Monday, February 12, 2018

4 yr old tantrums going to preschool

My son is four and was late at learning how to walk and talk. He’s always had anger issues and even as a baby would scream and scream and we never knew why. Now his behavior matches your description of a child who has anger overload; he’s good when he’s not experiencing that. So my first question is, what resources do you recommend for those of us who have a child this young, and secondly, how do I get him to go to preschool. He starts regular school in August, so I am worried that if I don’t teach him to go to school now then he won’t then. He says he loves school but he has stayed at home his whole life up until now and is used to staying at home and playing games all day. Now he has to go to school and every morning it takes twenty minutes to get him from the car to the school; he kicks and screams as loud as you can possibly imagine. He tries to run away; he does everything he can to not go. I’ve given in to not taking him a couple of times but now I realize I need to stick to him going but it’s really hard and I feel guilty for giving the teachers a kid who is screaming and kicking like that.

Hi, Two of my books are written for parents to use for children of all ages:  "Anger Overload in Children:  A Parent's Manual" and the supplement: "Anger Overload in Children:  Additional Strategies for Teachers and Parents."  Two strategies that might be useful for your son are 1) changing the expectations and 2) altering the sequence.  Children who have a close bond with their parents often show separation anxiety when it is time to get ready for school.  For some children this takes the form of crying and for others there are angry tantrums.  How can you change expectations or the sequence in this case?  One expectation a child has is that if he screams loud enough, the parent will hear his distress and take him home.  After all, most parents pick up their child when he cries at home, so in a child's mind, why not scream now on the way to school? Thus, one thing to do is to leave immediately when the teacher meets you and your child.  Tantrums will last longer if your child expects he may be able to go home with you, and generally decrease in intensity once the parent is out of earshot and the child can no  longer expect to be taken home.  

Another rule of thumb is don't give in to the tantrum and stay longer, as the child has succeeded in delaying the separation from you and will continue screaming.  After a few weeks, tantrums usually lessen, as the child comes to expect you will leave despite his screams.  For some children this can take more than a few weeks, and others less time.

One way to change the sequence is to have someone else get your child ready in the morning and drive your child to school:  your spouse, or a grandparent, or a parent of another child going to the preschool.  Children will scream longer when leaving the parent to whom they are most attached.  Having a different adult come get him ready for school or come to pick him up will lessen the tantrums.  One possible scenario to disrupt the sequence is for you to stay in bed and pretend to be sleeping or pretend to be sick, and have another adult get your child ready for school.

Once a tantrum is in full gear, it is hard to stop.  This is when I recommend trying emotional distraction. In the case of leaving home for school, it can be difficult to change a child's emotional state, but if you can get your child to laugh, or to participate in singing a favorite song, or to play a favorite game in the car, it will lessen the tantrum. 

When your child is in full tantrum mode, do your best to ignore it.  Try not to talk with your child while he is screaming, as generally, the more attention you give, the longer it will last.  If your child settles down, talk with him then.  Don't feel guilty, it is okay for your child to react to separations.  And it is okay for you to ignore them.  Separation anxiety is quite common for preschool and kindergarten, and sometimes for early grades in elementary school.

Best, Dr. Dave Gottlieb


Wednesday, January 17, 2018

Medication question

I have an 8 year old that I think is experiencing anger overload based on your descriptions. He does not exhibit any symptoms that would indicate he also has ADHD.  If that is an isolated diagnosis, is there a particular medication route that you recommend in additional to cognitive and behavioral therapy?


Hi, There is no medication specifically for anger overload.  If there are other problems that are contributing to the anger overload, then sometimes medication can be helpful.  For example, if a child has ADHD or if a child exhibited signs of bipolar disorder, the medication for those problems might lessen the eruptions of anger.  Or if a child is highly anxious or depressed, there are medications that are sometimes helpful.    

If you want to read more about what else could contribute to anger overload, I explain about dual diagnoses and possible medications in my other books. One book is called: Your Child is Defiant:  Why is Nothing Working?  The website that reviews this book is yourdefiantchild.com.  You can also order the book from this site.

My earlier book is about dual diagnoses for ADHD.  It is called Why is My Child's ADHD Not Better Yet?  Recognizing the Undiagnosed Secondary Conditions That May Be Affecting Your Child's Treatment.  I wrote that book with two other authors, a psychiatrist and a learning disability specialist.  It is available on Amazon.

Take care, David Gottlieb, Ph.D.