Tuesday, April 24, 2018

12 yr old has outbursts playing soccer

Dear Dr. Gottlieb,

I am so glad to have found your blog today and look forward to reading your books (I just ordered on Amazon).  Your definition and explanation of anger overload (from the greatschools article) fits our twelve-year old boy very closely.  We have been working on this with him on this for about three years.  We have been seeing a child pshycologist for the last two years and feel like we’re making progress.   Initially he barely passed the threshold for ADHD but that diagnosis didn’t fit for us and an attempt at  trying the traditional stimulants was disastrous (several severe angry outbursts in a short period).  We then switched to SSRI’s on the view that he has underlying anxiety and together with cognitive therapy we think he’s much better at coping and avoiding outbursts.  As an example of our cognitive therapy, an angry outburst at home that involves swearing results in $1 fine to the swear jar.  This has dramatically reduced the swearing incidents.  We also try to talk thru the events afterwards, try to help him understand triggers, what he might have done differently, other’s perspective etc. 

At school, he has only had a few outbursts and never been punished beyond a call to us (twice in five years).  The real problem I’m concerned about is avoidance and withdrawal from “society” in the aftermath of these outbursts. This has meant withdrawal from team and group activities.  For example, he was kicked off a team 2 years ago for two big outbursts. Then after one season a second team would not invite him back due to another outburst.  This week he had another swearing, angry incident with a third team that he has been with for about two years.   He is one of the “stars” of the team, plays well with teammates, shares the ball, is normally kind and considerate etc. This is not a high-pressure team and the environment is generally positive, he usually enjoys practice and games very much. He is indeed a risk-taker and plays with passion and bravery.  However at practice this week he felt slighted by two of the other boys (he said they were tripping him on purpose), had the typical loss of control and angry outburst, and needed to be taken home to cool off.  He is now determined that he will not rejoin the team.   I am confident that on his own accord, he will not go back.

Do you have any advice?   He’s now 12 and I’m afraid we’re at an inflection point where letting him quit delivers the wrong message and won’t help him.   He loves soccer, loves playing, but I believe is now sad, embarrassed and doesn’t want to “face up” to the situation that led to the episode.  He did not want to go to school today (where he would likely see the same boys) but he didn’t protest too much and he was angry but did not lose control and made it to school   From experience, I know that if we try to talk through it, with the aim of getting him back to the team, he will likely become angry and defiant.   Bribery might work but probably not.  I doubt forcing him will work.  Punishment doesn’t seem to be the right approach either.

I would welcome any thoughts!

You've done a great job trying to help him understand his triggers and helping him understand the perspective of others.  It's a shame he was kicked off two teams and now does not want to go back to a third.  The first two incidents set a pattern unfortunately which your son now is continuing of his own volition for the third team.  You mention the trigger for the most recent incident was that he felt slighted and felt he was tripped on purpose. Do you think the boys were doing it on purpose, and were there other reasons he felt slighted?  

Once you have determined what else (if anything) he was reacting to, you would want to help him re-frame these incidents.  Try to help him look at "being slighted" and "being tripped on purpose" in a new way.  For example, you could talk about how even in professional soccer players get tripped, sometimes by accident when everyone is going for the ball, and sometimes on purpose to prevent the opposing player from making a good shot or good pass.  Which does your son think was happening in his game?  By giving him a choice of explanations, you are giving him a chance to say how he felt, and then you can do some re-framing that takes into account his feelings.  

He will probably say it was on purpose, and then you can explain why that happens in soccer, even at the professional level.  Name a  soccer star if he knows any, and explain that he gets tripped too.  The ref is supposed to call a foul, but if he doesn't the player would try to get the ball back when he was able, so that the opponent does not get the advantage by tripping him.  You could practice a mantra (I explain more about mantras in my blog and books):  "fouls happen in soccer."  and/or "When they trip you, it's because they can't keep up with you.  It means you're the better player."  Another possible mantra:  (Name a pro player he knows) and say:  "He gets up and uses his anger to try to get the ball back. You can do that too."  The basic idea is to help your son see that tripping happens a lot, that he is the better player, and that he can do something about it in the game to help his team.

Once you know the trigger, you can re-frame what happened and develop a mantra.  By the way, it's great you got him to go to school.  He will see by going to school that he can deal with what happened, and any anxiety will then decrease.  Whether he plays for this team or not, practice the mantra several times a week so that it will be in his head when he does participate again.  

One last thought:  if possible would the coach call him or have a couple of teammates reach out to say they miss him and need him?  Since he feels slighted, if he were to feel wanted, that would be the opposite feeling, and might help him feel like returning. 

Best, Dr. Dave Gottlieb

Wednesday, April 18, 2018

9 and 5 yr old bicker and break things

I read your November article in Greatschools and found it helpful. I will order your parents manual and the workbook.

I have a 9 year old and a 5.5 year old, both have significant anger overload issues, at home. At school they are model students.  My daughter is a high performer and probably has some stress related to that, she is also very shy so would never speak out at school. She is a nail and lip biter, so some evidence of anxiety. My son probably has dyslexia- we are working on that with a speech pathologist, and I think it affects him emotionally a little bit, but we talk about it and he seems fine at school. But in general at school they are incredibly well balanced and teachers say of both of them, that they are real carers always looking out for other students. They are popular with kids and have lots or friends, polite etc. No anger issues at all.

At home it's a different story. They are VERY active children and fight each other for sport. Sometimes this leads to major conflict between them, sometimes violent, biting, hitting, etc. I would say with pretty good frequency, daily? or almost daily.

Even without fights between them, they fly off the handle wildly and frequently. My son, if he struggles with legos will scream, really scream. He will throw things, damage things around the house.If he's really angry at me, he might pull all the bedding off my bed, or take clothes out of my cupboard and throw them on the ground. My daughter gets angry before school every morning because it's difficult to get my son out of the house. She shouts, at the top of her lungs and threatens him with toys she will never let him play with again. If he is in her vicinity she will trip him or push him.

Last week, we were watching a family movie and the children were bickering. I separated them. It continued. I reminded them that the consequence for yelling and out of control behavior was to lose the movie. So finally I switched the movie off. He took two wine glasses off a counter in the kitchen and threatened to smash them together. He kept threatening, until finally he banged them lightly and they shattered.

Then I lost my temper. And here I think is the root of the problem. I don't lose my temper very often, but occasionally. And I think it's enough that they see this behavior modeled by me, and then they model in the same way. 

I had a similar anger problem as a child and as a teenager. My parents could not manage me. I don't think I have ever lost my temper in public, and it's very much a 'fight or flight' anger related to feeling as though I cannot control a situation, feeling disrespected or humiliated.

So I usually try to remain calm and speak calmly and try tactics to help the kids avoid outbursts, but when I've been doing it for days on end I'm totally at the end of my own coping rope, I feel backed into a corner, because I cannot control this chronic daily problem, of screaming, back talk, and fighting. And then I explode. I shout. No hitting or throwing things. This solves the immediate problem, because the kids are scared and they stop. But I know it's a completely wrong tactic.

I am consistent with consequences, but there aren't very many in our house. Just our Friday night movies. We don't have any other TV etc.  I have also canceled playdates as a consequence.  We have a 'house rules chart' that indicates behaviors that are not allowed. We made that chart together.  Maybe we need to remake it. And I always make a point of praising them for good behavior, or managing themselves through situations that sometimes cause stress (like a lego problem, or solving their own conflict).

There are other things too of course. We are going through a stressful time in our life. We have lived abroad for eight years and are supposed to be leaving this year but we don't know where we will move or when. So there is ambient stress in the household. That said, they have more or less always been like this, it just happens to be worse right now.

Apart from the manual and the workbook, do you have any other suggestions for resources? 

I would be grateful for any additional advice.

Hi, you are doing a great job in a difficult situation.  I like that you have tried a chart and that you praise your children for good behavior.  One idea is to use a catch phrase (that suggests how they should behave) either before they misbehave or when there is the slightest sign of a problem.  So if you know they get into fights when they are doing a joint activity, such as watching a movie, explain beforehand that "movie time is quiet time" so we can all hear it.  At the slightest bickering, take away the movie.  Have in mind a go-to-place for each of them.  Tell them where that is ahead of time, and explain that if they both go to their places if you turn off the movie, they will get to watch the end of it later (mention a time), but if they don't go when you direct them to, the movie will be lost entirely.  The idea is to plan in advance, catch any problem early, and take action.  If they fail to obey, there is a significant consequence: no movie.  They may test you on this, but if you hold firm, they are likely to behave better the next time you show a movie.

With other situations, use the same principles:  catch phrases in advance, early intervention, and take action (using as few words as possible when they are misbehaving).  For example, with legos, say in advance that "legos break easily," in other words, predict what sometimes happens that frustrates your son.  You could add: "when they break, say 'I knew you would break.'"  Then you model the words by making something out of legos, say the catch phrase before you start, and then say "I knew you would break," when a piece breaks off.  After you model the behavior, then he is to say the catch phrase and then he can build something.  Praise him if he tries to follow your example.  When a piece breaks, if he does not say anything, you say "I knew you would break Mr. Lego."  

Another idea is to use humor and emotional distraction.  If you say something that makes him giggle or laugh that will interrupt his anger.  So you could talk to the legos:  "You silly legos, why don't you stay together?  I'm going to give you one more chance, or I'm going to tickle you."  Now we don't normally talk about tickling legos, but the idea is to say something strange to get him to laugh.

For your daughter, predict that her brother will be slow getting ready in the morning, and explain her job is to play in a different room and give him no attention until he is ready.  Explain that her brother probably likes making her mad because he has gotten her attention then.  If she does not understand this, that is okay, but try to have her play where he can't see her, and praise her later for ignoring him.

Hope this helps.  When you move, you might also want to meet with a therapist who works with children and their parents.  Best, Dr. Dave Gottlieb

Saturday, March 24, 2018

Risk Taking and Anger Overload in 3 yr olds

Dr Gottlieb,

I'm writing to thank you for your research and work regarding this subject. My wife and I have a very sweet and generally well-behaved 3 year old girl, who's been presenting "anger overload" behavior exactly as you describe in this article you authored in November. 

What really then took my breath away was this passage, which again described her almost perfectly:

these children are sometimes risk takers. They enjoy more physical play than their peers and like taking chances in playground games or in the classroom when they feel confident about their abilities. Other children are often in awe of their daring or scared of their seemingly rough demeanor. Perhaps most interesting is that these very same risk takers can be unsure of themselves and avoid engaging in other situations where they lack confidence.

This personality trait "fit" is uncanny! 

I've ordered your books on the subject, and look forward to reading them. We also plan to see a child therapist, as she has become disruptive at school and home when upset.  Do you have any recommendations for therapists?

Hi, you want a therapist who meets with children and with parents.  For younger children, parents are the main change agent.  That is, you will implement the strategies described in my parents' manual that will help your child develop better self control.  That is why meeting with the therapist without your daughter will be important.

For older children and teens, both parents and children can implement changes.  For children 8 years and older, I recommend the Anger Overload Workbook.  Both the workbook and the parents manuals are available online at book sellers like Amazon and Barnes and Noble.  Also, you may find some of the advice I've given to parents on this blog useful for you and your daughter.

Best, Dr. Dave Gottlieb   

Wednesday, March 7, 2018

Moving to a new community triggers anger overload

Good day Dr. Dave.

My family has recently moved out of the country, and this transition seems to have triggered anger overload with my 10 year old son. We think all the changes happening have affected him a lot more than we thought they would (leaving friends, family and pets, new home, new school, new culture, etc.). I’ve been reading about this condition and most of what I’ve read is reflected in my son’s behavior. We are trying to apply all the suggested actions, but are very concerned about his possible actions. He has threatened to run away at night, hurt himself and other unpleasant things to hear. He is violent verbally and physically towards us when having episodes. Is it very hard for him and ourselves in this situation, since there is currently not many people for him/us to reach out to since we’re in this new environment.

In this particular situation, do you think this could fade away once he’s adapted to this environment?

Hi, When a child is making repeated statements about running away or hurting himself, it is usually a sign that he is under significant stress.  An exception is when a child is being manipulative to try to get what he wants.  That does not seem to be the case here.  You mention in your letter the number of changes that have occurred since your move.  I would recommend listening empathically to your son's underlying concerns.  You may want to help him put it into words before or after a tantrum.  The idea is to help him verbalize what has changed and how hard it is for him.  But during a tantrum, try to say as little as possible.

Is there a counselor at school or in the community he can talk with as well?  Sometimes children can voice their concerns  more easily to a neutral person, rather than a family member.  For other children, it is easier to talk to a parent.  Which do you think would be easier for your son?

I would expect his tantrums to lessen, once he adapts more to the new community.  See if you can replicate some of what he liked in the previous community.  Was he into sports or the arts? Did he like hanging out with friends? Can you find avenues to meet these needs in your new community?  

Other suggestions for dealing with angry outbursts can be found in my parent's manuals and children's workbook on anger overload, or in other posts on this blog.

Best, Dr. Dave Gottlieb

Monday, February 12, 2018

4 yr old tantrums going to preschool

My son is four and was late at learning how to walk and talk. He’s always had anger issues and even as a baby would scream and scream and we never knew why. Now his behavior matches your description of a child who has anger overload; he’s good when he’s not experiencing that. So my first question is, what resources do you recommend for those of us who have a child this young, and secondly, how do I get him to go to preschool. He starts regular school in August, so I am worried that if I don’t teach him to go to school now then he won’t then. He says he loves school but he has stayed at home his whole life up until now and is used to staying at home and playing games all day. Now he has to go to school and every morning it takes twenty minutes to get him from the car to the school; he kicks and screams as loud as you can possibly imagine. He tries to run away; he does everything he can to not go. I’ve given in to not taking him a couple of times but now I realize I need to stick to him going but it’s really hard and I feel guilty for giving the teachers a kid who is screaming and kicking like that.

Hi, Two of my books are written for parents to use for children of all ages:  "Anger Overload in Children:  A Parent's Manual" and the supplement: "Anger Overload in Children:  Additional Strategies for Teachers and Parents."  Two strategies that might be useful for your son are 1) changing the expectations and 2) altering the sequence.  Children who have a close bond with their parents often show separation anxiety when it is time to get ready for school.  For some children this takes the form of crying and for others there are angry tantrums.  How can you change expectations or the sequence in this case?  One expectation a child has is that if he screams loud enough, the parent will hear his distress and take him home.  After all, most parents pick up their child when he cries at home, so in a child's mind, why not scream now on the way to school? Thus, one thing to do is to leave immediately when the teacher meets you and your child.  Tantrums will last longer if your child expects he may be able to go home with you, and generally decrease in intensity once the parent is out of earshot and the child can no  longer expect to be taken home.  

Another rule of thumb is don't give in to the tantrum and stay longer, as the child has succeeded in delaying the separation from you and will continue screaming.  After a few weeks, tantrums usually lessen, as the child comes to expect you will leave despite his screams.  For some children this can take more than a few weeks, and others less time.

One way to change the sequence is to have someone else get your child ready in the morning and drive your child to school:  your spouse, or a grandparent, or a parent of another child going to the preschool.  Children will scream longer when leaving the parent to whom they are most attached.  Having a different adult come get him ready for school or come to pick him up will lessen the tantrums.  One possible scenario to disrupt the sequence is for you to stay in bed and pretend to be sleeping or pretend to be sick, and have another adult get your child ready for school.

Once a tantrum is in full gear, it is hard to stop.  This is when I recommend trying emotional distraction. In the case of leaving home for school, it can be difficult to change a child's emotional state, but if you can get your child to laugh, or to participate in singing a favorite song, or to play a favorite game in the car, it will lessen the tantrum. 

When your child is in full tantrum mode, do your best to ignore it.  Try not to talk with your child while he is screaming, as generally, the more attention you give, the longer it will last.  If your child settles down, talk with him then.  Don't feel guilty, it is okay for your child to react to separations.  And it is okay for you to ignore them.  Separation anxiety is quite common for preschool and kindergarten, and sometimes for early grades in elementary school.

Best, Dr. Dave Gottlieb

Wednesday, January 17, 2018

Medication question

I have an 8 year old that I think is experiencing anger overload based on your descriptions. He does not exhibit any symptoms that would indicate he also has ADHD.  If that is an isolated diagnosis, is there a particular medication route that you recommend in additional to cognitive and behavioral therapy?

Hi, There is no medication specifically for anger overload.  If there are other problems that are contributing to the anger overload, then sometimes medication can be helpful.  For example, if a child has ADHD or if a child exhibited signs of bipolar disorder, the medication for those problems might lessen the eruptions of anger.  Or if a child is highly anxious or depressed, there are medications that are sometimes helpful.    

If you want to read more about what else could contribute to anger overload, I explain about dual diagnoses and possible medications in my other books. One book is called: Your Child is Defiant:  Why is Nothing Working?  The website that reviews this book is yourdefiantchild.com.  You can also order the book from this site.

My earlier book is about dual diagnoses for ADHD.  It is called Why is My Child's ADHD Not Better Yet?  Recognizing the Undiagnosed Secondary Conditions That May Be Affecting Your Child's Treatment.  I wrote that book with two other authors, a psychiatrist and a learning disability specialist.  It is available on Amazon.

Take care, David Gottlieb, Ph.D.

Wednesday, November 15, 2017

7 yr old throws things in anger at school

I have a 7 year old son who is having problems at school.  He did fine in kindergarten, but started 1st grade and explodes in anger on several occasions.  He gets angry if children are looking at him, he gets angry if he can't be the first person in line, he gets angry when he is told to stop talking.  Recently he got so angry that he crumbled up his work at school and threw his math book in the trash.  He also swung at his principal.  This led me to remove him from the school.  It was a private school.  He is now in another private school.  A couple of days ago he got angry because he wanted a certain eraser and the teacher told him someone else was using it.  He threw the eraser at the child, threw a pen at the teacher and ran out of the school into the street.  He tells the teacher that they can't tell him what to do and only his mommy can tell him what to do.

      I returned from a deployment a year ago in the military.  I was gone for about a year.  After a year, I came back for my son and he spent the duration of my deployment with me.  This is when the behavior started in school.

      He does not display this type of behavior at home or with my alternative babysitters. If he does get angry at home, it is only for a second and he changes his behavior.   He is a straight A student in school.  This new school is more challenging for him.  However, I feel that it is only a matter of time before this school dismisses him.  Any help would be appreciated.

Hi, I have a few thoughts.  One is I would consider convening a meeting with his teacher, and include your son. You could then say in front of your son that the teacher is the boss in the classroom and that it is important that everyone listen to her.  The teacher could send home a daily sheet with smiley faces if your son followed directions and if your son was respectful to others. Then you could praise your child for showing respect and self-control.  In a sense, what you would be doing is making the teacher an "extension" of yourself.  Since your child respects you, maybe this would help him learn to respect the teacher.

The theme of many of the triggers for your son's outbursts have to do with not getting what he wants or expects at school.  It is a tough developmental task for many young children to accept that they are just one of many students, and they cannot have everything they want.  At home, it is different.  Your son may be the only child, or one of a few children, so his needs are more front and center at home.  I would suggest telling nightly stories (you can make them up or ask the local librarian for suggestions for appropriate books for young children) about going to school and following directions, and how happy that makes Mommy.  Or draw pictures together at home about what to do when you don't get to be first in line, or don't get to use the eraser you want.  Stories and pictures are a good way to transmit behavioral expectations to young children.

The last thought I have is whether underlying your son's behavior is his need to be "first" because he missed being the center of your attention for a year, and in a sense wants to make up for lost time.  This can happen despite everything you have done to attend to your son. This is only speculation, but if your son does not make progress in self-control at school with the behavioral suggestions above (or with the additional suggestions in my parenting book on anger overload), then I would consider psychotherapy to examine possible underlying separation issues.

Best, Dr. Dave Gottlieb