Tuesday, June 25, 2013

5 yr old's anger: Low blood sugar, psych triggers

Hello Dr. Gottlieb,
I came across your article and just bought your book (waiting for delivery) Anger Overload for Children - A Parent's Manual. 
Our daughter is 5 1/2.  The summer before kindergarten she began having angry outbursts.  She'd first make angry faces like she was about to explode, then it started more often when she did not get what she wanted - no matter how minor.  It soon became - "I hate my family - I wish I was not part of this family - and you all hate me - that's why you are mean to me".  This only happens maybe 2-3 times per month - but the minor rages are often daily. They tend to last 5-15 minutes at most.

She has a 7-year old sister who often takes advantage fully of the 18 months more experience she has and pushes her buttons. The most common anger explosion is between her and her sister and it’s not unusual for her sister to have legitimately done something mean to trigger it - but the response of course is extreme.  Sister is generally very kind with no unusual behavioral problems.
The anger also often happens on play-dates when things don't go exactly her way.
It’s escalated in the past week where she'll just explode and go on a rant of how she wants another family.
While her teacher recognizes that she has a bit of an "edge" there have been no behavioral issues noted from school or from after-school programs she participates in. 
Does this seem to fit your concept around anger overload?  Could there be a link to low blood sugar?  (most outbursts are late afternoon or early evening between meals) Should we consider therapy or a child psychologist?

Hi, Yes, your description of your daughter's outbursts sounds like anger overload:  relatively minor frustrations lead to severe outbursts.  If your daughter's blood sugar drops significantly in the late afternoons, this could be a contributing factor.  Check with your child's doctor to rule out any serious medical conditions, and also consider giving her a snack every few hours.  Re-evaluate in a couple of weeks after you start the snacks and see if they have reduced the frequency of outbursts.  

You would also want to keep track of some of her psychological triggers (i.e. conflict with her sister, frustration with play dates).  Are there others?  Then think about how you can "re-arrange the sequence" (if possible) to avoid the triggers, or "inoculate" her before a play date, or teach her to become more aware of her triggers (the strategies that develop a child's awareness usually work better with children who are a little bit older).
By "re-arranging the sequence," I mean that you try to avoid certain situations that precipitate her anger.  For example, if she and her sister get into it at a certain time, try to get one of them to be busy in a different room to avoid any potential dispute.  

By "inoculation," what I mean is to talk briefly with your daughter before a trigger occurs; for example, when she is going on a play date, remind her that sometimes her friend is going to do something to annoy her.  Try to be specific and explain what her friend has done in the past.  Keep your explanation brief, and end with a catch phrase that you can repeat before future play dates, such as "remember to go with the flow!"  At home, you can model how to go with the flow when things do not go your way.  You could say "Oh well, things happen. I'm going to chill in my room for a few minutes."  Here you are not only modelling how to handle frustration, you are introducing another technique:  taking a break somewhere by yourself for a few minutes.

I explain more about these and other strategies in my parent's manual.  In my book, I explain you should start with strategies that you can control and that do not depend on your child becoming aware of her anger issues.  The second half of the book explains how to teach children about their anger and how to deal with it.  Anger is a difficult emotion for many children; change occurs gradually over a period of months.  If you do not see any changes in the frequency of outbursts or in their intensity after trying some of the strategies for several months, I would recommend you consult with a mental health professional.  Or you may prefer to work with a child and family psychologist at the same time that you apply some of the strategies in my book.   A child and family psychologist can help you develop a plan that you can use at home.    A neutral observer may see patterns or have ideas due to his (her) experience and objectivity.  You could ask a teacher, or your friends, or your child's doctor for suggestions for a mental health practitioner in your area.  All the best, Dr. Dave Gottlieb

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