Wednesday, May 22, 2013

Angry 3 year old whose young brother died

Good morning.  I came across your name and information when searching for help for our defiant and difficult 3-year-old daughter.  We are suspecting she struggles with the "anger overload" you have studied.  She is a preschool student and, according to her teachers, she is very well-mannered, focused, and listens to instructions.  However, at home it is a different story.  She regularly wakes up angry and gets completely angry and out of control when she is frustrated with even the smallest thing.  She will have a meltdown if she doesn't get attention when she wants it, if she wants a different cup, if she can't get her shoes on, etc.  It turns into a meltdown and takes quite a long time for her to settle back down.  We spend our entire days tiptoeing around her and trying to head off any potential "catastrophes."

My husband and I are at a complete loss.  We are also struggling with intense grief, as our infant son was mortally wounded in the care of a daycare provider just a couple of months ago.  We are unsure of how our young daughter is affected by his loss as well.  Our daughter refuses to play by herself for even a few minutes and I am worried about this going forward as she will likely be an only child now.  She thrives in the company of other children, and I am a bit concerned about her over the summer when she no longer has that connection.  I am a stay-at-home mom, but looking for a part-time job.  However, I will admit I am very cautious now about daycare providers and worry about putting her in a new place - one that I am unfamiliar with.

I guess I'm just seeking advice on what techniques might work or might not work for her.  We have met with psychologists in the past but they really just lump her problems into the "terrible twos" phase and nothing more, which isn't helping us at all.

Hi, I am sorry about the loss of your young son.  It must be so hard to deal with your grief and at the same time have to deal with the angry outbursts of your other child.  Did your daughter's meltdowns increase after her baby brother died?  Young children exhibit grief in different ways and at different times.  If you think she is in part responding to the loss, you would want to consult with a mental health professional who who has worked with children who have experienced a loss.  There are also support groups for children and parents, such as Brave Hearts.

If your child's meltdowns began earlier, before the loss, there are likely other reasons.  One possibility is that she is wanting attention, as you suggested.  Three year olds are expected to do more for themselves, but often act like they need your help because they miss being taken care of (like when they were younger).  If you think this could be happening, you would want to give her a little assistance sometimes and see if she can do part of the task herself with you watching and praising her.  In this way she is getting attention for being competent.  You would not want to react with strong disapproval when she cannot do something, or when she is complaining (like about the "wrong" cup), because then she would be getting your attention at the wrong time; keep in mind that any attention, even disapproval, can be rewarding to a child.  Try to ignore some of her complaints, or distract her with a silly comment, a song, or by talking about something that is happening later in the day.

In my workbook, I offer strategies for anger overload.  I describe how to intervene early before the anger reaches the overload phase, when possible.  I also explain when to use distraction, when to ignore, and when to use calming strategies.  If your daughter is in the overload phase, you would try to say as little as possible, and try to ignore her until she calms down.

Since she does so well with other children, I would talk with the preschool teacher or other parents, and try to get some phone numbers so that you can arrange play dates over the summer.  When she is by herself, will she do better if you are nearby and she can interact with you some of the time?  Maybe work with her on an art project or puzzle, and then say you will be back in a few minutes, and tell her you want her to show you when you get back what she did while you were in the other room.  Some young children need more "touch base" time than others.  Her need for your constant presence will probably diminish as she gets older.

Take care, Dr. Dave Gottlieb

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