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.

     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

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 with....it'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