Thursday, August 25, 2016

3 year old's outbursts at aftercare

Good Morning Dr. Gottieb, I have a 3 yr old son who is showing signs of "Anger Overload". He has been going to a before/aftercare facility for two semesters and recently has been having anger outbursts. Throwing his shoes, continuous crying, shouting, kicking/hitting, and shouting "No". My wife & I also witnessed the behavior recently, while we were out shopping in a Shopping Mall. I've tried the Negative Consequence approach but he seems to not respond to it lately depending on his environment. I must say when he's home with me, I don't receive nearly as much defiant behavior. I've used standing in a corner and/or sitting on the steps as a consequence for the anger behavior/outburst. I just brought your book "Your Child is Defiant:Why is Nothing Working?". I just am willing to do whatever it takes to help my son. Any assistance you can provide, I'd greatly appreciate. I look forward to your reply and have a good day.

Hi, in my book "Your Child is Defiant" I first ask parents to keep a record of what is happening before their child explodes.  After you make notes about several incidents, look for themes.  Not all situations will fit one theme, but you might find some overlap. In my defiance book, I write about loss of time with an adult as one possible trigger. Others could be: when the child is not getting to do what he wants, or when he has to switch activities, or when he expects something else to happen.  Once you see some patterns, you would try to intervene early in the behavior pattern in the future to try to head off an outburst.  You can use distraction techniques, cues in advance that explain what he can expect that day, or mantras (sayings to remind him how to deal with disappointment). I explain in detail how to use these techniques in my anger overload books, 

For three year olds, one aspect of emotional development at this age has to do with learning how to deal with limits (he can't have everything he wants!).  A three year old is going to experience disappointment as he learns the adult world does not always respond the way he wants.  Helping a child anticipate what to expect on a given day, and helping him move on when disappointed is an important goal.  The strategies I outline in my books are designed to help a child deal with frustrations and disappointment.  

Negative consequences do not often work with anger overload, because the emotions are so strong and quick.  I'd recommend trying distraction, advance cues, or mantras.  If you want to try incentives and consequences, make sure there are fairly immediate incentives for self control. Do not rely only on negative consequences.  The best negative consequence for young children is withdrawing your attention, so having your child stay by the stairs for a few minutes (as you are doing) makes sense.  But use some of the other strategies as well, rather than rely on time outs.

Best, Dr. Dave Gottlieb

Thursday, July 28, 2016

Adult not previously diagnosed with anger issues

I was told that I had ADHD as a child, but from what I have found out I also had anger issues. I also had learning problems. I don't know what all was done to treat this since this was in the 70's and I am now 50 years old. I have no memory of much of my childhood and I only know things that my sisters have told me. I still have many issues and I would like to know if there are any treatments that help adults with these issues because they didn't go away with age. Some days I think I'm loosing my mind. I have been on an antidepressant but it doesn't seem to work because I still have these issues.  I can control them until I get home and then I loose it. My husband tries to help but he doesn't understand how. If you could give me some insight to this and how l can get treatment for this it would mean the world to me and my life.  Thank you for taking time to read this.

Yes, it's not unusual that many adults in their 50's were not diagnosed as children with ADHD, learning problems, or anger overload.  More children are getting help today than in the past. But adults today can also get help for these issues.  I would recommend you meet with a psychologist who works with issues like ADHD and anger overload.  You can ask the doctor who has prescribed the medication who he/she would recommend, or you could call your state's psychological association for a referral in your area.  

The three issues you mention--ADHD, anger overload, and learning problems--can occur together and each one can impact the other.  For example, people with ADHD are sometimes impulsive, so that when they get frustrated it can be harder to stop and think before saying something they later regret.  Learning problems often co-exist with ADHD and can cause frustration and anger.  Children and adults who have trouble writing or reading for example can get frustrated when faced with a writing task in school or on their job.  A psychologist can help you strategize about how to deal with any of these possible issues.  

My anger overload workbook can help with anger issues.  While written with children and teens in mind, most of the exercises and strategies can be used by adults as well. It is available online at Amazon.

Best to you, Dave Gottlieb, Ph.D.

Tuesday, July 5, 2016

7 yr old removed from day care

Dr. Dave,

I saw your blog on the Internet and thought I would ask you for advice, honestly because I feel as though I have run out of other options. By the age of one, my son was kicked out of three daycare centers and working on the fourth. He would bite, hit, pull other children's hair, and so on. The teachers never recognized triggers that set him off and the acts seemed to always be random. Half of his first month in kindergarten, my son was suspended due to his aggression once again. He was finally old enough to be evaluated at that time and was diagnosed with impulsive ADHD.  The medication prescribed certainly helped with his level of energy because he could never sit still, but it did not help with his anger. 

Now at the age 7, he is looking to be removed from yet another daycare center after spending only three weeks there. From what the teachers say, the smallest events such as a kid not sharing a toy can lead to him being enraged. He throws chairs, punches other kids on the face, calls the teachers names, and so on.  Once he calms down, he realizes what he has done and feels guilty.  He can clearly verbalize what he did wrong and how he could have responded differently. 

Sometimes when I talk to him after school about his actions, he tells me he feels he is the worst child in the world and that I don't deserve to have a child like him. He has even gone as far to say that he wished he was dead. My heart absolutely breaks when I hear him say such hurtful things to himself.  He should not be saying these things especially at such a young age. I have taken him to see child psychologists before in the past to help him develop better coping skills but there was no improvement. 

I actually had a child psychologist tell me that he didn't even know what else to do to help. I read your article about anger overload and really feel that this could be the reason for his actions. The problem is I don't know how to help him. I am a single parent that has to work so he has to go to daycare. With that, he cannot get one on one care at daycare or school with a hundred other children running around. How would you recommend teachers, daycare providers, and myself working together to ensure we help him make better decisions even though they have other children to look after? I'm just not sure of what proactive measures to take. I would greatly appreciate any tools or advice you have to offer to help. He is really a sweet and loving boy but I want others to see that as well, to include himself. Thank you.

Hi, I outline some ideas for schools (that would apply to daycare as well) in volume two of my parents' manual that focuses on strategies for schools. You are on the right track about the idea of working together with the teachers and daycare providers.  A coordinated approach will work best.  First, everyone should observe for a week or more, and make a list of situations when he becomes extremely angry.  Then try to identify some themes.  You mention one in your email:  sharing toys.  

One strategy would be to try to change your child's expectations about sharing in daycare. You would create a short saying, or mantra, and say it out loud with him each morning and night. You might even have him draw a picture of it and put it on the refrigerator at home.  An example of a mantra would be:  "I'm 7. I'm old enough now to share toys."  or "Can I learn to share toys?  Or "Am I going to hit someone who wants to share?"  Or write a mantra with your child.  Pick one that he likes, so that he will be more likely to remember it.  The reason you practice saying it out loud twice a day at home is to increase the likelihood your son will remember it at the time someone wants to share.  It would also be helpful to have the day care adult remind him of the saying before he starts playing with toys each day. 

I write about other ideas, such as emotional distraction and relaxation stations, in the blog and in my parents' manuals.  You might also ask your son every day to tell you if he shared toys, and put a star on a calendar every day he shares at least once.  In addition, ask your town librarian for suggestions on children's books about sharing.  You make a big deal out of sharing, in other words.  

I would recommend focusing on only a couple of themes (or triggers) for a month before working on others.  You want your son (and the day care staff) to taste some success and feel good about him having self control, and if you try to do too much at once, it will be harder for your son to focus on what he needs to do.  As he gains self control, he will feel better about himself.  In the meantime, you might also "reframe" what he says when he says he wishes he were dead.  You could say, "You feel awful when you hit someone, but we will work together so that you can learn to control your anger."

Best, Dr. Dave Gottlieb

Thursday, June 30, 2016

4 yr old throws things


I stumbled upon your website as I had been desperately trying to find out how to help my son. He will be 5 in October and was a micro-preemie, born at 24 weeks and weighing just 1 lb 8 oz. He has experienced delays from the start; however, nothing major physically and he would have spurts where his speech or skills would catch up. But his emotional outbursts were always there from the beginning. From a very young age, he had issues with anger/frustration. He would actually fall to the ground into a type of "coma". That's the best way I could describe it. His eyes would be open and he was indeed awake but he wouldn't cry or speak until the feeling passed....sometimes for 30 minutes.

He doesn't do that anymore thank God but when angry, he still shuts down and will not communicate no matter what I try. He is now in preschool and having issues. he throws things and screams so loud for so long that the teachers are unable to control him and fear for the safety of the other kids (from him throwing things, not from him hitting.)  He has been through several evaluations and the Dr's all cannot find anything to explain it (he did not test on the spectrum) as 60-75% of the time he is quite normal, happy and social. People have been telling me it's me being paranoid since he was so early, or that he needs his butt whipped or that he'll eventually "catch up" and this has left me frustrated and feeling very alone in my search to help him.

Your article about Anger Overload was the FIRST thing that aligned with his symptoms!!! I have contacted a child counselor to see if they provide Parent - Child Interactive Therapy so I can learn how to best deal with his outbursts. I also plan on buying your book tonight in the hopes that this four year nightmare will finally end. It's not the anger I have an issue's NOT knowing what he is going through and how to help him. Having a name for it (and not succumbing to labeling him but rather focusing on giving him outlets) helps me so much. Thank You, thank you, thank you!!!!

Hi, research on anger suggests that the structures in the brain that have to do with anger and self control are the amygdala and cerebral cortex.  The cerebral cortex receives signals from the amygdala; for children who have difficulty with self control, one prominent theory is that the cortex is not developed enough yet to manage the signals from the amygdala.  The cortex gets overloaded.  Hence the term anger overload.  The exercises in my parent's manuals are designed to help children cope.  I think that as children practice the strategies the control centers in the brain become further developed.    

The emphasis of the first chapter of volume one is careful observation.  You would write down what happens and look for themes.  What issues sometimes trigger your child's anger?  Then you would keep an eye out for these triggers.  The next chapters of the manual offer a number of strategies.  One set of strategies involves changing the sequence of events to avoid a trigger.  When this is not possible, early intervention is key.  Emotional distraction can help if a child is not yet in overload.  Also, developing "mantras," or jingles, helps a child to change his mental set (his expectations) and this often helps to change the way a child acts. I explain how to develop these strategies (and more) in my parent's manuals and in other blog posts.  In the second volume of the manual, I also explain how to use the strategies in a school setting.

When a child is throwing things, he is in the overload phase.  It is hard to reason with a child in this stage because he is not thinking rationally.  His cortex is overloaded.  When he is calm, in addition to the above strategies, I would try to develop a "go to place" when he feels an upset coming on, and reward him heavily for trying to go there when he is frustrated.  In the "go to place," I would have something he could hold and/or squeeze to try to comfort himself.  If he throws something there, no one gets hurt.  It is not easy to accomplish this because your child (given his age), will not usually realize when he is starting to get upset. Thus, it is important to help him see early signs of getting frustrated and point out which situations he should look out for.  Most young children though need an adult to cue them to use the "go to place."  At that point, do not explain what you see happening, just cue him to use the "go to place."  Keep the cue short.  

For older children (ages 8 and above) we recently developed an anger overload workbook that parents can work on with their child.  But for younger children, the parents' manuals are what you should read.  Best, Dr. Dave Gottlieb

Monday, June 27, 2016

ADHD and anger overload

I am emailing you in hopes of some answers to the cause of my 6 year old daughter's anger outbursts. She has never been formally diagnosed with ADHD, but she has many of the symptoms for it. She can be fine one minute and if something sets her off, she goes into a rage of anger. I can't talk to her or go near her. She has attacked me, hitting me, slapping me, and kicking me. What do you think is going on?

First, you may want to ask your child's doctor or a local mental health professional to determine whether your daughter has ADHD.  There are several subtypes of ADHD: a) primarily inattentive, b) primarily hyperactive-impulsive, or c) combined type.  For inattentive ADHD, there will be signs of distractability, particularly when a child is not very interested in something.  This might be apparent during a long school day, such that the child tunes out at times.  

For hyperactive-impulsive ADHD, the child will be "on the go" a lot, and may 
exhibit extraneous movements of her limbs, or wiggle a lot in her seat.  You would also see signs of impulsivity, such as responding without thinking and blurting things out in school or at home. Many six year olds may have some of these behaviors, so that is why a professional would be able to tell you if it is more than expected for her age group. 

Children with ADHD may also exhibit anger overload.  If a child has the impulsive type of ADHD, he may be prone to reacting quickly and excessively when angry.  That is why treating ADHD may be helpful in lessening anger overload.  Keep in mind that these are two separate diagnoses, and your child may have one or the other but not both.

For anger overload, I discuss in my parent's manual how to keep track of your child's triggers and look for themes--is there one or more common factors that can help you predict when she will erupt?.  Then I outline a variety of strategies based on when you recognize your child is getting angry.  There are different strategies depending on whether you see early warning signs or not. Sometimes children go into the overload phase so fast that it is hard to work around it or to implement emotional distraction or relaxation strategies.  Over time though, you may be able to come up with mantras (short sayings) ahead of time to help your child deal better with frustration.  The mantras can be verbal, or you can work on pictures with your child that you can post on the refrigerator.  The content of the mantras depends on the theme(s) of your child's triggers.  The idea is to remind her ahead of time how to expect disappointment and how to handle it.  This process is described in more detail in my parent's manuals and in other blog posts.  It can take several months to develop and practice mantras with your child so that they become "internalized" by your child.  You would give her praise for practicing mantras with you daily while she is calm.  The more days you practice, the more likely the strategies will become effective.  

Best, Dr. Dave Gottlieb

Thursday, June 16, 2016

5 yr old's anxiety may trigger outbursts


I've been reading your blog lately (and have just ordered 'Anger overload in children' out of interest for my own five-year old daughter whose behavior is relatively consistent with descriptions of anger overload. I am writing to you for assistance with one particular and related issue she has: she doesn't seem to have 'normal' outlets for expressing anxiety and stress, seemingly resulting in anger/tantrum issues. For example, she rarely cries (something we've been working on) and has the tendency to bury her negative emotions until they become too overwhelming, leading to what are sometimes hour-long tantrums. The tantrums themselves can be triggered from innocuous daily activities, are rarely goal-driven, and are often triggered during sleep. The tantrum itself occurs almost always at home, and my spouse and I sit by her to ensure her safety and to provide verbal support. In the end she typically winds down herself or might be distracted (after 40-50 minutes) by a story and then snaps back to her usual, happy personality as if nothing happened. When queried about it hours later or the next day, she replies with unrelated comments and evades the question. Other than these events she seems like a regular kid. 

We've moved around quite a bit in the last few years so I suspect we know that the trigger is the anxiety, stress, and insecurity that comes with such moves. We're in the middle of our final move now where we will be settling for the next 20 years, but I'm concerned about how to deal with her in the here-and-now.

These explosions used to happen every few weeks (which seemed normal) but are now happening on a more regular basis (every few days), hence our concern. My main question/concern is that while we can often see the tantrum coming and if need be can distract her from having one, I question the wisdom of distracting her, as without one she seems to just continue to bury and build anxiety. Eventually, these feelings seemingly need to be released, I suspect. These tantrums, as disturbing as they are, seem to offer a release of sorts given her propensity to hold everything in. I was wondering if you might have insights regarding the need to actually have a tantrum to release anxiety and stress and how we might encourage her to release stress in real-time in other ways so that it doesn't build up in unnatural ways. Thanks kindly for your time.

Hi, I would recommend helping her deal with stress in other ways, if possible. Tantrums may release her frustration, but it would be ideal if she could learn a more adaptive way of dealing with whatever is bothering her.  First, I would think about what the stressors might be.  You mention frequent moves:  does she say anything about the moves, or does she seem more anxious right after a move?  Also, keep notes for a few weeks about what is going on before she has a tantrum.  While children can tantrum in many situations, see if there are any themes.  Does she feel disappointed or irritated by certain types of events?

You also mention it happens when she is sleeping.  Does she wake up with a nightmare, or is she having night terrors (when a child does not fully wake up)? If the former, see what the theme is and when she is fully awake try to talk with her about her fears.  Depending on what it is about, you can either "normalize" and empathize with her concerns, or reassure her if she is worrying about something that has little likelihood of occurring.  If it is night terrors, it is better to let her go back to sleep without necessarily intervening.  With night terrors, children are not awake and won't usually respond to being held or talked to.

If you feel it is about the frequent moves, then see if you can empathize with her about how hard that is.  Maybe the children's librarian can help you find a story book about a child who moves.  This may help her see it happens to other children and she may be able to talk about how the character in the story feels, without talking about herself.  Some children can talk better about their feelings indirectly--that is, about a story character.  This may help her relax.  

In my manuals, I write about developing mantras that help a child deal with feelings of frustration or disappointment.  The mantra would be short and catchy, and you would review it with her daily.  Maybe have her draw a picture of the mantra and put it on the refrigerator to help her remember.  In time, this may help her "express" her feelings.  

If you do not see a change in her behavior after you settle down in your new home, maybe check with a mental health professional who can try to assess what else might be bothering your daughter.  It sounds like you are very sensitive to her needs, and you may be able to  help her at home.  But sometimes we are so close to our children, we may not see something else that could be bothering them, so if you do not see any changes in the coming month or after you have settled into your new home, consider a therapy consultation.

Best, Dr. Dave Gottlieb

Monday, June 6, 2016

How does cognitive behavioral treatment work for anger overload?

In answer to the parent in my last blog post, I mentioned that my anger overload parent's manuals and children's workbook use aspects of cognitive behavioral therapy.  The "cognitive" part means than if you change the way someone looks at something, you can help them learn new ways of coping.  So part of helping someone with anger overload is helping them understand what is going on when they get angry.  This is why the first part of my books instructs parents and children to record some of the situations that have led to angry outbursts, and then look for patterns.  Not every outburst will fit into one pattern, but the more patterns you can discover, the better you will be able to help your child devise strategies to master his or her anger.

Now, because most children's emotional responses to frustration are so quick and "automatic," knowledge (about one's triggers) alone will often not be enough to prevent angry outbursts. This is why catching anger early, and, if possible, preventing it in the first place is so important.  Therefore, many of the strategies I outline in my parent's manual and children's workbook aim to help avoid or change the sequence of events that brings on a child's anger.  Knowing the child's triggers will make it possible in the future to avoid or change some situations that typically have led to anger overload.

Another group of strategies has to do with helping a child deal with his vulnerabilities that can trigger anger.  So if a child is triggered by losing a game (as was the case in the last post by the parent of the 9 year old) it is important to help change the child's perceptions about losing BEFORE he loses a game again.  This is where mantras, or catch phrases, can be helpful to a child.  If they learn to hear the mantra in their heads, they will realize that losing a game is to be expected.  If they accept new expectations about losing a game, they will be better able to cope when it happens.

Another section of the parent's manuals and children's workbook deal with emotional distraction.  If a parent or child is aware of the child's triggers, they can use emotional sayings, lyrics, or activities to re-direct a child's emotions.  To put this idea in another way, it is hard to be angry if you are laughing or feeling joyful.  It is important first to observe one's triggers, because then everyone will be more alert to when an emotional distraction may be needed.

Once anger reaches the overload stage, the strategy becomes one of containment.  Having a "go to place" in your house where a child can emote without alienating other family members can sometimes help.  However, it can be a struggle to get a child to use a "go to place" away from the family because the child is not thinking rationally at times of high emotion.  Thus, it may be necessary for family members to ignore or leave the scene of an outburst, and talk later about what happened when everyone is calmer.  Then the goal is to talk about the triggers later and to try to look for early warning signs that everyone can use next time to try to divert the child at earlier stages of frustration.

More about all these ideas is written in other blog posts and in my parent's manuals and children's workbook.  The children's workbook is designed for children 8 to 18, while the parent's manual is useful for parents of children of all ages.

Dave Gottlieb, PhD