Thursday, April 24, 2014

9 yr old's outbursts if hurt or if makes a mistake

Hello,  I have a 9 year old son.  He is a very smart boy bit also can be a very easily angered boy. Ever since he was very little he has been showing "anger overload". Since as far back as I can remember whenever my son would get hurt or embarrassed especially in front of people he would get quickly very mad and scream "don't look at me", followed by kicking or throwing or shoving someone or something. He still does this at age 9 but doesn't seem to do it at school very much.  He does do it in public and at family's houses and once at a friend's house. He also gets very angry if he gets answers wrong on his homework and such. He will instantly get mad and call himself stupid.  Same with playing with his brother if he is accidentally hurt, he instantly turns to anger.  When he is in time-out for bad behavior it is a screaming,  mocking me,  hitting,  kicking walls,  loudly praying and begging God for help and sobbing.  When not in an anger episode he is attentive,  loving,  engaging and a funny boy.  I took him to a counselor and he was quick to say ADHD even though he scored low on both mine and his teacher's evaluation.  If you have any thoughts it would be greatly appreciated! 
Thank you for your time.

Hi, You have begun on the right path by identifying some of the situations that lead to your son's rage.  The next step is to think about how to change your child's expectations or change the sequence of events before his anger escalates.  Once it escalates, it is best to say or do nothing, unless he is seriously hurting himself or someone else.  When in the overload phase, children generally do not listen until they are able to calm down.  

When he is not upset, I would recommend you begin to talk with him about one of his issues, for example when he makes mistakes.  You would work on trying to change his expectations so that making mistakes is "good" or "expected."  One way is to talk about mistakes you have made and how it is frustrating and how you try to deal with them.  Also you could talk about how making mistakes on homework is good because it shows he is learning new stuff.  If he made no mistakes that would be bad because that would mean he knows everything already and is not learning.  A third way to talk with kids about mistakes is to explain how some famous people made a lot of mistakes.  For example, you could get a book about Albert Einstein, the famous scientist, that explains he made tons of mistakes in spelling, and even in some of his scientific theories.  All creative people make mistakes plenty of times.  You would not hit him with this information all at once.  Try one or two approaches at a time, and stick with it for a month or more, and see if it gets through to him.  

An additional technique I write about in the parent's manual is to create a saying together with your son to help him remember that mistakes are good or normal.  For example, "everyone makes mistakes," or "Mom will be happy I made some mistakes today," or "Famous people make tons of mistakes."  You would repeat the saying with him before bed, or at some other time each day, for a month or more.  

It is hard for some children to control their anger.  So the process takes some time.  You mentioned he has had anger issues since he was younger, and this is common for children with anger overload.  Their brains react strongly and the self-control mechanisms in the cortical areas of the brain take time to develop.  By teaching him strategies, you will be helping his brain develop better control of angry feelings.  In my parent's manual I describe other strategies, such as teaching calming techniques, using distraction, and teaching your child to recognize early signs that he is beginning to get frustrated.  Early intervention is the key, whether it is a strategy you employ or one that your son learns to use himself.  My parent's manual is divided into two parts:  one has strategies you can use without your son's direct involvement, and the second half has strategies you work on together with your son.

Regarding ADHD, you would expect to see a number of signs at school and at home of distractability, impulsivity, and/or hyperactivity.  The signs would be present throughout the day and not just when he was frustrated. It is possible to have ADHD and anger overload, though.   If you want to learn more about ADHD, there are a number of parent's books on ADHD including a book I co-wrote some years ago about dual diagnoses (for children who have ADHD and another problem with it) called "Why is my child's ADHD not better yet?".  However, your examples sound more like anger overload!  

Take care, Dr. Dave Gottlieb

Tuesday, April 22, 2014

Update on 8 yr old's outbursts playing little league

Hi Dr. Gottlieb,

I emailed you last summer and you responded, thank you.

Our son, now 8, has been diagnosed with Anxiety. Maybe performance anxiety. They are uncertain. His therapist said maybe mood disorder along the depression spectrum.

Anyway, he is on 10mg of Prozac and seems happier overall, engaged, laughing etc. He is passionate about baseball. And if you recall last spring we had a terrible time with him on the field. Didn't matter if it was practice or games, he was very hard on himself, blurting out a swear word here and there, sometimes throwing his hat, bat or glove. It was pretty obvious that he was struggling and having anger outbursts. The coaches were pretty supportive telling us not to pull him but to let him play as this is where he'll learn.

Well we are headed into about 8 weeks of spring ball. He hasn't played any sports outside of gym class just because we haven't been able to handle the stress as a family.

We see more positive signs going into baseball this year, but are afraid of what we might encounter again this year.

We are trying to find a sports therapist, or someone along that lines. We just don't understand the undue pressure he puts on himself competitively and then gets upset when he doesn't perform or even gets upset if a ball isn't hit to him. Also, gets upset if his team looses. We do not put any pressure on him to play or not play. We just want him to have fun like the other 8 year old boys on the field.

Any thoughts? Suggestions?

Thank you Dr. Gottlieb

Hi, Last year in the post of June 4, 2013 you mentioned that you had given him time to cool down and had refrained from engaging him while he was in overload.  That is an important first step.  Next think about whether your son shows concern about his outbursts, that is, whether he indicates a wish to have better self control.  If not, the first step is to help him become aware of the problem and help him to develop self-observation skills. I discuss this at the beginning of the second half of the manual (see pages 32-37).  

If your son is already aware that he gets frustrated on the baseball field, then you would move to the strategies that involve changing one's perspective (i.e., seeing another point of view) and learning a "mantra," or saying that reinforces the new perspective.  Here's one possible thing you could say if your son finds it meaningful:  You could talk about how making mistakes are important, that if someone doesn't make mistakes, they are not human, they would be a machine, and we don't want you to be a machine, so please make some mistakes on the field.  

Another possible discussion could occur after you watch a professional game on television and talk about players making errors or striking out.  Talk about how they must feel.  Help him to see that upset feelings are okay but loud outbursts are signs that one's frustration has gotten out of control.  Ask him to think about what he could do when he feels the frustration coming on.  How could he reassure or distract himself so that he avoids a loud outburst?

Practice whatever strategy you decide on together before each game and practice.  Then ask afterward if he tried it.  Give him plenty of praise for trying, regardless of whether it worked.  Reassure him that the strategy takes time to work because frustration can be a powerful emotion.  It is important to warn him that it takes time, so that he does not become self-critical when he cannot control his emotions.

Lastly, try to use yourselves as models.  Talk out loud when you get angry about how you feel and what you are trying to do to calm down.  The more he sees other people working on self control, the more likely he will be motivated to try too.

All the best, Dr. Dave Gottlieb