Thursday, February 9, 2012

9 year old bites self and bangs head

I have come across your website with great interest and relief, as my 9-year old son is, I believe experiencing anger overload. Until this evening I had not managed to find any information about this age child having such a problem. Only younger children or teens with such anger and outbursts. My son has up to 3 or 4 episodes in a bad week, sometimes twice in a day, and gets so angry for no reason that he ends up turning his anger on himself and biting his arms/hands/legs, or banging his head on the wall or floor. It is very distressing and my husband and I do not know what to do for the best for him.

He is bright, normally a lovely calm and interesting boy, but when he feels angry or unfairly treated, he can react in this way, and he’s getting too strong for us to hold him and stop him from hurting himself.

Hi, While these seem to be instances of anger overload you are describing, you would also want to go to a mental health professional to rule out other possible co-existing problems, like a mood disorder or autistic spectrum disorder.  There are many books about these problems, and you can also read more about various co-existing disorders in my book on defiant behavior (see link in photo above).  Once you have ruled these out, then the exercises in my anger overload manual will be of help to you.  The final version of the manual should be ready in a couple of months.

A few ideas to get you started:  Chart the instances during the week when your son has anger overload.  You want to see if there are any patterns that would explain some of the situations when he has an outburst.  Then you can try to use this information to catch the overload early (if possible) and use distraction (see earlier blog entries about how to do this) or plan to avoid the triggering event in the future.  Develop a chill place in your house (see earlier blog items) which your son could use when he is getting agitated.

Once your son is in full overload, it will be hard to interrupt the outburst.  But you want to make sure he is safe, so if you can restrain him if he is hurting himself or someone else, then do so.  If the head banging is severe or biting is severe, can you safely bear hug him or restrain him on the floor?  You may need help depending on how much your child resists.  

You also can begin to make him aware of anger overload and how to work on it by using yourself as a model (see previous entries) and by labeling the level of anger (see earlier entries).  Once you are able to catch it earlier before total overload, there are other cognitive strategies that you can use, including developing a catch phrase to re-direct his thinking.  Catch phrases are short sayings used to remind the child that there are other points of view, other than his current view (which is leading to his extreme disappointment).  This will be fully explained in the manual.  

I hope this helps you get on track.  I will be leaving town for 10 days, but will try to respond afterward if you have more questions, David Gottlieb, Ph.D.

Monday, February 6, 2012

4 year old kicks, bites and throws things

Hello Doctor -

In my search to figure out what is going on with my son, I came across your website.

I had never heard of anger overload until today, but I believe my son may be experiencing this.
He is 4 years old and has been kicked out of his pre-school, with the possibilty of being let go from his new one.

My son is very intelligent and at times, very loving.
But almost anything can trigger a meltdown. He becomes so enraged: kicking, biting, throwing, turning over small chairs and tables, and even destroying anything that is around him.
I have been patient with him at home and manage to get it under control, but his teachers do not have the ability to control him, especially because it is hard to give him one-on-one time.
As I mentioned, anything can trigger these sudden outbursts. If he is told to go into thinking time for something he has done. If he loses a game (on the nintendo DS). Even if it is bedtime and I turn off the TV.
He can go from perfectly calm, to what looks like a monster.
This worries me so much because he is too young to have all this anger inside of him....Enough anger to break a closet door, and to try to turn over a high chair while a toddler was sitting in it and kicking doors.

I have a 6-year-old daugher is 100% opposite. She is saddened by her brother's behavior and sometimes she just skakes her head and sits scared and silent as this is happening.

He has had several therapy sessions - where ADHD and bi-polar were ruled out.
He does not open up at these sessions  he rather play with toys than talk. But every time the therapist has seen him, he has always been calm. When I describe the "monster" that comes out, people find it hard to believe or think I may be exaggerating because he is usually well-mannered.
I've been told by the therapist that he is just a 4-year-old boy acting like a 4-year-old boy.

I believe it's more.

Does this sound like Anger overload?

Yes, it could be anger overload.  Sometimes a young child's brain experiences overload when the child is frustrated or disappointed; one theory is that the amygdala (in the limbic system deep inside the brain) is overwhelming the person's prefrontal cortex (outer layer of the brain which has to do with self-control and planning, among other things).  Once the amygdala calms down, the child returns to normal.  In many of these cases, it is a developmental issue: in other words as your child gets older his brain will mature and self-control will likely get easier.  There are strategies you can use to help this process along.

My parent's manual should be ready for distribution in the next few months, and I will let you know when it is ready.  Also mention your son's rage to your pediatrician to make sure there are no other medical issues, and ask your son's therapist to consider anger overload.  It is a term I wrote about in an article about 10 years ago, which you can find online.  Also, the new diagnostic manual for mental health providers which will come out in a year or two will have a new diagnosis which is similar. 

In the meantime, keep track of the situations which trigger your child's rage.  See if there are some patterns.  If you can, anticipate when he might rage, and re-arrange the situation to try to lessen the chances of an outburst.  Another strategy is to use "emotional distraction." (see previous post on this subject)  I know it is not always possible to anticipate and re-direct your child, because a lot of different things can trigger frustration and then rage, and I realize your son's rage can occur very quickly.  But try to see what patterns you can find.

Develop a calming space in the house where you have a mat, a blanket, a stuffed animal, and the like.  Play with your child there when he is not angry so he gets used to the space.  Does he like being wrapped in a blanket or hugging a big stuffed animal.  Use tactile stimulation (being wrapped in the blanket for example) and pleasant odors or music in this space to make it appealing.  You can even have a hand held video game available for that space only, and you put it away when the child leaves the space.  Then after a few weeks, suggest your child go there if he is starting to wind up.  Once he hits overload, it is unlikely he will listen to you and try the space.  At that point try to say nothing.  Restrain him though if he is hurting anyone.  Once he calms down then talk again with him.

The manual will explain a number of cognitive strategies to help your child look at things from other people's perspectives.  This is tough to do with a four year old, but the manual will outline charts you fill out with your child and will show you other strategies to work on with your child.  One cognitive strategy you could begin now is to help your son become aware of the levels of his anger.  Develop a three step level system--low, medium and high--to describe his anger, and mention briefly what the level of his anger is (later when he is calm, or you could label it when it happens if your child is not already in overload).  You want your son to begin to realize that there are degrees of anger and to recognize those levels in his expressions of anger.

Also, begin modeling labeling and self-control yourself.  When you get angry, say out loud what level it is, and say later what you did to settle down.  Talk briefly about it when your son is calm and not in the middle of a game or activity.  Do not expect him to answer, but you are priming him to see that everyone gets angry and everyone works on it.

I will let you know as soon the the manual is ready so you can employ all the various strategies.  Keep working on it, because you will be teaching your son a skill that will help him throughout his life.  It will take time, but it is well worth it, David Gottlieb, Ph.D.

Friday, February 3, 2012

Child with anger overload goes out window onto roof

I just found you on the internet and boy is your definition of anger overload my son. My son has been difficult since he was 2.  At age 6, I did have him tested and they said their was no diagnosis and just to continue to receive play therapy. Play therapy didn't work maybe he was too young. (Family sister is bi-polar and my husband's mom has depression)
Most of his extreme anger outbursts are towards me and sometimes my husband and sometimes his cousin (they are like brothers), He never seems to have extreme outbursts to his sister who 16 months older.
The last two days have been extreme. First one was on Monday because of his homework and he didn't like how I was trying to help him. Got so angry that he said he was going to punch me. (he never hit me) It doesn't help that I know I fuel the fire because I wont allow him to treat me that way. He got very heated. Once everyone calms down he apologizes and said he wont do it again.
Next day he fought with his cousin about a sweatshirt he didn't want his cousin to wear. He got so mad, he hid it in his swim bag and lied to me that he did that. He got grounded cause he lied, then he ran out of the house with  socks on and was going to beat up his cousin because it was his cousin's fault. When he went in his room he opened his window and was standing on the ledge to yell at his cousin. He actually ripped the screen and had no idea that he could of fell and hurt himself because he was so ticked off.  
Really I think that we need tools to help him and us handle his outburst.

Dear Mom,

I would recommend you talk with your son about going out his window onto the roof now that he has calmed down and point out the risks and how much you love him and don't want to see him get hurt.  Explain an alternative would be to open the window and shout at his cousin or wait till his cousin comes inside.  If he goes out on the roof again, I would immediately insist he come in.  If it becomes a recurring issue I would even consider putting a guard on the window to prevent him from opening it.  I would also consider a serious consequence later (not to be discussed while he is in anger overload) that is tied specifically to this kind of dangerous behavior.

At other times when your son is not in danger, I would recommend not talking to your son while he is in anger overload.  You can always have a consequence later if he threatens to punch you again, but if you talk about it while he is agitated, his outburst is likely to go on.  

It is good that you are beginning to look for patterns:  you mention it happens more with you and the cousin.  Continue to note the triggers, and then see if you can plan around them sometimes.  For example, if you know helping him with homework sometimes triggers his rage, then take a break when he starts to get upset, walk away, and help him some more later.  It may be preferable for him to get a wrong answer to having a melt down.  Also if you walk away he will see that if he mistreats you he loses your attention.  Then pay attention to him when he calms down.  If you have a consequence for his threats or lies, talk about that later when everyone is calm.  

I will let you know when my parent's manual is ready in a couple of months so that you can work on some other strategies for anger overload with your son,     
                                                                              David Gottlieb, Ph.D.