Friday, September 7, 2012

4 year old has daily tantrums with people he knows

I found your site tonight while Googling for the thousandth time about the issues we’ve had with our son for the past few years.  I’m surprised I haven’t found it before, but better late than never.

We have just turned 4-year-old boy/girl twins and have had no real issues with our daughter over the last few years outside of what I consider normal 2/3/4 year old minor tantrums and defiance…testing limits and such.  But our son started having severe tantrums really early…somewhere around 10 or 11 months if I remember correctly.  It has just gone downhill since then.  We did work with a counselor (MSW,LCSW) who came to our home for a couple of months, but told us we really didn’t have an issue.  She told us to put him in timeout and simply wait for him to calm down, but we’ve been trying that for two years now with no improvement.  The problem is that until he is comfortable around someone, he actually behaves quite well.  It is the same each new year at preschool.  He’s great at the beginning of the year and then as he gets more comfortable the anger issues start rearing their heads.  He is a very smart, sensitive, loving kid half of the time, but the next minute he is mean and hurtful and screaming and kicking.  I’ve wondered if he was bipolar since it does run in my family, but I’ve called child psychiatrists who say he’s too young to be seen!!  He has multiple bad tantrums a day usually and even more shorter angry outbursts.  Once he “loses it” there is no talking to him, no calming him down, and he doesn’t know how to calm himself either.  And afterwards, we cannot talk about the behavior that sent him to timeout or the transgression at all, or it send him right back over the edge. 

I’m lost on what to do.  I am going to buy your book on defiance and also the one on anger overload, because they both seemed to hit a few nails on the head, but in the meantime, does this sound like something your book will help with?

He also has some mild sensory issues, but we’ve been working with an Occupational Therapist on those.  I was hoping it would help his behavior, but it has not significantly.

Thanks in advance for your response!

Hi, My book on defiance looks at various causes of defiant behavior in children.  The book helps parents identify the cause and then suggests strategies for each cause.  My book on anger overload is a parent's manual focusing on children who have severe meltdowns--tantrums that can last for minutes or hours--but who otherwise behave well.  The anger overload manual outlines specific strategies for you to try.  For four year olds, I recommend parents focus on the first half of the book:  the first two sections are "what is anger overload?"  and "parents as the agent of change."  The defiance book discusses anger overload but also other behavioral and personality issues.  There is a section on bipolar disorder in children, which you may find helpful, for example.  Yes, doctors do not usually diagnose and treat bipolar disorder in four year olds, because the brains of these children are still developing, and the children may develop better self control in the years to come.  Also the medications for bipolar disorder can have significant side effects, and most are not approved yet for young children.

     In the anger overload manual, I encourage parents to first observe the patterns, and if there are some situations that are more likely to trigger outbursts, I explain how to approach your child before he has an outburst.  You can change the sequence of events, lower your child's expectations in advance, use "emotional" distraction (I explain in the book that the distraction technique must grab your child emotionally in order for it to work.), or sometimes calming techniques can help.  Once your child is in overload, he is not thinking rationally and it is usually better not to say or do anything at that time, unless someone is being hurt.  Sometimes consequences can help later in the day when he is calmer, particularly if he uses some words that are not acceptable in your house, or if he broke something.  The consequence is not for anger overload per se, but for certain behaviors that you want to try to extinguish.  I explain more about these topics in the book.

     The last part of the anger overload book "teaching your child new skills" works better with older children--preteens and teens--however some young children benefit from using labels for the level of their anger.  The idea of the labels is to help children begin to be aware they are angry before they lose it.  Then they can be guided to use a calming technique before they explode.  Sometimes a fun activity works better than a relaxation technique to help a child calm down, but neither usually works well once a child is already in overload.  So you can see that the key is early intervention, when possible.   Otherwise you wait out the storm and try to not respond to mean or hurtful comments a child typically makes during overload.

All the best, Dr. Dave Gottlieb


  1. Thank you for your response! Yes, I think it sounds like we need both books. The biggest problem is the anger, but he is also becoming much more defiant as he gets older, so hopefully we’ll get some good information that we can use from both. I have two follow-up questions.

    I forgot to include this in my original e-mail, but he also has been known to be quite aggressive with other children if he feels slighted in any way…mostly pinching, squeezing, head butting or pushing, but occasionally biting. This has been a huge problem in our home since his twin sister delights in pushing his buttons, which is very easy to do. Some days she can just give him a funny look across the table and he’s set off immediately. Unfortunately, it is also becoming more of a problem at preschool too. Last year it started several weeks into the school year, but we already had an incident of biting the first day of preschool this year (he goes to two different preschools, and in one of them has the same teacher that he had last year…so it seems he feel very comfortable expressing his anger already at this school). Is this aggression towards other children when he perceives that he has been wronged in some way consistent with anger overload or does it sound more like some other behavior problem?

    As I mentioned, we had a hard time convincing a therapist that we had an “issue” because he is so well behaved, polite, and smart much of the time. Unfortunately for us, she was the only MSW, LCSW in our immediate area that is on our insurance plan, but nevertheless we plan to pursue treatment with another therapist out-of-network. How can I convince a new one that we do have a problem? We all walk on eggshells and feel like our household is run by his moods, so this can’t be normal toddler/preschooler behavior as some have tried to convince me!

    Thanks again!

    1. Hopefully you will be able to find a psychologist or other therapist who works a lot with children who have anger issues. Maybe your child's teacher or doctor will have a recommendation. Also, you could check with your state's psychological association for providers who work with children and families in your area.

      Often a precipitant for anger overload is an underlying insecurity. In my book I mention a couple of children who explode when they get their feelings hurt. You will want to help your child feel more secure over time. A therapist may be able to help, too. One child in my book felt hurt when his peers did not include him on the playground and another felt bad about being small for his age. Do you know what particularly gets under your child's skin? You will then want to rehearse with him many times in a playful way how to deal with that issue. (You can't deal with every precipitant that makes him feel slighted, so you start with one or two situations that clearly bother him.) You could role play, but you will probably need to keep it real brief, because young children have trouble usually staying with a role play. I give an example of a role play in my book.

      Make a big deal out of improvement in self control even if his response is not ideal. But you also do want to be firm about not physically hurting someone else. Restraining him and/or having serious consequences later that day for hurting someone is usually recommended.

      You can encourage your children to cooperate rather than tease each other by creating a star chart such that they both get a star (as a team) if they play cooperatively rather than tease or fight. If there is conflict, you would try to catch it early and separate them.