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

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