9 yr old with OCD and anger overload

Dear Dr. Gottlieb,

We bought your anger overload manual for parents, and it described perfectly what we are seeing in our 9 year old girl who has OCD.

In your experience, are your strategies effective on kids who have anger overload from OCD?  Would any of the techniques you offer need to be modified as we continue to support our daughter?

Are there any other resources you would recommend for this combination of symptoms?

Many thanks.

Hi, A book I have found helpful in working with children with OCD is "Talking Back to OCD" by Dr. John March, a psychiatrist from Duke University.  He has an approach for OCD that is similar to what I recommend for anger overload:  Teach the child how to be the boss of her thoughts.  

Some of my strategies are not actually taught to the child but are employed by the parents, especially at the outset, but then the child becomes a partner and is taught ways to be in control.  For example, one strategy is using mantras.  This is explained in some of my previous blog posts and in my two parents' manuals, and can be used for anger overload and for OCD.  Mantras are ways to help children take a different perspective and thereby help them feel more in control of their anger.  

The strategies in my manual can be employed with children who have OCD.  Think about what some of her routines or obsessive thoughts are, and also think about what some of he anger triggers are.  How much overlap is there?  Does the anger come when she is being rigid and can't adapt well to the demands of the situation.  Will humor and emotional distraction work to help her move on?  Or will new mantras help her look at the situation differently and prevent her getting into a rigid behavior pattern?  

If the problem is obsessive thoughts, and not ritualistic behaviors, try to teach her that she can be the boss of her thoughts, and maybe draw a picture or sing a tune of her "beating" the thoughts.  Dr. March's book and my manuals speak to changing a child's thoughts. Practice the new mantra and admire her whenever she tries to use it.  Make sure she does not expect it to work perfectly, because OCD children sometimes expect themselves to be perfect.  Trying the new strategy would be the goal, whether or not it helps right away.

Do some of her OCD habits come after she is angry?  Does she have negative self-talk and guilt after she explodes in anger.  In that case, you can forestall the OCD by using the strategies in my manuals to lessen anger overload.

Basically, think about how the two issues overlap, and then focus on the initial triggers to to try change her response.  First, you would keep an anger diary, so to speak, in order to see how the two issues interact and what some of the triggers are. Then you would look through the manuals to apply the strategies to those triggers.  

Best, Dr. Dave Gottlieb

5 yr old acts out for no reason

Hi Dr. Dave,
My 5 year old son has anger overload.  I recently purchased your Parent's Manual...the explanation is spot on and your approaches to when to intervene have really helped.  My son has 2 triggers that come together as one main trigger.  He doesn't like to be corrected (fussed at) and doesn't like to lose.  Combined, he easily disappoints himself.  

However, he will sometimes purposely disobey, for no apparent reason, and I will correct him.  It is almost as if he goes into this dark, vindictive world with the purpose of receiving negative attention.  We make a point to praise positive behavior, so the negativity out of left field is very upsetting.  His dad and I have been divorced since he was 18 months and he has never displayed any of this behavior with his dad (we have 50/50 custody and are amicable). Besides me, he had one anger overload outburst at school recently.  The triggers are random and seem to have no apparent reason.  Thoughts?  I should also note that he is very intelligent, well above his peers, and has many friends (no social anxiety).


Hi, It sounds like you identified a couple of his triggers, but there are times your son explodes and it doesn't fit a pattern, other than maybe to get negative attention.  And you mention that this happens with you but not his father.  Keep track of when he has overload the next few weeks, and see if there are any patterns besides the two triggers you already figured out.  Is he tired, frustrated by something else, or wanting attention?  

Your email suggests the latter as a possibility (he wants attention) even though you praise positive behavior.  If that is the case, if you can catch it early, try to use emotional distraction. You could make a silly unrelated comment, or talk about something he likes to talk about. But if he is already in anger overload, try to say and do as little as possible,  If he is wanting attention, you don't want to give it when he is in overload.  When he has calmed down then do a short activity with him, or talk about something he might be interested in.  

I know it must be frustrating since you already praise his positive behaviors. However, sometimes children get bored or feel out of sorts and want to interact with their parents, even when they have been getting attention throughout the day.  We want him to learn to reach out in a positive way.  When he is calm, like at dinner or bedtime,  you may even suggest ways to get your attention if he feels bored.  He could ask you a question, or come give you a hug, for example.  Suggesting this to him won't lead to his immediately doing it. However, over time he may remember how to connect when he is bored.  

The above comments assume he is seeking attention.  But if you identify a different trigger, then your approach may be different.  You might also ask his father if he uses any strategies that help.  You mentioned this does not happen with Dad.  Maybe you are gentler, and he is "experimenting" with this negative behavior.  See if you can figure it out, without giving him too much attention during the overload phase..  Best, David Gottlieb, Ph.D.

Will ADHD medications help?

I have a 7 year old son who is struggling with the same issues you discuss on your blog. I am a mental health professional and work with kids but it is difficult when it is my own child. We have him on a medication trial with concerta 18mg but it only seems to make him tired. He is in therapy but it is not really helping. Would straterra help. What do you suggest?

Hi, You mention two medications that can  be used for attention deficit disorder (ADHD).  If your child has ADHD, then your doctor may try either of those medications. Most doctors will try a stimulant like Concerta first.  Concerta is a time released form of ritalin.  More research has been done on stimulant medication for ADHD than any other class of medications, and stimulants have the highest percentage of positive results: from 70 to 90 per cent effective in reducing symptoms of ADHD.  The other medication you mentioned Strattera is sometimes used for ADHD, especially when a child has side effects to stimulant mediation.  However, I have not found it to be as effective in treating symptoms of ADHD.  

It is important to add that these medicines are not typically used for anger overload.  There is no research that I am aware of that they are helpful in the absence of ADHD.  If your child has anger overload issues and ADHD, then ADHD medicines may help your child self-regulate, i.e. become less impulsive.  And if your child is less impulsive, he may be able to pause and think more often when he is frustrated.  So you may then see some reduction in anger overload.  Still, it is unlikely that anger overload will disappear, and I would recommend you also work on the strategies in my anger overload manuals.  These cognitive behavioral strategies have been found to help reduce anger overload in a number of research studies of children.

Take care, David Gottlieb, Ph.D.

Will children outgrow anger overload?

So I have been reading your blog and plan on reading your books soon.  It sounds like my 6 year old could be any one of the kids mentioned in the blog.  I was wondering what the over all outlook for these kids are?  Do they ever "grow out of this"?  What can I expect when my child is a young adult in college or at 25?


Hi, You ask a good question.  I can't tell you exactly what will happen for any individual child, but overall studies, looking at groups of children, show that there are significant changes when children learn cognitive behavioral strategies, like those I present in my anger overload manuals.  The studies compared using these strategies with groups that did not receive therapeutic intervention, and the studies found that the group of children taught to use the strategies handled their anger better.  

What hasn't been studied yet is seeing what happens to these children over many years, in other words, a longitudinal study.  Do the children maintain their gains over a long time period, and what percentage are still having anger overload many years later?  We do know that the brain keeps maturing throughout childhood and early adulthood, and we do know that practice using these strategies is beneficial over the short term for most children, so we believe that most children will continue to improve as they get older.  

Questions still to be answered by future research:  Some adults have anger management issues.  Did these adults receive help as children?  Is there something about their biological or emotional development that interfered with their learning better self control?  We know that adults with anger problems do have subtle differences in parts of their brain.  But we don't know how this happened. Were there other life events that impacted them in a negative way?  For example, we know that if there are serious mood problems or drinking problems, there often are anger problems as well.  But more research still needs to be done.

Hope this brief overview is helpful, Dr. Dave Gottlieb

Medication versus behavioral strategies

Our "small for his age" and academically gifted 7 year son suffers from frequent anger outbursts and a co-worker recommended your Anger Overload manual to us. The 8-year-old you describe in the book could be our son. He can be a delightful boy when everything is going his way, but he cannot cope with even minor frustrations and disappointments without flying off the handle and turning verbally and physically abusive. It is severely impacting our family life and, though he generally keeps it together in school, has started to bleed into his social life.

In addition to seeing a CBT therapist, we have been diligently applying the strategies you recommend. Our son has great self-awareness and insights into his own behavior so he has been good at the worksheets, but when he's in anger mode he cannot stop and think rationally. Also, while we have learned to recognize his triggers and head off a lot of problematic situations at home, we can't protect him from every frustration and disappointment in life. 

This brings me to my question. Our son has a NOS diagnosis because he does not meet the full criteria for ADHD, ODD, or any mood disorder. Do you ever recommend medications like Intuniv for children like this? Our therapist is pushing for it, but we are reluctant. Do we just need to give these strategies more time, or will the medication help him leap forward?   Do you find, in your practice, that children tend to outgrow anger overload as their brains mature?

Hi, 

To my knowledge Intuniv is sometimes used for ADHD and has a "slowing down" effect on hyperactive behavior. I would check with a psychiatrist if you are considering it. The strategies in my manuals take time, often several months to begin to see changes, and may not work as well when his anger rises real quickly. If you can catch the frustration early sometimes, the cognitive strategies in the second half of the manual will be easier for your son to use. Otherwise you will need to rearrange the sequence, or lower the expectations, or use emotional distraction, or use mantras and imaginary stories (described in volume 2) ahead of time. The work you do with your son before an outburst, or when you review the day at night, is key for teaching children to have better self control.  I haven't had a child with anger overload take Intuniv so I'm not sure how it would work, but I suppose if it lessens his quick anger response it could be helpful. But this is new territory and I'd check with an M.D. who is familiar with these medications and who works with children.

Regarding changes in self control as a child matures, it is hard to say for sure how much is maturity and how much is due to practice because there are no controlled longitudinal (long term) studies of anger overload. Short term studies of anger indicate that cognitive behavioral strategies like I outline in my manuals are effective. Keep using strategies like labeling levels of anger and discussing options when he is calm, and developing mantras (sayings) that you can use before he gets upset to remind him to lower his expectations or to look at an issue in a different way, It may not help prevent overload immediately but it keeps the importance of self control in his mind and helps him begin to think about a frustrating situation in a different way. Let him know this is important, and you and he will keep working on it with him. Empathize that it's not easy but "seed" the idea that as he matures he will be able to do it, You want to communicate repeatedly that you are going to work as a team, and praise him (when he is calm) if he tries to use the strategies.  When he goes into anger overload, say as little as possible and wait until later, and then calmly review the trigger and how else he could think about that situation in the future.

Best, Dr. Dave Gottlieb

11 yr old escalates despite rewards

Dr Dave,

I have been reading your blog and everything sounds like my son.  My son is an 11 year old.  Mr popular at school, every person who meets him instantly falls in love with him.  He has this thing about him that instantly attracts people.  He is an amazing little boy, respectful, listens and follow the rules.  Teachers LOVE him and do not believe me when I explain his behavior at home.  I almost get the look of "What are you doing to him"  

The issues we have with him is his anger issues and how he treats his sister, myself and my husband.  Generally he is a great kid BUT when he gets angry....Watch out world.  I have changed some of the things I am doing with him and the major one is he has to earn his electronic / internet time on a daily basis.  His behavior in the morning, before school, after school etc.  

Yesterday morning we had an issue when it was time for him to leave for school (he walks); he decided it was too cold for him to walk and I needed to drive him to school.  I told him he needed to wear his jacket and he will be fine.  Apparently, he left his jacket at school so he felt he did nothing wrong and I needed to drive him.  I explained he could wear a sweatshirt and there were multiple excuses why wearing a sweatshirt would not work.  At this point his anger is set into high gear and he starts walking around the house in a circle almost in a panic mode looking for something to wear as if something was going to fall from the ceiling.  He is crying and carrying on like a toddler and insisting I drive him to school.  I explained calmly that this is not my fault he left his jacket at school and I will not drive him to school based on his behavior.  After screaming and crying and carrying on he finally left for school. 

When he came home from school he was angry with me and tried fighting and arguing again because he believed he was not in the wrong and wanted his gaming time.  I continued to stay calm and tried talking to him but his anger and the things he was saying I knew there was no point.  We have talked and agreed upon when he gets that way he needs to go into his room and calm down for a bit and then we can talk about it.  This time he REFUSED to go to his room to calm down and was screaming at me and telling me he was calm and we were going to talk about this NOW.  At this point I said well I am not calm so I need to walk away.  In his angry voice with attitude he said fine walk away you do not love me and you are not a good mom.  

After I was able to calm down I came back inside and he immediately hugged me and apologized for the way he acted.  I hugged him and told him I love him.  Things were fine at this point until I caught him on his IPOD playing on the internet.  He made up reasons on why he was on it and was justifying why he felt it was ok he was on it and that I should have not left his IPOD anywhere he could find it. 

At this point I reminded him of our agreement that he will be be able to go to the Homecoming Parade after school and the Homecoming football game ONLY if he had good behavior for the week and since he was unable to follow the rules and his was not showing good behavior he was not going.  That is when the anger started again and it was nearing time for bed and told him he needed to go to bed.  He attempted to argue with me and I just pointed to his bedroom.  

He finally went and laid on his floor punching his fist on the floor (when he gets to his rage part he will stand with his hands in a fist and shake) I did not say a word to him.  Next he turned his bedroom light on, screamed at his sister for no reason, and started doing sit ups in an angry way.  I went to his bedroom and turned his light off.  He turned his light back on and I turned it off again.  He screamed why are you doing that and I said you need to get in bed.  Of course he yelled saying he was not tired and was not getting in bed.  I did not respond and eventually he did get into bed. He cried and screamed for over an hour.  This morning he was calm when he first woke up and tried debating with me a different punishment for him so he could go to the game and parade.  I told him that was impossible and he needs to learn that when he has his anger fits he is not going to get any privileges.  He cried, punched things, tried telling me he was not going to go to school and how I hate him and tried telling me things his sister had done so I would ground her also.  

This is just an example of what happens.  Most of the time  the problem with his anger is when he does not get his way.  He feels everything he does is fine and he should just do whatever he wants.  And if things are not going to his plans then everyone around him needs to suffer.  I have been watching his anger get more and more severe.  He has not ever hit my husband or I, however, he has hit his sister which is more a sibling hitting type of behavior (not that I think it is ok).  I worry his anger problems are going to turn into more of a rage that becomes violent towards others.  

I read trying to turn the child's attention to something else but it happens so quickly and there is no reasoning with him.  I know this takes time and A LOT of energy which I am willing to do but I am not sure I am handling everything the best way or the way it should be.  It is also very hard for me to stay calm sometimes.  This is why I have started to walk away and not raise my voice.  Do you have any other suggestions or ideas of what we can be doing better.  This also tends to happen when my husband is not home (in the mornings after he leaves for work, or after school when he is not home etc.)  He has been around when it does happen but majority of the time it occurs when he isn't here. Sorry this is such a novel any help would be appreciated.

P.S. We have started using a code word when he gets upset and that worked for 2 days and now today he decided he does not care about the code word and will not use it anymore.  Of course I let him know that this is my home and my rules and these things are not for debate that we are using them to help all of us out. He didn't like that answer either.

Hi, I can tell how hard you are trying, and many of your ideas are excellent.  I like that you are walking away when you get upset; I might even walk away sooner, and talk less with your son when he is angry.  It is okay to review with him the day's events when everyone is calm, but do not start explaining things if he is still angry, because then he will escalate (as you have noted).  

I would rely less on week-long incentives and consequences.  Anger overload can happen several times a day, and it is too hard for a child to try to hold it together the whole week. Furthermore, your child will be less willing to work on his anger if he has already blown the reward for the week (e.g. homecoming).  If you are going to use incentives, I'd prefer you use the daily ones, like what you are doing with the IPOD.  I would also encourage you to still offer the reward if he makes an effort.  Children with anger overload are not always going to be able to calm down. There is a biological part to their anger, so you will need to use various strategies, and over time, the frequency and intensity of outbursts will lessen. I would establish a signal, like what you are doing with the code word.  If your son can go to his room when you give him the signal (within a minute or two) then he could still earn the reward, i.e. IPOD time.

If you can catch his anger at a lower level, apply the signal then.  Many of the strategies in my manual are more effective the sooner you can see signs of a child getting upset.  Once he is in overload, say as little as possible.  The more talking you do, the more he is likely to escalate.

The second half of the parent's manual explains cognitive strategies you can use, and volume two of the manual offers additional cognitive strategies.  One goal is to teach your son to be able to observe his own emotional state.  I recommend using labels to categorize anger as low level, medium, and overload.  If you can catch his anger at low level, you might mention out loud whatever label you choose and implement a calming strategy at that point. The strategy could be to distract him, like saying "wait a second, I need your help lifting this in the kitchen and then we can talk."  By re-directing him to do something immediately, it gives everyone a chance to catch their breath.  You'd have to have something in mind that you need help with, or you can use other forms of "emotional distraction" such as pointing out something funny you heard on the radio or television that day.  Or asking him about his favorite sports team.  

Whether or not you catch his anger at a low level, you would later that evening (when everyone is calm), help him see why you labeled his anger as low, medium or high, and suggest to him that over time you will work together to help him prevent overload.  You can explain that the more he can identify the level of anger he is feeling, the more control he will have (someday when he is older, he will be able to implement strategies on his own), and the more respect and appreciation he will receive form you and from other people he lives with someday.  

You might also think about why overload happens less when your husband is around.  If he is doing something that works, try to adapt it for you to use when he is not there.  

Other sections of the manuals explain how to teach your son about other points of view,how to use catch phrases and mantras, and how to look for patterns.

Best, Dr. Dave Gottlieb   

Gifted 9 yr old wants more freedom

In reading your article on the topic, I understood some of the underlying issues with children can often stem from having learning disabilities. Our 9 year old son presents as a child with anger overload, but actually is very bright, likely gifted- although I am resistant to having him tested. 

Are there examples and guidelines in your manual on how to deal with this type of child? We are challenged by his outbursts that are often triggered by our objecting to him engaging in activity that we feel is way above his age level, not allowing him the types of freedoms that are generally reserved for teens and pre-teens and his vehement protests to treatment toward him he feels is unjust (generally compared to his brother or others in his peer group). He has huge issues with our authority but thankfully it does not permeate into his school surroundings, Rather he has decided school, in general, offers him little and his teachers are, well...'dumb'. We are challenged every day. I'm hoping your book can assist us in putting a realistic approach in place that can help moderate his outbursts and help him cope until he matures to the point where his somewhat advanced mind catches up with his young body.

Hi,  First, what I would recommend is keeping track of what rules he feels are unjust.   What kind of freedoms does he want?  In other words, what are the issues he is getting angry about?

Then you would either try to anticipate these issues, and let him know ahead of time what the plan will be, or use "emotional distraction" (a technique discussed in the first half of my parents' manual and in other posts on this blog) to try to prevent outbursts.  You want to try to avoid a back and forth argument.  

In the second half of my book, I write about teaching your child new skills to cope with anger.  Here you want to teach your child self-observation skills and teach him about other points of view.  In my manual I give examples of how to do this.  One other technique to consider is to teach your child how to compromise.  Is there some part of what he is asking for that you would consider it he would lower his expectations?  This kind of discussion is best when everyone is calm, not in the midst of an argument.

You mention your son is bright, but also you bring up the topic of learning disabilities (LD). Does your son have a learning disability that is contributing to his outbursts?  If so, you would want to work with his school to address the LD issue, as this would likely help him deal with his anger better. 

Take care, David Gottlieb, Ph.D.