6 yr old tantrums in school

Dear Dr. Dave,

My 6 year old daughter seems to fit your profile for anger overload. I plan to buy your book. She just began talk therapy and may also begin occupational therapy soon for possible sensory integration problems but her angry outbursts at school are my main concern right now. She is basically holding the teachers at school "hostage" because they don't know how to control her screaming, until the school social worker is finally able to work with her. (interestingly, she never behaves this way for her stern AM teacher; PM teacher is young and easier to manipulate). She gets bent out of shape by negative peer interactions, a mean comment, if she doesn't do what the teacher asks, if the teacher yells at her, if she doesn't like her snack or lunch, etc. Would a child of her age benefit from anger management, either privately or as a group session? Could my use of Prozac during her pregnancy have caused this?

Thank you.

Hi,  On the blog and in my manual I have described a number of strategies to use with young children.  The strategies in the first half of my book are the best place to start with young children.  These strategies are directed by the parent and do not require the child to be aware of her triggers or early warning signs.  Most young children are not yet reflective about their anger, so I recommend parents and teachers a) observe some of the triggers and then b) try to change the sequence of events leading up to the outbursts (when possible), or c) try to change a child's perceptions about what is causing her frustration, or d) use "emotional distraction," or e) develop a relaxation station.  

In your child's case, I would talk with the teachers and determine what exactly the am teacher is doing that avoids an outburst.  Then I would see if the pm teacher could use some of the same strategies.  You mention that the am teacher is stern.  Talk with her (or have someone observe) how her demeanor is translated into actions in the classroom.  What exactly does she do when there are mean comments, or when a child does not listen to the teacher--you mention these are some triggers for your child.  My guess is that she catches the problems early and does not let things build up.  Also, with stern teachers, children know not to misbehave (or they will be seriously punished) so children often exhibit fewer provocative behaviors, and thus there are fewer conflicts.

If the pm teacher has trouble implementing the same approach, show her the other strategies in my manual and see if she can successfully implement one, or more, of them in her class.  One of the strategies that I use with older children, but might work for your child, is teaching a catch phrase that might help her think about a problem in a different way.  The catch phrase would be something you come up with together, and then make pictures with the phrase, and talk about it each day before school.  One example would be a phrase that might help her look at "mean" comments in a different way (so that she doesn't take it personally so often).  Help her see that mean comments are a sign that someone is having a bad day, and that the comments are not true.  Also, phrases that have some humor can help interrupt the build up of anger.  So one phrase I can think of now is "Meany needs go sleepy."  What you want her to consider is that the other person is tired, or out of sorts, or she wouldn't be so mean.  It's best to develop a phrase together that your child finds amusing.  It is important to explain that this is a special phrase for her to think of when someone is mean, but not to share with anyone--it is private between you and her, and you will ask her after school if someone was a meany today.  If your child does not like this strategy, or if she has trouble with the idea that this is a special phrase for her to think about when someone is mean, that is okay, then stick to the approaches I describe in the first half of my manual until she is older.

Regarding anger management groups, some schools arrange for small groups of children to meet with a social worker or psychologist to practice dealing with anger provoking situations.  In essence, my manual outlines strategies to help develop self control, or in other words, anger management. The more practice a child has, the more likely she is to remember the strategy at times of anger. So groups can help, but not every young child is ready to participate in groups.  It helps if the child is a) fairly verbal, b) can reflect afterward about her behavior, and c) wishes she could handle it differently.  If a child is not ready for such a group yet, then the teacher could still implement the strategies that do not require a child's direct participation, such as the strategies that I mention in the first half of my manual.

As for your question about prozac during pregnancy, I am not an expert on possible side effects of antidepressants.  I know that some of my female patients over the years have used SSRI medication like prozac during pregnancy.  Their medical doctors felt the benefits outweighed any possible risk.  If you want to know more, check with a medical specialist, like a neonatologist.

All the best, Dr. Dave Gottlieb

8 yr old erupts when teased

I was wondering if you could give me some advice.  My beautiful, creative, and intelligent boy has major fits of anger.  He has ruined many beautiful days by being hyper sensitive.  He has no tolerance when it comes to being teased, and will often become verbally and physically abusive towards other children.  His whole body becomes rigid and his face contorted.  He is impossible to distract when he is in the middle of his rages, and usually turns his anger on anyone who tries to help him.  His verbal abuse is getting worse as he gets older.  I am at my wits end.  I feel helpless and I am beginning to go out less, for fear of another outburst.  I have had all sorts of reward or incentive charts in place to no avail.  I can see him going to his angry space, but I can not seem to divert him from going there.  I feel like I want to give up and send him to live with his father, who has anger issues himself. This I know would be detrimental, but I feel he is ruining my life.  He is so rude and abusive, and I feel as though I have totally failed as a parent.  I have started smacking him, which is having little or not effect. I threaten to send him to his father's, which he begs me not to do.  I can't give up on him, but I feel so helpless. 

Do you have any advice that could help? I would be incredibly grateful.  Thanks.

Hi, Usually rewards and consequences do not work well for anger overload.  As you have observed, the anger erupts quickly, and a child is not thinking at that time about rewards.  He is not really rational at the moment of anger overload; his emotional brain is fired up and "running the show."   If you cannot distract him, or if there are no early signs of frustration, then during the overload phase you would try to not say or do much of anything, except to make sure that everyone is safe.  

As far as interventions, you would try to prevent some outbursts by working around some of his triggers.  You wrote that one trigger is when he is teased.  Try to make a list of the times he has been teased lately. Does it happen mostly in school?  If so, in what class or activity?  Can the teachers either a) work around that activity, or b) work with your son to view the activity differently?   "Working around the activity" could mean offering an alternative activity or sitting nearby to catch any "teasing" as it happens.  The first part of my parent's manual explains how to re-arrange a sequence of events to avoid a trigger.  The second half of the manual goes over techniques that you would work on with your son while he is calm, and one of these is helping him "view the activity differently." 

  

For teasing, I would suggest explaining that other children may be jealous of him, or want his attention, or want to get the focus off themselves. I ask the child to think about the "teaser" and what his motivation could be.  I also empathize with the child that no one likes being teased a lot. For minor teasing, I teach kids to ignore it (give a cold shoulder instead of giving attention to the "teaser"), and for more significant teasing, I teach kids to alert an adult or to sit near friends (preferably a big or popular kid) who might help intimidate the "teaser."  I would also encourage the child to invite other friends to join him at recess or lunch (where most teasing occurs in school), and I would ask the teacher to arrange to have friends (or at least "kind" peers) sit near the child more often in class.  For serious teasing, I explain to the child that the "teaser" has major problems, and it takes many people (the teacher and other students) working together to get through to a child who has major problems.

It would also be important to help your child see how he is likely viewed by others when he loses control of his anger.  Sometimes a child does not feel badly about losing control.  In that case, I recommend talking with the child when he is calm and explain that other children might get a kick out of seeing him explode, and then I would say that he does not want them to get a laugh at his expense.  Also, I would talk about how hard it can be to control anger, but that you are willing to work on it together. It will not be easy and it will take a while, but you both can work on it so that when he gets angry he can do things to head off an explosion. Explain also that he does not like it when his Dad loses his temper, so it would be important to learn how to act differently, or else his friends will someday want to avoid him.  In other words, it is important to help a child see that angry explosions have a cost and motivate the child to work on it with you.  

If a child is motivated to develop better self control, then the strategies that I mention above, like changing a child's perception of a trigger, will be more effective.  In the manual and in other posts I write about how to teach a child to look at things differently and how to come up with catch phrases to help a child remember to deal with his anger differently.  Whenever a child tries one of the strategies you work on together, be sure to praise him, regardless of whether the strategy worked to prevent an explosion.  You want your son to feel that you and he are a team, that you do not expect immediate results, and that you will be excited whenever he tries something you have discussed together.  If he continues to make an effort, eventually you and he will see progress. 

All the best, Dr. Dave Gottlieb

4 yr with anger overload, not ADHD

Dear Dr. Dave,

I have a four year old daughter that I have been having a problem with since she was 2 years old. She gets very angry, throws things, kicks, hits, destroys property, tells me she hates me, scratches, etc. She will even go as far as trying to hurt our family dogs. I have had her in behavioral therapy on and off for the past 2 years. We moved her to a psychotherapist who put her on quillivant, but that only made the angry outbursts worse. I took her off the medicine immediately. I just don’t know what to do anymore.

Hi, Quillivant is used for ADHD, but your daughter probably does not have ADHD.  Symptoms of ADHD include hyperactive behaviors, impulsivity, and distractability.  A child can have all or just some of these symptoms.  The difficulty with making an accurate diagnosis is that children prone to anger outbursts do have some characteristics of impulsiviity, at least when they get angry.  Thus, doctors may sometimes think a child is exhibiting ADHD when they have angry outbursts.  However, most of these children are not impulsive all the time, just when they get angry.  Thus, anger overload is a better fit than ADHD for many of these children.

The other diagnosis to rule out is pediatric bipolar disorder.   These children are prone to frequent changes in mood, including angry outbursts.  But with bipolar disorder there are other signs of manic behaviors, such as a) always being on the go, b) impulsivity, c) disregarding other people's feelings, and d) grandiose thinking.  It is difficult to diagnose with 4 year olds, because many children at that age are self-centered, somewhat grandiose, and sometimes moody.  So it is hard to determine, unless you are a clinician who has seen a lot of these children, whether a young child truly has pediatric bipolar disorder.  

More common than bipolar disorder in young children is anger overload.  In my parent's manual I explain that there can be delays in the development of the prefrontal cortex, which is the part of the brain that modulates angry emotions that emanate from the limbic system of the brain.  So when these children get angry, it can be extreme.  My manual goes over strategies that parents can use to lessen the frequency of outbursts.  The first half of the manual is appropriate for four year olds.  

When a child is in the overload phase, the best thing is to say or do little, unless someone is in danger physically, or unless something of value is about to be destroyed.  Then some form of physical restraint is called for.  Generally, children in overload need time to settle down, and the more parents engage them at that time, the longer the outburst usually goes on.

The manual explains how to intervene earlier in the cycle before the overload phase occurs.  This is not always easy because children with anger issues can escalate so quickly.  So it is important to observe some of the patterns (not that every outburst will follow a pattern) and either 1) change the sequence, 2) lower a child's expectations in order to lessen disappointments, 3) use "emotional distraction" or 4) develop a calming station in the house.   In the manual I explain each of these steps in more detail.  It takes several months or more sometimes to determine the best set of strategies and to learn when to use which approach for each child.  I would suggest using the manual, and if you have difficulty implementing the strategies, bring the book to a therapist who works with parents and who knows about cognitive behavioral strategies for anger, and work together on fine tuning the approaches for your child.

All the best, Dr. Dave Gottlieb

Intense 10 yr old has rages

Hello, I just read and article by you on Anger Overload in children and it brought tears to my eyes. You described my son so accurately it was alarming (and relieving because we were beginning to worry it was Bipolar).

He is as perfect as you could ask a ten year old boy to be 80% of the time.  The other 20% are horrific, humiliating, embarrassing and a terrible example to my other three children (he is an oldest but also a twin). He does not seem to rage at school although when he was younger he had "melt downs" on multiple occasions. They usually happened when he or someone else got in trouble for something they didn't really do, another child in the class had very bad behavior and he found it very upsetting, or he had a run in kickball called an out when he believed it wasn't (or something along those lines). He has always been and still is a perfectionist (to the point of lying to cover up something he believes makes him look imperfect to others), he has always been intense and he a has always been a worrier (even about things that are for the adult to be concerned with such as running out of gas or getting somewhere on time).

The majority of his bad and really concerning behaviors are at home or with us. He also seems to have a fresh and disobedient strain that comes out (more and more as he gets older) such as trying curse words when he thinks we aren't listening, watching a forbidden TV program or testing out discussing an adult topic in an inappropriate setting (when company is over etc.).  It seems to be getting worse, and it is taking a huge toll on me as I am a stay at home mother dealing with this more than anyone else, and it is having a bad influence on his siblings etc.  I want to be sure you know that I understand kids push limits and try things they aren't allowed to do. This is more in the category of defiance.

The article talks about strategies involving charts etc but at ten, he is a little beyond that.  I am at a loss.  I try stating clearly that if he continues he will have to go to his room, go back home, loose a privilege etc but he (when in or entering a rage) repeats himself to the point of seeming mentally insane. For example, if, for whatever reason, we tell him to give us his iTouch he will respond in an extremely loud voice "BUT I WANT IT, WHEN CAN I HAVE IT BACK, I WANT THE I TOUCH. HOW LONG DID I LOOSE IT FOR, BUT I WANT IT BACK, I WANT MY ITOUCH" this can go on for 10, 20, 30 minutes sometimes.  Sticker charts and redirection are not working on him.  He is too old, too smart, and way, way, way too intense.

Do you have any other advise or resources you could point me towards?

     Hi, Last year I published a parent's manual for anger overload; the first half of the manual explains strategies you can use without discussing what you are doing with your child.  Then the second half of the manual involves working with your child when he realizes he has a problem and wants to develop better self control.  The goal of the first half of the manual is to lower the frequency of outbursts, and the goal of the second half of the manual is to teach your child how to control himself better on his own.

     Taking away things when a child is getting upset usually does not lessen the outburst.  When children are in anger overload they are not thinking rationally, and thus incentives and consequences at that time are usually not very effective.  During the overload phase, it is best to say or do as little as possible.  The more you say, the more upset a child is likely to get.  Once your child is calm, then you can review what happened and sometimes a brief consequence can reinforce your message (though sometimes the consequence may re-ignite a child's anger).  When you talk with your child, you would explain how his anger was really over the top, and that together you want to work on helping him to say what he wants without losing it.  You could tell him you sometimes lose it too, and it is not easy to control anger, but you think it is important to try.  Ask him what he thinks, and if he seems motivated, then the second half of my manual describes a number of techniques you can work on together.

     If your child is not ready to work on anger with you, or feels it is someone else's fault that he gets angry, then you would use the strategies in the first half of the manual (that do not require his direct participation).  Some of these strategies are 1) to change the sequence to try to avoid one of his triggers, 2) "emotional distraction" in order to change a child's mood or emotional state, 3) developing a "fun" calming zone in the house.  These strategies work best if you can catch your child's frustration in the early stages.  I realize this is not always possible, because many situations can provoke anger overload, and you will not know all your child's triggers.  But try to keep a list for a few weeks of the kinds of situations that trigger his rage.  Then you can look for the early signs and try to head off an explosion.

     Regarding the issue of perfectionism, I'd refer you to some of the other posts (for example see April 24, 2014) where you will find recommendations for helping with children who are perfectionistic and get upset when making mistakes.   

     All the best, Dr. Dave Gottlieb

9 yr. old poked a child with a pencil

Dear Dr. Dave, 

I have just come across your blog regarding the "anger overload" issue. Wow I am excited to see that my child is not the only one that reacts like this! My son is 9 almost 10 and has always shown a sense of being overwhelmed by his emotions. He is a very smart, caring and thoughtful child but once he gets his mind made up that things are not going his way, his anger can get the best of him. He can be disrespectful to me and his friends. While he doesn't get physical with me or his friends he will punch or throw things out of anger.

 

Our home life is very normal, me and my husband both work but I am just part time so I am able to be with our son outside of school. He has been  involved in Tea Kwon Do for the past 3 years and is in line for his black belt. So if he wanted, he would actually do harm. I am scared that one day he may use this skill out of anger and not defense. I received a phone call last night from a parent of a friend he has goes to school with. She said that my son poked her son in the knee with a pencil and there were marks. When I asked my son about this he said that he was frustrated with another child and basically took it out on her son.   (Her son was also kicking him and would not stop when asked.) I feel this was out of anger and could have been much worse. My son was very remorseful that he had actually hurt his friend, so I know he wasn't trying to be mean. I just don't know what to think about this.

 

One thing that I know is not helping the situation is that he likes to play the video games. I have restricted him from playing during the week after his attitude and being disrespectful started showing. I am aware that these games are not very good for developing minds but he does enjoy them like any other 9 year old boy. 

I guess I am just venting thoughts and would like your opinion on any ways I may be able as a mother to change this behavior. Thank you for listening and appreciate any thoughts you may have. 

Sincerely, Concerned 

     Hi, Yes, many children have trouble controlling their anger, and the first step is for you to identify some of the situations that trigger your son's rage.  You mention that it happens at home when things are not going his way. If there are certain times that he is more likely to get disappointed about things not going his way, then you would try to anticipate these trouble spots, and  re-arrange those situations (if possible), For example, if he gets upset when he has to stop one activity in order to get ready to do homework, you would try to re-arrange the order so that what he wants to do (play a game) comes after what you want him to do (the homework).  Or, you could warn him in advance that something is about to happen that may disappoint him.  Sometimes if children know ahead of time what is coming, they do not respond so angrily.  You will not be able to anticipate every outburst, but if you see some patterns, then you can try to head off some problems before they reach the overload phase.  I write in my parent's manual how parents can either change the sequence, or lower a child's expectations, in order to head off angry outbursts. 

     Other techniques I write about in the first half of my parent's manual are "emotional distraction" (that changes a child's emotion from anger to laughter or to some other emotional state) and developing a calming zone in your house.  All these techniques you can employ without having to explain to your son that your goal is to prevent or lessen his outbursts..  The second half of the manual discusses other strategies that do require your son's participation, and they are useful once your son realizes he has a problem with anger and desires to develop better self-control.

     When he poked the child at school, what was he frustrated about?  Who was kicking whom?   If the provocation was serious (like being kicked), first empathize with your son's anger, and then think with him what else he could do if that happens again so that he would not get in trouble.  If the provocation was not serious, you would say that you see how your son interpreted what happened, but you would add that there are other ways to look at it.  You would then try to help your son understand the situation from the other child's point of view. In my manual, there is a section about teaching children about other points of view. Some children do not realize when another child's behavior (like bumping into someone) is accidental, and misinterpret an accidental bump as an intentional act.  If a child can see things from another person's point of view, he would be less likely to get angry.  So teaching your child (when he is calm) about other points of view may be helpful.  

     This can take months to really help at the time of emotional upset, though.  Because anger overload happens so fast, children often do not stop to think about what was going on and just react.  But it is worth the time and effort to go through examples where people think differently about something.  You can also use yourself as a role model, and talk about a time when you got upset, but realized later that the other person was not meaning to hurt you.  Another technique that can help is to practice repeating a phrase with your son at least once a day for the next few months that will help him remember to think first.    In my manual I write about how these "catch phrases" can help a child remember to think about things before reacting.

     All the best, Dr. Dave Gottlieb

9 yr old's outbursts if hurt or if makes a mistake

Hello,  I have a 9 year old son.  He is a very smart boy bit also can be a very easily angered boy. Ever since he was very little he has been showing "anger overload". Since as far back as I can remember whenever my son would get hurt or embarrassed especially in front of people he would get quickly very mad and scream "don't look at me", followed by kicking or throwing or shoving someone or something. He still does this at age 9 but doesn't seem to do it at school very much.  He does do it in public and at family's houses and once at a friend's house. He also gets very angry if he gets answers wrong on his homework and such. He will instantly get mad and call himself stupid.  Same with playing with his brother if he is accidentally hurt, he instantly turns to anger.  When he is in time-out for bad behavior it is a screaming,  mocking me,  hitting,  kicking walls,  loudly praying and begging God for help and sobbing.  When not in an anger episode he is attentive,  loving,  engaging and a funny boy.  I took him to a counselor and he was quick to say ADHD even though he scored low on both mine and his teacher's evaluation.  If you have any thoughts it would be greatly appreciated! 

Thank you for your time.

Hi, You have begun on the right path by identifying some of the situations that lead to your son's rage.  The next step is to think about how to change your child's expectations or change the sequence of events before his anger escalates.  Once it escalates, it is best to say or do nothing, unless he is seriously hurting himself or someone else.  When in the overload phase, children generally do not listen until they are able to calm down.  

When he is not upset, I would recommend you begin to talk with him about one of his issues, for example when he makes mistakes.  You would work on trying to change his expectations so that making mistakes is "good" or "expected."  One way is to talk about mistakes you have made and how it is frustrating and how you try to deal with them.  Also you could talk about how making mistakes on homework is good because it shows he is learning new stuff.  If he made no mistakes that would be bad because that would mean he knows everything already and is not learning.  A third way to talk with kids about mistakes is to explain how some famous people made a lot of mistakes.  For example, you could get a book about Albert Einstein, the famous scientist, that explains he made tons of mistakes in spelling, and even in some of his scientific theories.  All creative people make mistakes plenty of times.  You would not hit him with this information all at once.  Try one or two approaches at a time, and stick with it for a month or more, and see if it gets through to him.  

An additional technique I write about in the parent's manual is to create a saying together with your son to help him remember that mistakes are good or normal.  For example, "everyone makes mistakes," or "Mom will be happy I made some mistakes today," or "Famous people make tons of mistakes."  You would repeat the saying with him before bed, or at some other time each day, for a month or more.  

It is hard for some children to control their anger.  So the process takes some time.  You mentioned he has had anger issues since he was younger, and this is common for children with anger overload.  Their brains react strongly and the self-control mechanisms in the cortical areas of the brain take time to develop.  By teaching him strategies, you will be helping his brain develop better control of angry feelings.  In my parent's manual I describe other strategies, such as teaching calming techniques, using distraction, and teaching your child to recognize early signs that he is beginning to get frustrated.  Early intervention is the key, whether it is a strategy you employ or one that your son learns to use himself.  My parent's manual is divided into two parts:  one has strategies you can use without your son's direct involvement, and the second half has strategies you work on together with your son.

Regarding ADHD, you would expect to see a number of signs at school and at home of distractability, impulsivity, and/or hyperactivity.  The signs would be present throughout the day and not just when he was frustrated. It is possible to have ADHD and anger overload, though.   If you want to learn more about ADHD, there are a number of parent's books on ADHD including a book I co-wrote some years ago about dual diagnoses (for children who have ADHD and another problem with it) called "Why is my child's ADHD not better yet?".  However, your examples sound more like anger overload!  

Take care, Dr. Dave Gottlieb

Update on 8 yr old's outbursts playing little league

Hi Dr. Gottlieb,

I emailed you last summer and you responded, thank you.

Our son, now 8, has been diagnosed with Anxiety. Maybe performance anxiety. They are uncertain. His therapist said maybe mood disorder along the depression spectrum.

Anyway, he is on 10mg of Prozac and seems happier overall, engaged, laughing etc. He is passionate about baseball. And if you recall last spring we had a terrible time with him on the field. Didn't matter if it was practice or games, he was very hard on himself, blurting out a swear word here and there, sometimes throwing his hat, bat or glove. It was pretty obvious that he was struggling and having anger outbursts. The coaches were pretty supportive telling us not to pull him but to let him play as this is where he'll learn.

Well we are headed into about 8 weeks of spring ball. He hasn't played any sports outside of gym class just because we haven't been able to handle the stress as a family.

We see more positive signs going into baseball this year, but are afraid of what we might encounter again this year.

We are trying to find a sports therapist, or someone along that lines. We just don't understand the undue pressure he puts on himself competitively and then gets upset when he doesn't perform or even gets upset if a ball isn't hit to him. Also, gets upset if his team looses. We do not put any pressure on him to play or not play. We just want him to have fun like the other 8 year old boys on the field.

Any thoughts? Suggestions?

Thank you Dr. Gottlieb

Hi, Last year in the post of June 4, 2013 you mentioned that you had given him time to cool down and had refrained from engaging him while he was in overload.  That is an important first step.  Next think about whether your son shows concern about his outbursts, that is, whether he indicates a wish to have better self control.  If not, the first step is to help him become aware of the problem and help him to develop self-observation skills. I discuss this at the beginning of the second half of the manual (see pages 32-37).  

If your son is already aware that he gets frustrated on the baseball field, then you would move to the strategies that involve changing one's perspective (i.e., seeing another point of view) and learning a "mantra," or saying that reinforces the new perspective.  Here's one possible thing you could say if your son finds it meaningful:  You could talk about how making mistakes are important, that if someone doesn't make mistakes, they are not human, they would be a machine, and we don't want you to be a machine, so please make some mistakes on the field.  

Another possible discussion could occur after you watch a professional game on television and talk about players making errors or striking out.  Talk about how they must feel.  Help him to see that upset feelings are okay but loud outbursts are signs that one's frustration has gotten out of control.  Ask him to think about what he could do when he feels the frustration coming on.  How could he reassure or distract himself so that he avoids a loud outburst?

Practice whatever strategy you decide on together before each game and practice.  Then ask afterward if he tried it.  Give him plenty of praise for trying, regardless of whether it worked.  Reassure him that the strategy takes time to work because frustration can be a powerful emotion.  It is important to warn him that it takes time, so that he does not become self-critical when he cannot control his emotions.

Lastly, try to use yourselves as models.  Talk out loud when you get angry about how you feel and what you are trying to do to calm down.  The more he sees other people working on self control, the more likely he will be motivated to try too.

All the best, Dr. Dave Gottlieb