Monday, March 30, 2015

When 9 yr old makes mistakes, watch out

  I have a 9 soon to be 10 yr old boy that has extreme anger outbursts.  I tried saying it was terrible 2's followed by treacherous 3's. Now it is physical and verbal at 9 years old, and I cannot handle it any longer. I feel like I am constantly walking on egg shells because I don't know when he is going to get angry.  He can be a very sweet and sensitive boy.  He is a good athlete and seems to be better when he gets more physical activities.  When he makes mistakes or gets frustrated over something he becomes both physically and verbally abusive.  He cannot handle it if his perceives someone has cheated or not played by his rules at a game.  He is often afraid of anything new.  It makes going anywhere a challenge.  He constantly needs to be entertained:  either talking to him, computer games, television, or some stimulus.  He does not play quietly by himself anymore.  It is exhausting. I have tried taking computer away, time outs, helping him when I see he is getting upset ( that usually makes thing much worse). When he gets into a rage anything you say to him just escalates the thing.  Afterwards, he feels bad and gets upset again because he can't control himself.  He is smart but does not try at school.  He does not want to stand out.  His reading is below grade level this year and is becoming an issue.  He refuses to read and makes it so hard I finally cave in.  I can't argue anymore.  It is so hard on his older brother and me.  I am at a total loss.  Any suggestions would be greatly appreciated.

Thank you so much.


What you describe I see in a number of children with anger overload.  These children can be sweet and agreeable until they get frustrated by a mistake they make, or by someone else doing something that violates their sense of fair play.  Yes, talking when your child gets upset will generally not help reduce the outburst.  The key is really early intervention before the child's frustration begins.  In my second volume on anger overload in children that was published last month, I devote a section to sensitive children.  One idea is to develop a mantra that you will use daily with your son before an activity that might lead to "mistakes."  A mantra is a short saying that gets your son to look at himself in a different way.  Sensitive children tend to have high expectations of themselves, and it is impossible to always live up to such high expectations.  So it is important to have your son moderate his expectations somewhat, and that is what the mantra is designed to do.  Now it will not lead to immediate change, but over a period of several months, it is one tool that will help your child learn that "we all make mistakes" or that "mistakes are good, that means you are trying something new."  For one child, I suggested to him and his parents that he receive a hug or a reward when he made a mistake.   I explained that mistakes happen to everyone and if he can make a mistake and smile, he deserved a bonus!  For another child, we made the mantra into a funny song that helped the child remember to take a deep breath.

There are other ways to help a child change his expectations.  One is to use yourself as a role model, and every time you make a mistake, you would say out loud, "Oops, oh well, everyone makes mistakes."  Since your child looks up to you, you want to give voice to a more accepting view of mistakes.  If you talk with him about his anger, wait until he is calm later in the day, and in a non-critical way explain that everyone makes mistakes and suggest ways he could try to relax or distract himself in the future.  Do not punish him if he forgets.  It takes time to change old habits and to learn a new way to deal with frustration.  Negative consequences are often not helpful. Remember that a child is not thinking rationally during explosions, so imposing a consequence then will have no real significance to your child.

You mention your child is getting behind in his reading.  Ask his teacher if she sees any reasons why.  You mention he does not want to stand out.  Is he afraid of making a mistake in front of his classmates?  If so, you might ask the teacher to help him accept mistakes in a similar way that you would at home.  In my second volume on anger overload in children, I explain ways teachers can adapt the strategies for school time.

Take care, Dave Gottlieb, Ph.D.

Monday, March 23, 2015

3 yr old kicks and scratches at preschool

Our three year old son is very sweet and calm most of the time but he has a hard time coping when he feels left out, or is told no and doesn't get his way. He was just recently kicked out of his 3rd preschool for his behavioral issues. He only made about 2 days at this last place. Day 1 he hit 2 kids, said No to a teacher and scratched the teacher. Day 2 he kicked a teacher and his last day he was climbing up the slide and was told not to climb up the slide; this made him mad and he started throwing wood bark at the other kids and screaming. His fit was so bad that he had to be put in a separate room where he proceeded to destroy art work, and throw stuff, just very destructive. It was so bad that security had to escort my son and husband out of the facility. 

We have good routines at home:  we do time outs and we have worked with a therapy program to help our son. They introduced some relaxation techniques and games to help our son with self regulation.  He seemed to like the breathing exercises but they only work some of the time.  Our son was in a smaller in-home daycare with a small ratio only 4 children to a teacher and this helped. He had far less episodes and in the 9 months that he was there he only experienced 3 incidents of hitting and/or screaming where we were called to pick him up early. 

When we give our son 3 minute time outs he destroys his room and/or bangs on his door the whole time.  He has stopped throwing his stuff around after I brought a trash bag into his room and said I would throw his stuff away. He has an older sister who is 5 and they fight but they also play well together.  When they do fight it is normal sibling stuff, nothing out of the ordinary. We go on family outings and I take my son with me on errands and to work etc. He has always done fine 1:1. He is articulate, loving, kind and affectionate most of the time. He recognizes when he has done something wrong and he says sorry but he has zero coping when he feels hurt, ignored or left out.  

Last summer, we went to fireworks and it was scary for our son.  We were fairly close to where they were going off and the sound was scary for him.  When we left he started screaming and didn't want to get on the shuttle back to our car.  I held him tightly and we sat in the very back.  It was packed full of people and my son proceeded to scream let me go.  He was scratching me and kicking and screaming and his fit was so severe that other kids on the shuttle started to cry and everyone was staring at us. This went on for the entire shuttle ride 15 minutes.  Once we got to the car we could not buckle his seat belt and his fit continued for another 10 minutes at least. Now on that particular day we had been up early for an annual Fun Run and we had been on the go all day and he had not had a nap but he had been fine. Until the fireworks started he had been playing with the kids sitting next to us. The fireworks were what set him off. He hasn't had an episode like that since but it was very scary for my husband and I, and traumatic for all of us. Our son will be 4 in June and we are concerned that he will not be ready for public school when the time comes. Any suggestions you might have for helping him with his aggression would be greatly appreciated.

Hi, your email points to several precipitants that I often find with young children:  tiredness, loud noises, and not getting to do what they want to do.  Children's reserves get depleted if they are tired or frightened.  You learn what a child's limits are, and then you would try to avoid those triggers in the future, when possible.  

For the times he explodes when he does not get his way, like at preschool, it will be important to have a very predictable routine especially with a larger group of children.  With smaller in home daycare, there is more flexibility, and your child probably does not have to stop what he is doing so frequently.  I would recommend keeping him in daycare for another year.  During that time his brain will develop, and you can practice keeping to a schedule at home part of the day in order to prepare him for kindergarten.   When you are ready to practice for part of a day, explain ahead of time what the schedule will be.  Come up with cue words (and have him draw a picture with you of switching activities) that will remind him that it is important to go with the flow.  And have a fairly immediate reward ready for him when he is flexible and stops what he is doing and gets ready for the next activity.  For example, you could have play time and then lunch time.  If he stops playing when asked, he gets a special treat after lunch.  Be sure to remind him of the cue words before the first activity starts, and then repeat the cue words when it is almost time to switch. I explain more about this in volume two of my parenting books on anger overload in children.  

For other triggers, you would try to anticipate and use one of the strategies I outline in my first parent's manual or in my second volume of strategies for home and school.  Your use of relaxation is a good idea.  You will want to try to catch his frustration at an early stage when you can, and re-direct him to a relaxation station in your house that is fun and relaxing.  I write about this and other techniques such as emotional distraction, re-arranging the sequence, and changing a child's expectations.

Once a child loses it, there is not much you can do but hold him if he is being physically destructive.  What you did on the shuttle bus sounds right on, even though it is hard on everyone.  You have little choice at that point but to restrain him.  Children in the overload phase are not rational, and talking to them usually does not work.  I would explain to him later on when he is calm that it is important not to hurt people when he is angry.  You might say it is okay to scream for now, but if you hit, kick, scratch, or throw things, he would lose some of his toys for a few days (however long a period of time would motivate him in the future, and you don't know this until you try a certain amount of time, and see if the frequency of physical acting out diminishes over the next few weeks).  The fact that he stopped destroying his room when you took out the trash bag is a sign that he will try not to destroy things if he might lose them.

When he does return to school, it will be important to coordinate with the teacher:  introduce him to the routine ahead of time, and have a behavioral plan in place that includes cuing him, emotional distraction, relaxation stations, and potential rewards.  Depending on how much he grows emotionally in the next year, you would target specific behaviors that are disruptive or hurtful, such as throwing and kicking (if that is still going on in a year).  You could adjust the behavioral expectations depending on his progress, but be very specific about what you expect, and do it one step at a time.  In other words don't expect he will use exactly the right words to express his frustration from the get go.  As you probably recognize, change is gradual, and you want to set mini-goals for your son, and then you can change your expectations over time.

Best, Dr. Dave Gottlieb  

Monday, March 16, 2015

14 yr old with ADHD and anger

I have a 14 year old grandson who was diagnosed with ADHD when he was younger (5 or 6). His doctor has been treating it with medication.

In the last few months he has had several outbursts of intense anger. He is all but uncontrollable when this occurs. So far we have been able to calm him down to where we can have a reasonable conversation with him.

They seem to occur when he is asked to do something he does not want to do. For example, he was asked to stop playing his video games and to pick up his sport equipment in the backyard. He did it begrudgingly and had to be asked to do it again because he only picked up that he felt needed picking up. When confronted he became sassy, disrespectful, and continued to make "the last comment."  It escalated to a point where he was told to shut down the video games and take his shower. He argued the shower over and over because in his mind he had already taken one earlier in the day before going to a birthday party. Since he played at the party and in the back yard after he got home he was asked to take another shower.  It escalated very quickly from there to another outburst.
What started out as what seemed to be an "isolated" incident has all but become a weekly event.  My question to you is it possible that the medication he is on for ADHD is contributing to these outbursts?
Hi, If the outbursts have increased in the last few months, think back about what might have changed in your grandson's life.  If the medication changed right before the outbursts started, then I would recommend you ask the doctor if he/she thinks there could possibly be a medication effect.  In my experience, ADHD medications do not generally lead to an increase in children's anger.  Actually if a child has ADHD, medication helps with distractability and impulsivity, and thereby make it easier for a child to learn strategies to cope with anger.
I wonder if your grandson has started puberty and is dealing with hormonal changes and new emotions.  Some children when they hit adolescence become more argumentative when adults ask them to do things.  You mentioned for example that he got irate when you asked him to take another shower after playing outside.  You explained that he had not expected to have to take another shower.  What I would recommend is to sit down with him when everyone is calm and explain your rules about showers.  The idea is to change your grandson's expectations ahead of time.  Another way you could do that is to remind him before he goes out to play that he will need to take a shower when he comes in. 
Some adults also limit game or television time in the evening until a child showers.  Then your grandson will have an incentive to shower.  If you can enforce that the television does not get turned on, then you do not have to argue with him, but let the potential consequence do the "speaking" for you.
If picking up things outside is another frequent issue, try to apply the same principles:  talk when everyone is calm, remind him before he goes out to play what you expect, and have something he wants to do later depend on his picking up outside.   I explain other strategies in my books on anger overload: such as a) emotional distraction, b) labelling levels of anger to develop self-awareness, and c) teaching him about other points of view. 
Best, Dr. Dave Gottlieb

Tuesday, March 10, 2015

12 yr old explodes at home and school

My son is 12 in 5 weeks time and suffers from what I believe to be Anger Overload.

I believe what I call not normal behavior begin as a toddler.  Almost OCD like, he would flip out if for exampleIf he said he was going to turn the light off and I did it instead.  He would have to turn it back on and then off again.  All the while screaming and crying about it.  While the OCD type behaviour died a natural death his anger/rage bursts have escalated.

He is of above average intelligence, and does not struggle academically in school. Although he does suffer some anxiety, and requires details/explanations of the task at hand to be repeated to him at times.  He will say it's too hard or I don’t know what to do, when the task at hand is quite within him.  The same happens with homework.  He is very good at sports and participates In many activities.

His outbursts are over the slightest thing, or if he feels he has been wronged.  His rage is intense both verbally and physically. He yells, screams, crys, punches, hits, pushes etc.  There is no calming him once he gets to that danger zone.  Trying to restrain or talk to him in this moment is fruitless.  He will sometimes say he wants to kill someone (mum,.dad,younger sister) or kill himself while raging. As he has gotten older this school outbursts have lessened but near the end of each year (like now) problems arise at school again.  We have had 3 occurrences in as many weeks.  He goes to a small school of only 230 kids and so only a small group of his age to play with.  There are 2 kids especially who push his buttons.

The other worrying sign is that he appears to have what I can only describe as rage blackout.  He will recollect a school incident at home; it is rarely his fault, but when I speak to teacher more information comes out.  Then when you ask him about this he says it never happened that way, I honestly believe him too.  He has no recollection of this extra information, usually the most damning. He is always remorseful and upset after such episodes but tells us he just can't stop.

His sister is nearly 6 years younger than him, and most of his rage at home is about her.  He has next to no tolerance of her.  Don’t get me wrong,  they can play nicely together, but when it goes wrong it really goes wrong.  His outbursts at home would be 4-5 per week. We have seen psychologists since he was about 8, at first he was very uncooperative with this, but over time this situation has improved.  I just don’t know if I am wasting my time and money on something that is not helping.

He saw a pediatrician at age 8-9 who did nothing more than a GP and deduced it was a behavioral and he needs to learn to control himself. He has also had saliva hormone tests done in the past and was found to have no melatonin in his body and cortisol levels also out of whack. I am also concerned with his growth and development.  While he is of average height / weight (50 percentile). In saying this though he is the shortest in his class.

His motor skills ?? are not progressing.  He has done athletics since he was 8-9 years old and still sprinting, jumping same times and distances as he is now nearly a 12 year old.
I don’t know much about this but I would assume that between ages 4-14 we all get faster, jump higher/longer etc even if we have no sporting ability.

The entire situation is tearing our family apart., and I just don’t know what to do anymore.  I  read the above and it doesn’t sound that bad, but believe me I don’t know how much more we can take.  I am falling apart, my husband is at his wits end, and I fear for our daughter, how this is affecting her seeing this behaviour constantly.  I fear for him as he gets older and what will become of him if he continues down this path.

Hi, It sounds like you have been through a lot and have not seen much improvement.  There are a number of strategies I recommend in my Parent's Manual for Anger Overload in Children, and in the recently published Anger Overload in Children, volume two.  In volume two, I make some additional suggestions for helping sensitive children deal with anger, and I also explain how to apply the strategies in school.  One important idea is trying to catch a child's frustration early, before it escalates into a tantrum. Admittedly this is not always possible because children can escalate so quickly.  

What you want to do first is chart each time your son loses it over the next few weeks, and then look for patterns or themes.  Then you would develop a strategy to deal with each theme.  For example, if he is frustrated when he feels the homework is too hard (though he can do it, you explained) you could prompt him before starting the homework in one of these ways to encourage him to hang in there:  "Homework can be hard, and it's okay to make mistakes."  Or "everyone makes mistakes."  Or "just do what you can, no one is perfect."  The idea is to normalize mistakes and thereby lessen his feelings of frustration.  Other possible strategies, such as emotional distraction, relaxation, and changing the sequence are explained in other blog posts and in my two books on anger overload.

If he has trouble with certain kids in school, try to find out what happens before he gets angry, and see if you or the teacher can use a mantra (or short saying) each day to remind him how to handle it.  The more you can anticipate and help him "normalize" certain frustrations, or help him learn how to deal with frustrations, you might be able to prevent some upsets.  You are right that it is hard to intervene once a child is in the overload phase.

Your son sounds a little rigid: you mention the earlier OCD.  Make sure the psychologist you see has ruled out Asperger's, which is a high functioning level of autism.  This is not likely, but you want to rule it out.  The fact that he does not remember all the details of the problems in school is not that unusual.  I find many children either minimize or forget what they did in school that contributed to the problems.  What might help is for the school counselor to meet with your son regularly to go over some of the incidents while they are still fresh in his mind, and gently help him see the connection between what he said or did, and what the other student said or did.  Then the counselor might be able to suggest a strategy for your son to deal with the  other student, or suggest a strategy the teacher could use to intervene before an outburst might occur again.  

If you feel your son is not developing motor skills or coordination, you could get a consult from a developmental pediatrician or a pediatric occupational therapist (OT).  OT's look at sensory integration and motor skills.  

Hope you see gradual improvement in the coming months, Dr. Dave Gottlieb