Monday, May 7, 2012

14 yr old with depression and anger overload

Dear Dr. Gottlieb,
  I want to thank you for your article "Anger Overload in Children:  Diagnostic and Treatment Issues".  My husband and I agree that our 14 year old son fits this description.  He was diagnosed with depression in Nov 2011 and is on Prozac, which not only helped with the depression but also helped with these severe anger moments (lasting approx 1 hour).  He now only experiences these anger reactions approx 2-3 times a month.  However, even though we are down to 2-3 a month, when he does have them, they are just terrible.  When he gets angry, he completely looses control and nothing can stop his anger.  We let him know there are consequences for these behaviors (we take away all electronic such as I-pod, computer and TV for 24 hours), but that just seems to get him more angry.  It's like he is a different person and it appears that he cannot control himself. Fortunately, he does not hurt himself or anyone else, but he does throw things and kick things (but has not broken anything).
 We read in your article that counseling can help.   If you have any other advise for us, we would sure appreciate it as well.
Thank you so much.

Hi, I would suggest not mentioning any consequences during an outburst because, like you have observed, most children escalate further.  When someone is in the overload phase he is not thinking rationally and most anything you say will be met with anger.  You can use consequences later or the next day if he violates a house rule like swearing or physically acting out.  In other words you would target any behaviors which were in violation of house rules and not target your son's anger per se.  Anger overload is tough to control so I do not generally recommend consequences for the anger itself.

In my parent's manual I offer a number of strategies that you can use before and after overload. The "before" strategies include emotional distraction, changing the sequence, and calming strategies, if you can catch the anger early enough.  If not, the "after" strategies include labeling the level of anger, teaching your child about other points of view, catch phrases, and teaching compromise techniques.  These strategies will help if practiced regularly after outbursts.  The idea is to make self-control an important issue and enlist your child's participation by non-judgmentally working on the anger episodes together.  All the best, Dr. Gottlieb

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