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

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