Wednesday, July 17, 2013

Do 6 year olds outgrow anger problems?

Hi Dr. Dave-

Out six-year-old has been having angry outbursts since he was about 18 months old.  He screams, cries, beats on the door, throws things, kicks and bites for up to an hour.  When he was younger, he would stop when he got too tired to go on and would fall asleep. The tantrums don't last as long anymore.  I honestly can't tell you what makes them stop.  He eventually just runs out of steam I think.

Then, after he's done, it often takes 30-40 minutes until he is really approachable.  He just seems on edge and if I can avoid frustrating him, eventually he just seems to forget.  Once it's over, he is happy, sweet, wants hugs and is almost overly happy.  Sometimes it's like he just flips.  One second he's raging, the next minute he's happy and sweet. 

It comes and goes.  When he was ages 2-4 it probably happened 3-4 times a week, up to a few times a day. Now, he won't have any tantrums for a month or two and then will have five in a week.  It seems to me like if he has low blood-sugar or is tired, he's more likely to have a tantrum.

I think he has control over it because he rarely has done it with people he doesn't trust and know well.  It has happened a handful of times at school and not until well in to the year when I think he felt safe with his teacher.  He has done it a few times with grandparents and one time with two different babysitters that he knew well and trusted.  But it almost always happens with me and sometimes with his dad.  

In general, he is a happy, fun and creative kid.  He is impulsive and reactive compared to other children and he has more energy than any kid I've seen.  He is definitely a risk-taker and talks more about all the awesome things he can/will do then actually doing them. 

We saw a behavior specialist in his pediatrician's office once and he basically told me to just be consistent and reinforce positive and negative consequences. 
I wanted to pull my hair out because I have been very consistent with him and feel like I honestly can't do any better. 

I'm exhausted from six years of parenting him.  I love him but much of my time with him is difficult.  I can't keep him entertained or engaged and I never know what is going to set him off.  It's typically when he's told no or has a fight with his 4-year-old sister over something but it's not consistent enough for me to determine why he does it. I'm a stay-at-home-mom with two other kids (ages 2.5 and 4) and it's almost impossible for me to manage it all.  He has set an example of anger and defiance and taught them many of his raging behaviors that they mimic now.  

In seasons, I've thought he has outgrown this and felt relief but it always comes back.  He seems to fit the profile of a kid with anger overload.  I also think he has symptoms of ADHD (both his dad and I have it) but he's doing well at school and his teacher says he is a "model of patience and listening" so I haven't pursued this with a doctor yet.  He is impulsive and doesn't seem to have a sense of when to stop things that are bothering other people but he seems to be able to focus well in some areas.  

Do kids with anger overload outgrow this type of behavior or do they struggle with this all their life?

Hi, There are not longitudinal studies of anger overload, to my knowledge, but my experience with children over thirty years is that most children can learn to better control their outbursts.  For some children, there remain times when they lose it as they get older.

If there are additional diagnoses, it is important to address all these issues; then the it will be easier for children to develop self control.  In your son's case, you would want to rule out "ADHD, hyperactive-impulsive type," and rule out "pediatric bipolar disorder."  At some point I would make an appointment with a psychologist or psychiatrist who specializes in childhood mental health issues in order to rule out these additional diagnoses.  The way you describe your son's energy and impulsiveness is why I recommend you make sure.

ADHD can take different forms; not all these children are inattentive.  Some show hyperactivity and impulsivity without serious attention problems.  Children with high energy and impulsivity have a harder time with self-control when they get angry.  They tend to be quick reactors when they are emotional. If they become less impulsive over time, their anger control will usually improve as well.

Pediatric bipolar disorder is more rare; some key symptoms are frequent severe mood changes, impulsivity, dangerous risk taking, frequent pleasure seeking behaviors without regard for consequences, and grandiose thinking.  It is more difficult to diagnose, and you would want a mental health professional with experience in diagnosing this disorder in children.  

For anger overload, you should focus first on the strategies in the first half of my parent's manual.  You mention above a couple of triggers: when your son is told no and when he fights with his younger sister.  One key is to try to catch his anger in early stages; this is not often possible because kids can erupt so quickly.  I describe in the manual how to use "emotional distraction" and a "calming" zone when you can catch it early.

You would also want to try to re-arrange situations so that you avoid certain triggers.  For example, if the kids fight over using the computer or the television, you would arrange a schedule to try to avoid the conflict.  Maybe there would be no television or computer some nights, or alternating days when one child gets to choose or go first.  You might also try to verbally praise both children when you see them cooperating.  I don't know what you have tried so far, but keep experimenting until you find a strategy that works.  Rewards and consequences do not usually help much with anger overload because children are not thinking rationally when they are very angry.

I also recommend using a neutral label for levels of anger to help your child begin to recognize when he is starting to get angry.  I give examples in my manual, one labeling system being colors like blue (for low level of anger) to orange (for mid range) and red (for overload phase).  The idea is to help a child recognize when they are at the blue or orange levels, because it is at this stage when they still have a chance to avoid overload.  Once they recognize early stages, you would teach them strategies to help them with self control.  I explain this in more detail in part two of my manual.  

The process takes months, and sometimes a year or more, but it is well worth the effort, because self-control is a key to success in life.  It sounds like your son already has some control because he has fewer outbursts outside the home.  That is a good sign.  With practice he will eventually be able to use strategies at home.  All the best, Dr. Dave Gottlieb

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