Monday, October 22, 2012

8 year old with separation anxiety and anger overload

Dr. Gottlieb,
  About eighteen months ago my daughter, who was then 7 years old, was in her second semester of the second grade. In late February of that year, with no warning, woke up saying she was not going to school. This behavior lasted two months. She resisted, then panicked, and then would outright resist in a panicking anxiety attack. She would run from us around the house trying to escape going to school. Once at school her mother and I, along with the Principal and school counselor would have to pulled her dragging and screaming into the Principal's office. There she would immediately calm down, yet was still in resistance of going. After two to three hours she would then agree to go to class. During this time we were helped as much as possible by the school counselor. My daughter would come up with any excuse not to go, which may be she was sick (when she wasn't) to "they" will be mean to her, which would later be anyone from the teacher, which before this time absolutely worshipped, to the principal, to the fourth grade kids, to her best friend, to whomever she could think of. It usually would come back to wanting to be with her mother, who at the time had been substituting at school. During this time my wife quit substituting at her grade school to try to lessen the temptation of her wanting to leave class "because she was about to throw up" and then would always find her way to my wife's class. In the afternoons she would get home and begin worrying about going to school the next day. At night she was prone to getting mad quickly and have horrible tantrums. Her pediatrician ran blood work on her but found nothing she felt was any causing factor....
Luck for us during this time her resistance to school came to a stop. Between the teachers, counselor, principal, and my wife and I, we never could figure out what the problem was. But she continued to have the anger issues, which was something that she had been doing off and on for quite awhile before the school anxiety issue came up. She would glare at you straight in the eye when she didn't get her way or something made her mad and yell at you like a drill sergeant. She would use phrases like "you are crazy lady", "I wished I lived with someone else", "I hate it here", "don't you look at me like that". Time outs and all the punishments suggested did little if any good. We had literally at times spent up to two hours trying to get her to stay in a time out. These occurrences were not all the time, but would occur about once or twice a week....
Although the school anxiety has subsided, her anger is off the charts, even with the medicine. If she wants to do something that you cannot make happen, she goes into anger mode. Again she will stand there and verbally assault you and argue like an adult. She tries to twist anything and everything around to make it our fault. (Once we planned to camp in the yard one weekend night but storms moved in and it rained all evening. Her response was "you promised!!!! This wouldn't have happened if you had set the tent up this morning!!!!". We have tried (and still making the attempt) not to argue and just walk off, but even then she will follow you and keep hammering at you until we finally feel we have no choice but to send her to her room or ground her. At the time, she shows no remorse, and does not care what you take away. When she calms down she returns to being in a great mood.
During all this time, when she is not in school anxiety or anger mode, she is a happy, energetic child, always on the move. In school she does great (she got into the Gifted and Talented Program this year) and the teachers, counselor and principal all say she is a fantastic, well behaved student in class. And although she had resisted the teachers about going to class, they said she was never hateful or disrespectful, just matter of fact.
She is now getting to the point when she "overloads" she is showing aggression to her mother, reaching out and trying to squeeze or claw her arms. She does this with no one else, and does not show any aggression in school. Her counselor keeps wanting us to try the "speak softly and use 1-2-3 Magic..." When we do this, all she does is mock us by screaming "1-2-3-4-5 blah blah blah".
After reading your articles today I want to ask you, from what I have described, is this "anger overload"?
Hi, It sounds like you have been through a lot.  The level and duration of anger fit with the criteria for anger overload.  The separation anxiety is separate from anger overload, but it is interesting that in both cases, once the emotion (anxiety or anger) starts, it often escalates and is difficult for her to control.  You were on the right track when you kept taking her to school despite the anxiety and when you had your wife stop working nearby.  Those decisions probably helped her eventually to see that she could handle school without having to stay home and without having to go to her mother's classroom.  One other possible diagnosis for children who have intense emotional reactions (that your doctors may have ruled out already) is pediatric bipolar disorder.  For this diagnosis there are frequent fluctuations in mood.  Does your daughter also have periods of excess energy, agitation, irritability, or risk taking behaviors even when she is not in the anger overload phase? 

In my manual I describe how to re-arrange the sequence and lower children's expectations in order to try to head off anger overload.  For example, if she is excited about an upcoming event (like the camp out), you would caution her ahead of time that you might not be able to have it, that it depended on the weather,  that it was a possibility only.  In addition if there are certain times when she is more likely to explode, can you change the situation around to avoid the precipitant?  For example, some children get angry when they have to get off a video game and go to bed.  Then you would either not allow video games on school nights, or stop the video games much earlier in the evening.  Admittedly you cannot frequently predict when a child will explode with anger, but you try to keep a record of her explosions and head off what you can in the future.

In the second half of the manual, I explain ways to teach your child about anger overload and how to develop self control.  You would do this while she is calm later in the evenings.  You help her learn about different levels of anger, about ways to develop self soothing, about using catch phrases  to "catch" the anger early, and about how to see things from other people's point of view.  You also teach her about compromise.  
You are right to not talk with her while she is exploding.  However, if she harmed your wife, I would have significant consequence for the following 24 hours .  I would tell her ahead of time what it would be and not discuss it during overload.  But when everyone was calm again, I would be sure to impose the consequence.  You would not be punishing her for anger overload, but for the particular behavior of hurting someone.  
Best, Dr. Dave Gottlieb

No comments:

Post a Comment