These mental processes are believed to be based in the pre-frontal region of the brain. For many individuals, these processes occur naturally and allow one to move through day-to-day tasks easily; however, for an individual with ADHD, there is an impairment or deficit in executive function. An example of what this might look like is:

Emma’s mother tells her to start her homework (initiating task). Five minutes passes and Emma still has not started her homework (lack of motivation). When she finally sits down to start her homework, she cannot find where she wrote down her assignments (lack of planning and strategic thinking). She calls a friend to get her assignment but gets distracted by talking to her friend about her new toy (no sense of time/interference control).  Emma looks at her assignments and is overwhelmed by all the work she has to accomplish (lack of initiating task). Not sure where to begin she begins watching television (interference control/lack of motivation). Her mom redirects her to start her homework. She picks up her pencil and notices it is dull. She wonders where her sharpener could be. This leads Emma to dumping out her backpack looking for a pencil sharpener (interference control). By this time an hour has passed and Emma has not completed any of her homework (no sense of time).

Because these deficits exist for individuals with ADHD, it is important for individuals to exercise skills that will improve their executive function.  The following are suggestions and tools that may help improve these mental processes:

• Planning/strategic functioning/working memory: planners, checklists, calendars, charts, reminders
• Regulating emotions: talking, drawing, writing, exercising
• Internalized language: positive self-talk, post or memorize sayings, proverbs, and Bible verses,      meditating/reflecting
• Interference control: turn off television, limit distractions, silence cell phones, and prioritize tasks
• Self-motivation/initiating action: small/easy tasks first, set deadlines/due dates, evaluate reward/consequence

Here is how the above story might be different when focus is placed on improving executive functions. (Notice the mother’s role is to equip and empower her child to improve her executive function.)

Emma’s mother tells her to start her homework (initiating task). Emma, with her mother’s help, unpacks and organizes her books and assignment notebook/folder from her backpack. She decides what assignments she will do first (strategic thinking/planning.) Emma notices her favorite show is coming on later that night and her mother reminds her that if she plans to watch television later, she must complete her homework.(sense of time). Emma’s mom decides to turn off the television so she does not get distracted (interference control). To help her stay on task with each assignment, Emma’s mom sets a timer that allows Emma to know when it is time to move to the next assignment (shifting between task/sense of time). While working on her math, Emma’s pencil lead breaks. But Emma knows her sharpener is located in her pencil bag because she organized her backpack and zipper binder before starting homework (strategic thinking/planning). An hour passes and Emma is about to check off her last homework assignment.

Of course it is never quite this easy, however the goal is to equip the child with these skills so as the brain continues to develop, so will the executive function. Just like a young baseball player does not start out knowing all the skills and techniques of baseball but begins learning the basic skills and techniques. As he grows and develops, it becomes a natural part of playing baseball.

Dendy, Chris A. Zeigler M.S. “Executive Function: What Is This Anyway?” CHADD ATTENTION magazine: February 2002.

Yeager, Marcia LCSW, RPT-S. “Executive Function: A Key to Understanding the ADHD Mind.” Play Therapy Magazine: June 2009.