Thursday, March 29, 2012

4 year old's defiant outbursts

My girlfriend has a 4 year old son. He will be 5 in August. He is an intelligent boy. His name is Larry.. He is outgoing and social with everyone he meets. His father just had a new baby. He didn't inform Larry of the baby until the end of the second trimester. His mother and I have helped to excite Larry about being a big brother. I also have a 4 year old son. I work offshore and only get to see my son every 4 weeks. He and Larry play well together. I'm not a professional, but Larry has been a typical preschooler, until now. The baby was born last week. I have had no problem getting Larry to obey and follow direction. His mother is the disciplinarian and his father is very passive of Larry's behavior. I was home from work and witnessed the most obscene behavior that I have ever seen from Larry.

1) His mother and I took Larry and my son to a parade in town. Larry was very defiant and did not want to listen to either one of us. I usually let his mother control him, but I stepped in to help. It seemed to have worked.

2) We were at Larry's grandmother's home. He was rude to his uncle and began screaming and slapping at him. His mother stepped in and could not control him. He screamed at her and would not cooperate with her. I intervened and helped him to obey his mother.

3) Yesterday, his mother was called from his daycare. Larry has been in attendance of the center since the age of 6 weeks. He began yelling at the teacher and slapped at her when she asked him to get out of a chair. It became so violent that the male owner had to physically remove him from the chair. He continued to scream and his mother was called to intervene.

4) Today the daycare called and said that his actions from yesterday have begun, but have worsened. He was suspended from daycare for the remainder of the day and tomorrow. They are contemplating removing him from the center as a result of his behavior.

Sir, what can we do? His mother cannot afford counseling and we have tried to read articles to better help us. We both are in desperate need of help.

Hi, It sounds like there has been a dramatic change in Larry's behavior recently.  In my book "Your child is defiant" one important diagnostic issue I write about is whether the defiant behavior has been going on a for a long time or is of recent origin.  If recent, I label the problem "situational," and I suggest parents look for what has changed recently in the child's life.  You point to the birth of the new baby.  Some questions to consider are:  how has the baby's birth changed Larry's schedule and his relationship with key adults in his life?  Is the time with the father different, or has the father's emotional availability to the son changed?  Is there anything else that has changed in Larry's life recently that could account for his angry, defiant behavior?  For example, you mention you are away offshore for several weeks at a time.  Is Larry attached to you, and does he miss you?

Another thing to observe:  what is going on when Larry erupts?  What was happening at the parade, with the uncle, and at day care when he got angry?  What was going on right before he got angry?  Can you see any patterns?  If you can narrow down the triggers, you can then try to anticipate his rage and alter the situation ahead of time. 

If the child is being disobedient, but not in an out-of-control rage, then be firm about what is expected of him.  Have a short term consequence (like a time out)  ready if he does not comply.  If the child is in anger overload (out of control and not rational) then you can try to distract him, but you will probably need to ignore him.  Talking about what you expect of the child at these times is ineffective.  However, when he is physically violent, (when he is striking someone), then you will need to yell stop and/or restrain him.  You can also use incentives and consequences, but these do not usually help in the middle of an out-of-control tantrum because the child is not thinking rationally at that time.  You can impose a consequence later after the child calms down. You can read more about behavior modification strategies in my book, or other books about discipline.

Another thing to consider:  what was your approach that seemed to work to settle Larry down?  Is it something that the other adults can do too?  Also, it is important for the parenting figures in Larry's life to try to be a united front.  If he feels one adult does not support what the other is doing, then Larry will be less likely to listen.

My last suggestion gets back to the first thing you noted in your e-mail:  the birth of the baby.  If you all think this is what might be causing the outbursts, then it would be important to talk more with Larry about the baby, find a role for him when he visits the baby, and help him with his worries or anger about how the baby has affected him.

If you do not have success, try talking to Larry's doctor.  Also most states have community mental health centers with sliding fee scales, and someone there may be able to help further to figure out what to do.  Take care, Dr. Dave Gottlieb

Friday, March 23, 2012

6 year old with anger isssues

I just read your article about anger overload, and it gave me a lot of hope that maybe my six year old can get some help for his anger. Just this week my husband and I have decided that it is time to seek professional help for him since despite our concentrated efforts to be consistent with him, he has only seemed to get worse. I have made an appointment with his pediatrician since I don't know where else to start. I would love some more information.

Hi, Starting with your pediatrician is a good idea, because he will know good child psychologists in your area.  A psychologist will ask you when your son first displayed severe anger and what were the circumstances.  A first interview also includes a brief developmental history and a discussion whether other family members have had similar issues.  Your psychologist will then form a working diagnosis.  He may offer some suggestions or prefer to wait until he has met your child (the meeting with the child usually takes place after you have given him some background).

In the meantime there are things you can start to do, such as keeping track of the circumstances when your child gets angry:  what is the sequence?  Look for any patterns:  what tends to precipitate his rage?  You will not be able to predict his outbursts in some situations, but you might find some similarities some of the time.  Then you can try to prevent some of the outbursts by re-directing or reassuring your child (depending what the issue is) before he gets angry.  Once your child is in extreme overload, though, it is best not to say much of anything and wait for him to calm down (unless he is hurting himself or someone else and then you have to intervene and restrain him). 

In my upcoming manual I will offer many strategies which you can use to help limit anger overload.   I will let you know when manual is available.  In the meantime, read through the blog and you will get some ideas of things you can begin to do.  Take care, David Gottlieb, Ph.D.

Wednesday, March 21, 2012

10 year old with ADHD and anger overload

Dr. Dave,
My daughter is almost 10. When she was a baby she would bang her head against the wall if she was upset. When she was a toddler she would slap the face of whoever was holding her if she was upset. Now she is starting puberty and reacts physically kicking and swinging when she is upset, even over very small things. Her reaction usually involves crying. The reaction lasts approximately 5 to 20 minutes. She is remorseful afterwards and wishes she didn't feel so angry. I recently read your article from August 2001 about anger overload in children. She has a lot of the characteristics you mention. She was recently diagnosed with ADHD and has started a low dose stimulant. This has not helped with the anger or crying. Sometimes she just cries for a few minutes without the physical reaction. There is some family history of bi-polar and ADHD, but I really think anger overload better describes her behavior. Please notify me when your manual is available.

Hi, Yes I will do that.  The manual will have a number of concrete strategies for you.  I think anger overload is a separate diagnosis from ADHD and bipolar disorder, but some similar behaviors can occur in all three diagnoses.  Some ADHD children are impulsive, as are many children with bipolar disorder, and  some with anger overload.  What is different is how the impulsivity is expressed.  With anger overload, we see impulsive outbursts of anger; these children (if they do not have an additional diagnosis of ADHD or bipolar disorder) are relatively calm otherwise.

ADHD children often blurt out answers and move around and bump into other people (because they didn't notice who is nearby).  In addition, some ADHD children also react emotionally without thinking first.  In the latter case, the behavior is like a child with anger overload. 

Finally bipolar children will often get mad in a quick and explosive way, but also have other characteristics which a child with anger overload does not exhibit.  For example, bipolar children have frequent (often daily) changes in mood and often engage in impulsive, risk-taking behaviors. 

For more on the differences between these diagnoses, see my earlier book "Your child is defiant" in which I explain the differences between mood disorders and anger overload.   The anger overload manual will be published in about a month.  In the meantime, review other posts where I have suggested some approaches for anger overload.  Take care, Dr. Dave

Tuesday, March 20, 2012

Anger overload manual is due out early May

Hi, I've had several queries recently about the parent's manual for dealing with anger overload.  I am currently making final revisions. It should be available from Amazon and other online retailers in early May.  I will contact those of you who have asked to be notified, and will also post a notice here on the blog.  Thanks for your patience, Dr. David Gottlieb