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Section 10
Children's Hyperactivity due to Loss

Question 10 | Test | Table of Contents

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In the last section, we discussed guidelines for trauma.  There are three guideline topics for treating traumatized children that we discussed. The three topics are how a parent can help their traumatized children, what to say to their traumatized child, and what not to say.

In this section, we will discuss hyperactivity resulting from loss. Topics we will discuss regarding hyperactivity resulting from loss include manifestations of hyperactivity resulting from loss and the five feelings technique. There are five steps in the five feelings technique. The five steps are introducing the five feelings, inventorying the five feelings, avoiding anticipating or feeding the child answers, asking clarifying questions, and repeating the technique at later sessions if necessary. As you listen to this section, you might consider how to apply the information and technique to a grieving child you are treating.

♦ #1 Manifestations of Hyperactivity Resulting from Loss
Leann, age 11, was an active child. After both of her parents died in an automobile accident, Leann was sent to live with her aunt Julie and uncle Adam. After the transition, Leann appeared to display manifestations of  hyperactivity which resulted from her loss. 

Adam stated, "Ever since she came to live with us, Leann has chattered, fidgeted, made nonsense noises, and just never stops moving. When she’s around it’s hard to think, let alone to carry on a conversation, or to relax. Suppertime is real chaotic. Leann squirms, giggles, taps, and bangs things."

I stated to Adam, "After a loss, people of all ages may become preoccupied with keeping busy in order to avoid thinking about what has happened. As outside conditions make it harder for Leann to keep reality at bay, she may become more and more frenzied and desperate." Have you treated a grieving children, like Leann, who displays manifestations of grief through hyperactivity?

I have found that other manifestations of hyperactivity in grieving children may include a dislike of playing alone or a demand for constant company or TV to distract themselves from grief.  Children may also avoid grief by immersing themselves in school, sports, clubs, or hobbies in order to feel competent and avoid grief.

Adolescents may use headphones or the telephone to fill quiet times and block internal grief reactions. Or, adolescents may begin to use alcohol or drugs to help them forget or stop caring about a loss. Sometimes, the hyperactive behavior of grieving children may manifest in more disturbing ways. When expected to be quiet, grieving children may rock back and forth, talk to themselves, or even masturbate. 

Have you experienced some teachers, caregivers, or even pediatricians suggesting medicating children in this phase of grief?  Differentiating between agitated grief and ADD or other hyperactive disorders can effectively reduce inappropriately prescribed medications.  Would you agree that hyperactive children may simply be displaying manifestations of a suppressed, but otherwise normal, grief reaction?  Think of your Leann.  Could changes following a significant loss be the cause of your grieving client’s hyperactive behavior? 

By discovering as much as possible about Leann’s behavior before her loss, I found that the changes in her behavior were recent.  As you know, Leann was uncomfortable with her grief and became hyperactive to avoid her feelings. Therefore, in our sessions it was difficult to open Leann to discussing her feelings.  If you are treating a grieving child, like Leann, who is suppressing grief and not comfortable with talking about her feelings, the following technique may help.

♦ Technique: The Five Feelings Technique
To foster open communication with Leann and find out more about her feelings, I used the five feelings technique.  This is a five step technique which I use regularly to begin communications with reserved children regarding their grief. 

Step #1 - First, I start by introducing the five feelings. I stated to Leann, "This isn’t hard.  There are five important feelings that children and adults have."  I held up one hand, fingers spread, and moved each finger consecutively as I listed the feelings for Leann. I stated, "The Five Feelings are sad, mad, happy, scared, and lonely. Let’s check it out." 

Step #2 - The second step is to inventory the child’s feelings.  I held up one finger and asked, "When you think about your mom and dad do you have any sad feelings?" Leann shook her head, indicating that she had no sad feelings. I continued, "OK, no sad feelings. Do you have any mad feelings?" Leann shrugged and I stated, "OK. Looks like you’re not so sure about mad."  I then proceeded through the entire list, each time putting Leann’s quiet reactions into words. 

Step #3 - In addition to introducing the five feelings and inventorying the five feelings, the third step in the five feelings technique is to avoid anticipating or feeding the child answers. For example, though I believed that Leann was sad about her parents death, she indicated that she had no sad feelings regarding her mother and father. 

Step #4 - The fourth step is to ask clarifying questions. When unsure about what a child is sharing, I find it productive to ask questions to clarify. For example, I may state, "I’m mixed up.  Your mouth said no, but your head went up and down in a yes. Will you help me out so I’m sure I understand?" I then restate the question.

Would you agree that this kind of respectful checking not only avoids confusion, but also helps the child believe that you are truly interested in understanding his or her feelings?

Step #5 - In addition to introducing the five feelings, inventorying the five feelings, avoiding anticipating or feeding the child answers, and asking clarifying questions, the fifth step in the five feelings technique is to repeat the technique at later sessions as necessary. With Leann, it took three sessions before she admitted her sad feelings.

Think of your grieving client.  Is he or she displaying hyperactivity resulting from suppressed grief? Could the five feelings technique help you foster an open and productive dialogue?

In this section, we have discussed hyperactivity resulting from loss. Topics we have discussed regarding hyperactivity resulting from loss include manifestations of hyperactivity resulting from loss and the five feelings technique. There are five steps in the five feelings technique. The five steps are introducing the five feelings, inventorying the five feelings, avoiding anticipating or feeding the child answers, asking clarifying questions, and to repeat the technique at later sessions as necessary. 

In the next section, we will discuss grief and explaining separation. Children who experience grief from separation may benefit from having the type of separation explained to them.  The four types of separation discussed in the next section, may be difficult to explain to children.  The four types of separation we will discuss are parental rejection, incarceration, mental illness, and alcohol and drug abuse. 

- Count, D. L. (2000). Working with Difficult Children from the Inside Out: Loss and Bereavement and How the Creative Arts Can Help. Pastoral Care in Education, 18(2), 17-27. doi:10.1111/1468-0122.00157
Reviewed 2023

Peer-Reviewed Journal Article References:
Bloh, C. (2010). Assessing self-control training in children with attention deficit hyperactivity disorder. The Behavior Analyst Today, 10(3-4), 357–363.

Ford, J. D., Racusin, R., Daviss, W. B., Ellis, C. G., Thomas, J., Rogers, K., Reiser, J., Schiffman, J., & Sengupta, A. (1999). Trauma exposure among children with oppositional defiant disorder and attention deficit–hyperactivity disorder. Journal of Consulting and Clinical Psychology, 67(5), 786–789.

Marshall, A. D., Roettger, M. E., Mattern, A. C., Feinberg, M. E., & Jones, D. E. (2018). Trauma exposure and aggression toward partners and children: Contextual influences of fear and anger. Journal of Family Psychology, 32(6), 710–721. 

Murray, K. J., Sullivan, K. M., Lent, M. C., Chaplo, S. D., & Tunno, A. M. (2019). Promoting trauma-informed parenting of children in out-of-home care: An effectiveness study of the resource parent curriculum. Psychological Services, 16(1), 162–169.

Review of Life & loss: A guide to help grieving children (2000). [Review of the book Life & loss: A guide to help grieving children (2nd ed.), by L. Goldman]. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 21(3), 141.

Salinas, C. L. (2021). Playing to heal: The impact of bereavement camp for children with grief. International Journal of Play Therapy, 30(1), 40–49.
                                                                                                                 
QUESTION 10
What are the five steps in the five feelings technique? To select and enter your answer go to Test.

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