Tuesday, December 16, 2014

What to Do If Tantrum Disrupts Dinner

My wife and I are presently reading and working through your workbook entitled "Anger Overload in children".
We have a 7 year old boy who will have a tantrum, let's say at the dining room table or while someone is playing piano as examples.  We will ask him to leave the room and go to his bedroom until he has calmed down.  Our challenge is what to do when he will not comply with the request, as his tantrum then severely disrupts the rest of the family's experience with whatever they are involved (we do not live in a very large house).  You suggest in your book that we should ignore the tantrum, however in order to get him to his room, we must continue to give him attention.
Do you have a suggestion for this issue?
Thanks so much in advance!

Hi, you ask a very good question that I get in my clinical practice as well.  There are several possibilities.  One is to have a "back up" consequence that applies if he does not go up to his room when he is told.  You would talk about the back up consequence at some other time when he is calm.  You want the back up consequence to be something short term that he will miss, such as a favorite toy or game.   It has to be something he really cares about.  Then the next he next erupts, you would ignore him, and later when everyone is calm put the back up consequence into effect.  The downside of this approach is that he may escalate again when you impose the consequence, and also you still have to put up with the noise when he does not go to his room.  Furthermore, if he is in a huge tantrum, he will not care about the back up consequence, as he is not thinking rationally then. Your goal with the back up consequence is to have him consider it in his mind when he is only a little angry, that is when he is still rational.  Then if the back up consequence is something he cares about, he will eventually cooperate more often.  So you would need to ask him to go to his room before he gets too emotional, and this is not always possible! 

Another possibility is to set up his room as a relaxing place to go play when he is not angry.  Then you would cue him before someone starts at the piano, before he gets mad.  The downside here is that you cannot always predict which situations will cause a tantrum. 
A third possibility is just to ignore the tantrum and try to talk or play the piano as best you can.  Over time, his screaming will subside if it was being "fed" by your attention.  Remember that nothing you say at that point will help.  The problem with this approach is that if your child is so angry that he is not thinking rationally, it may take him a while to soothe himself even if he is not getting your attention.

Finally, see if you can identify a theme for what is causing some of his tantrums.  Is he jealous that others are getting attention at dinner or at the piano?  Then you may be able to head off a tantrum by a reassuring comment or a distracting activity (like a hand held game or drawing materials).  Let's say the theme is that his sibling is getting your attention at dinner.  Then before you start talking with his sibling, you could say to your 7 year old something like "now it is your brother's turn to talk, but I will give you a turn in a few minutes."  Then compliment him while he is waiting and remind him it will soon be his turn.  Try not to wait too long the first few times you try this. The question therefore to ask yourself is why does he have tantrums at the dining table or while the piano is being played, and see if you can come up with a reassuring statement or a distracting activity for him that will head off a tantrum.  It is harder to deal with of course once the tantrum occurs.  

Best, Dr. Dave Gottlieb 

Wednesday, December 3, 2014

6 yr old withdraws when angry

I am concerned with one of my granddaughters. She is 6 years old; she has some anger issues that really worry me. It kind of sounds like anger overload, except she does the opposite of yelling and screaming.  She will go sit on the couch, floor, corner, etc...and not talk, she likes to seclude herself, and if we try to talk to her she gets more upset, and also says troubling comments.  Like "I shouldn't be in this family", "I wish I was dead". I'm really concerned. Her mom and dad are divorced since she was about 2; they argued in front of her until recently. She is a wonderful, sweet little girl when not upset. I'm considering buying your book.  My son works out of town. Between her other grandmother and me we help watch her while her mom works.  Please any advise would be greatly appreciated. Thank you.

Hi, Usually children with anger overload are explosive rather than withdrawn when angry, but still your granddaughter sounds like something is really bothering her.  Think about what some of the triggers have been: What is going on when she withdraws silently?  Make a list of a few situations when she gets upset and then think about what are the themes:  Has someone said something to her that she does not like or that she misinterprets?  Is she disappointed about something?  Does she feel badly about something she has done?  If you are unsure, keep track of the situations in the next two weeks when she gets angry.  

One approach then would be to address the underlying "hurt."  Maybe offer a reassuring word, or else a distracting comment, but do not talk a lot while she is withdrawn.  Talking with her while she is angry seems to bring out more anger and her negative comments about wishing she were dead.  Usually when children make these comments only when they are angry, it is a reflection of their anger and not their wish to hurt themselves or die. But if she makes these comments even when she is not upset, or if they are frequent, you should consider a consult with a mental health professional in your area to determine if your granddaughter has an underlying depression.

When she is calmer, try to engage her in a conversation about what bothered her.  Even if you think she is misunderstanding or exaggerating something, show empathy for what she feels.  Then gently help her see that there might be another way of looking at things (if she is not seeing something).  But if she feels hurt by this, then stop and let her know you love her and understand that her feelings were hurt.  Empathy can go a long way toward helping a child feel better.  

You mention that her parents used to argue in front of her.  That is likely to be one cause of her distress. Hopefully her parents will cooperate about child raising issues.  Your granddaughter wants to love both her parents no doubt, and does not want to hear arguments, nor would she want to hear negative comments by one parent about the other.  If the parents' tension recurs, it would be ideal if they sought help from a family therapist.  Even though they are not married, they still are parents together and it will be best if they can cooperate when it comes to the children.  It is great that you and the other grandparents can help out when the parents are working or out of town,  I can tell you care a great deal about your granddaughter, and if things don't improve, consider asking the school social worker if she can talk with your granddaughter, or ask the child's doctor for a recommendation for a therapist in your area.

Best, Dr. Dave Gottlieb    

Thursday, November 13, 2014

7 yr old sensitive and explodes in school

I have a 7 year old son who fits your description to a tee. It started out mostly at school where something triggers him and he will become enraged. It was never physical with another person, only objects. He screams for 20 minutes straight, covers his ears, is disrespectful to adults, kicks things, throws things, rips things off the wall.  The triggers are usually very minor. He will get upset if he is not called on, or if someone gets a turn and he doesn't.  He does not know how to cope. 

He is beginning to become really aware that others know he is different. When he talks and the other children look at him, he will yell "don't look at me." This is very wearing on the teachers and I feel he has now been labeled at his new school after 2 months. He hit another child, which rarely happens but said the other boy hit him first. No one saw the other boy hit my son, so my son was punished. 

He has developed really low self esteem saying you don't love me, no one believes me, and often calls himself dumb. He has even questioned what is wrong with me? He was diagnosed with ADHD, but his current doctor doesn't offer therapy and wants to keep him on the lowest dose. It is helping a lot with the frequency of outbursts, but i need to do something now. I'm having a hard time finding a good therapist for my son who won't let him run the show in sessions. Could you help us find a good therapist?

Hi, I would recommend you ask the school psychologist or social workers whom other parents have gone to in the area, and ask your child's primary care doctor as well.  Another resource is that most states have a psychological association, and that association has names of masters and doctoral level therapists who work with children.  When you get a few names, you want to find out how often they work with children and whether they have helped children who have intense angry outbursts.  You might even refer them to my blog or parent's manual to see if they have experience in some of these strategies.  Also, a therapist could help rule out other possible causes for your child's outbursts. 

It sounds like your son is very sensitive to feeling left out when he is not called on.  It might help for the teacher to cue him first thing each morning that she will give him a turn once in a while when he raises his hand, but that she needs to call on other children to give them a chance too.  He could earn points for staying calm when other children are called on.  

You would want to identify other triggers as well, and work on ways to help him think through ahead of time (on a daily basis) another way of looking at these triggers.  These cues would be brief reminders to help him keep perspective.  He could also draw pictures to illustrate the situations and together you could come up with a short phrase to say to himself when these situations occur. Then you could remind him of the saying in the morning before he goes to school, and check in with him after school if he used the saying that day.  The basic idea is to get him thinking of a new way of looking at the situations that trigger him before he explodes.  

Once he is having an outburst, it is best to say as little as possible.  If he can be moved to a quiet area until he calms down, that would be ideal.  But not every school has a space nearby for children to calm down.  Check with the social worker or psychologist in your child's school to see what space might be available for calming down; also the school social worker could work with your child's teacher on putting these strategies into practice.

All the best, Dr. Dave Gottlieb

Tuesday, October 28, 2014

Manual helps, but young child won't talk about anger

Just a line to thank you so much for your excellent helpful Manual on Anger Overload. My 5 year old son has always from 2 until 3 and a half ish had intense and prolonged aggressive tantrums in reaction to being told no. However as he started school we experienced a set of much heightened responses, mainly directed at me his mother. He shouted nonstop, hit, kicked spat, words, used very violent words, and indeed tried to hurt himself. Hurting himself and being so distressed was truly awful. The rage lasted up to an hour and NOTHING could distract from this locked in response. It almost had to wear out from him. 

Thanks to your Manual we have felt an immediate ability to calmly attempt the emotional change at a trigger moment and start to help him and us cope with strategy that works. It is very hard at times to know what to do for the best. But we feel that your expertise diffused via the book and website has rescued what for us was almost becoming a crisis situation. So I feel immensely grateful to have found your knowledge which is so readily shared and accessible. And most importantly works. We know it will be a long haul but with this blueprint we have a model to work with.
My son finds it difficult to want to talk about his overloads - he doesn't want to address his responses so would you have any advice please about how we get him to be reflective. He has a wide vocabulary and seems to respect his father more than me. Should he start more of the discussion?

Many thanks indeed for your help.

Hi, For five year olds, many of the strategies in the second half of the manual will not work yet. Young children are often not ready to look at and discuss their behavior.  The first half of the manual is key for young children, and it sounds like you are applying those strategies. These are directed by the parent, and do not require the child's direct participation.  

What you could try is making up a story with dolls or puppets, and use any that your child already likes.  They could be stuffed animals or superhero figures he has at home or watches on television.  Think carefully about what themes you want the story to contain. Use themes that are consistent with your child's triggers, and write stories and resolutions that are dramatic, but metaphors for how your child could someday handle anger.  In other words, use fantasy in the story; your child's triggers would be disguised.  You want the story to be appealing and send a message, but it needs to be indirect for your child to be interested and listen. So the character in the story may for example throw giant boulders (when angry) and the boulders may almost land on a house.  But then a wise superhero says "you are destroying their house.  Why don't you build a fort with the boulders instead." Eventually after a few weeks, the ending may be about making peace with whomever the character was angry with.  "Talking works when you don't scream,": the wise sage could explain.

Another idea would be to make up a funny song with lyrics about anger that has a helpful resolution, or make pictures together about anger, or read a story together. (There is one by Mercer Mayer, for example, called "I was so mad.")   The basic idea is to begin a "discussion" about anger indirectly with your young child.  

Also, be sure to use yourselves as an example.  Talk out loud sometimes about what got you angry one day, and how you handled it.  All these techniques give the message to your child that everyone gets angry and that it is okay to talk about it.  It may be a year or more before your child is ready to talk more directly about his anger.  At that point, you might start by using a labeling system for levels of anger, which is one of the strategies I write about in the second half of  my manual.  The idea behind that strategy is to develop greater awareness about levels of anger.  It is easier to control anger if one takes an action at lower levels of anger.  But first a child needs to observe that anger comes in different forms.
All the best, Dr. Dave Gottlieb

Wednesday, October 15, 2014

How to get an 8 yr old to work on her anger

I have an 8 year old daughter who has always had substantial anger issues. She does not have ADD or ADHD, is not bipolar, I'm sure, although I've never tested her for anything honestly. I am an American ex-pat living in Europe with my husband and we moved here about a year after our daughter was born. These kinds of diagnosis and definitely medication for mental health are just not as common and practiced here as they are in America, and I never thought she was bad enough to warrant the diagnosis anyway. However, she does happen to have a very strong personality, wants to be the leader at all times, is very bossy, and many times has emotional outbursts with us, other family and her friends and teachers at school. 

She very easily cries in general and many times if she feels that another child intentionally tried to wrong her, even though many times her behavior leading up to the episode is usually be a big cause of that. Sadly, she is an easy target for teasing at times, because other children realize how sensitive she is and her reactions are always very impulsive and even if she is right in being angry about something, her reaction is so intense that it overshadows her valid feelings. 

She also tends to say things in a very rude way and acts disrespectful but doesn't seem to realize when she is doing it, and why others may not want to be around her,  no matter how many times we've discussed good manners and treating others with kindness. I will always make a point to praise her when she has done something nice or thoughtful, which she is also many times capable of. 

The interesting thing is that when she becomes extremely angry with other children at school and has a dramatic outburst, it doesn't last long.  She seems to realize quickly that she went too far and then wants to move on, many times joking about things and completely changing the subject like nothing happened. she also says things like "i'm so messed up, i don't know how to act." followed by behavior i can only explain as degrading of herself. As I'm sure you can imagine, it's heartbreaking as a parent to watch this dysfunctional pattern repeat itself over and over. 

She is very smart, no problems academically and loves music and art and has great talent. She is very sweet, funny and loving and craves attention. It's easy enough to get her to do things like homework, practicing piano and some chores...bedtime is tough, but probably nothing over the norm resistance wise. However regarding her anger, I feel like I don't know what to do anymore and my biggest fear is that we will lose our bond as she grows older and continues in these patterns because she can feel that I am always disappointed when these episodes occur..which these days is daily. Even though I try my best to be patient and as understanding as possible, talking to the teachers, keeping communication open, I know she probably hears too much criticizing from my husband and I when we try to explain things to her and why it's bad to behave that way. .

I know we are not perfect. I wish I knew of a better way to approach everything, but what do you do when you walk into the building to pick up your child from school and can hear them yelling at another child at the top of their lungs down the hall because they are so angry about something? I am so weary of the school pick up and hearing about what she did that day. Last year she really started to show improvement and the teacher was really proud of her. She had a group of friends she enjoyed and seemed to be turning a corner, but it seems like its always one step forward, 2 steps back. We did have to change schools because her other school was private and it became too expensive, so I am aware this could have a huge deal to do with her current state..but it's really always been an issue more or less.....

I am sorry if my email seems like an excessive complaint of my child - I am just trying to point out all of the details so that you can understand the challenges and perhaps offer guidance to the best approach..because simply speaking, I am at a loss trying to figure out the best approach and need some help. I happened upon your blog and thought I would try to get in touch. I feel like a failed parent, but I love my daughter so much..it breaks my heart that she has to make things so hard on herself. Any insight or advice is very, very much appreciated. Thank you and all the best to you.

Hi,  The positive signs in your e-mail are that she realizes after an outburst that she has gone too far, and it is also a good sign that the outbursts are short in duration.  She regains control and feels sorry about her behavior.  This indicates that she will be motivated to work on her behavior in the coming months.  It does not mean she will be able to consistently stop from having outbursts in the short term because she feels "injured" emotionally fairly easily and because her anger is easily stimulated.  So how do you get started helping her?  

First, I would talk with her about how some people have quicker angry reactions than others, but that everyone gets angry sometimes.  Tell her you would like to work together on how to express anger, and give an example when you exploded and what you thought you could have said (or not said) when you calmed down.  You want to show her she is not alone, and that you empathize with how hard it can be to control anger sometimes.  

In my manual, I offer worksheets to keep track of anger.  Basically, you want to work together each day on what triggered her anger that day and how she reacted.  Talk about whether there are any early signs that she is getting angry.  Help her to see any early signs as a cue to take an alternative path.  We can all control anger better the earlier we realize we are getting angry.

When you review different situations, write down what she said and what the other person said.  You would do this repeatedly for the next month or two, and you want to keep the records together; it is important that this be done patiently and non-critically in order to sustain your child's participation.  Praise her for her efforts keeping the records together.  
The idea is that over time, she will begin to see some patterns of what provokes her.

I also suggest you establish labels for different levels of anger.  In my manual I write about using colors for low, medium and explosive anger:  blue, yellow and red.  The idea is to help your child see that there are different levels of anger, and for her to see that she has better control at the lower levels.  

In the manual I write about how to tie her observations of early signs of anger with calming strategies.  You want to share with her how you calm yourself and have her choose some ways that feel good for her.  Then you practice together.  If she is willing, you could role play an anger provoking situation and practice one of the calming strategies she prefers.  

It is a gradual process of recognition of triggers and of developing calming techniques.  In addition, over time your daughter may realize that there are other ways to look at "provocations" (a different perspective) that might help her not feel so angry.  Finally, you want to reassure her that she is not "messed up," and that everyone has things that come easy and things that take time to work on.  Give her examples from your life, and point out what comes easy to her too.  

All the best, Dr. Dave Gottlieb

Sunday, October 12, 2014

Shy child hates to leave home, has outbursts

My son is 11. He has had anger overload issues since he was about 5. When he gets angry it does not last long. Most of the time it's because he lost in a game or he can't do something on his own. Otherwise he is very funny and sweet.

Now when he is at school he does not talk...does not get angry...instead he puts his head down on his desk.  I asked him why he only gets angry at home and he said because that would be too embarrassing. So he is aware of it. He tells me he has anger issues. He also is very shy.

The school thinks he has many emotional issues. Me, as his Mom, I think it's this anger overload...and he is very sensitive.  Is there any type of testing to get done to see what he really has? He is not on any medication.  He goes to school...which is a fight everyday...other than that he hates to leave the house.

Hi, it is possible to have anger overload and to be sensitive or shy as well.  It sounds like your son has some anxiety about leaving home, but you can get him to go to school, which is good.  Mild anxiety can best be overcome by going through with whatever triggers the anxiety.  In this way, the person sees that he can do it, and over time, anxiety usually lessens. 

It is good that your son recognizes he has an issue with anger since he will be more willing to work on it then.  It is also good that he does not explode at school.  This shows that he has some self control.  I would suggest you work on the strategies in my manual to help with the situations you describe:  when he loses a game or when he can't do something on his own.  Consider using emotional distraction (from the first half of the manual) and using a "mantra" that lowers his expectations about winning (from the second half of the manual). 

There is no test specifically for  anger overload.  Anger overload is defined as having frequent, intense rage reactions to disappointments or frustrations.  Children with anger overload can have other issues as well.  You mention the school thinks he has emotional issues.  Ask them to be more specific.  And if you are unsure what the underlying issues are, it might be wise to get an evaluation from the school psychologist and/or a local mental health professional who works with children and families.  By interviewing you and talking with your son, a mental health professional could advise you what issues seem most important and how best to work on them.

All the best, Dr. Dave Gottlieb

Tuesday, October 7, 2014

What can teachers do for outbursts in school?

Thank you for posting your article on Anger Overload. I have only just found it and have already ordered your book.  I am so relieved to finally find an accurate description of my son's behavior after 8 months of going to multiple therapists and experts -- all of whom tell me "he's unusually complicated" with multiple issues at play.  They all agree he has anxiety related to his learning disabilities.  But, the intensity and sporadic nature of his anger (despite two very patient, even-keeled parents) hasn't been explained...until now.

My son is a loving, cuddly, creative kid who makes friends easily.  As a competitive gymnast, he will practice back flips and dangerous stunts anywhere he goes (not just during his 9+ hrs/wk at the gym).  He has been diagnosed with reading, processing and anxiety disorders.  While he has shown signs since preschool of extreme anger when triggered, he can go for months without an episode.  Summers, vacations and sports practices tend to be anger-free -- school is the main location of his rage-episodes.  It appears to increase in frequency and intensity as the academic expectations increase.  He can be triggered by all the things you mentioned in your article (being told no, minor criticism, noticing other kids finish their test while he is still working, etc.).  I can't tell you how eager I am to read your book.

In the meantime, I have a question:  Do you have a recommendation for the teachers on what they should do when he gets into a rage-state?  He can't hear anything while he is in that state (hitting himself, kicking the desk, being verbally disrespectful to the teacher, literally covering his ears, etc.), but they can't just wait it out while the other children's learning is being impacted.  He does go to a private school with a Learning Specialist and Social Worker on site, but they are not always available.

Any guidance you can give would be greatly appreciated.

Hi, Yes, while at home a parent can ignore an angry outburst, in school this is usually not an option if a child is disrupting the class.  So one key is early recognition and developing an assortment of tools your child can use.  First, I would recommend the teachers record what is going on when the outbursts occur in the next couple of weeks.  You mention some triggers in your e-mail, such as minor criticisms and finishing his test while others are still working.  Once some of the triggers are identified, the teachers would develop possible interventions for each trigger.  For example, before mentioning a minor criticism, the teacher could point out something your son has done well, so that he is less likely to feel "injured." Your son can't keep critical comments in perspective yet, and that is not unusual for children with learning issues.  They get frustrated easily and sometimes feel inadequate compared to their peers. So the teachers could help him keep their remarks in perspective by pairing a critical remark with a positive one.

For testing, it sometimes helps a child with learning issues to take tests in a separate room so that they are not distracted or concerned with their peers.  Like my previous suggestion, this would be a way to prevent an outburst from  occurring.  

But what happens when your son is getting frustrated and the staff did not see it coming--and this will happen sometimes no matter how much planning the teachers do.  First, early intervention is important.  Are there warning signs before your son erupts?  Could the teachers have a "go to place" or a distracting activity that would help him calm down?  I would recommend the teachers talk with your son privately while he is calm, and explain they want to help him with his frustrations, and mention that they will give him a signal (it could be verbal or a nonverbal signal) when they want him to stop working and go somewhere (in or out of the class).  They would explain this is not a punishment but a way to help him "chill".  He could get points, or a positive note home, for following directions about using the chill place.  They would empathize with him that sometimes the work will be hard.  They could also say we all have trouble working when we get frustrated, so that's why it is good to take a short break then.

Once a child totally erupts it will be hard to distract him.  At that point, the teacher could either tell the class that your son is having a hard time and ask them to please try to let him calm down on his own, or he would need to be escorted out of the room.  The staff would explain to your son in advance where this place would be, and then without much discussion take him there as needed.  Depending on the age and size of your child, they may need help from a strong adult to bring him to that place.  It would preferably be different place than the "chill" zone.  The "chill zone" is often within the class, whereas when a child erupts, it is usually best to leave the class.

In the second half of my parent's manual, I explain also how to teach a child to use a catch phrase to help him with frustration.  This doesn't work during the anger overload phase, but can help if the anger can be caught at an earlier stage.  For your son, the catch phrase could be something like:  "School can be a pain sometimes" or "Yes, somethings are hard but other things are easy for me."  It would be important to practice saying the catch phrase to himself several times a day so that eventually it becomes automatic.  You would discuss with him some possibilities and pick one that he likes.  Another possibility is to help him think of a funny scene when Mom or Dad had trouble with something.  He could try to think about this when he is frustrated in school to help him realize everyone has trouble sometimes.  These latter strategies work better with children who acknowledge they can get very angry sometimes, and want to try to learn to control it on their own.

All the best, Dr. Dave Gottlieb  

Monday, October 6, 2014

8th grader becomes violent

I've been doing some research and came across your article/blogs on anger overload. This is the first I have heard of this and seems to really match what my son is going through. 8 months ago we found out he had a 'stroke' in the caudate nucleus region. It shocked a lot of doctors as he didn't have classic signs; he actually had hemi chorea as the major symptom. As a result he has been put on many meds from high dose steroids down to folic acid and aspirin. He has experienced side effects from majority of the big meds such as methotrexate. Witihin hours of his once a week dose he would become extremely violent and nasty. Each week the outbursts increased in severity and duration. We saw the correlation with the meds and were told to take him off them.
Since then the aggression and violence has definitely reduced. However, every few (4-5) weeks we have another outburst where he'll hit and swear and break things and it all starts with a minor issue such as telling him no. We can generally see a pattern and predict when they occur by his body actions and facial expressions. For 1 -2 days prior we can swerve him off track if we see him starting to fixate on different topics. However when we do this we've noticed it only prolongs having an outburst. It's like he 'needs' to have them.
He is generally a pretty good kid, gets on well with others, is extremely intelligent (his latest neuropsych testing puts him well above his age level); it is just these periods that are really worrying and affecting our family of 5. We realize he has gone through a lot in the last 8 months. We are a pretty positive thinking family and are just extremely grateful it's a better outcome than first thought. Our biggest concern is his instant change from the loving child we know to an aggressive child who has a completely different person inside him.
I am writing to you as I feel I have exhausted my local community. He had been going to counselling in the past but due to unforeseen circumstances he had to change counsellors and hasn't been available to go back yet. The neuro team has been great for medical questions but they always manage to see the polite well behaved child and seem to think he's just preteen and has a lot happening to him. All outbursts have been at home and majority have been whilst his father is away.
My biggest worry is how to help him. He became that violent yesterday, all our cooling down techniques had failed, and after 2 hours of being left alone he was still trying to hurt us. He had tried a number of times to smash windows so I ended up calling police...more as a shock tactic...thankfully it worked.
We are beside ourselves as how to help him and how do we punish someone who seems to disappear once the outburst is over. He is very remorseful once done and tries to make things better which makes things hurt more for us.  My question is do you think my son may have anger overload or is this just him retaliating from everything he's gone through recently. I understand it's a hard age anyway.
Any input you have would be greatly appreciated.  He starts high school next year and I think if not helped now...things are only going to get worse.
Hi, First of all, let me say it sounds like a lot of your interventions are excellent, and I can see why the latest violent outburst was concerning.  I think you did the right thing by calling the police, because your son needed to see that you would do what is necessary to protect him and yourselves.  While he is calm, think (with him) about a cue word that you will only use if he is getting to the point that the police may be called again.  It could be a color, like the word red, or the name of a mountain peak--the color, or mountain, represent the idea that his anger is getting extreme and dangerous.  Let him know that when you use that word, he needs to stop physically harming people immediately, but that he can scream or use verbal means to express himself.  At this point in time, you would not call the police even if he were using extremely obnoxious language.  You would be trying to show him that there is a particular limit for violence because everyone's safety is your number one concern.  In the future you can work on verbal alternatives that are more appropriate expressions of anger.
 It sounds like you see early warning signs often and can head off the anger in some of these cases.  Terrific.  Continue to develop alternatives to distract and change the focus from whatever he is getting frustrated about.  Also, try to work with him when he is calm on understanding different points of view and how to compromise.  I explain how to teach these techniques in the second half of my parent's manual.  Hopefully, over time he will be able to use the strategies to change his feeling state from frustration to contentment.
You mention the brain "stroke" and how sometimes it seems like he needs a release.  Strokes in young children are very rare, and I am not an expert on them, but I understand that the caudate nucleus is involved in many brain functions, including motor and cognitive control.  I wonder if the neuropsychologists you are working with have any other ideas about how to work around that area of the brain and help other regions develop cognitive control.  I'm hoping that the cognitive techniques I write about in my manual can help his brain develop more control.  Anger overload is a condition that can have different causes.  I'm wondering how often he had angry outbursts before the "stroke" you describe.  Did they happen before, but get worse after?  Usually when there is brain damage of some kind the techniques I describe in the manual take more time and practice.  But the human brain is malleable, so keep using the techniques you have already described in your post and try some from my manual.  The brain keeps developing throughout adolescence and young adulthood, so there is hope that with continued "practice" you will see improvement. 
Hang in there, and all the best, Dr. Dave Gottlieb

Wednesday, October 1, 2014

Door slamming and "smart mouth"

I am writing to you because we are at the end of our rope with our son and his constant anger outbursts... He talks to us like we are nobody and gets so mad. He slams doors, then comes out and starts in again and has a smart mouth. He does not talk to his peers in this manner and they all say  how sweet  he is.. We have not had him tested for anything, he is starting to have trouble in school with following directions or putting the answer down on paper and then trying to explain the answer.. I have worked with kids that are ADD and ADHD and I don't see any of those things in him, but I could be blind to it since he is our son.. The more we take away from him, he gets worse or if we say we are going to do something about it , then he says we don't love him.. Any help or advice would be great so that we can get this under control before it gets worse.
Thank you for your time

Hi, Anger overload often happens more at home than with peers.  It is a good sign that he realizes he cannot act that way with peers or else they would avoid him.  Now how can you reduce the slamming of doors and the smart mouth at home?  First, I would try to record the times he has outbursts over the next couple of weeks.  What is going on at the time?  What was he doing before he got angry, and what were you doing or saying?  After two weeks, look over your notes and see if there are any patterns.  Are his tantrums more with one parent, more during a particular activity, more when a parent asks him to do something? There will be outbursts that do not fit any pattern, but hopefully you will see a pattern(s) for some of them.

The next step is to think about whether you can change the sequence that leads to an outburst.  For example, if an outburst is more likely when you ask him to turn off the computer and start his homework, you might re-arrange the schedule in the future so that he does not start on the computer until his homework is done.  Basically, the idea is to get him to do what you want before he enjoys time doing what he wants.  If his preferred activity comes second, he will be more motivated to cooperate with you.

In my parent's manual and in other blog posts I describe other strategies, such as emotional distraction and when to ignore a child.  One recommendation about ignoring:  it is generally not a good idea to discuss consequences while a child is having an outburst.  You can talk about consequences after everyone has settled down.  Also, you want the consequence to be targeted to a specific behavior, not to anger per se.  Many of these children have short fuses, and so you will not eliminate all expressions of anger.  But you could target door slamming, or a particular obnoxious word or two.  Help him to see when he is calm what words would not trigger the consequence.  Also, pick a consequence that he cares about but that is relatively short term, from as little as an hour to a day at most.  It does not matter whether he says it bothers him or says that you do not love him.  Apply the consequence when everyone is calm, and then after a few weeks, think about whether the behavior you have targeted has decreased in frequency.  If it has, then your consequence was successful.  If there has been no improvement, then you should think about changing the consequence, or trying a totally different strategy.

In my manual I describe strategies parents can employ without a child's direct participation, and also strategies that involve discussions with your child.  The second half of the manual is about teaching your child new skills to improve self-control.

If your son continues to have difficulty in school with directions or with comprehension, you might ask the school psychologist or a private psychologist to evaluate him to determine whether there is ADHD or a learning issue affecting his performance in school.  Some children with ADHD have trouble with attention, but are not hyperactive or impulsive.  The first step regarding his school performance might be to consult with his teacher and/or school psychologist or social worker.  

Best, Dr. Dave Gottlieb

Wednesday, September 17, 2014

7 yr old reacts to "negative" comments

Dr. Gottlieb,

It was great to read your blog and finally find a description of our 7 year old daughter.   We have been in therapy for about five months with a diagnosis of ADHD.  The therapy was split into two sessions - one for us as parents and one for my daughter with the therapist alone. We recently experimented with family therapy as well.  While the therapist seems to be a good listener, we have tried many different methods but have not seen much progress.

In August, we decided to explore medication and have not had much luck.  The stimulants we have tried, seem to make her more hyper and bring a higher rage level and the non-stimulant did not seem to do anything.  It is interesting that she seemed to have no side effects from any of the medications such as sleep or eating issues.

Based on our limited success, we are questioning the ADHD diagnosis and wanting some answers.  While our daughter expresses some traits of ADHD, she is not an antsy kid and does have some focus issues but that is not her main struggles.  However, her fuse is extremely short and when she goes down the angry path, she is impossible to bring back. She is very sensitive to any negative comments or what she perceives as negative comments and lashes out.  In addition, we have difficulty disciplining her because she expresses no remorse and she seems to not care if we take anything away.

In our last meeting with the therapist, she recommended a psychiatric analysis to determine next steps.

At this point, we seem to be at a cross roads.

Hi, You mentioned that negative comments are a trigger for her anger.  You also mention that sometimes this is her perception though the remarks may not be intended to be negative.  One thought I have is to try to anticipate her reaction and preface your remarks with "you know you are a terrific kid" or, better yet, point out something she has done well that day before you mention something she might perceive as negative.  Hopefully, the balance of positive and "negative" comments will help her to not feel criticized.  Keep track over the next two weeks of comments that seem to trigger her rage, and then try to preface similar comments in the future with a positive remark.

Down the road, you could also try a technique I write about in the second half of my parent's manual:  teaching your child about other points of view.  With this technique, you show your daughter how two people can look at something in different ways.  Once she understands this concept, you help her see how a comment's meaning may be perceived differently, e.g. those "negative" comments may not be intended as negative, though the person receiving the comments may still feel hurt.  Help her see how you, her parents, have sometimes felt hurt by comments someone has made that may not have been intended as hurtful.  Also, confirm for your daughter that sometimes people do get frustrated and make a negative remark.  Help her to understand that people say things when they are frustrated that are not necessarily true and are not necessarily the person's true feelings.  

The reason why I write that I would not use this technique right away is because it requires a child to be able to recognize other points of view and apply that to her situation.  Not many seven year olds can do this.  But once the frequency of outbursts is less, and once you feel she may be ready, then try this technique.  It takes time for a child to internalize this way of thinking, so practice over time when she is calm.  

Other techniques in the near term would be to use emotional distraction, which is useful if you can catch the anger before the overload phase.  This is not always possible because anger can increase so quickly.  The idea of emotional distraction is to make a remark that changes your child's emotional disposition:  it could be a funny saying, or a silly comment that your child reacts to.  It can be trial and error to find a remark that your child might find funny or exciting.  But if your child laughs, this will interfere with, or interrupt, her angry feelings.

There are other techniques that I describe in my parent's manual.  Some do not require the child's direct participation, and these are described in the first half of the manual.  These techniques are particularly useful for younger children under the age of 10.  Some of the techniques in the second half of the manual can be tried with young children, but the effectiveness depends on the ability of the child to observe his/her behavior.  You will notice improvement over months, rather than days, as children with anger overload fire up so quickly that it takes time for children to internalize coping strategies.  As I mention in the beginning of my book, there are biological pathways that underlie anger overload, but improvement will usually occur with practice over time.   If there is an additional diagnosis, it will need to be addressed as well.  Since the ADHD medications did not work out, it is not a bad idea to get a psychiatric consult regarding the diagnosis.
Best, Dr. Dave Gottlieb

Thursday, September 11, 2014

11 yr old is disrespectful, rips books, picks up knives

I have twin eleven year old boys.  About three years ago we moved countries and it seems during the day that everything is going well- they bike ride to school, they hang out with their friends, they play soccer after school, they chat on their phones, they play games and talk “normally.” Twin A sometimes reacts over the top when denied certain items, activities, or when he thinks he is being treated “unfairly.”  He also has recently added in that he and Twin B are angry about where we moved and want to move back.  When Twin A gets angry there have been moments where he has picked up a knife - not harmed anyone but  is definitely trying to get my attention, ripped up a school book, screamed incredibly disrespectfully at me or my husband, etc.  He is very difficult to bring down from these scenarios.  They usually end with me saying that his phone is being taken away and he saying that he doesn’t care, me saying that he needs to pay for his school book and he saying that he doesn’t care he will rip more, etc.  Throughout the episodes there might be a flicker here and there of a logical response but then almost as quickly as it appears it is gone.  Over the years he has had random outbursts but especially the past few weeks these have escalated.  I need help.  I am worried about him hurting himself or anyone else around him.

Hi,  It is worrisome when children pick up knives.  If he acts like he might harm himself or someone else, it would be important to get a consult from a mental health professional in your area.  Generally, when children have outbursts that are verbal, I recommend not responding while they are heated up.  Since they are not thinking rationally at those times, they are unlikely to consider what you say, and they often will continue to argue and rage.  Wait to impose consequences until everyone is calmer.  You would tie the consequence to a particular behavior, like picking up knives, rather than targeting the anger per se.  For verbal outbursts, only use a consequence if you feel he was very disrespectful of adults, as you mention he often is.  If he can blow off steam without using the disrespectful language, then I would not recommend consequences.

What I would work on with him is looking for early warning signs and issues that are more likely to trigger him.  I explain in other posts and in my manual how to work on this with your child: to observe triggers and to develop strategies to change your child's expectations (if that is a trigger) or change the sequence (so that what he enjoys come after what he resists doing, if task compliance is a trigger).  Then there is a natural incentive for him to cooperate.  Also, I write about how to use "emotional distraction" and calming strategies before an outburst occurs.  Once an outburst is in overload mode though it is best to say as little as possible, unless someone is being physically harmed.

I write about a child in my manual who like yours erupts when he feels things are "unfair."  I explain how to help children look at other points of view (not during, but after an outburst subsides).  I also suggest families use catch phrases to alert their child when they feel he/she is getting frustrated (if you can catch anger before it erupts). The catch phrase would remind the child of a different way of looking at things.  For example, for children who get mad about sometimes performing below their standards, a catch phrase might be "everyone makes mistakes.." One other strategy that might help you is teaching your child a compromise technique, and I explain how to do that in the last section of my parent's manual.

All the best, Dr. Dave Gottlieb

Thursday, September 4, 2014

Multifaceted plan for 9 yr old

I've had a number of questions over the years about when to use rewards and also about dual diagnosis. I've been working with a boy (with multiple issues) and his mother for the last six months in my office, and wanted to share some approaches that have been helpful.

First of all, he had psychological testing to evaluate his learning disability (LD), and we suggested modifications in school to help lessen his stress and anger in school.  Mother also recently hired a reading specialist to help him twice a week after school.  In addition, a pediatric psychiatrist was contacted, and the boy recently started on ADHD medication.

During the last six months while the evaluation was going on, we began to work on his anger overload issues. Anger would erupt around turning off a computer game, starting homework, or doing his chores.  The themes had to do with schoolwork (which activated his frustration with reading) and with tasks that he was not expecting and that he did not like having to do.  We worked on a schedule together (so he could predict when chores would occur) and also a "mantra," or saying, that he would practice repeating to himself when he was frustrated:  we chose the saying "crap happens."  We chose these words because he felt it was "cool" to use those words, and because it captured the idea that not everything is easy or predictable.  We want him to learn to expect that things will not always go the way he wants.  We also established a "chill space" in his room.  If he went there either on his own or when cued by Mom, he would later receive a lot of praise.  If he did not "chill" but continued to rage, his mother tried to ignore him the best she could until he was calmer.

When there was a conflict with the babysitter (because she made him pick up toys that he said he had not used), we empathized later with his frustration, and talked about how people sometimes look at things from different perspectives.  We talked about how the babysitter did not see who played with the toys and just wanted things picked up before everyone went home, while he felt the other children made some of the mess so should help more.  It was difficult to talk about the issue calmly, and we stopped talking about it when he started to get wound up.  We will try again to talk about different perspectives that people have when similar issues come up in the future.

Recently, the boy protested going to tutoring, and got into a heated argument that led to pushing his mother. In our therapy session, we set a firm limit about physical contact with adults and talked about a significant consequence were it to happen again.  We explained that voicing his displeasure in a loud way would not trigger the severe consequence, just pushing, hitting or kicking.  Since then there have been no further incidents of pushing.  Notice that we did not punish anger per se, just the physical expression of it.

His anger outbursts have been lessening, and we decided to add a reward for his cooperation with the reading specialist.  He earns a small amount of money each week that he can use toward a purchase of his choice in the future.  He wants an action figure, and is saving up for it.  The reward is for cooperation, and at the same time eliminates a source of anger in the past.  Rewards can work when the frequency of angry outbursts has been lowered already with other strategies, and when the target is socially appropriate behavior that prevents anger from arising.  We did not establish a reward for never exploding verbally, because this would be too difficult and would probably lead to more frustration.  Hope this gives you some idea how to apply strategies (that I  discuss in more detail in other blog posts and in my parent's manual) and when to use consequences and rewards,

David Gottlieb, Ph.D.

Wednesday, August 27, 2014

Handling a 2 yr old's anger


My son is 2 years old.  In my situation, I must be both parental figures for him the majority of the time.  He sees his Dad every other weekend and my son seems to have worse behavior on Mondays after coming back home.  My son has typical "the Twos" behavior when he doesn’t mind me and throws fits.  Friends and family tell me that I need to spank him or punish him and get a handle on him now or it will just get worse when he gets older.  I notice though that punishment seems to upset him instead of correct him.  He can have meltdowns where he screams and cries for long periods of time to the point of making himself so upset that he starts shaking.  Usually it follows a situation where I am making him do something that he doesn’t want to do, like take a bath or get ready for bed, or even something as simple as coming inside from playing.  He will get mad and bite himself or pull his own hair.  He will fight with other kids, take toys or bite other kids.  Yet he can be a very lovable, happy little boy and laughs.

He does not handle his anger very well and he does not handle punishments or authority well.  He uses the word “NO” despite efforts to teach him to say yes or consequences.  If he has a meltdown, I get better results from distracting him or just giving him love and attention when he starts, but then I don’t want him to grow up thinking that he “gets his way” when he has fits.  His meltdowns come on quick and it is very hard to get him calmed down.  It can happen in public, which is more than frustrating and embarrassing. He is very energetic and constantly getting into things, climbing, jumping, running, he just goes all the time.  He has no fear.  He can't sit still unless I put him in the crib for naps or bed time, or car seat.  He is very smart for his age.

His father has anger problems which led to our divorce and his Dad used to physically abuse his mother which led to their divorce.  I see that it could be something in the family line.  I am just to the point where I don’t know what to do for him as I am very easy going by nature.  How do I choose a counselor that is right for him, and is Anger Overload his problem?  Is moving him from our home to see his Dad every other weekend adding to his emotional problems and how do I handle it?

Thank you.

Hi, First, let me say that I agree with your use of distraction.  When children are having a meltdown, consequences are not usually helpful.  When a child is in overload, he or she is not thinking rationally and is not thinking about avoiding punishment.  I've had other parents use hugs with young children, and this is okay to help him soothe, but I would then once he is calm still insist that he do what you asked.  If you feel he is melting down in order to get hugs, then you could rely more on distraction techniques.  I write about distraction techniques in the blog and in my parent's manual.

Another idea I have is to use an incentive after he completes a required task.  For example, you mention he gets angry when you have him take a bath or get ready for bed.  I would let him know that you will play a short game or read a favorite story once the bath is over or once he is in bed. If there is something fun that comes after a chore, then children are more willing to complete the chore.  If baths continue to be problematic, try moving the bath time earlier in the evening, so that there are natural incentives, such as television or other evening activity, that start once he finishes the bath.  Some parents also make baths into a game by getting water toys or soap crayons that children can use in the bath.

Regarding your questions about a counselor, I would show the counselor this blog or my parent's manual and see if they have experience with young children and with anger issues.  You want a counselor who meets with you, or with you and your child together, in order to strategize.  You don't want a counselor in this situation who is going to spend a lot of time with your child alone in therapy.

As for your question about whether seeing his Dad every other weekend is adding to the problem, I'd want to know to what extent your son is less likely to follow your rules after a visit with his Dad.  A little regression is not abnormal after a visit away from home and his home routine; however, if there is increased anger that lasts more than a few hours, I would try to meet with his Dad and discuss your concerns.  It would be important that neither parent bad mouth the other in front of the child, and that you have some overlap in your approach to anger and discipline.  You do not have to be in lock step, but if one parent has no rules, then it is sometimes hard for a child to adapt back to the rules once he is home.  Sometimes then a counselor can help divorced parents work better together as parents.

Hope this helps.  Best, Dr. Dave Gottlieb

Thursday, July 17, 2014

10 yr old getting angry at camp

My daughter is 10 years old and has been diagnosed with ADD since she was in 1st grade. However, I had to have her stimulant medication changed to a non-stimulant ADD medicine because it caused her to twitch and become anxious. This summer we decided to take her off that medicine too (Strattera 40mg) and she is only taking Clonidine to help her sleep at night. Her behavior off of the Strattera has not changed leading me to believe it wasn't really helping her. She is an amazingly smart girl but struggles in reading and writing. She is compliant with her teachers most of the time but I just got a call from her overnight camp that she is not listening to the counselors (who are teenagers), taking off without telling anyone, and yelling at her bunk mates to the point where they get scared. This she does at home with her brother and from time to time and has done with her friends. She gets very angry very quickly but can but it never lasts for more than 1/2 hour.

. The problem I am having is reward charts, consequence charts, sticker charts, grounding all of those things do not work. We implemented the Transform Your Child by Lehman. I mean we have tried everything. I just want her to be a happy and healthy ten year old. One that likes herself and that others want to play with. I need help.
Her 8 year old brother makes comments to me about her and her anger and I can see it bothers him as well.
Any suggestions or ideas of what may be causing this is greatly appreciated.
Thank you.

Hi, Children with ADD tend to be somewhat impulsive, such that when they get frustrated they sometimes act before they think.  What you would want to do first is keep track of what is going on before she erupts.  What are the counselors asking her to do, or what is going on when she yells at her bunk mates?  Similarly at home, what is going on with her brother or friends before she loses it?   If someone keeps track of that for a week or two, you might see a pattern for some of the times she gets angry.  In my parent's manual, I explain ways to deal with outbursts--sometimes "changing the sequence" of events to minimize frustration, sometimes "emotional distraction", and sometimes ignoring.  

The idea with technique called "changing the sequence" is to avoid the triggering event.  For example, some children have trouble going from a fun activity to a task like cleaning up or getting ready for bed  In that case, I would recommend doing the clean up earlier before the fun activity starts.  For bedtime routines, it is more difficult to insert a fun activity at the end, since turning out the lights is usually the last thing an adult does before a child goes to bed.  But what I recommend is to do a quick activity on the child's bed before turning the lights out.  This way a child has a natural incentive to get into bed so that he/she can play the fun activity (like a card game) with you.  (I write more about these techniques, including what I mean by the technique called "emotional distraction" in other blog posts and in my manual.) 

In my blog post on July 3rd,  I explained that traditional rewards and consequences often do not work well for extreme anger, because the anger occurs so quickly for children prone to anger overload, and they do not think rationally about earning incentives once they get mad. 

In the second half of my parent's manual I explain how you can teach your child to think about other points of view (that are different than her own), and also teach her compromise techniques.  But first it's best to lower the frequency of outbursts by using the approaches, like "changing the sequence" and "emotional distraction", that I explain in the first half of the manual.

If you do not make any headway after a few months, then you might want to consult with a mental health professional who works with families of children with anger issues.  There may be something else going on in addition to anger overload that would need to be addressed.  You mention the ADHD diagnosis and learning issues.  These may contribute to frustration for your child;  her anger episodes may decrease once reading and writing get easier for her.

All the best, Dr. Dave Gottlieb

Tuesday, July 15, 2014

6 yr old sensitive at school

I have 2 boys age 8 and 6.  I am struggling with my 6 year old at school. At home he is very sweet, cuddly, funny and very even keeled which is why I am struggling to understand the polar opposite character at school. He has struggled to join in with PE and shows. He was hit and bitten by another child in his first year and is now in a class with half the children from the year above as well. He is the youngest (June) and they are all big characters and some of them hard to handle. He seems to be overwhelmed and runs out of the classroom, crying and being rude when he is told to go back in. This seems to happen when he is told to do something he doesn't think he can do or feels some kind of pressure to complete. He has also hit or run away crying when he perceives that other children are being mean. He is very sensitive to injustice and being aggreived.  Last week this escalated so that he hit a teacher.

We are strict on discipline at home and encourage polite kind behaviour and reprimand rudeness. I reprimand the kids for saying each other is stupid etc and say it is not nice, and then when the other kids do it to him he feels they are being mean. He is very sensitive but he sticks his tongue out and yells "no" when the teachers try to get him back in the classroom. He seems to be out of control of his reaction in that he does not "cleverly" do it when the teacher is not looking, and the punishment seems to be nearly too much from his reaction to it but it does not stop the behaviour next time. The teacher introduced a smiley face chart where several times a day he had the opportunity to get a smiley face. He loved this a revelled in the praise but if he got a sad face he started to be frightened to come out of the classroom at the end of the day to tell me about it. I have never hit or really shouted so he seems very sensitive to peoples' opinions but unable to alter his behaviour accordingly. 

The teachers see him as attention seeking, mischievous, rude and opposing their rules. We (myself, husband, family and all his friends' parents, indeed anyone that spends time with him out of school) would describe him as gentle, funny.  He likes playing young games alone, he is an even keeled easy child, certainly not attention seeking and mischievous.

I have been reading about anger overload and it sounds very like our experiences. I have ordered your 2 books "Your Defiant child" (although he is not defiant in 99% of circumstances, only those that he is told to do something he is nervous about) and "Anger Overload a parent's manual". I was keen to hear your thoughts. I am a pet Behaviourist and have a Psychology degree and find it really hard to believe the behaviour of my child.

Thank you for your time.

Hi,  I think you are on the right track using the smiley faces.  Since your son is sensitive to negative feedback, I would hold off on the sad faces on his chart.  Instead just leave it blank when he is not achieving the goal. Also, think carefully about what to use as the goal.  It should be something that takes some effort but is not too difficult for him to achieve.  Over time, if your son is achieving the goal every day, you can increase the expectations gradually.

The other thought I have is to help him deal with the older, bigger children in his class.  Find out from your son and the teacher some examples of what unnerves him in school.  Maybe you can role play the situation at home; in other words, at home you would practice alternative behaviors that your son could then use at school.  First, say something empathic when you find out he has felt pressured or hurt by his peers.  Then wonder out loud what could he do when this happens so that he wouldn't get in trouble.  If he does not know what to do (most kids this age don't), suggest a few things and then have him pick one to practice with you.

Also, try to arrange a play date with one or two of the boys in his school.  If they become friends then it may help him during the school year to feel less intimidated by other children.  He won't feel all alone.  If he continues to have trouble bonding with some of his peers at school, think about other activities outside of school that might interest your son and that would involve other children his age.  It can help children to feel less "picked on" if they have a buddy they can see later in the day or later in the week.

Regarding the pressure he feels to complete his work, I would recommend his teachers take the pressure off, and have him finish another time or at home.  The pressure sounds like it is counter-productive.  Think about why he is having trouble finishing his work:  are there any learning issues or does it just take him a little longer at this age?  If there are learning issues, like difficulty with reading, then see if the school can work with him on any weaknesses.

My guess is that if he feels less pressure and more supported in school, there will be few outbursts.  Let him know too that being disrespectful to the teacher is not acceptable, and work with the teachers to give him the message about what is acceptable and what is not.  I find that some children do well if they know they can go somewhere in the class or outside the class to "chill" if they feel frustrated.  If the teachers can pick up on his frustration early on (before he is in overload), he is more likely to be able to show self control.  I explain more about this in my parent's manual.

All the best, Dr. Dave Gottlieb

Thursday, July 3, 2014

Can rewards and consequences help?

     I wanted to add a note to my last post about rewards and consequences.  Sometimes children respond to brief and immediate incentives or negative consequences, particularly if they have already learned a coping strategy or two.  Then you can work with your child on a brief incentive if he tries a new strategy when he starts to get upset.  There are a few keys to this:

1) Work on the strategy together for a week and practice when your child is not upset, and then in a week tell him/her you are proud of him and want to encourage him now to try it when he feels frustrated.

2) Talk together about some brief incentives and tell him he can choose one if he attempts the new strategy.  Notice that your child would get to pick one of the rewards that you both agreed on.  It is more fun if you don't use just one reward all the time.  

3)  Your child earns the reward if he tries.  It will be hard for him to control his anger and you don't want to focus on success, but on effort.

4) Try to help him "catch" the frustration in the early stages because it is then that his rational brain will be most engaged and it is at that time your child has the best chance of controlling his anger.

     I would not recommend using consequences until you have worked on strategies to help your child deal with anger (like those coping strategies I describe elsewhere on my blog and in my parent's manual).  It is possible that if at the time a child starts getting upset (before he reaches the anger overload phase) he remembers what a punishment felt like previously, then that memory could help motivate him try to use a self-control strategy.  The problem is that your child may reach the overload phase so quickly that he won't be thinking rationally about potential consequences.  This is why I don't usually recommend consequences for helping a child deal with anger.

     If you want to try this, pick a short term consequence, like no computer time after dinner.  Furthermore, be very clear about exactly what behavior would bring about a consequence (for example,  specific swear words).  Keep in mind that the consequence has to be something meaningful to your child, and sometimes you don't know what will catch his attention until you try something.  And do not talk about the consequence while your child is in anger overload.  First prepare him ahead of time when everyone is calm and then impose it after your child has calmed down.  Mention it in a matter of fact way without a lot of emotion or a lot of discussion.

     Be sure to praise your child whenever he tries a strategy, and if consequences cause more outbursts, then hold off in the future on these consequences, and go back to the other approaches in my parent's manual.

    In actuality, if you follow the guide in my manual, you are using natural incentives and consequences!  Specifically, you are paying attention (which is rewarding) to your child when he is working with you on self-control strategies, and you are ignoring (negative consequence) when he is in the anger overload phase.
David Gottlieb, Ph.D.

Saturday, June 28, 2014

How do you teach self-control?

I found your blog while looking for info on excessive anger in children and the person’s post on June 23 is where I am as well.  I am a “retired” Pediatrician who now home schools and the angry child is the youngest of 4.  I’m at my wit’s end and also looking for therapists. My child is bright, even precocious, and he’s always “hated being the youngest”.  I know his older brothers like to tweak him, too, and that’s normal, but his response is not.   The thing is, I feel like I’ve tried most of what I see suggested online. He does get physical, though, and I often have to pry him off of his sibling before I can send him to his room or talk to him.   I also know how sweet the child is after he’s calmed down, alone in his room.  Is my child going to be any more likely to try the “control methods” because a therapist suggests it?  Will going to an outside, objective person be more effective?  We just want the yelling/outbursts to stop—we’ve given him so many alternatives to that. 

I’ve heard there are some who “enjoy the rush of their anger”.  I struggle with anger, so I have some understanding of what this may mean, but a child?  I remember this child at around 2yo, with a viral illness, giving a guttural yell in an attempt to not vomit…which of course ultimately failed.  It was funny at the time.  I was sitting with him and the bucket for a few hours---and he did it every time the urge to vomit came.  So this makes me think some of this is “innate” and not a learned/developed behavior.  Am I looking for excuses?

This child is in his room today, grounded all day, which means he lies in his bed, no books (the height of torment in our house), staring at the ceiling.  This was my husband’s idea and I rejected it at first (the length of time, not the punishment), but maybe this will get the point across.  He is out for meals and some chore work only.  I just worry that an angry child will stew and get angrier with this, though—as opposed to something immediate and short.  But besides spanking, I don’t know of anything else like that.  I’ve been toying with a calendar of anger-free days with a large-ish reward at the end of a month.  Is that reasonable?  The only way it would work is if it restarted after each “failure”, but I honestly think this child would just give up—it would be “too much”.   One month to create a habit, right? 

I saw your blog and the opportunity to email.  I have a list of counselors but honestly am scared stiff about finding a “good fit”.  It seems more like a parenting/spiritual development issue which we should be able to handle at home.  I appreciate you taking the time to read this and would be interested in any comments or suggestions.   Thank you.  

Hi, The problem with rewards and punishments is that once in the overload phase, most children are not thinking rationally; that is their emotional brain (the limbic system) has temporarily overwhelmed their rational self-control mechanisms ( "powered" by the prefrontal cortex).  In order for rewards and negative consequences to work, a child would have to think to himself:  I've got to control this outburst because I don't want to lose this privilege or potential reward.  Most children in overload will be extremely emotional and not be thinking this way.  Even adults when highly emotional say and do things they later regret.

So the key is to build up a child's self-control mechanisms over time and to focus on techniques that can be used early in the anger sequence when a child is thinking more rationally.  I realize this is not always possible because children can "heat up" so fast.  In my parent's manual, I outline ways to pick up signals that a child is close to "blowing up" and I suggest ways to "re-route" a child's thinking and behavior.  First, it is important to  observe what happens before a child explodes.  Try to identify some of his triggers (though sometimes the outbursts will come out of the blue).  You mention that his brothers "tweak" him.  When you see this happen, one approach would be what I call in my book "emotional distraction."  You try to come up with a remark or an activity that your child finds amusing, stimulating, or in some way grabs your child emotionally. It is hard to get angry if you are laughing or excited about something else.  This strategy works best if you can catch the "frustration" before your child is in the overload phase.  Once a child is in overload, it is usually best to say or do as little as possible until the child is calmer.  You do not want to inadvertently "reward" the outburst by giving your child a lot of attention at that time.

Other techniques that parents can use (and that I explain more about on the blog and in my manual) are a) change the sequence to avoid the anger-arousing stimulus, b) lower expectations (if anger comes from high expectations that a child has), c) create a relaxation station in your house, d) teach your child a jingle that helps him change his mood, e) intervene with your older children when they "tweak" your younger son.  All these approaches are initiated by the parent.  I'm not sure how old your child is, but as he gets into his pre-teen years (and sometimes before that) you can teach him ways a) to change his perspective (or to consider other people's perspectives in addition to his own), and b) to use "cue words" or a "mantra" to help him relax, and c) to work on compromise with other people.  The second half of my manual explains how to help children develop techniques that they can use themselves when adults are not around to prompt them.

Basically, what all the techniques are designed to do is stimulate the self-control centers of the brain.  It is like exercising a muscle in a sense.  It takes time and continued practice, but you can help your son develop self-control.  Once he sees he can have some success, he will feel better about himself and he will be more engaged in the process.  So start with the techniques in the first half of the manual (that are directed by the parent) and then after a few months when you see some progress,  consider moving to the second half of the manual (where you teach him techniques to use himself).  

All the best, Dr. Dave Gottlieb