Saturday, November 16, 2013

7 yr old explodes over minor frustrations

My wife and I have been "under siege" by our nearly 7-year-old daughter (Simone) for a few months now (off and on).  Besides one incident where she hit a boy on the bus and made him cry, she gets along fine and school (has a lot of friends, seems really happy when she's picked up, no serious discipline problems at school besides that one hitting incident).  In public, she's also self-controlled and generally level-headed -- but she regularly ignores all other adults (never says hi or answers questions, even close family friends).
The real problems are always in the home. First of all, my wife and I have a very close and loving relationship.  We seldom argue and are a "united force" when it comes to privileges, discipline, etc.  We also have a 2 and 1/2 year old son. For the past couple of months, nearly each day for the past couple of weeks, Simone has had intense, sometimes violent reactions to things like (1) not being able to watch a TV show; (2) dinner time (in general -- she regularly claims that the food is "yucky" and then demands something else, often chanting it over and over again; (3) being asked to clean her room or pick up her belongings, (4) even extremely minor things like having difficultly pulling off her tights when changing into her PJs.

She doesn't seem to have a filter.  She "turns it up to 11" for everything -- whether she falls and gets a scrape or can't find the perfect pair of socks to wear for school.  She also FREAKS OUT if we try to show our son a "Curious George" video and she's doing something else ("I want to watch it!!! Don't start it yet!!!" ... then she may start sobbing loudly and uncontrollably).  And in general, she often tries to sabotage things when we're trying to have fun as a family.

She digs in deep and opposes us regularly (not always) for minor requests and instructions.  She has an amazing vocabulary and performs at a high level in school -- but it's really, really difficult to engage her in conversation.  I can usually sense when the "dark cloud" is about to descend over her. She'll get a really cross look on her face, with a frown, and seems intent on being miserable and making people around her miserable.  Even if we provide a decent solution, she makes sure it doesn't solve her problem.  

She often punches and kicks when she gets a surge of angry energy, often while frothing at the mouth and sobbing loudly.  

It's not fair to our youngest, especially when we have to stop a fun family activity in order to deal with Simone's outbursts, while my wife and I are feeling particularly shell-shocked by it all.  I'm not an objective source, but I feel like we've been incredibly patient and calm and have tried many methods.

Again, she's well-adjusted at school and in public, and is sweet to her brother (most of the time -- all siblings squabble sometimes), but very hard on us way too often.  

I plan on purchasing your book but wondered if you could be so kind as to provide some direct feedback as well.  My psychiatrist (I've been treated for depression/anxiety) suggested she may have oppositional defiant disorder, which has a high probability of turning into sociopathy in adulthood. That freaked me out, but upon further investigation it just doesn't seem like a fit. Thank you for your time and expertise.
It sounds like your daughter has anger overload, rather than oppositional defiant disorder (ODD).  For the latter, you would expect to see argumentative or disagreeable behavior toward adults in multiple settings, e.g. school as well as home.  Your daughter gets along fine at school you wrote, so I would be reluctant to use the ODD diagnosis.  Furthermore, in my experience most ODD kids do not become sociopathic.  Sociopaths exhibit a lack of empathy for others, and you describe your daughter as kind and likable when she is not angry.
The diagnosis you might want a mental health professional to rule out is pediatric bipolar disorder.  In this disorder there are also repeated outbursts.  In addition, there would be signs of grandiose thinking, frequent mood changes, risk taking behaviors, and impulsive decision-making.  It does not sound like your daughter exhibits risk taking or impulsivity, and it is unclear whether she exhibits grandiosity (feeling she is the most important and best most all the time).  From your description, she does have mood fluctuations, but this can occur with anger overload as well.  It sounds like your daughter frequently gets highly emotionally aroused by frustration.  Like you said, she has extreme reactions to so many frustrations and disappointments, and can't seem to dial it down.  This fits with anger overload:  these children get overheated, and we think there is a biological underpinning--the frontal cortex is not able to control the arousal of the emotional parts of the brain, mostly the amygdala. 
But with development and practice, there can be improvement.  The strategies in my parents' manual are intended to help that development along.  It will take time and practice, but your daughter can learn to have better self control when angry.  Part of the manual describes strategies you and your wife would use to help avoid tantrums.  Early detection here is critical.  You enumerate a number of situations when your daughter loses it.  You would want to anticipate these and try to find ways around them.  For example, getting dressed sounds like a frustrating time.  I would recommend being present, if possible, during these times, and be ready to assist or divert her if she starts to get frustrated.  Because of her low frustration tolerance, you may need to assist with tasks that you might otherwise leave a 7 yr. old to do on her own.  The same for cleaning up her room.  Be around to help; maybe making it a joint activity will remove some of the frustration for now.
For meal times and television, I would suggest trying to have a regular schedule as much as possible, and cue her with five or ten minutes to go that the next "activity" is about to start.  Try to arrange the schedule so that something fun comes after something she does not like.  Then there are natural incentives to follow the schedule.  If she does not cooperate, try not to engage her in a discussion at that point, but make sure the next activity does not start until she completes the one before it.  Talk as little as possible if she is in the overload phase.
In the second half of the manual, I explain strategies to try to engage your child in the process of learning self-control.  A first step is to assign a neutral word to each of three levels of anger:  low, medium, and overload.  I often use colors with kids:  blue for low, orange for medium, and red for real hot.  Once you arrive at the words to use together, you or your daughter could use the colors to point out when someone in the family was getting upset, preferably at the early stages.  Once this system is in place, you would tie diversions or relaxation exercises to the lower levels of anger.  The idea is to teach your child how to self-soothe.  This is a long process, admittedly, but it is worth the time and effort.  If children learn to self-soothe, it will make it so much easier for them to deal with the frustrations of everyday life!
All the best, Dr. Dave Gottlieb

Monday, November 11, 2013

5 yr old hits and bites if does not get his way

Hello .  I am hoping you can provide me with resources or maybe some feedback regarding my son.  He is 5 years old and gets very angry ( only towards close family members and most usually me ).  If I use a tone he doesn't like, doesn't feel listened to, or if I say No to somewhat he considers a "need," he will hit me and at times say that he wants to hurt me badly .  He has bit me and thrown objects at me .  He is cautious what he throws and usually will pick up a hard object put it down and then throw a soft object . 

 He is very sensitive .  He picks up on every emotion in the home .  My husband and I can bicker and I have been dealing with some complicated grief since losing my mom abruptly almost 4 years ago .  He has lots of energy and fidgets a lot but I don't think he fits the criteria for ADHD as he is focused and sits nicely in kindergarten .  He will take his time with his school work if he cares about it .  If he doesn't he rushes through it and if corrected ( by me typically) he yells at me that i am a mean mommy or says " be quiet , don't talk to me , I hate you , I want to hurt you ".    His outburst are very short lived ( thank god ) and I usually can redirect or distract him onto something desirable .  But this is a lot of work and emotionally draining for my husband and I . 

I don't know what makes him so angry .  He is an only child . He is pretty spoiled by my husband and immediate family who often give him many tangible items .  He feels that he should get something in every store we walk into and will wheel / deal any way he can to try get this "need" met .  Generally he is a very spirited boy who loves nature and noticing the seasons changing , he is pretty creative with art or even ideas about things, and his vocabulary is exceptional .  He is very loving and affectionate .  He loves our dog and is gentle with her . He is 5 ( six in April).  He shows little interest in reading but appears to be keeping up with his peers .  If he feels he has received genuine praise for something he is very prideful .  He picks up on "bullshit" easily . 

It is beginning to make me anxious as i don't know what will tick him off .  Additionally he needs us to always engage him .  Running errands or cleaning the house makes him irritable if he can't have an active role in it.  Watering down the cleaning to his level doesn't work, he wants to do whatever the adults can do .  He has recently been doing more mischievous things he knows is wrong as if he is looking for negative attention .   I feel terrible that I can't find a strategy of parenting that resonates with him.  He is acting out for a reason .  I don't think this is biochemical . I pray it's not .
Thanks in advance for any feedback you can provide .

Hi, I can tell you are trying real hard to understand your son, and it sounds like you are still grieving the loss of your mom. You mention too that you and your husband bicker sometimes.  Do you feel you need more emotional support at this time of your life?  I wonder if your frustration with your son is aggravated by your disappointment that he is another source of stress.  Maybe if you had more support (friends, support group in the community, or therapist), you could make limits stick better with your son.  You mention that he is spoiled.  Maybe you are trying too hard to please him.   It can be hard to say no when you anticipate a child will explode!

It is good that this is only happening in the home, because it means your son does have some self control.  Then the question is how you can get him more in control at home.  One thought I have is that it is going to be important to set a firm limit about physical violence. Do not talk to him while he is having an outburst.  When he is calm, however, you could all talk briefly about how dangerous this is.  Explain a couple of alternatives: saying "I don't want to" or "I don't like that." This does not mean he will get to do what he wants, but you will at least consider it.  And explain that in the future there will be serious consequences for violence.  Think with your husband what immediate, short term consequence might be meaningful for your son, e.g. no television for the day if this is important to him.  You do not have to announce the consequence right away if he is hitting or throwing things.

But when he calms down, let him know that it was dangerous, and he needs to find something to do other than television for today, and that if he does not hit for the rest of the day, he can have television tomorrow.  This may set him off at first, but in the long run you will establish a limit about violence.

The other approach to violence in the home for a young child is to restrain him when he becomes violent.  Bear hug him and hold him until he calms down (this could take many minutes).  It is reassuring to a child to know that you will not let him hurt anyone and that you are powerful enough to keep him and everyone else safe until he calms down.  Do not talk to him a lot during this time.  But talk with him after he calms down.

You want to pick your spots when it comes to discipline.  Think whether the issue is important to the functioning of the family.  For example, if his school work is rushed or incomplete, maybe you could let the teacher handle that with him.  If he cares about pleasing his teacher, her/his comments may help motivate him, and then you do not have to be the enforcer for homework.

I like how you distract him at times.  Also, consider ways to avoid tantrums.  For example, maybe don't take him to the store for a while if this is one of the battle grounds.  Maybe one of you go shopping and the other parent stay home with your son for now.  Or clean the house while he is in school, or while one of you takes him out for a walk.  You want to cut down on the number of possible conflicts until he learns better self control.

My manual for parents on anger overload explains some of these and other strategies you could use.  If you do not see some improvement in a few months, ask your school or family doctor for a referral for a child psychologist to help you. 

All the best, Dr. Dave Gottlieb