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

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