Wednesday, September 17, 2014

7 yr old reacts to "negative" comments

Dr. Gottlieb,

It was great to read your blog and finally find a description of our 7 year old daughter.   We have been in therapy for about five months with a diagnosis of ADHD.  The therapy was split into two sessions - one for us as parents and one for my daughter with the therapist alone. We recently experimented with family therapy as well.  While the therapist seems to be a good listener, we have tried many different methods but have not seen much progress.

In August, we decided to explore medication and have not had much luck.  The stimulants we have tried, seem to make her more hyper and bring a higher rage level and the non-stimulant did not seem to do anything.  It is interesting that she seemed to have no side effects from any of the medications such as sleep or eating issues.

Based on our limited success, we are questioning the ADHD diagnosis and wanting some answers.  While our daughter expresses some traits of ADHD, she is not an antsy kid and does have some focus issues but that is not her main struggles.  However, her fuse is extremely short and when she goes down the angry path, she is impossible to bring back. She is very sensitive to any negative comments or what she perceives as negative comments and lashes out.  In addition, we have difficulty disciplining her because she expresses no remorse and she seems to not care if we take anything away.

In our last meeting with the therapist, she recommended a psychiatric analysis to determine next steps.

At this point, we seem to be at a cross roads.

Hi, You mentioned that negative comments are a trigger for her anger.  You also mention that sometimes this is her perception though the remarks may not be intended to be negative.  One thought I have is to try to anticipate her reaction and preface your remarks with "you know you are a terrific kid" or, better yet, point out something she has done well that day before you mention something she might perceive as negative.  Hopefully, the balance of positive and "negative" comments will help her to not feel criticized.  Keep track over the next two weeks of comments that seem to trigger her rage, and then try to preface similar comments in the future with a positive remark.

Down the road, you could also try a technique I write about in the second half of my parent's manual:  teaching your child about other points of view.  With this technique, you show your daughter how two people can look at something in different ways.  Once she understands this concept, you help her see how a comment's meaning may be perceived differently, e.g. those "negative" comments may not be intended as negative, though the person receiving the comments may still feel hurt.  Help her see how you, her parents, have sometimes felt hurt by comments someone has made that may not have been intended as hurtful.  Also, confirm for your daughter that sometimes people do get frustrated and make a negative remark.  Help her to understand that people say things when they are frustrated that are not necessarily true and are not necessarily the person's true feelings.  

The reason why I write that I would not use this technique right away is because it requires a child to be able to recognize other points of view and apply that to her situation.  Not many seven year olds can do this.  But once the frequency of outbursts is less, and once you feel she may be ready, then try this technique.  It takes time for a child to internalize this way of thinking, so practice over time when she is calm.  

Other techniques in the near term would be to use emotional distraction, which is useful if you can catch the anger before the overload phase.  This is not always possible because anger can increase so quickly.  The idea of emotional distraction is to make a remark that changes your child's emotional disposition:  it could be a funny saying, or a silly comment that your child reacts to.  It can be trial and error to find a remark that your child might find funny or exciting.  But if your child laughs, this will interfere with, or interrupt, her angry feelings.

There are other techniques that I describe in my parent's manual.  Some do not require the child's direct participation, and these are described in the first half of the manual.  These techniques are particularly useful for younger children under the age of 10.  Some of the techniques in the second half of the manual can be tried with young children, but the effectiveness depends on the ability of the child to observe his/her behavior.  You will notice improvement over months, rather than days, as children with anger overload fire up so quickly that it takes time for children to internalize coping strategies.  As I mention in the beginning of my book, there are biological pathways that underlie anger overload, but improvement will usually occur with practice over time.   If there is an additional diagnosis, it will need to be addressed as well.  Since the ADHD medications did not work out, it is not a bad idea to get a psychiatric consult regarding the diagnosis.
Best, Dr. Dave Gottlieb

No comments:

Post a Comment