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'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