Monday, January 16, 2017

What type of classroom is best for 6 yr old?


I have an almost 6 year old (about 2 months shy) who for the most part is a sweet, amazing child, but when angry, will hit, kick, throw, scream, run.  It started surfacing when he was about 3.5 years old.  We went through a number of preschools and finally settled on a part time parent participation preschool with a nanny present at all times.  We took him to a developmental pediatrician and it ended up more about ruling things out (autism, ADHD) than knowing the root cause.
 
He's now in kindergarten and officially on an IEP, and in a specialized class with onsite behavior specialists and therapists, and on a shortened day.  As a part of the IEP, we're about to get in-home services with a therapist as well.  As a part of my search for answers, I stumbled upon your articles on anger overload, which is the first time I felt like someone was describing my son.  My husband and I have learned to change how we interact with him (our developmental pediatrician recommended "The Explosive Child" which helped us understand that blaming him for his behavior was like blaming a dyslexic child for not being able to read), and while we still have our moments, we've been able to really minimize his severe anger at home.
 
This is not the case at school.  Even with all the additional support, he's having problems where an incident report is written up multiple times a week.  What more could we be doing to help him?  Are there therapeutic programs we should be looking into?


Hi, Yes there are day schools for children with emotional problems, but that may not be ideal for your child.  The programs vary in what emotional issues they deal with and in what approaches they use.  So if you someday consider that option, check with your school district to see what day schools they work with and what types of problems the schools are designed to help.

It sounds like your school system is trying to help by placing your son in a specialized program within your home school district.  The advantage of that approach is your son does not have a long bus ride, and may eventually be able to be mainstreamed gradually once he develops better self control.

The second volume of my manual offers strategies for helping children with anger overload in the classroom. I show how to apply the core principles from the first volume of my parent's manual to the school setting.  The first step is looking for patterns:  are there some themes or triggers that precede your son's outbursts?  While you will not be able to categorize all of the situations, if you, or the teacher, notice some patterns in school, you can then try to prevent anger overload by either changing the child's expectations or changing the sequence of activities.  For example, if a child expects to be called on when he raises his hand, or in another example say he expects to use the computers when he arrives at school, the teacher may be able to cue the child before these situations occur.  in the first example, the teacher will explain to the child ahead of time that he will only be called on occasionally, or, in the second example, he will be able to use the computer after the class does something else first.  The teacher could develop a short verbal or visual cue to help remind the child of what to expect, and could compliment the child any time he shows self restraint in those situations.  

There are also ways to set up relaxation stations or use emotional distraction techniques if the child's frustration is caught at an early stage before anger overload is reached.  I explain more about these strategies in other blog posts and in volume two of my parent's manual.

The most difficult stage for the teacher to manage in the classroom is if the child reaches the anger overload phase.  When a child is in this phase the teacher will usually need the help of an aide to help the child leave the classroom.  The school should plan in advance where this place would be in the school, so that the child is able to settle down without too much attention from the aide.  This can be hard to do when there is a classroom full of other students, so that if there are frequent outbursts, a smaller class with a "go to" calming place would be needed.

I explain in my manual that rewards and consequences need to be used carefully, because children with anger overload are usually not able to stop their behavior to avoid a consequence.  Children are not thinking rationally during anger overload.  Also, writing up an incident report may not be helpful, unless if it is used to identify patterns, and not used to hand out punishments.  Determining patterns and triggers, as I mentioned above, is a useful first step toward developing a plan to help forestall an outburst.  Generally speaking, it is important to develop a good working relationship with your son's teachers and therapists. The more everyone is working together, the more likely your child will learn to develop better self control.

Best, Dave Gottlieb, Ph.D.

Wednesday, January 11, 2017

12 yr old loses it playing video games

Hi Dr. Dave,

Unfortunately, our 12 year old son has had a disappointment trigger for several years which causes intense rage. When he was younger (around 5 to 8 years old), it was tied to arcade claw games. When a prize wasn't grabbed and won, he'd throw a huge tantrum.

He's conquered that situation now that he's older, but now it occurs while playing a video game and something unexpected happens - usually tied to his perception of fairness (i.e. someone is thought to be cheating, loses when a win appears imminent, spends a great deal of time collecting materials within the game but is lost, etc).

Rage is almost instantaneous, not appropriate in terms of severity of the situation and can last for an hour or two if we don't distract him with something else. He often tries to break items around the house and appears to be unable to think rationally during these episodes.

His mother is bi-polar, but he doesn't display the same symptoms as her - except for the actions described above in very specific situations. Otherwise, he's a great kid that makes friends easily and does well in school. Also, I can only recall that he's displayed this behavior in front of someone other than family once, typically happens just in front of his parents, if that helps.

In short, what do you feel is the cause and what can we do to greatly reduce or eliminate this negative behavior?


Hi, What you describe sounds like anger overload--your child' has an angry outburst when he feels a something happens that is unfair in a video game. Many children are very excited and invested in the outcome of video games.  One approach you are already using is distraction.  While distraction can help in some situations, the problem with this approach with video games is that video games are so exciting (captivating for many youth) and your child's disappointment is so strong, that it will be hard to come up with a distraction that will capture his attention and change his emotional state. 

With video games, what I usually recommend to parents is to come up with a mantra that you repeat many times over the course of a month or more that describes the "unfairness" of video games. For example, one idea for a mantra is to explain that video games are made so that you will lose most of the time.  They want you to lose so that you will feel challenged to play again.  The game purposely leads you down blind alleys, or suddenly makes something happen to frustrate you.  If the game were always fair, you would win most of the time, and you would lose interest in the game.  Now the hard part is putting that idea into a succinct mantra.  You want it short and memorable so your child is more likely to remember it at the point he loses the game.  Practice explaining the issue when he is calm and ask him to help you come up with a sentence that he likes and that will help him remember when he plays that he is going to lose most of the time, because that is way the games are made.

Then each time he is about to play, you want to repeat the mantra in front of him, or ask him to remember what the mantra  is.  It is important for him to recall the mantra before he gets upset, while he is thinking rationally. The more often he repeats it over time, the more likely it will help.  It may take a month or more to have an impact, and it may work sometimes more than other times.  But you will see a gradual decrease in excessive outbursts if your child uses the mantra each time he plays.

Another approach some parents use is to specify certain unacceptable behaviors, like breaking or throwing things, and also specify more acceptable behaviors, like saying "this game can be so unfair" or "this game can be a pain." Then you explain while everyone is calm that if your child exhibits an unacceptable behavior during a game, he loses video game privileges for 24 hours, or some amount of time that is not endless!  You do not have to enforce the limit while he is raging, but later that day, explain that the 24 hour limit will start some time that day (whenever you have decided).  Sometimes this behavior modification (incentives or consequences) approach can help when used in conjunction with a mantra.  The potential consequence helps motivate a child, while the mantra helps a child learn what to expect when playing a video game.  

I lean more heavily toward the mantra approach, but each child is different, so you want to try different approaches until you find one (or a combination) that works best for your child. If you want to read more about devising mantras, check out other blog posts or my parent's manuals and my workbook for older children and teens.  There is a section about mantras in the workbook as well as in volume two of my parent's manuals:  "Anger Overload in Children: Additional Strategies for Parents and Teachers,"

Take care, Dr. Dave Gottlieb


Tuesday, November 29, 2016

4 yr old punches teacher at nap time

I have a 4 year old daughter who goes to a private school for Pre-K. She has always had normal behavior problems at school but has been evaluated by the county schools without any problems. She scored very high on cognitive processing and communication. Everything else was within normal range. She is exhibiting aggressive behavior towards one of her teachers. It usually occurs when her morning teacher leaves and children are with the afternoon teacher about to go down for a nap. She is defiant and does not want to nap. She has punched her teacher several times. We are not sure what to do with this point as we are anticipating that she is going to be expelled. She does not exhibit these behaviors at home.
Can you help?


Hi, You have identified a trigger for your child's anger:  nap time.  One solution would be for the teacher to substitute a quiet activity for your child in a space where she does not disturb the other children.  The teacher may be concerned how this will affect the other children, so you want to work with the teacher to come up with an idea that works for her and for your child.  You or the teacher should probably practice with your child in advance so she understands what to do.  You could explain that this is a privilege, but that if she disturbs the other children, she will not be allowed to do the substitute activity, One way to avoid anger overload is to anticipate it and then change the situation or the expectations, if possible, so that you avoid the problem.  

If the teacher is not willing or not able to come up with an alternative, then you (or someone you know) might need to take your child out for a walk at that time.  Or if you feel your child really needs a nap, then try to come up with a quiet activity she could do on the mat, where she might eventually get tired and nod off.  Another possibility is to use incentives and consequences targeting the hitting of the teacher, but I find that incentives and consequences do not often forestall anger overload.  Most young children are not thinking about consequences when a situation arouses their anger.

You also mention that she has had "normal behavior problems."  I'm wondering what that refers to.  If there are other triggers for her anger, other than nap time, then I would refer to my parents' manuals (and look at other blog posts) to learn about other ways to help reduce anger overload in children.

Best, Dr. Dave Gottlieb

Monday, November 7, 2016

7 yr old hits, bites and kicks at home

     My grandson changed about 2 yrs ago.  It has progressively gotten worse.  He hits, bites, kicks, is destructive and defiant.  When he is not having an anger episode he is the most polite, caring and loving child you could ask for.  He does not have any anger issues at school at all.  All issues are when he is home or with family.  My daughter has taken him to a behavior therapist a couple of times with no real change.  She did take him to a different behavioral place and after speaking with my grandson for 10 minutes and looking over his health issues and talking with my daughter for about 10 minutes, they recommended intensive outpatient  3 hour group therapy for 4 weeks, 3 days per week. However this therapy is over an hour away and he would have to miss the last hour of school to go.  Then by the time he would get home, eat, do homework , etc. he would be exhausted and this would cause more anger issues.  Any recommendations you could offer would be greatly appreciated.  I love him so much and hate to see him spiral out of control.

Hi,
     First, it is a good sign that he is only out of control in one setting.  Since he is in self control at school, this shows that he knows it is wrong to hurt others and shows that he can control himself in settings other than the home.  So the question becomes why is this happening at home.

     I would recommend you and his parents keep track for a few weeks what exactly is going on right before he loses it.  What is he doing and saying and what are the adults at home saying or doing.  Then look for common threads in some of the precipitating events.  Is there a theme in some of the outbursts?  Do they happen at certain times of the day, or when he is expected to do certain things, or when he feels ignored, criticized or unfairly treated? Look for themes in how he feels before outbursts, or what he is doing at those times.  In my parenting manuals I provide worksheets to help parents identify triggers.

     You mention that things have gotten worse the last two years.  Think about what changed two years ago.  Did expectations change, were there any losses, or did parents' or the child's schedules change?

     Once you identify some triggers, you try to develop a plan to reduce the likelihood of upset.  Here are a few examples.  For more, see my parenting manuals.  Sometimes you change the sequence of events, for example, if the problem occurs when he has to stop playing and get ready for bed, then you would get him ready for bed right after dinner, before he starts playing.  Then the sequence is such that your grandson gets to do what he wants after he does what the parents want.  

     Another possible approach is to change your grandson's expectations.  For example, if he expects that he will always get to play on the computer when he wants, rather than share time on the computer with another family member, you would talk with him while everyone is calm about the new plan or expectation.  Sometimes I have children come up with a catch phrase and/or drawing to reflect the new expectation, and I suggest parents practice the catch phrase with their child daily.  

     Sometimes the outbursts do not fit a theme and happen so quickly, that it is difficult to change a child's expectations.  Then I recommend "emotional distraction."  What this means is coming up with something you can do or say that changes the way your grandson feels. For example, if you can say something silly that he laughs about, it is less likely that he will explode.  But if he is already exploding, it is best to say or do as little as possible unless someone is getting hurt. It is not possible to reason with a child in the overload phase, and furthermore if you talk a lot then, it inadvertently rewards his outburst.  This is why I recommend saying as little as possible.  If someone is getting hurt, it may be necessary to bear hug your grandson, or in some way restrain him until he calms down.

     Also consider what has changed in the last two years and if your grandson is feeling worried or unhappy about something, try to address his fears (or the source of upset) to see if the angry episodes lessen then. Looking for underlying causes is another approach to dealing with anger overload.  

     If nothing is helping, then consult with a therapist who works with families and children.  I find that in most cases young children do better when a therapist strategizes with parents, in addition to the child, rather than just meeting with the child.  Young children often have trouble implementing strategies without their parents' help.

Best to you and your family, Dave Gottlieb, Ph.D.




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