Tuesday, September 24, 2019

7 yr old's intense outbursts

Hi Dr Gottlieb,

I've just been scanning through the Internet as I often do after we've had an 'outburst' from our son (7yrs old), usually in hope of finding some miracle advice. I have stumbled upon your page and read all about 'Anger Overload' and It is the only thing I've ever read that seems to fit 100% of our little boy's characteristics. 

I have danced around various self diagnostics over the months/years and have thought (amongst many) that he had ADHD, Bipolar, ODD, Depression, Anxiety, Border line personality disorder.... All of which he shows some characteristics of but not ever 'fitting' 100% of the profile. By the way its not a good place to be in when you're looking to pin a 'label' on your child just so you can make sense of their behaviour, but I'm constantly needing some reassurance that there's a reason behind his extreme behaviour. 

We have reached out to various people recently (school, doctors, professionals from various sources) but we have come to the conclusion that help and resources are extremely limited and this is something we're going to have to deal with alone, certainly for the time being until we're moving further up the queue. 

I'm writing to you to ask if in your opinion you agree that my little boy has the signs of Anger Overload? I fear that if I start putting things in place to treat the wrong thing, I may make the situation worse. I'll give you the details of today's out burst..... 

We simply asked him to sit at the table as dinner was ready. He firstly said he wasn't hungry, but then asked for a bowl of cereal instead. I explained he was not having cereal and he was to come to the table to eat with us (me & dad). He came to the table with his ipad which we do not allow, we asked that he put it away until we'd eaten and he could have it back after. He said no and that was the start of it. He punched his dinner (boiling hot meat pie) and this went all over the table and walls. We asked calmly that he stopped and this lead on to a barrage of abuse, we have become desensitized to this over the recent months as we've heard it all before, but he starts with nasty names aimed at me or his dad and when that doesn't work he threatens either us (saying he wants us to die) or himself (saying he wants to kill himself). We have on a few occasions seen him attempt harm on himself (trying to jump out of his bedroom window) but usually this isn't followed through. Today led to him trashing his bedroom and running away. It lasted in total around an hour or 2.

We have used various strategies to try and deal with these outbursts, we've been calm and understanding, we've been stern, we've used punishments and set boundaries, we've tried ignoring him in an attempt not to give him the attention we assume he's wanting, we've tried to get him to tell us what's causing these outbursts (after he's calmed down), we've done reward charts and reward systems and we're not seeing any improvement. 

The problem is, when he's good, he's very good and when he's bad it's catastrophic, there's no in between. We seriously fear for his well being at times as he now has started to run out of the house when he gets angry and we're currently running after him but we fear one day he'll run into the road in a rage. He throws his bedroom furniture around and how he hasn't managed to hurt himself doing this is beyond me. Hes tried to throw himself down the stairs (we had to pull him back over the banister) all of which starts out from a simple 'No' from either me or his dad. 

The problem is, even after he has finally calmed down and we try and ask him what just happened, why is he so angry and what is going on his his head, he always blames us. After today's instance, it was a good hour or two before he finally settled down, and I asked why he behaved like he did... He said out of nowhere "because you won't buy me a ukulele" which is the most random thing he has said yet (I almost laughed out loud, it's really not funny in the slightest but I think hysteria was setting in) To our knowledge he hasn't ever asked us for a ukulele, so where that came from is a mystery. 

I just have this awful feeling that we're missing something here. I also fear that unless we get this sorted sooner rather than later he will soon be a very tall 15 year old young man with a lot of strength and power. I fear he will end up in jail, if he continues with this behaviour into adolescent, surely that's what's going to happen. No parent wants to see their child unhappy. I want him to get this under control but I'm at a loss as to how to do this. All my efforts have so far been useless and unless he accepts his behaviour as being under his control then when will he ever get it under control?? 

He always blames someone else, or something else. He's never accountable. Will he grow out of this naturally? He's only 7, am I expecting too much from him? I'm just lost. 

Can you help in any way? 

Hi, I can see you have tried so hard to understand and help your son.  Firstly, I would try to get him in with a psychologist who deals with anger issues and who would strategize with you as well as meet with your son.  Family involvement is key with young children with anger issues because children will not usually use strategies on their own.

I would try to make a list of the type of situations when he is most likely to erupt:  is dinner time one of those times?  What are the themes, that is, what are the types of triggers?  Since your son is not invested or aware of when he will erupt, you would try to anticipate when he might be close to erupting, and try to divert him, or re-arrange the situation to try to avoid an outburst in the future.  For example if dinner time is sometimes a problem, make sure electronics are put out of reach until after dinner.  If he is a picky eater, I would recommend having an alternate in mind, but not struggle over his joining you.  You and your husband would have dinner and wait him out.  At some point that day or the next he will get hungry and eat.  I know this is hard to do as parents, but you would try to predict and avoid struggles around issues like food. 

Two other strategies I especially like to use with young children are emotional distraction and color labels.  Emotional distraction is trying to change a child's mood to prevent an outburst.  It is hard to have a melt down if he is laughing.  Make up a story about something that he might find funny, for example.  The story would come out of the blue, but if he is not too angry, he might listen and laugh.

Color labels are a way to try to get your son to observe his moods.  You would label everyone's anger in the family, not just his.  Blue is for low anger, orange for medium, and red for "hot" anger.  Then over time, you would introduce calming techniques and mantras to help keep anger below the red level.  I write about this strategy in my books and on this blog.  

But when it reaches the stage of jumping out the window, i.e. when someone could get seriously hurt, it would be important to see a mental health professional to see if other issues might be contributing to his anger or if any medicine might be needed to help him.

Best, Dr. Dave Gottlieb

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