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


  1. I am looking forward to the anger overload manual. This describes my son accurately. we have never felt that he is ODD because his angry outbursts are situational, and mainly about school.
    He struggles greatly there with his ADHD and LD. He is very sensitive and has sensory integration issues. His IEP includes sensory breaks. But he then also gets very angry when he feels that something is unfair or if he is afraid something will be too hard. He goes into fight or flight mode and either elopes and hides or has a tantrum kicking or breaking something.
    It's brief Nd he is remorseful after. His rages are seasonal at school or at home about school and become more frequent in the Spring , mainly I think because he has had so many bad experiences that add up and he finally starts to fall apart. We are about to start therapy again and will talk about anger overload. what do you think about homeschooling these kids.
    Frankly he gets most of his work done at home already
    The negative experiences and drama is destroying his self esteem.

    1. Hi, The anger overload manual should be ready in about a month. Without seeing your son, it does not seem like ODD to me either since it is related to s specific issue and it reflects frustration more than oppositionality. If you can anticipate his outbursts or if you can see him getting frustrated, you can try to distract him, or lower the expectations ("you don't have to do it all," or "it's okay to make mistakes") or do smaller amounts at a time ("let's just do this much now"), and give a lot of encouragement for effort rather than content of his responses. Having a home tutor who is knowledgeable about LD is a good idea, but there are pros and cons about home schooling. It puts a lot of pressure on the parent-child relationship to become the main teacher, and it also takes him away from peer interaction (though you could sign him up for after school peer activities). The manual will have other suggestions for helping him cope with frustration. Take care, Dr. Dave Gottlieb

  2. Thanks so much. We'll definitely look for the manual in May. Best, Susan

  3. Hey Dr. Dave,
    I've got a 8yr old daughter who was said to just be a strong welled child and change adjustment disorder. But it dosnt seem to fit her. The anger overload descibes her. She does great in school. She gets very angry and will scream and kick the wall anywhere from 20 min to a hour. as long as she is not triggered she is the sweetest child. Im worried about how i could probarly have her diagnosed. i dont want her being but on some medicine that zones her out. They had here on zoloft for awhile but was concerned about the side affects. so i dont know where to go from here?

    1. Check with your state's psychological association or with your family doctor for a psychologist who works with children and their parents. You want someone who is familiar with anger issues. Explain what you wrote me.
      In the new diagnostic manual that doctors use to make diagnoses, there will be a diagnosis that is mostly similar to anger overload called disruptive mood dysregulation disorder. Ask the therapist you see to consider this or to check out my articles online about anger overload in children. Not every child with anger problems has mood or adjustment issues. You may want to read my anger overload manual and try some of the strategies I write about or check my blog posts for ideas on what to do at home.