Thursday, April 26, 2012

9 year old with severe anger problems

My 9-year old son is struggling with severe anger problems.  From the time he was born, we could see in him a spirit of anger and discontent.  As he grew older... it became more and more evident.  When he started kindergarten he was diagnosed with ADHD and ODD.  We've tried medication that worked for a while, but recently (last few months) things have taken a big turn for the worse.  He is angry almost constantly, and often erupts into HUGE outbursts where he screams, rages, and says horrible, horrible things.  Nothing will soothe him.  The only thing we've found is to completely ignore the behavior… which is almost impossible as we have other kids and a life to live!  He seems to function okay at school, but at home he's almost impossible to live with.

We've tried rewards systems, we've tried discipline, but nothing seems to work.  He just seems to be constantly filled with anger.

We're talking to a psychiatrist and psychologist, but I saw your site and thought I'd ask if you had any advice.

 Hi, It sounds extremely difficult because of the frequency and severity of your son's outbursts.  I'm glad you are checking with clinicians in your area.  Children with anger overload can have additional diagnoses such as pediatric bipolar disorder or autistic spectrum disorder, and you would want to rule out these additional diagnoses.  If your son met criteria for those diagnoses, it would alter the approach both in terms of medications and in terms of psychotherapy.

If your son has ADHD, there would usually be signs in the classroom, such as distractability or impulsivity.  If so, ADHD medication should be considered.  If no signs in school, then I would not recommend ADHD meds.  For ODD, you would expect oppositional behavior in more than one setting, i.e. in school as well as home.  If your son does not get into arguments, refuse to cooperate, or get angry in school, then again I would be cautious about diagnosing him with ODD.  Your description sounds like there could be a mood disorder.  Some children respond to antidepressants and some respond to bipolar medications, depending on the diagnosis.  Ask your local clinicians what they think.  My book "Your child is defiant:  Why is nothing working?" looks at the different possible diagnoses underlying angry, defiant behavior.

For anger overload, my new manual "Anger overload in children:  A parent's manual" outlines steps you could take to help, but it takes time, as I'm sure you realize by now.  It is important to try to catch it early sometimes, or work around sore spots, because you want to lower the frequency and intensity of outbursts.  So observe what some of the triggers are and try to avoid them.  I know this is not always possible, and maybe not even possible most of the time, but if you can lower the level of outbursts somewhat, it is easier to proceed with the other steps in the manual.  You are right that in the middle of an outburst, your child is on overload and is not thinking rationally, so will not respond to incentives or consequences at that time. 

The key is what you do before the outbursts and what you do after he has calmed down.  I give you a number of strategies in my manual which then over time will help lessen the frequency and intensity of your son's outbursts.   Strategies include changing the sequence leading up to an outburst, emotional distraction techniques, how to use praise and consequences, developing your child's self-observation skills, and teaching your child about other points of view and how to compromise.  In the manual I offer specific instructions with worksheets for each of the strategies.  It will take several months unfortunately, but it is well worth it.  Self-control is as important as learning to read.  Try some of the suggestions in the manual and/or see what your local clinicians recommend.  Let us know how things go, Dr. Gottlieb

Thursday, April 19, 2012

Follow-up from parent of out of control 3 year old

I greatly appreciate your response. He has been in his new day care for 2 weeks (6 days) and they are doing the same things you suggested with the smiley faces. With mine and my husbands work schedule, we pretty much just wing our entire day, and the only routine we have is dinner and bath time, and bed of course. I'm going to try and get on a stricter schedule, and use the smiley faces like they do at school to sort of integrate everything at home and school into one. I have yet to go to the doctor, I was kind of waiting to see how it went at school, but I will take him now. I'm worried there could be something wrong, and if there is I want to work with him as soon as possible. I don't want to have him frustrated like this either, it hurts me when hes upset too. Thanks so much for your help!

Hi, Glad the school is on the same track.  It always goes better when the school and parents are working together.  Good luck, Dr. Gottlieb 

P.S. To see the original comments, go to the April 15th post. 

Monday, April 16, 2012

My parent's manual is available now

 Hi,  My parent's manual for anger overload in children is now available from the publisher at the link below.  The price is 17.95 per copy.

Next week, the manual will also be available on Amazon for the same price, and in about a month it will be available at other book seller's like Barnes and Noble.  

The manual explains all the steps I have been using with parents in my office for dealing with anger overload.  The manual greatly expands on the articles I have published previously.  It gives you detailed instructions and worksheets for each step.  If you have questions, you can e-mail me at, Take care, Dr. David Gottlieb

Sunday, April 15, 2012

Out of control 3 year old

My son is 3 and is completely out of control. Everyday is stressful, from eating to playing to bathtime. He freaks out if he doesn't get his way, he hits, kicks, punches, spits, bites, smacks and pulls hair. When I try and discipline him, by putting him in time out, he will hit and scratch and bite and punch until I cuddle him. If I spank his butt for his behavior, he gets worse, like it works for the behavior then, but it won't last. Today alone he's been in and out of time out at least 10 times and it's not even dinner time, If I put him in time out everytime he hit when he didn't get his way it would have been over 20 times. My husband and I are at a loss of what to do. I'm taking him to the doctor for sure to see what suggestions they have and we are starting parenting classes soon and working with his new day care, but do you have any discipline suggestions until then?

It sounds so frustrating.  Yes, I would check with your doctor.  In the meantime if there are certain situations that are more likely to lead to his out-of-control behavior, think about whether you can re-arrange the sequence in any way.  For example, if he loses control when he has to do something, try to arrange a short activity that your son likes to come after the thing he does not like.  Then there is a natural incentive for him to cooperate.  You could remind him ahead of time what comes after his cooperation.  You could also start a "cooperation" or "self-control" chart on the refrigerator, and your son could earn smiley faces each time he cooperates.  At the end of the day if there are enough smiley faces (you would need to determine in advance what number is an improvement, even if not perfect), he could earn a bonus activity (short game or extra story) before bedtime.  In this way you are building in incentives to try to motivate your child.

One problem I see is that you cuddle him when he does not respond to your disciplining.  This is inadvertently rewarding your child for his lack of cooperation.  In other words, in his mind, he sees that his awful behavior leads to cuddling.  So I would recommend you change that pattern.  It is best to totally ignore your child if he is in anger overload, unless he is hurting himself or someone else and then you will need to restrain him. 

When you meet with the doctor, see if he or someone he recommends can rule out any developmental delay that may be intefering with his acceptance of the rules.  Is there any learning delay, or sensory integration problem (he may be on edge a lot of the time if he has trouble with loud noises or tactile stimulation for example), or beginning mood or social interaction problems that could underlie his outbhursts.  I'm not saying that he does, but you would want someone to rule these things out. 

My new book, "Anger overload in children:  A parent's manual" is in press and should be available on in about a week.  It has other helpful suggestions for parents.  Good luck, Dr.Dave Gottlieb

Monday, April 2, 2012

4 year old's aggressive behavior in school

I’m reaching out to you, like many parents, with sadness, desperation and frustration.  My son, who is 4 years old (to be 5 in July) has been having behavioral problems for a long time.  He was always a very strong willed child, however, we started having more serious issues after enrolling him in nursery school at the age of 2 years and 4 months.  He was expelled from his first nursery school for aggressive behavior towards teachers and too hyperactive (this was after 6 months of attending the school).  After this incident, my husband and I were very careful at selecting another school.  He was then enrolled in a Montessori school.  He has been attending this school for 2 years now.  As in the other school, he has been very aggressive towards teachers.  He has been suspended from school many, many times due to his behavior. Recently, he started to show aggression towards other children (becomes frustrated because he doesn’t win, etc) which was never a problem before.  He has been (unofficially)diagnosed with ADHD and he is currently attending behavioral therapy with some improvement.  My husband and I can work with him very well, but his behavior at school is a big challenge.   My question is regarding any strategies that can be used in a classroom environment.  His teachers try very hard to work with him, and I know that they will try any techniques that can improve his behavior at school.  I’m looking forward to your new book, please let me know once it becomes available.

Hi, First, think about what is going on when your son becomes aggressive toward teachers.  Can you and the teachers identify some triggers, and can you alter the scenario to reduce your child's frustration?  For example, if transition time is difficult for your child, maybe he can be cued ahead of time, and he could earn an incentive for cooperation.  If you use incentives, you could use smiley faces, for example, that your child could trade for a special activity when he gets home.  The activity would vary each day or two so your child does not become bored with it (and could repeat the following week), would be something your child likes, and would need to be short term (no more than a half hour) or else it gets too difficult for you to do the activity with your son on a regular basis.

If your child gets angry with other children when he loses, you and the teachers could cue him when he starts a game that "everyone loses," or direct him toward non-competitive games.  You want to try to use catch phrases like "everyone loses sometimes" before he starts to get upset, because it will be harder for him to delay and think rationally once he gets upset.  He could also earn a smiley face (or other reward) if he shows self-control when playing with other children. 

If he has a tantrum, it is best to remove him to a time out area where he does not get any attention until he calms down.  He could also lose a privilege that night at home, or you could just go with the time out in school as a consequence if the school is able to do this.  If you use consequences make them short term and fairly immediate if possible.  If he has a lot of tantrums, set the goal ( to earn a reward or to avoid a consequence) as a reduction in frequency of aggressive behavior rather than make the goal "zero" tantrums. 

I would recommend you set up play dates if possible so he can practice interacting with one child at a time.  Many young children have trouble managing the interactions in bigger groups, so it would be good then for him to develop social skills in one-on-one situations first.  I also wonder if there is delayed social development, or if he shows any Asperger's signs (check my book or others on the subject).  You would want to work with him on social skills if this is a problem.  Check with a psychologist or therapist in your area if you are concerned about social skills issues.

Mostly in school you would want to start with behavior modification strategies until he matures and is able to show more self control on his own.  I describe a number of other strategies in my book, and will let you know when it is available, Dr. David Gottlieb