Monday, January 25, 2016

Avoiding 5 yr old tantrums

Good morning, 
I have a 5 year old son who is loving, generous, sensitive, loves to laugh and out of my 5 children is my biggest cuddle bug.  He loves to help with things, especially helping his dad build things, changing batteries in toys or cooking. He thinks himself much more capable than he actually is. Yet he hates to be alone or even be in another room by himself.  He has always been a physical child, tends to play a little rough and has a hard time calming down and understanding when it's time to stop. When he was younger he would have what we thought were night terrors and he has always had the ability to throw outstanding tantrums!  With all of our children we prefer to avoid spanking.  

We have, what we call the Stick. They can earn sticks for good behavior and lose sticks for bad behavior. At the end of the day they use their sticks like money to buy stickers and collect 20 stickers for a reward of their choosing, baking a treat, money for piggy, etc.  If they lose all of their sticks for bad behavior and they have no sticks we move to time-outs.  If they refuse this they have to take a break in their room and then come out when they are calm and take their time-out.  

This seemed to be working very well and it does for the other children. However my son, recently, has become straight up defiant at times.  Will tell us no to anything he does not wish to do, from picking up his toys to getting ready to leave. Refuses to sit in time-out or stay in his room. 4 times it has escalated to him hitting, biting, scratching and saying the most horrible things. As a last resort he received a spanking, this did nothing!!! Not knowing what to do, myself or his father restrain him on our lap and hold him in such a way that he cannot hurt himself or us. He continues to fight, spit, blow snot out his nose, say horrible things, he even peed his pants once. I continue to stay calm and tell him as soon as he calms down we can let go and that we love him. Then it stops as quickly as it starts.  His whole body relaxes and he cries and says how sorry he is and that he loves us and didn't mean anything he said. It is heart-wrenching. 

Other days, like yesterday he is an absolute angel. I taught preschool for 10 years, I have 5 children of my own and we are youth ministers.  We have dealt with ADD, ADHD, Hyperactivity and Sensory disorders.  I have never dealt with something like this before and I am at a loss. My husband and I both agree that this more closely resembles Anger Overload than anything else we have read about.  The way I understand it, it is important to find out if there is more to it, which could be medical, chemical or behavioral.  Is this correct?  What can I do, what is our next step?  I have ordered your book, but it will not be here for a week or two. Please, any advice would help.

Hi, My first thought is to ignore him right away when he refuses to do what you ask.  I realize this can be a problem if you need to go somewhere, but otherwise you might be able to "become deaf" until he is sorry or until he cooperates.  With anger overload, incentives often  do not work because the child gets so emotional so quickly that he is not thinking rationally about rewards or consequences.   The more you talk, the more your child is likely to escalate.  Initially, when you try to ignore him, your son may get angry that you are saying nothing, but over the next few weeks he will likely realize that you are not going to talk with him until he calms down and cooperates.  

Another strategy I write about in my parent's manual is to re-arrange the sequence.   What I mean by this is to ask him to do what you want before he gets to do what he wants.  In other words, if something he is looking forward to comes after he does what you ask, then he is more likely to cooperate.  You just don't start the activity he likes until he cooperates.

In volume two of my manual, I write about using mantras (short amusing sayings) in order to focus a child on dealing with something that has been challenging for him in the past.  For example, if he is slow to get ready to leave, you could say something like "chug along choo choo.  It's the train.  We have to get on it."  He will hopefully smile and stop what he was doing.  Or another way to change a child's mood is to say "Big hug time. (hug him) I really need your help now"  Then ask him to help you get ready.  Another option is to have something fun to do in the car.  Make sure he only gets to play with it in the car.  

Each child reacts a little differently, so you would try a strategy and see if it helps.  The main idea is to avoid a power struggle when possible and use a strategy that helps before an outburst occurs.  Once a child is in anger overload, you wait it out or bear hug him if he is hurting someone (like what you already do).

Best, Dr. Dave Gottlieb 


Thursday, January 21, 2016

8 yr old loses temper in school

Hi there
I have recently read your article on the above subject. I have an 8yr old boy who losses his temper and gets frustrated only at school. He was born by emergency c-section and his dominent hand is his left. Do you have any suggestions as to why this could be only happening at school. Is there any articles or books which would be useful for me to read?
Many thanks.

Hi, In volume two of my parent's manual, I have a whole section on how to apply interventions in the school setting.  I go over the strategies for each level of anger: a) prevention strategies (like changing the sequence and lowering a child's expectations), b) strategies for low levels of anger (like emotional distraction and relaxation), and c) strategies for high levels of anger,  Also I explain how schools have an advantage over home life in using rewards and consequences.  I explain how to tailor rewards and consequences for anger issues.

I would also suggest you rule out other sources of frustration in school, such as learning issues and attention deficit disorder.  If his academic work is good across the board, then learning disabilities are unlikely. If he pays good attention, then attention disorders are unlikely.  So then what I would suggest is that the teachers keep track of your child's triggers (what situations more often lead to outbursts) and use some of the above strategies for each trigger.  Sometimes it helps for parents to meet periodically with the teachers to plan strategies together.  That way you can discuss progress with your child at home after school, and then remind him in the mornings before school (using mantras) how he can deal with frustrating events in school. 

I know of no evidence that left handedness or birth by C-section relate to angry outbursts. Was the pediatrician concerned about brain abnormalities from the birth?  Has your child's development been otherwise normal?

Best, Dr. Dave Gottlieb 

Monday, January 18, 2016

10 yr old with trauma and ADHD

I have a 10 yr old daughter that I'm at my end of rope.  We never had any problems with her until 2nd grade in school where she experienced trauma from a male teacher. Her father and I reach out and got help for her and been having an in home behavior therapist coming in once a week now.  2 yrs later she has an explosive temper that she gets so mad she doesn't even realize what she says to people, and she will scream, yell, throw, swear, hit, and if you don't pay attention to her it still goes on for hours and it seems like it happens when she can't get her way or what she wants to hear and school has started to become a nightmare with her and her teacher. I don't know what to do because she is on meds for ADHD . Please can you help.

Hi, I would recommend a consult with a psychologist or psychiatrist who specializes in childhood disorders.  There are so many possible causes.  ADHD can occur with other conditions such as post traumatic stress disorder, mood disorders (like bipolar disorder), oppositional defiant disorder, or learning disorders.  You would want a full evaluation to rule  out these possibilities.  Not sure what the trauma was in 2nd grade, but post traumatic stress disorder can last for more than two years sometimes.  Did her anger issues start right after the trauma?  

My parent's manual on anger overload suggests a number of strategies that you could try after you have ruled out or treated other disorders.  You would want to observe what is happening when she doesn't like what she hears (you wrote that is when she explodes). What is she doing or wanting when she erupts?  And you say school is a nightmare--what happens there?  You would then try to target some of the times she has anger overload, by either avoiding the trigger (if possible), or re-arranging the sequence so that something she wants comes after she does what an adult asks of her.  There are also emotional distraction strategies that can help if she hasn't already hit the anger overload stage.  The activity has to be emotionally engaging for it to be effective.  

In the second volume of my parent's manual, I also explain how to use mantras (short, memorable sayings) and I make suggestions for dealing with anger in school.  Feel free also to read some of the other blog posts that explain about mantras and school problems in more detail.   

But first, you need to talk with your behavior therapist and probably get an evaluation with a psychologist or psychiatrist who could rule out other disorders.  It doesn't sound like she is making progress at this time. Is an underlying issue contributing to her exploding?    Wish I could be of more help.  Best, Dr. Dave Gottlieb  

Friday, January 15, 2016

Will manual help for 3 year old?

I just came across your blog and book in researching about my 3.5 year old's lengthy tantrums/anger outbursts. He fits your descriptions perfectly. As much as I would like to think your book would help, I wonder if he is too young to use the coping skills and  tactics? He has absolutely no ability to reason. What age do you think is the earliest the practical skills would be appropriate?

Hi, The parent's manual is divided into three sections.  The first explains the key characteristics and the biological evidence for anger overload, the second section offers strategies that a parent implements, and the third section is about teaching children new skills for self-control.  The third section requires the child's cooperation.  For the skills in this section, the child must be able to observe his own behavior, and also be able to realize that other people can have different points of view.  This section I would recommend for children ages 8 and up (though this can vary depending on each child's cognitive development).  

The strategies in the second section, the ones where the parent is the "agent" of change can be used effectively with three year olds.  These strategies do not need a child to directly participate.  There are prevention strategies that involve lowering a child's expectations or re-arranging the sequence of events, before a child would get mad.  Then I explain emotional distraction techniques that a parent can use.  These are most helpful if used while a child is starting to get angry but before he explodes.  For anger overload, it is better to ignore and say as little as possible.  But if a child is harming someone or breaking valuable items, I explain how restraining the child becomes necessary.  Finally, I write about when to use praise and consequences, and explain how parents could model some of the strategies for their child.

So it is the middle section that will be helpful for younger children.  I explain some of the above concepts like emotional distraction in other blog posts and of course in the parent's manual.  Best, Dr. Dave Gottlieb

Wednesday, January 13, 2016

8 yr old disobedient, hyperactive, and steals

I have been battling with my 8 year old son for several years now. He is extremely hyperactive even on a stimulant medication (medadate). He struggles in school and is very disrespectful and very disobedient when asked to do simple things. He has been tried on several stimulant medications. Also he is taking intuniv and respiradone which doesn't seem to help especially with with his extreme impulsive disrespectful disobedient behavior. Also for several months now he has begun to steal money from us and at times from stores. 
If possible I would love your input in this matter. Because I have seriously considered  finding a military based boot camp. Because if he continues down this path he is on I am worried he could hurt his 2 month old sister when he gets in his uncontrollable aggressive  rages of anger.

Hi, Here is what I would try first before considering military school.  I would try to have him in psychotherapy.  My parent's manual gives a number of strategies for anger overload, but for children who are hyperactive and stealing in addition to having outbursts, it would be important to have professional help. You want someone who can figure out what some causes might be for your son's behavior, and someone who works with children and families.

Secondly, it will be important to work closely with the school staff.  Is he struggling in school because of his hyperactivity, or might he have a learning disability?  The school could help rule that out.  

With children who are out of control in school and at home, it is important to coordinate strategies with the school. It is real important that you and the teachers work together.  Ask for an IEP (individualized education plan).   Since your son's behavior is affecting his learning, your son is entitled to extra services.  Sometimes a smaller specialized classroom is called for.  Sometimes the school can make modifications in a child's current classroom.  See what the staff thinks would be the best classroom situation for your son.  Then check out what class or plan is offered to make sure you think it will be helpful for your child.

If that does not lead to changes, or if you have already tried these suggestions for a period of time, then you could check out boarding schools.  Military schools can help, but you want one that has a caring environment as well as structure and discipline.  Your son's school district should consider residential placement, and pay for it, if an intensive day program has been tried and failed to help. .  Keep in mind that if your son is hyperactive, he will most likely need to stay on medication, so you want a school that accepts that.  

Best, Dr. Dave Gottlieb