Thursday, May 9, 2013

8 year old with anger overload, anxiety, and ADD

Hi Dr. Gottlieb,

I was very glad to find your article as it most accurately described the problems my wife and I are having with our 8 year old son.  For the most part, our son is a very happy, very obedient child with a very bright personality. He tries hard in school, has lots of friends, engages in sports and social activities. He lives a very healthy, normal life, and has two very loving parents. He is very sensitive, however, and on certain occasions he will act out with extreme rage, sometimes lasting up to 30 minutes.  The “anger overload” is always a disproportionate response to the situations that seem to trigger it.  We notice that his rage also seems to be coupled with anxiety. Examples of triggers can be: if he is unable to adequately perform a task in school or if he does not perform well in a sports. He actually does well but seems to set high expectations for himself. His teacher has even mentioned that he is doing quite well but tends to cut himself short.  He’s very hard on himself and calls himself “stupid”, the “dumbest kid in the class” or he’ll “never be good at anything”, etc.. 

Other triggers can be questioning our love or his acceptance from others.  For example, he blames his teacher for singling him out among others, over reacts to another child’s behavior towards him, or claims his grandmother favors his cousins over him. If we try to discipline him he responds with “I’m sorry” but often over uses it as a defense mechanism.  He can also misinterpret our disciplinary tone as being “mean” or that we don’t “love” him. Early on I felt that he may be trying to manipulate the situation but over time I’ve come to realize that these thoughts and reactions are very genuine.  The “anger overload” has been occurring more frequently at 8 years of age.  He also is very embarrassed and ashamed for his behavior after he feels better and does not want to talk about. 

Background: He has been diagnosed with ADD, had private tutoring and special attention in class that has helped to overcome some learning hurdles. He has made great improvements since the 1st and 2nd grades.  As a toddler he would sometimes hit a lot when he was unable to communicate verbally his frustrations and sometimes would hit his head on the ground in a temper tantrum.

A certain episode of “anger overload” just recently caught my attention.  He said things like “help me”, “you don’t understand how I feel”, “I wish I were a different person”, “I just want to leave everyone and live alone like a hobo”.  It was quite disturbing and frightening to see.  After we put him to bed my wife was in tears and I was at a loss.  I don’t know what to do and definitely want to deal with this head on before it gets worse.  Luckily, he has not been physically harmful to himself (only breaking pencils, swinging at the air or punching inanimate objects) or to others but obviously we want to prevent anything like this from happening if it goes untreated.

Hi,  In addition to using the strategies I outline in my workbook for anger overload, there is a brief discussion in the first half of the book about dealing with a child's insecurities.  Some children with anger overload are sensitive to criticism or have high expectations of themselves.  Basically, you want to work on his underlying high expectations.  One approach would be to sit down with him when everyone is calm and explain that you are supposed to make mistakes in school because you are still learning new things.  If you got everything right you wouldn't need to go to school, you'd be the teacher!  Then before school each day, you would mention a "catch phrase" like "it's good to make mistakes, it means you are learning new things" or "Don't forget to make a mistake today, and tell me about it when you get home."  

If he tells you about a mistake later in the day, be proud of him, and remind him that means he is trying new things.  Also, you and your wife want to model how to handle mistakes.  So when you forget something, or drop something, or make a mistake at work, mention it out loud at dinner time, or whenever everyone is around, and then say out loud a catch phrase like "everyone makes mistakes."  You are trying to help your son have a different set of expectations.  It will take a number of months for these new ideas to compete with his high expectations of himself, so don't be surprised if the negative self-statements continue for a while.  Over time, there will be a shift in his thinking about himself if you continue to seed the new, more realistic expectations.  Remember do do it calmly.  If he disagrees with you, do not argue with him, let it go for that day.  With one child, we even gave him points on a chart for telling us about mistakes he made in school.  The points would earn him a reward. 

For sports, you want to remind him of an appropriate catch phrase before each game.  In my son's case, he was a fan of Frank Thomas of the White Sox, so I'd remind him that even Thomas strikes out quite a bit.  I'd also remind him that the ball is small, so you are supposed to miss it a lot, or the game would be too easy.   The catch phrases were "you're supposed to miss, or the game would be too easy," and "even Frank Thomas strikes out a lot."  Depending on your son's expectations of himself, you would work out an appropriate catch phrase.

The feelings that he has about how adults love other people more than him may require more than catch phrases.  Children who are sensitive and who have ADHD notice that they often get reprimanded more than other children.  If your son is impulsive (which some ADHD children are) or if he is distractable, the teacher or other adults may need to remind him to pay attention or to slow down.  These children need an approximately equal number of positive comments during the day to help their self esteem.  Ask the adults who work with him to try to remember to notice things your son handles well, and to make brief comments admiring him.  Explain to your son that the ADD means he may be reminded of things more often than some kids, but that's minor compared to how smart and lovable he is.  Then give him a few examples of his positive qualities.  It will take time for your son to really feel okay about himself.  You may want to consult with a psychologist in your area to work on this issue in more detail.  

The comments your son made recently about wanting to live alone like a hobo and about wishing he were another person illustrate how hurt he feels sometimes, and I can see why your hearts go out to him.  It's a good idea to make an empathic comment at these times, like "I can see how hurt you feel when..."  Hopefully, the interventions in my workbook and in this posting will help him feel less hurt.  But sometimes children with ADHD, and children who have anger issues, do become depressed.  If he regularly makes comments that indicate he feels worthless or hopeless, and/or if he loses interest in doing activities with other people, it would be important to consult with a mental health professional in your area. 

All the best, Dr. Gottlieb

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