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

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