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

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