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.  

Wednesday, February 10, 2016

Will children improve over time?

My son, who is now 12, appears to suffer with anger overload.  I am wondering what the general prognosis is for children who have this issue.  I can see that over time his ability to self-regulate and his rationality and self-knowledge about his anger issue increases.  So I see hope for the future.  But how do kids with anger overload – but no other mental health problem – fare over time?  Do most of them stop being so angry as their brain fully develops. or at least are they able to live normal lives after they have the maturity to handle their anger?  Thanks much. 

Hi, Over the last few years several parents have asked this question and it is a good one. Here is what I have found:   Research studies, looking at groups of children, show that there are significant changes when children learn cognitive behavioral strategies, like those I present in my anger overload manuals.  The studies compared using these strategies with groups that did not receive therapeutic intervention, and the studies found that the group of children taught to use the strategies handled their anger better.  

What hasn't been studied yet is seeing what happens to these children over many years, in other words, a longitudinal study.  Do the children maintain their gains over a long time period, and what percentage are still having anger overload many years later?  We do know that the brain keeps maturing throughout childhood and early adulthood, and we do know that practice using these strategies is beneficial over the short term for most children, so we believe that most children will continue to improve as they get older. 

Keep in mind that these studies have been for children as a group.  We can't make predictions for any individual child. 

A question we can't answer yet is why do some adults have anger management issues.  Did they have anger overload as children?   Did these adults receive help as children?  Is there something about their biological or emotional development that interfered with their learning better self control?  We know that adults with anger problems do have subtle differences in parts of their brain.  But we don't know how this happened. Were there other life events that impacted them in a negative way?  For example, we know that if there are serious mood problems or drinking problems, there often are anger problems as well.  But we don't know if the drinking or emotional problems caused the problem with anger, of if there is some other underlying cause.

I hope this is helpful, David Gottlieb, Ph.D.

Monday, February 8, 2016

8 yr old accused of assault in school

Hi: I have a 8 year old great nephew in whom I have been awarded the custody of in a bitter custody battle a year ago.  He has lived with me since 7 weeks of age and has been diagnosed with ADHD.  His father suffered from this as well and his biological mother  too.  He is over weight and is taking medication for ADHD.  We had an incident at school with another child trying to take his book from him.  He and the other child began pushing each other, and my son tried to hit the other child with the book.  The teacher stepped in and demanded my son to give her the book.  He refused, and she went to take the book from him, and he reacted by trying to obtain the book.  The school says he pushed on her arm twice, and they are charging him with assault on school personnel.  I have never been involved in anything like this before and don't know my options or how to even begin to protect my son.  We were supposed to meet to put his IEP in place for other health impairment. Can you help me or give me direction where to look for advice?

I have been reading your blog and it is so helpful to see that other parents are going through some of what I am going through.

Hi, I would check with your child's doctor, or your state's psychological association, or a local chapter of CHADD (support group for ADHD) to see who they recommend to help counsel you and your nephew, and at the same time make recommendations for the school.  When a child has an IEP, there ought to be spelled out ways of handling problem areas.  I have not heard of an 8 year old being charged with assault for the type of incident you describe.  Yes, there ought to be limits for being physical with a teacher, but a detention, and in school suspension, or an out of school suspension might be needed.  If it's his first time getting physical the punishment ought to be on the lighter side. 

Furthermore, I would recommend you and the staff discuss ways of handling your nephew when he gets frustrated in the future.  In my anger overload manual volume 2, I explain ways of handling anger in the schools.  There are strategies teachers can use to work around problem areas (by changing the sequence to avoid frustration, or by using mantras to remind the child how to deal with frustration).  Other approaches I explain are how to use emotional distraction when a child is just starting to get angry (including giving the child something to do, like taking something to the office to help you, since that removes the child from the difficult situation), and how to use behavior modification in schools (rewards and consequences) to increase the frequency of self-control behaviors.

Hopefully cooler heads will prevail at your upcoming IEP meeting.  Try to see a local mental health professional before your meeting, if possible.  The mental health professional can help identify possible underlying issues (maybe the bitter custody fight, or his feelings about his weight, or his ADHD), and the professional can help you devise strategies to help at home and school.  See if the person can come to the IEP meeting as well.

Best, Dr. Dave Gottlieb