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


  1. My 12 yo son fits the description of anger overload to a tee. He is a text book case. He is exhausted after an outburst, often sleeping for 10 hrs after. He rarely remembers the entire episode, only bits and pieces. His outbursts can last up to 2 hrs. We are new at this and I am learning more about it and strategies we can use together to minimize and then eliminate the episodes. What can you tell me about the nutritional supplements that some are using for this?

  2. Hi, There is research going on in the area of nutritional supplements, for example with omega-3 fatty acids and zinc. However, the only large scale studies I am aware of regarding anger and nutrition have to do with hypoglycemia. If a child is pre-diabetic, or low in sugar, there are can pronounced irritability and difficulty controlling emotions like anger.