Wednesday, March 27, 2013

7 year old's episodic outbursts at school and school

Hello Dr. Gottlieb:
My wife and I came across your article yesterday on "Anger Overload" in an attempt to understand an anger management issue we are experiencing with our youngest son who is age seven. We have experienced, for some time, anger management issues with Nick and have taken him to a child psychologist in the area we live in. Unfortunately when we took Nick to talk to the therapist he refused to speak. The psychologist told us at this point that it doesn't make sense to continue to bring him to her since he will not talk to her or engage with her in any way.

This past week  his elementary school called us three times due to his anger related behavior. The last call came on Friday when he was in the Principal's office banging desks and kicking a window in an adjoining office. When my wife and I arrived we were told that he became upset while in his homeroom and it escalated to a gym class shortly afterward. He was asked to get in line with the other students in gym but repeatly refused and became disruptive to the point where the teacher sent him to the principal's office. As mentioned, in the principal's office he was banging desks and kicking a window in the office area.

We spent considerable time shortly after the events on Friday ascertaining my son and  the rationale for his behavior. His class was having a party at the end of the day and he was looking forward to attending. When he realized that his gym teacher had sent him to the office he became enraged to think that he wasn't going to be able to attend the party. We asked Nick what he was thinking while in the principal's office and he said that his head was telling him to to bang the windows.

My wife found your article early Saturday morning after a sleepless night searching for something on the internet to assist us. She read to me your article on Anger Overload and it was as if you were describing our son. Our intent is to meet with the school staff to discuss suggestions/thoughts on recognizing potential anger outbursts in advance and develop interventions to prevent an anger overload.

 One suggestion we discussed with our son yesterday was to bring to school a picture of his dog and look at it once he feels he is getting mad to prevent him from going to an anger outburst. Another suggestion we are interested in trying is the use of "play therapy" that was suggested by both the school psychologist was well as social worker. We are waiting to schedule such therapy the coming week and see if this is effective. We are also planning to discuss telling our son that he will be rewarded for "good days" where we are not told of an anger outburst situation. Like any other seven year old he enjoys buying toys/games with his own money once is has saved enought to do so.  

Nick is a very bright loving child at home 90% of the time but does have episodes where he could be described as in Anger Overload. I truly believe, from his feedback to us, that he doesn't like feeling out of control with his anger and wants help.Unfortunately, he tends to shut down when we try and discuss what he could do differently.   As mentioned earlier it can be a challenge for him to open up about his feelings and thoughts following an outburst event. We want more than anything for him to be happy.  I would greatly welcome any thoughts/ suggestions you may have and be willing to answer any questions you may have.

Hi, You are on the right track when you mentioned that you would meet with the school and work together to pick up early signs of anger and find alternatives that are workable in your school.  If the adults together can pick up early signs that your son is frustrated or angry, then your interventions are more likely to work.   Also, by brainstorming together with your son's teachers, you can develop a plan that everyone can get behind.  

In my book, I explain how it is important first to keep a written record of what precedes a child's outbursts.  What patterns do you see?  Does your child think he is going to miss out (like with the class party you mention)?  Does that kind of situation lead to  him getting angry sometimes?  What happened in the homeroom before gym that started him on the road to anger overload?  If you see a few patterns, you and the teachers will better be able to anticipate your son's anger and distract him before he gets to the overload phase.

 Rewards sometimes help, but sometimes not.  Sometimes children get so angry so quickly that they do not think about rewards and consequences at the time.  Whether you use rewards or just talk about alternatives for expressing anger appropriately in school, I would use words like "self-control" to describe the goal for your child, and then give him examples of what he can do when he gets upset that would show self-control.   You would only do this while your child is calm, not in the midst of a meltdown.  If your child does not want to talk about his anger yet, then you and the teachers can still try to anticipate outbursts, and use distraction and calming strategies (I like your idea of his looking at the picture of his dog, as the picture may help soothe him) that I describe in the first half of my book.

At some point your child may be ready to work on the causes with you.  Eventually you would try to help him look at situations from another perspective and help him think through what to do.  The second half of my workbook explains how to help him recognize early signs of anger, and how to look at things from another perspective before he gets overwhelmed with emotion.
I encourage parents to teach their children "catch phrases" to help them remember to look at things in a new way.  For example, for a child who gets angry when an adult does not respond right away, you could teach the child to say to himself  "she still cares about me, she is just busy now,"  or "she will help if I wait."  Or if the child feels the adult is depriving him of something, the catch phrase could be "Maybe Mom or Dad have a different way of looking at this, they are not trying to be mean to me."   You would work on the catch phrase with your child and pick words that everyone agrees are meaningful to your child's situation.

All the best, Dr. Dave Gottlieb

Wednesday, March 20, 2013

2nd grader who gets mad at himself

Dr. Dave,
First of all, thank you so much for your research and forum about anger overload. I have often felt very alone as a parent dealing with my son's outbursts and your blog has really opened my eyes to others experiencing similar cases.

We have tried some of your modification techniques on our own over the years, but I'm anxious to try others that you've mentioned and make a commitment to be more consistent in our approach as well. My son is triggered by disappointment in sports or other competitive activities mostly, although the majority of the time he thrives and really enjoys the teams he participates with. He performs extremely well in school, but has had a handful of issues with his anger there too, usually when he doesn't feel like he's mastering something he's learning very quickly. His outbursts usually are displayed with screaming and flailing his body onto the floor, etc... He is always brought to tears during his outbursts though, which isn't something I've seen mentioned by others in this blog. He talks very poorly about himself during the episode and the tears just continue to roll. He has gone through times where we've noticed his outbursts are fewer and farther between and we begin to think he's growing out of it. Then, all of the sudden, he seems to regress. Because of this repetitive behavior he has been labeled as a 'cry baby' by his peers and there are many boys who know that he is an easy target and which 'buttons' make him react.

My son has always been way ahead of the 'curve' physically and academically, but emotionally I've always felt that he is far behind his peers. We've tried to be supportive and encouraging as much as possible (even when we're at our wits end!). We explain that it's completely fine to feel the emotions he's feeling and to be sad and disappointed, but it's not ok to react the way he reacts. He's continuing to label himself all the time and I'm worried that it will continue to alienate him as he grows. His self-esteeem seems to be so high and stable most of the time and then he puts himself down and feels awful during these moments of overload.

I would appreciate any additional advice you could give. Have you had patients who become extremely sad and cry in these anger overload moments too?

Thanks so much!
Mom of frustrated 2nd grader

Yes, I've worked with children who cry and direct anger at themselves when they make mistakes or do not perform as well as they expected.   Most of what I've written about in the blog is about children who become extremely angry at other people, rather than themselves.  What you are describing is a variant of anger overload where anger is self-directed and where there are displays of sadness or self-criticism. 

You can apply some of the exercises in my workbook to this problem.  I write in the book about a child who explodes because he feels peers do not like him.  Another child is my practice blows up when he walks a batter in a little league baseball game.  One important thing to work on with your son is changing his expectations of himself.  After he calms down, talk about how everyone makes mistakes in school or in sports.  Mention a sports figure or academic figure he might know about.  For example, in Chicago the White Sox slugger Adam Dunn hits a lot of homers but also strikes out a lot.  Or Albert Einstein was brilliant but had trouble spelling.  The idea is to convey that people are not good at everything they try, and also, even when they are good at something they have off days or make mistakes.  Review these ideas after each explosion is over.  Also, teach him to say a catch phrase to himself every morning when he gets up, something like "everyone makes mistakes," or "it's impossible to get everything right."  Pick a catch phrase that your son likes and that applies to some of his outbursts.  Over a few months time he may be able to soothe himself at the moment of upset by remembering the catch phrase and then not react so strongly.

In the meantime, let him know it is okay to cry.  Explain that the crying is his way of letting out frustration, and explain that when he learns that it is cool to make mistakes, the crying will probably lessen, because he will not be so frustrated then.

Another strategy is to use distraction if you can catch him starting to get upset.  This is hard to do if the upset happens real quickly.  I explain in the book how to use "emotional distraction," that is to say something that makes your child laugh, amused, or curious about something. 

Also, keep a list for yourself of the times that he gets upset.  You may start out focusing on changing his expectations about mistakes, and then find there are other situations that are causing distress.  Then you will need to come up with a new catch phrase!  But only work on one or two catch phrases at a time.  When he is handling one situation better, then you can work on another.

Hope this helps, Dr. Dave Gottlieb

Sunday, March 17, 2013

9 yr old is disruptive at school, wants to change

Dear Dr Dave,
I've read your article on anger overload.  I've also read the blogs. I too feel the article was written for our son who is 9 yrs.  A lot of the parents; comments ring true for us.  Our feeling is that there is a strong link between his well being and his behavior; he goes through spells where for a week or so he throws things, kicks things etc and is quite extreme then it settles back to his "normal level" which is still not great. It appears to go in cycles.  His behavior at school is causing real issues. This week he said he couldn't understand why he was so disruptive at school when his sister isn't like that and his Dad and I were good in school, "I hate it Mum".  If he is being disobedient it always helps if he goes to the toilet and does a poo; he comes back a calm, changed child. He generally has large bowel movements, up to three times a day.  We also have to omit artificial additives from his diet where at all possible as they cause his behavior to spiral out of control. I have tried lots of treatments, mostly alternative but as yet nothing has made much difference.  He is a kind, caring , generous, helpful wee guy who is well liked by adults generally.  A number of his peers know which buttons to press for a fire works display and tend to sit back and enjoy the show!!  I look forward to hearing from you. 

Hi, First what I would recommend is keeping notes for a week or two of what is happening when a tantrum starts.  What is each person saying before your child escalates?  Then see if you can find some patterns.  I describe how to do this in my workbook on anger overload.  You want to see if there are some issues or themes that trigger him.  Then I describe in the book a number of ways to try to avoid a blow-up.  First, it is up to the parents and teachers to try to change the sequence of behavior to try to go around whatever causes a blow-up.  You won't be able to avoid all causes by any means, but if you can avoid of few of the situations, that will help lower the number of outbursts

Once your child gets angry, if he is just a little mad, try to use "emotional distraction," that is, try to change his mood by directing him to something that makes him laugh or that makes him curious (and thereby stop thinking about whatever was making him upset).  Once he gets very upset, then it is best to back away until he calms down.  The more you say when he is in a tantrum, usually the longer the tantrum will go on.  

In the second half of my workbook, I write about strategies you can teach your child.  You mention that several peers push his buttons.  You would discuss those situations briefly in the evenings and teach him how to look at these situations differently.  You could also teach him catch phrases that he would eventually memorize to help him look at these situations differently.  For example, if a peer is teasing him about something he said, you could teach him that the peer may be jealous or may like to see people get upset.  So the catch phrase might be "keep quiet or he wins,"  or "he wants me to scream, so I'll say nothing,"  or "I won't let him get to me."  Explain to your son how effective the "cold shoulder" is, and practice at home by role playing a recent situation at school.  Review and practice several times a week for two to three months.

It can take several months for children to begin to implement what you teach them, so be patient and non-judgmental when you work with your child on these strategies.  If he gets annoyed then take a break for a few days.  Tell him anger is a real important thing to learn how to control.  

If the teacher or social worker at school can work with him in a similar fashion, it would help your son.  Repetition of strategies over a number of months is key because children with anger overload tend to react so quickly that it is hard for them to remember the strategies at the moment of upset.  But frequent practice helps the process along.  All the best, Dr. Dave Gottlieb

Monday, March 11, 2013

Almost 5 year old has "terrible" tantrums at school

Hi Dr. Dave -
I stumbled upon your article about anger overload and your ask Dr. Dave blog when googling anger in children.  I have a 4 year 11 month old child who is super sweet, super kind, focused and creative.  She has been sent home early from preschool two times in the past two weeks because she throws terrible tantrums for at least an hour and they cannot control her.  She will throw items, scratch anyone who gets in her way, knock down items.  I, at first, wanted to blame her school environment because I do not see these issues at home.  I was at first afraid that it might be ADHD or bipolar because of the severe mood swings that can occur.  However, your description of anger overload describes my child to a T.  It is like you wrote the description based off her.  

In school everyone loves her, everyone loves playing with her and everyone calls her their best friend.  She is super smart, but lately, when asked to clean up, or pick up a mess she created she gets set off and cannot be controlled.  We think this may be due to having to stop an activity, or being treated unfairly (in her eyes).  Today's episode was because her and her friend made two messes during free time.  The teacher asked each child to clean up a mess.  My daughter said it was unfair that she had to clean up one mess by herself because she had help making it.  It set her off.  We also had a teacher tell us when she was two that she was a four year old (her sister's age) stuck in a 2 year old's body.  She gets frustrated with kids her age and when given a choice will always play with older kids because they think and act more like her than kids her age. 

I don't think I see these episodes at home because I do in fact stop them with distraction techniques or making her laugh before they get out of control.  (Mother's instincts kicking in).  I was wondering two things.  1.  Can this be seasonal?  We notice that these episodes happen more frequently and more severe in Feb / March time frame.  (She was actually expelled from her last preschool in February last year, and now she is getting more calls home to be picked up because she is uncontrollable these past few weeks at her new school that she has been at for about a year now).  Do you have any suggestions that I can give to her teacher to help us with controlling the anger before it gets out of hand?  Are there any resources for teachers, or do I direct her to parenting resources.  It is really frustrating for me because I am not with my daughter when these episodes happen, so I am going off of second hand experiences, and I do not see the full blown episodes at home, although I do believe that they are happening at school.

Hi, See if you can share with your child's teacher some of the strategies you are using at home, such as distraction, or using humor.  In addition, I would suggest the teacher continue to track the situations when your daughter gets frustrated.  Which activity led to the mess she did not want to clean up?  Could the teacher direct your child away from that activity and toward a different one?  Would a five minute warning before clean up time help?  

I would also help your daughter "re-frame" the issue after she calms down.  The teacher could do this, or you could do this if the teacher shares the details with you.  You could talk about what was happening before she had a tantrum and then explain that the teacher just wanted things cleaned up and did not mean to single anyone out.  Do this each time after your daughter has calmed down.  You would be trying to help her look at things from a different perspective.  This may not help her avoid tantrums right away, but pay dividends down the road.

 You could also suggest a "catch phrase" which you could practice at home, such as "All right I'll do it." or "She didn't mean to pick on anyone."  or "Better to clean than scream."  I explain more about the use of catch phrases in my parent's manual. 

I would also suggest you offer a reward if the teacher sends a note home that your daughter was a big "helper" today.   You want to reinforce the idea of helping the teacher.  If "helping" is not usually the issue, then use different words to capture what you want your child to work on.

If clean up time is not the usual precipitant, you could use these ideas--reviewing other points of view after she calms down, catch phrases, distraction, and daily rewards-- for whatever situation precedes her tantrums.   

I am not aware of seasonal changes in angry outbursts in late winter, though some children and adults have "cabin fever" by this time of year.  But in that case there would be mood changes or irritability in other situations throughout the day.  All the best, Dr. Dave Gottlieb