I have a sweet and cooperative child that has had anxiety and
anger bursts as long as I can remember. Reading your blog has brought an
extreme amount of relief knowing that I am apparently not alone.
I am searching for a psychologist in the Houston area that possibly
could help. Would you have any recommendations as I would obviously
prefer to visit with one familiar with anger overload?
Hi, I am in the Chicago area and don't have a specific recommendation in Houston. However, I would make these suggestions. You want someone who has worked with parents and children on anger issues. With younger children (pre-teens), it is especially important that the mental health professional meet with the parents at times (either along with the child or separately) and not just see the child. Since many children do not yet recognize when they are getting frustrated and are likely to "blow-up" if no one intervenes, it is important that parents be ready to deal with potentially difficult situations. Parents need to have in mind several strategies to use in anger-provoking situations. Parents can then apply a strategy and sometimes prevent blow-ups, or guide their children so that anger can be more easily controlled. Also, I find it is real helpful if parents can review anger arousing situations with their children after everyone has calmed down, rather than wait until the next therapy session, by which time the child may have forgotten what happened. Many of the strategies that I outline in my book involve the parents taking the lead.
So if the therapist wants to just meet with your child and not with you, ask why. If there has been a trauma in your child's life, it might make more sense to meet primarily with your child, but if your child has experienced anger overload over the years and there is no clear precipitant, then it is unlikely your child will learn to develop better self-control without your help.
You might want to ask your child's teacher or pediatrician for suggestions of therapists in your area. Also, you could ask if the mental health professional in your area has either heard of anger overload or of the diagnosis called disruptive mood dysregulation disorder (or DMDD). In the new diagnostic manual (for mental health professionals) that is coming out in a few months, there will be a diagnosis DMDD that is similar in many ways to anger overload. Anger overload is a phrase I coined twelve years ago to capture the extremely angry outbursts some children (and teens) have when they are disappointed or frustrated . The main difference between anger overload and DMDD is that for anger overload the child does not necessarily exhibit irritable mood in between outbursts, whereas for DMDD, there is a continual mood issue. But in both cases angry outbursts occur regularly. So if the therapist is familiar with DMDD and how to treat it, the therapist should be able to help with anger overload. I hope this is helpful, Dr. David Gottlieb
Monday, February 25, 2013
Wednesday, February 6, 2013
5 year old with anger and anxiety
Hello, I just read an article regarding your book
Anger Overload in Children. Would definitely want to read the book. I
have few question/ concerns regarding my own son who is 5 years old. He
is one of the twins. He is a very emotional child ( my husband is also
very emotional). He does not have many friends in school, only two of
them. He is generally very good to his twin sister, but at times hits
her, when she does not do as told by him. He gets upset very
often, he won't listen or understand something that is not correct
according to him. Does this happen with 5 yr olds?
When we go out to a mall, my daughter and son always want to buy things, even if they have been told that we are not going to buy any toys as you have loads of them already. Any major toys will be purchased only on birthdays, though we keep buying books for them and never say no, if we come across any. Even when we go to any restaurant or any family gathering, we instruct them, especially my son, that there should be no crying, whining, screaming; whatever is troubling them should be talked out to either of the parent, and yet we have an outburst each time.
My son does not like crowds, so even any birthday parties of his friends, I always have trouble with him, he would not participate in any games, or dance, he is just sitting with me all the while. Any attempt to make him participate would be followed by an outburst at the party, though he mentions later that he did like it at the party. He also gets up each morning crying, wanting me to be by his side when he wakes up (which becomes very difficult, as there is always a rush in the mornings). Every attempt to make him understand fails, as he does not want to listen to what according to him is not right.
When we go out to a mall, my daughter and son always want to buy things, even if they have been told that we are not going to buy any toys as you have loads of them already. Any major toys will be purchased only on birthdays, though we keep buying books for them and never say no, if we come across any. Even when we go to any restaurant or any family gathering, we instruct them, especially my son, that there should be no crying, whining, screaming; whatever is troubling them should be talked out to either of the parent, and yet we have an outburst each time.
My son does not like crowds, so even any birthday parties of his friends, I always have trouble with him, he would not participate in any games, or dance, he is just sitting with me all the while. Any attempt to make him participate would be followed by an outburst at the party, though he mentions later that he did like it at the party. He also gets up each morning crying, wanting me to be by his side when he wakes up (which becomes very difficult, as there is always a rush in the mornings). Every attempt to make him understand fails, as he does not want to listen to what according to him is not right.
I have consulted with a Developmental Pediatrician
Hi, I would suggest you also consult with a child psychologist. There could be several causes for your son's behavior, and an evaluation by a mental health professional who works with children may help you decide on the best course of action. Here are some of my thoughts: your son's anger may be part of an underlying anxiety disorder or social developmental disorder. You note that he is uncomfortable in crowds, and shy at birthday parties. He also shows some signs of separation anxiety: he has a hard time leaving your side at the parties and also wants you by his side in the mornings when he wakes up. What an evaluation by a mental health professional could determine is whether your son's anxiety is part of a social developmental disorder (in which case therapy would focus on social skill development) or is a sign of separation anxiety (which would call for somewhat different suggestions to deal with the anxiety). It is hard for me to tell exactly what is going on without someone doing a more complete evaluation. You are right to be concerned and to look into what is underlying his behavior. Early intervention is a good idea.
Your son's anger and frustration might be part of the social or anxiety issue, in which case it would improve as those issues are worked on, or his anger may be somewhat separate. If it is the latter, then the strategies I recommend in my book would help. One recommendation in my book is to re-arrange the sequence to avoid certain triggers of your son's anger. So if going to the mall is a difficult situation for your son, I would take him less often. With birthday parties, I would recommend you continue to take him, but I would not force him to participate. What I recommend instead is that you sometimes get a little busy at the parties talking to the other parents. Maybe your son will eventually model your behavior and talk to the other children. Also, if you are busy part of the time, he may get tired of sitting there doing nothing. However, if there is an underlying social or anxiety disorder you will have to go slow with this, and you will need to work with a psychologist on how to develop his social skills.
When he gets angry and hits his sister, I would use some behavior modification strategies, such as a short time out. In addition, I would try to intervene early (if there is a chance to intervene when he is starting to get upset). Sometimes children's anger escalates so fast that it is hard to catch early. If you can catch it sometimes before there is an explosion, then use distraction, or separate the children by getting one of them interested in a different activity. Another strategy is to reward both of them with a small treat or a hug if they can play together without fighting for a certain period of time. It sounds like they do cooperate much of the time, which is terrific. All the best, Dr. David Gottlieb
Saturday, February 2, 2013
7 year old whose biological mother smoked crack cocaine
I have just discovered your 2002 piece on Anger Overload. This is our
turning-seven daughter! Wow! She was tox positive at birth, so
probably does have a few neurological bees in her bonnet. Turning the tv
on and saying "hey, your show is on," shifts her behavior very quickly,
but its been hard to heft our tv around (just kidding), and people keep
saying it's reinforcing. I think of this anger as the survival fight or
flight response turned up to 11.. Old brain overpowering new brain.
The inability for her to be calmed, or to be rational, we call "brain-lock." My concern is tantrums begetting tantrums; the more tantrums she has, the "shorter" the neural pathway becomes getting to rage when "threatened." I would like to use use a non-permanent course of anti-depressants which might enable her to learn self-soothing, and maybe (?) slow her response time to perceived threat. She has been evaluated, head-shrunk, stickered, timed-out, restrained, charted, etc. etc. etc.; meanwhile, her self-esteem gets lower and lower....
Are there any practitioners in North Carolina who treat kids with this profile or train their parents?
Thanks for any help,
P.S. Her memory and IQ are over the moon, possible ADD, possible ODD (but she does have the sweet and caring disposition your article mentions), anxiety, depression, and sensory processing disorder. She gets monthly OT for SPD. She was removed from her birth-mother at 5 days ( full-term, 5 pounds 12 oz), and has been with us since, and adopted at 20 months. Birth mother and father chain smoked, used crack cocaine, and presumably other recreational/street substances. Her happy, quiet, calm began to change at about 3 years.
Hi, I would recommend an evaluation at the Duke child psychiatry department. Duke has a good child mental health team and they could do a multi-disciplinary evaluation and make treatment recommendations. They would also know some good practitioners in your area. Given that there are probably some neurological issues, possibly related to her biological mother's drug use, I like that you have had her to psychological and occupational therapists. It is possible that anti-depressant medication and/or ADHD medication may help, but I would get a work-up first from a psychiatrist and/or neurologist who specializes in children. Changes may be gradual if your daughter's biological mother used crack cocaine on a regular basis during pregnancy. Children who have been affected by drug and alcohol use in utero can still learn over time to develop better self-control but it will take more repetition and more time (over a period of months and years). Your goal would be to reduce the frequency and severity of outbursts, but there still may be some outbursts when her brain gets overheated.
In terms of psychological approaches, I like that you are using distraction techniques. I would recommend you try to determine as many of her triggers as you can, and pick a couple to start with, and develop routines to alter the chain of events. I describe this process in more detail in my book, but essentially you would arrange routines to avoid as many triggers as you can. For example, if a trigger is getting ready for bed, you would arrange the routine so that getting ready for bed happens earlier in the evening and is followed by something your daughter likes to do, such as to play a game with you.
You would also use behavior modification techniques but the reinforcements would need to be fairly immediate and you would probably have to vary them in order to continue to hold your daughter's interest. Rewards and consequences do not work well when children are in the midst of a tantrum, though, so when your daughter is in overload, I would recommend not talking with her, unless she is harming herself or someone else, in which case you would have to intervene. Once the tantrum is over, you can either talk about something else that has nothing to do with the tantrum, or sometimes later in the evening you would review what you think triggered her and what she can do instead next time she is frustrated. Try to pick an alternative that your daughter would be likely to do. If she uses physical releases, pick something she can do physically that is not harmful, and gradually try to move her in the direction of using words to express her anger (in the beginning she does not have to use polite words!).
In my book, I also describe cognitive behavioral approaches, such as having cues (one example is to use colors to cue your daughter that she is beginning to heat up), teaching calming techniques, and teaching children to consider alternative points of view. These latter ideas work better once a child's anger is not too extreme, and once a child realizes she has an anger problem. If she is not ready to look at her anger yet, then you would stick with the techniques that I describe in the first part of my book, techniques that do not require her direct participation--like when parents re-arrange the sequence of events to avoid triggers or to re-arrange the sequence so that something she likes to do comes last.
You sound like you are already on the path, and you have good ideas. I would not worry too much though that her current tantrums will shorten her neural pathway and lead to more tantrums. As the frontal cortex develops over time, children are better able to learn self-control techniques. In fact the cortex keeps developing even past adolescence. Continue your efforts to help her brain development along, and get a multi-disciplinary evaluation when you can. All the best, Dr. Dave Gottlieb
The inability for her to be calmed, or to be rational, we call "brain-lock." My concern is tantrums begetting tantrums; the more tantrums she has, the "shorter" the neural pathway becomes getting to rage when "threatened." I would like to use use a non-permanent course of anti-depressants which might enable her to learn self-soothing, and maybe (?) slow her response time to perceived threat. She has been evaluated, head-shrunk, stickered, timed-out, restrained, charted, etc. etc. etc.; meanwhile, her self-esteem gets lower and lower....
Are there any practitioners in North Carolina who treat kids with this profile or train their parents?
Thanks for any help,
P.S. Her memory and IQ are over the moon, possible ADD, possible ODD (but she does have the sweet and caring disposition your article mentions), anxiety, depression, and sensory processing disorder. She gets monthly OT for SPD. She was removed from her birth-mother at 5 days ( full-term, 5 pounds 12 oz), and has been with us since, and adopted at 20 months. Birth mother and father chain smoked, used crack cocaine, and presumably other recreational/street substances. Her happy, quiet, calm began to change at about 3 years.
Hi, I would recommend an evaluation at the Duke child psychiatry department. Duke has a good child mental health team and they could do a multi-disciplinary evaluation and make treatment recommendations. They would also know some good practitioners in your area. Given that there are probably some neurological issues, possibly related to her biological mother's drug use, I like that you have had her to psychological and occupational therapists. It is possible that anti-depressant medication and/or ADHD medication may help, but I would get a work-up first from a psychiatrist and/or neurologist who specializes in children. Changes may be gradual if your daughter's biological mother used crack cocaine on a regular basis during pregnancy. Children who have been affected by drug and alcohol use in utero can still learn over time to develop better self-control but it will take more repetition and more time (over a period of months and years). Your goal would be to reduce the frequency and severity of outbursts, but there still may be some outbursts when her brain gets overheated.
In terms of psychological approaches, I like that you are using distraction techniques. I would recommend you try to determine as many of her triggers as you can, and pick a couple to start with, and develop routines to alter the chain of events. I describe this process in more detail in my book, but essentially you would arrange routines to avoid as many triggers as you can. For example, if a trigger is getting ready for bed, you would arrange the routine so that getting ready for bed happens earlier in the evening and is followed by something your daughter likes to do, such as to play a game with you.
You would also use behavior modification techniques but the reinforcements would need to be fairly immediate and you would probably have to vary them in order to continue to hold your daughter's interest. Rewards and consequences do not work well when children are in the midst of a tantrum, though, so when your daughter is in overload, I would recommend not talking with her, unless she is harming herself or someone else, in which case you would have to intervene. Once the tantrum is over, you can either talk about something else that has nothing to do with the tantrum, or sometimes later in the evening you would review what you think triggered her and what she can do instead next time she is frustrated. Try to pick an alternative that your daughter would be likely to do. If she uses physical releases, pick something she can do physically that is not harmful, and gradually try to move her in the direction of using words to express her anger (in the beginning she does not have to use polite words!).
In my book, I also describe cognitive behavioral approaches, such as having cues (one example is to use colors to cue your daughter that she is beginning to heat up), teaching calming techniques, and teaching children to consider alternative points of view. These latter ideas work better once a child's anger is not too extreme, and once a child realizes she has an anger problem. If she is not ready to look at her anger yet, then you would stick with the techniques that I describe in the first part of my book, techniques that do not require her direct participation--like when parents re-arrange the sequence of events to avoid triggers or to re-arrange the sequence so that something she likes to do comes last.
You sound like you are already on the path, and you have good ideas. I would not worry too much though that her current tantrums will shorten her neural pathway and lead to more tantrums. As the frontal cortex develops over time, children are better able to learn self-control techniques. In fact the cortex keeps developing even past adolescence. Continue your efforts to help her brain development along, and get a multi-disciplinary evaluation when you can. All the best, Dr. Dave Gottlieb
Wednesday, January 30, 2013
Why does 8 year old forget his outbursts?
I have found your blog and articles so helpful. We have a son who is almost
8. He became upset last night and said things like, "I don't want to live. I
want to be killed" and "I want out of this family/" This was in response to his
not getting his way to play some Wii with a new babysitter. We greatly limit the
Wii time, but thought it would be a good icebreaker with a new sitter. When his
older brother (who is almost 9 w/ADHD/anxiety) and he began to argue over
which game to play, we told them that they were not going to be playing
Wii. Our younger son flew into a complete rage. I took him in another
room, held him and he was crying very hard and saying all of these awful,
awful things.
But yet, when I asked him today about it, he said he doesn't remember
saying any of that. Is that possible? The whole meltdown lasted for about 25
minutes. After he calmed down a bit, my husband and I were able to get out to
dinner nearby and we kept in close touch with the sitter. We were told that he
calmed down after we left. We had a great day today--went to a science museum
and went for a hike as a family. And he was happy. He also said he liked the
sitter.
Is the fact that he's not remembering his rages a sign of being bipolar? He
is an excellent student, but is very behind socially and is having a great deal
of trouble making friends.
Thanks so much for listening.
Hi, Many children do not remember the details of their tantrums after they are over. Usually they remember they got upset, but because their brain was on emotional overload, the details of what happened may not get into long term memory. Not remembering does not mean your son has bipolar disorder. With bipolar disorder there are frequent changes in mood, not just angry episodes. Also, with bipolar disorder, children often exhibit impulsive, risk-taking behavior.
If your child only says he does not want to live during an outburst, it is unlikely he has plans to harm himself. During overload, children often say extreme things, in part because they are lashing out at their parents, and in part because they so overloaded that it is hard for them to put there feelings into more nuanced language. If your child does actually harm himself during outbursts, or if your child talks about self-harm while he is calm, then it is more worrisome, and it would be advisable to have a mental health professional evaluate what is going on.
Since he has trouble making friends, you might want to talk with the school social worker to see if there is a social skills group at school, or ask if the social worker knows of one in your community. Also, if your son has a friend in school, maybe he can invite the friend over some day. The more one-on-one practice with peers, the better to develop skills. Group settings can be harder for children to manage unless they are structured by an adult. In unstructured groups, there are so many social interactions going on that it is generally more difficult for children to keep track of the conversations and know how best to respond.
All the best, Dr. Dave Gottlieb
Monday, January 28, 2013
3 year old and "all hell breaks loose"
I recently started looking into Anger Overload. I have a very lovable 3-year-old but when she gets upset, all hell breaks loose. I’ve had friends and family tell me it is just her age, but once they’ve seen the tantrums they admit that it’s bad. When these melt downs happen they generally last an hour or more and she is impossible to console, she doesn’t want me to touch her but gets more upset if I turn or walk away from her. One of the common triggers is when I’m making her leave somewhere she doesn’t want to leave, so often times we are sitting in the car and I can’t get her into her car seat to deal with it at home. I’ve read some new ways to deal with it on your blog and other resources, but I noticed a lot of the information is focused on older children who are more developed. Do you have some tips on dealing with a younger child in these situations? I’ve thought about calling her pediatrician, but I have a feeling I’m just going to be told that they can’t tell at such an early age. Should I call?Thank you!
Hi, Three year olds can have some severe tantrums when they are frustrated; they often have difficulty containing anger and have difficulty delaying gratification. What I would recommend is that you try to help your daughter deal with leaving somewhere she likes by changing her expectations in advance. Let her know where you will be going and that it is for a short time only. She may not understand what "short" really means, so you should also have something fun to distract her in the car (that she only gets to use once in the car seat), or tell her in advance about an activity she will look forward to doing once you get home (and remind her about it on the way to the car). In essence you re-arrange the sequence of events so that the visit is one in a series of fun activities.
Another strategy (if she is not in a full blown tantrum yet) is to distract her, maybe by singing a fun song she likes, or by talking about a favorite cartoon character, or by talking to one of her favorite stuffed animals and asking the animal what she would like to do next. Maybe you can speak in a make believe voice for the stuffed animal.
If your daughter is already screaming and can't be consoled, I would recommend waiting there (unless you are in a hurry) and maybe sit in the front seat and get busy with something, maybe check your cell phone for messages. Try not to talk with her while she is screaming but once she has calmed down then talk about a topic she will find interesting (rather than talk about the tantrum). You use distraction, as any mention of the tantrum is likely to prolong it.
In the first half of my book I describe these strategies in more detail. Your daughter will likely develop more self control as she gets older. The frontal cortex of the brain will grow in the years to come, but in the meantime, try some strategies and see what helps with your daughter. You may not have success all the time, but if you can reduce the frequency or severity of her outbursts sometimes, it will help you get through the day! If there is no improvement in the next month, then check with your pediatrician for someone who works with young children who have angry outbursts. All the best, Dr. David Gottlieb
Hi, Three year olds can have some severe tantrums when they are frustrated; they often have difficulty containing anger and have difficulty delaying gratification. What I would recommend is that you try to help your daughter deal with leaving somewhere she likes by changing her expectations in advance. Let her know where you will be going and that it is for a short time only. She may not understand what "short" really means, so you should also have something fun to distract her in the car (that she only gets to use once in the car seat), or tell her in advance about an activity she will look forward to doing once you get home (and remind her about it on the way to the car). In essence you re-arrange the sequence of events so that the visit is one in a series of fun activities.
Another strategy (if she is not in a full blown tantrum yet) is to distract her, maybe by singing a fun song she likes, or by talking about a favorite cartoon character, or by talking to one of her favorite stuffed animals and asking the animal what she would like to do next. Maybe you can speak in a make believe voice for the stuffed animal.
If your daughter is already screaming and can't be consoled, I would recommend waiting there (unless you are in a hurry) and maybe sit in the front seat and get busy with something, maybe check your cell phone for messages. Try not to talk with her while she is screaming but once she has calmed down then talk about a topic she will find interesting (rather than talk about the tantrum). You use distraction, as any mention of the tantrum is likely to prolong it.
In the first half of my book I describe these strategies in more detail. Your daughter will likely develop more self control as she gets older. The frontal cortex of the brain will grow in the years to come, but in the meantime, try some strategies and see what helps with your daughter. You may not have success all the time, but if you can reduce the frequency or severity of her outbursts sometimes, it will help you get through the day! If there is no improvement in the next month, then check with your pediatrician for someone who works with young children who have angry outbursts. All the best, Dr. David Gottlieb
Friday, January 18, 2013
When your child has a tantrum in public
Hi, I have written a brief article for the neighborhood parents network in Chicago. The article will appear on their website on Tuesday, January 22nd. The topic is how to handle your child's tantrums in public places. The website is: http://www.npnparents.org/posts/515
If you have questions on this topic after you read the article, feel free to send them to my e-mail address: drdavegot@gmail.com and I will answer your questions on my blog, or you can comment on the neighborhood parents network website. Take care, Dr. Dave Gottlieb
If you have questions on this topic after you read the article, feel free to send them to my e-mail address: drdavegot@gmail.com and I will answer your questions on my blog, or you can comment on the neighborhood parents network website. Take care, Dr. Dave Gottlieb
Friday, January 11, 2013
What to do for 11 year old with 20 minute tantrums
We
need help. We have an 11 year old son that has rage. Most of the day
he is a great kid. He gets good grades and has nice friends at school.
He is active in sports and school, but there are triggers that will set
him off. When he has an tantrum it usually will last about 15-20 minutes
but sometimes longer than an hour. We try and follow a lot of the
things that are discussed, including, let our son calm down, we try not
to talk with him while he is upset and do it when he is calm, we give consequences
for the behavior that caused it and not the tantrum, but all this
doesn't seem to be working. It is like a switch in his head flips on
and no matter what we do
or say he doesn't listen while he is upset. Then the switch will go
off and he will listen and we can talk about it. Whenever we ask him,
"what set you off" or "why did you act that way" the answer is "I don't
know". It is like his brain shuts down and and he can't control it and
has no idea why. Any ideas?
Hi, What I would do first is chart what is going on before the tantrums start, so that you develop ideas about what triggers his rage. Then begin sharing your chart with your son while he is calm. Show him what you have come up with. When he tantrums again, wait till he is calmer and then fill out the chart together. Do this repeatedly after tantrums have ended. I have an example of a chart in my book and I include blank charts for parents to use. The purpose is to make your child more aware of his triggers.
Once he is beginning to see some patterns, then you and your son can develop strategies to catch his frustration in earlier stages before a tantrum is extreme. In my book, I explain how to use benign (nonjudgmental) labels, like colors, to point out when anger is beginning. The label is like a signal for your child to think about what is happening while he is still rational, and then to try to use a calming strategy. If he can't, or won't, use a calming strategy, then you try to distract or re-direct him. I also explain how to teach your child to look at other people's perspectives. Often children have misperceptions about other people's intentions, and many children have egocentric perceptions about what people should be doing for them. For example, one child felt parents didn't care about him if they said no to a sleepover. Teaching a child to look at other points of view is a key part of developing self-control.
Lastly, I explain in my book how to teach a child to compromise. Basically, you pose the dilemma to him and ask how he thinks you all should solve it: "I feel....and you feel..., what are we going to do?" You have this discussion before a tantrum, or if the tantrum has already occurred, you discuss possible compromises later when he is calmer. Then in the future you try to problem solve together before he erupts. This approach works for issues where you are okay with compromise. Some rules are non-negotiable in families, like he must attend school and he cannot physically hurt other people, so you wouldn't use this strategy then.
All the best, Dr. Dave Gottlieb
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