12 year old is having fewer outbursts

        Hi, I receive some notes about children who have improved, and I wanted to share this update on the blog because it explains the various changes these parents made to help their son develop better self-control.  Notice that there are a combination of changes:  from altering a stressor (math class) to walking away during a tantrum. Also, note that there are still some outbursts, but the frequency has gone down significantly.  There are changes over time, rather than a quick fix, in most cases. (For the original description of this child's behavior, go to the Nov. 7, 2012 post on the blog.)  Here now is the update: 

Hi Dr. Gottlieb,  Although there are still occasional anger outbursts, the frequency has declined dramatically, for several reasons (I believe):

1.  We are so extremely fortunate to have a Math teacher as dedicated as our son's.  After explaining that our son was having a lot of issues stemming from his anxiety in Advance Math, she went above and beyond her duties, and had been staying after school, as well as, during lunch to help him with his homework.  She also promptly gave him an "award" for "Most Improved Student" last month to boost his morale.  Although his grade has only improved slightly, that gave him a peace of mind immensely.

2.  He is less aggressive with his sister, after we explained that he is her leader, and she looks up to him.  He really took that role as "Big Brother" seriously now.

3.  He has not had any physical episodes with me since we implemented all these changes.  There were still a few 'shouting matches," but those subsided much faster than before.

4.  My son seems to be more aware of his actions now, and it helps that I just walk away when he escalates.  That "little break" helped to calm him down and he is managing to calm himself down quicker as well.

5.  We also told our son that if he finds Adv Math too challenging, he can go back down to his own grade level next year.  That option seemed to sit very well with him as well.

I understand that not one single thing brought on these changes, but I truly believe that your suggestions set us on the right path. 

In addition, and I'm not sure if it's just coincidence, however, we have permanently eliminated all his TV programs.  It took a few months to adjust and it was tough at first.  But now, he seems a lot calmer now.  He only watched Disney and Nickelodeon channels before (so nothing violent), but even those programs seemed too stimulating for him.  He is still allowed occasional movies, but no more regular TV shows.  Perhaps there is a strong correlation between his anger outbursts and television.

I just wanted to give you an update, and also to say thank you for everything.

Finding a professional to work with

Hi Dr. Gottlieb:

I write to you because I read your article today and finally I could give a name to what I have been dealing with my son for the last 8 years .  I am writing from Norway and here in this country, I believe that this disorder is very little known.  My question is do you know anybody in Norway who could be treating this disorder here ? If not, is there someone else in Scandinavia that I could contact?  I believe that many kids in this country haven´t been diagnosed yet.  I really need to get this information to this country.  I believe that I am not alone and that a lot of families need information of the treatment for this disorder.


Hi, Unfortunately I do not know who to recommend in Europe.  Maybe you could print the article, or sections of my blog:  yourchildisdefiant.blogspot.com, or my parent's workbook (available from Amazon:  Anger Overload in Children: A Parent's Manual) and show one of these things to a professional and see if they use similar methods.  My blog (see the Feb. 25, 2013 entry) also has one previous answer to a parent about picking a mental health professional.  Basically, I said there you want someone who works with parents and children, not just children, and someone who teaches strategies parents and children can use at home.  All the best, Dr. Gottlieb

7 year old's episodic outbursts at school and school

Hello Dr. Gottlieb:

My wife and I came across your article yesterday on "Anger Overload" in an attempt to understand an anger management issue we are experiencing with our youngest son who is age seven. We have experienced, for some time, anger management issues with Nick and have taken him to a child psychologist in the area we live in. Unfortunately when we took Nick to talk to the therapist he refused to speak. The psychologist told us at this point that it doesn't make sense to continue to bring him to her since he will not talk to her or engage with her in any way.

This past week  his elementary school called us three times due to his anger related behavior. The last call came on Friday when he was in the Principal's office banging desks and kicking a window in an adjoining office. When my wife and I arrived we were told that he became upset while in his homeroom and it escalated to a gym class shortly afterward. He was asked to get in line with the other students in gym but repeatly refused and became disruptive to the point where the teacher sent him to the principal's office. As mentioned, in the principal's office he was banging desks and kicking a window in the office area.

We spent considerable time shortly after the events on Friday ascertaining my son and  the rationale for his behavior. His class was having a party at the end of the day and he was looking forward to attending. When he realized that his gym teacher had sent him to the office he became enraged to think that he wasn't going to be able to attend the party. We asked Nick what he was thinking while in the principal's office and he said that his head was telling him to to bang the windows.

My wife found your article early Saturday morning after a sleepless night searching for something on the internet to assist us. She read to me your article on Anger Overload and it was as if you were describing our son. Our intent is to meet with the school staff to discuss suggestions/thoughts on recognizing potential anger outbursts in advance and develop interventions to prevent an anger overload.

 One suggestion we discussed with our son yesterday was to bring to school a picture of his dog and look at it once he feels he is getting mad to prevent him from going to an anger outburst. Another suggestion we are interested in trying is the use of "play therapy" that was suggested by both the school psychologist was well as social worker. We are waiting to schedule such therapy the coming week and see if this is effective. We are also planning to discuss telling our son that he will be rewarded for "good days" where we are not told of an anger outburst situation. Like any other seven year old he enjoys buying toys/games with his own money once is has saved enought to do so.  

Nick is a very bright loving child at home 90% of the time but does have episodes where he could be described as in Anger Overload. I truly believe, from his feedback to us, that he doesn't like feeling out of control with his anger and wants help.Unfortunately, he tends to shut down when we try and discuss what he could do differently.   As mentioned earlier it can be a challenge for him to open up about his feelings and thoughts following an outburst event. We want more than anything for him to be happy.  I would greatly welcome any thoughts/ suggestions you may have and be willing to answer any questions you may have.

Hi, You are on the right track when you mentioned that you would meet with the school and work together to pick up early signs of anger and find alternatives that are workable in your school.  If the adults together can pick up early signs that your son is frustrated or angry, then your interventions are more likely to work.   Also, by brainstorming together with your son's teachers, you can develop a plan that everyone can get behind.  

In my book, I explain how it is important first to keep a written record of what precedes a child's outbursts.  What patterns do you see?  Does your child think he is going to miss out (like with the class party you mention)?  Does that kind of situation lead to  him getting angry sometimes?  What happened in the homeroom before gym that started him on the road to anger overload?  If you see a few patterns, you and the teachers will better be able to anticipate your son's anger and distract him before he gets to the overload phase.

 Rewards sometimes help, but sometimes not.  Sometimes children get so angry so quickly that they do not think about rewards and consequences at the time.  Whether you use rewards or just talk about alternatives for expressing anger appropriately in school, I would use words like "self-control" to describe the goal for your child, and then give him examples of what he can do when he gets upset that would show self-control.   You would only do this while your child is calm, not in the midst of a meltdown.  If your child does not want to talk about his anger yet, then you and the teachers can still try to anticipate outbursts, and use distraction and calming strategies (I like your idea of his looking at the picture of his dog, as the picture may help soothe him) that I describe in the first half of my book.

At some point your child may be ready to work on the causes with you.  Eventually you would try to help him look at situations from another perspective and help him think through what to do.  The second half of my workbook explains how to help him recognize early signs of anger, and how to look at things from another perspective before he gets overwhelmed with emotion.
  

I encourage parents to teach their children "catch phrases" to help them remember to look at things in a new way.  For example, for a child who gets angry when an adult does not respond right away, you could teach the child to say to himself  "she still cares about me, she is just busy now,"  or "she will help if I wait."  Or if the child feels the adult is depriving him of something, the catch phrase could be "Maybe Mom or Dad have a different way of looking at this, they are not trying to be mean to me."   You would work on the catch phrase with your child and pick words that everyone agrees are meaningful to your child's situation.

All the best, Dr. Dave Gottlieb

2nd grader who gets mad at himself

Dr. Dave,
First of all, thank you so much for your research and forum about anger overload. I have often felt very alone as a parent dealing with my son's outbursts and your blog has really opened my eyes to others experiencing similar cases.

We have tried some of your modification techniques on our own over the years, but I'm anxious to try others that you've mentioned and make a commitment to be more consistent in our approach as well. My son is triggered by disappointment in sports or other competitive activities mostly, although the majority of the time he thrives and really enjoys the teams he participates with. He performs extremely well in school, but has had a handful of issues with his anger there too, usually when he doesn't feel like he's mastering something he's learning very quickly. His outbursts usually are displayed with screaming and flailing his body onto the floor, etc... He is always brought to tears during his outbursts though, which isn't something I've seen mentioned by others in this blog. He talks very poorly about himself during the episode and the tears just continue to roll. He has gone through times where we've noticed his outbursts are fewer and farther between and we begin to think he's growing out of it. Then, all of the sudden, he seems to regress. Because of this repetitive behavior he has been labeled as a 'cry baby' by his peers and there are many boys who know that he is an easy target and which 'buttons' make him react.

My son has always been way ahead of the 'curve' physically and academically, but emotionally I've always felt that he is far behind his peers. We've tried to be supportive and encouraging as much as possible (even when we're at our wits end!). We explain that it's completely fine to feel the emotions he's feeling and to be sad and disappointed, but it's not ok to react the way he reacts. He's continuing to label himself all the time and I'm worried that it will continue to alienate him as he grows. His self-esteeem seems to be so high and stable most of the time and then he puts himself down and feels awful during these moments of overload.

I would appreciate any additional advice you could give. Have you had patients who become extremely sad and cry in these anger overload moments too?

Thanks so much!
Mom of frustrated 2nd grader

Yes, I've worked with children who cry and direct anger at themselves when they make mistakes or do not perform as well as they expected.   Most of what I've written about in the blog is about children who become extremely angry at other people, rather than themselves.  What you are describing is a variant of anger overload where anger is self-directed and where there are displays of sadness or self-criticism. 

You can apply some of the exercises in my workbook to this problem.  I write in the book about a child who explodes because he feels peers do not like him.  Another child is my practice blows up when he walks a batter in a little league baseball game.  One important thing to work on with your son is changing his expectations of himself.  After he calms down, talk about how everyone makes mistakes in school or in sports.  Mention a sports figure or academic figure he might know about.  For example, in Chicago the White Sox slugger Adam Dunn hits a lot of homers but also strikes out a lot.  Or Albert Einstein was brilliant but had trouble spelling.  The idea is to convey that people are not good at everything they try, and also, even when they are good at something they have off days or make mistakes.  Review these ideas after each explosion is over.  Also, teach him to say a catch phrase to himself every morning when he gets up, something like "everyone makes mistakes," or "it's impossible to get everything right."  Pick a catch phrase that your son likes and that applies to some of his outbursts.  Over a few months time he may be able to soothe himself at the moment of upset by remembering the catch phrase and then not react so strongly.

In the meantime, let him know it is okay to cry.  Explain that the crying is his way of letting out frustration, and explain that when he learns that it is cool to make mistakes, the crying will probably lessen, because he will not be so frustrated then.

Another strategy is to use distraction if you can catch him starting to get upset.  This is hard to do if the upset happens real quickly.  I explain in the book how to use "emotional distraction," that is to say something that makes your child laugh, amused, or curious about something. 

Also, keep a list for yourself of the times that he gets upset.  You may start out focusing on changing his expectations about mistakes, and then find there are other situations that are causing distress.  Then you will need to come up with a new catch phrase!  But only work on one or two catch phrases at a time.  When he is handling one situation better, then you can work on another.

Hope this helps, Dr. Dave Gottlieb

9 yr old is disruptive at school, wants to change

Dear Dr Dave,

I've read your article on anger overload.  I've also read the blogs. I too feel the article was written for our son who is 9 yrs.  A lot of the parents; comments ring true for us.  Our feeling is that there is a strong link between his well being and his behavior; he goes through spells where for a week or so he throws things, kicks things etc and is quite extreme then it settles back to his "normal level" which is still not great. It appears to go in cycles.  His behavior at school is causing real issues. This week he said he couldn't understand why he was so disruptive at school when his sister isn't like that and his Dad and I were good in school, "I hate it Mum".  If he is being disobedient it always helps if he goes to the toilet and does a poo; he comes back a calm, changed child. He generally has large bowel movements, up to three times a day.  We also have to omit artificial additives from his diet where at all possible as they cause his behavior to spiral out of control. I have tried lots of treatments, mostly alternative but as yet nothing has made much difference.  He is a kind, caring , generous, helpful wee guy who is well liked by adults generally.  A number of his peers know which buttons to press for a fire works display and tend to sit back and enjoy the show!!  I look forward to hearing from you. 

Hi, First what I would recommend is keeping notes for a week or two of what is happening when a tantrum starts.  What is each person saying before your child escalates?  Then see if you can find some patterns.  I describe how to do this in my workbook on anger overload.  You want to see if there are some issues or themes that trigger him.  Then I describe in the book a number of ways to try to avoid a blow-up.  First, it is up to the parents and teachers to try to change the sequence of behavior to try to go around whatever causes a blow-up.  You won't be able to avoid all causes by any means, but if you can avoid of few of the situations, that will help lower the number of outbursts

Once your child gets angry, if he is just a little mad, try to use "emotional distraction," that is, try to change his mood by directing him to something that makes him laugh or that makes him curious (and thereby stop thinking about whatever was making him upset).  Once he gets very upset, then it is best to back away until he calms down.  The more you say when he is in a tantrum, usually the longer the tantrum will go on.  

In the second half of my workbook, I write about strategies you can teach your child.  You mention that several peers push his buttons.  You would discuss those situations briefly in the evenings and teach him how to look at these situations differently.  You could also teach him catch phrases that he would eventually memorize to help him look at these situations differently.  For example, if a peer is teasing him about something he said, you could teach him that the peer may be jealous or may like to see people get upset.  So the catch phrase might be "keep quiet or he wins,"  or "he wants me to scream, so I'll say nothing,"  or "I won't let him get to me."  Explain to your son how effective the "cold shoulder" is, and practice at home by role playing a recent situation at school.  Review and practice several times a week for two to three months.

It can take several months for children to begin to implement what you teach them, so be patient and non-judgmental when you work with your child on these strategies.  If he gets annoyed then take a break for a few days.  Tell him anger is a real important thing to learn how to control.  

If the teacher or social worker at school can work with him in a similar fashion, it would help your son.  Repetition of strategies over a number of months is key because children with anger overload tend to react so quickly that it is hard for them to remember the strategies at the moment of upset.  But frequent practice helps the process along.  All the best, Dr. Dave Gottlieb

Almost 5 year old has "terrible" tantrums at school

Hi Dr. Dave -
I stumbled upon your article about anger overload and your ask Dr. Dave blog when googling anger in children.  I have a 4 year 11 month old child who is super sweet, super kind, focused and creative.  She has been sent home early from preschool two times in the past two weeks because she throws terrible tantrums for at least an hour and they cannot control her.  She will throw items, scratch anyone who gets in her way, knock down items.  I, at first, wanted to blame her school environment because I do not see these issues at home.  I was at first afraid that it might be ADHD or bipolar because of the severe mood swings that can occur.  However, your description of anger overload describes my child to a T.  It is like you wrote the description based off her.  

In school everyone loves her, everyone loves playing with her and everyone calls her their best friend.  She is super smart, but lately, when asked to clean up, or pick up a mess she created she gets set off and cannot be controlled.  We think this may be due to having to stop an activity, or being treated unfairly (in her eyes).  Today's episode was because her and her friend made two messes during free time.  The teacher asked each child to clean up a mess.  My daughter said it was unfair that she had to clean up one mess by herself because she had help making it.  It set her off.  We also had a teacher tell us when she was two that she was a four year old (her sister's age) stuck in a 2 year old's body.  She gets frustrated with kids her age and when given a choice will always play with older kids because they think and act more like her than kids her age. 

I don't think I see these episodes at home because I do in fact stop them with distraction techniques or making her laugh before they get out of control.  (Mother's instincts kicking in).  I was wondering two things.  1.  Can this be seasonal?  We notice that these episodes happen more frequently and more severe in Feb / March time frame.  (She was actually expelled from her last preschool in February last year, and now she is getting more calls home to be picked up because she is uncontrollable these past few weeks at her new school that she has been at for about a year now).  Do you have any suggestions that I can give to her teacher to help us with controlling the anger before it gets out of hand?  Are there any resources for teachers, or do I direct her to parenting resources.  It is really frustrating for me because I am not with my daughter when these episodes happen, so I am going off of second hand experiences, and I do not see the full blown episodes at home, although I do believe that they are happening at school.

Hi, See if you can share with your child's teacher some of the strategies you are using at home, such as distraction, or using humor.  In addition, I would suggest the teacher continue to track the situations when your daughter gets frustrated.  Which activity led to the mess she did not want to clean up?  Could the teacher direct your child away from that activity and toward a different one?  Would a five minute warning before clean up time help?  

I would also help your daughter "re-frame" the issue after she calms down.  The teacher could do this, or you could do this if the teacher shares the details with you.  You could talk about what was happening before she had a tantrum and then explain that the teacher just wanted things cleaned up and did not mean to single anyone out.  Do this each time after your daughter has calmed down.  You would be trying to help her look at things from a different perspective.  This may not help her avoid tantrums right away, but pay dividends down the road.

 You could also suggest a "catch phrase" which you could practice at home, such as "All right I'll do it." or "She didn't mean to pick on anyone."  or "Better to clean than scream."  I explain more about the use of catch phrases in my parent's manual. 

I would also suggest you offer a reward if the teacher sends a note home that your daughter was a big "helper" today.   You want to reinforce the idea of helping the teacher.  If "helping" is not usually the issue, then use different words to capture what you want your child to work on.

If clean up time is not the usual precipitant, you could use these ideas--reviewing other points of view after she calms down, catch phrases, distraction, and daily rewards-- for whatever situation precedes her tantrums.   

I am not aware of seasonal changes in angry outbursts in late winter, though some children and adults have "cabin fever" by this time of year.  But in that case there would be mood changes or irritability in other situations throughout the day.  All the best, Dr. Dave Gottlieb

Sensory overload and anger overload in 5 year old

I am writing in regards to my 5 year, 10 month old daughter.  I am a pediatric speech pathologist and have worked on a multidisciplinary team with pediatric occupational therapists for 14 years.  I have always described my daughter as "spirited"!  Very active, risk taker (climbing things at a very early age, no fear, etc).  She screamed for about 18 hrs/day and slept very little the first 6 months of her life, which I wrote off to severe reflux (which she was medicated for), but now looking back, I feel like she has never been able to regulate her body on her own.  We had to swaddle her extremely tightly, rock her, shush her, bounce on a ball, etc to even begin to calm her and most times that didn't even work, but she has ALWAYS needed help calming down when she gets amped up....what I would call in therapy terms "dysregulated" or "sensory overload".  This is when she displays the exact symptoms of what you are describing as Anger Overload and your article describes her perfectly.  When she is "regulated" and in a good space, she is kind, compliant, sweet, caring, creative.  She can attend to tasks--even non-preferred tasks if she is not on overload.

She does not kick, bite, hit or get violent during her meltdowns  (although she did go through a pretty bad biting stage in her two's even though her language was excellent).....she just cries, screams, holds her head and will yell things like "You just don't understand...my body just can't think" or "My body is just so angry right now I can't stand it".

We learned a long time ago that talking to her in that moment does not work, that she will only "hear" us when she is calm, but even though she is bright....it doesn't deter the behavior from continuing to happen.
I have tried everything I know to do from a regulatory standpoint.......exercise breaks, breathing balls/techniques, picture schedules to make routines easier (even though she is ahead in communication skills), making a frustration jar with glitter to shake, giving her heavy input/tight squeezes.  She ABSOLUTELY cannot access her frontal lobe functions when she is in this state.  Is this what you mean by anger overload?  Does it mimic regulatory dysfunction?  If not....how would you separate the two?

My other question is.....besides behavioral strategies, is something like this ever treated with medication?  and if so, would it be and ADHD med? SSRI? something else?

I really appreciate your help.  I have used all the tricks in my bag and am at my wits end, because I can't stop her blow ups.  I have tried tracking data to find her antecedents, and can control them maybe 1/10 of the time.  Luckily, they are only happening with us (parents) and not at play dates or at kindergarten...yet.


Hi, It sounds like one precipitant for your child is sensory overload.  I find that some children with extreme reactions to frustration (i.e. anger overload) also have sensory overload and some do not.  Some children only get dysregulated when angry, whereas other children have difficulty with sensory overload in general.  Regarding your description of your child's free spirited nature, I have found that many of the children with anger overload are also free spirited or headstrong, but not all.  In an earlier book I wrote (called "Your child is defiant: Why is nothing working?") I have a chapter on strong willed children who also have anger overload.  When anger overload occurs along with a strong willed personality, or along with sensory overload, then you will need to use a number of strategies, and it will take more time to help (probably over the next year or two you will see improvement, as opposed to just months).

I like a lot of what you are doing for sensory overload.  I would recommend some additional strategies specifically designed to help with anger.  You are right to wait until she calms down before you talk with her.  One really good sign is that she can verbalize at times that she is so angry.  The goal over time is to help her recognize early warning signs, because it is more likely that she will be able to calm herself the earlier she realizes she is getting frustrated.  In order for this to happen, in the beginning you will be the one to try to pick up the early signs and precipitants.  After an outburst, you want to record what the sequence of events were leading up to the blow-up.  The more you do this, the more you will see patterns.  You will not be able to anticipate many of the outbursts, but hopefully you will be able to some of the time.  

In my book on anger overload, I describe how to use "emotional distraction" and calming strategies in the early stages.  Many of the calming strategies overlap with what you are already doing, like the using the ball or blanket to help her soothe.  As for what I call  "emotional distraction," this works by re-directing the child to something that makes them laugh, or feel happy, or stop and think, such that they forget about their frustration for a few moments.  

In the second half of my book I describe strategies to teach to your child.  The one I would begin soon with you child is introducing a color labeling system for the levels of her anger--blue hot might be for low anger, orange hot for medium anger, and red hot for extreme anger.  See if she can eventually use these words.  You would tie the blue and orange labels to certain calming activities, and reward her for trying them, whether they work or not.  Sometimes your child will still move on to the red stage.  But if she tries, she is on the right track, so I would think about short term rewards for later that day.

The other approach is to plan events to avoid certain frustrating situations.  For example, if you have determined that stopping a video game often leads to an outburst, you might limit video games to days where there is more time.  If you cannot avoid a trigger, then you plan ahead and predict for your child that she will need to shift gears at a certain time of the day, and then you give her another warning five or ten minutes before the change will occur.  I also describe in the book ways to lower your child's expectations (if her high expectations are a trigger for anger overload).  

Your question about medication is a good one.  I will answer from my experience seeing children as a psychologist, but I do not prescribe, and I would recommend you check with a pediatric psychiatrist.  My experience is that ADHD medication does not help unless the child also displays symptoms of that disorder.  There are some reports in the research literature that SSRIs help some adults with severe anger problems.  With children, I have seen them help sometime when the child also shows frequent signs of irritability (even when not in overload).  Some children are prescribed mood stabilizers or the atypicals, but these can have significant side effects, so they tend to be a last resort.

I think that some day we will be able to do imaging studies of the brain that will show that in many of these children there is immature development of the pathways between the amygdala and frontal cortex, or immature development in the frontal cortex.  The ventromedial frontal cortex has been found to be different in adults with anger problems.  But there is a lot of growth in the frontal cortex throughout childhood and early adulthood,  and many children improve with repeated practice of the kinds of exercises I have outlined.  As you know in your work, the brains of children are quite malleable, and there will be a lot of development during the primary grades for your daughter, so keep trying different strategies and see what works best for her.  Progress may be slow for a while and then you may see a jump in self-control.  It is like the strategies click in, maybe because at the same time there is a leap in brain development.  All the best, Dr. David Gottlieb