7 yr old reacts to "negative" comments

Dr. Gottlieb,

It was great to read your blog and finally find a description of our 7 year old daughter.   We have been in therapy for about five months with a diagnosis of ADHD.  The therapy was split into two sessions - one for us as parents and one for my daughter with the therapist alone. We recently experimented with family therapy as well.  While the therapist seems to be a good listener, we have tried many different methods but have not seen much progress.

In August, we decided to explore medication and have not had much luck.  The stimulants we have tried, seem to make her more hyper and bring a higher rage level and the non-stimulant did not seem to do anything.  It is interesting that she seemed to have no side effects from any of the medications such as sleep or eating issues.

Based on our limited success, we are questioning the ADHD diagnosis and wanting some answers.  While our daughter expresses some traits of ADHD, she is not an antsy kid and does have some focus issues but that is not her main struggles.  However, her fuse is extremely short and when she goes down the angry path, she is impossible to bring back. She is very sensitive to any negative comments or what she perceives as negative comments and lashes out.  In addition, we have difficulty disciplining her because she expresses no remorse and she seems to not care if we take anything away.

In our last meeting with the therapist, she recommended a psychiatric analysis to determine next steps.

At this point, we seem to be at a cross roads.

Hi, You mentioned that negative comments are a trigger for her anger.  You also mention that sometimes this is her perception though the remarks may not be intended to be negative.  One thought I have is to try to anticipate her reaction and preface your remarks with "you know you are a terrific kid" or, better yet, point out something she has done well that day before you mention something she might perceive as negative.  Hopefully, the balance of positive and "negative" comments will help her to not feel criticized.  Keep track over the next two weeks of comments that seem to trigger her rage, and then try to preface similar comments in the future with a positive remark.

Down the road, you could also try a technique I write about in the second half of my parent's manual:  teaching your child about other points of view.  With this technique, you show your daughter how two people can look at something in different ways.  Once she understands this concept, you help her see how a comment's meaning may be perceived differently, e.g. those "negative" comments may not be intended as negative, though the person receiving the comments may still feel hurt.  Help her see how you, her parents, have sometimes felt hurt by comments someone has made that may not have been intended as hurtful.  Also, confirm for your daughter that sometimes people do get frustrated and make a negative remark.  Help her to understand that people say things when they are frustrated that are not necessarily true and are not necessarily the person's true feelings.  

The reason why I write that I would not use this technique right away is because it requires a child to be able to recognize other points of view and apply that to her situation.  Not many seven year olds can do this.  But once the frequency of outbursts is less, and once you feel she may be ready, then try this technique.  It takes time for a child to internalize this way of thinking, so practice over time when she is calm.  

Other techniques in the near term would be to use emotional distraction, which is useful if you can catch the anger before the overload phase.  This is not always possible because anger can increase so quickly.  The idea of emotional distraction is to make a remark that changes your child's emotional disposition:  it could be a funny saying, or a silly comment that your child reacts to.  It can be trial and error to find a remark that your child might find funny or exciting.  But if your child laughs, this will interfere with, or interrupt, her angry feelings.

There are other techniques that I describe in my parent's manual.  Some do not require the child's direct participation, and these are described in the first half of the manual.  These techniques are particularly useful for younger children under the age of 10.  Some of the techniques in the second half of the manual can be tried with young children, but the effectiveness depends on the ability of the child to observe his/her behavior.  You will notice improvement over months, rather than days, as children with anger overload fire up so quickly that it takes time for children to internalize coping strategies.  As I mention in the beginning of my book, there are biological pathways that underlie anger overload, but improvement will usually occur with practice over time.   If there is an additional diagnosis, it will need to be addressed as well.  Since the ADHD medications did not work out, it is not a bad idea to get a psychiatric consult regarding the diagnosis.

 

Best, Dr. Dave Gottlieb

11 yr old is disrespectful, rips books, picks up knives

I have twin eleven year old boys.  About three years ago we moved countries and it seems during the day that everything is going well- they bike ride to school, they hang out with their friends, they play soccer after school, they chat on their phones, they play games and talk “normally.” Twin A sometimes reacts over the top when denied certain items, activities, or when he thinks he is being treated “unfairly.”  He also has recently added in that he and Twin B are angry about where we moved and want to move back.  When Twin A gets angry there have been moments where he has picked up a knife - not harmed anyone but  is definitely trying to get my attention, ripped up a school book, screamed incredibly disrespectfully at me or my husband, etc.  He is very difficult to bring down from these scenarios.  They usually end with me saying that his phone is being taken away and he saying that he doesn’t care, me saying that he needs to pay for his school book and he saying that he doesn’t care he will rip more, etc.  Throughout the episodes there might be a flicker here and there of a logical response but then almost as quickly as it appears it is gone.  Over the years he has had random outbursts but especially the past few weeks these have escalated.  I need help.  I am worried about him hurting himself or anyone else around him.

Hi,  It is worrisome when children pick up knives.  If he acts like he might harm himself or someone else, it would be important to get a consult from a mental health professional in your area.  Generally, when children have outbursts that are verbal, I recommend not responding while they are heated up.  Since they are not thinking rationally at those times, they are unlikely to consider what you say, and they often will continue to argue and rage.  Wait to impose consequences until everyone is calmer.  You would tie the consequence to a particular behavior, like picking up knives, rather than targeting the anger per se.  For verbal outbursts, only use a consequence if you feel he was very disrespectful of adults, as you mention he often is.  If he can blow off steam without using the disrespectful language, then I would not recommend consequences.

What I would work on with him is looking for early warning signs and issues that are more likely to trigger him.  I explain in other posts and in my manual how to work on this with your child: to observe triggers and to develop strategies to change your child's expectations (if that is a trigger) or change the sequence (so that what he enjoys come after what he resists doing, if task compliance is a trigger).  Then there is a natural incentive for him to cooperate.  Also, I write about how to use "emotional distraction" and calming strategies before an outburst occurs.  Once an outburst is in overload mode though it is best to say as little as possible, unless someone is being physically harmed.

I write about a child in my manual who like yours erupts when he feels things are "unfair."  I explain how to help children look at other points of view (not during, but after an outburst subsides).  I also suggest families use catch phrases to alert their child when they feel he/she is getting frustrated (if you can catch anger before it erupts). The catch phrase would remind the child of a different way of looking at things.  For example, for children who get mad about sometimes performing below their standards, a catch phrase might be "everyone makes mistakes.." One other strategy that might help you is teaching your child a compromise technique, and I explain how to do that in the last section of my parent's manual.

All the best, Dr. Dave Gottlieb

Multifaceted plan for 9 yr old

I've had a number of questions over the years about when to use rewards and also about dual diagnosis. I've been working with a boy (with multiple issues) and his mother for the last six months in my office, and wanted to share some approaches that have been helpful.

First of all, he had psychological testing to evaluate his learning disability (LD), and we suggested modifications in school to help lessen his stress and anger in school.  Mother also recently hired a reading specialist to help him twice a week after school.  In addition, a pediatric psychiatrist was contacted, and the boy recently started on ADHD medication.

During the last six months while the evaluation was going on, we began to work on his anger overload issues. Anger would erupt around turning off a computer game, starting homework, or doing his chores.  The themes had to do with schoolwork (which activated his frustration with reading) and with tasks that he was not expecting and that he did not like having to do.  We worked on a schedule together (so he could predict when chores would occur) and also a "mantra," or saying, that he would practice repeating to himself when he was frustrated:  we chose the saying "crap happens."  We chose these words because he felt it was "cool" to use those words, and because it captured the idea that not everything is easy or predictable.  We want him to learn to expect that things will not always go the way he wants.  We also established a "chill space" in his room.  If he went there either on his own or when cued by Mom, he would later receive a lot of praise.  If he did not "chill" but continued to rage, his mother tried to ignore him the best she could until he was calmer.

When there was a conflict with the babysitter (because she made him pick up toys that he said he had not used), we empathized later with his frustration, and talked about how people sometimes look at things from different perspectives.  We talked about how the babysitter did not see who played with the toys and just wanted things picked up before everyone went home, while he felt the other children made some of the mess so should help more.  It was difficult to talk about the issue calmly, and we stopped talking about it when he started to get wound up.  We will try again to talk about different perspectives that people have when similar issues come up in the future.

Recently, the boy protested going to tutoring, and got into a heated argument that led to pushing his mother. In our therapy session, we set a firm limit about physical contact with adults and talked about a significant consequence were it to happen again.  We explained that voicing his displeasure in a loud way would not trigger the severe consequence, just pushing, hitting or kicking.  Since then there have been no further incidents of pushing.  Notice that we did not punish anger per se, just the physical expression of it.

His anger outbursts have been lessening, and we decided to add a reward for his cooperation with the reading specialist.  He earns a small amount of money each week that he can use toward a purchase of his choice in the future.  He wants an action figure, and is saving up for it.  The reward is for cooperation, and at the same time eliminates a source of anger in the past.  Rewards can work when the frequency of angry outbursts has been lowered already with other strategies, and when the target is socially appropriate behavior that prevents anger from arising.  We did not establish a reward for never exploding verbally, because this would be too difficult and would probably lead to more frustration.  Hope this gives you some idea how to apply strategies (that I  discuss in more detail in other blog posts and in my parent's manual) and when to use consequences and rewards,

David Gottlieb, Ph.D.

Handling a 2 yr old's anger

Hello,

My son is 2 years old.  In my situation, I must be both parental figures for him the majority of the time.  He sees his Dad every other weekend and my son seems to have worse behavior on Mondays after coming back home.  My son has typical "the Twos" behavior when he doesn’t mind me and throws fits.  Friends and family tell me that I need to spank him or punish him and get a handle on him now or it will just get worse when he gets older.  I notice though that punishment seems to upset him instead of correct him.  He can have meltdowns where he screams and cries for long periods of time to the point of making himself so upset that he starts shaking.  Usually it follows a situation where I am making him do something that he doesn’t want to do, like take a bath or get ready for bed, or even something as simple as coming inside from playing.  He will get mad and bite himself or pull his own hair.  He will fight with other kids, take toys or bite other kids.  Yet he can be a very lovable, happy little boy and laughs.

He does not handle his anger very well and he does not handle punishments or authority well.  He uses the word “NO” despite efforts to teach him to say yes or consequences.  If he has a meltdown, I get better results from distracting him or just giving him love and attention when he starts, but then I don’t want him to grow up thinking that he “gets his way” when he has fits.  His meltdowns come on quick and it is very hard to get him calmed down.  It can happen in public, which is more than frustrating and embarrassing. He is very energetic and constantly getting into things, climbing, jumping, running, he just goes all the time.  He has no fear.  He can't sit still unless I put him in the crib for naps or bed time, or car seat.  He is very smart for his age.

His father has anger problems which led to our divorce and his Dad used to physically abuse his mother which led to their divorce.  I see that it could be something in the family line.  I am just to the point where I don’t know what to do for him as I am very easy going by nature.  How do I choose a counselor that is right for him, and is Anger Overload his problem?  Is moving him from our home to see his Dad every other weekend adding to his emotional problems and how do I handle it?

Thank you.

Hi, First, let me say that I agree with your use of distraction.  When children are having a meltdown, consequences are not usually helpful.  When a child is in overload, he or she is not thinking rationally and is not thinking about avoiding punishment.  I've had other parents use hugs with young children, and this is okay to help him soothe, but I would then once he is calm still insist that he do what you asked.  If you feel he is melting down in order to get hugs, then you could rely more on distraction techniques.  I write about distraction techniques in the blog and in my parent's manual.

Another idea I have is to use an incentive after he completes a required task.  For example, you mention he gets angry when you have him take a bath or get ready for bed.  I would let him know that you will play a short game or read a favorite story once the bath is over or once he is in bed. If there is something fun that comes after a chore, then children are more willing to complete the chore.  If baths continue to be problematic, try moving the bath time earlier in the evening, so that there are natural incentives, such as television or other evening activity, that start once he finishes the bath.  Some parents also make baths into a game by getting water toys or soap crayons that children can use in the bath.

Regarding your questions about a counselor, I would show the counselor this blog or my parent's manual and see if they have experience with young children and with anger issues.  You want a counselor who meets with you, or with you and your child together, in order to strategize.  You don't want a counselor in this situation who is going to spend a lot of time with your child alone in therapy.

As for your question about whether seeing his Dad every other weekend is adding to the problem, I'd want to know to what extent your son is less likely to follow your rules after a visit with his Dad.  A little regression is not abnormal after a visit away from home and his home routine; however, if there is increased anger that lasts more than a few hours, I would try to meet with his Dad and discuss your concerns.  It would be important that neither parent bad mouth the other in front of the child, and that you have some overlap in your approach to anger and discipline.  You do not have to be in lock step, but if one parent has no rules, then it is sometimes hard for a child to adapt back to the rules once he is home.  Sometimes then a counselor can help divorced parents work better together as parents.

Hope this helps.  Best, Dr. Dave Gottlieb

10 yr old getting angry at camp

Hello,

My daughter is 10 years old and has been diagnosed with ADD since she was in 1st grade. However, I had to have her stimulant medication changed to a non-stimulant ADD medicine because it caused her to twitch and become anxious. This summer we decided to take her off that medicine too (Strattera 40mg) and she is only taking Clonidine to help her sleep at night. Her behavior off of the Strattera has not changed leading me to believe it wasn't really helping her. She is an amazingly smart girl but struggles in reading and writing. She is compliant with her teachers most of the time but I just got a call from her overnight camp that she is not listening to the counselors (who are teenagers), taking off without telling anyone, and yelling at her bunk mates to the point where they get scared. This she does at home with her brother and from time to time and has done with her friends. She gets very angry very quickly but can but it never lasts for more than 1/2 hour.

. The problem I am having is reward charts, consequence charts, sticker charts, grounding all of those things do not work. We implemented the Transform Your Child by Lehman. I mean we have tried everything. I just want her to be a happy and healthy ten year old. One that likes herself and that others want to play with. I need help.

Her 8 year old brother makes comments to me about her and her anger and I can see it bothers him as well.

Any suggestions or ideas of what may be causing this is greatly appreciated.

Thank you.


Hi, Children with ADD tend to be somewhat impulsive, such that when they get frustrated they sometimes act before they think.  What you would want to do first is keep track of what is going on before she erupts.  What are the counselors asking her to do, or what is going on when she yells at her bunk mates?  Similarly at home, what is going on with her brother or friends before she loses it?   If someone keeps track of that for a week or two, you might see a pattern for some of the times she gets angry.  In my parent's manual, I explain ways to deal with outbursts--sometimes "changing the sequence" of events to minimize frustration, sometimes "emotional distraction", and sometimes ignoring.  

The idea with technique called "changing the sequence" is to avoid the triggering event.  For example, some children have trouble going from a fun activity to a task like cleaning up or getting ready for bed  In that case, I would recommend doing the clean up earlier before the fun activity starts.  For bedtime routines, it is more difficult to insert a fun activity at the end, since turning out the lights is usually the last thing an adult does before a child goes to bed.  But what I recommend is to do a quick activity on the child's bed before turning the lights out.  This way a child has a natural incentive to get into bed so that he/she can play the fun activity (like a card game) with you.  (I write more about these techniques, including what I mean by the technique called "emotional distraction" in other blog posts and in my manual.) 

In my blog post on July 3rd,  I explained that traditional rewards and consequences often do not work well for extreme anger, because the anger occurs so quickly for children prone to anger overload, and they do not think rationally about earning incentives once they get mad. 

In the second half of my parent's manual I explain how you can teach your child to think about other points of view (that are different than her own), and also teach her compromise techniques.  But first it's best to lower the frequency of outbursts by using the approaches, like "changing the sequence" and "emotional distraction", that I explain in the first half of the manual.

If you do not make any headway after a few months, then you might want to consult with a mental health professional who works with families of children with anger issues.  There may be something else going on in addition to anger overload that would need to be addressed.  You mention the ADHD diagnosis and learning issues.  These may contribute to frustration for your child;  her anger episodes may decrease once reading and writing get easier for her.

All the best, Dr. Dave Gottlieb

6 yr old sensitive at school

I have 2 boys age 8 and 6.  I am struggling with my 6 year old at school. At home he is very sweet, cuddly, funny and very even keeled which is why I am struggling to understand the polar opposite character at school. He has struggled to join in with PE and shows. He was hit and bitten by another child in his first year and is now in a class with half the children from the year above as well. He is the youngest (June) and they are all big characters and some of them hard to handle. He seems to be overwhelmed and runs out of the classroom, crying and being rude when he is told to go back in. This seems to happen when he is told to do something he doesn't think he can do or feels some kind of pressure to complete. He has also hit or run away crying when he perceives that other children are being mean. He is very sensitive to injustice and being aggreived.  Last week this escalated so that he hit a teacher.

We are strict on discipline at home and encourage polite kind behaviour and reprimand rudeness. I reprimand the kids for saying each other is stupid etc and say it is not nice, and then when the other kids do it to him he feels they are being mean. He is very sensitive but he sticks his tongue out and yells "no" when the teachers try to get him back in the classroom. He seems to be out of control of his reaction in that he does not "cleverly" do it when the teacher is not looking, and the punishment seems to be nearly too much from his reaction to it but it does not stop the behaviour next time. The teacher introduced a smiley face chart where several times a day he had the opportunity to get a smiley face. He loved this a revelled in the praise but if he got a sad face he started to be frightened to come out of the classroom at the end of the day to tell me about it. I have never hit or really shouted so he seems very sensitive to peoples' opinions but unable to alter his behaviour accordingly. 

The teachers see him as attention seeking, mischievous, rude and opposing their rules. We (myself, husband, family and all his friends' parents, indeed anyone that spends time with him out of school) would describe him as gentle, funny.  He likes playing young games alone, he is an even keeled easy child, certainly not attention seeking and mischievous.

I have been reading about anger overload and it sounds very like our experiences. I have ordered your 2 books "Your Defiant child" (although he is not defiant in 99% of circumstances, only those that he is told to do something he is nervous about) and "Anger Overload a parent's manual". I was keen to hear your thoughts. I am a pet Behaviourist and have a Psychology degree and find it really hard to believe the behaviour of my child.

Thank you for your time.


Hi,  I think you are on the right track using the smiley faces.  Since your son is sensitive to negative feedback, I would hold off on the sad faces on his chart.  Instead just leave it blank when he is not achieving the goal. Also, think carefully about what to use as the goal.  It should be something that takes some effort but is not too difficult for him to achieve.  Over time, if your son is achieving the goal every day, you can increase the expectations gradually.

The other thought I have is to help him deal with the older, bigger children in his class.  Find out from your son and the teacher some examples of what unnerves him in school.  Maybe you can role play the situation at home; in other words, at home you would practice alternative behaviors that your son could then use at school.  First, say something empathic when you find out he has felt pressured or hurt by his peers.  Then wonder out loud what could he do when this happens so that he wouldn't get in trouble.  If he does not know what to do (most kids this age don't), suggest a few things and then have him pick one to practice with you.

Also, try to arrange a play date with one or two of the boys in his school.  If they become friends then it may help him during the school year to feel less intimidated by other children.  He won't feel all alone.  If he continues to have trouble bonding with some of his peers at school, think about other activities outside of school that might interest your son and that would involve other children his age.  It can help children to feel less "picked on" if they have a buddy they can see later in the day or later in the week.

Regarding the pressure he feels to complete his work, I would recommend his teachers take the pressure off, and have him finish another time or at home.  The pressure sounds like it is counter-productive.  Think about why he is having trouble finishing his work:  are there any learning issues or does it just take him a little longer at this age?  If there are learning issues, like difficulty with reading, then see if the school can work with him on any weaknesses.

My guess is that if he feels less pressure and more supported in school, there will be few outbursts.  Let him know too that being disrespectful to the teacher is not acceptable, and work with the teachers to give him the message about what is acceptable and what is not.  I find that some children do well if they know they can go somewhere in the class or outside the class to "chill" if they feel frustrated.  If the teachers can pick up on his frustration early on (before he is in overload), he is more likely to be able to show self control.  I explain more about this in my parent's manual.

All the best, Dr. Dave Gottlieb

Can rewards and consequences help?

     I wanted to add a note to my last post about rewards and consequences.  Sometimes children respond to brief and immediate incentives or negative consequences, particularly if they have already learned a coping strategy or two.  Then you can work with your child on a brief incentive if he tries a new strategy when he starts to get upset.  There are a few keys to this:

1) Work on the strategy together for a week and practice when your child is not upset, and then in a week tell him/her you are proud of him and want to encourage him now to try it when he feels frustrated.

2) Talk together about some brief incentives and tell him he can choose one if he attempts the new strategy.  Notice that your child would get to pick one of the rewards that you both agreed on.  It is more fun if you don't use just one reward all the time.  

3)  Your child earns the reward if he tries.  It will be hard for him to control his anger and you don't want to focus on success, but on effort.

4) Try to help him "catch" the frustration in the early stages because it is then that his rational brain will be most engaged and it is at that time your child has the best chance of controlling his anger.

     I would not recommend using consequences until you have worked on strategies to help your child deal with anger (like those coping strategies I describe elsewhere on my blog and in my parent's manual).  It is possible that if at the time a child starts getting upset (before he reaches the anger overload phase) he remembers what a punishment felt like previously, then that memory could help motivate him try to use a self-control strategy.  The problem is that your child may reach the overload phase so quickly that he won't be thinking rationally about potential consequences.  This is why I don't usually recommend consequences for helping a child deal with anger.

     If you want to try this, pick a short term consequence, like no computer time after dinner.  Furthermore, be very clear about exactly what behavior would bring about a consequence (for example,  specific swear words).  Keep in mind that the consequence has to be something meaningful to your child, and sometimes you don't know what will catch his attention until you try something.  And do not talk about the consequence while your child is in anger overload.  First prepare him ahead of time when everyone is calm and then impose it after your child has calmed down.  Mention it in a matter of fact way without a lot of emotion or a lot of discussion.

     Be sure to praise your child whenever he tries a strategy, and if consequences cause more outbursts, then hold off in the future on these consequences, and go back to the other approaches in my parent's manual.

    In actuality, if you follow the guide in my manual, you are using natural incentives and consequences!  Specifically, you are paying attention (which is rewarding) to your child when he is working with you on self-control strategies, and you are ignoring (negative consequence) when he is in the anger overload phase.
 
David Gottlieb, Ph.D.