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.