Wednesday, July 25, 2012

10 year old melts down during baseball game

The "7 year old lashes out when angry" could have been my son... only difference is he is 10 years old, will throw things (bat to ground, batting helmet into dugout...) when angry, and exhibits astonishing disrespect for adults trying to "calm" him when in one of his rages. His primary triggers also include being teased or when he thinks someone is making a personal attack at him. Most recently he was removed from a baseball team for having a "melt-down" after striking out on a pitch he felt was fair. After the fact, his is quite remorseful and is fully aware of how his behavior was unacceptable. He also knows how he should have handled the situation.  He is seeing a child psychologist and has been given tools to help himself in these situations. We discuss the tools before every game; however, it seems that he just goes into a different realm when he gets mad and those tools are disregarded - it's like he's left his body and the mean/crazy guy has moved in. He is devastated over the removal from the team and wants to "fix" his anger issue. How can we do this when his primary trigger for outbursts is in a competitive situation?? We are all pretty much done with this as it has been going on for years...

Hi, One thought I have is to create a lower level competitive situation and "practice" dealing with striking out.  For example, could you do some hitting with him in the backyard or park, and have him practice cognitive strategies when he misses the ball.  Some catch phrases he could repeat out loud (and eventually in his mind) are "everyone makes mistakes,"  or "even Adam Dunn (or whoever his hero is) strikes out a lot."  The more he practices this "mantra" in situations with lower stress, the more likely he will internalize it.  I would also consider having him participate in sports (if he likes them) that have less focus on individual performance, such as soccer or basketball or football.  Yes, there can be pressure in these sports too, but there is not a long period of time when everyone is watching one play, like in baseball.  The action is faster and no one expects you will always score a goal in soccer, for example.  The basic idea is to expose your son to situations that have some pressure, but less than in a little league baseball game, and once he can regularly deal with those pressures, then try little league again if he really wants to.

I would also work on the underlying trigger--feeling teased or attacked.  Role play how to deal with those situations.  In addition, you as parents can model how to deal with criticism.   If someone criticizes something you do, say out loud how you feel and how you are going to deal with it.  Furthermore, help your son to "catch it early."  Anger can be more easily controlled before it reaches the overload stage.   What are his internal warning signs that he is getting angry?  Does he start breathing fast, does his hear race, does he feel flush in the face?  Have him learn to recognize these signs and develop calming strategies before he reaches overload.  Offer a lot of verbal praise if he practices a calming strategy even if it does not always work to calm him.  I go over possible strategies in my book.  They do not have to be quiet activities to be calming. 

All the best, Dr. Dave Gottlieb

Monday, July 23, 2012

3 year old screams and kicks when told "No"

I have a son who is 3.5 yrs old. He is an extremely angry young man and has been since birth. The word "no" normally sets him off into fits of rage. he frequently screams, kicks and tells me he hates me, or is going to punch me when  he doesn't get his way. I am not sure what to do anymore. I saw your book and wondered if he was too young for me to start blaming this on anything other than "being a toddler". Some days I feel like there is something very wrong with him, and other days he is an angel.   He is smart, has a great vocabulary, and at times can be just perfect, unless I say NO. He usually takes 20min to an hour to calm down after raging. Please help.

Hi, It is not unusual for 3 year olds to be egocentric and have tantrums when they do not get their way.  You write that he has been "extremely angry" since birth, and that comment makes me wonder whether your child is exhibiting anger overload, and not just age related tantrums.  In either case, you would use the same strategies I outline in my anger overload manual.  You would concentrate on the strategies in the first half of the book:  strategies you can employ that do not require your child's direct participation.

You first record the situations where he has outbursts over a two week period.  Is there some theme for some of the outbursts, and can you re-arrange certain situations to avoid the tantrums?  Or if your child expects something and often tantrums when he does not get it, can you lower his expectations ahead of time?  This could be key with your son:  you said he rages when you say "no."  So, in essence, you want to warn him before you say "no."  If you have to go somewhere soon, for example, you could say something like "we are going to have fun today but there is not a  lot of time before we have to go somewhere.  Let's play this quick card game before we go."  (You are offering something fun but not letting him get started on a longer game that you would have to interrupt.)  Or if you are going to say no to some dessert or say no to playing outside, you could say well in advance we are not going to do this today but we are going to do it tomorrow (or in the next couple of days).  Let's do this now.  (You get him busy so he does not obsess about what he cannot do.) You won't be able to use these strategies all the time, because children will sometimes explode when we don't expect it.

The next set of strategies has to do with the early phase of anger.  If your child has already begun to get angry but is not in full overload yet, then you would try emotional distraction or calming techniques.  I describe a number of these strategies in previous posts online and in my book.

Once in the overload phase, it is better not to say or do anything, unless your child is hurting someone or damaging something of value.  When he screams and says I hate you, think to yourself that this is "verbal diarrhea."  Your child is angry and does not mean what he says when he is angry.   If he is physically hurting someone, then you could bear hug him, or in some way prevent him from harming others or himself. 

You may also want to check with your family doctor to rule out other possible causes, like a mood disorder or social/personality disorders such as Asperger's.  You can read about these diagnoses in my book "Your Child is Defiant:  Why Is Nothing Working?"  While these diagnoses are not likely, if you are not able to lessen the frequency of outbursts over the next few months, then check with a professional to make sure nothing else is underlying your child's tantrums.

All the best, Dr. Dave Gottlieb

Monday, July 16, 2012

3 year old tantrums right when he wakes up

I have a son (he'll be 4 in November) who has anger / temper tantrum issues. His  normal disposition is very sweet and kind. In fact he can seem a bit shy. My friends whom have never witnessed my son's tantrums can't even imagine he has anger issues. However, during his "episodes" his anger is explosive - he bites, punches, tries to hurt me and himself. He will scream at the top of his lungs until he is hoarse and will repeat demands over and over again even if it's totally irrational. His episodes can last up to 45 minutes long. This behavior has put a tremendous stress on our household. I also worry about the future - when he gets bigger and stronger and I will no longer be able to help him.

I purchased your book Anger Overload in Children / A Parent's Manual - for the first time I felt I had found something that accurately described my son. I have been charting his triggers and trying to identify patterns. I created a chill out space in his room with his favorite "blankie" and stuffed animals.

My question is this - sometimes (usually 2x per week) my son wakes up in the full throes of a temper tantrum. There does not seem to be a pattern when this is going to  happen and there is no distracting him as he is already over the ledge. Do you have any suggestions or have you seen this in any of your other patients?

Hi, Charting to identify triggers will eventually help you to change some of the the sequences and thereby head off anger overload, and the chill space can be used if you catch the anger early enough that he will go to the space.  When your son is in full overload, you would either ignore or restrain him.  In either case, I would not say much of anything while he is in overload.  The more you talk, usually the more a child will escalate.  Restraining (like a bear hug, or holding your son on the couch, bed, or floor) is called for when a child is seriously harming himself or others.  As he gets older his self control will probably improve.  If he gets too big to restrain, you might consult with a child psychistrist who could prescribe medication to lower the level of agitation. (There are medications that a child can take daily, or take only as needed.  However, I usually recommend waiting on the medication and trying the strategies in the book first because some of the medications have potential side effects, and it would be preferable if your son could learn how to control his anger.)

As for when he first wakes up, does the anger start because he is tired and does not want to get out of bed, or is he having a nightmare or a night terror?  For the latter, "night terrors," children are really still asleep and cannot be soothed.   Holding him will not work, and may make matters worse.  You wait it out, and the night terror passes, and he will continue sleeping.  If on the other hand he is having a "nightmare," then he will wake up when you talk with him.  You do not say a lot, but you would try to reassure him that he was having a dream, and if he wants to talk about it, you would listen.  If he does not want to talk, but escalates, then you try to distract him with music, television, or the chill space.

If the anger starts as he is waking up (not from a bad dream or night terror), then you would try to determine why.  Many childern are moody when they first wake up, and children who are prone to anger overload can sometimes escalate very quickly from irritability to an explosion.  Try to develop a wake up routine that is gradual and soothing.  Allow enough time for him to get up slowly.  Maybe put on some soft music, a favorite cartoon, or a small light, unless he finds these stimuli to be noxious.  Is there a pet who can be near him that he might find soothing or distracting?  Would a back rub work?  Think about what he might find soothing. 

The problem could be too much stimulation as he is getting up, in which case try the above.  But if the problem is that he is still tired in the mornings, think about moving his bedtime earlier so he can sleep longer.  Some young children need a lot of sleep.  I'm not sure if there is something else that might be affecting him in the mornings.  Feel free to write back if I have not hit upon anything that applies to your son.  All the best, Dr. Dave Gottlieb

Tuesday, July 10, 2012

7 year old lashes out when angry

Hi Dr. Dave,

I came across your blog today as I was researching anger issues in children.  My son is 7 1/2 years old and he has been displaying these behaviors over the last year.  He's never been an "easy" child, but nothing was ever so much that we thought there was a true issue until the last year.  He is usually smart, happy, and affectionate, however when he gets frustrated or angry he lashes out verbally saying things like, "I wish you were never born!" to his sister and "You're stupid, you're an idiot" to someone who he is playing with. Usually it's to what we would think is minor or they were arguing and he freaks out unnecessarily.  We have taken him off sports teams as he had one screaming fit in the middle of the basketball court when he felt he was "wronged," and because he would get overly frustrated each game and it would often end in tears somehow.  He is seeing a therapist (although he may not be a good fit) and an occupational therapist (who is awesome), but I feel like we need to tighten the reigns on him and while trying to understand where he is coming from, also let him know certain things are unacceptable, like insulting your sister.  I fear he won't have friends and will alienate himself.  He doesn't seem to have learning disabilities and is a bit above his grade level.  He does well in the classroom, it seems to occur in unstructured environments like playing and intense situations like sports.

Any help you can offer would be very appreciated!

Hi, Your description sounds like anger overload: your son is usually affectionate and happy, but lashes out when something seemingly minor frustrates him.  It sounds like one precipitant is competitive activities.  Are there other themes for when he loses it?  I discuss a number of strategies in my parent's manual.  One for your son would be to predict he will get angry when he is losing a game or thinks something is unfair, and role play how to handle it.  You can be him at first, and first act out how he now erupts, and then model alternatives.   In the future when he does actually lash out, you wait until he is calm (later in the day) and review again what he could say next time.  Repetition is necessary because it is hard for your son to regulate his anger because it gets so intense so quickly.  So learning self-control takes time.  I also agree with your approach to limit his participation in intense competitive activities for now, such as the basketball games. 

You may also want to develop cues and catch phrases to help your son "catch" it early.  The cues should be brief and used in a non-critical way.  One strategy is to label the levels of anger with concrete phrases (e.g. you can use the colors of a fire--blue, orange, and red--for low, medium and intense anger, or in miles per hour of a race car).  The idea is to help your son become aware of his anger as he is winding up.  Also, you could use catch phrases when he is starting an activity with his sister to remind him "everyone loses sometimes" or "everyone makes mistakes."  You could also suggest calming activities when he begins to get angry, activities that you have all decided on in advance, and reward him for trying them.  Some children like to do physical activities and others like music or computer games--whatever is distracting can help. 

If you use consequences for saying hurtful things to his sister, I'd recommend being very specific, and only targeting a couple of phrases to start.  Wait and impose the consequences after he has calmed down.  It is going to be hard for your son to control his language once he is at the highest levels of anger, and that is why it is important to try the suggestions I mentioned above to catch it early.  I know this is not always possible because usually kids with anger overload heat up so fast.  Once he can eliminate a couple of phrases, you can then try to add another one or two to the list.  Use a lot of praise if he makes an effort to not be insulting.  Also, help your daughter to understand that he does not mean what he says when he is angry.  He says whatever he thinks will most upset her, and I liken it to "verbal diarrhea." 
At that point it is best to ignore him.

I offer other strategies in my book.  Feel free to review other posts in the blog as well.  All the best, Dr. Dave Gottlieb

Wednesday, July 4, 2012

7 year old with tantrums that can last a half hour

My son, who is seven, experiences outbursts of anger that are completely disproportionate to the triggers. When calm, he is a very bright little boy, but he is prone to fits of rage if things don't happen the way that he wants them to. Losing a piece of lego will precipitate a tantrum that can last up to half an hour, during which he will scream 'it is all your fault' and accuse me of not loving him and not caring about him, which I find immensely upsetting. Interestingly, after these tantrums, he is often calm and thoughtful, almost as though he has released some pressure. He is often contrite, promising not to do it again, until the next time, which at its worst can be later that day or the next day. Does this sound like anger overload? I think that it does judging by the limited amount of research that I  have done, and which of your books would you recommend to try and help all of us in our attempts to modify our behaviour?

I am desperate to do something, and keen to see if we can help ourselves overcome this problem. His irrational behaviour has the ability to ruin family occasions and as he gets older, I am running out of excuses as to why he behaves like this.

There have been no problems at school and despite direct questioning, the teachers deny that there are any issues with his behaviour in school.

Hi, Yes it sounds like anger overload, and I'd recommend first you read "Anger Overload in Children:  A Parent's Manual."  It is a "how to" book and explains various strategies in concrete terms and provides charts to help you implement the strategies.  My other book on defiant behavior is useful if you want to determine whether there are other underlying problems contributing to the anger overload.  Sometimes there are social, academic, or emotional disorders that can bring on anger overload, but your description does not suggest that this is the case for your son.  I'd try the strategies for anger overload and if you reach an impasse, I would check with a mental health professional to help.  (My third book is about ADHD and how in more than half of children with this diagnosis there are co-occurring conditions that need to be considered for treatment to be successful.)

There are often biological underpinnings for anger overload.  Some children react more intensely to frustration and have longer outbursts, and we think this is because for some children the prefrontal cortex (outside layer of the brain) is not developed enough yet or because the inner limbic brain, particularly the amygdala, is flooding the prefrontal cortex when anger is stimulated.  With repeated practice of strategies to change the way a child thinks about and reacts to triggers, a child can learn to have better control of his anger.  Our brains develop when we repeatedly use new behaviors.

I know it is hard not to feel bad when your child, in the midst of an outburst, accuses you of not loving him.  However, keep in mind that when your child is that angry he is not thinking rationally and he will strike out with the most awful statements.  It is like "verbal diarrhea."  When your child is calmer, he would be able to acknowledge that you really do love him, and it is what he says when he is calm that is truly meaningful.

In the manual, I first go through the steps that you can use with or without your child's direct participation.    In other posts and in the manual, I review in detail how you, as "agents of change" can sometimes alter the situations that bring on your child's rage.  In the second half of the manual I explain strategies you can work on with your child.  These "cognitive behavioral" strategies take time and practice.  Change occurs over weeks and months, rather than in days.  It is not easy for your child because he is biologically prone to quick and intense anger.  But with practice, he will learn to develop better self control, and this is so critical for him to get along better in the family and in his future relationships.  All the best, Dr. Dave Gottlieb

Monday, July 2, 2012

10 year old with anger overload in school

On searching through the internet trying to find something that will help my 10 year old son and I have come  across your article on anger overload. It seems an accurate description of my son.  His anger meltdowns have nearly always been at school, starting from the age of 6.  Perhaps I missed the signs before then, he was a confident, independent and sometimes willful toddler and I put any outburst down to normal toddler tantrums.  The numerous experts have found it odd that I don't experience the same problems at home (except for bringing him home when he's had a meltdown and he's still in quite an hysterical state which me turning up often heightens) but I think it's down to environment and the fact as a parent you can naturally nip things in the bud.  At school he likes to do well and generally does perform well but if there is a topic that he is struggling with he gets angry - he doesn't like others to do better than him - even though we always say we only want him to do his best and that will always be good enough.  He sets himself a high standard and is disappointed when he doesn't achieve his inflated expectations of himself.
He can't take teasing from others and has other meltdowns when his pride is hurt and feels humiliated.

However 90% of the time he is a lovely boy and everyone says so, he charms all the therapists he sees.  All my friends are genuinely shocked that he gets into trouble including those that we have holidayed with and have therefore spent substantial time with him but the truth is that he does have the worst kind of meltdowns, where he cannot be calmed or reasoned with by anyone.  He will cry, scream, shout, swear, kick, throw chairs, tear up his own work as well as wall displays in school.  He hates everyone when he's in that zone but does struggle to accept responsibility.  He understands the anger is wrong but feels he was justified by whatever passed before.  These episodes vary in frequency, there can be a flurry of them in a week but months can pass without incident.

Over the past 4 years he has had learning mentors, education psychologist, child behavorists, counselors and occupational therapists but of course when they see him it's never a situation he's got a problem with.  Even class observations have been a waste because it's not all the time.  I felt the overload of people talking to him started to have a very detrimental and damaging effect emotionally, he became very unhappy, felt that he was a "freak".  He started to struggle in how to behave in social settings.  He wouldn't play at parties.   He became worried about how to handle things because he was getting into so much trouble and with them all asking him about his feelings he started to feel that his feelings must matter above others.  He was excluded from school  on numerous occasions for 1 - 5 days at a time.

When he was 8, I took him out of school and home educated him for one academic year as I felt I was losing him and it was spiraling out of control.  He remained under the occupational therapists assigned by Child and Adolescent Mental health service (CAMHS) but was discharged during that time as he was calm and happy.  He has been back at school for this past academic year, a new school and he is generally happy there, very popular with the other children as he always makes friends easily and is quite funny.  However he had a one day exclusion last month and is now on a 5 day exclusion.  The head has said his latest meltdown was the worse she had ever seen and she said she had worked in many schools where children had a lot of behavioral problems but not witnessed anything like this.  She added that had it occurred in a high school it would be a permanent exclusion.

I have been back to my GP and asked to be referred back to CAMPHS but how do I ensure he gets the correct diagnosis and help?  Is anger overload accepted in the UK?  Do you think that is what it is?  I don't want him to get the wrong diagnosis and not get the correct therapy. So often the experts discuss his low self esteem but I don't think that's the case - he is aware of what he is good at but also what he's not so good at.  He wants to do well at school as he has a dream job ( Lego designer!) in mind.

I'm so frightened that my son, who isn't a hard street wise kid is going to be sent to a referral unit if this happens again because the school understandably cannot cope with these outbursts and they are concerned for the other children when it happens.  I feel that time is running out to get him the correct help but the experts brought in so far seem to be on the wrong track and it's wasting precious time.
I would be very grateful for your thoughts on this and if you could suggest routes I can follow.

Hi, It sounds like you have been through a lot, and it sounds like he has seen a number of professionals.  It sounds to me like anger overload; other possible diagnoses include mood disorders, but I assume the professionals have ruled these out, and it doesn't sound like your son is depressed or manic, but has episodic outbursts in school.

Anger overload is a term I coined ten years ago to describe this problem.  The new diagnostic manual of the American Psychiatric Association will probably include a diagnosis somewhat similar called disruptive mood dysregulation disorder (DMDD).   The main difference between this disorder and anger overload is that for DMDD, there is a persistently negative mood even when the child is not in anger overload.  DMDD does not sound like your son.  What you describe is a happy child who gets extremely angry when he is disappointed in himself or teased by his peers.  The key is going to be to help him with these precipitating events and to coach him on other ways of handling his anger before he reaches the overload phase.  There can also be alternatives for when he is in overload, but he is less likely to listen to suggestions at that point.

I outline many of my suggestions for dealing with anger overload at home in my parent's manual.  However, many of the strategies can be adapted for school.  When he is calm, it is important to reinforce the idea that he is smart and very capable but that smart people get frustrated when they make mistakes sometimes.  They want to be right.  In essence you are empathizing with him first, and then you want to talk with him about ways to handle his frustration so that he does not get in trouble at school, a goal he probably cares about (and will thus feel motivated to work with you and the teachers on this). 

You may also want to explain to him that people have different kinds of reactions to frustration, and that some of us react more strongly and have to work at holding onto our anger in public.  Let him know what ways he can express it to himself (in written form, pictures, asking to be excused, going to talk to someone, squeezing a soft little ball).  Many of these will be hard for him to do right away because by the time he realizes he is angry, he will likely already be in the overload phase when a person is not really rational.  Are there early warning signs that he or the teacher can catch?  It sounds like you do this at home and re-direct him.  Can the teacher watch for the triggers (1--frustration with his performance in school and 2--teasing by peers) and signs of anger (does he get red in the face, start to squirm or complain, or grimace?)  and re-direct him before he hits overload.  Once he reaches overload it is best not to talk with him and offer him a quiet space to calm down. 

It is important to notice (and celebrate) steps along the path of control of anger.  It is not going to be easy and not going to be a straight line of success.  Let your son know that sometimes we will not catch it in time, but it will get easier as he gets older.  (The prefrontal cortex generally develops well into adulthood and is the part of our brain that helps us control anger, and what you want to do is help him learn the skills to move the process forward.)

Regarding the teasing, you want him to know that smart kids get teased sometimes.  It's a sign that people think he is smart, almost like a badge of honor.  Or think of some other way to re-frame the teasing:  maybe help him see that others get teased too, and that the more he reacts, the more he will get teased.  

I give a number of cognitive behavioral strategies in my manual, including gently labeling the levels of anger (so he begins to recognize the stages), using catch phrases that help re-frame the triggers into less upsetting words, developing calming techniques when possible, and teaching your child about other points of view.  The manual is available from the publisher (see link above in my blog) or from Amazon.  I hope this has been helpful, Dr. Gottlieb