7 yr old explodes over minor frustrations

My wife and I have been "under siege" by our nearly 7-year-old daughter (Simone) for a few months now (off and on).  Besides one incident where she hit a boy on the bus and made him cry, she gets along fine and school (has a lot of friends, seems really happy when she's picked up, no serious discipline problems at school besides that one hitting incident).  In public, she's also self-controlled and generally level-headed -- but she regularly ignores all other adults (never says hi or answers questions, even close family friends).

 

The real problems are always in the home. First of all, my wife and I have a very close and loving relationship.  We seldom argue and are a "united force" when it comes to privileges, discipline, etc.  We also have a 2 and 1/2 year old son. For the past couple of months, nearly each day for the past couple of weeks, Simone has had intense, sometimes violent reactions to things like (1) not being able to watch a TV show; (2) dinner time (in general -- she regularly claims that the food is "yucky" and then demands something else, often chanting it over and over again; (3) being asked to clean her room or pick up her belongings, (4) even extremely minor things like having difficultly pulling off her tights when changing into her PJs.

She doesn't seem to have a filter.  She "turns it up to 11" for everything -- whether she falls and gets a scrape or can't find the perfect pair of socks to wear for school.  She also FREAKS OUT if we try to show our son a "Curious George" video and she's doing something else ("I want to watch it!!! Don't start it yet!!!" ... then she may start sobbing loudly and uncontrollably).  And in general, she often tries to sabotage things when we're trying to have fun as a family.

She digs in deep and opposes us regularly (not always) for minor requests and instructions.  She has an amazing vocabulary and performs at a high level in school -- but it's really, really difficult to engage her in conversation.  I can usually sense when the "dark cloud" is about to descend over her. She'll get a really cross look on her face, with a frown, and seems intent on being miserable and making people around her miserable.  Even if we provide a decent solution, she makes sure it doesn't solve her problem.  

She often punches and kicks when she gets a surge of angry energy, often while frothing at the mouth and sobbing loudly.  

It's not fair to our youngest, especially when we have to stop a fun family activity in order to deal with Simone's outbursts, while my wife and I are feeling particularly shell-shocked by it all.  I'm not an objective source, but I feel like we've been incredibly patient and calm and have tried many methods.

Again, she's well-adjusted at school and in public, and is sweet to her brother (most of the time -- all siblings squabble sometimes), but very hard on us way too often.  

I plan on purchasing your book but wondered if you could be so kind as to provide some direct feedback as well.  My psychiatrist (I've been treated for depression/anxiety) suggested she may have oppositional defiant disorder, which has a high probability of turning into sociopathy in adulthood. That freaked me out, but upon further investigation it just doesn't seem like a fit. Thank you for your time and expertise.

 

Hi,

 

It sounds like your daughter has anger overload, rather than oppositional defiant disorder (ODD).  For the latter, you would expect to see argumentative or disagreeable behavior toward adults in multiple settings, e.g. school as well as home.  Your daughter gets along fine at school you wrote, so I would be reluctant to use the ODD diagnosis.  Furthermore, in my experience most ODD kids do not become sociopathic.  Sociopaths exhibit a lack of empathy for others, and you describe your daughter as kind and likable when she is not angry.

 

The diagnosis you might want a mental health professional to rule out is pediatric bipolar disorder.  In this disorder there are also repeated outbursts.  In addition, there would be signs of grandiose thinking, frequent mood changes, risk taking behaviors, and impulsive decision-making.  It does not sound like your daughter exhibits risk taking or impulsivity, and it is unclear whether she exhibits grandiosity (feeling she is the most important and best most all the time).  From your description, she does have mood fluctuations, but this can occur with anger overload as well.  It sounds like your daughter frequently gets highly emotionally aroused by frustration.  Like you said, she has extreme reactions to so many frustrations and disappointments, and can't seem to dial it down.  This fits with anger overload:  these children get overheated, and we think there is a biological underpinning--the frontal cortex is not able to control the arousal of the emotional parts of the brain, mostly the amygdala. 

 

But with development and practice, there can be improvement.  The strategies in my parents' manual are intended to help that development along.  It will take time and practice, but your daughter can learn to have better self control when angry.  Part of the manual describes strategies you and your wife would use to help avoid tantrums.  Early detection here is critical.  You enumerate a number of situations when your daughter loses it.  You would want to anticipate these and try to find ways around them.  For example, getting dressed sounds like a frustrating time.  I would recommend being present, if possible, during these times, and be ready to assist or divert her if she starts to get frustrated.  Because of her low frustration tolerance, you may need to assist with tasks that you might otherwise leave a 7 yr. old to do on her own.  The same for cleaning up her room.  Be around to help; maybe making it a joint activity will remove some of the frustration for now.

 

For meal times and television, I would suggest trying to have a regular schedule as much as possible, and cue her with five or ten minutes to go that the next "activity" is about to start.  Try to arrange the schedule so that something fun comes after something she does not like.  Then there are natural incentives to follow the schedule.  If she does not cooperate, try not to engage her in a discussion at that point, but make sure the next activity does not start until she completes the one before it.  Talk as little as possible if she is in the overload phase.

 

In the second half of the manual, I explain strategies to try to engage your child in the process of learning self-control.  A first step is to assign a neutral word to each of three levels of anger:  low, medium, and overload.  I often use colors with kids:  blue for low, orange for medium, and red for real hot.  Once you arrive at the words to use together, you or your daughter could use the colors to point out when someone in the family was getting upset, preferably at the early stages.  Once this system is in place, you would tie diversions or relaxation exercises to the lower levels of anger.  The idea is to teach your child how to self-soothe.  This is a long process, admittedly, but it is worth the time and effort.  If children learn to self-soothe, it will make it so much easier for them to deal with the frustrations of everyday life!

 

All the best, Dr. Dave Gottlieb

 

 

 

 

5 yr old hits and bites if does not get his way

Hello .  I am hoping you can provide me with resources or maybe some feedback regarding my son.  He is 5 years old and gets very angry ( only towards close family members and most usually me ).  If I use a tone he doesn't like, doesn't feel listened to, or if I say No to somewhat he considers a "need," he will hit me and at times say that he wants to hurt me badly .  He has bit me and thrown objects at me .  He is cautious what he throws and usually will pick up a hard object put it down and then throw a soft object . 

 He is very sensitive .  He picks up on every emotion in the home .  My husband and I can bicker and I have been dealing with some complicated grief since losing my mom abruptly almost 4 years ago .  He has lots of energy and fidgets a lot but I don't think he fits the criteria for ADHD as he is focused and sits nicely in kindergarten .  He will take his time with his school work if he cares about it .  If he doesn't he rushes through it and if corrected ( by me typically) he yells at me that i am a mean mommy or says " be quiet , don't talk to me , I hate you , I want to hurt you ".    His outburst are very short lived ( thank god ) and I usually can redirect or distract him onto something desirable .  But this is a lot of work and emotionally draining for my husband and I . 

I don't know what makes him so angry .  He is an only child . He is pretty spoiled by my husband and immediate family who often give him many tangible items .  He feels that he should get something in every store we walk into and will wheel / deal any way he can to try get this "need" met .  Generally he is a very spirited boy who loves nature and noticing the seasons changing , he is pretty creative with art or even ideas about things, and his vocabulary is exceptional .  He is very loving and affectionate .  He loves our dog and is gentle with her . He is 5 ( six in April).  He shows little interest in reading but appears to be keeping up with his peers .  If he feels he has received genuine praise for something he is very prideful .  He picks up on "bullshit" easily . 

It is beginning to make me anxious as i don't know what will tick him off .  Additionally he needs us to always engage him .  Running errands or cleaning the house makes him irritable if he can't have an active role in it.  Watering down the cleaning to his level doesn't work, he wants to do whatever the adults can do .  He has recently been doing more mischievous things he knows is wrong as if he is looking for negative attention .   I feel terrible that I can't find a strategy of parenting that resonates with him.  He is acting out for a reason .  I don't think this is biochemical . I pray it's not .
Thanks in advance for any feedback you can provide .


Hi, I can tell you are trying real hard to understand your son, and it sounds like you are still grieving the loss of your mom. You mention too that you and your husband bicker sometimes.  Do you feel you need more emotional support at this time of your life?  I wonder if your frustration with your son is aggravated by your disappointment that he is another source of stress.  Maybe if you had more support (friends, support group in the community, or therapist), you could make limits stick better with your son.  You mention that he is spoiled.  Maybe you are trying too hard to please him.   It can be hard to say no when you anticipate a child will explode!

It is good that this is only happening in the home, because it means your son does have some self control.  Then the question is how you can get him more in control at home.  One thought I have is that it is going to be important to set a firm limit about physical violence. Do not talk to him while he is having an outburst.  When he is calm, however, you could all talk briefly about how dangerous this is.  Explain a couple of alternatives: saying "I don't want to" or "I don't like that." This does not mean he will get to do what he wants, but you will at least consider it.  And explain that in the future there will be serious consequences for violence.  Think with your husband what immediate, short term consequence might be meaningful for your son, e.g. no television for the day if this is important to him.  You do not have to announce the consequence right away if he is hitting or throwing things.

But when he calms down, let him know that it was dangerous, and he needs to find something to do other than television for today, and that if he does not hit for the rest of the day, he can have television tomorrow.  This may set him off at first, but in the long run you will establish a limit about violence.

The other approach to violence in the home for a young child is to restrain him when he becomes violent.  Bear hug him and hold him until he calms down (this could take many minutes).  It is reassuring to a child to know that you will not let him hurt anyone and that you are powerful enough to keep him and everyone else safe until he calms down.  Do not talk to him a lot during this time.  But talk with him after he calms down.

You want to pick your spots when it comes to discipline.  Think whether the issue is important to the functioning of the family.  For example, if his school work is rushed or incomplete, maybe you could let the teacher handle that with him.  If he cares about pleasing his teacher, her/his comments may help motivate him, and then you do not have to be the enforcer for homework.

I like how you distract him at times.  Also, consider ways to avoid tantrums.  For example, maybe don't take him to the store for a while if this is one of the battle grounds.  Maybe one of you go shopping and the other parent stay home with your son for now.  Or clean the house while he is in school, or while one of you takes him out for a walk.  You want to cut down on the number of possible conflicts until he learns better self control.

My manual for parents on anger overload explains some of these and other strategies you could use.  If you do not see some improvement in a few months, ask your school or family doctor for a referral for a child psychologist to help you. 

All the best, Dr. Dave Gottlieb

14 yr old breaks things, smacks mother

My husband and I have 3 daughters and we are raising 3 of my brothers children.  We are a poor but proud family that is in dire need of some serious help.  Our middle daughter, who will be turning 14 in November, has been seeing a developmental pediatrician at a local hospital. He has told us that our daughter suffers from ADD/ADHD combo, social and educational anxiety and oppositional defiance disorder.  I've tried all but 1 of the methods that he has offered and they are not helping.  Unfortunately we can't find a cognitive therapist that will accept her medical card and I honestly am at my wits end!!!  

We can't handle her any more and it is causing a lot of problems in our home.  One minute she is the sweetest most helpful person and in the blink of an eye, she's throwing things, breaking things, yelling and screaming.  My husband tries to get control of her but all it does is cause fights and things end up broken and holes in the walls. Just tonight she broke a fairy figurine that my aunt gave me and she upset her dresser, put a huge hole in her wall and she smacked me so hard on my bare chest and neck that it left a welt.  

The other kids are on edge and scared when she starts to act out and I'm ready to have a nervous breakdown. Our daughter is at her wit's end too.  She just left a few minutes ago to go to my mom's house for a few days.  My mom just texted and told me that our daughter was very upset and said that she feels like she really needs help and that she has prayed to God and asked him to help her.  She's like a yo-yo!  When she's with my mom, she says she feels she needs help, but when she is home with us, she thinks she's fine and refuses any help.  

I have thought several times about having her admitted to a major psychiatric hospital.  She has been to the ER at our local hospital and admitted at the local psychiatric unit a few times.  I don't know if putting her in a psychiatric unit would help resolve the issues or not.  I guess what I'm hoping for, is that you might know of something we might be able to do, or somewhere we might be able to take her, to help our daughter take control of her anger and help us all to be a family again.


Wow, you have been though a lot at home and have tried getting her professional help.  Yes, ongoing outpatient therapy with someone trained in dealing with anger issues is a good idea.  The psychiatric hospital you mention might help too, especially if she continues to be out of control and physically endangering family members.  One question I have is about the diagnosis.  The way you describe the intense and rapid changes in mood make me wonder if pediatric bipolar disorder has been ruled out.  There are medications especially helpful for bipolar disorder if she were to have that condition.  Maybe ask your pediatrician, or check with a psychiatrist who sees teenagers to help decide about the diagnosis.  

The fact that your daughter said recently she wants help (at least when she was with your mom) is a good sign.  You would want to talk with her at times when she is reflective and wants help, and talk about strategies she could develop to recognize and head off her angry outbursts.  The second half of my parent's manual outlines strategies you can teach your daughter.  These are cognitive behavioral strategies, which is what your doctor recommended.  The first step is to develop your child's observation skills.  I explain in the manual how to help your daughter identify when her anger is rising, and to identify some of her triggers.  Then she would try different calming strategies.  It is hard work to identify triggers and to intervene early enough to head off an outburst.  But if your daughter is motivated, it would be a good time to try some of these strategies. 

See if she will let you work together.  Explain you would be the assistant coach, who might notice triggers and help her develop calming strategies, but that she would be the head coach and could decide whether she agrees or not.  The more you can get her thinking about the triggers and alternative strategies, the more likely she will be able to slow down her impulsive outbursts.  It will not always work out because anger is a powerful emotion, and when in full force, it is hard to get the rational part of our brain to act.  But at early stages, when a trigger is just beginning, it is easier to head off anger.  So one key is early identification of situations that cause frustration or disappointment for your daughter.

If one cause of the outbursts is arguments with you or her father, then you would work on teaching your daughter about different points of view and ways to compromise.  There are sections in my manual about how to help children recognize that there are different ways of looking at things.  Often new information about other people's motives help children to see others (you and your husband) as benign and as trying to help them.  Many teens think their parents are just trying to manipulate or control them, and that perception makes their anger worse. You want your daughter to see that there are different ways of looking at things, and that you are not trying to manipulate her.  For example, parents' rules about curfew are intended to help children to stay safe and to get to sleep at a reasonable hour.  Many teens think parents are trying to prevent them from having fun with their friends.  Once teens understand there are different ways of looking at curfew, there is a chance they will react less angrily and learn to compromise.

Lastly, if your daughter can calm down at your mother's house, this might be a good place to start with a family discussion about the strategies I outline in the manual.  Your mother could be in on the discussion if your daughter is less likely to explode in her presence.  Sometimes having a neutral party present helps teens to think about things rather than react emotionally.  All the best, Dr. Dave Gottlieb 

What to do when there are additional problems

Hi, I wanted to let my blog readers know that you can find brief articles I have written about other parenting issues on a website for the Chicago parents' network.  So far I have written about how to handle these issues: temper tantrums (usually an expression of anger overload), potty training, divorce, and most recently shyness.  Sometimes children with anger overload have additional issues, and if any of my blog readers would find these articles useful, below is a link to the Chicago parenting website.  This link gets you to my recent article on shyness, but once you are on that website you can search the blog posts for my other articles.  To find my other articles, go to the left side of the parents' webpage and look under these blog categories: "children and divorce,"  "diapers and potty training," and "behavior and discipline."  Take care, David Gottlieb, Ph.D.

If you first click the link below, and you do not get immediately to the article, a message should appear that you then click on again.

http://www.npnparents.org/posts/722,is-your-child-shy

Parent uses manual and 6 yr old hits in school

Dear Dr. Gottlieb,
I have a 6 year old son that seems to fit your description of a child that experiences anger overload. I've been following your advice outlined in your manual along with using strategies described by Dr. Ross Greene in The Explosive Child. Thank you for your manual. It feels like a god send as I live in a small town where it is very hard to find quality health care.

I have two main questions about what we are experiencing in the early stages of our new approach. We’ve only been trying these techniques for about 3 weeks.

(1)  While it seems like we are improving with avoiding overload altogether by detecting triggers and sensing his body language when he is getting frustrated, it now seems like he is triggered more often. His episodes are shorter and less intense, but it seems like there are more of them now. An example would be that just this week he hit a fellow student. School has never been a setting where he acts on his anger. It’s always at home or when he is with me and/or his father. He is triggering in more situations now at home too. Is this a common phenomenon that you experience with your patients as they start the techniques you prescribe?

(2)  The second question I have is concerning a broader pattern. Sometimes he seems to go for weeks without much of a struggle even in the face of his usual triggers. We often think of his triggers in terms of ultimate and proximate. He might be upset because his spelling his hard, but if he is hungry, it’s a greater challenge to control his anger during difficult homework exercises. There are times when he is fed and rested and has had play time (all ultimate triggers covered) ….but he is still excessively trigger sensitive. And then in other times, he can control his anger fairly well with the same triggers in play. In your opinion, is there is evidence to show that there are periods where hormones can affect his trigger sensitivities for weeks on end? Or is there another situation that could cause this?

My deepest appreciation!

Hi, You ask good questions.  Generally, there is not an increase in anger overload in new situations when you apply the techniques in the manual.  Do you know what was going on before he hit the student in class?  What was the trigger?  Sometimes a child struggles to contain his anger in school (and is usually able to exhibit self control), but then there is a day when he is more sensitive (tired or hungry).  When in addition on those days there is an unusually difficult situation, he may have a melt down.  For example, sometimes a child does not do well on a test or assignment, and is feeling down about it, and then the same day a fellow student is verbally provocative.  The combination of triggers is overwhelming and leads to hitting.  My guess is that this will not happen often for your child in school.   If it recurs, it would be important to try to figure out the triggers, and also apply the strategies you are using successfully at home.  You might meet with the teacher and explain what you are doing at home, and see if the teacher would apply similar techniques (or one of the other techniques in my manual--the teacher might feel a different technique might work better in her class).  Usually over time a child develops better self control and there are fewer explosions at home and school.  

I don't know the answer to your second question.  I have also observed that some children have better control some weeks, but I do not know of any research that looks at fluctuations in hormones or brain chemicals over time and their effect on anger.  There have been some studies on violent behavior in adults that show that low levels of a brain chemical called serotonin are associated with more violent behavior.  But even these studies have not looked at week to week fluctuations in serotonin.  Furthermore, the correlation between serotonin and violent behavior does not mean that low levels of the brain chemical cause violence.  It is possible that there is a third variable that causes changes in violent behavior and changes in serotonin.  It is also important to keep in mind that violence is not the same as anger overload.  There are various contributing factors to violence that have nothing to do with anger.

  

My guess is that there can be week to week fluctuations biologically that affect anger overload.  Also, there can be fluctuations in environmental stressors, and we don't always know our children are feeling stressed until they explode.  But that doesn't mean your child still can't develop better control even during those weeks where he is biologically vulnerable.  He may need more help with the strategies those weeks, and over time (several months) there will often be a decrease in explosions, though not necessarily a total cessation.  As your son gets older, you will be able to apply more of the strategies in the second half of the manual that will help him become more aware of his triggers and how to use strategies himself.   Usually at age six, the strategies in the first half of the manual (that involve parents directing the child) are more effective.

All the best, Dr. Dave Gottlieb

8 year old loses it doing homework

Hello Dr. Dave,
I'm at my breaking point with my son.  I have 3 children, he is my middle 8 year old.  He's always been sensitive, easily angered, quick to cry when feelings are hurt, and quietly emotional (will run to his room to cry if his brother hurts his feelings etc.).  However, he's generally a pleasant, happy child.  When things are going his way (ie. he has a friend over for a playdate, and his siblings aren't getting involved) he is sweet, kind to others, and incredibly funny.

Lately (just started the 3rd grade) he's been frustrated by schoolwork, and I believe he bottles up that frustration until he gets home.  With me he is incredibly angry, won't do homework, and when I press forward and insist that homework needs to be completed...well that's blow up time.  I try and stay calm, but one little thing I say can set him off and he's throwing cushions off the couch, he runs and buries his head in his bed, he cries, yells at his siblings.  He never has hurt anyone, but he throws things now and he's a strong boy.  I'm afraid of this escalating, and having him cause damage to things or hurting someone during his fits.

I also am ashamed to admit that he has gotten me so worked up that even I have lost my patience and I've yelled, or tonight I turned one of his Lego bins upside down in his room because I was so completely exhausted and enraged, I lost it.  I tried so hard to talk to him, but he won't talk. He says I ruin his life, that he hates everything, and he doesn't want to go anywhere for help.  I've offered tutoring, a doctor to help us figure out a way to work together so we are both happy. Ugh! I'm so upset, if  you have any recommendations, please let me know.

Hi, It sounds so frustrating for you and for your son.  We all have trouble containing our emotions sometimes.  When your son is calm, you may mention that sometimes you get so angry too, and add what you try to do to control your anger.  You can be a role model for your son.  He may not respond to your remarks, but he may feel less frustrated knowing that he is not alone in having times of overload.

You mention that some of the blowups recently have occurred at homework time.  Did this problem begin this year in third grade?  Do you have any ideas why now homework is getting to be a struggle for your son?  You might want to talk with his teacher if you suspect that the work is difficult for him or if you think he is having difficulty concentrating.  You would want to rule out a subtle learning disability and rule out attention deficit disorder. If the teacher is unsure, then you could ask the school to do some testing to rule out learning problems.  If there is a chance that your son has a learning disability, you would want to take some pressure off doing all the homework until you and the teachers know how to help him.   If you think there is no learning problem nor attention issues, and if you think that the problem is motivational, what is your son wanting to do instead of homework?  Is there a way you can tie in completion of homework with extra time doing what he wants when he finishes?  Make sure that whatever your son loves to do comes after (and not before) the homework. 

You mention also that your son is sensitive to being hurt by his sibling and that he is emotional then.  Some children are more quick to cry than others, and crying by itself is not a problem, but if your son feels inadequate in some ways compared to his brother, you would want to try to help him with his self esteem.  Help him see that he has an area of expertise, or help him build an area of expertise (for example, sports, music, art, social service, or kindness to others) or explain that his brother has had more practice in the areas where your son feels frustrated (if this is the case).  Continue to have friends over that your son enjoys, and think about whether there is some other activity in your community where your son would like to participate (and it could become an area of pride for your son).

When your son gets angry, if you can, try to intervene before his anger is explosive.  In my parent's   manual, I explain how to do this:  by using "emotional distraction"  or calming  strategies.  In addition, you would want to lower your son's expectations (in whatever area causes him stress) when he is not angry.  It sounds like your son does not like to talk much about his anger, but you may be able to propose a new way of looking at things when he is calm, maybe later in the evening.  Keep your comments brief, since he is sensitive about his anger issues.  In the parent's manual, I explain how to do this. 

When your son is explosive, do not talk with him then.  As long as no one is being hurt or nothing valuable is being destroyed, then try to wait it out.  Usually the more you talk when a child is in overload, the more emotionally reactive a child becomes.

As far tutoring or counseling, think about what you feel is best, or consult with his teacher.  Then you make the decision, rather than ask him his opinion.  Your son may not like the idea at first, but if the person you hire can form a good rapport with your son, his resistance will decrease.  Remember he is frustrated and just wants the problem to go away.  But you know that it won't go away without something changing, so you have to do what you think best.  Hang in there!  I can tell you care a lot about what your son is going through.  Hope these comments are helpful.

All the best, Dr. Dave Gottlieb

6 yr old explodes when touched or if not in charge

My son is almost six, and simply cannot seem to control himself when he gets angry.  If he is pushed, or touched (even by accident) he explodes. His anger is often directed to those whom he perceives as threats in some way (his younger brother, a threat for his attention) or peers who have strong personalities (He likes to be in charge.).   He rarely will hurt or explode at someone younger than him, or girls (He actually usually plays very nicely with girls and passive boys.).

He gets easily frustrated with himself when he cannot accomplish something, and can also explode then. 

He has not had issues in school yet, and in fact his teachers have even told me that he is a rule follower, and a great listener. focus and attention do not seem to be issues either.  I have watched him in sports and activities and notice than when he is engaged, he is the paragon of good behavior, However, left to his own devices, he is not to be trusted, and I am concerned that one day he is going to really hurt someone in one of his fits of anger. 

He seems to fit many of the characteristics of children with anger overload.  He is very energetic, and loves to play on the playground and loves jumping, climbing, and physical activity. While he is often very outgoing and confident in many areas, other times he is shy, especially if he is late or does not know people.  There are many moments of kindness, and sweetness, and friendship.  However, there are also too many times where he gets angry and can't control it. 

I have tried everything. positive reinforcement seems to work best, but he will go through phases of good behavior and then revert back to a downward spiral of behavior rooted in anger. 

I just ordered your book on amazon, but was wondering if you might think other diagnoses would be appropriate rather than anger overload.  Also, I don't know if your book mentions when to seek professional help and/or medication rather than rely on do it yourself behavioral therapy.  I am willing to try one more thing, but am wondering when enough is enough.

Hi, 

From what you describe, it sounds like your son exhibits anger overload.  It sounds like he pays attention well in school (does not have ADHD) and is not unusually moody (not depressed or bipolar).  It does sound like he likes to be in control, which is true of many children.  In addition to the strategies I outline in my manual, you might want to talk with your son (when he is calm) about how to handle certain tough situations you have noticed.  For example, help him understand  how to respond to pushing or touching by peers.  You could recommend he look at the other child and think about whether it was an accidental touch or a more deliberate shove.  Explain how he could respond verbally to each type of situation.  Practice with him short, firm, verbal responses if he thinks he was deliberately pushed, like "Don't push me." or "stop it."  If it was an accident (and the other child wasn't looking at him but just walking by) suggest he say to himself "no harm no foul" or "he didn't do it on purpose."  Since your child responds to rewards, you and/or the teacher could set up a reward if he tells you about a situation when he held back.  

Your son may not be able to implement these ideas right away if his anger escalates quickly, because as I discuss in my book, some children are flooded so fast with emotion that it is hard for them to delay and think about what to do.  Adult observers become key then.  If an adult can intervene early and distract him, engage him, or help him soothe, he may be able to slow down without exploding some of the time.  The important point is to intervene early, if possible, before your child's anger reaches the overload phase.  Or, re-arrange situations in advance to avoid a trigger.  For example, if your child is jealous of his sibling getting your attention, cue your son when you are about to help your other child that it will be his turn (to talk with you or do something with you) in a few minutes.  You want to give him a heads up since that may help soothe him and prevent overload.  

My manual is designed so that parents can try the strategies themselves.  But it can also be used in conjunction with therapy.   Sometimes there are underlying insecurities that contribute to a child's anger overload, and a therapist can be helpful in addressing possible concerns or worries that a child might have.   In other posts to this blog, I have explained how to find professional help.   

In my experience working with children with anger overload, medication is not helpful.  Medications might help if a child is depressed, anxious, or distractable, but do not help with anger issues alone.  Anger overload does take time to work through with a child because there can be biological factors, such as immaturity of the frontal cortex of the brain.  However, the strategies I explain in the manual will help a child develop better self control.   If you do not see any changes over a few months, then I would recommend a professional consult to see what else may be affecting your child. 

All the best, Dr. Dave Gottlieb