Monday, April 16, 2012
My parent's manual is available now
Hi, My parent's manual for anger overload in children is now available from the publisher at the link below. The price is 17.95 per copy.
https://www.createspace.com/3780222
Next week, the manual will also be available on Amazon for the same price, and in about a month it will be available at other book seller's like Barnes and Noble.
The manual explains all the steps I have been using with parents in my office for dealing with anger overload. The manual greatly expands on the articles I have published previously. It gives you detailed instructions and worksheets for each step. If you have questions, you can e-mail me at drdavegot@gmail.com, Take care, Dr. David Gottlieb
Sunday, April 15, 2012
Out of control 3 year old
My son is 3 and is completely out of control. Everyday is stressful, from eating to playing to bathtime. He freaks out if he doesn't get his way, he hits, kicks, punches, spits, bites, smacks and pulls hair. When I try and discipline him, by putting him in time out, he will hit and scratch and bite and punch until I cuddle him. If I spank his butt for his behavior, he gets worse, like it works for the behavior then, but it won't last. Today alone he's been in and out of time out at least 10 times and it's not even dinner time, If I put him in time out everytime he hit when he didn't get his way it would have been over 20 times. My husband and I are at a loss of what to do. I'm taking him to the doctor for sure to see what suggestions they have and we are starting parenting classes soon and working with his new day care, but do you have any discipline suggestions until then?
It sounds so frustrating. Yes, I would check with your doctor. In the meantime if there are certain situations that are more likely to lead to his out-of-control behavior, think about whether you can re-arrange the sequence in any way. For example, if he loses control when he has to do something, try to arrange a short activity that your son likes to come after the thing he does not like. Then there is a natural incentive for him to cooperate. You could remind him ahead of time what comes after his cooperation. You could also start a "cooperation" or "self-control" chart on the refrigerator, and your son could earn smiley faces each time he cooperates. At the end of the day if there are enough smiley faces (you would need to determine in advance what number is an improvement, even if not perfect), he could earn a bonus activity (short game or extra story) before bedtime. In this way you are building in incentives to try to motivate your child.
One problem I see is that you cuddle him when he does not respond to your disciplining. This is inadvertently rewarding your child for his lack of cooperation. In other words, in his mind, he sees that his awful behavior leads to cuddling. So I would recommend you change that pattern. It is best to totally ignore your child if he is in anger overload, unless he is hurting himself or someone else and then you will need to restrain him.
When you meet with the doctor, see if he or someone he recommends can rule out any developmental delay that may be intefering with his acceptance of the rules. Is there any learning delay, or sensory integration problem (he may be on edge a lot of the time if he has trouble with loud noises or tactile stimulation for example), or beginning mood or social interaction problems that could underlie his outbhursts. I'm not saying that he does, but you would want someone to rule these things out.
My new book, "Anger overload in children: A parent's manual" is in press and should be available on amazon.com in about a week. It has other helpful suggestions for parents. Good luck, Dr.Dave Gottlieb
It sounds so frustrating. Yes, I would check with your doctor. In the meantime if there are certain situations that are more likely to lead to his out-of-control behavior, think about whether you can re-arrange the sequence in any way. For example, if he loses control when he has to do something, try to arrange a short activity that your son likes to come after the thing he does not like. Then there is a natural incentive for him to cooperate. You could remind him ahead of time what comes after his cooperation. You could also start a "cooperation" or "self-control" chart on the refrigerator, and your son could earn smiley faces each time he cooperates. At the end of the day if there are enough smiley faces (you would need to determine in advance what number is an improvement, even if not perfect), he could earn a bonus activity (short game or extra story) before bedtime. In this way you are building in incentives to try to motivate your child.
One problem I see is that you cuddle him when he does not respond to your disciplining. This is inadvertently rewarding your child for his lack of cooperation. In other words, in his mind, he sees that his awful behavior leads to cuddling. So I would recommend you change that pattern. It is best to totally ignore your child if he is in anger overload, unless he is hurting himself or someone else and then you will need to restrain him.
When you meet with the doctor, see if he or someone he recommends can rule out any developmental delay that may be intefering with his acceptance of the rules. Is there any learning delay, or sensory integration problem (he may be on edge a lot of the time if he has trouble with loud noises or tactile stimulation for example), or beginning mood or social interaction problems that could underlie his outbhursts. I'm not saying that he does, but you would want someone to rule these things out.
My new book, "Anger overload in children: A parent's manual" is in press and should be available on amazon.com in about a week. It has other helpful suggestions for parents. Good luck, Dr.Dave Gottlieb
Monday, April 2, 2012
4 year old's aggressive behavior in school
I’m reaching out to you, like many parents, with sadness, desperation and frustration. My son, who is 4 years old (to be 5 in July) has been having behavioral problems for a long time. He was always a very strong willed child, however, we started having more serious issues after enrolling him in nursery school at the age of 2 years and 4 months. He was expelled from his first nursery school for aggressive behavior towards teachers and too hyperactive (this was after 6 months of attending the school). After this incident, my husband and I were very careful at selecting another school. He was then enrolled in a Montessori school. He has been attending this school for 2 years now. As in the other school, he has been very aggressive towards teachers. He has been suspended from school many, many times due to his behavior. Recently, he started to show aggression towards other children (becomes frustrated because he doesn’t win, etc) which was never a problem before. He has been (unofficially)diagnosed with ADHD and he is currently attending behavioral therapy with some improvement. My husband and I can work with him very well, but his behavior at school is a big challenge. My question is regarding any strategies that can be used in a classroom environment. His teachers try very hard to work with him, and I know that they will try any techniques that can improve his behavior at school. I’m looking forward to your new book, please let me know once it becomes available.
Hi, First, think about what is going on when your son becomes aggressive toward teachers. Can you and the teachers identify some triggers, and can you alter the scenario to reduce your child's frustration? For example, if transition time is difficult for your child, maybe he can be cued ahead of time, and he could earn an incentive for cooperation. If you use incentives, you could use smiley faces, for example, that your child could trade for a special activity when he gets home. The activity would vary each day or two so your child does not become bored with it (and could repeat the following week), would be something your child likes, and would need to be short term (no more than a half hour) or else it gets too difficult for you to do the activity with your son on a regular basis.
If your child gets angry with other children when he loses, you and the teachers could cue him when he starts a game that "everyone loses," or direct him toward non-competitive games. You want to try to use catch phrases like "everyone loses sometimes" before he starts to get upset, because it will be harder for him to delay and think rationally once he gets upset. He could also earn a smiley face (or other reward) if he shows self-control when playing with other children.
If he has a tantrum, it is best to remove him to a time out area where he does not get any attention until he calms down. He could also lose a privilege that night at home, or you could just go with the time out in school as a consequence if the school is able to do this. If you use consequences make them short term and fairly immediate if possible. If he has a lot of tantrums, set the goal ( to earn a reward or to avoid a consequence) as a reduction in frequency of aggressive behavior rather than make the goal "zero" tantrums.
I would recommend you set up play dates if possible so he can practice interacting with one child at a time. Many young children have trouble managing the interactions in bigger groups, so it would be good then for him to develop social skills in one-on-one situations first. I also wonder if there is delayed social development, or if he shows any Asperger's signs (check my book or others on the subject). You would want to work with him on social skills if this is a problem. Check with a psychologist or therapist in your area if you are concerned about social skills issues.
Mostly in school you would want to start with behavior modification strategies until he matures and is able to show more self control on his own. I describe a number of other strategies in my book, and will let you know when it is available, Dr. David Gottlieb
Hi, First, think about what is going on when your son becomes aggressive toward teachers. Can you and the teachers identify some triggers, and can you alter the scenario to reduce your child's frustration? For example, if transition time is difficult for your child, maybe he can be cued ahead of time, and he could earn an incentive for cooperation. If you use incentives, you could use smiley faces, for example, that your child could trade for a special activity when he gets home. The activity would vary each day or two so your child does not become bored with it (and could repeat the following week), would be something your child likes, and would need to be short term (no more than a half hour) or else it gets too difficult for you to do the activity with your son on a regular basis.
If your child gets angry with other children when he loses, you and the teachers could cue him when he starts a game that "everyone loses," or direct him toward non-competitive games. You want to try to use catch phrases like "everyone loses sometimes" before he starts to get upset, because it will be harder for him to delay and think rationally once he gets upset. He could also earn a smiley face (or other reward) if he shows self-control when playing with other children.
If he has a tantrum, it is best to remove him to a time out area where he does not get any attention until he calms down. He could also lose a privilege that night at home, or you could just go with the time out in school as a consequence if the school is able to do this. If you use consequences make them short term and fairly immediate if possible. If he has a lot of tantrums, set the goal ( to earn a reward or to avoid a consequence) as a reduction in frequency of aggressive behavior rather than make the goal "zero" tantrums.
I would recommend you set up play dates if possible so he can practice interacting with one child at a time. Many young children have trouble managing the interactions in bigger groups, so it would be good then for him to develop social skills in one-on-one situations first. I also wonder if there is delayed social development, or if he shows any Asperger's signs (check my book or others on the subject). You would want to work with him on social skills if this is a problem. Check with a psychologist or therapist in your area if you are concerned about social skills issues.
Mostly in school you would want to start with behavior modification strategies until he matures and is able to show more self control on his own. I describe a number of other strategies in my book, and will let you know when it is available, Dr. David Gottlieb
Thursday, March 29, 2012
4 year old's defiant outbursts
My girlfriend has a 4 year old son. He will be 5 in August. He is an intelligent boy. His name is Larry.. He is outgoing and social with everyone he meets. His father just had a new baby. He didn't inform Larry of the baby until the end of the second trimester. His mother and I have helped to excite Larry about being a big brother. I also have a 4 year old son. I work offshore and only get to see my son every 4 weeks. He and Larry play well together. I'm not a professional, but Larry has been a typical preschooler, until now. The baby was born last week. I have had no problem getting Larry to obey and follow direction. His mother is the disciplinarian and his father is very passive of Larry's behavior. I was home from work and witnessed the most obscene behavior that I have ever seen from Larry.
1) His mother and I took Larry and my son to a parade in town. Larry was very defiant and did not want to listen to either one of us. I usually let his mother control him, but I stepped in to help. It seemed to have worked.
2) We were at Larry's grandmother's home. He was rude to his uncle and began screaming and slapping at him. His mother stepped in and could not control him. He screamed at her and would not cooperate with her. I intervened and helped him to obey his mother.
3) Yesterday, his mother was called from his daycare. Larry has been in attendance of the center since the age of 6 weeks. He began yelling at the teacher and slapped at her when she asked him to get out of a chair. It became so violent that the male owner had to physically remove him from the chair. He continued to scream and his mother was called to intervene.
4) Today the daycare called and said that his actions from yesterday have begun, but have worsened. He was suspended from daycare for the remainder of the day and tomorrow. They are contemplating removing him from the center as a result of his behavior.
Sir, what can we do? His mother cannot afford counseling and we have tried to read articles to better help us. We both are in desperate need of help.
Hi, It sounds like there has been a dramatic change in Larry's behavior recently. In my book "Your child is defiant" one important diagnostic issue I write about is whether the defiant behavior has been going on a for a long time or is of recent origin. If recent, I label the problem "situational," and I suggest parents look for what has changed recently in the child's life. You point to the birth of the new baby. Some questions to consider are: how has the baby's birth changed Larry's schedule and his relationship with key adults in his life? Is the time with the father different, or has the father's emotional availability to the son changed? Is there anything else that has changed in Larry's life recently that could account for his angry, defiant behavior? For example, you mention you are away offshore for several weeks at a time. Is Larry attached to you, and does he miss you?
Another thing to observe: what is going on when Larry erupts? What was happening at the parade, with the uncle, and at day care when he got angry? What was going on right before he got angry? Can you see any patterns? If you can narrow down the triggers, you can then try to anticipate his rage and alter the situation ahead of time.
If the child is being disobedient, but not in an out-of-control rage, then be firm about what is expected of him. Have a short term consequence (like a time out) ready if he does not comply. If the child is in anger overload (out of control and not rational) then you can try to distract him, but you will probably need to ignore him. Talking about what you expect of the child at these times is ineffective. However, when he is physically violent, (when he is striking someone), then you will need to yell stop and/or restrain him. You can also use incentives and consequences, but these do not usually help in the middle of an out-of-control tantrum because the child is not thinking rationally at that time. You can impose a consequence later after the child calms down. You can read more about behavior modification strategies in my book, or other books about discipline.
Another thing to consider: what was your approach that seemed to work to settle Larry down? Is it something that the other adults can do too? Also, it is important for the parenting figures in Larry's life to try to be a united front. If he feels one adult does not support what the other is doing, then Larry will be less likely to listen.
My last suggestion gets back to the first thing you noted in your e-mail: the birth of the baby. If you all think this is what might be causing the outbursts, then it would be important to talk more with Larry about the baby, find a role for him when he visits the baby, and help him with his worries or anger about how the baby has affected him.
If you do not have success, try talking to Larry's doctor. Also most states have community mental health centers with sliding fee scales, and someone there may be able to help further to figure out what to do. Take care, Dr. Dave Gottlieb
1) His mother and I took Larry and my son to a parade in town. Larry was very defiant and did not want to listen to either one of us. I usually let his mother control him, but I stepped in to help. It seemed to have worked.
2) We were at Larry's grandmother's home. He was rude to his uncle and began screaming and slapping at him. His mother stepped in and could not control him. He screamed at her and would not cooperate with her. I intervened and helped him to obey his mother.
3) Yesterday, his mother was called from his daycare. Larry has been in attendance of the center since the age of 6 weeks. He began yelling at the teacher and slapped at her when she asked him to get out of a chair. It became so violent that the male owner had to physically remove him from the chair. He continued to scream and his mother was called to intervene.
4) Today the daycare called and said that his actions from yesterday have begun, but have worsened. He was suspended from daycare for the remainder of the day and tomorrow. They are contemplating removing him from the center as a result of his behavior.
Sir, what can we do? His mother cannot afford counseling and we have tried to read articles to better help us. We both are in desperate need of help.
Hi, It sounds like there has been a dramatic change in Larry's behavior recently. In my book "Your child is defiant" one important diagnostic issue I write about is whether the defiant behavior has been going on a for a long time or is of recent origin. If recent, I label the problem "situational," and I suggest parents look for what has changed recently in the child's life. You point to the birth of the new baby. Some questions to consider are: how has the baby's birth changed Larry's schedule and his relationship with key adults in his life? Is the time with the father different, or has the father's emotional availability to the son changed? Is there anything else that has changed in Larry's life recently that could account for his angry, defiant behavior? For example, you mention you are away offshore for several weeks at a time. Is Larry attached to you, and does he miss you?
Another thing to observe: what is going on when Larry erupts? What was happening at the parade, with the uncle, and at day care when he got angry? What was going on right before he got angry? Can you see any patterns? If you can narrow down the triggers, you can then try to anticipate his rage and alter the situation ahead of time.
If the child is being disobedient, but not in an out-of-control rage, then be firm about what is expected of him. Have a short term consequence (like a time out) ready if he does not comply. If the child is in anger overload (out of control and not rational) then you can try to distract him, but you will probably need to ignore him. Talking about what you expect of the child at these times is ineffective. However, when he is physically violent, (when he is striking someone), then you will need to yell stop and/or restrain him. You can also use incentives and consequences, but these do not usually help in the middle of an out-of-control tantrum because the child is not thinking rationally at that time. You can impose a consequence later after the child calms down. You can read more about behavior modification strategies in my book, or other books about discipline.
Another thing to consider: what was your approach that seemed to work to settle Larry down? Is it something that the other adults can do too? Also, it is important for the parenting figures in Larry's life to try to be a united front. If he feels one adult does not support what the other is doing, then Larry will be less likely to listen.
My last suggestion gets back to the first thing you noted in your e-mail: the birth of the baby. If you all think this is what might be causing the outbursts, then it would be important to talk more with Larry about the baby, find a role for him when he visits the baby, and help him with his worries or anger about how the baby has affected him.
If you do not have success, try talking to Larry's doctor. Also most states have community mental health centers with sliding fee scales, and someone there may be able to help further to figure out what to do. Take care, Dr. Dave Gottlieb
Friday, March 23, 2012
6 year old with anger isssues
I just read your article about anger overload, and it gave me a lot of hope that maybe my six year old can get some help for his anger. Just this week my husband and I have decided that it is time to seek professional help for him since despite our concentrated efforts to be consistent with him, he has only seemed to get worse. I have made an appointment with his pediatrician since I don't know where else to start. I would love some more information.
Hi, Starting with your pediatrician is a good idea, because he will know good child psychologists in your area. A psychologist will ask you when your son first displayed severe anger and what were the circumstances. A first interview also includes a brief developmental history and a discussion whether other family members have had similar issues. Your psychologist will then form a working diagnosis. He may offer some suggestions or prefer to wait until he has met your child (the meeting with the child usually takes place after you have given him some background).
In the meantime there are things you can start to do, such as keeping track of the circumstances when your child gets angry: what is the sequence? Look for any patterns: what tends to precipitate his rage? You will not be able to predict his outbursts in some situations, but you might find some similarities some of the time. Then you can try to prevent some of the outbursts by re-directing or reassuring your child (depending what the issue is) before he gets angry. Once your child is in extreme overload, though, it is best not to say much of anything and wait for him to calm down (unless he is hurting himself or someone else and then you have to intervene and restrain him).
In my upcoming manual I will offer many strategies which you can use to help limit anger overload. I will let you know when manual is available. In the meantime, read through the blog and you will get some ideas of things you can begin to do. Take care, David Gottlieb, Ph.D.
Hi, Starting with your pediatrician is a good idea, because he will know good child psychologists in your area. A psychologist will ask you when your son first displayed severe anger and what were the circumstances. A first interview also includes a brief developmental history and a discussion whether other family members have had similar issues. Your psychologist will then form a working diagnosis. He may offer some suggestions or prefer to wait until he has met your child (the meeting with the child usually takes place after you have given him some background).
In the meantime there are things you can start to do, such as keeping track of the circumstances when your child gets angry: what is the sequence? Look for any patterns: what tends to precipitate his rage? You will not be able to predict his outbursts in some situations, but you might find some similarities some of the time. Then you can try to prevent some of the outbursts by re-directing or reassuring your child (depending what the issue is) before he gets angry. Once your child is in extreme overload, though, it is best not to say much of anything and wait for him to calm down (unless he is hurting himself or someone else and then you have to intervene and restrain him).
In my upcoming manual I will offer many strategies which you can use to help limit anger overload. I will let you know when manual is available. In the meantime, read through the blog and you will get some ideas of things you can begin to do. Take care, David Gottlieb, Ph.D.
Wednesday, March 21, 2012
10 year old with ADHD and anger overload
Dr. Dave,
My daughter is almost 10. When she was a baby she would bang her head against the wall if she was upset. When she was a toddler she would slap the face of whoever was holding her if she was upset. Now she is starting puberty and reacts physically kicking and swinging when she is upset, even over very small things. Her reaction usually involves crying. The reaction lasts approximately 5 to 20 minutes. She is remorseful afterwards and wishes she didn't feel so angry. I recently read your article from August 2001 about anger overload in children. She has a lot of the characteristics you mention. She was recently diagnosed with ADHD and has started a low dose stimulant. This has not helped with the anger or crying. Sometimes she just cries for a few minutes without the physical reaction. There is some family history of bi-polar and ADHD, but I really think anger overload better describes her behavior. Please notify me when your manual is available.
Hi, Yes I will do that. The manual will have a number of concrete strategies for you. I think anger overload is a separate diagnosis from ADHD and bipolar disorder, but some similar behaviors can occur in all three diagnoses. Some ADHD children are impulsive, as are many children with bipolar disorder, and some with anger overload. What is different is how the impulsivity is expressed. With anger overload, we see impulsive outbursts of anger; these children (if they do not have an additional diagnosis of ADHD or bipolar disorder) are relatively calm otherwise.
ADHD children often blurt out answers and move around and bump into other people (because they didn't notice who is nearby). In addition, some ADHD children also react emotionally without thinking first. In the latter case, the behavior is like a child with anger overload.
Finally bipolar children will often get mad in a quick and explosive way, but also have other characteristics which a child with anger overload does not exhibit. For example, bipolar children have frequent (often daily) changes in mood and often engage in impulsive, risk-taking behaviors.
For more on the differences between these diagnoses, see my earlier book "Your child is defiant" in which I explain the differences between mood disorders and anger overload. The anger overload manual will be published in about a month. In the meantime, review other posts where I have suggested some approaches for anger overload. Take care, Dr. Dave
My daughter is almost 10. When she was a baby she would bang her head against the wall if she was upset. When she was a toddler she would slap the face of whoever was holding her if she was upset. Now she is starting puberty and reacts physically kicking and swinging when she is upset, even over very small things. Her reaction usually involves crying. The reaction lasts approximately 5 to 20 minutes. She is remorseful afterwards and wishes she didn't feel so angry. I recently read your article from August 2001 about anger overload in children. She has a lot of the characteristics you mention. She was recently diagnosed with ADHD and has started a low dose stimulant. This has not helped with the anger or crying. Sometimes she just cries for a few minutes without the physical reaction. There is some family history of bi-polar and ADHD, but I really think anger overload better describes her behavior. Please notify me when your manual is available.
Hi, Yes I will do that. The manual will have a number of concrete strategies for you. I think anger overload is a separate diagnosis from ADHD and bipolar disorder, but some similar behaviors can occur in all three diagnoses. Some ADHD children are impulsive, as are many children with bipolar disorder, and some with anger overload. What is different is how the impulsivity is expressed. With anger overload, we see impulsive outbursts of anger; these children (if they do not have an additional diagnosis of ADHD or bipolar disorder) are relatively calm otherwise.
ADHD children often blurt out answers and move around and bump into other people (because they didn't notice who is nearby). In addition, some ADHD children also react emotionally without thinking first. In the latter case, the behavior is like a child with anger overload.
Finally bipolar children will often get mad in a quick and explosive way, but also have other characteristics which a child with anger overload does not exhibit. For example, bipolar children have frequent (often daily) changes in mood and often engage in impulsive, risk-taking behaviors.
For more on the differences between these diagnoses, see my earlier book "Your child is defiant" in which I explain the differences between mood disorders and anger overload. The anger overload manual will be published in about a month. In the meantime, review other posts where I have suggested some approaches for anger overload. Take care, Dr. Dave
Tuesday, March 20, 2012
Anger overload manual is due out early May
Hi, I've had several queries recently about the parent's manual for dealing with anger overload. I am currently making final revisions. It should be available from Amazon and other online retailers in early May. I will contact those of you who have asked to be notified, and will also post a notice here on the blog. Thanks for your patience, Dr. David Gottlieb
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