Monday, May 20, 2013

Outbursts and sensitive to criticism in school

I came across this blog after reviewing an article you had written. My son every year since 1st grade has failed one or more subjects, but the teachers place him in the next grade because he knows the work; he simply does not apply himself and the outbursts of anger/emotional behavior impede his performance in class. I have been told that he has done better this year and has shorter cooling off periods.

With me, I do not have the issues of these outbursts at home. He can be belligerent and non responsive to adults in general including me, but I don't see the anger fits. The school wants me to test him for ADD, yet I am trying to decide if the medication would make things worse or treat the root issues. I tend to believe situational circumstances have lead to this behavior and not a chemical imbalance. He was beat by his father when he was 3 several times; after the divorce the father took off and has seen my children once in 5 years. His dad calls and that seems to be a behavior trigger. My son has had to help with his sister, we have no family, and the only grandparents he knows do not spend time with us. Sometimes I feel his belligerence towards adults has to do with him feeling no one cares, or he sometimes feels he is an adult and equal to his teachers above other students. I have tried to correct this thinking numerous times. He is hypersensitive to any and all seemingly criticisms. The teachers feel he is impulsive, wanting to do what he wants to at times; I'm just at a loss. They say he is a sweet kid, but the acting out/anger pushes him over the top. I asked if depression could manifest as anger, as bipolar does not seem to fit as he is not a risk taker at all. I don't see the mania.

I am a nurse as well as my friends, one ICU the other pediatric. I thought perhaps I am trying to avoid the inevitable,  but they have known us for several years spending a good amount of time with us and also do not see him symptomatic of ADD. He does have issues with authority, but the rage seems to be exclusively at school. They do not want him held back and negatively effect the incoming younger kids, but they say his behavior does not warrant an alternative school. He doesn't hit or kick, it would be ripping up his assignments, emotional outburst, crying (mad), everything is measured by fairness in his mind. What should I do?

Hi, I would bring him to a psychologist who works with children and families in order to have him evaluated.  There are several possible causes of his behavior.  You would want someone to determine whether he meets criteria for ADD, post traumatic stress, anger overload, and/or self esteem issues.  You mentioned that he feels no one cares and that he is sensitive to criticism.  Do the outbursts at school come after he feels criticized, or are there other triggers as well.  You would want to identify the triggers and then brainstorm with his teachers to find ways to help him cope with the triggers.  

Sometimes a kind word will help insulate a child from criticism and thereby prevent some outbursts; I often suggest parents or teachers point out as many positive behaviors as negative, so that the child does not feel only criticized.  In addition, can some of the triggers be avoided by cuing him that after he finishes something he does not like he will then have a chance to do something he likes?  Of course this will only work if there is time for him to do something he wants after he completes an assignment.  Another possibility is to earn points that he can trade in for a reward at home later in the day.

For anger overload, my workbook outlines a number of other strategies to head off anger before it escalates.  You want to intervene early in a potentially difficult situation if possible, because it is harder to head off anger once it is in the overload phase.  However, if there are self-esteem issues, post traumatic stress, or possibly ADD, you would want to address these too.  That's why getting an evaluation by a mental health professional would be a good idea.  You want to know, as best you can, what the underlying issues are so that you can address each of them.  

One last thought:  It sounds like there has been some growth in self-control, since you mention that your son cools off faster than previously.  Is there something you or the school has done to help him with self-control this year?  Check with the teachers to see what they have done in class to help him cool off.   Once you find something that helps, continue on the track if possible.

All the best, Dr.Dave Gottlieb  

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