Thursday, September 26, 2013

Parent uses manual and 6 yr old hits in school

Dear Dr. Gottlieb,
I have a 6 year old son that seems to fit your description of a child that experiences anger overload. I've been following your advice outlined in your manual along with using strategies described by Dr. Ross Greene in The Explosive Child. Thank you for your manual. It feels like a god send as I live in a small town where it is very hard to find quality health care.

I have two main questions about what we are experiencing in the early stages of our new approach. We’ve only been trying these techniques for about 3 weeks.

(1)  While it seems like we are improving with avoiding overload altogether by detecting triggers and sensing his body language when he is getting frustrated, it now seems like he is triggered more often. His episodes are shorter and less intense, but it seems like there are more of them now. An example would be that just this week he hit a fellow student. School has never been a setting where he acts on his anger. It’s always at home or when he is with me and/or his father. He is triggering in more situations now at home too. Is this a common phenomenon that you experience with your patients as they start the techniques you prescribe?

(2)  The second question I have is concerning a broader pattern. Sometimes he seems to go for weeks without much of a struggle even in the face of his usual triggers. We often think of his triggers in terms of ultimate and proximate. He might be upset because his spelling his hard, but if he is hungry, it’s a greater challenge to control his anger during difficult homework exercises. There are times when he is fed and rested and has had play time (all ultimate triggers covered) ….but he is still excessively trigger sensitive. And then in other times, he can control his anger fairly well with the same triggers in play. In your opinion, is there is evidence to show that there are periods where hormones can affect his trigger sensitivities for weeks on end? Or is there another situation that could cause this?

My deepest appreciation!

Hi, You ask good questions.  Generally, there is not an increase in anger overload in new situations when you apply the techniques in the manual.  Do you know what was going on before he hit the student in class?  What was the trigger?  Sometimes a child struggles to contain his anger in school (and is usually able to exhibit self control), but then there is a day when he is more sensitive (tired or hungry).  When in addition on those days there is an unusually difficult situation, he may have a melt down.  For example, sometimes a child does not do well on a test or assignment, and is feeling down about it, and then the same day a fellow student is verbally provocative.  The combination of triggers is overwhelming and leads to hitting.  My guess is that this will not happen often for your child in school.   If it recurs, it would be important to try to figure out the triggers, and also apply the strategies you are using successfully at home.  You might meet with the teacher and explain what you are doing at home, and see if the teacher would apply similar techniques (or one of the other techniques in my manual--the teacher might feel a different technique might work better in her class).  Usually over time a child develops better self control and there are fewer explosions at home and school.  

I don't know the answer to your second question.  I have also observed that some children have better control some weeks, but I do not know of any research that looks at fluctuations in hormones or brain chemicals over time and their effect on anger.  There have been some studies on violent behavior in adults that show that low levels of a brain chemical called serotonin are associated with more violent behavior.  But even these studies have not looked at week to week fluctuations in serotonin.  Furthermore, the correlation between serotonin and violent behavior does not mean that low levels of the brain chemical cause violence.  It is possible that there is a third variable that causes changes in violent behavior and changes in serotonin.  It is also important to keep in mind that violence is not the same as anger overload.  There are various contributing factors to violence that have nothing to do with anger.

My guess is that there can be week to week fluctuations biologically that affect anger overload.  Also, there can be fluctuations in environmental stressors, and we don't always know our children are feeling stressed until they explode.  But that doesn't mean your child still can't develop better control even during those weeks where he is biologically vulnerable.  He may need more help with the strategies those weeks, and over time (several months) there will often be a decrease in explosions, though not necessarily a total cessation.  As your son gets older, you will be able to apply more of the strategies in the second half of the manual that will help him become more aware of his triggers and how to use strategies himself.   Usually at age six, the strategies in the first half of the manual (that involve parents directing the child) are more effective.

All the best, Dr. Dave Gottlieb

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