Tuesday, December 18, 2012

6 year old lashes out at school

I am on my last leg with my 6 yr old son. His behavior at school has gotten so out of control that he is on the verge of being kicked out.....permanently. The school has a system where your name either gets written on the white board or a check mark is given by your name. My son lashes out verbally and physically when this occurs. He fully understands why this happens, but still has this behavior. He has changed teachers due partly to his behavior and the teacher's personal issues.
I have tried to sit with him and discuss why he acts this way in school, he always seems to blame other kids as his reason for acting out in school.
Do you feel counseling is an option at his age?

Hi, Yes I think counseling would be appropriate.  You would want a therapist who is also going to communicate with the school staff and with you.  It would be important for everyone working with your son to think about why he is getting so upset when he gets a check mark, and what alternatives there might be.  Sometimes, cuing him when his behavior is starting to be a problem, rather than using a check mark, may work better for your son.  Try also to "normalize" check marks.  Though not ideal, they are not the end of the world.  In the morning before school, predict that he might get one, and tell him you won't be angry.  I would even consider a small reward the next couple of times he gets a check mark and does not blow up about it.  (It could be a pat on the back by the teacher, or a high five when he gets home, or a treat that he does not usually get for dessert.)

Also, ask the teacher to keep track of what your son is doing before he gets these check marks.  Is he interacting with peers, is he angry about something,  is he easily distracted, or is some subject matter in class frustrating for him?  A psychologist could help you figure out if there is anything else going on with your son that is contributing to his reaction to the check marks.

Sometimes, when I meet with a child and the parent, we go through what happened leading up to the blow-up.  I ask what was happening before the child gets angry, what he said or did, and what others said or did.  I say that I am just trying to understand what happened.  (I do not judge or assign blame.)  Once a child is comfortable with this process, I might add:  "what can you do so you won't get in trouble next time?  I see why you are angry, and I want to help figure out a way you can deal with it so you do not get punished."  I try to get the child to see me as an ally, and we work on the issue together.  If the child does not have suggestions, I offer some alternatives and then ask which he would prefer, if any.  The next time the child comes in, we talk about situations that happened that week, what he said, and what other options he would have.  I do not criticize, nor do I expect him to be able to use my suggestions right away.  Also, this process cannot be done in the heat of the moment (while he is still angry) and cannot be done until your son has an alliance with the therapist.  See if there is a therapist in your area who works with children on anger issues.  In my parent's manual, I outline other approaches you can use to help your child deal better with angry feelings.

All the best, Dr. Gottlieb  

Sunday, December 16, 2012

What to do when 2 year old hits and yells

Hi, I came across your email address when researching "anger overload" and was wondering if you can help me. I have a 2 year old girl whom I believe has "anger overload". She'll be perfectly fine until I say she can't have something or something doesn't go the way she wants it (toys won't stand up, blocks fall etc.) that's when she becomes so angry she throws things, yells, hits etc. Is there anything I can do to help stop this from happening? Any advice you can offer me will be greatly appreciated!

Hi, First make a list of the situations when your daughter gets extremely angry.  Look for patterns, and think about how you might head off some of the tantrums before the situations get to that point.  For example, you mention she gets angry when the blocks fall.  You could try telling your daughter when she starts playing with the blocks that they will fall soon, because that is what blocks will do.  Tell her "when that happens we will put them back together."  Then when you see the blocks getting closer to the breaking point, remind her they are going to fall soon.  The strategy is to change your child's expectations before she reaches the breaking point.

Often you will not be able to predict an outburst.  If she is getting frustrated but has not exploded yet, you can use "emotional distraction" to try to head off a tantrum.  By "emotional distraction," I mean that you try to do something that will change her emotional state from one of frustration to laughter or curiosity.  For example, you could mention a favorite activity, song, or funny story to try to distract her.  If she likes trains, make the sound of a train and start waving your arms and make funny noises.  Your behavior does not have to make sense to another adult (who might think you are acting silly), it just has to grab your child's attention.  Another option is to start an activity that your child likes in order to distract her.  For example, if she likes blocks, you could say "look at me building these blocks.  I could sure use your help."

Once your daughter reaches the point of anger overload, it is usually best to say and do nothing, unless she is hurting someone or breaking something of value.  If you have to restrain her, you should do so, but if you can wait her out, do that.  Young children will usually tantrum longer if you try reasoning with them while they are in the middle of a tantrum.  Furthermore, you do not want to give them attention for negative behavior.  While it might be hard to listen to her scream, she is more likely to settle down in the future if she has not received any attention from you during previous tantrums.  You will not see change immediately, but over the coming weeks, tantrums will usually get shorter or less intense if she gets no reaction from you during the tantrum.  Once she settles down, then talk with her (about other things) or play with her.

Two year olds do not have the verbal or thinking skills yet to deal well with frustration, so tantrums are more likely at this age, and should wane as she gets older.  In the meantime, try some of these strategies and see if they help.  You can read more about these ideas in my parent's manual about anger overload in children.  All the best, Dr. Dave Gottlieb

Wednesday, December 5, 2012

9 year old won't go to his room to chill

Dr. Gottlieb, We have a 9 year old boy who gets really angry sometimes when his leggos break, sometimes when we send him to his room for fighting with his younger brother, and sometimes when we tell him do do something.  We try to catch his anger at an early stage and ask that he go to his room for a few minutes to calm himself, but he usually refuses.  So we started leaving the room and ignoring him.  He seems to calm down faster then, but we worry that he is getting the message that it is okay to argue with us or fight with his brother.  Any other suggestions?

Hi, When you establish a "go to" place for anger overload, discuss it with your child ahead of time, and do not pick the same place that you use for a time out or a punishment.  Even though you are not punishing your child when you ask him to chill in his room, he may see it as a punishment, especially if his room is also used for time outs.  When your child is beginning to overheat, instead of asking him to leave the room, suggest that he take three slow deep breaths.  The deep breaths may help him to slow down.  Anything he does for a few moments may help him to gain more control of his anger.  Once he is in full overload, though, anything you say will probably lead to his responding with more anger.

Your idea to leave the room is also a good one.  Another option is to stay in the room but stop talking until your child is calmer.  If your child is not receiving any verbal feedback from you while he is getting angry, he is more likely to settle down.  I do not think your child will see your leaving the room as a "victory."   You will still expect him to do what you asked after he calms down.

Another option for the issue of his fighting with his brother would be to have them both cooperate to earn smiley faces each day if they do not fight.  They either both get the smiley face, or neither do.  They can then trade one, two, or three smiley faces for a fun activity, like a card game, with you or your spouse.  (The number of smiley faces needed to earn the game time depends on how immediate you think the reward needs to be for them to be motivated.)   

Finally, do not forget to review with your child the sequence of events after each blow up is over.  Once your child is calm, you want to briefly talk with him about what was the trigger and what else he could do if it happens again.  You do this regularly later in the day when there has been an upset, so that your child begins to recognize what causes his outbursts and so that eventually he may catch the sequence before he explodes.  During anger overload, it is hard for most children (and adults for that matter) to think about alternative behaviors, but the more you go over examples with your child, the sooner he may remember at the crucial moments when he gets angry. 

If the leggos breaking continues to trigger his anger, you might also create a list of sayings that your child could think of when he starts to get mad.  For example, one could be "leggos break eventually" or "we can always fix it."  You write them on a sheet of paper that you can look at with your child after future blow ups.  The purpose is to get your child to expect difficulties, in other words, to help your child develop more realistic expectations.  I explain more about his in my parent's manual.  All the best, Dr. Gottlieb

Tuesday, November 13, 2012

7 year old who kicks and throws things

We have three children, all of whom were adopted. Our son always sweet as a baby is now our biggest source of stress and heart break. He was somewhat obsessive about skateboarding, even when he was 2 but not more than many boys were with trains. He had a language issue when he was a baby and was very frustrated, and was classified so he could have help negotiating himself in the nursery school classroom. He was always very much a "boy" but all his teachers said it was never a problem. Starting second grade he decided not to go to school . It was too hard, not enough breaks and too long of a day. He has always been insecure about his intelligence. He gets some reading support at school but is not behind the curve and is doing very well now. Over the summer, and spring, he developed a love for video games, especially Mind Craft, which he dreams about but reacts to it like crack. We've tried sticker charts, the explosive child strategies, therapy, punishment of all sorts and every thing  works a little for a little while. He is getting more angry when he doesn't get his way. He kicks doors, chairs, throws things, and is 7. I fear what may happen when he gets a little older. If you can help in anyway it would be greatly appreciated. 

Hi, some children have trouble regulating anger.  Once they get frustrated, their anger quickly escalates into explosive behavior.  The key is to try to intervene early in the sequence when possible.  Rewards don't always work because these children are not thinking ahead at those times, but reacting emotionally.  The first thing to do is to observe carefully what some of your son's triggers are, i.e. what situations lead to his tantrums.  Then think about whether you can re-arrange the situation to avoid the trigger.  Or if you cannot avoid the trigger, can you prepare him in advance to get ready for the situation.  Before he gets aroused, he may listen to suggestions or incentives. 

The other set of strategies is to teach him how to handle his frustrations.  The key here is to get your child to think with you about his explosions each time they happen (later in the day once he is much calmer).  You talk about what happened, what the trigger was, and help him think of alternative ways of thinking and alternative ways of reacting.  I explain the steps in my parent's manual.  If your son does not yet see his tantrums as a problem to work on with you, then you will focus on the strategies in the first half of the manual (strategies you can employ without your son's cooperation).  You would still talk a little after an explosion (but not during) to try to get him to see the costs of his behavior.  Once he recognizes the pain he is causing, he would be ready for teaching him alternative ways of thinking and alternative approaches to regulating anger.

You would also want to deal with any insecurities your son has, especially if they contribute to his anger.  Does his reading problem, though improved,  precede an outburst?  You mentioned mine craft:  does he have trouble getting off that game?  Are other transitions hard for him?  Did his therapist have any thoughts about problems that could be contributing to his explosions?  You would want to help your son deal better with any underlying insecurities.

All the best, Dr. Gottlieb

Wednesday, November 7, 2012

12 year old with increasing angry outbursts

Dear Dr. Gottlieb:
     I came across your blog and book while searching for ways to help our son.  We quickly ordered your book and your description of children with anger overload really does describe our son perfectly.  He directs his anger only towards me and his 4 year-old sister, whom I tried to shield.  He blames her for everything and thinks it's unfair that he has to do homework, while she has none.  He would literally go into a tirade unless I give her some "homework" to do.  I eventually printed out some letters and shapes for her to trace, which she was very willing to do.  That did not appease my son, and he soon found something else to complain about his sister.  He would push her or slap her every time he passed by her.  We had our daughter when my son turned 8.  At the beginning, he was excited, but soon became increasingly jealous and annoyed of her presence.  Whenever we could, either my husband or myself would take our son out to the movies or to lunch, just to have a one-on-one day.  He really enjoys those.  When he comes home from those trips, he is usually much nicer to his sister, but in a day or so, he will be extremely annoyed with her again. 

     The second trigger is homework, in particular, Math.  Math is his favorite subject, so when he moved up to Advance Math, he was super excited.  However, the bulk of his tantrums are during Adv Math homework time or studying for a Math test.  He would literally open up his text book and throw a fit.   I started keeping a "tantrum" chart to keep a record of his outbursts, and he seriously goes into one of his tirades every other day.  My husband and I have asked my son to step down to regular Math, so that he will be less stressful, but he refused and threw another tantrum.  So I told him that I will help him with his Math (I excelled in Math and used to be a Math tutor) and we will go through the homework together.  But that didn't help, because with or without me, he will do all his other homework first, and would procrastinate until the very last minute before he will tackle his Math homework.  Then he would throw a tantrum because by then, he's stressed AND tired.   So we suggested that we would tackle the Math homework and/or studying first.  That just threw him into another fit because he didn't want to....he wanted to tackle his Math last.  

    He also, a few weeks ago, started to hit me physically, point his finger at me, and curse incessantly at me (with the f-word and all).  He would literally scream at the top of his lungs.  I tried talking him down before a full-blown episode, but it just hastened the onslaught.  But he's only like that at home.  Everyone else thinks the world of him.  He's very respectful, humble, talkative, nice and easy-going at school.  Even his friends' parents like having him around.  The only person he disrespects constantly is me.

     I admit that there had been occasions where I had lost it as well, and there would be really horrible shouting matches.  Mentally I'm so exhausted, but I have to bear the brunt of it because my husband is short-fused.  He grew up with an extremely angry and volatile father.  I truly believe that there is something inherited here...something in the genes so to speak.

     We tried to seek professional help and looked into counseling.  The counselor only wanted to meet with our son.  At first we trusted her and hoped for the best.  But later, as things deteriorated, we inquired about his sessions, and the counselor refused to divulge any information. 

     So, what can we do if the trigger is a part of life?  How do I isolate our daughter from our son?  What can a parent do when homework is the trigger?  Any suggestions or insights would be greatly appreciated.  We have just started the 2-week observation period suggested by your book.  Thank you so much.

Hi,  It sounds like you have tried several things, like doing one-on-one activities with your son, offering to help with his math work, and trying to talk him down.  You identified two triggers: jealousy of your attention to his sister, and frustration with the math homework.  How best to respond to these triggers?

First, I would talk less when he gets angry about math, and I would not offer choices (since he refuses the options and escalates).  Decide if you want to help him with math or let him do whatever he can, and then he could ask the teacher or a tutor for help.  You pointed out he does not get angry outside the family, so he would probably work better with a tutor or the teacher.  If you are going to work with him, let him know when you are available (what time of day, preferably the same time each day) and tell him you will stop for the day if he yells at you or tries to hit you.  Then stick to your guns.  Only help at the time you say and stop if he yells.  Yes, he will likely tantrum worse then at first, but over the course of the next few weeks he will probably realize that you are going to continue to withdraw when he loses his temper.  Remember that talking at these times does not usually work.  Most children will escalate if you try talking with them while they are angry.

Also, I would have a serious consequence for any hitting or physical contact.  Tell him ahead of time what that consequence would be (usually 24-48 hours with no "screens"--television or computer, or something else that he would miss), and then let him know when he is calm (after a hitting episode) that the consequence is now in effect.

I like that you are spending some one on one time with your son, and in addition, I would set up some rewards for cooperative activities with his sister.  Explain that he is the leader, and he can choose the activity, but that any fun activity he does with her, you will then do an activity with him alone later that day or the next day.   Since he has kept her busy, you can say you were able to get your chores done, and in appreciation you will do something with him.

Basically, you are re-arranging the sequence, so that cooperation leads to time with you, and yelling or hitting does not.  You also eliminate the homework issue if you have a neutral party help him with math.  It is hard for some children to have their parents be tutor and parent.  These children have trouble accepting help (do not want to make mistakes) in front of their parents.

In my book, I also explain how to use cues and calming strategies, and how to teach children about other points of view.  I also have a section about how you and your husband can be role models by talking out loud about what you do to handle your anger.  You will get to these chapters after you finish the worksheets in the first half of the manual.   As for therapy, there are different approaches, but you might have a better experience with a psychologist or social worker who talks with the parents as well as the child, and who works with anger regulation issues.

All the best, David Gottlieb, Ph.D.

Monday, October 22, 2012

8 year old with separation anxiety and anger overload

Dr. Gottlieb,
  About eighteen months ago my daughter, who was then 7 years old, was in her second semester of the second grade. In late February of that year, with no warning, woke up saying she was not going to school. This behavior lasted two months. She resisted, then panicked, and then would outright resist in a panicking anxiety attack. She would run from us around the house trying to escape going to school. Once at school her mother and I, along with the Principal and school counselor would have to pulled her dragging and screaming into the Principal's office. There she would immediately calm down, yet was still in resistance of going. After two to three hours she would then agree to go to class. During this time we were helped as much as possible by the school counselor. My daughter would come up with any excuse not to go, which may be she was sick (when she wasn't) to "they" will be mean to her, which would later be anyone from the teacher, which before this time absolutely worshipped, to the principal, to the fourth grade kids, to her best friend, to whomever she could think of. It usually would come back to wanting to be with her mother, who at the time had been substituting at school. During this time my wife quit substituting at her grade school to try to lessen the temptation of her wanting to leave class "because she was about to throw up" and then would always find her way to my wife's class. In the afternoons she would get home and begin worrying about going to school the next day. At night she was prone to getting mad quickly and have horrible tantrums. Her pediatrician ran blood work on her but found nothing she felt was any causing factor....
Luck for us during this time her resistance to school came to a stop. Between the teachers, counselor, principal, and my wife and I, we never could figure out what the problem was. But she continued to have the anger issues, which was something that she had been doing off and on for quite awhile before the school anxiety issue came up. She would glare at you straight in the eye when she didn't get her way or something made her mad and yell at you like a drill sergeant. She would use phrases like "you are crazy lady", "I wished I lived with someone else", "I hate it here", "don't you look at me like that". Time outs and all the punishments suggested did little if any good. We had literally at times spent up to two hours trying to get her to stay in a time out. These occurrences were not all the time, but would occur about once or twice a week....
Although the school anxiety has subsided, her anger is off the charts, even with the medicine. If she wants to do something that you cannot make happen, she goes into anger mode. Again she will stand there and verbally assault you and argue like an adult. She tries to twist anything and everything around to make it our fault. (Once we planned to camp in the yard one weekend night but storms moved in and it rained all evening. Her response was "you promised!!!! This wouldn't have happened if you had set the tent up this morning!!!!". We have tried (and still making the attempt) not to argue and just walk off, but even then she will follow you and keep hammering at you until we finally feel we have no choice but to send her to her room or ground her. At the time, she shows no remorse, and does not care what you take away. When she calms down she returns to being in a great mood.
During all this time, when she is not in school anxiety or anger mode, she is a happy, energetic child, always on the move. In school she does great (she got into the Gifted and Talented Program this year) and the teachers, counselor and principal all say she is a fantastic, well behaved student in class. And although she had resisted the teachers about going to class, they said she was never hateful or disrespectful, just matter of fact.
She is now getting to the point when she "overloads" she is showing aggression to her mother, reaching out and trying to squeeze or claw her arms. She does this with no one else, and does not show any aggression in school. Her counselor keeps wanting us to try the "speak softly and use 1-2-3 Magic..." When we do this, all she does is mock us by screaming "1-2-3-4-5 blah blah blah".
After reading your articles today I want to ask you, from what I have described, is this "anger overload"?
Hi, It sounds like you have been through a lot.  The level and duration of anger fit with the criteria for anger overload.  The separation anxiety is separate from anger overload, but it is interesting that in both cases, once the emotion (anxiety or anger) starts, it often escalates and is difficult for her to control.  You were on the right track when you kept taking her to school despite the anxiety and when you had your wife stop working nearby.  Those decisions probably helped her eventually to see that she could handle school without having to stay home and without having to go to her mother's classroom.  One other possible diagnosis for children who have intense emotional reactions (that your doctors may have ruled out already) is pediatric bipolar disorder.  For this diagnosis there are frequent fluctuations in mood.  Does your daughter also have periods of excess energy, agitation, irritability, or risk taking behaviors even when she is not in the anger overload phase? 

In my manual I describe how to re-arrange the sequence and lower children's expectations in order to try to head off anger overload.  For example, if she is excited about an upcoming event (like the camp out), you would caution her ahead of time that you might not be able to have it, that it depended on the weather,  that it was a possibility only.  In addition if there are certain times when she is more likely to explode, can you change the situation around to avoid the precipitant?  For example, some children get angry when they have to get off a video game and go to bed.  Then you would either not allow video games on school nights, or stop the video games much earlier in the evening.  Admittedly you cannot frequently predict when a child will explode with anger, but you try to keep a record of her explosions and head off what you can in the future.

In the second half of the manual, I explain ways to teach your child about anger overload and how to develop self control.  You would do this while she is calm later in the evenings.  You help her learn about different levels of anger, about ways to develop self soothing, about using catch phrases  to "catch" the anger early, and about how to see things from other people's point of view.  You also teach her about compromise.  
You are right to not talk with her while she is exploding.  However, if she harmed your wife, I would have significant consequence for the following 24 hours .  I would tell her ahead of time what it would be and not discuss it during overload.  But when everyone was calm again, I would be sure to impose the consequence.  You would not be punishing her for anger overload, but for the particular behavior of hurting someone.  
Best, Dr. Dave Gottlieb

Tuesday, October 9, 2012

Out of home placement for child with severe symptoms?

Dear Dr. Dave:
Today after school we are meeting with our daughter's psychiatrist and psychologist to discuss placing our 12 year old daughter out of our home.
When I read your article on Anger Overload, it gave me hope because it so describes my daughter. She has no diagnosis; I am advised I do not want one and must treat the symptoms, as treatment would be the same regardless.
Her anger is always just under the surface and once triggered (which I cannot always predict) lasts until some violent climax. She used to hurt her two-year younger brother but now focuses mainly on me.
She loves using the worst language and insults to engage. She takes pot shots at me and even comes up behind me and hurts me.
I can't figure out why she is so angry except she tells me that I've never loved her and that I only love her brother, which is ridiculous.
I would like to work on this at home with behavior modification.
Can you suggest anything please?
Thank you.

Hi, My book on anger overload explains when to use behavior modification (ignoring, other consequences, and incentives), and the manual also outlines strategies to teach your daughter about her anger triggers and how to control her angry responses.  The first part of the book is about what you can do as the parent, and the second half describes a program you work on in conjunction with your daughter.  The second half of the book works best with children who are 8 years old or older, but some younger children can participate in the exercises in the second half of the manual with assistance from their parents.  

It is important to try not to say much of anything when she is in the overload phase.  Your daughter is not rational at that time, and anything she says is meant to get your goat, but is not what she really feels.  You can use consequences later, if you want, for language you forbid in your house (wait till everyone is calm), but do not say or do much while she is screaming or insulting you.  If she tries to harm you than you will need to restrain her or call for someone to help you do that.

I wish more clinicians recognized anger overload as a serious problem, rather than lump these children into the diagnoses of oppositional defiant disorder or bipolar disorder (a mood disorder).  There is much evidence in the psychological literature on brain function that some people have intense angry reactions, without necessarily having an underlying mood disorder.  The current thinking is that the prefrontal cortex is not fully developed, and behavioral strategies can help children learn better self control.   There is also research going on about "SSRIs" and "atypical antipsychotic" medications to see if they can help children with anger problems. 

Do you or your daughter's doctors have further ideas about her triggers?  You wrote that she feels you love her brother better.  Does she say this when she is calm too?  Is she sensitive about other people not caring about her too?  How long how this been going on, and did something happen when this started?   Does she let you do some activity just with her, and does she feel better then, or still feel rejected?  Is she depressed?  I know these are a lot of questions to consider, but I'd recommend going over these with your daughter's doctors if you haven't already.

Placing your child out of the home is a tough decision, and I would try to get more help for your daughter first if you have not already done so:  more intensive outpatient treatment (such as day treatment program), or aides in the home (for children with serious behavior problems many states have funding for help in the home though it is sometimes hard to qualify).   It sounds like you have two professionals helping you, and they know your situation better than I, so see what they recommend when you see them later today.

All the best, David Gottlieb, Ph.D.

Tuesday, October 2, 2012

9 year old with angry outbursts at home

I was excited to find your article about anger overload.  My 9 year old son has issues controlling his anger at times.  I don't think that he fits the description of oppositional defiance disorder and the like, but I know that something is wrong.
He's normally a sweet boy and he is extremely smart.  He is in his school's gifted program.  He has never had an issue at school.  Most of his outbursts occur at home, although he has had a couple during soccer games when he felt he was wronged (which was very embarrassing). Usually, his outbursts involve his older brother.  Big brother knows which buttons to push and this is something that we have been working on, too.  Summer was a trying time, since the boys were together all day, every day.  Things have been better since school has started up again.

His outbursts usually involve a lot of yelling, slamming doors, throwing or kicking things.  During the incident, he has no concept of reason and has no remorse.  That changes once he has completely calmed down. We have asked him about his behavior when he is calm.  He tells us that he can't control himself when he is angry.  I have also asked him why this doesn't happen at school.  He said that no one bothers him at school.

Unfortunately, once when he got angry with his brother, he tried to throw a large toy at him.  Instead he accidentally hit his cousin in the head, resulting in stitches.  Yesterday during an argument over a game, he threw a large rock at his brother.  I told him to stop and during the short time while I was making my way to where the boys were, he picked up another large rock and threw it.  Luckily, no one was hurt.  I worry that he may hurt someone again or have an outburst when he is away from me (at a friend's or relative's house.)   

We try to prevent his anger outbursts by intervening when we see he is getting upset and making sure he gets enough sleep.  He is definately more prone to them when he is sleep deprived.  However, life is life and I can't control all of the circumstance.  He needs to be able to cope on his own.

My main concern is two fold.  First, how do I know when he needs professional help and second, what techniques should I be using to help him?  I am looking forward to getting your book and I appreciate any insight you can provide.
Hi, What you describe is consistent with anger overload.  These children feel an intense surge of anger that is difficult for them to control.  One step that you have taken already is to try to intervene early in the sequence when your child is beginning to get upset; what I would recommend you do next is to try to prevent a blow-up from even starting.  See if you can identify some of your son's triggers as early as possible and try to re-arrange situations to avoid these triggers, when possible.   You mention that he often gets angry with his older brother.  See if you can identify the themes for some of these situations:  does the anger erupt in competitive activities, or when he is teased?  If the latter, what activity is going on when he is teased?  If you can identify some of the types of situations that trigger your son's rage, you can prepare him (and your older son) in advance:  "When you guys play soccer (if this were the situation, for example), remember that you are older and stronger, so I don't want you to play against each other, but rather on the same team."  You try to avoid a blow-up by identifying your younger son's trigger and preparing him (and his brother) in advance.  You repeat your advice regularly before they go out to play.

You can also teach your son other strategies that I outline in my parent's manual.  For some of the strategies, it is important first that your son recognize that he has a problem with anger, and believe that it is important to work on it.  You lay the groundwork after each incident of anger overload.  When he is calm, you review the situation, and explain that you are going to work on this together so that he can learn to be the master of his anger.  I explain in the manual that it is important for parents to be empathize with how hard this is, but also parents should point out to their child that he can learn tools to have better control, and that you, the parents, are going to help him.
In the first part of the manual, I explain strategies that parents can use without having their child agree on a plan of action.  If your son is not ready to see his angry outbursts as a problem, there are still strategies you can employ to lessen the frequency and severity of his outbursts.  
A professional can help when you are not making headway at home.  Sometimes parents are "so close" to the situation that they overlook something, or they inadvertently do something that angers their child.  One common mistake is to talk to children when they are raging.  This usually prolongs an angry episode.  You want to take action if someone is about to be hurt, but otherwise you want to wait out your child's outburst.  Whether you have to take action or not, you do not want to talk much.  The more you say, the more your child will say back.  As you point out in your comments above, children are not thinking rationally during anger overload, so they will not listen to what parents have to say at that time.
Besides helping to implement the strategies, a professional can help if there is an area of vulnerability (maybe there is a self-esteem issue) that underlies the episodes when he gets angry.  Another reason it may be hard to make headway at home is that there could be a secondary diagnosis that a professional can help identify.  So if you do not make headway in the next month or two, consider reaching out to a mental health professional in your area.  All the best, Dr. Dave Gottlieb

Monday, September 17, 2012

14 year old with history of angry outbursts

Hi Dr. G., Today is the first I've ever heard of "anger overload", but I think this describes by 14 year old daughter.  But like most disorders, it's hard to to know if this really is the correct diagnosis.

My daughter is 14. She is a straight A student and always has been.  I can't say that all school work comes easy to hear, but she's willing to spend the hours needed to do well.  A classic overachiever.  She does not exhibit angry behaviors at school (that we know of) and respects authority figures.  She has friends and engages in extra-curricular activities.  She would appear to be a typical teenager.  She is a middle child; her brothers are 14 and 8.

As long as I can remember, she has had severe outbursts of anger.  It was and still is primarily directed at my wife or my sons.  Something that would seem so minor to someone else can set her off and she become verbally abusive.  Some of the things that she says are so horrible that I refuse to believe she actually means what she says.  When she was very young her outburst would result in prolonged screaming session.  Any attempt to speak to her (or console) her made it worse.  

As time went, the anger outbursts become shorter in length but no less traumatic for the family.  Early on we tried to use consequences for this behavior but it didn't change anything.  As much as she disliked the consequences, the anger remained.  We brought her to a nutritionist because we thought her diet was possibly triggering the anger. I still do. It seemed to help some but the anger continued.  As a family, we just learned to tolerate this behavior because we needed to get through the day and care for her brothers (and ourselves).  She refused therapy for a long time but currently we are seeing a social worker therapist to get help.  Unfortunately, I don't think she fully understands what we are trying to describe.

I've been a high school teach for over 20 years and have been in countless IEP's and 504 meetings.  I've heard about and dealt with children with many types of disorders.  I honestly believe that she cannot control her anger.  My wife has not always agreed with me on this point.  I think she can learn to deal with anger better but the anger will still be there.  I'd like to think that somehow we can find a way to make all the anger go away as this has taken a toll on our family.  This is something we deal with every single day.

Here are some other bit is information:

She has never really showed any empathy toward others.  She will NEVER admit she is wrong or apologize.  She's only said "I'm sorry" a few times in her life that I know of and even then there may have been an ulterior motive (facing consequences).  Outbursts last 10-15 minutes with the strength of a hurricane.  She retreats to her room for an hour or so and comes back down as if nothing has happened.  My wife, sons and I are still emotionally drained from the experience but she's completely fine.  As if nothing happened.  While in therapy she has admitted that she has a problem and doesn't want to continue being angry.

This may sound like she's a terrible girl but aside from the anger issues, she can be as normal and sweet as any girl.  She's very intelligent and has lots of interests.  One on one, without her brothers around, she can be so much fun.  At times even over the top giddy.  Sometimes we actually set her off unintentionally by calling her on a comment when she was just trying to be funny.  She has a  dry sense of humor.

Here is what I constantly struggle with in terms of consequences.  Is it fair to continually punish her for something that she can't control?  She has always had this anger.  I do feel that she can and should try to control this anger better so I try to distinguish between the two.  It is impossible to have a discussion with her about these issues (even when she's calm), she will not engage.  I have found that emailing or texting her is the only way we can communicate about the subject.  Never face to face.  I could go on and on but I hope this is enough to give you an idea of what we are dealing with.

Thank you.
Yes, what you describe fits with anger overload.  Anger overload is a term I began writing about ten years ago.  Other clinicians have written about children who have angry outbursts, and the next psychiatric diagnostic manual  will have a diagnosis called "disruptive mood dysregulation disorder" (or DMDD), which is similar to anger overload, but for DMDD there is negative mood even when the child or teen is not in the overload phase.  I have seen many children who have anger overload, but do not otherwise show signs of irritable or negative mood; that's why I prefer the term anger overload.   In the psychological research literature, there is discussion of children and adults who have recurring bouts of extreme anger, and there is more and more evidence that there is an area of the prefrontal cortex that seems to be involved.  These individuals have difficulty regulating anger.  However, with maturation and with practice, children can improve.  That is what my anger overload manual is about.  I offer strategies parents can use to help their children develop better self control.  The outbursts will be less frequent and less extreme.  

It is a good sign that your daughter agreed to therapy and wants to have better control.  If she is motivated to work on it, the second half of my book describes strategies parents can work on together with their children.  
Consequences do not work on a consistent basis for anger overload.  It is as if the brain is overheated, and the person is not thinking entirely rationally at that point.  This is why I tell parents not to take what their children say seriously when they are in overload.  It is also why I recommend ways for parents to catch their children's anger early, when possible, and suggest ways to change their children's expectations (it is often some kind of disappointment that precedes the angry outbursts) or change the sequence of events that sometimes lead up to an outburst.

Consequences sometimes help after everyone has calmed down if you are trying to stop one specific kind of behavior during the overload phase.  In other words, consequences do not generally work to stop anger, but if your child says a particular word, or throws things, you can target one of these extreme behaviors, and if the consequence is meaningful to your child, she may try to avoid it by stopping herself from saying the words you want to extinguish.  But sometimes this backfires, and the child says the "dreaded" words even more so.  Thus, the more useful approach is to teach your child strategies that will help her control herself before she reaches the overload phase.  Check out other blog entries or my book for other ways to limit anger overload.  All the best, Dr. Gottlieb

Monday, September 10, 2012

Making a Diagnosis: Hyperactivity, Oppositional, or Anger Overload

Dr. G,
I just happened across your blog while researching my son's behavior. You have described him almost to a tee. He has been diagnosed as hyperactive and also as oppositional defiant. Although he has showed some behavior relating to those disorders I have never felt like they were spot on. My question is:  How would I go about getting a proper diagnosis? (I am positive he has anger overload) and How do I help my son?
Thank You! I feel you are an answer to my prayers.

Hi,   A diagnosis can be made by a medical doctor (M.D.) or a doctor of psychology (Ph.D. or PsyD. degree) or a licensed clinical social worker (LCSW).  You would want to see someone in your area who has experience with children who have anger issues.  You could ask who your school or family doctor recommends, or check with your state's psychological association.  My book on defiance in children explains to parents the characteristics of the diagnoses you mention (oppositional defiant disorder, hyperactivity, and anger overload) and gives suggestions for what to do for each diagnosis.  My book on anger overload focuses on that issue and has a step-by-step guide for parents.  Ultimately if you are trying to decide on a diagnosis and there are several possibilities, it would be wise to check with a clinician who has experience seeing children with these diagnoses, so he or she can help you decide what is going on and what to do.

It is possible your child has aspects of two or more diagnoses.  It is not unusual to have a couple of things going on.  Furthermore, in the real world, people do not always fall perfectly into one diagnosis or another.  Your child could have some aspects of oppositional defiant disorder for example and not meet full criteria for this diagnosis.  To fully meet the diagnosis of oppositional disorder, the a child's argumentativeness with authority figures needs to be frequent and persistent over time (6 months or more), and must affect the child's performance in school, or social situations.  In other words, the child is oppositional  even in situations where it hurts his performance in something where he ordinarily does well:  in school, or in a sport, or in some other extracurricular activity, or affects his social standing with people outside the family.   If a child just argues frequently with his parents in the home, but not with other authority figures, there are some oppositional features but the child would not meet criteria for oppositional defiant disorder.

For more information on this or other diagnoses, read my book "Your child is defiant:  Why is nothing working?"  My book will help you think about what is going on and have suggestions for you.  But you can't really make a diagnosis yourself; it's best to check with a professional in your area to decide among the diagnoses you are considering.  Take care, Dr. Dave Gottlieb

Friday, September 7, 2012

4 year old has daily tantrums with people he knows

I found your site tonight while Googling for the thousandth time about the issues we’ve had with our son for the past few years.  I’m surprised I haven’t found it before, but better late than never.

We have just turned 4-year-old boy/girl twins and have had no real issues with our daughter over the last few years outside of what I consider normal 2/3/4 year old minor tantrums and defiance…testing limits and such.  But our son started having severe tantrums really early…somewhere around 10 or 11 months if I remember correctly.  It has just gone downhill since then.  We did work with a counselor (MSW,LCSW) who came to our home for a couple of months, but told us we really didn’t have an issue.  She told us to put him in timeout and simply wait for him to calm down, but we’ve been trying that for two years now with no improvement.  The problem is that until he is comfortable around someone, he actually behaves quite well.  It is the same each new year at preschool.  He’s great at the beginning of the year and then as he gets more comfortable the anger issues start rearing their heads.  He is a very smart, sensitive, loving kid half of the time, but the next minute he is mean and hurtful and screaming and kicking.  I’ve wondered if he was bipolar since it does run in my family, but I’ve called child psychiatrists who say he’s too young to be seen!!  He has multiple bad tantrums a day usually and even more shorter angry outbursts.  Once he “loses it” there is no talking to him, no calming him down, and he doesn’t know how to calm himself either.  And afterwards, we cannot talk about the behavior that sent him to timeout or the transgression at all, or it send him right back over the edge. 

I’m lost on what to do.  I am going to buy your book on defiance and also the one on anger overload, because they both seemed to hit a few nails on the head, but in the meantime, does this sound like something your book will help with?

He also has some mild sensory issues, but we’ve been working with an Occupational Therapist on those.  I was hoping it would help his behavior, but it has not significantly.

Thanks in advance for your response!

Hi, My book on defiance looks at various causes of defiant behavior in children.  The book helps parents identify the cause and then suggests strategies for each cause.  My book on anger overload is a parent's manual focusing on children who have severe meltdowns--tantrums that can last for minutes or hours--but who otherwise behave well.  The anger overload manual outlines specific strategies for you to try.  For four year olds, I recommend parents focus on the first half of the book:  the first two sections are "what is anger overload?"  and "parents as the agent of change."  The defiance book discusses anger overload but also other behavioral and personality issues.  There is a section on bipolar disorder in children, which you may find helpful, for example.  Yes, doctors do not usually diagnose and treat bipolar disorder in four year olds, because the brains of these children are still developing, and the children may develop better self control in the years to come.  Also the medications for bipolar disorder can have significant side effects, and most are not approved yet for young children.

     In the anger overload manual, I encourage parents to first observe the patterns, and if there are some situations that are more likely to trigger outbursts, I explain how to approach your child before he has an outburst.  You can change the sequence of events, lower your child's expectations in advance, use "emotional" distraction (I explain in the book that the distraction technique must grab your child emotionally in order for it to work.), or sometimes calming techniques can help.  Once your child is in overload, he is not thinking rationally and it is usually better not to say or do anything at that time, unless someone is being hurt.  Sometimes consequences can help later in the day when he is calmer, particularly if he uses some words that are not acceptable in your house, or if he broke something.  The consequence is not for anger overload per se, but for certain behaviors that you want to try to extinguish.  I explain more about these topics in the book.

     The last part of the anger overload book "teaching your child new skills" works better with older children--preteens and teens--however some young children benefit from using labels for the level of their anger.  The idea of the labels is to help children begin to be aware they are angry before they lose it.  Then they can be guided to use a calming technique before they explode.  Sometimes a fun activity works better than a relaxation technique to help a child calm down, but neither usually works well once a child is already in overload.  So you can see that the key is early intervention, when possible.   Otherwise you wait out the storm and try to not respond to mean or hurtful comments a child typically makes during overload.

All the best, Dr. Dave Gottlieb

Thursday, August 23, 2012

Is it anger overload or manipulative behavior?

Hello Dr.,
I have been coming to the conclusion that there is something going on with my 5 soon to be 6 year old son. I want to give you a bit of background on our particular situation and I would like to have some insight from you. My husband and I decided in 2010 that he would join the military to better our family as a whole. My mother in law did not like the idea nor did she stand behind my husband and the choice he made. Two days prior to my husband leaving for basic training she told my husband "you are taking the easy way out." My husband was hurt by that and we did not think that what happened next would ever happen.

After my husband left my son was 3 turning 4 and she was all I had to help me out with my children. She started coming by just about everyday and she would take the kids for a walk or we would all go for a walk and she would tell me "stay here do your laundry or whatever you need to get caught up  on." I did not think anything of it until one day my son hit my daughter and I told him to sit for a time out. When I told him that he looked at me and said "Well I know I can get a new mommy that will treat me a lot better than you do." And that broke my heart. Not thinking of where he would have heard that I allowed him to get up and do what he was doing. This had gone on for a few months.

About 2 months into this all my best friend had come over and sat me down and told me there had to be something going on with my son, but he would not talk to me so she talked to him. And in his words "Well Nanny told me if I tell mommy that I can get a new mommy then she would let me do what I want, and I want to do what I want." I never thought in a million years that my own mother in law would do this to me. I knew that she did not like me but to hurt my children like this. I did not have the heart to tell my husband that something was up because he needed me to be his rock at this point in order to get him through basic training....

If I had told him no to playing a game or watching a particular movie or anything really he would get very mad at me. Then the time came that we were moving with my husband and I thought everything was going to get better. And there for a while it did. It was really good. My son is very bright, very intelligent and wonderful until he has these what we call breakdowns. When we went to Korea he did not have a breakdown from June all the way until October....

In Feb of this year we moved to Texas where my husband is now based. My son gets upset and rages out when someone doesn't listen to him or does not want to play with him or if he just feels like someone does not like him. He gets loud with me, his dad and his sister. He hits his sister and he starts school this year and I am very afraid that he is going to have a lot of social issues. I know he will do well in class but worried about the interaction if he gets pushed out of a group of kids or something. Now my question for you is do you think that he would have "anger overload"? If you can message me back would be great. I am just a mom worried about her son. I never thought that I would have to medicate my child or get them help for any reason like this. It is breaking my heart and I have finally come to the conclusion that I am not the reason he is like this. I do everything I can for my children, they are my life and since I know that there is something going on with my son it is killing me.

Hi, It is important that all parenting figures, including grandparents, if they are in regular contact with the children, work together when it comes to discipline.  I'm sorry that your mother-in-law coached your son to disobey you.  One question I have is what do you think changed with the move from Korea to Texas, because it sounds like your son's behavior regressed this year when you moved again.  Why do you think he stopped misbehaving in Korea, and can you re-capture what you were doing there?

Anger overload lasts from minutes to hours.  So my question for you is:  once your son gets angry, does he usually get out of control and stay upset for a while, or does he get loud to get his way, but cuts it out as soon as he wants?  The former is more consistent with anger overload, and the latter is more typical of a child who uses his anger to get his way, but does not lose control.   If the problem is anger overload, then my parent's manual and other posts on this blog explain a number of strategies to help your son develop self control.   If the problem is the latter (your son uses anger to get his way, but not to the point of overload), then you will need to apply behavior modification strategies (incentives, consequences, ignoring, and timeouts) to make sure that you son does not get a lot of attention nor get his way when he gets angry.  There are a number of books for parents that help teach behavior modification, including a chapter in my earlier book about defiant children.  And remember what your son told you earlier:  grandma said to say this so that he would get his way.  He does not really want a new mother, so try to act like you are deaf and do not react to comments like that, as best you can.  

Also, if your mother-in-law is going to have contact with the children again, you and your husband will have to set firm limits or stay in the house when she is there.   This is assuming your son is accurately describing what the grandmother told him.  You and your husband may want to talk with her more about what your son said and how it has affected his behavior, or you may want to contact a family therapist in your area about how to proceed with her.   All the best, Dr. Gottlieb

Wednesday, August 22, 2012

4 year old twins egg each other on

I have 4 year old boy/girl twins. Both are fairly good and independent of each other but they play off of each other when they get rowdy. In other words, I feel like I have no control if I try to discipline them when they are playing together. They have their own built in playmate who eggs them on when I'm telling them no. I have a harder time with my son than my daughter. He will hit, have attitude, look me in the eye and do exactly what I tell him not to do, etc. We have tried time outs but I feel like my anger escalates to yelling and spanking and personally, I don't like myself like that, nor do I feel like it's effective. If he doesn't get his way, he will scream and tell me I'm a bad mommy or that he doesn't love me which of course breaks my heart. Any advice on how to handle this situation? It is affecting our whole household. Thank you!!

     Hi, Twins can have a special relationship and support each other, which sometimes makes it difficult if they are misbehaving.  In general, their close relationship is a good thing, but if they are misbehaving, I would separate them and give them each a time out or other brief consequence, even if one of them is more defiant than the other.  If one child is egging the other on, then both are involved, and both should receive a consequence.  This will encourage them to not support the other's misbeavior or risk a consequence.

     In order for consequences to be effective, they must be something that the children care about.  Some possibilities include time outs, loss of television time, loss of a favorite activity, or earlier to bed.  What do your children care about more?  Whatever you choose, it should be brief.  The next day everyone should start with a clean slate.

     You can also use brief incentives for self-control or cooperative behavior.  If you do this, give concrete examples of what you are looking for.  Incentives can be extra television or computer time, or an extra game with you. 

     Sometimes it is helpful to use your hand like a stop sign if the children are misbehaving and count slowly to three.  If they stop by the time you get to three, they earn a point, and if they get two points over one or two days, they earn the incentive.  (I  would also give them a point if they do not need you to put up your hand on a given day because they have behaved well.)

    When your son screams and tells you are a bad Mommy, remember that he is angry and will say whatever he thinks might hurt you at that point.  I would not use your hand as a stop sign nor impose an immediate consequence at that point.  You child sounds like he is in anger overload then.   Do not take what he says (when angry) as truth.  Try your best not to respond, as he is just trying to get your goat.  If you can ignore these comments, they are likely to lessen in the coming months.  You could later on that day impose a consequence if he was misbehaving prior to his angry comments, but do not talk about consequences while he is in overload, as this will lead to a longer tantrum.

     All the best, Dr. Dave Gottlieb

Sunday, August 19, 2012

5 year old tantrums at home

Hi Dr. Dave,
My five year old has been acting out at home and sounds to have what you describe as anger overload. He does not act out at school or for anyone else but at home with us. He has meltdowns if I ask him to help pick up his toys or if he gets frustrated at a toy he can't work or if he gets in trouble for messing with his little brother. Lately it worse with starting kindergarten and not really napping like normal. He has been screaming at the top of his lungs and hitting himself in the face, throwing stuff and just acting crazy. We've tried time outs, talking, and sending him to his room. Usually it escalates to spankings which don't help either. He usually calms down 15 minutes later after being sent to his room. He then acts loving and sweet. I don't know what to do, but I'm emotionally exhausted and would rather stay at work everyday than to come home with him. I'm worried my two year old will soon start acting like his older brother!!! Help please???

Hi,  With kindergarten starting and with less sleep, it is not unusual for five years olds to have some melt downs.  Your son will probably do better with more sleep, and you should see a decrease in his overload behaviors as he matures in the coming year.  However, here are some suggestions to move things along--to help him develop greater self-control:

1) Try to catch your son's frustration in the early stages, if possible.  It is easier to re-direct a child if the anger is not so intense.  So if you see him starting to get into it with his brother, try to distract one of them, or invite your older son to do something or show you something--it has to be something he really likes to do. 

2) If your son is getting frustrated with a toy, try to help him (if he will let you) or empathize by saying something like "Ugh is that toy being a pain in your butt?"  Your son will be less likely to explode if your comment strikes a chord in him. 

3)  When he is in full anger overload, try not to say or do much of anything unless he is hurting himself or someone else, in which case you may need to bear hug him, or restrain him in some way.  Anger overload does take some time to wind down because your son's brain is "overheated" at that point.  It takes time for the chemicals in your son's brain to return to normal.  Until that happens you do not want to talk with him because that will likely prolong the outburst and may inadvertently reinforce his negative behaviors.  You can either send him to his room, walk away yourself, or just sit there and act like you are deaf, whatever is easiest to do in your family situation.  When your son calms down, then talk with him about something of interest to you both.  That reinforces his efforts to be in self-control.  Furthermore, once children calm down, most act normally, as if their explosion is way in the past.  It often takes parents longer to relax after these explosions, and it can be a trying time for parents to get through them without feeling like they've been through the ringer! 

If there is not a decrease in the frequency of outbursts in the coming couple of months, check with your doctor or teacher to see if they would recommend you get a psychological consult.  All the best, Dr. Dave Gottlieb

Wednesday, August 15, 2012

4 year old rages only with his parents

About 7 weeks ago my daughter and her family moved from another state to live with us temporarily.  My daughter and son-in-law are loving, intelligent, and all around great people.  Their 6-month old baby girl is an absolute joy all the time; beautiful and so very happy.  Their 4 year old son can be such a wonderful boy to be around, but those moments seem few and far between.  By this I mean that not a single day has gone by when he hasn't screamed several times during the day, sometimes for hours, because he gets so angry about something; I can't even categorize his anger triggers because everything seems to trigger him.  The only thing that doesn't make him angry is if the people he is directing do exactly as he says with no variation, the moment he says it with no delay, and basically allow him to do whatever he wants.  But even then, sometimes he gets mad.  At least 5 times since they've been here, the screaming has escalated to screaming, biting, hitting, spitting, kicking, hair-pulling bouts and they are almost always against his mother.  My kids read countless books on spirited children (i.e., raising them, setting limits, etc.), but I'm concerned that this could be something more than just spiritedness.

The reason I feel this way is that on a few occasions they have let me babysit both children; once they were gone for only 90 minutes, a second that I recall they were gone for about 3.5 hours.  On both of these occasions, my grandson was a loving, fun, reasonable, 4-year old with absolutely zero outbursts let alone a complete melt-down. He was disappointed when I said I could only read two books instead of his usual 4 and then again for some other reason, but both times, he kept his disappointment to nothing more than the usual 4-year-old-expected-whine, and then he got over it as we moved on to other activities.  Also, at bedtime, he gave me no grief.  Bedtimes and naptimes with his parents are daily battle/war/big bang with him.  When it's just him and his sister with us (me and my husband), we love being around him as he really is quite pleasant, fun and funny.  When he's home with his parents, we've taken to hiding in our room (luckily it is quite spacious and relatively sound-proof.)   

We've offered to help but they don't really want our help, so we try to remain respectful of this as long as our grandson isn't hurting our son (who has autism), destroying any of our property, or being disrespectful to us.  One night, after a few too many glasses of wine, we recommended that the kids look into professional help - if not for their son then perhaps for them because they are getting worn down whether they choose to see it or not.  They haven't done this and I'm not sure if it's because we had wine and they thought we were just being silly, or perhaps because they don't yet have medical insurance, or maybe they truly believe that the books they are reading are going to help them.  They've read these types of books for about 6 months, btw with no change.  If anything, he seems to have gotten worse.  During one period my grandson went two days with just his usual, daily multiple screaming fits.  The following day he had one of his screaming, biting, hitting, etc. fits.  His dad commented on how it was a "...bummer because he'd been having such good days."  I didn't know what to say.  I thought, wow, so our bar (our limit) is when he turns violent.  
I bought your book and am eager to read it (too bad it's not on Kindle I would have downloaded immediately!)  I'm wondering if this is some sort of situational anger overload?  Does it sound remotely bi-polar? Oppositional defiant disorder?  I know you can't diagnose since you know nothing other than what is in this email.  I just feel so sad and helpless and reading the synopsis on your book made me reach out to you.  Thank you.
Hi,   As you wrote, I can't diagnose without doing an evaluation in person, but the fact that he did not erupt with you and your husband when the parents were away makes me lean towards anger overload rather than bipolar or oppositional defiant disorder.  The latter two diagnoses generally occur in multiple settings and regardless of which adult is in charge.  If the outbursts occur only with the parents, it sounds more like anger overload.

A question many parents ask is why does a child usually erupt more often at home with them.   Often parents are targets of anger overload 1) because their children know they will be loved no matter what, 2) because their children feel so close to their parents and therefore more easily disappointed if their parents do not respond to their wishes,  and 3) sometimes also because the parents (in their love for their children) have had a hard time sticking to their rules, and their children know that.  It is usually best not to respond at all during anger overload (except to keep someone from being physically hurt), because the more you talk and/or compromise at that point, the more likely the child will continue screaming you, and in addition the child will be more likely to rage the next time he is disappointed because "it worked" (in the sense that he got a response, even if it is not exactly what he wanted).

In my parent's manual, I outline strategies parents can take early in the sequence in anger.  The first part of the book is what parents do (without their child's direct participation) and the second part of the manual describes interventions parents work on together with their child.  It will take time (often several months) to see a lot of progress; how smoothly things go depend on the child's biological make up, as well as on the parents' emotional energy and motivation to stick with the new strategies (when change takes weeks or months, rather than days). It is worth the effort though, and parents are relieved when they see improvement. 
If you or the parents have questions after reading the manual, feel free to write again, Dr. Gottlieb

Tuesday, August 7, 2012

7 year old has melt downs aound school work

We have a seven year old son who displays anger and when he's angry he's very disrespectful.  He attended a private school in which many of the kids, him included, were bullied.  We eventually pulled him out after a year and a half and placed him at another private school in which he started hitting the same boy every day and he was asked to leave (this boy was very smart and was grades above the classroom he was placed in).  I home schooled him for the remaining part of the year.  We knew from both schools that he was what they considered gifted:   in first grade he was reading at a fourth grade sight word and comprehension level.  However, when I started home schooling him I got to see the behavior he was displaying at school.  When asked to do something that he didn't like to do or wasn't good at, like writing, he would completely melt down, refuse to do it, call myself or his tutor anything he could think of and sometimes throw his pencil across the room.  We would try to do things that were fun as part of our learning time, however, he became bored with those quickly.  If he masters, or he considers mastered, something he doesn't want to do it any longer, he says it's boring to him.  

For years we have always "saw" a melt down coming and could sometimes stop it before it happened, however, when he's in school it's much harder for the teacher to sense what's coming and catch it in time.  We know it's coming if he's frustrated, overly tired or hungry.  Instead of using his words to explain what he's feeling he will just explode.  Sometimes he feels bad for the behavior and other times he doesn't; it depends on who he has treated poorly.  If it's me, he's sorry and tries to make it better.  If it's his grandmother he sees every day he doesn't seem to mind that he treats her that way (my mother) or his other grandmother whom he sees weekly.  He tends to be very sorry when he's disrespectful to his father, but not always.

Our son is a very loving child, very sweet, very smart and caring person, when he wants to be, but when these episodes happen he turns into a different person, very disrespectful, angry, name calling and sometimes hitting (as with the second school he attended).  We have had him tested, IQ, academic placement and behavioral, but being in a school environment versus an office with a psychologist just isn't the same setting and we feel this may not show his true behavior.  We are awaiting the results of the testing and will get them next week.  I was just hoping to get your opinion about if you felt this was Anger Overload or something else.  

The testing may help identify if there are any learning issues; you mention he gets frustrated with writing for  example.   Also, you will find out what his strengths are, and knowing both his strengths and weaknesses will help you plan for this school year.  Furthermore, if the evaluator asked you about his behavior, or asked you to fill out check sheets about your son's behavior, the report would integrate this information even if your son did not misbehave during the testing situation.   If the evaluator did not ask you about your son's behavior, then you may want to explain when you meet with him. 

 Generally I recommend children with behavioral issues not stay out of school too long.  If you can coordinate with the school after you get the testing report and plan an appropriate class for your son, he may do well there.  If there are problems, you and the school can devise a behavior plan to deal with any outbursts.    The key is to work together with the school staff, and set up a behavior plan in advance.  You would want to include some of the suggestions in my book, such as having all the adults be aware his triggers, and then try to catch his frustration early.  Having a "go to" place for your child to settle down would be ideal, and it would be best not to talk with him when he is real upset, but to give him space to calm down.  The school social worker could work with him on calming strategies.  Sometimes rewards and consequences also help in school.  

Does your son have other triggers or are his melt downs generally around frustration with school work?  If the latter, then the anger overload would be limited to that particular situation, and having everyone involved in your son's education develop strategies to lessen his frustration would be key.  If there are anger outbursts about a number of issues, you would want to work on the other triggers as well.    In the second half of the book I suggest strategies to help children become more aware of their level of anger and their triggers, and I explain how to teach children to consider other points of view, and to compromise.

Take care, Dr. Dave Gottlieb

Wednesday, August 1, 2012

8 year old with anxiety and anger issues

Hi, I am writing to you about my 8 year old daughter. I think she may have anger overload and/ or anxiety issues and was wondering if the two can go hand in hand.

    The problems seem mostly associated with school.  She struggles with reading and starting in the first grade would shut down and not respond to the teacher.  In second grade she had a wonderful teacher that worked with her to try and overcome her oral reading anxiety.  She did very well and I thought we were making strides in not shutting down.  This summer I have her 2nd grade teacher tutoring her and it has been a disaster. She gets very upset when I try and leave her and will refuse to work with her.  If I am able to leave, the teacher is usually able to calm her down and get her to do math but when she has to read she shuts down again. Most of the time her and the teacher get along well and have friendly conversations, but when it is time to do more difficult work she changes.  She has told the teacher she won't do it and that she doesn't have to listen to her because she is not in 2nd grade anymore.  Before we go to tutoring she says she is going to do the work and not give us a problem going in but she always does even though she knows it will mean she can not go out when she gets home.  We follow through on the consequence each time.

Here is what happened today:
      As soon as teacher came in she refused to work.  Both the teacher and I tried to talk her into it.  She begins squeezing my hands and shirt. I leave the room.  She runs out of room and refuses to listen to teacher when asked to come back in the room.  Even when teacher returns to room she remains in hall.  I return, we get her to sit down, and she plays a math game with tutor.   They then move on to reading.  She refuses to read aloud, and lays down flat on chair.  She refuses to speak to teacher.  She tries to speak through me.  I tell her she needs to speak to the teacher and she refuses.  Eventually with about 15 minutes left she begins whispering the reading.  At the end she leaves as if nothing happened.  She asks if she can watch movie in car and is told no.  She is punished in room when we get home.

      I have had her evaluated for a learning disability and she refused to work with the people administering the test.  The psychologist who performed the iq test noted that she exhibited anxiety and that the test was not an accurate assessment of her IQ.  Homework is a constant battle.  When she becomes frustrated with it she cries, screams, and yells.  A common phrase is I hate you and don't want to be a part of this family.

      For the most part she is a lovely girl.  She did not have behavioral problems as a toddler and did well in preschool.  It was only when the work became more difficult for her that she began to exhibit these behaviors. I can pinpoint the moment she began to shut down as the middle of first grade when she refused to read her book report in front of the class and was forced to do so or receive a bad grade.  Also during that time I had another child which I also think may have contributed to her behavior.

      I have tried behavior modifications and they seem to work for a time but then we take a giant step backward like we did today.  I have also tried punishment but it as if during the time she is shutting down or having the outburst the punishment doesn't mean anything.  I also have an older son and he does not have anger issues.

      I am not sure if I should handle this as an anger or anxiety issues.  Any insight you might have would be helpful.

     Hi, Your daughter's anger seems tied to her difficulty and anxiety about reading.  You mentioned one day the tutor broke the ice with a math game.  That was a great idea.  When a child is anxious about something like reading, it is a good idea to approach the task in steps.  Have your child get comfortable with an educational game and build up her confidence and energy for academic work, and then move on to reading.  Also, if the reading is tough for her, move slowly into more difficult material.  If possible, make reading into a game too, like you did for the math.  I realize this means the tutor will be spending less time on reading, but if you do not take it in steps, you will probably continue to meet a lot of resistance.

     There is a group of professionals who work with children with learning issues:  "educational therapists."  It is a relatively new certification, but these professionals are trained to diagnose learning problems and help children who have learning and anxiety issues. 

     At some point, when she is comfortable with a psychologist or with an educational therapist, I would try again to diagnose what is causing the problem with reading.  My guess is it is a combination of a learning weakness of some kind (there can be various possible cognitive causes of reading issues) and anxiety.  It seems to me the anger issues are secondary to the anxiety issues in your daughter's case.  You can use some of the strategies in my book for anger overload, particularly when she is screaming at you or the tutor, but if you don't also address the underlying reading anxiety, you will probably continue to see signs of frustration and anger.

All the best, Dr. Gottlieb

Wednesday, July 25, 2012

10 year old melts down during baseball game

The "7 year old lashes out when angry" could have been my son... only difference is he is 10 years old, will throw things (bat to ground, batting helmet into dugout...) when angry, and exhibits astonishing disrespect for adults trying to "calm" him when in one of his rages. His primary triggers also include being teased or when he thinks someone is making a personal attack at him. Most recently he was removed from a baseball team for having a "melt-down" after striking out on a pitch he felt was fair. After the fact, his is quite remorseful and is fully aware of how his behavior was unacceptable. He also knows how he should have handled the situation.  He is seeing a child psychologist and has been given tools to help himself in these situations. We discuss the tools before every game; however, it seems that he just goes into a different realm when he gets mad and those tools are disregarded - it's like he's left his body and the mean/crazy guy has moved in. He is devastated over the removal from the team and wants to "fix" his anger issue. How can we do this when his primary trigger for outbursts is in a competitive situation?? We are all pretty much done with this as it has been going on for years...

Hi, One thought I have is to create a lower level competitive situation and "practice" dealing with striking out.  For example, could you do some hitting with him in the backyard or park, and have him practice cognitive strategies when he misses the ball.  Some catch phrases he could repeat out loud (and eventually in his mind) are "everyone makes mistakes,"  or "even Adam Dunn (or whoever his hero is) strikes out a lot."  The more he practices this "mantra" in situations with lower stress, the more likely he will internalize it.  I would also consider having him participate in sports (if he likes them) that have less focus on individual performance, such as soccer or basketball or football.  Yes, there can be pressure in these sports too, but there is not a long period of time when everyone is watching one play, like in baseball.  The action is faster and no one expects you will always score a goal in soccer, for example.  The basic idea is to expose your son to situations that have some pressure, but less than in a little league baseball game, and once he can regularly deal with those pressures, then try little league again if he really wants to.

I would also work on the underlying trigger--feeling teased or attacked.  Role play how to deal with those situations.  In addition, you as parents can model how to deal with criticism.   If someone criticizes something you do, say out loud how you feel and how you are going to deal with it.  Furthermore, help your son to "catch it early."  Anger can be more easily controlled before it reaches the overload stage.   What are his internal warning signs that he is getting angry?  Does he start breathing fast, does his hear race, does he feel flush in the face?  Have him learn to recognize these signs and develop calming strategies before he reaches overload.  Offer a lot of verbal praise if he practices a calming strategy even if it does not always work to calm him.  I go over possible strategies in my book.  They do not have to be quiet activities to be calming. 

All the best, Dr. Dave Gottlieb

Monday, July 23, 2012

3 year old screams and kicks when told "No"

I have a son who is 3.5 yrs old. He is an extremely angry young man and has been since birth. The word "no" normally sets him off into fits of rage. he frequently screams, kicks and tells me he hates me, or is going to punch me when  he doesn't get his way. I am not sure what to do anymore. I saw your book and wondered if he was too young for me to start blaming this on anything other than "being a toddler". Some days I feel like there is something very wrong with him, and other days he is an angel.   He is smart, has a great vocabulary, and at times can be just perfect, unless I say NO. He usually takes 20min to an hour to calm down after raging. Please help.

Hi, It is not unusual for 3 year olds to be egocentric and have tantrums when they do not get their way.  You write that he has been "extremely angry" since birth, and that comment makes me wonder whether your child is exhibiting anger overload, and not just age related tantrums.  In either case, you would use the same strategies I outline in my anger overload manual.  You would concentrate on the strategies in the first half of the book:  strategies you can employ that do not require your child's direct participation.

You first record the situations where he has outbursts over a two week period.  Is there some theme for some of the outbursts, and can you re-arrange certain situations to avoid the tantrums?  Or if your child expects something and often tantrums when he does not get it, can you lower his expectations ahead of time?  This could be key with your son:  you said he rages when you say "no."  So, in essence, you want to warn him before you say "no."  If you have to go somewhere soon, for example, you could say something like "we are going to have fun today but there is not a  lot of time before we have to go somewhere.  Let's play this quick card game before we go."  (You are offering something fun but not letting him get started on a longer game that you would have to interrupt.)  Or if you are going to say no to some dessert or say no to playing outside, you could say well in advance we are not going to do this today but we are going to do it tomorrow (or in the next couple of days).  Let's do this now.  (You get him busy so he does not obsess about what he cannot do.) You won't be able to use these strategies all the time, because children will sometimes explode when we don't expect it.

The next set of strategies has to do with the early phase of anger.  If your child has already begun to get angry but is not in full overload yet, then you would try emotional distraction or calming techniques.  I describe a number of these strategies in previous posts online and in my book.

Once in the overload phase, it is better not to say or do anything, unless your child is hurting someone or damaging something of value.  When he screams and says I hate you, think to yourself that this is "verbal diarrhea."  Your child is angry and does not mean what he says when he is angry.   If he is physically hurting someone, then you could bear hug him, or in some way prevent him from harming others or himself. 

You may also want to check with your family doctor to rule out other possible causes, like a mood disorder or social/personality disorders such as Asperger's.  You can read about these diagnoses in my book "Your Child is Defiant:  Why Is Nothing Working?"  While these diagnoses are not likely, if you are not able to lessen the frequency of outbursts over the next few months, then check with a professional to make sure nothing else is underlying your child's tantrums.

All the best, Dr. Dave Gottlieb

Monday, July 16, 2012

3 year old tantrums right when he wakes up

I have a son (he'll be 4 in November) who has anger / temper tantrum issues. His  normal disposition is very sweet and kind. In fact he can seem a bit shy. My friends whom have never witnessed my son's tantrums can't even imagine he has anger issues. However, during his "episodes" his anger is explosive - he bites, punches, tries to hurt me and himself. He will scream at the top of his lungs until he is hoarse and will repeat demands over and over again even if it's totally irrational. His episodes can last up to 45 minutes long. This behavior has put a tremendous stress on our household. I also worry about the future - when he gets bigger and stronger and I will no longer be able to help him.

I purchased your book Anger Overload in Children / A Parent's Manual - for the first time I felt I had found something that accurately described my son. I have been charting his triggers and trying to identify patterns. I created a chill out space in his room with his favorite "blankie" and stuffed animals.

My question is this - sometimes (usually 2x per week) my son wakes up in the full throes of a temper tantrum. There does not seem to be a pattern when this is going to  happen and there is no distracting him as he is already over the ledge. Do you have any suggestions or have you seen this in any of your other patients?

Hi, Charting to identify triggers will eventually help you to change some of the the sequences and thereby head off anger overload, and the chill space can be used if you catch the anger early enough that he will go to the space.  When your son is in full overload, you would either ignore or restrain him.  In either case, I would not say much of anything while he is in overload.  The more you talk, usually the more a child will escalate.  Restraining (like a bear hug, or holding your son on the couch, bed, or floor) is called for when a child is seriously harming himself or others.  As he gets older his self control will probably improve.  If he gets too big to restrain, you might consult with a child psychistrist who could prescribe medication to lower the level of agitation. (There are medications that a child can take daily, or take only as needed.  However, I usually recommend waiting on the medication and trying the strategies in the book first because some of the medications have potential side effects, and it would be preferable if your son could learn how to control his anger.)

As for when he first wakes up, does the anger start because he is tired and does not want to get out of bed, or is he having a nightmare or a night terror?  For the latter, "night terrors," children are really still asleep and cannot be soothed.   Holding him will not work, and may make matters worse.  You wait it out, and the night terror passes, and he will continue sleeping.  If on the other hand he is having a "nightmare," then he will wake up when you talk with him.  You do not say a lot, but you would try to reassure him that he was having a dream, and if he wants to talk about it, you would listen.  If he does not want to talk, but escalates, then you try to distract him with music, television, or the chill space.

If the anger starts as he is waking up (not from a bad dream or night terror), then you would try to determine why.  Many childern are moody when they first wake up, and children who are prone to anger overload can sometimes escalate very quickly from irritability to an explosion.  Try to develop a wake up routine that is gradual and soothing.  Allow enough time for him to get up slowly.  Maybe put on some soft music, a favorite cartoon, or a small light, unless he finds these stimuli to be noxious.  Is there a pet who can be near him that he might find soothing or distracting?  Would a back rub work?  Think about what he might find soothing. 

The problem could be too much stimulation as he is getting up, in which case try the above.  But if the problem is that he is still tired in the mornings, think about moving his bedtime earlier so he can sleep longer.  Some young children need a lot of sleep.  I'm not sure if there is something else that might be affecting him in the mornings.  Feel free to write back if I have not hit upon anything that applies to your son.  All the best, Dr. Dave Gottlieb