Tuesday, November 29, 2016

4 yr old punches teacher at nap time

I have a 4 year old daughter who goes to a private school for Pre-K. She has always had normal behavior problems at school but has been evaluated by the county schools without any problems. She scored very high on cognitive processing and communication. Everything else was within normal range. She is exhibiting aggressive behavior towards one of her teachers. It usually occurs when her morning teacher leaves and children are with the afternoon teacher about to go down for a nap. She is defiant and does not want to nap. She has punched her teacher several times. We are not sure what to do with this point as we are anticipating that she is going to be expelled. She does not exhibit these behaviors at home.
Can you help?

Hi, You have identified a trigger for your child's anger:  nap time.  One solution would be for the teacher to substitute a quiet activity for your child in a space where she does not disturb the other children.  The teacher may be concerned how this will affect the other children, so you want to work with the teacher to come up with an idea that works for her and for your child.  You or the teacher should probably practice with your child in advance so she understands what to do.  You could explain that this is a privilege, but that if she disturbs the other children, she will not be allowed to do the substitute activity, One way to avoid anger overload is to anticipate it and then change the situation or the expectations, if possible, so that you avoid the problem.  

If the teacher is not willing or not able to come up with an alternative, then you (or someone you know) might need to take your child out for a walk at that time.  Or if you feel your child really needs a nap, then try to come up with a quiet activity she could do on the mat, where she might eventually get tired and nod off.  Another possibility is to use incentives and consequences targeting the hitting of the teacher, but I find that incentives and consequences do not often forestall anger overload.  Most young children are not thinking about consequences when a situation arouses their anger.

You also mention that she has had "normal behavior problems."  I'm wondering what that refers to.  If there are other triggers for her anger, other than nap time, then I would refer to my parents' manuals (and look at other blog posts) to learn about other ways to help reduce anger overload in children.

Best, Dr. Dave Gottlieb

Monday, November 7, 2016

7 yr old hits, bites and kicks at home

     My grandson changed about 2 yrs ago.  It has progressively gotten worse.  He hits, bites, kicks, is destructive and defiant.  When he is not having an anger episode he is the most polite, caring and loving child you could ask for.  He does not have any anger issues at school at all.  All issues are when he is home or with family.  My daughter has taken him to a behavior therapist a couple of times with no real change.  She did take him to a different behavioral place and after speaking with my grandson for 10 minutes and looking over his health issues and talking with my daughter for about 10 minutes, they recommended intensive outpatient  3 hour group therapy for 4 weeks, 3 days per week. However this therapy is over an hour away and he would have to miss the last hour of school to go.  Then by the time he would get home, eat, do homework , etc. he would be exhausted and this would cause more anger issues.  Any recommendations you could offer would be greatly appreciated.  I love him so much and hate to see him spiral out of control.

     First, it is a good sign that he is only out of control in one setting.  Since he is in self control at school, this shows that he knows it is wrong to hurt others and shows that he can control himself in settings other than the home.  So the question becomes why is this happening at home.

     I would recommend you and his parents keep track for a few weeks what exactly is going on right before he loses it.  What is he doing and saying and what are the adults at home saying or doing.  Then look for common threads in some of the precipitating events.  Is there a theme in some of the outbursts?  Do they happen at certain times of the day, or when he is expected to do certain things, or when he feels ignored, criticized or unfairly treated? Look for themes in how he feels before outbursts, or what he is doing at those times.  In my parenting manuals I provide worksheets to help parents identify triggers.

     You mention that things have gotten worse the last two years.  Think about what changed two years ago.  Did expectations change, were there any losses, or did parents' or the child's schedules change?

     Once you identify some triggers, you try to develop a plan to reduce the likelihood of upset.  Here are a few examples.  For more, see my parenting manuals.  Sometimes you change the sequence of events, for example, if the problem occurs when he has to stop playing and get ready for bed, then you would get him ready for bed right after dinner, before he starts playing.  Then the sequence is such that your grandson gets to do what he wants after he does what the parents want.  

     Another possible approach is to change your grandson's expectations.  For example, if he expects that he will always get to play on the computer when he wants, rather than share time on the computer with another family member, you would talk with him while everyone is calm about the new plan or expectation.  Sometimes I have children come up with a catch phrase and/or drawing to reflect the new expectation, and I suggest parents practice the catch phrase with their child daily.  

     Sometimes the outbursts do not fit a theme and happen so quickly, that it is difficult to change a child's expectations.  Then I recommend "emotional distraction."  What this means is coming up with something you can do or say that changes the way your grandson feels. For example, if you can say something silly that he laughs about, it is less likely that he will explode.  But if he is already exploding, it is best to say or do as little as possible unless someone is getting hurt. It is not possible to reason with a child in the overload phase, and furthermore if you talk a lot then, it inadvertently rewards his outburst.  This is why I recommend saying as little as possible.  If someone is getting hurt, it may be necessary to bear hug your grandson, or in some way restrain him until he calms down.

     Also consider what has changed in the last two years and if your grandson is feeling worried or unhappy about something, try to address his fears (or the source of upset) to see if the angry episodes lessen then. Looking for underlying causes is another approach to dealing with anger overload.  

     If nothing is helping, then consult with a therapist who works with families and children.  I find that in most cases young children do better when a therapist strategizes with parents, in addition to the child, rather than just meeting with the child.  Young children often have trouble implementing strategies without their parents' help.

Best to you and your family, Dave Gottlieb, Ph.D.

Thursday, August 25, 2016

3 year old's outbursts at aftercare

Good Morning Dr. Gottieb, I have a 3 yr old son who is showing signs of "Anger Overload". He has been going to a before/aftercare facility for two semesters and recently has been having anger outbursts. Throwing his shoes, continuous crying, shouting, kicking/hitting, and shouting "No". My wife & I also witnessed the behavior recently, while we were out shopping in a Shopping Mall. I've tried the Negative Consequence approach but he seems to not respond to it lately depending on his environment. I must say when he's home with me, I don't receive nearly as much defiant behavior. I've used standing in a corner and/or sitting on the steps as a consequence for the anger behavior/outburst. I just brought your book "Your Child is Defiant:Why is Nothing Working?". I just am willing to do whatever it takes to help my son. Any assistance you can provide, I'd greatly appreciate. I look forward to your reply and have a good day.

Hi, in my book "Your Child is Defiant" I first ask parents to keep a record of what is happening before their child explodes.  After you make notes about several incidents, look for themes.  Not all situations will fit one theme, but you might find some overlap. In my defiance book, I write about loss of time with an adult as one possible trigger. Others could be: when the child is not getting to do what he wants, or when he has to switch activities, or when he expects something else to happen.  Once you see some patterns, you would try to intervene early in the behavior pattern in the future to try to head off an outburst.  You can use distraction techniques, cues in advance that explain what he can expect that day, or mantras (sayings to remind him how to deal with disappointment). I explain in detail how to use these techniques in my anger overload books, 

For three year olds, one aspect of emotional development at this age has to do with learning how to deal with limits (he can't have everything he wants!).  A three year old is going to experience disappointment as he learns the adult world does not always respond the way he wants.  Helping a child anticipate what to expect on a given day, and helping him move on when disappointed is an important goal.  The strategies I outline in my books are designed to help a child deal with frustrations and disappointment.  

Negative consequences do not often work with anger overload, because the emotions are so strong and quick.  I'd recommend trying distraction, advance cues, or mantras.  If you want to try incentives and consequences, make sure there are fairly immediate incentives for self control. Do not rely only on negative consequences.  The best negative consequence for young children is withdrawing your attention, so having your child stay by the stairs for a few minutes (as you are doing) makes sense.  But use some of the other strategies as well, rather than rely on time outs.

Best, Dr. Dave Gottlieb

Thursday, July 28, 2016

Adult not previously diagnosed with anger issues

I was told that I had ADHD as a child, but from what I have found out I also had anger issues. I also had learning problems. I don't know what all was done to treat this since this was in the 70's and I am now 50 years old. I have no memory of much of my childhood and I only know things that my sisters have told me. I still have many issues and I would like to know if there are any treatments that help adults with these issues because they didn't go away with age. Some days I think I'm loosing my mind. I have been on an antidepressant but it doesn't seem to work because I still have these issues.  I can control them until I get home and then I loose it. My husband tries to help but he doesn't understand how. If you could give me some insight to this and how l can get treatment for this it would mean the world to me and my life.  Thank you for taking time to read this.

Yes, it's not unusual that many adults in their 50's were not diagnosed as children with ADHD, learning problems, or anger overload.  More children are getting help today than in the past. But adults today can also get help for these issues.  I would recommend you meet with a psychologist who works with issues like ADHD and anger overload.  You can ask the doctor who has prescribed the medication who he/she would recommend, or you could call your state's psychological association for a referral in your area.  

The three issues you mention--ADHD, anger overload, and learning problems--can occur together and each one can impact the other.  For example, people with ADHD are sometimes impulsive, so that when they get frustrated it can be harder to stop and think before saying something they later regret.  Learning problems often co-exist with ADHD and can cause frustration and anger.  Children and adults who have trouble writing or reading for example can get frustrated when faced with a writing task in school or on their job.  A psychologist can help you strategize about how to deal with any of these possible issues.  

My anger overload workbook can help with anger issues.  While written with children and teens in mind, most of the exercises and strategies can be used by adults as well. It is available online at Amazon.

Best to you, Dave Gottlieb, Ph.D.

Tuesday, July 5, 2016

7 yr old removed from day care

Dr. Dave,

I saw your blog on the Internet and thought I would ask you for advice, honestly because I feel as though I have run out of other options. By the age of one, my son was kicked out of three daycare centers and working on the fourth. He would bite, hit, pull other children's hair, and so on. The teachers never recognized triggers that set him off and the acts seemed to always be random. Half of his first month in kindergarten, my son was suspended due to his aggression once again. He was finally old enough to be evaluated at that time and was diagnosed with impulsive ADHD.  The medication prescribed certainly helped with his level of energy because he could never sit still, but it did not help with his anger. 

Now at the age 7, he is looking to be removed from yet another daycare center after spending only three weeks there. From what the teachers say, the smallest events such as a kid not sharing a toy can lead to him being enraged. He throws chairs, punches other kids on the face, calls the teachers names, and so on.  Once he calms down, he realizes what he has done and feels guilty.  He can clearly verbalize what he did wrong and how he could have responded differently. 

Sometimes when I talk to him after school about his actions, he tells me he feels he is the worst child in the world and that I don't deserve to have a child like him. He has even gone as far to say that he wished he was dead. My heart absolutely breaks when I hear him say such hurtful things to himself.  He should not be saying these things especially at such a young age. I have taken him to see child psychologists before in the past to help him develop better coping skills but there was no improvement. 

I actually had a child psychologist tell me that he didn't even know what else to do to help. I read your article about anger overload and really feel that this could be the reason for his actions. The problem is I don't know how to help him. I am a single parent that has to work so he has to go to daycare. With that, he cannot get one on one care at daycare or school with a hundred other children running around. How would you recommend teachers, daycare providers, and myself working together to ensure we help him make better decisions even though they have other children to look after? I'm just not sure of what proactive measures to take. I would greatly appreciate any tools or advice you have to offer to help. He is really a sweet and loving boy but I want others to see that as well, to include himself. Thank you.

Hi, I outline some ideas for schools (that would apply to daycare as well) in volume two of my parents' manual that focuses on strategies for schools. You are on the right track about the idea of working together with the teachers and daycare providers.  A coordinated approach will work best.  First, everyone should observe for a week or more, and make a list of situations when he becomes extremely angry.  Then try to identify some themes.  You mention one in your email:  sharing toys.  

One strategy would be to try to change your child's expectations about sharing in daycare. You would create a short saying, or mantra, and say it out loud with him each morning and night. You might even have him draw a picture of it and put it on the refrigerator at home.  An example of a mantra would be:  "I'm 7. I'm old enough now to share toys."  or "Can I learn to share toys?  Or "Am I going to hit someone who wants to share?"  Or write a mantra with your child.  Pick one that he likes, so that he will be more likely to remember it.  The reason you practice saying it out loud twice a day at home is to increase the likelihood your son will remember it at the time someone wants to share.  It would also be helpful to have the day care adult remind him of the saying before he starts playing with toys each day. 

I write about other ideas, such as emotional distraction and relaxation stations, in the blog and in my parents' manuals.  You might also ask your son every day to tell you if he shared toys, and put a star on a calendar every day he shares at least once.  In addition, ask your town librarian for suggestions on children's books about sharing.  You make a big deal out of sharing, in other words.  

I would recommend focusing on only a couple of themes (or triggers) for a month before working on others.  You want your son (and the day care staff) to taste some success and feel good about him having self control, and if you try to do too much at once, it will be harder for your son to focus on what he needs to do.  As he gains self control, he will feel better about himself.  In the meantime, you might also "reframe" what he says when he says he wishes he were dead.  You could say, "You feel awful when you hit someone, but we will work together so that you can learn to control your anger."

Best, Dr. Dave Gottlieb

Thursday, June 30, 2016

4 yr old throws things


I stumbled upon your website as I had been desperately trying to find out how to help my son. He will be 5 in October and was a micro-preemie, born at 24 weeks and weighing just 1 lb 8 oz. He has experienced delays from the start; however, nothing major physically and he would have spurts where his speech or skills would catch up. But his emotional outbursts were always there from the beginning. From a very young age, he had issues with anger/frustration. He would actually fall to the ground into a type of "coma". That's the best way I could describe it. His eyes would be open and he was indeed awake but he wouldn't cry or speak until the feeling passed....sometimes for 30 minutes.

He doesn't do that anymore thank God but when angry, he still shuts down and will not communicate no matter what I try. He is now in preschool and having issues. he throws things and screams so loud for so long that the teachers are unable to control him and fear for the safety of the other kids (from him throwing things, not from him hitting.)  He has been through several evaluations and the Dr's all cannot find anything to explain it (he did not test on the spectrum) as 60-75% of the time he is quite normal, happy and social. People have been telling me it's me being paranoid since he was so early, or that he needs his butt whipped or that he'll eventually "catch up" and this has left me frustrated and feeling very alone in my search to help him.

Your article about Anger Overload was the FIRST thing that aligned with his symptoms!!! I have contacted a child counselor to see if they provide Parent - Child Interactive Therapy so I can learn how to best deal with his outbursts. I also plan on buying your book tonight in the hopes that this four year nightmare will finally end. It's not the anger I have an issue with....it's NOT knowing what he is going through and how to help him. Having a name for it (and not succumbing to labeling him but rather focusing on giving him outlets) helps me so much. Thank You, thank you, thank you!!!!

Hi, research on anger suggests that the structures in the brain that have to do with anger and self control are the amygdala and cerebral cortex.  The cerebral cortex receives signals from the amygdala; for children who have difficulty with self control, one prominent theory is that the cortex is not developed enough yet to manage the signals from the amygdala.  The cortex gets overloaded.  Hence the term anger overload.  The exercises in my parent's manuals are designed to help children cope.  I think that as children practice the strategies the control centers in the brain become further developed.    

The emphasis of the first chapter of volume one is careful observation.  You would write down what happens and look for themes.  What issues sometimes trigger your child's anger?  Then you would keep an eye out for these triggers.  The next chapters of the manual offer a number of strategies.  One set of strategies involves changing the sequence of events to avoid a trigger.  When this is not possible, early intervention is key.  Emotional distraction can help if a child is not yet in overload.  Also, developing "mantras," or jingles, helps a child to change his mental set (his expectations) and this often helps to change the way a child acts. I explain how to develop these strategies (and more) in my parent's manuals and in other blog posts.  In the second volume of the manual, I also explain how to use the strategies in a school setting.

When a child is throwing things, he is in the overload phase.  It is hard to reason with a child in this stage because he is not thinking rationally.  His cortex is overloaded.  When he is calm, in addition to the above strategies, I would try to develop a "go to place" when he feels an upset coming on, and reward him heavily for trying to go there when he is frustrated.  In the "go to place," I would have something he could hold and/or squeeze to try to comfort himself.  If he throws something there, no one gets hurt.  It is not easy to accomplish this because your child (given his age), will not usually realize when he is starting to get upset. Thus, it is important to help him see early signs of getting frustrated and point out which situations he should look out for.  Most young children though need an adult to cue them to use the "go to place."  At that point, do not explain what you see happening, just cue him to use the "go to place."  Keep the cue short.  

For older children (ages 8 and above) we recently developed an anger overload workbook that parents can work on with their child.  But for younger children, the parents' manuals are what you should read.  Best, Dr. Dave Gottlieb

Monday, June 27, 2016

ADHD and anger overload

I am emailing you in hopes of some answers to the cause of my 6 year old daughter's anger outbursts. She has never been formally diagnosed with ADHD, but she has many of the symptoms for it. She can be fine one minute and if something sets her off, she goes into a rage of anger. I can't talk to her or go near her. She has attacked me, hitting me, slapping me, and kicking me. What do you think is going on?

First, you may want to ask your child's doctor or a local mental health professional to determine whether your daughter has ADHD.  There are several subtypes of ADHD: a) primarily inattentive, b) primarily hyperactive-impulsive, or c) combined type.  For inattentive ADHD, there will be signs of distractability, particularly when a child is not very interested in something.  This might be apparent during a long school day, such that the child tunes out at times.  

For hyperactive-impulsive ADHD, the child will be "on the go" a lot, and may 
exhibit extraneous movements of her limbs, or wiggle a lot in her seat.  You would also see signs of impulsivity, such as responding without thinking and blurting things out in school or at home. Many six year olds may have some of these behaviors, so that is why a professional would be able to tell you if it is more than expected for her age group. 

Children with ADHD may also exhibit anger overload.  If a child has the impulsive type of ADHD, he may be prone to reacting quickly and excessively when angry.  That is why treating ADHD may be helpful in lessening anger overload.  Keep in mind that these are two separate diagnoses, and your child may have one or the other but not both.

For anger overload, I discuss in my parent's manual how to keep track of your child's triggers and look for themes--is there one or more common factors that can help you predict when she will erupt?.  Then I outline a variety of strategies based on when you recognize your child is getting angry.  There are different strategies depending on whether you see early warning signs or not. Sometimes children go into the overload phase so fast that it is hard to work around it or to implement emotional distraction or relaxation strategies.  Over time though, you may be able to come up with mantras (short sayings) ahead of time to help your child deal better with frustration.  The mantras can be verbal, or you can work on pictures with your child that you can post on the refrigerator.  The content of the mantras depends on the theme(s) of your child's triggers.  The idea is to remind her ahead of time how to expect disappointment and how to handle it.  This process is described in more detail in my parent's manuals and in other blog posts.  It can take several months to develop and practice mantras with your child so that they become "internalized" by your child.  You would give her praise for practicing mantras with you daily while she is calm.  The more days you practice, the more likely the strategies will become effective.  

Best, Dr. Dave Gottlieb

Thursday, June 16, 2016

5 yr old's anxiety may trigger outbursts


I've been reading your blog lately (and have just ordered 'Anger overload in children' out of interest for my own five-year old daughter whose behavior is relatively consistent with descriptions of anger overload. I am writing to you for assistance with one particular and related issue she has: she doesn't seem to have 'normal' outlets for expressing anxiety and stress, seemingly resulting in anger/tantrum issues. For example, she rarely cries (something we've been working on) and has the tendency to bury her negative emotions until they become too overwhelming, leading to what are sometimes hour-long tantrums. The tantrums themselves can be triggered from innocuous daily activities, are rarely goal-driven, and are often triggered during sleep. The tantrum itself occurs almost always at home, and my spouse and I sit by her to ensure her safety and to provide verbal support. In the end she typically winds down herself or might be distracted (after 40-50 minutes) by a story and then snaps back to her usual, happy personality as if nothing happened. When queried about it hours later or the next day, she replies with unrelated comments and evades the question. Other than these events she seems like a regular kid. 

We've moved around quite a bit in the last few years so I suspect we know that the trigger is the anxiety, stress, and insecurity that comes with such moves. We're in the middle of our final move now where we will be settling for the next 20 years, but I'm concerned about how to deal with her in the here-and-now.

These explosions used to happen every few weeks (which seemed normal) but are now happening on a more regular basis (every few days), hence our concern. My main question/concern is that while we can often see the tantrum coming and if need be can distract her from having one, I question the wisdom of distracting her, as without one she seems to just continue to bury and build anxiety. Eventually, these feelings seemingly need to be released, I suspect. These tantrums, as disturbing as they are, seem to offer a release of sorts given her propensity to hold everything in. I was wondering if you might have insights regarding the need to actually have a tantrum to release anxiety and stress and how we might encourage her to release stress in real-time in other ways so that it doesn't build up in unnatural ways. Thanks kindly for your time.

Hi, I would recommend helping her deal with stress in other ways, if possible. Tantrums may release her frustration, but it would be ideal if she could learn a more adaptive way of dealing with whatever is bothering her.  First, I would think about what the stressors might be.  You mention frequent moves:  does she say anything about the moves, or does she seem more anxious right after a move?  Also, keep notes for a few weeks about what is going on before she has a tantrum.  While children can tantrum in many situations, see if there are any themes.  Does she feel disappointed or irritated by certain types of events?

You also mention it happens when she is sleeping.  Does she wake up with a nightmare, or is she having night terrors (when a child does not fully wake up)? If the former, see what the theme is and when she is fully awake try to talk with her about her fears.  Depending on what it is about, you can either "normalize" and empathize with her concerns, or reassure her if she is worrying about something that has little likelihood of occurring.  If it is night terrors, it is better to let her go back to sleep without necessarily intervening.  With night terrors, children are not awake and won't usually respond to being held or talked to.

If you feel it is about the frequent moves, then see if you can empathize with her about how hard that is.  Maybe the children's librarian can help you find a story book about a child who moves.  This may help her see it happens to other children and she may be able to talk about how the character in the story feels, without talking about herself.  Some children can talk better about their feelings indirectly--that is, about a story character.  This may help her relax.  

In my manuals, I write about developing mantras that help a child deal with feelings of frustration or disappointment.  The mantra would be short and catchy, and you would review it with her daily.  Maybe have her draw a picture of the mantra and put it on the refrigerator to help her remember.  In time, this may help her "express" her feelings.  

If you do not see a change in her behavior after you settle down in your new home, maybe check with a mental health professional who can try to assess what else might be bothering your daughter.  It sounds like you are very sensitive to her needs, and you may be able to  help her at home.  But sometimes we are so close to our children, we may not see something else that could be bothering them, so if you do not see any changes in the coming month or after you have settled into your new home, consider a therapy consultation.

Best, Dr. Dave Gottlieb

Monday, June 6, 2016

How does cognitive behavioral treatment work for anger overload?

In answer to the parent in my last blog post, I mentioned that my anger overload parent's manuals and children's workbook use aspects of cognitive behavioral therapy.  The "cognitive" part means than if you change the way someone looks at something, you can help them learn new ways of coping.  So part of helping someone with anger overload is helping them understand what is going on when they get angry.  This is why the first part of my books instructs parents and children to record some of the situations that have led to angry outbursts, and then look for patterns.  Not every outburst will fit into one pattern, but the more patterns you can discover, the better you will be able to help your child devise strategies to master his or her anger.

Now, because most children's emotional responses to frustration are so quick and "automatic," knowledge (about one's triggers) alone will often not be enough to prevent angry outbursts. This is why catching anger early, and, if possible, preventing it in the first place is so important.  Therefore, many of the strategies I outline in my parent's manual and children's workbook aim to help avoid or change the sequence of events that brings on a child's anger.  Knowing the child's triggers will make it possible in the future to avoid or change some situations that typically have led to anger overload.

Another group of strategies has to do with helping a child deal with his vulnerabilities that can trigger anger.  So if a child is triggered by losing a game (as was the case in the last post by the parent of the 9 year old) it is important to help change the child's perceptions about losing BEFORE he loses a game again.  This is where mantras, or catch phrases, can be helpful to a child.  If they learn to hear the mantra in their heads, they will realize that losing a game is to be expected.  If they accept new expectations about losing a game, they will be better able to cope when it happens.

Another section of the parent's manuals and children's workbook deal with emotional distraction.  If a parent or child is aware of the child's triggers, they can use emotional sayings, lyrics, or activities to re-direct a child's emotions.  To put this idea in another way, it is hard to be angry if you are laughing or feeling joyful.  It is important first to observe one's triggers, because then everyone will be more alert to when an emotional distraction may be needed.

Once anger reaches the overload stage, the strategy becomes one of containment.  Having a "go to place" in your house where a child can emote without alienating other family members can sometimes help.  However, it can be a struggle to get a child to use a "go to place" away from the family because the child is not thinking rationally at times of high emotion.  Thus, it may be necessary for family members to ignore or leave the scene of an outburst, and talk later about what happened when everyone is calmer.  Then the goal is to talk about the triggers later and to try to look for early warning signs that everyone can use next time to try to divert the child at earlier stages of frustration.

More about all these ideas is written in other blog posts and in my parent's manuals and children's workbook.  The children's workbook is designed for children 8 to 18, while the parent's manual is useful for parents of children of all ages.

Dave Gottlieb, PhD

Wednesday, June 1, 2016

9 yr old erupts during games at home

My husband just stumbled over your article on Anger Overload in Children and it really describes my 9 year old son.

My son has been having anger outbursts since he was around 4 or 5.  When he was in first grade we took him to a therapist. She had us read 1-2-3 Magic which we began using but it did not really help alleviate the tantrums.  In first grade we saw another therapist and he honestly did nothing.  My son would not talk with him and really could not express his emotions or even discuss what happened when he had an outburst or why.  The therapist basically stopped seeing us.

Then at the beginning of this school year I took him to a psychologist and then did some testing on him.  It was minimal testing and she said he was borderline ADD and ODD.  She offered no direction for us so we have been trying to work with him on our own.

Our son does not have any behavior problems at school.  He is always described as a great student who is happy and social. The problems all occur at home, mostly at home and really never in public. He is a moody child, and if he does not get enough sleep it seems to trigger him.  He is extremely disrespectful and can be very difficult when asked to do the simplest routines (i.e. brush his teeth, take a shower).  It's like walking on eggshells with him and we are never sure when he will react this way.  Sometimes he follows directions and can be sweet and loving, other times the smallest things will set him off. My husband is in the military. We have 3 children, 2 boys and a 19 month old daughter who we adopted at birth. 

Last night he was playing checkers with his younger brother.  One of the checker pieces fell into the AC vent on the floor.  He completely lost it screaming, crying, saying ugly words.  He could not be calmed and there was no rationalizing with him.  He could not let it go, "my life is horrible." We try to ignore the ranting or put him in his room, but he screams all sorts of things in his room, slams the door, throws things.  He will eventually calm down, every once in a while the tantrum will last a while, but they are usually over in about 15-20 minutes or so.  I have to be very careful not to engage with him, but when he is breaking things and throwing things it can be difficult.  After he calmed down and my husband got him in the shower, my other son and I began playing Life.  We asked him if he wanted to play but he grumbled no (he was still going on about the checker).  He did come out and ask to play. Everything was going fine until something in the game did not go his way.  He began screaming and crying, saying it was not fair.  He quickly became enraged and out of control, especially as I told him that was not how to play the game.  I gave him a chance to calm down, but he would not, so he was asked to go to his room.  We had to physically put him in his room where he acted as I described above.  My other son is pleading with me, "Mom just let him have his way."  But I don't want to do that.  That will teach him if he throws a fit he will get his way.

We have tried behavior charts, incentives, consequences and all of that, but now I honestly am not sure what to do.  I wonder if some of the things we have implemented have caused harm.  I want my son to feel safe and loved and I am not sure if he does.  He sometimes seems detached about it.  He is remorseful most of the time, but he does like to blame others for his mistakes.  We just feel lost and are unsure of how to help him.

The ironic part is that before I had children, I was a special education teacher and spent some of that time as a behavior specialist.  I had success with other people's children but now I am at a complete loss and really feel heartbroken and desperate for my child.  I just purchased your books but have not received them yet.

I know my husband and I need help with him.  I am sick of constantly second guessing myself and my parenting with him and blaming myself.  I want to find a therapist for him, but am hesitant about choosing one.  I don't want to bring our son to someone else who is not going to be able to help us.  Do you have any suggestions on the type of therapist we should see?  Are there certain things I need to ask the therapist to see if they are a good fit for us?

I feel better after reading your article because it gives me some hope.  Any insight or suggestions you may have to help us with our son and to help our family would be greatly appreciated.  Thank you so much.

Hi, It sounds like you have been through a lot of tantrums with your son, and you have tried a number of tactics.  I like that you try to ignore the tantrums.  Unless something important to you is being broken, it is usually best to ignore tantrums.  The key to changing the problem is to intervene at the earliest stages of upset, because once your son is in overload, it will be difficult to reach him until he calms down.  When you get my parent's manual and children's workbook, you will see a number of strategies to try to prevent an upset, or to interrupt an upset in the early stages.  

First, make a list of some recent triggers, for example, you noted when the checker piece fell into the vent or when something he felt was "unfair" (in the other board game) had occurred, he erupted.  One strategy then would be to talk with him before starting a competitive game and to develop a mantra, or saying, to remind him before he starts the game what could go wrong and how he might handle it.  One kind of mantra would be "things don't always go our way in games; mistakes happen, or sometimes we lose.  Get ready for something to happen, Remember if you always won every game, you would get bored.  Games wouldn't be exciting then."  Now that is really too long for a mantra.  You would want to shorten it to come up with a sentence that fits best for your son, one that he can relate to.  In my anger overload workbook (written for children and teens ages 8 and up) I try to involve the child in planning the mantras. The parents' manual on anger overload coaches parents on what to do, even if their children are not ready for the workbook. 

There are other strategies, such as emotional distraction.  For this strategy you could come up with a funny or exciting saying that might help distract him, for example, "I think our dog just farted". Children around age nine love jokes about going to the bathroom, but your son may have other kinds of jokes he likes.  Another possible emotional distraction is a song, movie, or activity your child loves.  If you can ask him about one of his favorite things, or sing a verse of one of his favorite songs, or imitate one of his favorite characters, it could get his mind off the missing checker piece. The idea is to grab his attention by evoking an emotion other than anger, and thereby distract him from having an upset.  

You will see other strategies to try in the parents' manual and children's workbook.  You want it to be a collaborative effort if possible.  The more engaged your son is in the process, the quicker the strategies will help him.  The strategies do take time and practice, often several months to be effective on a regular basis.  And you won't always be able to stop a tantrum in advance. I explain in my books how to review tantrums and plan for the future when everyone calms down.  

As for finding a therapist, you could share with him the manual or workbook and see if he or she uses some of these strategies.  Many of the strategies fall under the heading of "cognitive behavioral" therapy.  They work better than incentives and consequences in most cases, because when a child is upset, he is not thinking rationally and won't care at that time about incentives.  

Also, you want a therapist who works with the parents as well as your child because therapy will go faster if you are acting as your son's coach, and the therapist can advise you how to help him work on the strategies at home..

Best, Dr. Dave Gottlieb

Tuesday, April 19, 2016

3 yr old tantrums daily

In doing a little research today, I found your blog and wondered what your view might be on an issue with my three-year-old grandson. He has angry outbursts, usually everyday, when he doesn't get what he wants. He will scream and cry and yell, sometimes for a few minutes, other times for thirty minutes or more. A few times I have seen this go on for as long as an hour. At times he will hit his parents or me when he is angry. We have tried distracting him, which only works occasionally to calm him down, and we have tried time-outs, etc., which never seems to work. Otherwise, he is a sweet, loving child with a good imagination. His language skills have developed a bit slowly, but he seems very intelligent to me. Would you recommend him seeing a professional? Any advice you could give me would be so greatly appreciated. Thank you very much.

Hi, Once a young child is in overload, time outs are not usually helpful.  Your grandson is not thinking rationally at those times so he is likely to resist going to time out.  If no one is being physically harmed, try to ignore him until he calms down.  I realize this is hard to do and may take some time to work, but the less attention for tantrums the better.  If someone is being hurt, you will need to physically restrain him. 

An important strategy would be to try to anticipate some of the issues that cause these outbursts. In my parent's manual I explain the importance of keeping a record of what is going on before an outburst.  Then look for patterns.  Once you find a situation that often precipitates an outburst,  try to change the sequence of events.  For example, if he tantrums at bath times, try to have something fun come after the bath so your grandson is more likely to cooperate in the bath.  

Or if the problem sometimes occurs in stores, try to lower your grandson's expectations before going to the store (i.e., we can't buy toys today), or do not take him there, if it is possible to shop without him.  Lower expectations in advance or avoid the situations that you can.

When you use distraction, try to use it early before he is in overload, and use humor or imaginary stories that might captivate his attention.  For example, when getting a young child dressed (if this is a problem), start telling a story before you put on his clothes, so that he is distracted from the start.  

I discuss these strategies more in other blog posts and in my manuals.  But if you do not make progress over the next month, then consider getting an in-person consult with a professional in your area.  The cause could be something else going on in the child's life and that can best be addressed in person.  Best, Dr. Dave Gottlieb

Tuesday, April 5, 2016

How to help a 14 yr old

I have now got your book the parent's manual and find it very helpful and reassuring. I and my husband thought my son was getting so angry because I was a bit 'soft' on him.
He has always had what we thought was a very short fuse and difficult to settle even as a baby. My instinct has been to not punish for the anger outbursts as he is so upset when calm about it and cross with himself but my husband believes he is not learning and should be disciplined in case gets wrong message. I do most of parenting as I work part time.
My concern is that we are starting so late. He is a lot better than when he was little but there is still the occasional serious outburst. He is better at telling us now he is angry but it can be hard not to argue when he starts blaming us for his behaviour and saying we provoke him, not that it is a video game making him stressed.
Is it still possible to help him at 14?

Yes, absolutely you can help him at age 14 to continue to learn how to control his angry responses.  The first half of the parent's manual is about strategies you can employ without the direct participation of your teen.  The second half of the manual goes over strategies you can work on together with him.  For children and teens (ages 8 and up) our new anger overload workbook (published last month) has step by step exercises to help them learn better self control.  Keep in mind that studies of the brain show that it is still developing well into a person's 20's and even at age 30.  What the strategies do is help move development along.  Studies show that strategies, like the ones in my manual and workbook, help children and teens learn better self control.

For your son, I would especially look at sections in the manual about using labels for levels of anger, as well as the sections about other points of view and about using catch phrases, or mantras.  If he can learn to label his anger when it is at the low stage, he will have a better chance to use a strategy because once he is in the high anger stage it is harder to stop and think.  Then it is best to go somewhere by himself until he feels calmer.

Once he is calm, or when he is in the low anger stage, see if he can learn a mantra to help him keep perspective.  You want him to learn that there is more than one way to look at a situation, and I explain how to practice this in the manual.  For more exercises about this strategy see the Anger Overload Workbook.  The idea is to pick a situation that arouses his anger (like video games) and help him anticipate that it will be stressful (that the game is made so that people will lose because then they are challenged to play the game more and more).  If he can anticipate a frustrating situation and he remembers to say a mantra to himself to help him think about it in a new light, then he will be less likely to explode when the frustration occurs.  

I explain why rewards and punishments are not usually very helpful for anger overload in my second parent's manual that provides additional information for parents and for teachers about how to deal with anger overload in children.  Rewards for trying to use a new strategy might help, but any consequence you use while he is in overload is unlikely to help because he is not thinking rationally at those times.  Sometimes it can help to use a brief consequence (once everyone is calm) if he does not try to use a strategy, but wait until your son shows signs that he has learned the strategy before you impose any consequences.

Best, Dr. Dave Gottlieb

Tuesday, March 29, 2016

12 yr old with anxiety and anger overload

Dear Dr. Gottlieb, 

I just finished reading your blog about angry children. I couldn't believe what I was reading. It was as if you'd been standing in my room watching and listening to my 12 year old son. He is currently diagnosed with anxiety and ADHD, but after having read this, I think it is more likely that he has anxiety and anger overload issues. 

My son has very little self confidence, thanks in large part to poorly educated teachers. He has had wonderful teachers up to this point in his education, and they worked very hard along side of us to build his confidence. This year, his Special Ed case manager, and his teachers have formed a wall that has prevented him from achieving his goals. In fact, they have added obstacles in front of him at every opportunity. 

He struggles with his anxiety to the point that he often has insomnia and can literally have breakdowns. When he gets to that point, his next reaction is almost always anger. He knows when it is coming on thanks to a lot of cognitive behavioral therapy that was started when he was just 7. I received training from his specialist at the time on the techniques to help him learn his triggers and recognize the signs of an impending meltdown or explosion. He has become an outstanding advocate for himself. 

This year, when he advocated for himself, he is told that he has to "prove that it will help" to have a request fulfilled. For example, he and I have made several requests to have him moved up in his classes. He is currently in the lowest level classes (intended for children who are significantly below grade level). He doesn't feel challenged in them at all. His standardized test come back with him being at grade level, and last year's teachers agreed that he should be placed with grade level peers. The teachers this year - without consulting us, moved him down. It was a blow to him. He has been trying to prove himself all year to meet the expectations that they set for him as proof of his ability, however these have never been clearly defined, nor discussed. We have been told multiple times that he will be moved in "a few days" or "a couple weeks" but then some "reason" happens and they do not follow through. 

To add to that, he has been dealing with a bully in his classes. She is in all of his classes, and they claim that due to her "special needs" they can't do much to stop her or help him. He is beyond frustrated and now shuts down in class to try to avoid being her target. This has compounded the problems with the teachers believing he is an able student. 

I plan to print this article to give a copy to his special edication case manager. Perhaps if she reads this, it will shed light on the difficulties he is having, and just maybe they will begin to see why he has struggled, and why I continue to advocate for him so strongly.

Thank you for your insight.

Hi, It sounds like you have worked hard to help your child, and I hope the school will help consider his strengths academically.  Sometimes when a child has anxiety or anger that at times affects his school behavior, schools overlook the child's strengths.  Hope they will look at your "whole" child, and determine which class is the best fit for him.

In my parent manuals and child workbook, the sections on mantras would be helpful.  It sounds like your son can already identify his triggers, and mantras are ways of looking at the triggers from a new perspective.    

Best, Dr. Dave Gottlieb

Friday, March 25, 2016

Just Published: The Anger Overload Workbook for Children and Teens

Hi.  We just published our new workbook for children and teens that builds on the Anger Overload Parents' Manuals.  The workbook is written for children and teens ages 8 to 18.  It provides step by step instructions and worksheets to help children and teens identify their triggers and to choose from a number of strategies.  Parents or counselors have a role as coaches, and we provide instructions for coaches at the beginning of the workbook.  The workbook is meant to accompany our popular parents' manuals, and is available from the publisher at https://www.createspace.com/6151028.  It is also available on Amazon and other online book sellers.

David Gottlieb, Ph.D.

Tuesday, March 22, 2016

6 yr old hates to lose and hates to make mistakes

I found an article you wrote on Anger Overload, and it describes my 6 year old son to the T! Since preschool his teachers have been concerned with his lack of emotional self control. Now he is in first grade, and it is really starting to become a major problem at school. According to his teacher, he frequently has anger outbursts if he makes a mistake, is embarrassed, loses a game, or feels rejected. His outburst often seem inappropriate to the situation, and it is difficult to get him to calm down. Lately, the outbursts have gotten worse. He is banging his head and fist on the desk, kicking the wall, and screaming at other children.

He has been attending a social skills group once a week at school, but so far I haven't seen any improvement. They also have a color chart at school which is their from of behavior modification. Again, I am not sure how effective this system is for my son. We were doing small rewards when he came home on good colors, but lately we have been having so many issues at school he hasn't been able to earn anything.

At home, we rarely have any issues with him. He is a sweet little boy, and very affectionate. He is also extremely smart. He tested above the 95 percentile in Math in the school standardized tests!

Everyday before school I remind him that he needs to have control, but at least once a week I am getting a phone call from the school. I don't know how to help my son, and it breaks my heart. I want him to have a positive school experience, but the past few months have been extremely difficult for him.

Do you have any recommendations for how to talk to his teacher/school about Anger Overload? Does my child need to be evaluated for this? How can I get a couple of our Manuals ?

Any advice would be greatly appreciated!

Hi, First, the manuals are available online at book sellers like Amazon.  Search for "anger overload" on Amazon, for example, and my original parent's manual will appear as well as volume two (that has additional strategies for parents and teachers).

The manuals will help the teachers focus specifically on anger overload, because a  more general behavior modification chart will be less effective..  One approach I would strongly recommend that you and the school try is to develop "mantras" (short memorable sayings) for his triggers.   You mention four triggers above: losing a game, feeling rejected, making a mistake and embarrassment.  For embarrassment and rejection, you would want to keep track of when specifically he feels embarrassed or rejected, before you develop a mantra for those issues. But for the other two triggers, you could develop mantras now.  Here's how: 

For losing a game, you would talk with your son about someone he looks up to and explain how that person loses games as well.  In fact everyone does sometimes.  You would then work on a mantra, or saying, to express that fact, and then practice the mantra each day before school and again at school.  He could even draw a picture of someone losing a game, and you could post it on the refrigerator to help him remember the mantra.  The mantra could be something like "everyone loses sometimes" or "everyone, even ____loses." Fill in the blank with someone he respects.  

Another related idea would be to tell him you are going to give him a hug if he comes home and tells you he lost a game, or he could earn points for a special dessert if he loses three times in a week.  The idea is to normalize losing.  You are helping him develop a new perspective on losing.  

You would do something similar for making mistakes.  The mantra could be something like "it is good to make mistakes because it means you are learning new things" or "everyone makes mistakes."  You would pick words that he finds easy to remember, and practice the mantras each day at home and school.  Use no more than two mantras (for two issues) at a time.  Once he masters one problem, you could switch to another issue and develop a third mantra.

This is one of many strategies I outline in other blog posts and in my parent's manuals. Hope this helps you get on the right track.  Best, Dr. Dave Gottlieb

Thursday, March 17, 2016

How to help a strong willed 7 yr old

Ahhh I found your blog and book and finally feel like I have some hope—that we are not alone!  We have a 7 year old boy who has always been more competitive, more active and more of a risk taker than other kids.  He is at the top of his class in first grade, and has not had any problem with behavior at school or with anyone other than my husband and I.  He is very, very confident in himself-sometimes I worry too much so, but then I see all of the little boys on his Y-Ball team we coached, and they were much alike-so who knows! He is also a very loving, affectionate child, who loves hugs and still likes to sit with mom and snuggle:)

   He has always been strong willed, but we could distract him or convince him to make the right decisions with different behavior charts and incentive programs we’ve used.  When we did send him to time out, we’d send him to his room and tell him he could come out when he was ready to “make good choices”.  At times (not always) he would throw something, kick the wall, but it was very short lived, and once he calmed himself, he would come out and say “I’m sorry” and our day would go on happily. Self soothing and letting him calm down always worked better than us trying to talk it out like it did with our daughter.   

Most of the time, he is a smart, very funny little boy. However, a couple years ago, he began having angry outbursts, when he didn’t get what he wanted or was being told what to do(bedtime, chores, etc…).   It always seems like fatigue plays a part ( later than normal bedtime, or end of the week) -but for heavens sake, he goes to bed around 7 each night and sleeps 10-11 hours so I am not sure?   It usually begins with him talking back or arguing with his sister, we can see it coming, he pushes us—with a lot of attitude ( and even laughing at times), and then eventually turns into an explosion.  When we try to initiate bedtime, get him to do something, or lay out consequences, he yells, talks back, throws things,  and even pushes us or kicks us when we are trying to calm him.  If we ignore him, he yells things out his door, if we stay and try to talk-he just says mean things and tries to provoke us.  So we aren’t sure what to do?   He is completely inconsolable and irrational.  I am not sure how my funny, smart little boy can get so angry, so fast?  

I feel like your explanation fits him to a T, because except for intermittent (once a week or twice a month) angry outbursts, he is what I would think of as a normal 1st grade boy.  But my husband, daughter and I ( and grandparents) have unfortunately seen him explode, and it is so frustrating!  I know this is a lot, but am hoping that it gives you some insight and you can advise us in some way to conquer or learn to work through his anger.  I found your book on Amazon and so it should be here in 2 days, but if you have any advice, can you please send it our way?  Thank you so much!   I have been feeling hopeless and concerned about our little guy, and I am hoping your book may have some answers. 

Hi,  You write that you can often see it coming, and on those days you have more options to intervene.  At lower levels of anger, you can often use emotional distraction, relaxation strategies, or mantras to help your child settle down before a complete melt down.  I explain how to use each of these strategies in earlier blog posts and in my manuals.  When my manual comes, note that you can either use interventions in the first half of my manual without planning ahead with your child, or you can try to involve your child in observing his anger triggers.  In either case, you want to keep track of his triggers yourselves (which is sounds like you have already begun to do), because then you will know when a possible explosion is coming and can try to head it off.  

If you involve your son in the plan, try to help him see what some of his triggers are.  Be sure to do this in a noncritical way, and maybe talk a little about your triggers, because that will help him see that everyone has triggers.  You want to encourage him to work with you on this.  Then you can develop a mantra or distraction strategy for when one of the triggers occurs.  

If you decide to use interventions without discussing your plan with your child (if you think he will be resistant to working on it with you) then you would think through possible emotional distractions with your husband and your parents.  An activity or a funny remark that captures your child's attention will help divert him if you can catch his anger before it reaches the explosive stage.

If he is exploding, then try to say as little as possible.  When he is irrational, talking will not work. You can try talking after he is calm.  In the future, you would want to try to re-arrange the sequence of events such that you try to avoid or change the timing of whatever was frustrating him.  You mention bedtime routine as one trigger.  Try to have him prepare earlier and then do something fun together in bed, so that he is more motivated to get into bed.  You could play a short card game or read together.  If he is arguing with his sister (another trigger you mention), then try to re-position your daughter or son to avoid whatever they typically start to argue about.  Another option is to set up a cooperation chart, so that each evening there are no squabbles, they earn points together to do something fun on the weekend.  

You mention that your son is strong willed, and this can be an asset in most situations in life. But sometimes it can lead to difficulty with compromise, and as he gets older (if not now) take a look at my chapter on compromise, and consider working on it with him.

Best, Dr. Dave Gottlieb

Monday, March 14, 2016

Will 10 yr old become a "functional adult"?

My 10 year old has been having "fits" since he was a baby. He would get angry and spend 45 minutes to an hour just screaming, crying and throwing things. Kindergarten - 3rd grade was awful. I would be called into his school 2 to 3 times a week. I worked with guidance counselors, behavioral therapist, psychologist, psychiatrist, and nothing seemed to work. He was labeled as ADHD but the medications didn't help at all. I never thought he was ADHD but trying everything else I figured, why not? 

He is very bright and has been tested for gifted but misses it by a fraction. Every year his teachers say that he is the smartest kid in the class and they do not understand why he reacts to situations the way he does. If something does not go his way, something or anything can set him off. He never want to hurt anyone but will beat his head on the floor or throw a chair, or just scream and cry and hide in the bathroom. Now in 4th grade his "fits" have been better but still he gets so upset. I am worried for his future. Can he function like this as a teenager or an adult? He can be so sweet but turn so quickly. I am just worried no matter what I do he is going to end up with severe issues later, due to his anger. What steps can I take to help him become functional adult?

Hi, read through my blog posts over the last three years, and you will see your son is not alone, and you will see some ways you can work with him.  My parents' manuals are available on Amazon.  Also, in the next six weeks, I will be publishing a child and adolescent workbook on anger overload.  It follows the basic structure of the parents' manuals, and gives many concrete worksheets you can do together with your child.

Most children learn how to control their anger through practice and experience.  It doesn't happen over night, but if your child recognizes anger overload is an issue for him, then you can work him him on various strategies.  Some of the strategies that I outline in the parents' manuals you can implement without your child's direct participation.  The more advanced strategies you work on together.  

There are several overriding principles.  One is building a good working alliance with your child to help him take charge of his anger.  The second principle is to try to catch your child's frustration early (if possible).  The third principle is to develop different strategies depending on the level of your child's anger.  Some strategies require calm thinking, and that can't happen in the midst of an outburst.  

As your child feels some success, he will be encouraged to work some more on other strategies.  Having a "toolbox" of strategies is ideal, so that a child can use a different strategy depending on the situation.  

Best, Dr. Dave Gottlieb 

Tuesday, February 23, 2016

6 yr old tantrums only at home

Hello,  I’m so very excited to find your blog and hopefully get your book on anger overload.  My 6 year old daughter seems to fit the tee with anger overload.  At 4 years old she lost her great grandpa and the short little outbursts began.  We took her to grief counseling and she seemed to adapt well.  Her kindergarten school year she started to show a mild bout of fits that we just chalked up to be tantrums for not getting her own way.  By that summer they were more and more, however not aggressive, and we opted to take her to a psychologist where she was diagnosed with severe anxiety.  

As of two weeks ago the rages are more frequent and very aggressive.  She will begin by growling at you and then her whole demeanor changes and she goes into a rage, hitting me, my husband and especially her 4 year old sister.  She tells everyone that she hates them and has even said she wished she were dead.  This rage lasts over two hours and we finally took her to the emergency room for help.  Once we arrived at the emergency room she quickly changed and was nice and polite and the doctors couldn’t believe that this sweet little girl was doing what she was doing at home.  

She also is very good at school, sports and anything else while in public.  No one on the outside would ever think that she could act in such a manner because she is always pleasant.  She has also stated that she doesn’t want anyone to know about this (her rage).  Her rages are so frequent that my 4 year old is becoming afraid, as we have to keep my 6 year old in an enclosed area during this as she strikes out at my 4 year old.  

My husband and I are at a lost on trying to help her.  Her psychologist discharged her only after 3 months of therapy saying she was fine.  We have been on a waiting list for another therapist for going on 2 years.  I need my other daughter to feel safe in our home and I don’t want this to affect the relationship between the 4 and 6 year old in years to come.  When she is in a rage, do we just let her follow us around yelling and screaming while not saying anything to her, we just don’t know what we are supposed to do when she is in these fits, and I feel we must be doing it wrong because they seem to go longer and longer. 

Thank you.

Hi, First let me say it is a good sign that your daughter controls her temper out of the house.  That shows she is capable of self control.  Then the question is why the tantrums are increasing at home.  I wonder why the psychologist said she had severe anxiety--what was the anxiety about?  

What I would do is chart the sequence of events leading up to a tantrum for the next two weeks. What is she doing, and what are the adults doing right before an outburst?  See if you find any patterns.  If you do, then you can alter the sequence or avoid a trigger (when possible).  I explain how to do this in my parent's manual.  You want to try to intervene early, if you can, to head off an outburst.   Another strategy I outline in my manual is emotional distraction.   If you catch her frustration early, you might be able to come up with a funny comment, or you might be able to interest her in something else.

However, once she explodes, it is usually not helpful to talk with her until she calms down.  You are doing the right thing by ignoring her the best you can.  She may be escalating to see if she can get you to react to her.  

I wonder if she is jealous of the four year old, as you mention she sometimes strikes out at her.  If you think this is happening, try to find ways you can admire your 6 year old for helping you or for helping her sister. Express how proud you are of her at these times.  Maybe she can help in the kitchen or help you carry something.  Praise her helpful or cooperative behaviors.   

Best, David Gottlieb, Ph.D.