Monday, January 28, 2019

11 yr old with anger overload, ADD, and anxiety

Hi Dr. Dave,

I have just read your blog and article at Great Schools. I write to you because I feel identified with the stories you share. My son has been diagnosed to have ADD. He is also is diagnosed by IEP and by his pediatrician to have OCD, anxiety and mild depression.

My kid is having a hard time to at least find one close friend to come over for a play date that makes him feel very lonely, even when I am trying my best to have him busy. I find this situation challenging for me as a mother with not family close by. I have also a 14 year old, and he has good friends, and my 11 years old is always jealous and defiant with him because he cannot get friends like him. I am teaching  my older son to help his bother and be kind and tolerant because of the current issues with him. 

I see your description of overload anger and it pictures my child suffering from that more than anything else. I am a divorced mother. His father used to have this overload anger too very often, throwing things to the floor when you did not do things in his way or was in disagreement. Yelling or getting angry very fast for any minor issue. Sometimes yelling or even slapped one of my boys for minor things. I see my child react the same sometimes by throwing things to the floor or yelling.  

I found your techniques very interesting. I would like you yo please give me the title of all your books to help me out to help my son. He is 11. I wonder if you still work in Chicago. I am willing to maybe set up an appointment with you via phone conference if you are still in practice. 

Unfortunately, the father of my kid doesn’t want to accept that my kid has an ongoing neurological problem. I asked his father to come along to therapists, and he always discusses and affirms to them that my kid doesn’t have any problem at his place and he is well behaved at his home. I always believe he may have had this problems as a kid and he doesn’t admit it or want doctors  know it. However, he doesn’t understand that denying this problem and not accepting participation and leaving my son with no  therapy will leave him growing up unhappy and increase his anxiety and possibly a constant depressive mood. 

Please I would like to know your thoughts! 
Thanks for support with articles to parent like me!!


My books are available at online sites like Amazon and Barnes and Noble.  My books include Anger Overload:  A Parent's Manual, 
Anger Overload:  Additional Strategies for Teachers and Parents,  
The Anger Overload Workbook for Children and Teens,  
Your Child is Defiant:  Why is Nothing Working?
Why is My Child's ADHD Not Better Yet?   

It would help if all the adults worked together on the strategies I outline in my manuals.  Maybe don't disagree with the Dad about what happens at his house, but still let him know what you are working on at your house.  Maybe then he will consider the strategies too, even though he says that he does not need them.  Also, you could ask his father to let your son know that he supports your plans and wants your son to use the strategies at your house. 

Read the parent's manual first.  Next, the workbook for children and teens is for children 8 and over, and you could read that book with your son and devise strategies together. One of the books is especially written for teachers.  The other books help give advice for ADHD and for defiance.  

Regarding making friends, ask his teacher if there is anyone he spends time with at lunch or recess.  Also, try to find a children's club or group activity that meets regularly in your area.  Sometimes, a friend emerges from these activities.  Also, the school might have a social skills group that meets weekly during school hours. 

I don't do phone consultations, as state licensing laws do no yet permit that in most states.  Keep working with a mental health professional in your area and with the school.  See if you can implement some of the strategies in my books.  Over time, your son can develop better self control.

Best, Dr. Dave Gottlieb

Thursday, January 3, 2019

Grandma worried about 8 year old

Dear Dr. Dave,

I was just reading your blog and so many of them describe my grandson.  I am so worried about him.  He is an 8 year old boy who for the past 3 years has shown outbursts of anger.  It has gotten worse over the past year.  My daughter is taking him to a psychologist for the past few months.  She has suggested several different ideas to help him work out his anger.  Glitter jar to shake, or go to his bedroom, or make a fort to go to into when he is angry, but he does not do these things. When he gets angry he sometimes gets physical.  I notice that sometimes before it starts, he makes a growling noise.  He cannot tell us why he is getting angry.  There have been problems in the home at times.  His parents argue in front of the kids.  It is breaking my heart to see him going through this.  He tells them sometimes in this rage that he wishes they were dead.  

Does this sound like anger overload?  Need help to understand and help him!!!!

Hi, What I would recommend is writing on some paper what is going on each time before he explodes.  Has there been a disagreement among his parents?  Is he disappointed that something did not go his way?  If you can keep track of what happens first, then you might notice a theme or pattern.  You might be able to see what kind of issues precipitate his anger.

Then, you can try to head off an outburst by using one of the techniques I describe in my parent's manual.  You can use "emotional distraction," or lower your grandson's expectations before he gets upset, or use a calming technique with him. I describe these strategies in my manual and in other blog posts.

One thought I have is to use his growling noise as a sign that he is close to getting into the overload phase.  See if you can use emotional distraction or a calming strategy  at that point, before he explodes.

The reason why the strategies you describe above (like going inside a fort) do not work well is that once a child gets to the overload phase, he is not thinking rationally.  So the child will not usually follow advice at that point.  Then you have to wait it out and walk away (unless he is doing something dangerous).  I know that this is a difficult time for parents, and it's hard to walk away, but if you pay too much attention or try to reason with him during an outburst, he is likely to get more angry.

If there are family issues, then having the parents work on those issues with the psychologist will pay dividends for the whole family.  Also, you will need the parents' help to keep track of what goes on before an outburst, so having them involved in the therapy is important.

Best, Dr. Dave Gottlieb

Thursday, August 9, 2018

What to do about anger overload in children

I discovered your blogsite searching anger overload. My daughter is 7 years old.  She has been diagnosed with ADHD and anxiety.  She has outbursts in school and at home.  Her outbursts can range from screaming and defiance to physical aggression.  After she “blows up” she feels better and can always tell me how she should have handled herself.  She is usually remorseful after she has hurt someone and apologetic.  She has told me that she can’t control her anger.  She is a bright young girl and such a sweet child until she gets angry.  We have been to several therapists, a psychiatrist, and a pediatrician.  Nobody can seem to help.  They just want to keep pushing meds.  Is Anger Overload a real thing?  Is there anything that can help her?  She has so much potential.  This cannot be her life.  There has to be something out there to help this child.  Any information would be helpful.

Hi, I coined the term "anger overload" to describe the intense outbursts that some children have to frustration.  The diagnostic manual that mental health professionals use does not have a diagnosis for frequent angry outbursts, but I have been seeing children and teens for 30 years, and this can be a problem independent of other issues.  

I have written manuals for parents and children about how to reduce the frequency of these outbursts.  Other blog posts also describe some of the approaches:  monitoring when the outbursts happen and looking for themes, altering the routine that precipitates an outburst when possible, lowering a child's expectations to lessen disappointment, using emotional distraction because anger diminishes if you can get a child to giggle or smile, using labels and mantras to help a child anticipate frustration and head off an outburst.  These are some of the techniques I discuss in my manuals for parents and children.  The children's manual is best if a child is 8 or older.  My manuals are available from Amazon and other online book sellers.  

Best, Dr. Dave Gottlieb

Thursday, July 12, 2018

Follow-up about therapy and the use of consequences

Can I ask a couple more questions? 
Regarding seeing a clinician - If anger overload is something you coined, what language might they use? Should we see his pediatrician for a referral?
Regarding incentives - Would you stop consequences altogether? Do we seek a balance?

Again - thank you so much for responding and giving us some direction.

Hi, I would ask about whether the clinicians work with children and families on "anger issues," or an alternative question would be whether they work with children who have "repeated outbursts."  Pediatricians are a good source for referrals in your area.  Sometimes the school social worker or school psychologist know who to recommend, and lastly other parents might have suggestions.

I would recommend a balance of incentives and consequences, as each can increase a child's motivation.  But remember that they only help if the child is thinking rationally, and that is not likely at the moment of overload.  However, sometimes incentives and consequences help if the child thinks about them before he gets into the overload phase.

Best, Dr. Dave Gottlieb

Thursday, June 28, 2018

Questions about therapy, consequences and long term outlook

Hey Dr. Dave,
So many things running through my head, so I'll try to narrow them down. Our son is soon to be seven and exhibits behavior consistent with anger overload, though we've never seen a professional and thus no diagnosis. Frankly, I'm hesitant to have him diagnosed/labeled. Instead, we've done our own research, read your book and blog posts, and are convinced this is what we're dealing with. We've taken your advice to heart, even changing our own behavior to model appropriate anger, and have seen improvement in the few months since we started. Are we wrong in that approach? Are we depriving him (and us?) of help? Can you share your thoughts on this?

Our main challenge, lately, has been consequences. For the most part, we do well to recognize his triggers, attempt to distract, use coping words and techniques (e.g. 3 slow breaths), ignore him while he rages, give him a place to cool down, etc. But when it comes time to enforce the consequence for his inappropriate behavior, it seems so insignificant compared to the fit he threw. Additionally, he doesn't seem to care. He accepts the consequence as a matter of fact (disobedience = consequence), but it doesn't seem to serve as a warning the next time he gets angry. We need help determining what kinds of consequences are appropriate and will help teach the lesson. Should the consequence be proportional to the anger? Time out seems inconsequential when he's destroyed a bedroom or living room. We've taken away toys, had him sit out during pool time or other fun activities his siblings do, but none of it seems to stave off the next outburst. In fact, some of the consequences have triggered a new outburst.

Finally, is there information regarding how kids with anger overload turn out as adults? Are they more prone to mental health issues? Or to be verbally or physically abusive in relationships? Do they have trouble transitioning into adulthood from adolescence? I guess we're looking for reassurance that he can grow out of this.

Thanks for your work - it's been helpful!

Hi, you are effectively using a number of strategies outlined in my parent's manual, and you ask some good questions about where to go from here.  Let me start with your first question.  If you reach a point where the frequency and intensity of outbursts does not diminish over a month's time, then getting a professional consult might be helpful.  In that case, you would want a mental health professional who works with children and families on anger issues.  "Anger overload" is a term I coined to describe these outbursts; your clinician may not use that term, but what is important is that he/she works with anger issues.  The other thing a clinician can help with is to determine if there is another psychological issue that is contributing to anger overload.

In answer to your second question:  Consequences only help if the child has enough self control such that he is motivated to control his anger in order to avoid the consequence.  The problem is that most children in the overload phase are not thinking rationally and are on "automatic pilot" so to speak.  This is why consequences are not particularly helpful for anger overload.  Sometimes if you catch the anger before overload, the child can hold on in order to achieve an incentive or avoid a consequence.  I would recommend if you continue to try consequences that you also try incentives.  Some children respond better to incentives.  The incentive should be something short term and something the child really wants to do.  But incentives, like consequences, only work if the child is thinking rationally at the time of anger.

There are no longitudinal studies of anger overload that I am aware of.  However, from my experience and from articles written by other clinicians, I think most children improve significantly in self control as they get older, and these strategies help the process along.  Repeated use of emotional distraction, using calming techniques, developing self observation skills, and learning mantras all help with development of self control.  There is likely biological underpinnings of these changes.  We think there is better coordination with practice between emotional centers of the brain, like the amygdala, and the control centers in the prefrontal cortex.  

Best, Dr. Dave Gottlieb

Monday, June 11, 2018

Learning issues and anger overload

Dear Dr Dave,

We are writing to summarize some of the difficulties we are facing as a family in the hope that you can assist us, or direct us to the help we need.

Our daughter is in year 3 at school and is the elder of our 2 children.

She has presented some behavioural difficulties in the home for years (we would probably say she was “born like this”). Recently we have reached an impasse as a family and we fear what will develop in the future if we don’t tackle it now.

80-90% of the time she is a happy loving child, but intermittently she is very unhappy, dissatisfied with our parenting, angry and abnormally egotistical. Asking her to “do” anything can involve extensive negotiation and bribery. She can occasionally extract a high price for co-operation and pushes the boundaries of what is acceptable. She finds it hard to “empathize” and consider the feelings of others. She states that she is not given enough freedom or choice, that we are “mean” and that we constantly criticize her or tell her “no” all the time. Her relationship with us often feels “transactional”. She states that other families are “nicer” and that her friends “get what they want” whereas we are too strict. We are trying to give her more responsibility in life (which she enjoys) but continues to push the boundaries on what’s acceptable.

In opposition to us, she occasionally flies into uncontrollable rages lasting about 30 minutes to an hour. She shouts (loudly) and can be rude during these outbursts. Often the rages are preceded by a discussion about doing written homework (which is a major flash point), or more commonly by some perceived “unfairness” in relation to her sister. Often the issues that “set her off” seem quite trivial from the outside.

The rages are most common at bedtime when she is tired but finds it very very difficult to get to sleep. (She goes to bed at 8pm but is rarely asleep before 9.30/10pm.)

We find that in these rages she spirals out of control, unable to self-regulate her behaviour or return to a balanced emotional state. We have always tried “reasoning” and discussion, but with age she has only used this time to create narrative explanations that justify her point of view, rather than accepting any wrong-doing or the need to calm-down / apologise. We end up in lengthy conversations where she challenges us. This pattern seems unproductive.

Recently we have smacked her to bring an end to tantrums. We have then apologized to her but it is clear that she is upset and that it has caused more harm than good. This is not how we intended to parent and we are both mortified it has come to this.

We are working within fairly fixed routines at home to avoid these escalating confrontations. She has always responded best to routines and to discussing (often at length) what is involved with any trip or activity. However, slight changes to plan can be met with outbursts and angry talk. We are unable to confidently leave her in the care of others, including most of the grand-parents, who cannot “cope” with her over night.

We are particularly concerned about the impact of food on her behaviour. She has a limited diet and has never taken to eating much hot food. To avoid confrontation we have accepted that she will only eat familiar foods and only eat sandwiches after school. She prefers packaged foods, hates nearly all fruit and vegetables, is upset by “texture” and is obsessed with sugar. We try to restrict this because we see a strong link between it and her more challenging behaviour. This is now another flash-point because she “hates” us for limiting her access to sweets. This is especially difficult because many of her friends are now given more control over their food (and larger treats). Her best friend has very relaxed permissive parents who rarely discipline or limit sugar and this is an increasingly difficult situation.

She is particularly critical of our parenting in relation to school-work, claiming that we “push her” and try to make her “better than other children.” If we ever did imagine that we would invest / contribute to her learning, then we have long since dropped this view in favor of modest objectives such as completing home-\work. We also know that we are doing much less with her than many of our friends do with their (very happy) children, so it is hard to understand why she hates us and feels so inadequate.

In reality we are worried about her reading (phonics has been a disaster), hand-writing (messy, not joined) and spelling (dreadful and random), and no doubt we have been mistaken in allowing her to know we are concerned. However, the school assures us she will “get there in the end” and we have decided to trust in their judgement.

Indeed the school reports that she does “meet expectations.” She has mild dyslexia, which seems to be enough to make her dislike written work, but not enough to merit any extra help or interventions within the school budget.

She is on the national average for most subjects. She is certainly well behaved in class and liked by teachers but has needed “pushing” to get her started on tasks which she tends to procrastinate.  She is naturally “efficient,” putting in the least amount of work to answer the question. She is also a funny mixture of “relentlessly logical” and intense, whilst also being very messy / disordered / forgetful.

We observe that she is mostly on-track and very ordinary in all her development. She has a few personal “quirks” that include vocalizing (loudly) by talking to herself, singing, clicking and whistling at home. That has been difficult to live with and sometimes causes tension. She likes to hang off furniture, is quite clumsy with herself and her toys and finds it a challenge to do things that require a good understanding of “left and right” or any dexterity (such as cutlery.) She finds it hard to copy from the board or follow straight lines while reading. At one point we wondered if there might be something else wrong but have dismissed the thought because the extent of it is all quite mild and is improving.

However, the rages are an ongoing issue and because of them we are not enjoying the parenting experience. We feel our relationship with her is slightly broken. The whole environment is placing enormous stress on an otherwise happy marriage.

Our younger daughter has an entirely different character and is very upset by the negative environment that can develop at home. At the moment she is coping but shows signs of stress. She hides from her sister, takes the brunt of the anger (verbally) and tells us that she does like the “shouting.” A sad state.

We might need to speak to someone.

Any advice you can give much appreciated.

Hi, Sounds like you have tried a number of things, and it must be very frustrating to see little or no change in her angry outbursts.  While I will mention a few strategies to try, it sounds to me like you should meet with a mental health professional in your area who works with children and families.  

One concern is that there are various signs of subtle developmental lags, and these lags are probably causing her frustration with schoolwork.  You mention the dyslexia which will affect her interest in reading, writing, and schoolwork generally.  Maybe it is a reason why she resists homework.  You also mention her difficulty with distinguishing left and right and with fine motor tasks.  I would recommend a complete psycho-neurological evaluation that looks at her cognitive strengths and weaknesses, as well as a pediatric occupational therapy evaluation that looks at her fine motor skills and her ability to distinguish left from right.  Sometimes when kids get help with these skills, it reduces the frequency of temper tantrums as they feel less frustrated and feel more adequate in relation to their peers (and her sister).  What if testing shows she is bright but struggling in school because of learning disabilities?  You would want to address those issues while she is young and her brain is growing.

In terms of anger, I like your use of routines to try to head of outbursts.  If there is a change in routine, try to let her know early in the day.  If you discuss reasons, keep it brief, and stop if she escalates.   In regards to her relationship with her sister, I would try to ask the local children's librarian for books about jealousy with siblings, because indirect stories may help her gain perspective, whereas when it is about her, she may get emotional and not be able to reason.  Also try to play games where she and her sister are on the same team against you or her father, and encourage cooperative activities both kids enjoy.  

When she feels things are unfair, I would avoid a discussion because it is hard to change a child's mind if she feels it is unfair.  Sometimes children will work for "go with the flow" points.  I would mention ahead of a possible conflict that this is a "go with the flow" opportunity.  You could tie one or two points into earning a special game or baking a fun dessert.  This may or may not help because sometimes children debate whether they earned a point or not.  And it only works if you give a signal to earn a point before she gets angry.  If you forget, wait for another occasion before she gets mad.

Lastly consider making a funny comment if she is just starting to get angry.  Sometimes humor changes a child's mood.  If she giggles, she won't be mad at the same time.  Sometimes ridiculous comments work well--like "hey there is a gigantic elephant pooping in our backyard"  or "I think I hear our cat is saying 'feed me.'" I mention other ideas in my parent's manual and children's workbook on anger overload.  

Best, Dr. Dave Gottlieb

Thursday, May 31, 2018

7 yr old rages at home

Hi there 
I have two sons ages 7 and 4. My oldest lost his father in a car accident at age 3 and have always thought it was an underlying cause for his behavior. We are on a waitlist for in home counseling and I have ordered your book on anger overload. He screams for minutes and slams doors when he doesn’t get his way or over small inconveniences. Sometimes he becomes physical with me and his brother. At school he is quiet and withdrawn, and refuses to do work though his teacher says it’s not lack of ability because he is more than capable when he chooses to be. Other days he’s the sweetest most caring little boy. I think this is what overload sounds like but I guess I’m asking if this is it? Am I on the right track to help him with his anger? 

Hi, the intense rage reaction to disappointment or frustration is what characterizes anger overload.  In my books and in this blog I offer strategies to lessen angry outbursts.  One idea is to identify some of his triggers and anticipate when he might get angry.  Then you can try to avoid the situation or you can lower your child's expectations before the triggering event recurs.  

Once your child starts to get angry (before he is in overload), try to distract him with funny sayings or funny songs.  If you can change his emotion before he gets enraged, you can prevent anger overload.  Once he gets overheated, it is usually best to ignore your child unless he is hurting himself or someone else.  

Having someone come to the home for counseling is a good idea.  That person can help you identify triggers and help you develop strategies.  At school, are there any patterns when he is more likely to refuse work: Certain subjects or times of the day?  Sometimes an incentive chart will help with motivation in school.  If you develop a chart with the teacher, make sure the incentives are exciting to your child and fairly immediate (not delayed to the end of the week--for young children).  But there may be some issue causing him to stop working.  See if you can identify that with the teacher's help.  If the teacher is unsure, you could ask the school do do an evaluation of his learning strengths and weaknesses.

Best, Dr. Dave Gottlieb