Monday, July 8, 2013

Is the manual helpful for three year olds?

Dr. Gottlieb,
I’m thinking of getting your book about anger overload. My 3 year old has thrown epic, enraged, crazed fits since she was 1. They are becoming violent now, with her biting, scratching and kicking me, her grandmother, herself and everything in sight. She has no calming mechanism and will completely destroy a room with a quite impressive display of strength for someone who still wears 24-month clothes.

Does your book address children this young?

Is there any other advice you have? I really worry that she needs to see a professional. Yes, we have babied her (her sister is 20 months older). Yes, she is likely showing spoiled behavior when being told no. Yes, we engage in her fits when we shouldn’t. But she’s done this since before she could walk. I fear that this is more than a discipline issue.

Thanks for your help.

Hi, Some young children have a very difficult time soothing themselves and have explosive outbursts.  After reading your e-mail, some questions I have are 1) what is the frequency of her violent outbursts, 2) what are some of the triggers, 3) what have you tried so far.  In my book I explain that the first step is to carefully observe the triggers for a couple of weeks to see what patterns there might be.  Then I explain various strategies that you can employ.  The first half of my book would be useful for working with a three year old.  These strategies do not involve your child's direct participation.  If you have observed triggers for your daughter's outbursts, ask yourself if you can you sometimes alter the sequence of behaviors to avoid an outburst?  For example, if she rages when you tell her she has to stop playing and take a bath, you could re-arrange the sequence so that the bath comes earlier before she starts to play.  A related topic in my parent's manual is to lower your child's expectations.  The idea is to try to prevent an outburst when possible. 

The next section of the manual explains how to use "emotional distraction" and calming strategies.  In your case, it would be important to practice calming strategies with your daughter while she is not having an outburst.  You would try to develop a quiet and fun place in the house (some parents use a mat with blankets and pillows and wrap their child in a blanket, or have their child lie in a bunch of pillows) and put on distracting and calming music or a video.   Once your daughter is enjoying this space when she is calm, you would sometimes suggest she go there with you when she is just a little bit frustrated.

This is not likely to work however when she is already in serious overload.  Then you say as little as possible, but if she is hurting you, you would need to restrain her (possibly bear hug her) for a few minutes or more until she is no longer trying to hurt you.  It is real important then to give her more of your attention once she has calmed down, so that she sees there are definite advantages to calm behavior. 

Since it sounds like the outbursts are severe and have worsened the last two years, it would be helpful to get a consult with a mental health professional who sees young children.  You would want to rule out developmental delays, and possible co-occurring conditions like autistic spectrum disorders, attention disorders, and sensory integration issues.  A young child's brain is growing so much, but sometimes there is unevenness in development such that self-soothing is delayed.  You would want to learn why this might be happening, especially if you do not see some improvement in using the strategies in my manual over a couple of months.   I'd also recommend you read my post from June 12, 2013 that was in response to another parent of a three year old.  All the best, Dr. Dave Gottlieb


  1. Thanks for your response!
    She has definitely always had a self-soothing issue. She sucked her thumb until a few months ago and stopped the habit with the help of a band-aid on her thumb quite easily. I was shocked!

    As for your questions:
    1) Frequency: They can happen a few per week, then she can go a couple weeks to even a month without one.

    2) Triggers usually involve an object (she is a little hoarder with all toys), anger over being told "no", or frustration over generally not getting to do something she wants to do. She also will be acting naughty (like at bedtime), and as my anger increases, hers can too, and then sometimes it turns into a rage. That being said, she does not always go into a rage. Sometimes she cries or has a more normal fit. What is the trigger for her bad fits? It's hard to tell. I need to watch more closely to those triggers.

    3) What have I tried so far? I feel like I've tried it all for the past two years. Ignoring (she follows me and flips out even more); snuggling and being compassionate (she pushes me away); telling her she's doing great at the slightest sign of calming down (she yells "no I'm not!"); yelling at her (clearly this just adds fuel to the fire); talking to her rationally about how I can help her problem (she just babbles on very repetitive demands that make no sense). Oh, and did I mention lately she pees when she throws a fit?

    Anyway, distraction is typically the only thing that works, like a TV show. But if she knows she's being distracted, she won't buy in.

    I really like the idea of the calm space. I'll try that.

    I have her set up for a speech and behavior screening next month. She'll also start full-time daycare next month, which if it's all behavioral toward me and her grandmother (she does not do this much at all for her dad), maybe that will help.


  2. Since a lot of the triggers have to do with not getting to do what she wants, I would make a list of what some of these things are, and then plan a schedule for some of these activities, and post the schedule in the kitchen so she can see when things will happen. Try to schedule things she wants to do after things you want her to do, so that there will be a natural incentive for her to cooperate with you. The idea of a routine is to help her lower her expectations to play with whatever she wants whenever she wants. Furthermore, if she knows the activity is planned for later that day or the next, she will be more likely to wait for it.

    Since her anger sometimes increases in tandem with yours, try your best to stay calm with her. Tell yourself that your daughter has a problem with anger and that she is not doing this deliberately to frustrate you. If you can see it this way, you may not get as angry with her. Use distraction and a calming space if your daughter's anger is at a relatively low level, and just try to stay out of her way (or restrain her) if she is lashing out at you. She may escalate if you say nothing because she will keep trying to get you to respond to a tantrum. But if you keep your response to a minimum, eventually (it may be a few weeks or more) she will realize that tantrums don't pay off (in the sense that you do not give her much attention during those times). Then pay attention to her when she has calmed down. This will help motivate her to work on self-control, but it may still take some weeks (or longer) if her internal soothing ability is not highly developed yet.

  3. OK, thank you so much for those ideas. This idea of anger overload isn't something I'd heard of before, but it seems to make a lot more sense than some of the other possibilities like ADHD, conduct disorder, etc. It seems our whole family has anger issues (I sure know my parents do, which rubbed off on my brother and I - low tolerance for frustration, definitely). Hers seems extreme, but maybe that's a combination of genetics and learned behavior. I truly hope that's it and not a greater problem. In all other areas, she is developing at a very typical rate (her speech is a bit slow, but I think that's from being the baby and having her sister talk for her a lot).

    Thanks again!