Thursday, December 17, 2015

5 yr old has daily outbursts

I just found your blog while doing a "google search" about anger management/tantrum issues in 5 year olds.  I guess I'm just looking for a little insight.
At first reading about anger overload, it sounds very much like it describes my son.  I have two boys, an 8 yr old and an almost 5 year old.  It's my youngest son who is having the anger outbursts.  He's in preschool 3 days a week and will be starting Kindergarten next September. 
He usually has more than one but less than 5 outbursts of anger in a day.  He is very physical and loves to have wrestling time with Dad or with his older brother.  There is usually lots of competition between the two brothers.  Older son usually escalates things and feels the need to compete with the younger, which generally makes issues worse. 
When he becomes angry it is escalated very quickly and he can become irrational.  A typical instance would be he was playing with older brother and decided he didn't like something, so he kicks, punches or hits him.  I try to reprimand to send him to his room for a time out but am met with him yelling at me, telling me I'm a mean mommy.  He wishes he had another mommy.  It could even be something more simple such as me asking him to eat another bite of his dinner and he might start yelling that I'm a mean.  Sometime he can get over a bout of anger fairly quick and other times it takes awhile or escalates.
He does have tantrums sometimes that result in extreme bouts of crying where nothing we seem to do helps him.  He doesn't calm when I hold him, yet he'll still want me to be with him.  Usually tantrums happen from him not getting some item he thought he'd get or when he has just woken up from a nap.  He is still usually taking daily naps of about an hour.  This morning he started yelling at me about a candy cane that he couldn't have until after school.  Then the candy cane broke and it quickly turned into a crying, full blown, tantrum.  Tantrums with him usually last anywhere from 10-40 minutes depending on the situation, or if he's tired.  Occasionally he'll hit or motion to hit me or his father when he's very upset.
Once he's calmed down from an instance he'll usually apologize on his own accord and be very calm and caring.  But it doesn't take long until his next outburst.  We talk a lot with him about taking a time out for himself to gain control.  About how hurting people is never okay and he's allowed to tell us how he feels, rather then hurting to express himself.  He's stated that when he gets upset that he's really frustrated and lot control.  We also tell him how he can do some deep breathing or just walk away instead of letting something upset him to the point of anger.

He has had some issues with hitting, yelling at or kicking kids at school.  He seems to be a little better now than he was at the beginning of the year, however the teacher said he still sometimes has some problems, but she won't tell us about it unless it's more of an extreme problem.  She has a theory that my son, along with a select other number of boys in the class which are also younger siblings, have an extreme sense of needing and demanding to be "top dog" since they can never be top at home.  I can see how this may be an issue with my son.  He does always want to be the "leader" and ahead of big brother and recently went through a phase where he kept asking, "when I'm 8, can I do ... too?
I'd appreciate any ideas or tips you might have to help me deal with his angry outbursts.  Thank you.


It does sound very frustrating.  You mention several triggers:  1) things not going his way in a game with his brother, 2) not getting an item he thought he would get, 3) waking up from a nap.  It helps to know some of the triggers because then you can anticipate when he might have an upset and try to avoid the situation, if possible.  If you can't avoid a situation, you would try to lower his expectations in advance.  For example, in games with his brother you would tell him just before he starts that he is probably going to lose because his brother is older, or you could say everyone loses sometimes.  For things he expects, you would lower those expectations.  For example, you could say we only have candy at _____time.  You do this every time you think he is expecting something, or every time he is about to play with his brother.  

If he still escalates you could try emotional distraction.  You would say something amusing, silly or captivating to your son in order to try to change his mood.  I write about this more in my parent's manual.  But if he tantrums, you say as  little as possible so long as everyone is safe.  At that time, do not talk about consequences because your child will not be rational when he is in overload, and will likely escalate the more you say at that point.

For waking up for naps, you could do a warm up activity that he likes, whether it is reading a story, watching a short video, eating a snack--something that is not likely to trigger an outburst and something he likes as he is becoming more awake. 

You mention he might want to be the leader, in which case, try to think of ways he can be a big boy and help you--maybe in the kitchen he could  help set the table.  It has to be something he wants to do, and something you make a big deal over how much you need his help and how much you appreciate it after he helps.

I know this just scratches the surface with the number of tantrums you face daily.  But if you can make some headway with some tantrums, it is likely to help everyone feel better, and he will begin to see the benefits of having self control, i.e. you praise and listen to him more when he has self control (and ignore him the best you can while he is in overload).  

Best, Dr. Dave Gottlieb

Monday, December 7, 2015

9 yr old with OCD and anger overload

Dear Dr. Gottlieb,

We bought your anger overload manual for parents, and it described perfectly what we are seeing in our 9 year old girl who has OCD.

In your experience, are your strategies effective on kids who have anger overload from OCD?  Would any of the techniques you offer need to be modified as we continue to support our daughter?

Are there any other resources you would recommend for this combination of symptoms?

Many thanks.

Hi, A book I have found helpful in working with children with OCD is "Talking Back to OCD" by Dr. John March, a psychiatrist from Duke University.  He has an approach for OCD that is similar to what I recommend for anger overload:  Teach the child how to be the boss of her thoughts.  

Some of my strategies are not actually taught to the child but are employed by the parents, especially at the outset, but then the child becomes a partner and is taught ways to be in control.  For example, one strategy is using mantras.  This is explained in some of my previous blog posts and in my two parents' manuals, and can be used for anger overload and for OCD.  Mantras are ways to help children take a different perspective and thereby help them feel more in control of their anger.  

The strategies in my manual can be employed with children who have OCD.  Think about what some of her routines or obsessive thoughts are, and also think about what some of he anger triggers are.  How much overlap is there?  Does the anger come when she is being rigid and can't adapt well to the demands of the situation.  Will humor and emotional distraction work to help her move on?  Or will new mantras help her look at the situation differently and prevent her getting into a rigid behavior pattern?  

If the problem is obsessive thoughts, and not ritualistic behaviors, try to teach her that she can be the boss of her thoughts, and maybe draw a picture or sing a tune of her "beating" the thoughts.  Dr. March's book and my manuals speak to changing a child's thoughts. Practice the new mantra and admire her whenever she tries to use it.  Make sure she does not expect it to work perfectly, because OCD children sometimes expect themselves to be perfect.  Trying the new strategy would be the goal, whether or not it helps right away.

Do some of her OCD habits come after she is angry?  Does she have negative self-talk and guilt after she explodes in anger.  In that case, you can forestall the OCD by using the strategies in my manuals to lessen anger overload.

Basically, think about how the two issues overlap, and then focus on the initial triggers to to try change her response.  First, you would keep an anger diary, so to speak, in order to see how the two issues interact and what some of the triggers are. Then you would look through the manuals to apply the strategies to those triggers.  

Best, Dr. Dave Gottlieb

Wednesday, December 2, 2015

5 yr old acts out for no reason

Hi Dr. Dave,
My 5 year old son has anger overload.  I recently purchased your Parent's Manual...the explanation is spot on and your approaches to when to intervene have really helped.  My son has 2 triggers that come together as one main trigger.  He doesn't like to be corrected (fussed at) and doesn't like to lose.  Combined, he easily disappoints himself.  

However, he will sometimes purposely disobey, for no apparent reason, and I will correct him.  It is almost as if he goes into this dark, vindictive world with the purpose of receiving negative attention.  We make a point to praise positive behavior, so the negativity out of left field is very upsetting.  His dad and I have been divorced since he was 18 months and he has never displayed any of this behavior with his dad (we have 50/50 custody and are amicable). Besides me, he had one anger overload outburst at school recently.  The triggers are random and seem to have no apparent reason.  Thoughts?  I should also note that he is very intelligent, well above his peers, and has many friends (no social anxiety).

Hi, It sounds like you identified a couple of his triggers, but there are times your son explodes and it doesn't fit a pattern, other than maybe to get negative attention.  And you mention that this happens with you but not his father.  Keep track of when he has overload the next few weeks, and see if there are any patterns besides the two triggers you already figured out.  Is he tired, frustrated by something else, or wanting attention?  

Your email suggests the latter as a possibility (he wants attention) even though you praise positive behavior.  If that is the case, if you can catch it early, try to use emotional distraction. You could make a silly unrelated comment, or talk about something he likes to talk about. But if he is already in anger overload, try to say and do as little as possible,  If he is wanting attention, you don't want to give it when he is in overload.  When he has calmed down then do a short activity with him, or talk about something he might be interested in.  

I know it must be frustrating since you already praise his positive behaviors. However, sometimes children get bored or feel out of sorts and want to interact with their parents, even when they have been getting attention throughout the day.  We want him to learn to reach out in a positive way.  When he is calm, like at dinner or bedtime,  you may even suggest ways to get your attention if he feels bored.  He could ask you a question, or come give you a hug, for example.  Suggesting this to him won't lead to his immediately doing it. However, over time he may remember how to connect when he is bored.  

The above comments assume he is seeking attention.  But if you identify a different trigger, then your approach may be different.  You might also ask his father if he uses any strategies that help.  You mentioned this does not happen with Dad.  Maybe you are gentler, and he is "experimenting" with this negative behavior.  See if you can figure it out, without giving him too much attention during the overload phase..  Best, David Gottlieb, Ph.D.

Saturday, November 28, 2015

Will ADHD medications help?

I have a 7 year old son who is struggling with the same issues you discuss on your blog. I am a mental health professional and work with kids but it is difficult when it is my own child. We have him on a medication trial with concerta 18mg but it only seems to make him tired. He is in therapy but it is not really helping. Would straterra help. What do you suggest?

Hi, You mention two medications that can  be used for attention deficit disorder (ADHD).  If your child has ADHD, then your doctor may try either of those medications. Most doctors will try a stimulant like Concerta first.  Concerta is a time released form of ritalin.  More research has been done on stimulant medication for ADHD than any other class of medications, and stimulants have the highest percentage of positive results: from 70 to 90 per cent effective in reducing symptoms of ADHD.  The other medication you mentioned Strattera is sometimes used for ADHD, especially when a child has side effects to stimulant mediation.  However, I have not found it to be as effective in treating symptoms of ADHD.  

It is important to add that these medicines are not typically used for anger overload.  There is no research that I am aware of that they are helpful in the absence of ADHD.  If your child has anger overload issues and ADHD, then ADHD medicines may help your child self-regulate, i.e. become less impulsive.  And if your child is less impulsive, he may be able to pause and think more often when he is frustrated.  So you may then see some reduction in anger overload.  Still, it is unlikely that anger overload will disappear, and I would recommend you also work on the strategies in my anger overload manuals.  These cognitive behavioral strategies have been found to help reduce anger overload in a number of research studies of children.

Take care, David Gottlieb, Ph.D.

Wednesday, November 4, 2015

Will children outgrow anger overload?

So I have been reading your blog and plan on reading your books soon.  It sounds like my 6 year old could be any one of the kids mentioned in the blog.  I was wondering what the over all outlook for these kids are?  Do they ever "grow out of this"?  What can I expect when my child is a young adult in college or at 25?

Hi, You ask a good question.  I can't tell you exactly what will happen for any individual child, but overall studies, looking at groups of children, show that there are significant changes when children learn cognitive behavioral strategies, like those I present in my anger overload manuals.  The studies compared using these strategies with groups that did not receive therapeutic intervention, and the studies found that the group of children taught to use the strategies handled their anger better.  

What hasn't been studied yet is seeing what happens to these children over many years, in other words, a longitudinal study.  Do the children maintain their gains over a long time period, and what percentage are still having anger overload many years later?  We do know that the brain keeps maturing throughout childhood and early adulthood, and we do know that practice using these strategies is beneficial over the short term for most children, so we believe that most children will continue to improve as they get older.  

Questions still to be answered by future research:  Some adults have anger management issues.  Did these adults receive help as children?  Is there something about their biological or emotional development that interfered with their learning better self control?  We know that adults with anger problems do have subtle differences in parts of their brain.  But we don't know how this happened. Were there other life events that impacted them in a negative way?  For example, we know that if there are serious mood problems or drinking problems, there often are anger problems as well.  But more research still needs to be done.

Hope this brief overview is helpful, Dr. Dave Gottlieb

Tuesday, October 20, 2015

Medication versus behavioral strategies

Our "small for his age" and academically gifted 7 year son suffers from frequent anger outbursts and a co-worker recommended your Anger Overload manual to us. The 8-year-old you describe in the book could be our son. He can be a delightful boy when everything is going his way, but he cannot cope with even minor frustrations and disappointments without flying off the handle and turning verbally and physically abusive. It is severely impacting our family life and, though he generally keeps it together in school, has started to bleed into his social life.

In addition to seeing a CBT therapist, we have been diligently applying the strategies you recommend. Our son has great self-awareness and insights into his own behavior so he has been good at the worksheets, but when he's in anger mode he cannot stop and think rationally. Also, while we have learned to recognize his triggers and head off a lot of problematic situations at home, we can't protect him from every frustration and disappointment in life. 

This brings me to my question. Our son has a NOS diagnosis because he does not meet the full criteria for ADHD, ODD, or any mood disorder. Do you ever recommend medications like Intuniv for children like this? Our therapist is pushing for it, but we are reluctant. Do we just need to give these strategies more time, or will the medication help him leap forward?   Do you find, in your practice, that children tend to outgrow anger overload as their brains mature?

To my knowledge Intuniv is sometimes used for ADHD and has a "slowing down" effect on hyperactive behavior. I would check with a psychiatrist if you are considering it. The strategies in my manuals take time, often several months to begin to see changes, and may not work as well when his anger rises real quickly. If you can catch the frustration early sometimes, the cognitive strategies in the second half of the manual will be easier for your son to use. Otherwise you will need to rearrange the sequence, or lower the expectations, or use emotional distraction, or use mantras and imaginary stories (described in volume 2) ahead of time. The work you do with your son before an outburst, or when you review the day at night, is key for teaching children to have better self control.  I haven't had a child with anger overload take Intuniv so I'm not sure how it would work, but I suppose if it lessens his quick anger response it could be helpful. But this is new territory and I'd check with an M.D. who is familiar with these medications and who works with children.

Regarding changes in self control as a child matures, it is hard to say for sure how much is maturity and how much is due to practice because there are no controlled longitudinal (long term) studies of anger overload. Short term studies of anger indicate that cognitive behavioral strategies like I outline in my manuals are effective. Keep using strategies like labeling levels of anger and discussing options when he is calm, and developing mantras (sayings) that you can use before he gets upset to remind him to lower his expectations or to look at an issue in a different way, It may not help prevent overload immediately but it keeps the importance of self control in his mind and helps him begin to think about a frustrating situation in a different way. Let him know this is important, and you and he will keep working on it with him. Empathize that it's not easy but "seed" the idea that as he matures he will be able to do it, You want to communicate repeatedly that you are going to work as a team, and praise him (when he is calm) if he tries to use the strategies.  When he goes into anger overload, say as little as possible and wait until later, and then calmly review the trigger and how else he could think about that situation in the future.

Best, Dr. Dave Gottlieb

Tuesday, October 6, 2015

11 yr old escalates despite rewards

Dr Dave,

I have been reading your blog and everything sounds like my son.  My son is an 11 year old.  Mr popular at school, every person who meets him instantly falls in love with him.  He has this thing about him that instantly attracts people.  He is an amazing little boy, respectful, listens and follow the rules.  Teachers LOVE him and do not believe me when I explain his behavior at home.  I almost get the look of "What are you doing to him"  

The issues we have with him is his anger issues and how he treats his sister, myself and my husband.  Generally he is a great kid BUT when he gets angry....Watch out world.  I have changed some of the things I am doing with him and the major one is he has to earn his electronic / internet time on a daily basis.  His behavior in the morning, before school, after school etc.  

Yesterday morning we had an issue when it was time for him to leave for school (he walks); he decided it was too cold for him to walk and I needed to drive him to school.  I told him he needed to wear his jacket and he will be fine.  Apparently, he left his jacket at school so he felt he did nothing wrong and I needed to drive him.  I explained he could wear a sweatshirt and there were multiple excuses why wearing a sweatshirt would not work.  At this point his anger is set into high gear and he starts walking around the house in a circle almost in a panic mode looking for something to wear as if something was going to fall from the ceiling.  He is crying and carrying on like a toddler and insisting I drive him to school.  I explained calmly that this is not my fault he left his jacket at school and I will not drive him to school based on his behavior.  After screaming and crying and carrying on he finally left for school. 

When he came home from school he was angry with me and tried fighting and arguing again because he believed he was not in the wrong and wanted his gaming time.  I continued to stay calm and tried talking to him but his anger and the things he was saying I knew there was no point.  We have talked and agreed upon when he gets that way he needs to go into his room and calm down for a bit and then we can talk about it.  This time he REFUSED to go to his room to calm down and was screaming at me and telling me he was calm and we were going to talk about this NOW.  At this point I said well I am not calm so I need to walk away.  In his angry voice with attitude he said fine walk away you do not love me and you are not a good mom.  

After I was able to calm down I came back inside and he immediately hugged me and apologized for the way he acted.  I hugged him and told him I love him.  Things were fine at this point until I caught him on his IPOD playing on the internet.  He made up reasons on why he was on it and was justifying why he felt it was ok he was on it and that I should have not left his IPOD anywhere he could find it. 

At this point I reminded him of our agreement that he will be be able to go to the Homecoming Parade after school and the Homecoming football game ONLY if he had good behavior for the week and since he was unable to follow the rules and his was not showing good behavior he was not going.  That is when the anger started again and it was nearing time for bed and told him he needed to go to bed.  He attempted to argue with me and I just pointed to his bedroom.  

He finally went and laid on his floor punching his fist on the floor (when he gets to his rage part he will stand with his hands in a fist and shake) I did not say a word to him.  Next he turned his bedroom light on, screamed at his sister for no reason, and started doing sit ups in an angry way.  I went to his bedroom and turned his light off.  He turned his light back on and I turned it off again.  He screamed why are you doing that and I said you need to get in bed.  Of course he yelled saying he was not tired and was not getting in bed.  I did not respond and eventually he did get into bed. He cried and screamed for over an hour.  This morning he was calm when he first woke up and tried debating with me a different punishment for him so he could go to the game and parade.  I told him that was impossible and he needs to learn that when he has his anger fits he is not going to get any privileges.  He cried, punched things, tried telling me he was not going to go to school and how I hate him and tried telling me things his sister had done so I would ground her also.  

This is just an example of what happens.  Most of the time  the problem with his anger is when he does not get his way.  He feels everything he does is fine and he should just do whatever he wants.  And if things are not going to his plans then everyone around him needs to suffer.  I have been watching his anger get more and more severe.  He has not ever hit my husband or I, however, he has hit his sister which is more a sibling hitting type of behavior (not that I think it is ok).  I worry his anger problems are going to turn into more of a rage that becomes violent towards others.  

I read trying to turn the child's attention to something else but it happens so quickly and there is no reasoning with him.  I know this takes time and A LOT of energy which I am willing to do but I am not sure I am handling everything the best way or the way it should be.  It is also very hard for me to stay calm sometimes.  This is why I have started to walk away and not raise my voice.  Do you have any other suggestions or ideas of what we can be doing better.  This also tends to happen when my husband is not home (in the mornings after he leaves for work, or after school when he is not home etc.)  He has been around when it does happen but majority of the time it occurs when he isn't here. Sorry this is such a novel any help would be appreciated.

P.S. We have started using a code word when he gets upset and that worked for 2 days and now today he decided he does not care about the code word and will not use it anymore.  Of course I let him know that this is my home and my rules and these things are not for debate that we are using them to help all of us out. He didn't like that answer either.

Hi, I can tell how hard you are trying, and many of your ideas are excellent.  I like that you are walking away when you get upset; I might even walk away sooner, and talk less with your son when he is angry.  It is okay to review with him the day's events when everyone is calm, but do not start explaining things if he is still angry, because then he will escalate (as you have noted).  

I would rely less on week-long incentives and consequences.  Anger overload can happen several times a day, and it is too hard for a child to try to hold it together the whole week. Furthermore, your child will be less willing to work on his anger if he has already blown the reward for the week (e.g. homecoming).  If you are going to use incentives, I'd prefer you use the daily ones, like what you are doing with the IPOD.  I would also encourage you to still offer the reward if he makes an effort.  Children with anger overload are not always going to be able to calm down. There is a biological part to their anger, so you will need to use various strategies, and over time, the frequency and intensity of outbursts will lessen. I would establish a signal, like what you are doing with the code word.  If your son can go to his room when you give him the signal (within a minute or two) then he could still earn the reward, i.e. IPOD time.

If you can catch his anger at a lower level, apply the signal then.  Many of the strategies in my manual are more effective the sooner you can see signs of a child getting upset.  Once he is in overload, say as little as possible.  The more talking you do, the more he is likely to escalate.

The second half of the parent's manual explains cognitive strategies you can use, and volume two of the manual offers additional cognitive strategies.  One goal is to teach your son to be able to observe his own emotional state.  I recommend using labels to categorize anger as low level, medium, and overload.  If you can catch his anger at low level, you might mention out loud whatever label you choose and implement a calming strategy at that point. The strategy could be to distract him, like saying "wait a second, I need your help lifting this in the kitchen and then we can talk."  By re-directing him to do something immediately, it gives everyone a chance to catch their breath.  You'd have to have something in mind that you need help with, or you can use other forms of "emotional distraction" such as pointing out something funny you heard on the radio or television that day.  Or asking him about his favorite sports team.  

Whether or not you catch his anger at a low level, you would later that evening (when everyone is calm), help him see why you labeled his anger as low, medium or high, and suggest to him that over time you will work together to help him prevent overload.  You can explain that the more he can identify the level of anger he is feeling, the more control he will have (someday when he is older, he will be able to implement strategies on his own), and the more respect and appreciation he will receive form you and from other people he lives with someday.  

You might also think about why overload happens less when your husband is around.  If he is doing something that works, try to adapt it for you to use when he is not there.  

Other sections of the manuals explain how to teach your son about other points of view,how to use catch phrases and mantras, and how to look for patterns.

Best, Dr. Dave Gottlieb   

Wednesday, September 16, 2015

Gifted 9 yr old wants more freedom

In reading your article on the topic, I understood some of the underlying issues with children can often stem from having learning disabilities. Our 9 year old son presents as a child with anger overload, but actually is very bright, likely gifted- although I am resistant to having him tested. 

Are there examples and guidelines in your manual on how to deal with this type of child? We are challenged by his outbursts that are often triggered by our objecting to him engaging in activity that we feel is way above his age level, not allowing him the types of freedoms that are generally reserved for teens and pre-teens and his vehement protests to treatment toward him he feels is unjust (generally compared to his brother or others in his peer group). He has huge issues with our authority but thankfully it does not permeate into his school surroundings, Rather he has decided school, in general, offers him little and his teachers are, well...'dumb'. We are challenged every day. I'm hoping your book can assist us in putting a realistic approach in place that can help moderate his outbursts and help him cope until he matures to the point where his somewhat advanced mind catches up with his young body.

Hi,  First, what I would recommend is keeping track of what rules he feels are unjust.   What kind of freedoms does he want?  In other words, what are the issues he is getting angry about?

Then you would either try to anticipate these issues, and let him know ahead of time what the plan will be, or use "emotional distraction" (a technique discussed in the first half of my parents' manual and in other posts on this blog) to try to prevent outbursts.  You want to try to avoid a back and forth argument.  

In the second half of my book, I write about teaching your child new skills to cope with anger.  Here you want to teach your child self-observation skills and teach him about other points of view.  In my manual I give examples of how to do this.  One other technique to consider is to teach your child how to compromise.  Is there some part of what he is asking for that you would consider it he would lower his expectations?  This kind of discussion is best when everyone is calm, not in the midst of an argument.

You mention your son is bright, but also you bring up the topic of learning disabilities (LD). Does your son have a learning disability that is contributing to his outbursts?  If so, you would want to work with his school to address the LD issue, as this would likely help him deal with his anger better. 

Take care, David Gottlieb, Ph.D.  

Wednesday, September 9, 2015

3 yr old with high energy and melt downs

Good morning,

I am the grandmother to an adorable three year old girl. I am also a social worker looking for answers. There is a history of mental illness in my maternal family with ADHD, OCD, Bipolar Disorder, generalized anxiety, and Schizophrenia. My granddaughter is usually friendly, loving and kind. However, when she has her "melt downs," she rages and screams, uncontrollably for up to half an hour. They occur a minimum of five times a week.  She contorts her body, twists her fingers, and has extraordinary strength.  She does not injure herself or breaks things.  

Any little thing can trigger her.  For example, her sandals came off and she wanted to put them back on instead of me, or she wants her teddy bear, but she wants someone else to retrieve it although it’s right next to her.  It’s almost as if a switch goes off in her brain and she needs to go through the melt down.  Sometimes she becomes fixated on saying certain words during her melt down and keeps repeating them.   Her parents and I have tried to see if there is a pattern, like if she is sleepy, tired, hungry, had too much sugar, etc.  But there seems to be no pattern.  

We have done time out, ignored her, but nothing seems to diminish them.   We talked to the pediatrician who said these are tantrums and she will outgrow this behavior.  But….. it doesn’t seem like a regular tantrum.  Additionally, she is fearless and a risk taker in the playground and at home.  She has lots of energy and can spend hours in the park, or jumping in those party bouncing houses without taking a break.  When she is watching a video clip on my phone that she likes or listening to a song, she repeats it like 25 or more times. Any suggestions or strategies we might use?  At this young age should we see a child psychologist or psychiatrist?

Hi, Given your granddaughter's high energy level, intense tantrums, and family history, I would recommend you consult with a child psychologist or child psychiatrist.  Your pediatrician is also right that it is not uncommon for three year olds to have tantrums.  But the family history and her high energy level makes it possible the tantrums are an early sign of anger overload and may not remit in the next couple of years without working on strategies to help her self regulate.  You would want to consult with someone who sees young children and their families.  I doubt they would suggest medication at her young age but they might recommend strategies similar to what I outline in my parent's manual.  My manual is designed so that you can use it on your own or with a therapist. 

In the situations you describe, she wants things her way, and rather than engage her when she seems ready to get into a power struggle, I would recommend trying "emotional distraction" or a relaxation strategy, if possible, before she erupts.  Emotional distraction means that you come up with a song, saying, or activity that changes your child's mood from one of irritation to silliness or happiness. You can sing her favorite song, or you can change the mood by bringing up her favorite activity or doll and asking her or the doll to play together with you.  Basically you are re-directing her, but in a way that just doesn't distract her for a moment, but changes her emotional state.  

Relaxation strategies for this age child might involve her hugging a large stuffed animal or wrapping her in a blanket or having her lay down on her stomach and rubbing her back.  Sometimes a spray with a cool fragrance can help a child relax.  I realize all these suggestions take up time, and you may not be able to do them if you need to get somewhere or do something else.  

If she does tantrum, try to give her as little attention then as possible until she calms down.  Since she is not hurting herself or anyone else during the tantrums, you do not need to restrain her.  By ignoring her at this point, you will not stop the tantrum, but you send an implicit message that she will not get your attention this way.  Over time (weeks or months) the tantrums may lessen in frequency or duration.

Part of what may be feeding the tantrums is her high energy level and high activity level.  Children who react quickly and intensely to stimulation are also prone to react quickly and strongly to frustration, and hence are more likely to exhibit anger overload.  So it will take time (again months) to see improvement in many of these cases, but working on strategies, like what I outline in my manual, are important to help children develop self regulatory (calming) skills.

Best, Dr. Dave Gottlieb

Tuesday, August 25, 2015

7 yr old acts out in school

Hello. I was reading about anger overload and that is totally my 7 year old son.  Every year since kindergarten my son starts school and it's like 5 months of craziness before he gets settled in.  He acts out in class, get aggressive with other kids, and ends up miserable and with no friends and obviously upset about it. He says he's a jerk, everyone hates him, that I (his mother) think he's a jerk or an idiot.  He's always touching other kids and annoying them.  He gets angry when he feels like things aren't fair or he's not good enough.  He's really smart though. Has no problems learning. I would even say he's a little gifted.. 

I don't know what to do and it stresses me out daily. I work full time and so does his dad.  My mom watches them most days.  When he's at home or with one friend he's amazing! Totally nice, sweet, thoughtful, loves his mommy and family very much..  I'm used to when I do go to school to drop him off or pick up I get dirty looks from parents and already know the teacher is going to tell me something he did wrong that day.  I try not to yell at him at all, when he's in a rage kicking his closet and punching holes in the door I let him be until he calms down.   I take things away for short periods of time, he gets grounded for a day or two, sometimes it works and sometimes it doesn't. It's hard because he's really great at home but when he's at school it's a different story.  He does sports, swims, skateboards, and is very active.  What more can I do. I'm so tired of this and I know it hurts him that he doesn't have super close friends and relationships with peers.  I don't want him to have to feel this way anymore.
Thank you!

Hi, You point out several scenarios at school when he is likely to blow, e.g. a) he touches other kids and annoys them, or b) when he thinks things are not fair, or c) when he feels he is not good enough.  Work with the teacher to review when these types of triggers are likely to occur. That is, a) what is going on right before he touches other kids, b) what does he not think is fair, and c) what is he doing when he does not feel he is good enough.  Let's take the first scenario:  Young children often want more attention from peers and will touch them to get attention.  Does he seem to want interaction when he touches others?  If so, you could practice at home how to get someone's attention without annoying them.  Role play a situation in class.  Ask your child who he wants to interact with and then practice a way that uses words and does not intrude on another person's space.  Or if your child does not want to role play, then make up a story at bedtime that "shows" him indirectly how to get someone's attention in school.  In volume two of my parent's manual, I explain how to use imaginary stories and also explain other strategies for school.  

Self esteem issues are often another trigger.  You mention that he sometimes does not feel good enough.  There are different techniques you can use here.  In the first volume of my manual for parents, I write about lowering a child's expectations ahead of time, before anger is triggered.  The teacher may be able to intervene and use a "mantra" like "everyone makes mistakes" at the beginning of assignments that in the past have triggered your child's frustration.   .At home you can reinforce the message by telling your child that you hope he made at least one mistake today because that shows he is learning something new.  Ask him to tell you about a mistake and be proud of him for sharing this information with you.

Fairness is another trigger for many children..  Often these children have difficulty seeing other points of view.  Here I recommend helping your child to expect that things sometimes won't go his way.  Also, in the second half of my parent's manual, I explain how to teach child about other points of view.

The underlying principle of all these strategies is to try to alter a child's way of looking at things before he gets upset.  Once anger overload occurs, it is more difficult to intervene because a child is not thinking rationally then.  It is usually better to say as little as possible when a child is in overload, and work on strategies, like those mentioned above, while he is calm.  If you can catch anger early, you can also use emotional distraction:  the teacher could try saying something that can change your child's mood.  Something silly or funny often helps.  It is hard to be extremely angry while you are laughing!  There is more about emotional distraction and relaxation strategies in my original manual for parents.

Best, David Gottlieb, Ph.D.

Tuesday, August 18, 2015

Behavior charts do not work well with 5 yr olds

Hello, I am in desperate need of advice. I have a 5 year old son and over the last year we have had many issues with his anger. He got kicked out of 2 day cares last year. Towards the end, we found a great daycare that would take him aside when he would get angry and take him away from the situation and take him on a walk outside. The director really took him under her wing and he started doing a lot better. But school ended and I was at home all summer with him and my other 2 year old son. We worked on a behavior chart and spent a lot of time together and he seemed to be doing well. We saw a therapist who suggested no yelling or spanking him and implementing the behavior chart w rewards. He started a new daycare this week. The first day he was okay, the second day he got upset and pushed his chair at his teacher. Then yesterday he had a very good day and he was very proud of himself. Then today he scratched another kid and hit him in the face for not playing the way he wanted to and then was hitting and kicking the director. So now he has been kicked out of the daycare. He was supposed to start Kindergarten on August 24th. I have no idea what to do. The therapist I took him to said he's too young to tell if he has ADHD and that he should do fine at school....well obviously not. And now when I call back, they tell me he was only an intern and is now gone. I need help.

Hi, With anger overload, the outbursts happen so quickly that behavior charts are not often very helpful.  For a reward to work, the child has to be thinking rationally and be ready to try to earn the reward.  But when a child is in overload, he is not thinking rationally and is not thinking about the rewards.  Sometimes charts can help if they target early signs of frustration and help a child choose a calming technique in order to avoid overload.  But this requires early recognition of anger arousing situations, and young children will need adults to help them recognize their emotional triggers.  

So first it is important to keep notes of what is going on immediately prior to an episode, and see over several weeks what triggers emerge.  Then you (or the teacher in day care) can either "change the sequence" or "lower a child's expectations" in advance in order to prevent anger overload.  Or if you can pick up signs that your child is getting frustrated, then you (or the teacher) can also use "emotional distraction" or "relaxation activities". (I explain more about the above strategies, the strategies in quotation marks, in my original manual on anger overload in children and in other posts in this blog.)   Basically, the adult is helping to catch and re-direct a child before he reaches the overload phase.  It is unrealistic to expect five year olds to monitor their own emotional states, and that is why it is important for the teachers and  parents to implement strategies.  

Last year's day care director who took your child out of the situation was on the right track. Avoidance and distraction are key strategies.  I explain how to implement all these strategies in a school setting in my second recently published volume entitled Anger Overload in Children:  Additional Strategies for Teachers and Parents.  Both the original manual and the second volume with additional strategies for teachers can be found on online book stores.

ADHD can lead to impulsive behaviors, and can contribute to episodes of overload. Psychologists who specialize in working with young children can help you diagnose whether this is a contributing factor in your child's case.

Best, David Gottlieb, Ph.D.

Wednesday, July 8, 2015

The overload phase and what to do about it

All the descriptions of anger overload fit our son perfectly! I understand the long term approach to identifying the triggers and working over time to develop alternative strategies.  Can you please give some suggestions about what to do when he is in a rage? Regardless of where we are he will scream incredibly loudly and be very defiant.  We are very strict at following through on consequences, and once he has come out of his rage, he will accept them and get on with it. The problem is dealing with the rage in the most appropriate way while it is happening so to shorten it and limit the extremity of it. Any advice would be greatly appreciated.

Hi, You bring up an important issue.  The strategies, especially the cognitive approaches in the second half of volume one (as well as the suggestions in part two of volume two), can take weeks or months for children to learn to use at times of anger.  On the other hand, the strategies that parents can use without a child's direct participation (part one of the first manual) can be implemented more quickly but hinge on catching the anger quickly (when possible).  That is why identifying triggers is important:  then you can anticipate difficult situations for your child and try to head off anger before it reaches the overload phase.  

The first step is prevention.  If you see some patterns, you can change your child's expectations ahead of time, or change the sequence to avoid an upset.  In volume one, I explain how to do this.  In volume two, I explain how to do this for sensitive children by using cues and mantras with your child.  

The second step is the early anger phase when you can implement relaxation and distraction strategies (see volume one).  When a child moves right to the overload phase, as your question suggests, it is usually not possible to distract a child.  Then the best approach is to say as little as possible, not even talk yet about consequences.  In other words, try your best to ignore your child, unless he is hurting himself or someone else, and then you need to physically restrain him.  A child in the overload phase is not acting rationally and will usually escalate if you try to talk him through it.  As painful as it is, try to wait it out, giving as little attention to your child as possible.  Save any talk about alternative coping techniques, or consequences, until your child has calmed down and is thinking more rationally.  

Anger overload has a physiological basis in most cases, and therefore it takes time for children to calm down after they reach the overload phase.  But you can lessen the frequency of these events by using the strategies that prevent overload.  Once a child is in the overload phase, your options are limited.  That is why early intervention and planning how to deal with triggers is so important.

Best, Dr. Dave Gottlieb

Monday, June 8, 2015

4 year old with anger overload and sensory sensitivity


Thank you very much for reading my email and for any advice you have for me. I just bought your 2 books today about anger overload, but they will not be here until next week.

My son is almost 4 and a half and about 6 months ago seemed to change into a person that is very angry at times and can also be very negative too. His feelings can be very easily hurt, even if no one meant it that way. If my son felt hurt by what you said, then he will burst out crying and run to the next room. He just finished his second year of preschool and has done very well there. His issues are almost always at home with me or his dad. 

We have tried to keep track of his outbursts, and they mostly seem to happen around changing activities (especially if it is an activity that he does not want to stop, like playing baseball) or if it is an activity that he does not want to do such as a bath or go to bed. Most of the time the outburst starts with excessive crying and him running away to the next room. If I go after him and try to reason with him (which I am learning I should not be doing), that is when the violence starts with things like him trying to hit or kick me and call me names. He will also say things like "you don't want me to do anything" or "you don't love me". Then he will say outlandish things like " go ahead, put me in jail" or "just throw me out in the garbage". I have no idea why he would say something like that because I have never said anything like that to him. The outburst can last anywhere from 1 to 15 minutes. When the outburst is over he is remorseful, saying he is sorry and is asking for hugs and kisses. 

He seems to have these outbursts at least once a day up to 3 times a day. My husband and I have been trying different techniques, but if my husband does not see improvement in a few days, he wants to move on to something else. I think we need to be patient. I know this will take time to get better. We need to be consistent. 

My husband and I have differing views on how to discipline our child. He does time outs where I take things away from our son. I realize that both of us need to be on the same page so we do not send mixed signals to our son. The only thing we agree on is that we will never hit our son. 

The other thing that has happened is our son started to be an extremely picky eater at about 2 years old. He is now doing much better with his eating and is willing to try new things to eat. We call it the " no thank you bite". If he does not want to eat something, he has to at least have the no thank you bite to try it. 

He has never liked loud noises and still doesn't. He also has an extremely sensitive sense of smell. That started when he was 3. I have taken self-tests for him being highly sensitive, which it seems he is, but a lot of the books I have read do not go into the anger and/or negativity issues that our son has.

He does not seem to fit ADHD or ODD or even pediatric bipolar disorder. Do you think that this can be anger overload? And/or high sensitivity as well?

Thank you very much for your time and with helping us. This is causing a lot of problems in our family and in our marriage. 

Yes, I think it could be anger overload and sensory sensitivity.  It is not unusual for these two issues to occur together in young children.  Being sensitive to intense sounds, smells, or other extreme sensory input can be irritating for some young children and there is some overlap between the area of the brain that processes sensory input and the area of the brain that deals with emotional stimulation.  For example, the temporal lobes are involved in processing sound and smell as well as emotion.  And the frontal lobes help people organize and control their responses to all different kinds of stimuli, sensory and emotional.  For children with anger overload, there is probably either a lag in the development of part of the prefrontal cortex (that processes and controls emotions like anger) or a lag in communication between the prefrontal cortex and the amygdala (an inner brain area that sends emotional signals to the prefrontal cortex).  With time and practice, children's brains develop, and children learn to better control their anger, but it does not happen over night. 

You are right not to follow your son into the other room and try to reason with him when he has outbursts.  Give him time to settle down.  Also try to arrange troublesome situations, like bath time, so that something fun comes afterward.  For bedtime, it is tough to arrange for a subsequent fun activity but try to sit near him in bed and spend five to ten minutes with a favorite story or quiet activity before you turn the lights out.  You want your son to look forward to this bedtime activity so that he will get ready without a big fuss, and sit in bed with you.

You also mention that he erupts sometimes when his feelings are hurt.  Keep track of those situations and look for a theme.  If for example you think he is feeling criticized sometimes, try to mention something that he handled well that day at the same time that you mention something he might not like to hear.  Keep your comments short.  If there are early signs of displeasure or disappointment, try to re-direct him or distract him before he gets too upset. 

In my manual (part 1), I explain how to use emotional distraction and relaxation strategies. The first half of this manual will be especially relevant for four year olds.  In my second book (Anger Overload Volume Two)  I explain how to help sensitive children keep perspective. This section should be helpful to you as well.  In essence you are helping to head off anger overload before it happens, and also helping your son feel better about himself so that he doesn't get as easily hurt.  

Best, Dr. Dave Gottlieb

Wednesday, April 29, 2015

8 yr old has outbursts when he fails at something

Thank you in advance for taking time to read this email. My 8 year old son has not been diagnosed with any emotional issues. He has always been doing well in school and has extra curricular martial arts and swim classes weekly.

Ever since his toddler stage he had night terrors, he still has the rare occasional night terrors (we still deploy a pacifier to settle him, that lasts about 15-30 minutes) At around 5 he started to sleep walk; his night terror episodes decreased. He has in the past 2 years, developed angry outburst when he fails at tasks. He does not get physical or verbal but will burst into grunts, tears and shakes. Talking to him or reasoning seems to not work, nor do distractions. We've tried to use his martial arts to let him learn control but he seems not to be getting better at it. We have used the time out to think method, it resulted in him sitting in his room crying and grunting for 20-30 mins. These outbursts will always trigger sleep walking and at times night terrors on the night following the anger. He and his younger brother both attend a school for advanced academics. He has not experienced these outbursts during school hours despite the work load.

Are there other ways we can help him to gain better anger control? He is a very smart young boy who is very socially accepted in school, but he seems not to control his anger at home.

Family back ground: we are an active duty military family and lived in many large military towns. I have two sons, both were born into military life, most of their classmates are the same. I am a stay at home mom and my husband does not spend much time away from home.

Thank you for any advice you can give me. Having to move around a lot makes getting professional advice difficult.


One thought I have is to help your son anticipate that he will sometimes fail at tasks, and that this is to be expected because he is learning new things.  If he doesn't sometimes fail, you would be concerned that he wasn't learning anything new.  In other words you want to normalize failing, since you said this is a situation that leads to his angry outbursts.  You would need to do this before he gets upset, not during an upset.  During an outburst he is not thinking rationally, and the more you try to talk to him, it is possible that he will continue to escalate. 

In  the second volume of my parents' manual, I write about developing a mantra that you repeat daily to your child in order to help him change whatever perception is precipitating an outburst--in this case it is failing at a task.  The mantra is a short saying with a new message for him to consider.  You could discuss with him when he is calm some alternatives and pick one together.  Examples for failing:  a) everyone fails sometimes, b) it's good to fail sometimes because it means you are learning something new, c)  I hope you will fail sometimes, or d) even (famous person like Einstein) failed a lot.  

If you discuss what led to an outburst (after he calms down), you could be understanding about his disappointment in himself, but also help him to look at things a little differently. You could even suggest that you will get him an ice cream (reward) the next time he fails (whether he gets mad or not)!  Then after a few weeks, you could say that the ice cream will be earned if he changes one thing about his upsets, and you would pick one thing he says that you would like him to eliminate or change.  You would be very specific and still allow him to get upset and earn the ice cream.  This of course assumes he like ice cream and also assumes that he does not have access to ice cream otherwise.  You could pick something different for the reward based on the interests of your son.

In the first volume of my manual, I explain other strategies:  how to teach children to recognize different levels of anger and how to look at things from different perspectives. There is also a section about developing relaxation strategies.  

Remember to be patient and understanding as you "seed" a new way of looking at failure. You don't want to rush things because then your son might feel like a failure for not being able to accept failure right away!   

Best, Dr. Dave Gottlieb

Friday, April 3, 2015

4 yr old explosive only with family

In advance, thanks for any thoughts or insight you can provide.  We appreciate your time and expertise on this matter.  My wife and I have been having issues with our 3 (will turn 4 next week) year old daughter and to us, it sounds like the personification of Anger Overload. 

Our daughter is usually sweet and lovable with a really good vocabulary for most of the time.  She has a really good imagination and often plays by herself with her dolls or colors for long stretches by herself.  She also behaves herself perfectly fine at school (really no complaints and no violence or acting out) and with almost everyone else- other than us (my wife and I).  With us, her fuse is often incredibly short and can be lit by even the most minor (as perceived by us) slight or use of the word no.  She has a big brother (he’s almost 7) and he sets her off rather frequently as well.  

Once the tantrum or behavior has started, usually with hardly any advanced warning, she calls us every bad name she can find, often says we’re ‘meanies’ or she hates us or she doesn’t love us, and tries to throw anything she can find on the ground.  Sometimes she rips things in half or will just throw things across the room.  It’s like she’s possessed and focused on violence and destruction for as long as it lasts.  There are also frequent episodes of violence (hitting, kicking, scratching) against us or her brother mixed into these fits of anger.  The duration is anywhere from 1 minute to 20 minutes but they usually end as she explodes with emotion and regret- crying, hugging, telling us she loves us, and she’s sorry.  It has forced us to walk on eggshells for risk of setting her off and has certainly adversely affected life in our home- both for our daughter and for our entire family.

Do you have any thoughts on this?  We recently bought your book through Amazon and are just getting to read it.


First, keep track over the next few weeks of some of the "minor slights" or times you say "no" that lead to her outbursts.   Do you see any themes, or issues, that come up repeatedly?  If you can find find some patterns, it allows you to anticipate and try to head off a tantrum.  Admittedly there will be unexpected outbursts, but you want to try to anticipate some of them so you have a chance of preventing them.  Once a child is in anger overload, it is best to say or do as little as possible, but if someone is being hurt or something of value is being destroyed, you may have to restrain her.  

There are a number of strategies I discuss in my two volumes on anger overload in children that you can employ if you find patterns and can catch your daughter's frustration early, before she erupts.  For example, you can alter a routine so that what she wants to do comes after what you want her to do (if some task is contributing to some of the outbursts).  Another option is to use language that is balanced with "carrots" when you say no to her.  For example, when she cannot play a game, at the same time that you say no, mention when she will be able to play it.  Or use emotional distraction:  come up with a pithy saying or a visual distraction that will get her to laugh or be amused.   It is unlikely that she will rage if she is feeling amused.  The two emotions are contradictory.  I explain more about this strategy in volume one of my manual.

Often children are more explosive at home.  In your case, your daughter has no outbursts except with you and her brother.  The question is why?  Is she real sensitive because she counts so much on your approval?  Is she jealous of things her brother can do but she can't yet?  Is she strong willed and self-centered, as most three and four year olds are?  If you can figure out any underlying emotional sensitivity at home, you can try to help her out by using empathy, and by using mantras that speak to a different way for her to look at things.  I explain about mantras in my second volume.  Essentially it is a way of seeding a new idea, by repeating a catchy phrase daily before any emotional situation arises.  Over time, a child will internalize the phrase (if she pays attention when you say it--that's why it has to be "catchy").  This is one way to help your daughter begin to look at things from another perspective.  Looking at things from another perspective is difficult for young children, so expect that this strategy will not yield immediate results.

There are likely biological aspects to her rapid and intense emotional arousal, and the basic goal is to use cognitive and behavioral approaches that help her forestall the emotional outbursts.  It takes time, but it is well worth the effort.  Also remember that the part of her brain (prefrontal cortex) that helps her with self-control will develop further over the years, so that in this way, time is on your side!

Best, Dr. Dave Gottlieb