Sunday, March 16, 2014

6 yr old hurts his siblings

Hello Dr. Dave!
I am writing about my 6.5 year old son. He is the youngest of 3. He is a sweet, loving, caring and extremely intelligent boy. But he has these outbursts (he always has) where he is out of control and so angry. He never exhibits this behavior at school or when he is on a play date (when I am not there). We have a great life, he has everything he needs but not overly. My husband is also very intelligent, and has similar outbursts (not physical just gets angry very quickly.) I am home with the kids, I only work one day while they are in school.

We have had our son in therapy for a bit now but it isn't helping at all. Our son takes out his aggression on his 8 year old sister for the most part. She cries constantly because he hurts her (physically & verbally). My daughter also has screaming fits but nothing physical at all.
He even hits and kicks his 13 year old brother who rarely fights back. He has started cutting holes in his walls now and destroys things he knows we love.  Everyone is afraid of him!

But then he is a sweet, cuddly, huggy little guy. He has great focus and pays attention so I am not concerned about ADD or ADHD. He makes great eye contact and is very personable.
I don't allow kids at the house anymore because our son is so unpredictable. The last play date he yelled and screamed for the boy to leave--he didn't want to share his toys. Our son shares my love for animals and we talk about animal rights and how to care for them all the time. He loves that. He is very athletic and loves art.

I am to the point where I am considering medication for him. Any thoughts?
Thank you dearly in advance. I will do anything to get our lives back on track.

Hi, First, I would recommend you try some of the strategies in the first half of my book that are specifically designed for anger overload for young children.  If your son is still in therapy, you could discuss the strategies and work on a plan with your child's therapist.  I would recommend you and your husband meet together with the therapist to plan and then to review the effectiveness of your interventions. If your child's therapist does not work on strategies with parents, then I would suggest you ask him/her for a referral to a professional who works with parents and families.  I find that parent meetings and family therapy are more effective in reducing anger overload than individual child therapy.  

Most young children are not attuned to the causes of their angry outbursts and are not particularly motivated to change their behavior, so that individual therapy for anger overload is not usually that helpful (unless there is some underlying source of anxiety or unhappiness that can be addressed with the child).  Hopefully in time your child will become more motivated to control his behavior, and I discuss in my book some ways to help a child realize how important a goal this is.  As a child becomes more interested in self-control, there are a number of additional strategies (in the second half of my book) that can be implemented with a child's participation.

Though you explain that your son's anger overload has been going on a long time, I would hesitate about medication, unless there are other types of problems (like anxiety or a mood disorder) in addition to anger overload.  There is no medication that focuses only on anger without the possibility of significant side effects. Often psychiatrists will try either mood stabilizers, anti-depressants, or "atypical" anti-psychotic medications, but there can be side effects, such as weight gain or sedation when anti-psychotics are used.

A first step before planning some strategies is to make notes of the types of situations that provoke your child's anger.  Look for themes.  You mention one so far in your comments: when he did not want to share his toys.  If you have not done so yet, you would try to discuss with your son his concerns about sharing (when he is calm), and help him try to figure out a way to share some toys and put away others (that he does not want to share) before a play date comes over.  The basic idea of this strategy is to try to prevent an outburst, by preparing in advance and trying to avoid the precipitant.  

Another strategy is to lower your child's expectations (if a source of frustration is disappointment in someone or something).   You mention that your son hurts his siblings. Observe what is going on before he strikes out. Is he wanting their attention, or does he feel they are somehow in his way, or is he bored? Once you identify the precipitant, you can apply strategies that lower your child's expectations or change the sequence, such that you avoid some of the triggers.   For example, if he is angry that they are not doing things with him, you would try to lower his expectations (later when he is calm) and help him and his siblings think of ways to interact positively (change the sequence).

Another type of strategy I call emotional distraction.  You can use this approach if you can catch your son's anger in its early stages (if there are early signs of frustration).  I explain in the book that emotional distractions "speak" to a child's emotional brain.  There is a biological basis for anger overload:  the rational part of our brains (specifically the "prefrontal cortex") is sometimes not able to control the emotional signals from the inner "limbic system" of the brain.  Emotional distractions aim to create a different emotional response (such as laughter) that blocks the arousal of anger.  It is hard to laugh and be angry at the same time!  So if you can get your child to laugh at a silly joke or comment, you block the arousal of anger. Once your child is "amused" or laughing, you could then more easily re-direct him.

Take a look at other posts on the blog and/or read my parents' manual for more details about these and other ways to help a child learn self-control.  All the best, Dr. Dave Gottlieb

Sunday, March 9, 2014

Strategies for 4 yr old: Should you spank?

Hi Dr. Gottlieb,
I came across some articles today on Anger Overload while I was researching about my 4 year old son. FINALLY, something that describes his behavior accurately.

My son is generally a very sweet, well mannered and extremely caring boy. He is extremely intelligent and does very well academically. Both parents are in the home and we have a good relationship, we fight occasionally but generally get along well. He has a younger sister who is 2. Both my husband and I are very Type A people, strong willed and driven. We see a lot of that in our son. While he is very sweet, he often has angry outbursts that end in hitting his sibling, a friend, parent or teacher. He has exhibited anger since he was under a year old. I would notice that when he was working on a puzzle or something, if he couldn't get it right he would get extremely angry. This has progressed as he's gotten older.
Now, he can have several "Hulk"-like outbursts a day. It's causing trouble at school and I feel bad for us and him. Once he has an outburst and hits someone he will often quickly apologize, but we have got to find a way to stop the physical violence before it gets worse. Right now, it's worse at school than at home. I often try to "talk him down" when he is angry and this sometimes works and he will "be happy again".

I just purchased a copy of your book and I'm looking forward to getting started with it. A few questions:
1) Would you recommend that he see a psychologist?
2) You seem to stress parental interaction, how important is teacher interaction?
3) With consequences, what are your feelings related to spankings? We are thinking that we need to be tougher with him than we are right now. None of us like the idea of corporal punishment, but we're not sure what else to do. 
Thanks and I look forward to your response.

Hi, In answer to your questions, let me first say that parent interaction is key at home, and teacher interaction is key at school.  With younger children especially, most of the interventions need to be initiated by the adult.  Generally most 4 year olds will not be able to anticipate nor modulate their outbursts on their own.  The frontal cortex (that is critical for self-observation and planning) is not fully developed.  For strong willed children and for children who have quick emotional reactions, this can be a problem.  Their emotional energy is strong but the cognitive capacity to handle it is not all there yet.
After you have observed some patterns of behavior and have ideas about some of the precipitants, you or his teacher would try to intervene before your son reached the overload phase.  You will see in the manual that I explain how to lower a child's expectations (if this is one cause).  I also recommend parents alter the sequence of events in order to avoid a potential anger-arousing situation, when possible.

The next "line of defense" if a child has begun to get frustrated is to use either "emotional distraction" or calming techniques.  I describe in the manual how to use distraction and how to set up a calming zone.

In answer to your questions about spankings, I find that this does not usually work.  There may be an initial decrease in violence by your child if you spank him, but his anger will continue to be aroused frequently (because of his biological stage of development and because of his strong willed personality) and you will not want to spank him repeatedly.  Also, spanking on a regular basis can lead to more violent reactions by your child because he may model your actions when he gets frustrated.

I have found that incentives and consequences help reduce anger for some children but not others.  If you want to try incentives and consequences, they need to be meaningful to your child and fairly immediate.  It is sometimes trial and error to find what might motivate your child.  But remember that the problem is not really that your child isn't trying; the problem is that there is strong arousal along with limited cognitive capacity to observe and modulate emotion.  Incentives and consequences do not work so well in that case; they are more effective when the problem is a lack of motivation on the part of a child.

There are certain communication techniques to keep in mind with young children.  Generally, it helps to remain calm, give concrete and positive commands, and specify one request at a time.  For example, if a child is running around when they should be sitting, it would be better to say "Come sit by me" rather than say "stop running around."  And keep in mind that children with anger overload tend to already provoke a lot of negative reactions from others, so more punishment is not usually going to help.

As for the question about professional help, it depends whether you make headway in the coming few months.  It often takes a long time to see a huge change, but you would want to see some improvement in the next few months; otherwise consulting a professional is a good idea.  Some parents find it is helpful to both work with a professional and use my workbook at home.  There may be particular characteristics of your situation that a professional could pick up on.
All the best, Dr. Dave Gottlieb 

Sunday, March 2, 2014

Mom worries about her 10 yr old daughter

Dear Dr. Dave,

I have stumbled across your page about anger overload, whilst looking for answers about my daughter.  My daughter is a beautiful, intelligent 10 yr. old (almost 11) who is very loving and sensitive to others feelings. She has a sister, aged 7, who doesn't have any behavior issues

She grew up with myself (mother) and her father, until we separated 18 months ago (I moved out, my ex-husband remains in the family home). My ex-husband and I have shared care (i.e. girls are with me from Wed afternoon to Sunday morning each week, and him the remainder of the week).

My daughter has had angry outbursts for as long as I can remember. I have taken her to see a number of professionals, including 2 child psychologists, (for extended periods of time, and not all at the same time!!). She is currently seeing a consultant psychologist, but I am having trouble getting her to understand or realize how severe this problem is, and this has always been the case. I feel so frustrated, that these professionals give me literature on parenting skills etc. which never really seem to make any difference. I am almost at breaking point, and need help so badly.

She has always performed very well academically, and there have never been any behavior issues at school (teachers look at me strangely when I try to explain the behaviors that occur at home).

Triggers are usually minor, and reactions seem way over-the-top e.g. her homework sheet gets scrunched up in her bag, and she screams and yells that it is completely ruined, and will continue to rant for up to an hour. Or I tell her I am going to wash her hair (as it's Wed night, we always wash hair on Wed night) and she yells and starts kicking the door and slamming doors  etc.

She has started to physically attack me, and she will kick me, punch me, scratch and slap me.  She has displayed this behavior with her father, and with my mother (who has been a significant person in her life), however, I seem to bear the brunt of the behavior, when she is with me.

I have a long history of depression and anxiety, and my daughter is well aware of this (probably too aware for someone aged 10) and I really struggle at times to manage and cope with her behavior (I have been very well supported by my mom, thankfully, and hence her being a significant person in my daughter's life).  My daughter has indicated that she believes that I left the family home because I had depression, and feels that it was her responsibility to make me happy, and that she failed in doing so. I have explained that people don't get their happiness from other people, but from inside themselves, but she can't seem to get past this point.

A strong trigger for my daughter, seems to be around my new partner, who doesn't live with us, but does spend quite a bit of time with us. My daughter has openly said that she hates him, because he makes me happy, and she couldn't.  I have tried to stress to her that she, nor anyone else, is responsible for other people's happiness. I also wonder if she is somewhat anxious, because the mom she has always known (i.e. depressed, sick, lying on the lounge - which was always reinforced by her father i.e. "mom is sick, leave mom alone") is now healthy, happy and vibrant (something very new and strange, maybe threatening? to her). I have reassured her time and time again, that I am always going to be her mom, I am not going anywhere.

As advised by my psychiatrist, and my daughter's child psychologist, we have a "girls' night" and "girls day" each week (which is time without my partner being there). And my daughter frequently has one-on-one time with myself.

I feel like I have read a gazillion self-help and parenting books, (maybe that's my problem??!!) and have spent a fortune on therapists (I wouldn't mind if it helped), but I don't ever seem to get anywhere. Do you think my daughter may have "Anger Overload?" I would be so grateful for any advice you may offer.

Hi, It sounds like you have tried really hard to help your daughter.  In the long run it is going to be good for your daughter as well as you that you are happier.  It sounds like your daughter's anger issues began a number of years ago, and thus it is unlikely that your new relationship is the cause.  She may be jealous of him in part, but she may also be relieved that you are feeling better (though she does not say this and may not be aware yet of all her feelings about this).  Deep down children want their parents to be happy and feel relieved generally when that is the case.  It is great how you are able to spend some time alone with her, and despite her protestations, I would also recommend doing some fun activity with her when your partner is around, if you do not already do so, so that she sees she can have fun then too.  It sounds like you have tried verbally to reassure her that you love her, and I would talk less about this now, because she may try to make you feel guilty at times to get all that verbal reassurance. 

It is a good sign that she has self control in school.  When she explodes at home, you want to say as little as possible until she is calmer (unless she is hurting someone or breaking something of value).  In my parents' manual I outline a number of strategies parents can use at different stages of anger overload.  What I just said about ignoring her is usually effective when a child is in the extreme overload phase.  If you can catch the anger in an earlier stage, you would use a different strategy, for example what I call "emotional distraction."  You try to come up with something engrossing, silly, or funny, that distracts your child.  For regular events, like washing hair (which you describe is one trigger) you would want to have a significant fun activity follow this on an every week basis.  If she refuses or tantrums when it is time to wash hair, she would not earn the fun activity.  Or if hair washing is still upsetting to her, try to think about how you could make it fun.  Would different color shampoos help (she could squirt or mix the colors), and what about letting her hold a mirror so that she can see what is happening?  Is she upset about getting soap in her eyes?  Is there a way, in other words, to ease her anxiety? 

You want to try to set a rule about physical violence when everyone is calm, and you may need to bear hug her (restrain her) if she is hurting someone or move away from her (if this is possible).  You would not say a lot at that point, but later in the day, you might review what happened and explain what alternatives (verbal) would be acceptable when she gets angry in the future.  Some children respond over time when a privilege is taken away for 24 hours (after physical violence) and some children's behavior is unaffected.

The key is really to use the strategies I outline at earlier stages of anger overload whenever possible.  Your daughter is at the age where she might be able be able to learn some self control skills.  The second half of my manual is about how to teach your child these important skills.  If you think she is ready to understand the seriousness of her behavior and wants to control it, you would start with some of the strategies that have to do with developing self-observation skills.  If you do not think she is ready yet for this, then stick with the first half of the manual, which explains what parents can do (without requiring a child's direct participation).

One last thought:  It would be important for all the adults to work together to give her the message about physical violence.  You want to be a united front if at all possible.  

All the best, Dr. Dave Gottlieb