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

No comments:

Post a Comment