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


  1. Thank you so much for taking the time to respond to my query. I look forward to reading your book and can now see the light at the end of the tunnel. I was really disappointed by how my own psychiatrist handled my question -- a back-of-the-napkin diagnosis of "pre-sociopathy" is very unprofessional.

    So thanks for assuaging my fears.


  2. Just got your manual in the mail. Thanks!

    1. Hi Steve,
      I have a 9 year old daughter with very similar behaviors. We have been dealing with them for a couple years now. We did put her on medication and she did very well for a year, so the Dr took her off and all the behaviors are back. I also just ordered Dr. Gottlieb's manual. I was just wondering how it is going for you so far? Thanks for your post!