Monday, January 16, 2017

What type of classroom is best for 6 yr old?

I have an almost 6 year old (about 2 months shy) who for the most part is a sweet, amazing child, but when angry, will hit, kick, throw, scream, run.  It started surfacing when he was about 3.5 years old.  We went through a number of preschools and finally settled on a part time parent participation preschool with a nanny present at all times.  We took him to a developmental pediatrician and it ended up more about ruling things out (autism, ADHD) than knowing the root cause.
He's now in kindergarten and officially on an IEP, and in a specialized class with onsite behavior specialists and therapists, and on a shortened day.  As a part of the IEP, we're about to get in-home services with a therapist as well.  As a part of my search for answers, I stumbled upon your articles on anger overload, which is the first time I felt like someone was describing my son.  My husband and I have learned to change how we interact with him (our developmental pediatrician recommended "The Explosive Child" which helped us understand that blaming him for his behavior was like blaming a dyslexic child for not being able to read), and while we still have our moments, we've been able to really minimize his severe anger at home.
This is not the case at school.  Even with all the additional support, he's having problems where an incident report is written up multiple times a week.  What more could we be doing to help him?  Are there therapeutic programs we should be looking into?

Hi, Yes there are day schools for children with emotional problems, but that may not be ideal for your child.  The programs vary in what emotional issues they deal with and in what approaches they use.  So if you someday consider that option, check with your school district to see what day schools they work with and what types of problems the schools are designed to help.

It sounds like your school system is trying to help by placing your son in a specialized program within your home school district.  The advantage of that approach is your son does not have a long bus ride, and may eventually be able to be mainstreamed gradually once he develops better self control.

The second volume of my manual offers strategies for helping children with anger overload in the classroom. I show how to apply the core principles from the first volume of my parent's manual to the school setting.  The first step is looking for patterns:  are there some themes or triggers that precede your son's outbursts?  While you will not be able to categorize all of the situations, if you, or the teacher, notice some patterns in school, you can then try to prevent anger overload by either changing the child's expectations or changing the sequence of activities.  For example, if a child expects to be called on when he raises his hand, or in another example say he expects to use the computers when he arrives at school, the teacher may be able to cue the child before these situations occur.  In the first example, the teacher will explain to the child ahead of time that he will only be called on occasionally, or, in the second example, he will be able to use the computer after the class does something else first.  The teacher could develop a short verbal or visual cue to help remind the child of what to expect, and could compliment the child any time he shows self restraint in those situations.  

There are also ways to set up relaxation stations or use emotional distraction techniques if the child's frustration is caught at an early stage before anger overload is reached.  I explain more about these strategies in other blog posts and in volume two of my parent's manual.

The most difficult stage for the teacher to manage in the classroom is if the child reaches the anger overload phase.  When a child is in this phase the teacher will usually need the help of an aide to help the child leave the classroom.  The school should plan in advance where this place would be in the school, so that the child is able to settle down without too much attention from the aide.  This can be hard to do when there is a classroom full of other students, so that if there are frequent outbursts, a smaller class with a "go to" calming place would be needed.

I explain in my manual that rewards and consequences need to be used carefully, because children with anger overload are usually not able to stop their behavior to avoid a consequence.  Children are not thinking rationally during anger overload.  Also, writing up an incident report may not be helpful, unless it is used to identify patterns, and not used to hand out punishments.  Determining patterns and triggers, as I mentioned above, is a useful first step toward developing a plan to help forestall an outburst.  Generally speaking, it is important to develop a good working relationship with your son's teachers and therapists. The more everyone is working together, the more likely your child will learn to develop better self control.

Best, Dave Gottlieb, Ph.D.

Wednesday, January 11, 2017

12 yr old loses it playing video games

Hi Dr. Dave,

Unfortunately, our 12 year old son has had a disappointment trigger for several years which causes intense rage. When he was younger (around 5 to 8 years old), it was tied to arcade claw games. When a prize wasn't grabbed and won, he'd throw a huge tantrum.

He's conquered that situation now that he's older, but now it occurs while playing a video game and something unexpected happens - usually tied to his perception of fairness (i.e. someone is thought to be cheating, loses when a win appears imminent, spends a great deal of time collecting materials within the game but is lost, etc).

Rage is almost instantaneous, not appropriate in terms of severity of the situation and can last for an hour or two if we don't distract him with something else. He often tries to break items around the house and appears to be unable to think rationally during these episodes.

His mother is bi-polar, but he doesn't display the same symptoms as her - except for the actions described above in very specific situations. Otherwise, he's a great kid that makes friends easily and does well in school. Also, I can only recall that he's displayed this behavior in front of someone other than family once, typically happens just in front of his parents, if that helps.

In short, what do you feel is the cause and what can we do to greatly reduce or eliminate this negative behavior?

Hi, What you describe sounds like anger overload--your child' has an angry outburst when he feels a something happens that is unfair in a video game. Many children are very excited and invested in the outcome of video games.  One approach you are already using is distraction.  While distraction can help in some situations, the problem with this approach with video games is that video games are so exciting (captivating for many youth) and your child's disappointment is so strong, that it will be hard to come up with a distraction that will capture his attention and change his emotional state. 

With video games, what I usually recommend to parents is to come up with a mantra that you repeat many times over the course of a month or more that describes the "unfairness" of video games. For example, one idea for a mantra is to explain that video games are made so that you will lose most of the time.  They want you to lose so that you will feel challenged to play again.  The game purposely leads you down blind alleys, or suddenly makes something happen to frustrate you.  If the game were always fair, you would win most of the time, and you would lose interest in the game.  Now the hard part is putting that idea into a succinct mantra.  You want it short and memorable so your child is more likely to remember it at the point he loses the game.  Practice explaining the issue when he is calm and ask him to help you come up with a sentence that he likes and that will help him remember when he plays that he is going to lose most of the time, because that is way the games are made.

Then each time he is about to play, you want to repeat the mantra in front of him, or ask him to remember what the mantra  is.  It is important for him to recall the mantra before he gets upset, while he is thinking rationally. The more often he repeats it over time, the more likely it will help.  It may take a month or more to have an impact, and it may work sometimes more than other times.  But you will see a gradual decrease in excessive outbursts if your child uses the mantra each time he plays.

Another approach some parents use is to specify certain unacceptable behaviors, like breaking or throwing things, and also specify more acceptable behaviors, like saying "this game can be so unfair" or "this game can be a pain." Then you explain while everyone is calm that if your child exhibits an unacceptable behavior during a game, he loses video game privileges for 24 hours, or some amount of time that is not endless!  You do not have to enforce the limit while he is raging, but later that day, explain that the 24 hour limit will start some time that day (whenever you have decided).  Sometimes this behavior modification (incentives or consequences) approach can help when used in conjunction with a mantra.  The potential consequence helps motivate a child, while the mantra helps a child learn what to expect when playing a video game.  

I lean more heavily toward the mantra approach, but each child is different, so you want to try different approaches until you find one (or a combination) that works best for your child. If you want to read more about devising mantras, check out other blog posts or my parent's manuals and my workbook for older children and teens.  There is a section about mantras in the workbook as well as in volume two of my parent's manuals:  "Anger Overload in Children: Additional Strategies for Parents and Teachers,"

Take care, Dr. Dave Gottlieb