Tuesday, April 9, 2013

8 year old with ADHD and anger overload

First of all, I want to tell you how thankful I am that I found your article on anger overload.  I had been struggling for months with these meltdowns with my son and had figured out some strategies that worked but just didn't have any answers.   I was feeling alone and quite frankly pretty hopeless when I finally came across your article.  It explained my son exactly and was a huge relief to me that I was doing some things right.  I have purchased your parent's manual and plan on implementing your strategies in finding even more success with my son.  Thank you for giving me hope.
I have a few questions for you regarding anger overload.  My 8 year-old son has ADHD and is in 2nd grade (repeating).  His pediatrician diagnosed him in May of last year and he has been taking Strattera ever since.  He was doing very well on the Strattera (combined with a daily report card), was showing improvement with his work in the classroom and at home, and seemed very happy in school.  Then in November a new special needs student entered his classroom.  This student cries, screams, and disrupts the classroom on a regular basis.  This is highly stressful on my son, from comments he has made to me.  The time period that this student entered his classroom is when I started seeing these anger overloads in my son at home.  Being that everything is consistent at home and had not changed at all during this time, I really felt this student was the underlying factor in my son's behavior. 
His meltdowns are always with me, and have never occurred at school.  Is it possible that he is holding all of these frustrations in at school and then they are triggered at home with me? Do children with this problem sometimes only exhibit this behavior at home? 
I also wanted to know if you have seen Strattera cause a higher incidence of these anger overloads in children?  Or make the anger overloads more severe?  I am just concerned because I have seen improvements in my son with the meds, but I wonder if these anger overloads are reason enough to take him off of the medication.  Honestly, I have received very poor or no advice regarding his medication and these meltdowns.
Thank you very much for your time.  I greatly appreciate any information you can share with me.

Hi,  In answer to your first question about whether children often have anger overload at home and not in school, the answer is yes.  Often this is the case.  I think these children try really hard at school to control their emotions because they do not want to be embarrassed in front of their peers and/or do not want to get a detention.  Many children let their guard down at home, or like you said, they have worked so hard at school to control themselves that they have difficulty maintaining self-control later in the day.  Also, I think children know their parents are more likely to listen to their complaints.  Parents need to be careful to not give their time and attention when their children are in overload because that usually increases the frequency of anger overload in the home.  In my book, I explain how to catch anger early (when possible) and use "emotional distraction," but when you can't catch it early, try to ignore your child during an outburst.  I know that is not easy to do!   I also explain when to talk with children about their behavior and how to encourage children to use various techniques, such as catch phrases, to help them deal with their anger.

Since you have had a good experience with Strattera for your child's ADHD symptoms, I would be hesitant to change course.  It does not sound like your son's outbursts increased when he started the Strattera, but if they did increase when you started (or increased) the medication, then I would recommend you consult with your child's doctor.  A possible side effect with Strattera is increased moodiness, but I have not seen this in children I have worked with.  Also, you should know that I am not an expert in medication; psychologists in my state cannot prescribe, so I leave it to child psychiatrists and pediatricians to handle the medications.  
From your description it sounds like your son's anger increased when the new student entered his classroom in the fall.  See if you can talk with the school staff about your observation and work with them to reduce the effect on your son.  Maybe also talk with your son from time to time when he is calm about this child and how he could try to tune him out.  In my parent's manual, I write about the importance of reviewing alternatives on a regular basis later in the day when children are calm and not busy with another activity.  You could also brainstorm with the school about ways they might help.  Would the school allow him to get up and get a drink if he needed a break?  Could he use ear plugs for a few minutes until the other child calmed down?  Could the school remove the other child more quickly if the child begins screaming?  The key is to talk with your son and with the school about what would work best in that school setting.  All the best, Dr. Dave Gottlieb

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