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

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