Dear Dr Dave
I came across your article on anger overload after desperately in tears reviewing the internet. It is the first time I have actually read something that sounds like what my just turned 5 year old has!
We are waiting for proper Assessments to be carried out at the moment but first discussion with Pediatrics & we were asked to complete Conners 3 & the social communication checklist. Neither myself or or the teachers at my sons school think he has ADHD or Autism. He is a very intelligent little boy & is extremely loving especially to animals & younger children & his no problem with attention. They have witnessed his sweetness & had great conversations with him over lunch.
From an early age he has what we call a flip switch, where he just loses his temper. It's usually linked to frustration, what he thinks is unfairness or just not getting his own way.
Sometimes we can distract him out of it, normally with something that requires thinking & sometimes we can't. Outbursts at home are limited probably as we have learned to control them or just tackle major stuff but at nursery (where the changes began in preschool room lashing out at adults) & now school it is has been a real problem.
First two weeks at school he struggled to settle (separating from me) but then after this, he had great first term & even got certificates & awards for his good work. The teachers have said he is ahead with his work. It all changed in 3rd week in December last year. None of us know why.
He has taken to lashing out at the teachers & walls mainly, shouting, hitting, kicking in an anger episode. He also sometimes runs off when he gets cross down the corridor. The outbursts are short in time & never normally over 30 minutes.
He was taken in from the playground one day in January due to fighting with two other boys & he wouldn't calm down. He deemed this to be unfair & he then trashed the classroom. Throwing things off pegs, pen pots, books etc, kicking teachers & hurting them. The teachers called me to collect my son. This happened again later that week & the whole classroom was trashed. I was devastated & he was then excluded & then put on a reduced timetable since the end of January. This is when we reached out to our GP.
Outbursts have reduced in intensity & he has not wrecked classroom since (he didn't like mummy crying & being upset) but ED psychologist linked to school has suggested a few things like 1:1 supervision & to give him choices out of two options & they now use now & next cards to prepare him. This strategy has seemed to back fire. This last week he has started to refuse more & more direction at school & the anger outbursts (hitting staff) have returned almost daily. One day he was great until he was asked to use soap to wash his hands & he got angry & lashed out. I asked him later, & he said they don't usually have soap available in the toilets to use & so he has to usually use just water.
He is not allowed playtime with the other children as the staff are worried that another child may get hurt in his outbursts. It is difficult for us to understand as we have play dates, go to parties etc & if he ever gets cross we are able to manage it but this is rarely. We suppose we are in a fun setting, we are there & can intervene & he knows this.
We have tried reinforcing how he should behave at school, no hitting, kicking & reading books together on how he should act & rule following. Even sticker charts don't seem to be working.
Have you ever come across anger overload happening more often in a controlled setting? And refusal of direction? Do you have any advice as how I can help the school?
We are not sure if there is anything underlying linked to school that is increasing the anger episodes there.
After reading your parent guide I am planning to start recording occasions at home. I was going to ask school to do this too?
Any advice you can give I would really appreciate it.
Hi, You have done a good job of trying different techniques and worked well with the school. It must be so frustrating that your son's outbursts at school increased in December. Do you have any idea whether something changed in your son's life at home or school at that time?
I try to get clues about the triggers from what is happening when a child gets angry. As I read through your email, I was making notes of some of your son's triggers: separation when you drop him off, when there was a dispute on the playground with two other boys, and when he was asked to use soap to wash his hands (when he was used to only washing with water). Transition times seem to be a trigger sometimes, and unexpected changes seem to be another trigger. Keep trying to make a list of triggers and then see if you and the teachers can anticipate a stressful situation for your child and intervene before the overload phase. It will be difficult to anticipate all things that will trigger his anger, but if you can anticipate some, and work out a strategy ahead of time with the school, it may reduce the frequency of outbursts. I outline how to use emotional distraction and relaxation strategies in my parents' manuals. The second manual has a section specifically on applying the strategies to anger in school. Also in the second manual, I explain how to develop jingles or mantras that you would practice with your child ahead of time.
I like the ideas of the school psychologist: offering a choice of two options sometimes helps head strong children. But if a strategy stops working, then the school may need to try something else. I find that mantras, early emotional distraction, and relaxation "stations" (a place separate from the other children with relaxing objects) are often helpful. In answer to your question, structure usually helps, but not always with children who are head strong.
If you try again to use positive reinforcement, keep the chart brief--one or two items--and have a daily, exciting reward. Sometimes it helps to teach your child how to "go with the flow." The teacher could use a hand signal when she wants your son to "go with the flow." Then if he does that once or twice a day, he earns a fun activity at home or school. Keep in mind that it is sometimes trial and error to find what rewards motivate a child.
I would continue with the evaluation by your child's doctor to see what else may be contributing to the outbursts. The frequency and intensity suggest that psychotherapy is a good idea.
Best to you, Dr. Dave Gottlieb
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