Grief Interventions for Children with ADHD

When experiencing loss, it’s common for children to become preoccupied with feelings related to grief: apprehension, inability to focus, overstimulation.

But for children who are diagnosed with ADHD, or attention deficit hyperactivity disorder, the manifestations of grief can exacerbate ongoing struggles to focus and manage stress.

“Their minds are occupied with adapting to all the changes that loss creates,” said Helen Harris, EdD, MSW, faculty member at Baylor University’s Diana R. Garland School of Social Work.

While traditional bereavement groups can provide stability, Harris said they are often designed for families grieving a death. But children with ADHD experience many other forms of loss and sometimes need interventions tailored to their specific needs.

Dr. Pauline Boss, an educator and researcher with expertise in family stress, defines ambiguous loss in two main categories:

When a person is physically present but psychologically absent.

When a person is physically absent but psychologically present.

While the death of a family member is an obvious source of grief, ongoing or disruptive sources of grief can come from less distinct sources, such as:

• Divorced parents
• Deployed parents
• Abuse by parents or guardians
• Placement in foster care
• Loss of a family pet
• Domestic violence or assault
• Separation from siblings or other family members
• Substance misuse of caregivers
• Mental illness of caregivers

With an existing ADHD diagnosis, some children may experience compounded challenges when the symptoms of grief and ADHD overlap. Signs that children are not coping well with grief may be masked by tendencies of children with ADHD to hide their feelings.

Overlapping Symptoms of ADHD and Grief

• Trouble focusing and low attention spans
• Constant need to move body
• Distancing from peers or interests
• Poor school performance and difficulty learning new material
• Impulsivity
• Trouble eating or sleeping

Some children who exhibit these symptoms may be misdiagnosed with ADHD if caretakers jump too quickly to conclusions. Conversely, children with ADHD may see their symptoms worsen.

“We need to have empathy for the fact that ADHD may cover over what’s going on for a child in their grieving process,” said David Anderson, PhD, clinical psychologist and senior director of national programs and outreach at the Child Mind Institute. “They may in fact have deeper emotions.”

Anderson explained that frontline intervention involves training adults to look for signs and help children by meeting them where they are.

“Adults have to realize that even though they aren’t the cause of the problem, they are a part of the solution,” he said.

For younger children, interventions may consist of training caregivers to facilitate and manage positive behaviors. When children age, it becomes more common to consider medication, he explained. As for teenagers, cognitive behavioral interventions can help young people manage their symptoms while gaining independence. 

Harris cautioned caregivers from making preliminary diagnoses before consulting a clinician. Assuming that a child is depressed or that medication is necessary can lead to ineffective or inappropriate treatment plans.

“We do our best treatment and intervention when we’re intervening for the right thing,” Harris said.

Strategies for Interventions

Be open and available to listen to needs.

Create spaces where children can focus.

Monitor eating and sleeping routines.

Refer to a bereavement group to provide stability.

Have child meet with a mental health care provider.

Talk to a medical provider about medication.

Experts at the American Academy of Pediatrics caution adults to be mindful that the home environment can lend itself to more stress or exacerbate symptoms. Identifying sources of stress within the home can help caretakers more effectively intervene.

Modeling Healthy Coping Mechanisms for Children with ADHD
Modeling Healthy Coping Mechanisms for Children with ADHD
Modeling Healthy Coping Mechanisms for Children with ADHD

In most cases, children with loss initially experience shock and denial. They may protest, rail against it, get angry, strike out, and break things.

“Our cultural response is to tell children to stop behaving badly,” Harris said.

It’s easy to punish misbehavior and expect that kids will learn from repeated consequences. But adults must understand that kids’ feelings and behaviors are connected, she said.

Caretakers can’t expect the drivers of behavior will just go away with time nor that medication will eliminate the tendencies for unhealthy coping. Harris pointed out children often learn behaviors by mimicking the actions of people they look up to; adults can be pivotal role models in displaying responses to grief in constructive and positive ways.

How to Model Healthy Expressions of Grief

• Be honest about negative feelings but not destructive.
• Acknowledge that pain exists.
• Have a conversation and take ownership of your feelings.
• Manage your own behavior and emotions.
• Avoid overwhelming or scaring children.
• Use language to empathize with kids.

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Examples of things to say:

• I know this is hard; I miss them, too.
• We can do this together.
• It’s not always going to hurt this badly.
• Sometimes I cry, too.

Adults should also consider the compounded effects of grieving during the holidays or family gatherings and make time to address loss in a safe space.

Even after a child leaves the presence of a caregiver, they still may struggle with navigating grief. That’s why it’s important to think holistically about the continuum of care — the concept that healing and treatment can be a part of every environment or social group in a person’s life.

“A social worker’s role is to communicate hope, caring, community, and support.” 

Social workers can be a valuable source of support during challenging times. Children who have lost adult role models may need a companion who can be empathetic to their situation.

“A social worker’s role is to communicate hope, caring, community, and support,” Harris said.

Anyone can be part of the continuum of care, but Harris said it’s important for social workers to identify a caregiver who will be a constant and stable part of the child’s life.

Who can be part of the continuum of care?

• Social worker
• Foster parent
• Caregiver or legal guardian
• Grandparents or extended family
• Teachers and educators
• School counselors

In addition to finding and training stable caregivers for children in need of support, social workers can help children build resilience and navigate their emotions. These practices can help children through adolescence and young adulthood.

“Be a fellow traveler — someone who can accompany [them] on [their] journey,” Harris said.

For more information about grief and ADHD interventions, consider the following resources:

Citation for this content: Baylor University’s online master’s in social work program.