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

Tuesday, May 22, 2018

10 yr old angry when competing

Hello Dr. Dave,

My 10.5 year old son has been exhibiting fits of anger recently and I'm not sure what to do.  It has gotten progressively worse over this past year where previously this was not an issue.

He is a competitive athlete and I first noticed it there.  Where he used to be a great competitor and calm and collected, he's more frequently showing his frustration by "air hitting" his racquet on the ground (i.e. not smashing it but making the move as to) or jumping up and down or banging the tarp, etc. in ways that are noticeably off.

At home, we've had a couple incidents that were troubling.  Last night, he was playing chess with his dad and lost three games in a row.  His dad had sweetened the deal by offering him a prize if he won and he got close but lost.  He started banging his fists on the table in a violent manner.  When his dad when downstairs and said something to me, my son thought he was laughing at him and ran downstairs and started hitting my husband with his fists.  While they "rough house" for fun, this is the first time something like this has happened.  He then started banging his head (not hard) against the shower door and saying things like "I suck" "I hate myself" "I'm no good" etc.

So far there haven't been any issues at school, but he did say to me in passing that sometimes his friends make him so angry he could punch them (but he hasn't). He's also been more frustrated with me - if I am reminding him about something or nagging (yes I probably nag sometimes) he gets visibly frustrated and clenches his fists.

Most of the time, he is a wonderful, loving boy who does well at school.  But this recent-ish behavior is worrying me. Is this normal tween/ pre-teen stuff or should we be concerned? Is this something we can/ should try to work on with him as parents directly through behavior modifications, workbooks, etc. or should we be seeking the help of a therapist? 

Hi, one cause of anger overload in children is when their expectations of themselves are too high.  I would try to re-frame his expectations before he starts  competitive activity.  For example, you could work on a mantra with him, like "everyone wins some and loses some," or "even the best tennis player like Roger Federer (or other sports hero) loses some games."  You could also model this behavior by talking out loud when something does not go your way.  For example, you could say "it was frustrating when I didn't _____, but sometimes things don't go my way.  Oh well.  There will be a next time."  

I would practice a re-framing mantra before competitive activities and see if over the next couple of months, he develops better self control.  Also, try to find out more about what angers him with his peers, and see if you find a theme.  Then you could use re-framing for that type of situation as well.  

For "nagging" you could start by saying something like "I realize I may sound like a broken record, but I could sure use your help with _______."  There are two parts to this request:  You are anticipating that your son may get frustrated, and also you are asking him to help you.  This approach often lessens anger overload.  Other strategies for defusing anger are explained in this blog and in my parent workbooks.

You could start therapy now or wait a month to see if there is some improvement in self control.  Therapy can be very useful in helping kids look at potential anger triggers in a new way. Best, Dr. Dave Gottlieb

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