Sunday, May 4, 2014

Intense 10 yr old has rages

Hello, I just read and article by you on Anger Overload in children and it brought tears to my eyes. You described my son so accurately it was alarming (and relieving because we were beginning to worry it was Bipolar).

He is as perfect as you could ask a ten year old boy to be 80% of the time.  The other 20% are horrific, humiliating, embarrassing and a terrible example to my other three children (he is an oldest but also a twin). He does not seem to rage at school although when he was younger he had "melt downs" on multiple occasions. They usually happened when he or someone else got in trouble for something they didn't really do, another child in the class had very bad behavior and he found it very upsetting, or he had a run in kickball called an out when he believed it wasn't (or something along those lines). He has always been and still is a perfectionist (to the point of lying to cover up something he believes makes him look imperfect to others), he has always been intense and he a has always been a worrier (even about things that are for the adult to be concerned with such as running out of gas or getting somewhere on time).

The majority of his bad and really concerning behaviors are at home or with us. He also seems to have a fresh and disobedient strain that comes out (more and more as he gets older) such as trying curse words when he thinks we aren't listening, watching a forbidden TV program or testing out discussing an adult topic in an inappropriate setting (when company is over etc.).  It seems to be getting worse, and it is taking a huge toll on me as I am a stay at home mother dealing with this more than anyone else, and it is having a bad influence on his siblings etc.  I want to be sure you know that I understand kids push limits and try things they aren't allowed to do. This is more in the category of defiance.

The article talks about strategies involving charts etc but at ten, he is a little beyond that.  I am at a loss.  I try stating clearly that if he continues he will have to go to his room, go back home, loose a privilege etc but he (when in or entering a rage) repeats himself to the point of seeming mentally insane. For example, if, for whatever reason, we tell him to give us his iTouch he will respond in an extremely loud voice "BUT I WANT IT, WHEN CAN I HAVE IT BACK, I WANT THE I TOUCH. HOW LONG DID I LOOSE IT FOR, BUT I WANT IT BACK, I WANT MY ITOUCH" this can go on for 10, 20, 30 minutes sometimes.  Sticker charts and redirection are not working on him.  He is too old, too smart, and way, way, way too intense.

Do you have any other advise or resources you could point me towards?

     Hi, Last year I published a parent's manual for anger overload; the first half of the manual explains strategies you can use without discussing what you are doing with your child.  Then the second half of the manual involves working with your child when he realizes he has a problem and wants to develop better self control.  The goal of the first half of the manual is to lower the frequency of outbursts, and the goal of the second half of the manual is to teach your child how to control himself better on his own.

     Taking away things when a child is getting upset usually does not lessen the outburst.  When children are in anger overload they are not thinking rationally, and thus incentives and consequences at that time are usually not very effective.  During the overload phase, it is best to say or do as little as possible.  The more you say, the more upset a child is likely to get.  Once your child is calm, then you can review what happened and sometimes a brief consequence can reinforce your message (though sometimes the consequence may re-ignite a child's anger).  When you talk with your child, you would explain how his anger was really over the top, and that together you want to work on helping him to say what he wants without losing it.  You could tell him you sometimes lose it too, and it is not easy to control anger, but you think it is important to try.  Ask him what he thinks, and if he seems motivated, then the second half of my manual describes a number of techniques you can work on together.

     If your child is not ready to work on anger with you, or feels it is someone else's fault that he gets angry, then you would use the strategies in the first half of the manual (that do not require his direct participation).  Some of these strategies are 1) to change the sequence to try to avoid one of his triggers, 2) "emotional distraction" in order to change a child's mood or emotional state, 3) developing a "fun" calming zone in the house.  These strategies work best if you can catch your child's frustration in the early stages.  I realize this is not always possible, because many situations can provoke anger overload, and you will not know all your child's triggers.  But try to keep a list for a few weeks of the kinds of situations that trigger his rage.  Then you can look for the early signs and try to head off an explosion.

     Regarding the issue of perfectionism, I'd refer you to some of the other posts (for example see April 24, 2014) where you will find recommendations for helping with children who are perfectionistic and get upset when making mistakes.   

     All the best, Dr. Dave Gottlieb

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