Tuesday, May 23, 2017

Using the anger overload workbook

My son is 9.  He has many diagnoses over the years, from autism to bipolar to anxiety.  Anxiety is the one that has stuck and we have since found out he is gifted.  The problems with anger started when he was 3.  He had a flip switch and would rage for hours, run away from us, destroy daycare classrooms, etc.  He has gotten better over the years.  His IEP and behavior plan were removed this year due to his progress.  He has also gone off of his Risperdal and is tapering off and almost off of Trileptal.  However, starting at the beginning of May - his anger came back at school.  His triggers are during recess mostly (90%) and related to people not playing by the rules as he deems them.  For example, four square.  He knows all the rules because he has researched them and gets mad if others do not play that way.  He has hit, kicked, shoved.  The school  year ends in a few days and summer camp starts.  Summer camp is outside and has many of the games which have been his triggers this month.

I am thinking of having him complete the kids' workbook.  Any other thoughts to help?  Much thanks in advance!

Hi, in the beginning of the anger overload workbook, I ask children to keep track of their anger:  who did you get angry with, what did they say or do, and what did you say or do. Then I have children fill out worksheets that help them see patterns.  In your child's case, one pattern is when the rules are broken during playground games.  

Then the workbook explains strategies to deal with anger.  One chapter looks at how to prevent anger from starting, and another section of the workbook looks at what to do for early signs of anger, and then there is a section for the high anger stage.  Later I discuss more advanced techniques, like how to deal with different points of view and how to compromise.

For your son, he could prevent anger on the playground by playing a different, non-competitive game, but he probably would not like that idea.  So then I would work with him on mantras that would help him look at the game differently.  For example, one mantra could be "other kids won't always follow the rules, and I can't change that" or "some kids will make up their own rules, and if I want to keep being allowed to play with them, I have to play by their rules sometimes, even if I am right."  You would want your son to come up with a version that he thinks would help him remember how to deal with the kids during four square.  Then you want to practice it with him each night, or each morning before school. Remind him to repeat it during the game if he is starting to get aggravated.  

The next section of the workbook deals with low levels of anger.  We teach children how to be aware of body signals that they are getting frustrated. We also explain various coping strategies: a) physical activities, b) "chill" activities, c) reaching out to others, d) sensory activities, or e) mindfulness.  We explain how a child can implement these various techniques.  Some are more adaptable to a school environment.  Basically we want your child to have a toolbox of strategies, so that he can pick what he wants in a given situation. Then we recommend giving him a lot of praise for trying a strategy, whether it always works or not.  

If his anger gets to the overload phase, finding a "go to" place to calm down is important.  

As your child gets more reflective about what is happening, there are advanced techniques that we recommend toward the end of the workbook.

Best, Dr. Dave Gottlieb

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