Thursday, May 15, 2014

6 yr old tantrums in school

Dear Dr. Dave,

My 6 year old daughter seems to fit your profile for anger overload. I plan to buy your book. She just began talk therapy and may also begin occupational therapy soon for possible sensory integration problems but her angry outbursts at school are my main concern right now. She is basically holding the teachers at school "hostage" because they don't know how to control her screaming, until the school social worker is finally able to work with her. (interestingly, she never behaves this way for her stern AM teacher; PM teacher is young and easier to manipulate). She gets bent out of shape by negative peer interactions, a mean comment, if she doesn't do what the teacher asks, if the teacher yells at her, if she doesn't like her snack or lunch, etc. Would a child of her age benefit from anger management, either privately or as a group session? Could my use of Prozac during her pregnancy have caused this?

Thank you.

Hi,  On the blog and in my manual I have described a number of strategies to use with young children.  The strategies in the first half of my book are the best place to start with young children.  These strategies are directed by the parent and do not require the child to be aware of her triggers or early warning signs.  Most young children are not yet reflective about their anger, so I recommend parents and teachers a) observe some of the triggers and then b) try to change the sequence of events leading up to the outbursts (when possible), or c) try to change a child's perceptions about what is causing her frustration, or d) use "emotional distraction," or e) develop a relaxation station.  

In your child's case, I would talk with the teachers and determine what exactly the am teacher is doing that avoids an outburst.  Then I would see if the pm teacher could use some of the same strategies.  You mention that the am teacher is stern.  Talk with her (or have someone observe) how her demeanor is translated into actions in the classroom.  What exactly does she do when there are mean comments, or when a child does not listen to the teacher--you mention these are some triggers for your child.  My guess is that she catches the problems early and does not let things build up.  Also, with stern teachers, children know not to misbehave (or they will be seriously punished) so children often exhibit fewer provocative behaviors, and thus there are fewer conflicts.

If the pm teacher has trouble implementing the same approach, show her the other strategies in my manual and see if she can successfully implement one, or more, of them in her class.  One of the strategies that I use with older children, but might work for your child, is teaching a catch phrase that might help her think about a problem in a different way.  The catch phrase would be something you come up with together, and then make pictures with the phrase, and talk about it each day before school.  One example would be a phrase that might help her look at "mean" comments in a different way (so that she doesn't take it personally so often).  Help her see that mean comments are a sign that someone is having a bad day, and that the comments are not true.  Also, phrases that have some humor can help interrupt the build up of anger.  So one phrase I can think of now is "Meany needs go sleepy."  What you want her to consider is that the other person is tired, or out of sorts, or she wouldn't be so mean.  It's best to develop a phrase together that your child finds amusing.  It is important to explain that this is a special phrase for her to think of when someone is mean, but not to share with anyone--it is private between you and her, and you will ask her after school if someone was a meany today.  If your child does not like this strategy, or if she has trouble with the idea that this is a special phrase for her to think about when someone is mean, that is okay, then stick to the approaches I describe in the first half of my manual until she is older.

Regarding anger management groups, some schools arrange for small groups of children to meet with a social worker or psychologist to practice dealing with anger provoking situations.  In essence, my manual outlines strategies to help develop self control, or in other words, anger management. The more practice a child has, the more likely she is to remember the strategy at times of anger. So groups can help, but not every young child is ready to participate in groups.  It helps if the child is a) fairly verbal, b) can reflect afterward about her behavior, and c) wishes she could handle it differently.  If a child is not ready for such a group yet, then the teacher could still implement the strategies that do not require a child's direct participation, such as the strategies that I mention in the first half of my manual.

As for your question about prozac during pregnancy, I am not an expert on possible side effects of antidepressants.  I know that some of my female patients over the years have used SSRI medication like prozac during pregnancy.  Their medical doctors felt the benefits outweighed any possible risk.  If you want to know more, check with a medical specialist, like a neonatologist.

All the best, Dr. Dave Gottlieb

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