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

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