Monday, July 15, 2013

"Possessed" 4 yr old: Is it genetic?

I have a 4 year old daughter who has had many rage/anger episodes since the day she was born.  Yes, she was an angry newborn!  She has many triggers: being tired, not getting a toy/treat at the store, not wanting to share a toy with her brother, being sick, being in pain, waking up in middle of night, power struggles, etc.

Generally, she is a very happy,compassionate, active girl.  But, when a rage is triggered it can last hours.  The most mind boggling was recently she had a stomach flu. For 4 hours I held her hair, coddled her while she vomited and dry heaved.  The entire time she was soo angry at me.  Barking orders to give her water, a washcloth, blanket; etc. in a very angry manner.   Also, she frequently wakes up in the middle of night with growing pains. Again, she will be so mean to me.."Give me a heating pad, now!" or "No,  I will not take that medicine!".  She will cry, scream and growl..hours.  Like she is possessed!  Help!!

A few more thoughts on my 4 year old.  Another trigger is being restrained in a car seat.  It has gotten better recently but, from baby to 3 years old she would rage while we were driving; trying desperately to get out of her car seat. Screaming and crying the entire car ride.  Again, usually while she was tired.  We could never do night drives with her, she would scream the entire time.

We have ignored her, held and cuddled with her, took away "stars" for good behavior, put her in timeout,  told her she couldn't come out of her bedroom until she stopped screaming (that one escalates her anger big time!). 

Anger most definitely runs in my family.  I also struggle with anger.  My father, grandpa, brother, aunts,etc.  Something must be wrong with our genetic make up?

Hi, It is possible that there is a family component to your daughter's anger overload.  It can run in families; there can be genetic and environmental factors that contribute to the intensity and frequency of outbursts.  It would be best if everyone in the family worked on it, and you could mention out loud from time to time how you are trying to handle your anger--that can serve as model for your daughter.  If you talk about your anger, be very concrete about what aroused your anger and what you are doing to try to keep self-control.  You want to get across the message that many people get angry, and that the feelings are natural, but we all must try not to hurt or overwhelm other people with our anger.

Given that your daughter is only four, talking about anger will only get you so far.  What I would do is use a combination of strategies I explain in more detail in my parent's manual.  For  some situations, like the car seat or shopping for toys, I would cue your daughter a half hour so so before you leave what the plan is.  Remind her again before you walk to the car.  Sometimes knowing in advance helps children contain their anger.  You do not want to compromise on the car seat, because it is a safety issue.  Some children hate the feeling of being restrained in a seat.  Does it help to let her hold a favorite toy, or to watch a video, or listen to music in the car seat?  It sounds like your daughter is finally getting used to it, after several years!

When you can avoid a trigger, do so:  for example,  maybe sometimes avoid taking her to the store, if she gets mad when she does not get a toy.  Or, if you need to take her with you, have you tried lowering her expectations before you leave the house?   Explain ahead of time that there will be no toys today, but that she can bring something to hold if she wants.   

Exhaustion, fevers, and illnesses can make children (and adults!) irritable and more likely to have outbursts.  When a child's brain is physically exhausted or feverish, it is more likely that parts of the brain, like the frontal cortex (that is used for self-control)  will not operate at normal efficiency.  You may need to try to extend sleep time or encourage rest times.  I remember when one of my sons got a fever, he was totally out of sorts and inconsolable.  Once the fever went down, he was somewhat better.  We relied on liquid Tylenol to lower the fever.

Incentives and consequences often do not help with anger overload.  Especially when a child is already upset, there is not much that they will listen to.  Children are not really thinking rationally during an outburst, so the less said the better.  If she is sick or tired, I would try to do something soothing, like music, movies, pleasant aromas, or tactile stimuli (hugs form you or holding a teddy, blanket or pillow) if your daughter finds any of those things comforting.  You would want to establish a "soothing" or "calming" place and routine for several weeks while your daughter is already calm, before trying the routine when she is upset.  Also, this strategy is more likely to help if you catch her frustration before she explodes. 

I offer other ideas in my parent's manual.  Keep trying, because children can learn over time to develop better self-control, even when there is a familial component.   Improvement may be gradual, often over a number of months.  But it is worth it, because developing better self-control will help your daughter so much in the years to come!

All the best, Dr. Dave Gottlieb

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