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.

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