Tuesday, November 29, 2016

4 yr old punches teacher at nap time

I have a 4 year old daughter who goes to a private school for Pre-K. She has always had normal behavior problems at school but has been evaluated by the county schools without any problems. She scored very high on cognitive processing and communication. Everything else was within normal range. She is exhibiting aggressive behavior towards one of her teachers. It usually occurs when her morning teacher leaves and children are with the afternoon teacher about to go down for a nap. She is defiant and does not want to nap. She has punched her teacher several times. We are not sure what to do with this point as we are anticipating that she is going to be expelled. She does not exhibit these behaviors at home.
Can you help?

Hi, You have identified a trigger for your child's anger:  nap time.  One solution would be for the teacher to substitute a quiet activity for your child in a space where she does not disturb the other children.  The teacher may be concerned how this will affect the other children, so you want to work with the teacher to come up with an idea that works for her and for your child.  You or the teacher should probably practice with your child in advance so she understands what to do.  You could explain that this is a privilege, but that if she disturbs the other children, she will not be allowed to do the substitute activity, One way to avoid anger overload is to anticipate it and then change the situation or the expectations, if possible, so that you avoid the problem.  

If the teacher is not willing or not able to come up with an alternative, then you (or someone you know) might need to take your child out for a walk at that time.  Or if you feel your child really needs a nap, then try to come up with a quiet activity she could do on the mat, where she might eventually get tired and nod off.  Another possibility is to use incentives and consequences targeting the hitting of the teacher, but I find that incentives and consequences do not often forestall anger overload.  Most young children are not thinking about consequences when a situation arouses their anger.

You also mention that she has had "normal behavior problems."  I'm wondering what that refers to.  If there are other triggers for her anger, other than nap time, then I would refer to my parents' manuals (and look at other blog posts) to learn about other ways to help reduce anger overload in children.

Best, Dr. Dave Gottlieb

Monday, November 7, 2016

7 yr old hits, bites and kicks at home

     My grandson changed about 2 yrs ago.  It has progressively gotten worse.  He hits, bites, kicks, is destructive and defiant.  When he is not having an anger episode he is the most polite, caring and loving child you could ask for.  He does not have any anger issues at school at all.  All issues are when he is home or with family.  My daughter has taken him to a behavior therapist a couple of times with no real change.  She did take him to a different behavioral place and after speaking with my grandson for 10 minutes and looking over his health issues and talking with my daughter for about 10 minutes, they recommended intensive outpatient  3 hour group therapy for 4 weeks, 3 days per week. However this therapy is over an hour away and he would have to miss the last hour of school to go.  Then by the time he would get home, eat, do homework , etc. he would be exhausted and this would cause more anger issues.  Any recommendations you could offer would be greatly appreciated.  I love him so much and hate to see him spiral out of control.

     First, it is a good sign that he is only out of control in one setting.  Since he is in self control at school, this shows that he knows it is wrong to hurt others and shows that he can control himself in settings other than the home.  So the question becomes why is this happening at home.

     I would recommend you and his parents keep track for a few weeks what exactly is going on right before he loses it.  What is he doing and saying and what are the adults at home saying or doing.  Then look for common threads in some of the precipitating events.  Is there a theme in some of the outbursts?  Do they happen at certain times of the day, or when he is expected to do certain things, or when he feels ignored, criticized or unfairly treated? Look for themes in how he feels before outbursts, or what he is doing at those times.  In my parenting manuals I provide worksheets to help parents identify triggers.

     You mention that things have gotten worse the last two years.  Think about what changed two years ago.  Did expectations change, were there any losses, or did parents' or the child's schedules change?

     Once you identify some triggers, you try to develop a plan to reduce the likelihood of upset.  Here are a few examples.  For more, see my parenting manuals.  Sometimes you change the sequence of events, for example, if the problem occurs when he has to stop playing and get ready for bed, then you would get him ready for bed right after dinner, before he starts playing.  Then the sequence is such that your grandson gets to do what he wants after he does what the parents want.  

     Another possible approach is to change your grandson's expectations.  For example, if he expects that he will always get to play on the computer when he wants, rather than share time on the computer with another family member, you would talk with him while everyone is calm about the new plan or expectation.  Sometimes I have children come up with a catch phrase and/or drawing to reflect the new expectation, and I suggest parents practice the catch phrase with their child daily.  

     Sometimes the outbursts do not fit a theme and happen so quickly, that it is difficult to change a child's expectations.  Then I recommend "emotional distraction."  What this means is coming up with something you can do or say that changes the way your grandson feels. For example, if you can say something silly that he laughs about, it is less likely that he will explode.  But if he is already exploding, it is best to say or do as little as possible unless someone is getting hurt. It is not possible to reason with a child in the overload phase, and furthermore if you talk a lot then, it inadvertently rewards his outburst.  This is why I recommend saying as little as possible.  If someone is getting hurt, it may be necessary to bear hug your grandson, or in some way restrain him until he calms down.

     Also consider what has changed in the last two years and if your grandson is feeling worried or unhappy about something, try to address his fears (or the source of upset) to see if the angry episodes lessen then. Looking for underlying causes is another approach to dealing with anger overload.  

     If nothing is helping, then consult with a therapist who works with families and children.  I find that in most cases young children do better when a therapist strategizes with parents, in addition to the child, rather than just meeting with the child.  Young children often have trouble implementing strategies without their parents' help.

Best to you and your family, Dave Gottlieb, Ph.D.