Tuesday, October 28, 2014

Manual helps, but young child won't talk about anger

Just a line to thank you so much for your excellent helpful Manual on Anger Overload. My 5 year old son has always from 2 until 3 and a half ish had intense and prolonged aggressive tantrums in reaction to being told no. However as he started school we experienced a set of much heightened responses, mainly directed at me his mother. He shouted nonstop, hit, kicked spat, words, used very violent words, and indeed tried to hurt himself. Hurting himself and being so distressed was truly awful. The rage lasted up to an hour and NOTHING could distract from this locked in response. It almost had to wear out from him. 

Thanks to your Manual we have felt an immediate ability to calmly attempt the emotional change at a trigger moment and start to help him and us cope with strategy that works. It is very hard at times to know what to do for the best. But we feel that your expertise diffused via the book and website has rescued what for us was almost becoming a crisis situation. So I feel immensely grateful to have found your knowledge which is so readily shared and accessible. And most importantly works. We know it will be a long haul but with this blueprint we have a model to work with.
My son finds it difficult to want to talk about his overloads - he doesn't want to address his responses so would you have any advice please about how we get him to be reflective. He has a wide vocabulary and seems to respect his father more than me. Should he start more of the discussion?

Many thanks indeed for your help.

Hi, For five year olds, many of the strategies in the second half of the manual will not work yet. Young children are often not ready to look at and discuss their behavior.  The first half of the manual is key for young children, and it sounds like you are applying those strategies. These are directed by the parent, and do not require the child's direct participation.  

What you could try is making up a story with dolls or puppets, and use any that your child already likes.  They could be stuffed animals or superhero figures he has at home or watches on television.  Think carefully about what themes you want the story to contain. Use themes that are consistent with your child's triggers, and write stories and resolutions that are dramatic, but metaphors for how your child could someday handle anger.  In other words, use fantasy in the story; your child's triggers would be disguised.  You want the story to be appealing and send a message, but it needs to be indirect for your child to be interested and listen. So the character in the story may for example throw giant boulders (when angry) and the boulders may almost land on a house.  But then a wise superhero says "you are destroying their house.  Why don't you build a fort with the boulders instead." Eventually after a few weeks, the ending may be about making peace with whomever the character was angry with.  "Talking works when you don't scream,": the wise sage could explain.

Another idea would be to make up a funny song with lyrics about anger that has a helpful resolution, or make pictures together about anger, or read a story together. (There is one by Mercer Mayer, for example, called "I was so mad.")   The basic idea is to begin a "discussion" about anger indirectly with your young child.  

Also, be sure to use yourselves as an example.  Talk out loud sometimes about what got you angry one day, and how you handled it.  All these techniques give the message to your child that everyone gets angry and that it is okay to talk about it.  It may be a year or more before your child is ready to talk more directly about his anger.  At that point, you might start by using a labeling system for levels of anger, which is one of the strategies I write about in the second half of  my manual.  The idea behind that strategy is to develop greater awareness about levels of anger.  It is easier to control anger if one takes an action at lower levels of anger.  But first a child needs to observe that anger comes in different forms.
All the best, Dr. Dave Gottlieb

Wednesday, October 15, 2014

How to get an 8 yr old to work on her anger

I have an 8 year old daughter who has always had substantial anger issues. She does not have ADD or ADHD, is not bipolar, I'm sure, although I've never tested her for anything honestly. I am an American ex-pat living in Europe with my husband and we moved here about a year after our daughter was born. These kinds of diagnosis and definitely medication for mental health are just not as common and practiced here as they are in America, and I never thought she was bad enough to warrant the diagnosis anyway. However, she does happen to have a very strong personality, wants to be the leader at all times, is very bossy, and many times has emotional outbursts with us, other family and her friends and teachers at school. 

She very easily cries in general and many times if she feels that another child intentionally tried to wrong her, even though many times her behavior leading up to the episode is usually be a big cause of that. Sadly, she is an easy target for teasing at times, because other children realize how sensitive she is and her reactions are always very impulsive and even if she is right in being angry about something, her reaction is so intense that it overshadows her valid feelings. 

She also tends to say things in a very rude way and acts disrespectful but doesn't seem to realize when she is doing it, and why others may not want to be around her,  no matter how many times we've discussed good manners and treating others with kindness. I will always make a point to praise her when she has done something nice or thoughtful, which she is also many times capable of. 

The interesting thing is that when she becomes extremely angry with other children at school and has a dramatic outburst, it doesn't last long.  She seems to realize quickly that she went too far and then wants to move on, many times joking about things and completely changing the subject like nothing happened. she also says things like "i'm so messed up, i don't know how to act." followed by behavior i can only explain as degrading of herself. As I'm sure you can imagine, it's heartbreaking as a parent to watch this dysfunctional pattern repeat itself over and over. 

She is very smart, no problems academically and loves music and art and has great talent. She is very sweet, funny and loving and craves attention. It's easy enough to get her to do things like homework, practicing piano and some chores...bedtime is tough, but probably nothing over the norm resistance wise. However regarding her anger, I feel like I don't know what to do anymore and my biggest fear is that we will lose our bond as she grows older and continues in these patterns because she can feel that I am always disappointed when these episodes occur..which these days is daily. Even though I try my best to be patient and as understanding as possible, talking to the teachers, keeping communication open, I know she probably hears too much criticizing from my husband and I when we try to explain things to her and why it's bad to behave that way. .

I know we are not perfect. I wish I knew of a better way to approach everything, but what do you do when you walk into the building to pick up your child from school and can hear them yelling at another child at the top of their lungs down the hall because they are so angry about something? I am so weary of the school pick up and hearing about what she did that day. Last year she really started to show improvement and the teacher was really proud of her. She had a group of friends she enjoyed and seemed to be turning a corner, but it seems like its always one step forward, 2 steps back. We did have to change schools because her other school was private and it became too expensive, so I am aware this could have a huge deal to do with her current state..but it's really always been an issue more or less.....

I am sorry if my email seems like an excessive complaint of my child - I am just trying to point out all of the details so that you can understand the challenges and perhaps offer guidance to the best approach..because simply speaking, I am at a loss trying to figure out the best approach and need some help. I happened upon your blog and thought I would try to get in touch. I feel like a failed parent, but I love my daughter so much..it breaks my heart that she has to make things so hard on herself. Any insight or advice is very, very much appreciated. Thank you and all the best to you.

Hi,  The positive signs in your e-mail are that she realizes after an outburst that she has gone too far, and it is also a good sign that the outbursts are short in duration.  She regains control and feels sorry about her behavior.  This indicates that she will be motivated to work on her behavior in the coming months.  It does not mean she will be able to consistently stop from having outbursts in the short term because she feels "injured" emotionally fairly easily and because her anger is easily stimulated.  So how do you get started helping her?  

First, I would talk with her about how some people have quicker angry reactions than others, but that everyone gets angry sometimes.  Tell her you would like to work together on how to express anger, and give an example when you exploded and what you thought you could have said (or not said) when you calmed down.  You want to show her she is not alone, and that you empathize with how hard it can be to control anger sometimes.  

In my manual, I offer worksheets to keep track of anger.  Basically, you want to work together each day on what triggered her anger that day and how she reacted.  Talk about whether there are any early signs that she is getting angry.  Help her to see any early signs as a cue to take an alternative path.  We can all control anger better the earlier we realize we are getting angry.

When you review different situations, write down what she said and what the other person said.  You would do this repeatedly for the next month or two, and you want to keep the records together; it is important that this be done patiently and non-critically in order to sustain your child's participation.  Praise her for her efforts keeping the records together.  
The idea is that over time, she will begin to see some patterns of what provokes her.

I also suggest you establish labels for different levels of anger.  In my manual I write about using colors for low, medium and explosive anger:  blue, yellow and red.  The idea is to help your child see that there are different levels of anger, and for her to see that she has better control at the lower levels.  

In the manual I write about how to tie her observations of early signs of anger with calming strategies.  You want to share with her how you calm yourself and have her choose some ways that feel good for her.  Then you practice together.  If she is willing, you could role play an anger provoking situation and practice one of the calming strategies she prefers.  

It is a gradual process of recognition of triggers and of developing calming techniques.  In addition, over time your daughter may realize that there are other ways to look at "provocations" (a different perspective) that might help her not feel so angry.  Finally, you want to reassure her that she is not "messed up," and that everyone has things that come easy and things that take time to work on.  Give her examples from your life, and point out what comes easy to her too.  

All the best, Dr. Dave Gottlieb

Sunday, October 12, 2014

Shy child hates to leave home, has outbursts

My son is 11. He has had anger overload issues since he was about 5. When he gets angry it does not last long. Most of the time it's because he lost in a game or he can't do something on his own. Otherwise he is very funny and sweet.

Now when he is at school he does not talk...does not get angry...instead he puts his head down on his desk.  I asked him why he only gets angry at home and he said because that would be too embarrassing. So he is aware of it. He tells me he has anger issues. He also is very shy.

The school thinks he has many emotional issues. Me, as his Mom, I think it's this anger overload...and he is very sensitive.  Is there any type of testing to get done to see what he really has? He is not on any medication.  He goes to school...which is a fight everyday...other than that he hates to leave the house.

Hi, it is possible to have anger overload and to be sensitive or shy as well.  It sounds like your son has some anxiety about leaving home, but you can get him to go to school, which is good.  Mild anxiety can best be overcome by going through with whatever triggers the anxiety.  In this way, the person sees that he can do it, and over time, anxiety usually lessens. 

It is good that your son recognizes he has an issue with anger since he will be more willing to work on it then.  It is also good that he does not explode at school.  This shows that he has some self control.  I would suggest you work on the strategies in my manual to help with the situations you describe:  when he loses a game or when he can't do something on his own.  Consider using emotional distraction (from the first half of the manual) and using a "mantra" that lowers his expectations about winning (from the second half of the manual). 

There is no test specifically for  anger overload.  Anger overload is defined as having frequent, intense rage reactions to disappointments or frustrations.  Children with anger overload can have other issues as well.  You mention the school thinks he has emotional issues.  Ask them to be more specific.  And if you are unsure what the underlying issues are, it might be wise to get an evaluation from the school psychologist and/or a local mental health professional who works with children and families.  By interviewing you and talking with your son, a mental health professional could advise you what issues seem most important and how best to work on them.

All the best, Dr. Dave Gottlieb

Tuesday, October 7, 2014

What can teachers do for outbursts in school?

Thank you for posting your article on Anger Overload. I have only just found it and have already ordered your book.  I am so relieved to finally find an accurate description of my son's behavior after 8 months of going to multiple therapists and experts -- all of whom tell me "he's unusually complicated" with multiple issues at play.  They all agree he has anxiety related to his learning disabilities.  But, the intensity and sporadic nature of his anger (despite two very patient, even-keeled parents) hasn't been explained...until now.

My son is a loving, cuddly, creative kid who makes friends easily.  As a competitive gymnast, he will practice back flips and dangerous stunts anywhere he goes (not just during his 9+ hrs/wk at the gym).  He has been diagnosed with reading, processing and anxiety disorders.  While he has shown signs since preschool of extreme anger when triggered, he can go for months without an episode.  Summers, vacations and sports practices tend to be anger-free -- school is the main location of his rage-episodes.  It appears to increase in frequency and intensity as the academic expectations increase.  He can be triggered by all the things you mentioned in your article (being told no, minor criticism, noticing other kids finish their test while he is still working, etc.).  I can't tell you how eager I am to read your book.

In the meantime, I have a question:  Do you have a recommendation for the teachers on what they should do when he gets into a rage-state?  He can't hear anything while he is in that state (hitting himself, kicking the desk, being verbally disrespectful to the teacher, literally covering his ears, etc.), but they can't just wait it out while the other children's learning is being impacted.  He does go to a private school with a Learning Specialist and Social Worker on site, but they are not always available.

Any guidance you can give would be greatly appreciated.

Hi, Yes, while at home a parent can ignore an angry outburst, in school this is usually not an option if a child is disrupting the class.  So one key is early recognition and developing an assortment of tools your child can use.  First, I would recommend the teachers record what is going on when the outbursts occur in the next couple of weeks.  You mention some triggers in your e-mail, such as minor criticisms and finishing his test while others are still working.  Once some of the triggers are identified, the teachers would develop possible interventions for each trigger.  For example, before mentioning a minor criticism, the teacher could point out something your son has done well, so that he is less likely to feel "injured." Your son can't keep critical comments in perspective yet, and that is not unusual for children with learning issues.  They get frustrated easily and sometimes feel inadequate compared to their peers. So the teachers could help him keep their remarks in perspective by pairing a critical remark with a positive one.

For testing, it sometimes helps a child with learning issues to take tests in a separate room so that they are not distracted or concerned with their peers.  Like my previous suggestion, this would be a way to prevent an outburst from  occurring.  

But what happens when your son is getting frustrated and the staff did not see it coming--and this will happen sometimes no matter how much planning the teachers do.  First, early intervention is important.  Are there warning signs before your son erupts?  Could the teachers have a "go to place" or a distracting activity that would help him calm down?  I would recommend the teachers talk with your son privately while he is calm, and explain they want to help him with his frustrations, and mention that they will give him a signal (it could be verbal or a nonverbal signal) when they want him to stop working and go somewhere (in or out of the class).  They would explain this is not a punishment but a way to help him "chill".  He could get points, or a positive note home, for following directions about using the chill place.  They would empathize with him that sometimes the work will be hard.  They could also say we all have trouble working when we get frustrated, so that's why it is good to take a short break then.

Once a child totally erupts it will be hard to distract him.  At that point, the teacher could either tell the class that your son is having a hard time and ask them to please try to let him calm down on his own, or he would need to be escorted out of the room.  The staff would explain to your son in advance where this place would be, and then without much discussion take him there as needed.  Depending on the age and size of your child, they may need help from a strong adult to bring him to that place.  It would preferably be different place than the "chill" zone.  The "chill zone" is often within the class, whereas when a child erupts, it is usually best to leave the class.

In the second half of my parent's manual, I explain also how to teach a child to use a catch phrase to help him with frustration.  This doesn't work during the anger overload phase, but can help if the anger can be caught at an earlier stage.  For your son, the catch phrase could be something like:  "School can be a pain sometimes" or "Yes, somethings are hard but other things are easy for me."  It would be important to practice saying the catch phrase to himself several times a day so that eventually it becomes automatic.  You would discuss with him some possibilities and pick one that he likes.  Another possibility is to help him think of a funny scene when Mom or Dad had trouble with something.  He could try to think about this when he is frustrated in school to help him realize everyone has trouble sometimes.  These latter strategies work better with children who acknowledge they can get very angry sometimes, and want to try to learn to control it on their own.

All the best, Dr. Dave Gottlieb  

Monday, October 6, 2014

8th grader becomes violent

I've been doing some research and came across your article/blogs on anger overload. This is the first I have heard of this and seems to really match what my son is going through. 8 months ago we found out he had a 'stroke' in the caudate nucleus region. It shocked a lot of doctors as he didn't have classic signs; he actually had hemi chorea as the major symptom. As a result he has been put on many meds from high dose steroids down to folic acid and aspirin. He has experienced side effects from majority of the big meds such as methotrexate. Witihin hours of his once a week dose he would become extremely violent and nasty. Each week the outbursts increased in severity and duration. We saw the correlation with the meds and were told to take him off them.
Since then the aggression and violence has definitely reduced. However, every few (4-5) weeks we have another outburst where he'll hit and swear and break things and it all starts with a minor issue such as telling him no. We can generally see a pattern and predict when they occur by his body actions and facial expressions. For 1 -2 days prior we can swerve him off track if we see him starting to fixate on different topics. However when we do this we've noticed it only prolongs having an outburst. It's like he 'needs' to have them.
He is generally a pretty good kid, gets on well with others, is extremely intelligent (his latest neuropsych testing puts him well above his age level); it is just these periods that are really worrying and affecting our family of 5. We realize he has gone through a lot in the last 8 months. We are a pretty positive thinking family and are just extremely grateful it's a better outcome than first thought. Our biggest concern is his instant change from the loving child we know to an aggressive child who has a completely different person inside him.
I am writing to you as I feel I have exhausted my local community. He had been going to counselling in the past but due to unforeseen circumstances he had to change counsellors and hasn't been available to go back yet. The neuro team has been great for medical questions but they always manage to see the polite well behaved child and seem to think he's just preteen and has a lot happening to him. All outbursts have been at home and majority have been whilst his father is away.
My biggest worry is how to help him. He became that violent yesterday, all our cooling down techniques had failed, and after 2 hours of being left alone he was still trying to hurt us. He had tried a number of times to smash windows so I ended up calling police...more as a shock tactic...thankfully it worked.
We are beside ourselves as how to help him and how do we punish someone who seems to disappear once the outburst is over. He is very remorseful once done and tries to make things better which makes things hurt more for us.  My question is do you think my son may have anger overload or is this just him retaliating from everything he's gone through recently. I understand it's a hard age anyway.
Any input you have would be greatly appreciated.  He starts high school next year and I think if not helped now...things are only going to get worse.
Hi, First of all, let me say it sounds like a lot of your interventions are excellent, and I can see why the latest violent outburst was concerning.  I think you did the right thing by calling the police, because your son needed to see that you would do what is necessary to protect him and yourselves.  While he is calm, think (with him) about a cue word that you will only use if he is getting to the point that the police may be called again.  It could be a color, like the word red, or the name of a mountain peak--the color, or mountain, represent the idea that his anger is getting extreme and dangerous.  Let him know that when you use that word, he needs to stop physically harming people immediately, but that he can scream or use verbal means to express himself.  At this point in time, you would not call the police even if he were using extremely obnoxious language.  You would be trying to show him that there is a particular limit for violence because everyone's safety is your number one concern.  In the future you can work on verbal alternatives that are more appropriate expressions of anger.
 It sounds like you see early warning signs often and can head off the anger in some of these cases.  Terrific.  Continue to develop alternatives to distract and change the focus from whatever he is getting frustrated about.  Also, try to work with him when he is calm on understanding different points of view and how to compromise.  I explain how to teach these techniques in the second half of my parent's manual.  Hopefully, over time he will be able to use the strategies to change his feeling state from frustration to contentment.
You mention the brain "stroke" and how sometimes it seems like he needs a release.  Strokes in young children are very rare, and I am not an expert on them, but I understand that the caudate nucleus is involved in many brain functions, including motor and cognitive control.  I wonder if the neuropsychologists you are working with have any other ideas about how to work around that area of the brain and help other regions develop cognitive control.  I'm hoping that the cognitive techniques I write about in my manual can help his brain develop more control.  Anger overload is a condition that can have different causes.  I'm wondering how often he had angry outbursts before the "stroke" you describe.  Did they happen before, but get worse after?  Usually when there is brain damage of some kind the techniques I describe in the manual take more time and practice.  But the human brain is malleable, so keep using the techniques you have already described in your post and try some from my manual.  The brain keeps developing throughout adolescence and young adulthood, so there is hope that with continued "practice" you will see improvement. 
Hang in there, and all the best, Dr. Dave Gottlieb

Wednesday, October 1, 2014

Door slamming and "smart mouth"

I am writing to you because we are at the end of our rope with our son and his constant anger outbursts... He talks to us like we are nobody and gets so mad. He slams doors, then comes out and starts in again and has a smart mouth. He does not talk to his peers in this manner and they all say  how sweet  he is.. We have not had him tested for anything, he is starting to have trouble in school with following directions or putting the answer down on paper and then trying to explain the answer.. I have worked with kids that are ADD and ADHD and I don't see any of those things in him, but I could be blind to it since he is our son.. The more we take away from him, he gets worse or if we say we are going to do something about it , then he says we don't love him.. Any help or advice would be great so that we can get this under control before it gets worse.
Thank you for your time

Hi, Anger overload often happens more at home than with peers.  It is a good sign that he realizes he cannot act that way with peers or else they would avoid him.  Now how can you reduce the slamming of doors and the smart mouth at home?  First, I would try to record the times he has outbursts over the next couple of weeks.  What is going on at the time?  What was he doing before he got angry, and what were you doing or saying?  After two weeks, look over your notes and see if there are any patterns.  Are his tantrums more with one parent, more during a particular activity, more when a parent asks him to do something? There will be outbursts that do not fit any pattern, but hopefully you will see a pattern(s) for some of them.

The next step is to think about whether you can change the sequence that leads to an outburst.  For example, if an outburst is more likely when you ask him to turn off the computer and start his homework, you might re-arrange the schedule in the future so that he does not start on the computer until his homework is done.  Basically, the idea is to get him to do what you want before he enjoys time doing what he wants.  If his preferred activity comes second, he will be more motivated to cooperate with you.

In my parent's manual and in other blog posts I describe other strategies, such as emotional distraction and when to ignore a child.  One recommendation about ignoring:  it is generally not a good idea to discuss consequences while a child is having an outburst.  You can talk about consequences after everyone has settled down.  Also, you want the consequence to be targeted to a specific behavior, not to anger per se.  Many of these children have short fuses, and so you will not eliminate all expressions of anger.  But you could target door slamming, or a particular obnoxious word or two.  Help him to see when he is calm what words would not trigger the consequence.  Also, pick a consequence that he cares about but that is relatively short term, from as little as an hour to a day at most.  It does not matter whether he says it bothers him or says that you do not love him.  Apply the consequence when everyone is calm, and then after a few weeks, think about whether the behavior you have targeted has decreased in frequency.  If it has, then your consequence was successful.  If there has been no improvement, then you should think about changing the consequence, or trying a totally different strategy.

In my manual I describe strategies parents can employ without a child's direct participation, and also strategies that involve discussions with your child.  The second half of the manual is about teaching your child new skills to improve self-control.

If your son continues to have difficulty in school with directions or with comprehension, you might ask the school psychologist or a private psychologist to evaluate him to determine whether there is ADHD or a learning issue affecting his performance in school.  Some children with ADHD have trouble with attention, but are not hyperactive or impulsive.  The first step regarding his school performance might be to consult with his teacher and/or school psychologist or social worker.  

Best, Dr. Dave Gottlieb