Thursday, August 23, 2012

Is it anger overload or manipulative behavior?

Hello Dr.,
I have been coming to the conclusion that there is something going on with my 5 soon to be 6 year old son. I want to give you a bit of background on our particular situation and I would like to have some insight from you. My husband and I decided in 2010 that he would join the military to better our family as a whole. My mother in law did not like the idea nor did she stand behind my husband and the choice he made. Two days prior to my husband leaving for basic training she told my husband "you are taking the easy way out." My husband was hurt by that and we did not think that what happened next would ever happen.

After my husband left my son was 3 turning 4 and she was all I had to help me out with my children. She started coming by just about everyday and she would take the kids for a walk or we would all go for a walk and she would tell me "stay here do your laundry or whatever you need to get caught up  on." I did not think anything of it until one day my son hit my daughter and I told him to sit for a time out. When I told him that he looked at me and said "Well I know I can get a new mommy that will treat me a lot better than you do." And that broke my heart. Not thinking of where he would have heard that I allowed him to get up and do what he was doing. This had gone on for a few months.

About 2 months into this all my best friend had come over and sat me down and told me there had to be something going on with my son, but he would not talk to me so she talked to him. And in his words "Well Nanny told me if I tell mommy that I can get a new mommy then she would let me do what I want, and I want to do what I want." I never thought in a million years that my own mother in law would do this to me. I knew that she did not like me but to hurt my children like this. I did not have the heart to tell my husband that something was up because he needed me to be his rock at this point in order to get him through basic training....

If I had told him no to playing a game or watching a particular movie or anything really he would get very mad at me. Then the time came that we were moving with my husband and I thought everything was going to get better. And there for a while it did. It was really good. My son is very bright, very intelligent and wonderful until he has these what we call breakdowns. When we went to Korea he did not have a breakdown from June all the way until October....

In Feb of this year we moved to Texas where my husband is now based. My son gets upset and rages out when someone doesn't listen to him or does not want to play with him or if he just feels like someone does not like him. He gets loud with me, his dad and his sister. He hits his sister and he starts school this year and I am very afraid that he is going to have a lot of social issues. I know he will do well in class but worried about the interaction if he gets pushed out of a group of kids or something. Now my question for you is do you think that he would have "anger overload"? If you can message me back would be great. I am just a mom worried about her son. I never thought that I would have to medicate my child or get them help for any reason like this. It is breaking my heart and I have finally come to the conclusion that I am not the reason he is like this. I do everything I can for my children, they are my life and since I know that there is something going on with my son it is killing me.

Hi, It is important that all parenting figures, including grandparents, if they are in regular contact with the children, work together when it comes to discipline.  I'm sorry that your mother-in-law coached your son to disobey you.  One question I have is what do you think changed with the move from Korea to Texas, because it sounds like your son's behavior regressed this year when you moved again.  Why do you think he stopped misbehaving in Korea, and can you re-capture what you were doing there?

Anger overload lasts from minutes to hours.  So my question for you is:  once your son gets angry, does he usually get out of control and stay upset for a while, or does he get loud to get his way, but cuts it out as soon as he wants?  The former is more consistent with anger overload, and the latter is more typical of a child who uses his anger to get his way, but does not lose control.   If the problem is anger overload, then my parent's manual and other posts on this blog explain a number of strategies to help your son develop self control.   If the problem is the latter (your son uses anger to get his way, but not to the point of overload), then you will need to apply behavior modification strategies (incentives, consequences, ignoring, and timeouts) to make sure that you son does not get a lot of attention nor get his way when he gets angry.  There are a number of books for parents that help teach behavior modification, including a chapter in my earlier book about defiant children.  And remember what your son told you earlier:  grandma said to say this so that he would get his way.  He does not really want a new mother, so try to act like you are deaf and do not react to comments like that, as best you can.  

Also, if your mother-in-law is going to have contact with the children again, you and your husband will have to set firm limits or stay in the house when she is there.   This is assuming your son is accurately describing what the grandmother told him.  You and your husband may want to talk with her more about what your son said and how it has affected his behavior, or you may want to contact a family therapist in your area about how to proceed with her.   All the best, Dr. Gottlieb

Wednesday, August 22, 2012

4 year old twins egg each other on

I have 4 year old boy/girl twins. Both are fairly good and independent of each other but they play off of each other when they get rowdy. In other words, I feel like I have no control if I try to discipline them when they are playing together. They have their own built in playmate who eggs them on when I'm telling them no. I have a harder time with my son than my daughter. He will hit, have attitude, look me in the eye and do exactly what I tell him not to do, etc. We have tried time outs but I feel like my anger escalates to yelling and spanking and personally, I don't like myself like that, nor do I feel like it's effective. If he doesn't get his way, he will scream and tell me I'm a bad mommy or that he doesn't love me which of course breaks my heart. Any advice on how to handle this situation? It is affecting our whole household. Thank you!!

     Hi, Twins can have a special relationship and support each other, which sometimes makes it difficult if they are misbehaving.  In general, their close relationship is a good thing, but if they are misbehaving, I would separate them and give them each a time out or other brief consequence, even if one of them is more defiant than the other.  If one child is egging the other on, then both are involved, and both should receive a consequence.  This will encourage them to not support the other's misbeavior or risk a consequence.

     In order for consequences to be effective, they must be something that the children care about.  Some possibilities include time outs, loss of television time, loss of a favorite activity, or earlier to bed.  What do your children care about more?  Whatever you choose, it should be brief.  The next day everyone should start with a clean slate.

     You can also use brief incentives for self-control or cooperative behavior.  If you do this, give concrete examples of what you are looking for.  Incentives can be extra television or computer time, or an extra game with you. 

     Sometimes it is helpful to use your hand like a stop sign if the children are misbehaving and count slowly to three.  If they stop by the time you get to three, they earn a point, and if they get two points over one or two days, they earn the incentive.  (I  would also give them a point if they do not need you to put up your hand on a given day because they have behaved well.)

    When your son screams and tells you are a bad Mommy, remember that he is angry and will say whatever he thinks might hurt you at that point.  I would not use your hand as a stop sign nor impose an immediate consequence at that point.  You child sounds like he is in anger overload then.   Do not take what he says (when angry) as truth.  Try your best not to respond, as he is just trying to get your goat.  If you can ignore these comments, they are likely to lessen in the coming months.  You could later on that day impose a consequence if he was misbehaving prior to his angry comments, but do not talk about consequences while he is in overload, as this will lead to a longer tantrum.

     All the best, Dr. Dave Gottlieb

Sunday, August 19, 2012

5 year old tantrums at home

Hi Dr. Dave,
My five year old has been acting out at home and sounds to have what you describe as anger overload. He does not act out at school or for anyone else but at home with us. He has meltdowns if I ask him to help pick up his toys or if he gets frustrated at a toy he can't work or if he gets in trouble for messing with his little brother. Lately it worse with starting kindergarten and not really napping like normal. He has been screaming at the top of his lungs and hitting himself in the face, throwing stuff and just acting crazy. We've tried time outs, talking, and sending him to his room. Usually it escalates to spankings which don't help either. He usually calms down 15 minutes later after being sent to his room. He then acts loving and sweet. I don't know what to do, but I'm emotionally exhausted and would rather stay at work everyday than to come home with him. I'm worried my two year old will soon start acting like his older brother!!! Help please???

Hi,  With kindergarten starting and with less sleep, it is not unusual for five years olds to have some melt downs.  Your son will probably do better with more sleep, and you should see a decrease in his overload behaviors as he matures in the coming year.  However, here are some suggestions to move things along--to help him develop greater self-control:

1) Try to catch your son's frustration in the early stages, if possible.  It is easier to re-direct a child if the anger is not so intense.  So if you see him starting to get into it with his brother, try to distract one of them, or invite your older son to do something or show you something--it has to be something he really likes to do. 

2) If your son is getting frustrated with a toy, try to help him (if he will let you) or empathize by saying something like "Ugh is that toy being a pain in your butt?"  Your son will be less likely to explode if your comment strikes a chord in him. 

3)  When he is in full anger overload, try not to say or do much of anything unless he is hurting himself or someone else, in which case you may need to bear hug him, or restrain him in some way.  Anger overload does take some time to wind down because your son's brain is "overheated" at that point.  It takes time for the chemicals in your son's brain to return to normal.  Until that happens you do not want to talk with him because that will likely prolong the outburst and may inadvertently reinforce his negative behaviors.  You can either send him to his room, walk away yourself, or just sit there and act like you are deaf, whatever is easiest to do in your family situation.  When your son calms down, then talk with him about something of interest to you both.  That reinforces his efforts to be in self-control.  Furthermore, once children calm down, most act normally, as if their explosion is way in the past.  It often takes parents longer to relax after these explosions, and it can be a trying time for parents to get through them without feeling like they've been through the ringer! 

If there is not a decrease in the frequency of outbursts in the coming couple of months, check with your doctor or teacher to see if they would recommend you get a psychological consult.  All the best, Dr. Dave Gottlieb

Wednesday, August 15, 2012

4 year old rages only with his parents

About 7 weeks ago my daughter and her family moved from another state to live with us temporarily.  My daughter and son-in-law are loving, intelligent, and all around great people.  Their 6-month old baby girl is an absolute joy all the time; beautiful and so very happy.  Their 4 year old son can be such a wonderful boy to be around, but those moments seem few and far between.  By this I mean that not a single day has gone by when he hasn't screamed several times during the day, sometimes for hours, because he gets so angry about something; I can't even categorize his anger triggers because everything seems to trigger him.  The only thing that doesn't make him angry is if the people he is directing do exactly as he says with no variation, the moment he says it with no delay, and basically allow him to do whatever he wants.  But even then, sometimes he gets mad.  At least 5 times since they've been here, the screaming has escalated to screaming, biting, hitting, spitting, kicking, hair-pulling bouts and they are almost always against his mother.  My kids read countless books on spirited children (i.e., raising them, setting limits, etc.), but I'm concerned that this could be something more than just spiritedness.

The reason I feel this way is that on a few occasions they have let me babysit both children; once they were gone for only 90 minutes, a second that I recall they were gone for about 3.5 hours.  On both of these occasions, my grandson was a loving, fun, reasonable, 4-year old with absolutely zero outbursts let alone a complete melt-down. He was disappointed when I said I could only read two books instead of his usual 4 and then again for some other reason, but both times, he kept his disappointment to nothing more than the usual 4-year-old-expected-whine, and then he got over it as we moved on to other activities.  Also, at bedtime, he gave me no grief.  Bedtimes and naptimes with his parents are daily battle/war/big bang with him.  When it's just him and his sister with us (me and my husband), we love being around him as he really is quite pleasant, fun and funny.  When he's home with his parents, we've taken to hiding in our room (luckily it is quite spacious and relatively sound-proof.)   

We've offered to help but they don't really want our help, so we try to remain respectful of this as long as our grandson isn't hurting our son (who has autism), destroying any of our property, or being disrespectful to us.  One night, after a few too many glasses of wine, we recommended that the kids look into professional help - if not for their son then perhaps for them because they are getting worn down whether they choose to see it or not.  They haven't done this and I'm not sure if it's because we had wine and they thought we were just being silly, or perhaps because they don't yet have medical insurance, or maybe they truly believe that the books they are reading are going to help them.  They've read these types of books for about 6 months, btw with no change.  If anything, he seems to have gotten worse.  During one period my grandson went two days with just his usual, daily multiple screaming fits.  The following day he had one of his screaming, biting, hitting, etc. fits.  His dad commented on how it was a "...bummer because he'd been having such good days."  I didn't know what to say.  I thought, wow, so our bar (our limit) is when he turns violent.  
I bought your book and am eager to read it (too bad it's not on Kindle I would have downloaded immediately!)  I'm wondering if this is some sort of situational anger overload?  Does it sound remotely bi-polar? Oppositional defiant disorder?  I know you can't diagnose since you know nothing other than what is in this email.  I just feel so sad and helpless and reading the synopsis on your book made me reach out to you.  Thank you.
Hi,   As you wrote, I can't diagnose without doing an evaluation in person, but the fact that he did not erupt with you and your husband when the parents were away makes me lean towards anger overload rather than bipolar or oppositional defiant disorder.  The latter two diagnoses generally occur in multiple settings and regardless of which adult is in charge.  If the outbursts occur only with the parents, it sounds more like anger overload.

A question many parents ask is why does a child usually erupt more often at home with them.   Often parents are targets of anger overload 1) because their children know they will be loved no matter what, 2) because their children feel so close to their parents and therefore more easily disappointed if their parents do not respond to their wishes,  and 3) sometimes also because the parents (in their love for their children) have had a hard time sticking to their rules, and their children know that.  It is usually best not to respond at all during anger overload (except to keep someone from being physically hurt), because the more you talk and/or compromise at that point, the more likely the child will continue screaming you, and in addition the child will be more likely to rage the next time he is disappointed because "it worked" (in the sense that he got a response, even if it is not exactly what he wanted).

In my parent's manual, I outline strategies parents can take early in the sequence in anger.  The first part of the book is what parents do (without their child's direct participation) and the second part of the manual describes interventions parents work on together with their child.  It will take time (often several months) to see a lot of progress; how smoothly things go depend on the child's biological make up, as well as on the parents' emotional energy and motivation to stick with the new strategies (when change takes weeks or months, rather than days). It is worth the effort though, and parents are relieved when they see improvement. 
If you or the parents have questions after reading the manual, feel free to write again, Dr. Gottlieb

Tuesday, August 7, 2012

7 year old has melt downs aound school work

We have a seven year old son who displays anger and when he's angry he's very disrespectful.  He attended a private school in which many of the kids, him included, were bullied.  We eventually pulled him out after a year and a half and placed him at another private school in which he started hitting the same boy every day and he was asked to leave (this boy was very smart and was grades above the classroom he was placed in).  I home schooled him for the remaining part of the year.  We knew from both schools that he was what they considered gifted:   in first grade he was reading at a fourth grade sight word and comprehension level.  However, when I started home schooling him I got to see the behavior he was displaying at school.  When asked to do something that he didn't like to do or wasn't good at, like writing, he would completely melt down, refuse to do it, call myself or his tutor anything he could think of and sometimes throw his pencil across the room.  We would try to do things that were fun as part of our learning time, however, he became bored with those quickly.  If he masters, or he considers mastered, something he doesn't want to do it any longer, he says it's boring to him.  

For years we have always "saw" a melt down coming and could sometimes stop it before it happened, however, when he's in school it's much harder for the teacher to sense what's coming and catch it in time.  We know it's coming if he's frustrated, overly tired or hungry.  Instead of using his words to explain what he's feeling he will just explode.  Sometimes he feels bad for the behavior and other times he doesn't; it depends on who he has treated poorly.  If it's me, he's sorry and tries to make it better.  If it's his grandmother he sees every day he doesn't seem to mind that he treats her that way (my mother) or his other grandmother whom he sees weekly.  He tends to be very sorry when he's disrespectful to his father, but not always.

Our son is a very loving child, very sweet, very smart and caring person, when he wants to be, but when these episodes happen he turns into a different person, very disrespectful, angry, name calling and sometimes hitting (as with the second school he attended).  We have had him tested, IQ, academic placement and behavioral, but being in a school environment versus an office with a psychologist just isn't the same setting and we feel this may not show his true behavior.  We are awaiting the results of the testing and will get them next week.  I was just hoping to get your opinion about if you felt this was Anger Overload or something else.  

The testing may help identify if there are any learning issues; you mention he gets frustrated with writing for  example.   Also, you will find out what his strengths are, and knowing both his strengths and weaknesses will help you plan for this school year.  Furthermore, if the evaluator asked you about his behavior, or asked you to fill out check sheets about your son's behavior, the report would integrate this information even if your son did not misbehave during the testing situation.   If the evaluator did not ask you about your son's behavior, then you may want to explain when you meet with him. 

 Generally I recommend children with behavioral issues not stay out of school too long.  If you can coordinate with the school after you get the testing report and plan an appropriate class for your son, he may do well there.  If there are problems, you and the school can devise a behavior plan to deal with any outbursts.    The key is to work together with the school staff, and set up a behavior plan in advance.  You would want to include some of the suggestions in my book, such as having all the adults be aware his triggers, and then try to catch his frustration early.  Having a "go to" place for your child to settle down would be ideal, and it would be best not to talk with him when he is real upset, but to give him space to calm down.  The school social worker could work with him on calming strategies.  Sometimes rewards and consequences also help in school.  

Does your son have other triggers or are his melt downs generally around frustration with school work?  If the latter, then the anger overload would be limited to that particular situation, and having everyone involved in your son's education develop strategies to lessen his frustration would be key.  If there are anger outbursts about a number of issues, you would want to work on the other triggers as well.    In the second half of the book I suggest strategies to help children become more aware of their level of anger and their triggers, and I explain how to teach children to consider other points of view, and to compromise.

Take care, Dr. Dave Gottlieb

Wednesday, August 1, 2012

8 year old with anxiety and anger issues

Hi, I am writing to you about my 8 year old daughter. I think she may have anger overload and/ or anxiety issues and was wondering if the two can go hand in hand.

    The problems seem mostly associated with school.  She struggles with reading and starting in the first grade would shut down and not respond to the teacher.  In second grade she had a wonderful teacher that worked with her to try and overcome her oral reading anxiety.  She did very well and I thought we were making strides in not shutting down.  This summer I have her 2nd grade teacher tutoring her and it has been a disaster. She gets very upset when I try and leave her and will refuse to work with her.  If I am able to leave, the teacher is usually able to calm her down and get her to do math but when she has to read she shuts down again. Most of the time her and the teacher get along well and have friendly conversations, but when it is time to do more difficult work she changes.  She has told the teacher she won't do it and that she doesn't have to listen to her because she is not in 2nd grade anymore.  Before we go to tutoring she says she is going to do the work and not give us a problem going in but she always does even though she knows it will mean she can not go out when she gets home.  We follow through on the consequence each time.

Here is what happened today:
      As soon as teacher came in she refused to work.  Both the teacher and I tried to talk her into it.  She begins squeezing my hands and shirt. I leave the room.  She runs out of room and refuses to listen to teacher when asked to come back in the room.  Even when teacher returns to room she remains in hall.  I return, we get her to sit down, and she plays a math game with tutor.   They then move on to reading.  She refuses to read aloud, and lays down flat on chair.  She refuses to speak to teacher.  She tries to speak through me.  I tell her she needs to speak to the teacher and she refuses.  Eventually with about 15 minutes left she begins whispering the reading.  At the end she leaves as if nothing happened.  She asks if she can watch movie in car and is told no.  She is punished in room when we get home.

      I have had her evaluated for a learning disability and she refused to work with the people administering the test.  The psychologist who performed the iq test noted that she exhibited anxiety and that the test was not an accurate assessment of her IQ.  Homework is a constant battle.  When she becomes frustrated with it she cries, screams, and yells.  A common phrase is I hate you and don't want to be a part of this family.

      For the most part she is a lovely girl.  She did not have behavioral problems as a toddler and did well in preschool.  It was only when the work became more difficult for her that she began to exhibit these behaviors. I can pinpoint the moment she began to shut down as the middle of first grade when she refused to read her book report in front of the class and was forced to do so or receive a bad grade.  Also during that time I had another child which I also think may have contributed to her behavior.

      I have tried behavior modifications and they seem to work for a time but then we take a giant step backward like we did today.  I have also tried punishment but it as if during the time she is shutting down or having the outburst the punishment doesn't mean anything.  I also have an older son and he does not have anger issues.

      I am not sure if I should handle this as an anger or anxiety issues.  Any insight you might have would be helpful.

     Hi, Your daughter's anger seems tied to her difficulty and anxiety about reading.  You mentioned one day the tutor broke the ice with a math game.  That was a great idea.  When a child is anxious about something like reading, it is a good idea to approach the task in steps.  Have your child get comfortable with an educational game and build up her confidence and energy for academic work, and then move on to reading.  Also, if the reading is tough for her, move slowly into more difficult material.  If possible, make reading into a game too, like you did for the math.  I realize this means the tutor will be spending less time on reading, but if you do not take it in steps, you will probably continue to meet a lot of resistance.

     There is a group of professionals who work with children with learning issues:  "educational therapists."  It is a relatively new certification, but these professionals are trained to diagnose learning problems and help children who have learning and anxiety issues. 

     At some point, when she is comfortable with a psychologist or with an educational therapist, I would try again to diagnose what is causing the problem with reading.  My guess is it is a combination of a learning weakness of some kind (there can be various possible cognitive causes of reading issues) and anxiety.  It seems to me the anger issues are secondary to the anxiety issues in your daughter's case.  You can use some of the strategies in my book for anger overload, particularly when she is screaming at you or the tutor, but if you don't also address the underlying reading anxiety, you will probably continue to see signs of frustration and anger.

All the best, Dr. Gottlieb