Thursday, July 17, 2014

10 yr old getting angry at camp

My daughter is 10 years old and has been diagnosed with ADD since she was in 1st grade. However, I had to have her stimulant medication changed to a non-stimulant ADD medicine because it caused her to twitch and become anxious. This summer we decided to take her off that medicine too (Strattera 40mg) and she is only taking Clonidine to help her sleep at night. Her behavior off of the Strattera has not changed leading me to believe it wasn't really helping her. She is an amazingly smart girl but struggles in reading and writing. She is compliant with her teachers most of the time but I just got a call from her overnight camp that she is not listening to the counselors (who are teenagers), taking off without telling anyone, and yelling at her bunk mates to the point where they get scared. This she does at home with her brother and from time to time and has done with her friends. She gets very angry very quickly but can but it never lasts for more than 1/2 hour.

. The problem I am having is reward charts, consequence charts, sticker charts, grounding all of those things do not work. We implemented the Transform Your Child by Lehman. I mean we have tried everything. I just want her to be a happy and healthy ten year old. One that likes herself and that others want to play with. I need help.
Her 8 year old brother makes comments to me about her and her anger and I can see it bothers him as well.
Any suggestions or ideas of what may be causing this is greatly appreciated.
Thank you.

Hi, Children with ADD tend to be somewhat impulsive, such that when they get frustrated they sometimes act before they think.  What you would want to do first is keep track of what is going on before she erupts.  What are the counselors asking her to do, or what is going on when she yells at her bunk mates?  Similarly at home, what is going on with her brother or friends before she loses it?   If someone keeps track of that for a week or two, you might see a pattern for some of the times she gets angry.  In my parent's manual, I explain ways to deal with outbursts--sometimes "changing the sequence" of events to minimize frustration, sometimes "emotional distraction", and sometimes ignoring.  

The idea with technique called "changing the sequence" is to avoid the triggering event.  For example, some children have trouble going from a fun activity to a task like cleaning up or getting ready for bed  In that case, I would recommend doing the clean up earlier before the fun activity starts.  For bedtime routines, it is more difficult to insert a fun activity at the end, since turning out the lights is usually the last thing an adult does before a child goes to bed.  But what I recommend is to do a quick activity on the child's bed before turning the lights out.  This way a child has a natural incentive to get into bed so that he/she can play the fun activity (like a card game) with you.  (I write more about these techniques, including what I mean by the technique called "emotional distraction" in other blog posts and in my manual.) 

In my blog post on July 3rd,  I explained that traditional rewards and consequences often do not work well for extreme anger, because the anger occurs so quickly for children prone to anger overload, and they do not think rationally about earning incentives once they get mad. 

In the second half of my parent's manual I explain how you can teach your child to think about other points of view (that are different than her own), and also teach her compromise techniques.  But first it's best to lower the frequency of outbursts by using the approaches, like "changing the sequence" and "emotional distraction", that I explain in the first half of the manual.

If you do not make any headway after a few months, then you might want to consult with a mental health professional who works with families of children with anger issues.  There may be something else going on in addition to anger overload that would need to be addressed.  You mention the ADHD diagnosis and learning issues.  These may contribute to frustration for your child;  her anger episodes may decrease once reading and writing get easier for her.

All the best, Dr. Dave Gottlieb

Tuesday, July 15, 2014

6 yr old sensitive at school

I have 2 boys age 8 and 6.  I am struggling with my 6 year old at school. At home he is very sweet, cuddly, funny and very even keeled which is why I am struggling to understand the polar opposite character at school. He has struggled to join in with PE and shows. He was hit and bitten by another child in his first year and is now in a class with half the children from the year above as well. He is the youngest (June) and they are all big characters and some of them hard to handle. He seems to be overwhelmed and runs out of the classroom, crying and being rude when he is told to go back in. This seems to happen when he is told to do something he doesn't think he can do or feels some kind of pressure to complete. He has also hit or run away crying when he perceives that other children are being mean. He is very sensitive to injustice and being aggreived.  Last week this escalated so that he hit a teacher.

We are strict on discipline at home and encourage polite kind behaviour and reprimand rudeness. I reprimand the kids for saying each other is stupid etc and say it is not nice, and then when the other kids do it to him he feels they are being mean. He is very sensitive but he sticks his tongue out and yells "no" when the teachers try to get him back in the classroom. He seems to be out of control of his reaction in that he does not "cleverly" do it when the teacher is not looking, and the punishment seems to be nearly too much from his reaction to it but it does not stop the behaviour next time. The teacher introduced a smiley face chart where several times a day he had the opportunity to get a smiley face. He loved this a revelled in the praise but if he got a sad face he started to be frightened to come out of the classroom at the end of the day to tell me about it. I have never hit or really shouted so he seems very sensitive to peoples' opinions but unable to alter his behaviour accordingly. 

The teachers see him as attention seeking, mischievous, rude and opposing their rules. We (myself, husband, family and all his friends' parents, indeed anyone that spends time with him out of school) would describe him as gentle, funny.  He likes playing young games alone, he is an even keeled easy child, certainly not attention seeking and mischievous.

I have been reading about anger overload and it sounds very like our experiences. I have ordered your 2 books "Your Defiant child" (although he is not defiant in 99% of circumstances, only those that he is told to do something he is nervous about) and "Anger Overload a parent's manual". I was keen to hear your thoughts. I am a pet Behaviourist and have a Psychology degree and find it really hard to believe the behaviour of my child.

Thank you for your time.

Hi,  I think you are on the right track using the smiley faces.  Since your son is sensitive to negative feedback, I would hold off on the sad faces on his chart.  Instead just leave it blank when he is not achieving the goal. Also, think carefully about what to use as the goal.  It should be something that takes some effort but is not too difficult for him to achieve.  Over time, if your son is achieving the goal every day, you can increase the expectations gradually.

The other thought I have is to help him deal with the older, bigger children in his class.  Find out from your son and the teacher some examples of what unnerves him in school.  Maybe you can role play the situation at home; in other words, at home you would practice alternative behaviors that your son could then use at school.  First, say something empathic when you find out he has felt pressured or hurt by his peers.  Then wonder out loud what could he do when this happens so that he wouldn't get in trouble.  If he does not know what to do (most kids this age don't), suggest a few things and then have him pick one to practice with you.

Also, try to arrange a play date with one or two of the boys in his school.  If they become friends then it may help him during the school year to feel less intimidated by other children.  He won't feel all alone.  If he continues to have trouble bonding with some of his peers at school, think about other activities outside of school that might interest your son and that would involve other children his age.  It can help children to feel less "picked on" if they have a buddy they can see later in the day or later in the week.

Regarding the pressure he feels to complete his work, I would recommend his teachers take the pressure off, and have him finish another time or at home.  The pressure sounds like it is counter-productive.  Think about why he is having trouble finishing his work:  are there any learning issues or does it just take him a little longer at this age?  If there are learning issues, like difficulty with reading, then see if the school can work with him on any weaknesses.

My guess is that if he feels less pressure and more supported in school, there will be few outbursts.  Let him know too that being disrespectful to the teacher is not acceptable, and work with the teachers to give him the message about what is acceptable and what is not.  I find that some children do well if they know they can go somewhere in the class or outside the class to "chill" if they feel frustrated.  If the teachers can pick up on his frustration early on (before he is in overload), he is more likely to be able to show self control.  I explain more about this in my parent's manual.

All the best, Dr. Dave Gottlieb

Thursday, July 3, 2014

Can rewards and consequences help?

     I wanted to add a note to my last post about rewards and consequences.  Sometimes children respond to brief and immediate incentives or negative consequences, particularly if they have already learned a coping strategy or two.  Then you can work with your child on a brief incentive if he tries a new strategy when he starts to get upset.  There are a few keys to this:

1) Work on the strategy together for a week and practice when your child is not upset, and then in a week tell him/her you are proud of him and want to encourage him now to try it when he feels frustrated.

2) Talk together about some brief incentives and tell him he can choose one if he attempts the new strategy.  Notice that your child would get to pick one of the rewards that you both agreed on.  It is more fun if you don't use just one reward all the time.  

3)  Your child earns the reward if he tries.  It will be hard for him to control his anger and you don't want to focus on success, but on effort.

4) Try to help him "catch" the frustration in the early stages because it is then that his rational brain will be most engaged and it is at that time your child has the best chance of controlling his anger.

     I would not recommend using consequences until you have worked on strategies to help your child deal with anger (like those coping strategies I describe elsewhere on my blog and in my parent's manual).  It is possible that if at the time a child starts getting upset (before he reaches the anger overload phase) he remembers what a punishment felt like previously, then that memory could help motivate him try to use a self-control strategy.  The problem is that your child may reach the overload phase so quickly that he won't be thinking rationally about potential consequences.  This is why I don't usually recommend consequences for helping a child deal with anger.

     If you want to try this, pick a short term consequence, like no computer time after dinner.  Furthermore, be very clear about exactly what behavior would bring about a consequence (for example,  specific swear words).  Keep in mind that the consequence has to be something meaningful to your child, and sometimes you don't know what will catch his attention until you try something.  And do not talk about the consequence while your child is in anger overload.  First prepare him ahead of time when everyone is calm and then impose it after your child has calmed down.  Mention it in a matter of fact way without a lot of emotion or a lot of discussion.

     Be sure to praise your child whenever he tries a strategy, and if consequences cause more outbursts, then hold off in the future on these consequences, and go back to the other approaches in my parent's manual.

    In actuality, if you follow the guide in my manual, you are using natural incentives and consequences!  Specifically, you are paying attention (which is rewarding) to your child when he is working with you on self-control strategies, and you are ignoring (negative consequence) when he is in the anger overload phase.
David Gottlieb, Ph.D.