What can teachers do for outbursts in school?

Thank you for posting your article on Anger Overload. I have only just found it and have already ordered your book.  I am so relieved to finally find an accurate description of my son's behavior after 8 months of going to multiple therapists and experts -- all of whom tell me "he's unusually complicated" with multiple issues at play.  They all agree he has anxiety related to his learning disabilities.  But, the intensity and sporadic nature of his anger (despite two very patient, even-keeled parents) hasn't been explained...until now.

My son is a loving, cuddly, creative kid who makes friends easily.  As a competitive gymnast, he will practice back flips and dangerous stunts anywhere he goes (not just during his 9+ hrs/wk at the gym).  He has been diagnosed with reading, processing and anxiety disorders.  While he has shown signs since preschool of extreme anger when triggered, he can go for months without an episode.  Summers, vacations and sports practices tend to be anger-free -- school is the main location of his rage-episodes.  It appears to increase in frequency and intensity as the academic expectations increase.  He can be triggered by all the things you mentioned in your article (being told no, minor criticism, noticing other kids finish their test while he is still working, etc.).  I can't tell you how eager I am to read your book.

In the meantime, I have a question:  Do you have a recommendation for the teachers on what they should do when he gets into a rage-state?  He can't hear anything while he is in that state (hitting himself, kicking the desk, being verbally disrespectful to the teacher, literally covering his ears, etc.), but they can't just wait it out while the other children's learning is being impacted.  He does go to a private school with a Learning Specialist and Social Worker on site, but they are not always available.

Any guidance you can give would be greatly appreciated.

Hi, Yes, while at home a parent can ignore an angry outburst, in school this is usually not an option if a child is disrupting the class.  So one key is early recognition and developing an assortment of tools your child can use.  First, I would recommend the teachers record what is going on when the outbursts occur in the next couple of weeks.  You mention some triggers in your e-mail, such as minor criticisms and finishing his test while others are still working.  Once some of the triggers are identified, the teachers would develop possible interventions for each trigger.  For example, before mentioning a minor criticism, the teacher could point out something your son has done well, so that he is less likely to feel "injured." Your son can't keep critical comments in perspective yet, and that is not unusual for children with learning issues.  They get frustrated easily and sometimes feel inadequate compared to their peers. So the teachers could help him keep their remarks in perspective by pairing a critical remark with a positive one.

For testing, it sometimes helps a child with learning issues to take tests in a separate room so that they are not distracted or concerned with their peers.  Like my previous suggestion, this would be a way to prevent an outburst from  occurring.  

But what happens when your son is getting frustrated and the staff did not see it coming--and this will happen sometimes no matter how much planning the teachers do.  First, early intervention is important.  Are there warning signs before your son erupts?  Could the teachers have a "go to place" or a distracting activity that would help him calm down?  I would recommend the teachers talk with your son privately while he is calm, and explain they want to help him with his frustrations, and mention that they will give him a signal (it could be verbal or a nonverbal signal) when they want him to stop working and go somewhere (in or out of the class).  They would explain this is not a punishment but a way to help him "chill".  He could get points, or a positive note home, for following directions about using the chill place.  They would empathize with him that sometimes the work will be hard.  They could also say we all have trouble working when we get frustrated, so that's why it is good to take a short break then.

Once a child totally erupts it will be hard to distract him.  At that point, the teacher could either tell the class that your son is having a hard time and ask them to please try to let him calm down on his own, or he would need to be escorted out of the room.  The staff would explain to your son in advance where this place would be, and then without much discussion take him there as needed.  Depending on the age and size of your child, they may need help from a strong adult to bring him to that place.  It would preferably be different place than the "chill" zone.  The "chill zone" is often within the class, whereas when a child erupts, it is usually best to leave the class.

In the second half of my parent's manual, I explain also how to teach a child to use a catch phrase to help him with frustration.  This doesn't work during the anger overload phase, but can help if the anger can be caught at an earlier stage.  For your son, the catch phrase could be something like:  "School can be a pain sometimes" or "Yes, somethings are hard but other things are easy for me."  It would be important to practice saying the catch phrase to himself several times a day so that eventually it becomes automatic.  You would discuss with him some possibilities and pick one that he likes.  Another possibility is to help him think of a funny scene when Mom or Dad had trouble with something.  He could try to think about this when he is frustrated in school to help him realize everyone has trouble sometimes.  These latter strategies work better with children who acknowledge they can get very angry sometimes, and want to try to learn to control it on their own.

All the best, Dr. Dave Gottlieb  

8th grader becomes violent

I've been doing some research and came across your article/blogs on anger overload. This is the first I have heard of this and seems to really match what my son is going through. 8 months ago we found out he had a 'stroke' in the caudate nucleus region. It shocked a lot of doctors as he didn't have classic signs; he actually had hemi chorea as the major symptom. As a result he has been put on many meds from high dose steroids down to folic acid and aspirin. He has experienced side effects from majority of the big meds such as methotrexate. Witihin hours of his once a week dose he would become extremely violent and nasty. Each week the outbursts increased in severity and duration. We saw the correlation with the meds and were told to take him off them.

 

Since then the aggression and violence has definitely reduced. However, every few (4-5) weeks we have another outburst where he'll hit and swear and break things and it all starts with a minor issue such as telling him no. We can generally see a pattern and predict when they occur by his body actions and facial expressions. For 1 -2 days prior we can swerve him off track if we see him starting to fixate on different topics. However when we do this we've noticed it only prolongs having an outburst. It's like he 'needs' to have them.

 

He is generally a pretty good kid, gets on well with others, is extremely intelligent (his latest neuropsych testing puts him well above his age level); it is just these periods that are really worrying and affecting our family of 5. We realize he has gone through a lot in the last 8 months. We are a pretty positive thinking family and are just extremely grateful it's a better outcome than first thought. Our biggest concern is his instant change from the loving child we know to an aggressive child who has a completely different person inside him.

 

I am writing to you as I feel I have exhausted my local community. He had been going to counselling in the past but due to unforeseen circumstances he had to change counsellors and hasn't been available to go back yet. The neuro team has been great for medical questions but they always manage to see the polite well behaved child and seem to think he's just preteen and has a lot happening to him. All outbursts have been at home and majority have been whilst his father is away.

My biggest worry is how to help him. He became that violent yesterday, all our cooling down techniques had failed, and after 2 hours of being left alone he was still trying to hurt us. He had tried a number of times to smash windows so I ended up calling police...more as a shock tactic...thankfully it worked.

 

We are beside ourselves as how to help him and how do we punish someone who seems to disappear once the outburst is over. He is very remorseful once done and tries to make things better which makes things hurt more for us.  My question is do you think my son may have anger overload or is this just him retaliating from everything he's gone through recently. I understand it's a hard age anyway.

 

Any input you have would be greatly appreciated.  He starts high school next year and I think if not helped now...things are only going to get worse.

 

Hi, First of all, let me say it sounds like a lot of your interventions are excellent, and I can see why the latest violent outburst was concerning.  I think you did the right thing by calling the police, because your son needed to see that you would do what is necessary to protect him and yourselves.  While he is calm, think (with him) about a cue word that you will only use if he is getting to the point that the police may be called again.  It could be a color, like the word red, or the name of a mountain peak--the color, or mountain, represent the idea that his anger is getting extreme and dangerous.  Let him know that when you use that word, he needs to stop physically harming people immediately, but that he can scream or use verbal means to express himself.  At this point in time, you would not call the police even if he were using extremely obnoxious language.  You would be trying to show him that there is a particular limit for violence because everyone's safety is your number one concern.  In the future you can work on verbal alternatives that are more appropriate expressions of anger.

 

 It sounds like you see early warning signs often and can head off the anger in some of these cases.  Terrific.  Continue to develop alternatives to distract and change the focus from whatever he is getting frustrated about.  Also, try to work with him when he is calm on understanding different points of view and how to compromise.  I explain how to teach these techniques in the second half of my parent's manual.  Hopefully, over time he will be able to use the strategies to change his feeling state from frustration to contentment.

 

You mention the brain "stroke" and how sometimes it seems like he needs a release.  Strokes in young children are very rare, and I am not an expert on them, but I understand that the caudate nucleus is involved in many brain functions, including motor and cognitive control.  I wonder if the neuropsychologists you are working with have any other ideas about how to work around that area of the brain and help other regions develop cognitive control.  I'm hoping that the cognitive techniques I write about in my manual can help his brain develop more control.  Anger overload is a condition that can have different causes.  I'm wondering how often he had angry outbursts before the "stroke" you describe.  Did they happen before, but get worse after?  Usually when there is brain damage of some kind the techniques I describe in the manual take more time and practice.  But the human brain is malleable, so keep using the techniques you have already described in your post and try some from my manual.  The brain keeps developing throughout adolescence and young adulthood, so there is hope that with continued "practice" you will see improvement. 

 

Hang in there, and all the best, Dr. Dave Gottlieb

Door slamming and "smart mouth"

I am writing to you because we are at the end of our rope with our son and his constant anger outbursts... He talks to us like we are nobody and gets so mad. He slams doors, then comes out and starts in again and has a smart mouth. He does not talk to his peers in this manner and they all say  how sweet  he is.. We have not had him tested for anything, he is starting to have trouble in school with following directions or putting the answer down on paper and then trying to explain the answer.. I have worked with kids that are ADD and ADHD and I don't see any of those things in him, but I could be blind to it since he is our son.. The more we take away from him, he gets worse or if we say we are going to do something about it , then he says we don't love him.. Any help or advice would be great so that we can get this under control before it gets worse.

Thank you for your time

Hi, Anger overload often happens more at home than with peers.  It is a good sign that he realizes he cannot act that way with peers or else they would avoid him.  Now how can you reduce the slamming of doors and the smart mouth at home?  First, I would try to record the times he has outbursts over the next couple of weeks.  What is going on at the time?  What was he doing before he got angry, and what were you doing or saying?  After two weeks, look over your notes and see if there are any patterns.  Are his tantrums more with one parent, more during a particular activity, more when a parent asks him to do something? There will be outbursts that do not fit any pattern, but hopefully you will see a pattern(s) for some of them.

The next step is to think about whether you can change the sequence that leads to an outburst.  For example, if an outburst is more likely when you ask him to turn off the computer and start his homework, you might re-arrange the schedule in the future so that he does not start on the computer until his homework is done.  Basically, the idea is to get him to do what you want before he enjoys time doing what he wants.  If his preferred activity comes second, he will be more motivated to cooperate with you.

In my parent's manual and in other blog posts I describe other strategies, such as emotional distraction and when to ignore a child.  One recommendation about ignoring:  it is generally not a good idea to discuss consequences while a child is having an outburst.  You can talk about consequences after everyone has settled down.  Also, you want the consequence to be targeted to a specific behavior, not to anger per se.  Many of these children have short fuses, and so you will not eliminate all expressions of anger.  But you could target door slamming, or a particular obnoxious word or two.  Help him to see when he is calm what words would not trigger the consequence.  Also, pick a consequence that he cares about but that is relatively short term, from as little as an hour to a day at most.  It does not matter whether he says it bothers him or says that you do not love him.  Apply the consequence when everyone is calm, and then after a few weeks, think about whether the behavior you have targeted has decreased in frequency.  If it has, then your consequence was successful.  If there has been no improvement, then you should think about changing the consequence, or trying a totally different strategy.

In my manual I describe strategies parents can employ without a child's direct participation, and also strategies that involve discussions with your child.  The second half of the manual is about teaching your child new skills to improve self-control.

If your son continues to have difficulty in school with directions or with comprehension, you might ask the school psychologist or a private psychologist to evaluate him to determine whether there is ADHD or a learning issue affecting his performance in school.  Some children with ADHD have trouble with attention, but are not hyperactive or impulsive.  The first step regarding his school performance might be to consult with his teacher and/or school psychologist or social worker.  

Best, Dr. Dave Gottlieb

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