Monday, December 26, 2011

11 year old with anger overload

Hello Dr. Gottlieb,
When I came across your article on anger overload I finally felt like I had found an accurate description of what my 11 year old daughter and we have been going through (for 1-2 years).  She doesn't have the risk-taking behavior you mention but otherwise many of the characteristics are the same.  What drew me to your work was the distinction you made between anger overload and other clinical issues (defiant, ad/hd, autistic, etc) which do not seem to apply.   I am wondering about the relevance of your new book for our situation.
We have been unsuccessful in treating her/our issues, and in fact there is a pattern of escalation that is worrisome.   She had a period of depression (seemingly related to school) for several months last year that accompanied the anger overload but in large part that has subsided--leaving us with "just" the anger overload. We have seen counselors and read books on defiant children.  But after many, many months, we have achieved no real progress in this area. 
Our daughter is otherwise well behaved, does very well in school, has many friends, and plays sports well.  Her issues are generally confined to our home (although the disturbing behaviors do from time-to-time creep outside the home).  My wife tends to placate my daughter's behavior in order to avoid conflict, I tend to be the disciplinarian (especially when she is physical), and our other daughter gets stuck somewhere in the middle.
There have been many factors that could have influenced our daughter's behavior.  While our "middle class" home situation is generally calm and stable (no abuse, no alcohol or drugs, no divorce, not overly strict or loose), our daughter has certainly faced changes in her life over the last couple of years.  Her sister (age 15) was diagnosed with type one diabetes in 2009, there was a period where I was unemployed, her teachers have changed, there is a growing distance between her and her teenage sister, some friends have moved away etc.  She does not articulate any explanation of her emotions, and while not terribly apologetic about anger episodes, does share that she feels out of control at those times.
My response:
  In my new book I have a chapter which discusses strong willed children and anger overload.  Not sure how strong willed your daughter is, but if this also applies to her behavior, then this part of my book may be helpful to you.  Also, I will keep writing on this blog about how to work with children and teens with anger overload, as this is the topic about which I get the most questions.  In 2012,  I may publish a step by step guide for parents.

A few comments before I make a suggestion about working with anger overload.  If her episodes of anger overload occur more frequently when there is a downturn in mood, it would be wise to check with a professional to rule out a co-existing mood disorder.  Also, you mention some previous causes (changes in her life), but suggest the anger problem continues even though there do not seem to be any particular causes right now.  You might want to chart the next three episodes (I discuss this in an early chapter of my book as well), and then look for any patterns.  Does it happen when the attention is on someone else in the family, or when she is feeling lonely?  You mention her sister's diabetes and her friends moving away, so I wonder if any of these issues might still affect her.  Or you may find there is another issue which precipitates your daughter's outbursts.  If you see a particular type of trigger, then you can try to address that.

Whether or not there is an obvious pattern, you would want to enlist your daughter's help in understanding this problem.  As I suggested in my last post, there are ways to bring your daughter's attention to the problem without being critical of her.  When she is calm, you could point out any possible trigger you see, and ask her to consider if this seems correct.  If she disagrees, ask her if she has any ideas. Also, help her see when she is "heating" up next time by labeling the level of her anger (as I discuss in last week's post).   You are trying to get her to continue to think about the problem.  Bring this up as an issue you can work on together in the next few months.

For pre-teens and teens, it can be helpful to head off outbursts by discussing potential pitfalls and alternative solutions.  You can do this if you see some patterns.  You can talk about an issue from both your point of view and hers.  State what your concern is (for example if there is tension about homework or curfew, state why you have a certain rule) and then ask her what her point of view is.  You are trying to head off major conflict (assuming this is a cause of overload--let me know if there is some other cause and I'll try to advise you), and help your daughter begin to think about how there are different points of view.  Then you pose the question: how can we work this out?  You try to engage her in a discussion (when she is calm) about an issue and see if you all can come up with an alternative (compromise, if the issue is negotiable) that meets everyone's concerns.  You are helping her then not only identify an issue but practice working it out ahead of time. 

When overload occurs, it is best to avoid these kinds of discussions and encourage "chill" time.  Some kids chill with music, some by physical sensations (squeezing or holding something), some by music or drawing.  It may take some time for your daughter to discover a way that works for her, and you do not want to suggest too much, because it is best if she comes up with something herself.  After she calms down, ask her how she did it and reinforce her approach if it was effective and if it did not involve harming herself or anyone else.

One possible biological change that my help in the coming years is the continued growth of her frontal cortex, the part of the brain that controls emotions.  This growth will continue even into her twenties, but the strategies I have outlined can help this process along.  I will continue to post more strategies in the coming weeks.

In your addendum (which I just read but did not print above), you mention she gets headaches and feels tired sometimes before or after anger overload.  I have noticed that anger overload sometimes occurs when kids are tired, but have not noted any correlations with headaches at this time.  Certainly when kids are tired or not feeling well, they have fewer "resources" to deal with stress.  Furthermore, anger overload can be draining (like running an emotional marathon), especially if it goes on for more than a few minutes.  If you continue to note a correlation with headaches, I would mention it again to your doctor, and follow his lead, as he knows your daughter's situation better than I.  Hope this is helpful.  Take care, Dr. Gottlieb

Wednesday, December 21, 2011

Helping your child develop self-control

So far in the blog I have been mostly advising you what to do once your child is already in "tantrum" mode.   Another set of strategies is to to help your child develop self-observation skills.  Once your child recognizes he is "over-heating," then you can teach him strategies to deal with frustrations in a more mature way.   Your child has to recognize first there is a problem (his anger is sometimes "over the top") before he will be willing or able to work on the problem.  In this post, I will write about how to help your child learn to observe his emotional state.  In the next post, I will begin to outline strategies which your child can use to alter his emotional state.

The first step is to label his emotional level with colors or numbers.  You can use blue for "low" level of anger, yellow or orange for "getting hotter," and red for "scorching hot."  When your child is getting angry, try to use these labels in a non-critical way to help him see the differences in his emotional state.  You can also use the labels to point out your own level of anger at times, so that your child does not feel singled out.  Also, by pointing out your emotional state, you are modeling what you hope your child will be able to do for himself someday. 

You would explain the color system to your child when he is calm.  Then when he is angry you gently point out in just a few words the color of anger he is expressing:  "you are blue hot," "you are getting hotter, kind of orange now," or "you are red hot now."   An alternative is to use numbers (1-5) or the speed of cars, if you think these labels would appeal more to your child.  For example, you could say you going 10 miles per hour (for low levels of anger), or you are at 40 miles per hour (for mid range), or now you are going over 80 miles an hour!

This will not in itself lead to dramatic changes in your child's behavior.  But you are setting the stage for change by  helping him see the differences in how he expresses his angry feelings.  You will need to do this over a period of months for your child to recognize accurately how he is responding in different situations. 

Another self-observation skill to work on with your child is identifying triggers.  When your child is calm (after an outburst has subsided) point out what you think the trigger was.  For example, you could say "you got mad when you had to stop playing your game," or "you got mad when it was bedtime."  You are labeling the trigger in concrete words for your child.  You want him to begin to see the pattern.  Then in the future he can learn alternative ways to deal with his frustrations.  More about that in future posts.

Sunday, December 4, 2011

Anger Overload in Children: Diagnostic and Treatment Issues

Anger Overload in Children: Diagnostic and Treatment Issues

This is an article I wrote in 2002 on anger overload which was originally published in "Attention!" magazine.  You can read it by clicking on the link above. The article is available at the website for