Tuesday, December 16, 2014

What to Do If Tantrum Disrupts Dinner

My wife and I are presently reading and working through your workbook entitled "Anger Overload in children".
We have a 7 year old boy who will have a tantrum, let's say at the dining room table or while someone is playing piano as examples.  We will ask him to leave the room and go to his bedroom until he has calmed down.  Our challenge is what to do when he will not comply with the request, as his tantrum then severely disrupts the rest of the family's experience with whatever they are involved (we do not live in a very large house).  You suggest in your book that we should ignore the tantrum, however in order to get him to his room, we must continue to give him attention.
Do you have a suggestion for this issue?
Thanks so much in advance!

Hi, you ask a very good question that I get in my clinical practice as well.  There are several possibilities.  One is to have a "back up" consequence that applies if he does not go up to his room when he is told.  You would talk about the back up consequence at some other time when he is calm.  You want the back up consequence to be something short term that he will miss, such as a favorite toy or game.   It has to be something he really cares about.  Then the next he next erupts, you would ignore him, and later when everyone is calm put the back up consequence into effect.  The downside of this approach is that he may escalate again when you impose the consequence, and also you still have to put up with the noise when he does not go to his room.  Furthermore, if he is in a huge tantrum, he will not care about the back up consequence, as he is not thinking rationally then. Your goal with the back up consequence is to have him consider it in his mind when he is only a little angry, that is when he is still rational.  Then if the back up consequence is something he cares about, he will eventually cooperate more often.  So you would need to ask him to go to his room before he gets too emotional, and this is not always possible! 

Another possibility is to set up his room as a relaxing place to go play when he is not angry.  Then you would cue him before someone starts at the piano, before he gets mad.  The downside here is that you cannot always predict which situations will cause a tantrum. 
A third possibility is just to ignore the tantrum and try to talk or play the piano as best you can.  Over time, his screaming will subside if it was being "fed" by your attention.  Remember that nothing you say at that point will help.  The problem with this approach is that if your child is so angry that he is not thinking rationally, it may take him a while to soothe himself even if he is not getting your attention.

Finally, see if you can identify a theme for what is causing some of his tantrums.  Is he jealous that others are getting attention at dinner or at the piano?  Then you may be able to head off a tantrum by a reassuring comment or a distracting activity (like a hand held game or drawing materials).  Let's say the theme is that his sibling is getting your attention at dinner.  Then before you start talking with his sibling, you could say to your 7 year old something like "now it is your brother's turn to talk, but I will give you a turn in a few minutes."  Then compliment him while he is waiting and remind him it will soon be his turn.  Try not to wait too long the first few times you try this. The question therefore to ask yourself is why does he have tantrums at the dining table or while the piano is being played, and see if you can come up with a reassuring statement or a distracting activity for him that will head off a tantrum.  It is harder to deal with of course once the tantrum occurs.  

Best, Dr. Dave Gottlieb 

Wednesday, December 3, 2014

6 yr old withdraws when angry

I am concerned with one of my granddaughters. She is 6 years old; she has some anger issues that really worry me. It kind of sounds like anger overload, except she does the opposite of yelling and screaming.  She will go sit on the couch, floor, corner, etc...and not talk, she likes to seclude herself, and if we try to talk to her she gets more upset, and also says troubling comments.  Like "I shouldn't be in this family", "I wish I was dead". I'm really concerned. Her mom and dad are divorced since she was about 2; they argued in front of her until recently. She is a wonderful, sweet little girl when not upset. I'm considering buying your book.  My son works out of town. Between her other grandmother and me we help watch her while her mom works.  Please any advise would be greatly appreciated. Thank you.

Hi, Usually children with anger overload are explosive rather than withdrawn when angry, but still your granddaughter sounds like something is really bothering her.  Think about what some of the triggers have been: What is going on when she withdraws silently?  Make a list of a few situations when she gets upset and then think about what are the themes:  Has someone said something to her that she does not like or that she misinterprets?  Is she disappointed about something?  Does she feel badly about something she has done?  If you are unsure, keep track of the situations in the next two weeks when she gets angry.  

One approach then would be to address the underlying "hurt."  Maybe offer a reassuring word, or else a distracting comment, but do not talk a lot while she is withdrawn.  Talking with her while she is angry seems to bring out more anger and her negative comments about wishing she were dead.  Usually when children make these comments only when they are angry, it is a reflection of their anger and not their wish to hurt themselves or die. But if she makes these comments even when she is not upset, or if they are frequent, you should consider a consult with a mental health professional in your area to determine if your granddaughter has an underlying depression.

When she is calmer, try to engage her in a conversation about what bothered her.  Even if you think she is misunderstanding or exaggerating something, show empathy for what she feels.  Then gently help her see that there might be another way of looking at things (if she is not seeing something).  But if she feels hurt by this, then stop and let her know you love her and understand that her feelings were hurt.  Empathy can go a long way toward helping a child feel better.  

You mention that her parents used to argue in front of her.  That is likely to be one cause of her distress. Hopefully her parents will cooperate about child raising issues.  Your granddaughter wants to love both her parents no doubt, and does not want to hear arguments, nor would she want to hear negative comments by one parent about the other.  If the parents' tension recurs, it would be ideal if they sought help from a family therapist.  Even though they are not married, they still are parents together and it will be best if they can cooperate when it comes to the children.  It is great that you and the other grandparents can help out when the parents are working or out of town,  I can tell you care a great deal about your granddaughter, and if things don't improve, consider asking the school social worker if she can talk with your granddaughter, or ask the child's doctor for a recommendation for a therapist in your area.

Best, Dr. Dave Gottlieb