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