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

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