14 year old with history of angry outbursts

Hi Dr. G., Today is the first I've ever heard of "anger overload", but I think this describes by 14 year old daughter.  But like most disorders, it's hard to to know if this really is the correct diagnosis.

My daughter is 14. She is a straight A student and always has been.  I can't say that all school work comes easy to hear, but she's willing to spend the hours needed to do well.  A classic overachiever.  She does not exhibit angry behaviors at school (that we know of) and respects authority figures.  She has friends and engages in extra-curricular activities.  She would appear to be a typical teenager.  She is a middle child; her brothers are 14 and 8.

As long as I can remember, she has had severe outbursts of anger.  It was and still is primarily directed at my wife or my sons.  Something that would seem so minor to someone else can set her off and she become verbally abusive.  Some of the things that she says are so horrible that I refuse to believe she actually means what she says.  When she was very young her outburst would result in prolonged screaming session.  Any attempt to speak to her (or console) her made it worse.  

As time went, the anger outbursts become shorter in length but no less traumatic for the family.  Early on we tried to use consequences for this behavior but it didn't change anything.  As much as she disliked the consequences, the anger remained.  We brought her to a nutritionist because we thought her diet was possibly triggering the anger. I still do. It seemed to help some but the anger continued.  As a family, we just learned to tolerate this behavior because we needed to get through the day and care for her brothers (and ourselves).  She refused therapy for a long time but currently we are seeing a social worker therapist to get help.  Unfortunately, I don't think she fully understands what we are trying to describe.

I've been a high school teach for over 20 years and have been in countless IEP's and 504 meetings.  I've heard about and dealt with children with many types of disorders.  I honestly believe that she cannot control her anger.  My wife has not always agreed with me on this point.  I think she can learn to deal with anger better but the anger will still be there.  I'd like to think that somehow we can find a way to make all the anger go away as this has taken a toll on our family.  This is something we deal with every single day.

Here are some other bit is information:

She has never really showed any empathy toward others.  She will NEVER admit she is wrong or apologize.  She's only said "I'm sorry" a few times in her life that I know of and even then there may have been an ulterior motive (facing consequences).  Outbursts last 10-15 minutes with the strength of a hurricane.  She retreats to her room for an hour or so and comes back down as if nothing has happened.  My wife, sons and I are still emotionally drained from the experience but she's completely fine.  As if nothing happened.  While in therapy she has admitted that she has a problem and doesn't want to continue being angry.

This may sound like she's a terrible girl but aside from the anger issues, she can be as normal and sweet as any girl.  She's very intelligent and has lots of interests.  One on one, without her brothers around, she can be so much fun.  At times even over the top giddy.  Sometimes we actually set her off unintentionally by calling her on a comment when she was just trying to be funny.  She has a  dry sense of humor.

Here is what I constantly struggle with in terms of consequences.  Is it fair to continually punish her for something that she can't control?  She has always had this anger.  I do feel that she can and should try to control this anger better so I try to distinguish between the two.  It is impossible to have a discussion with her about these issues (even when she's calm), she will not engage.  I have found that emailing or texting her is the only way we can communicate about the subject.  Never face to face.  I could go on and on but I hope this is enough to give you an idea of what we are dealing with.

Thank you.

 

 

Yes, what you describe fits with anger overload.  Anger overload is a term I began writing about ten years ago.  Other clinicians have written about children who have angry outbursts, and the next psychiatric diagnostic manual  will have a diagnosis called "disruptive mood dysregulation disorder" (or DMDD), which is similar to anger overload, but for DMDD there is negative mood even when the child or teen is not in the overload phase.  I have seen many children who have anger overload, but do not otherwise show signs of irritable or negative mood; that's why I prefer the term anger overload.   In the psychological research literature, there is discussion of children and adults who have recurring bouts of extreme anger, and there is more and more evidence that there is an area of the prefrontal cortex that seems to be involved.  These individuals have difficulty regulating anger.  However, with maturation and with practice, children can improve.  That is what my anger overload manual is about.  I offer strategies parents can use to help their children develop better self control.  The outbursts will be less frequent and less extreme.  

It is a good sign that your daughter agreed to therapy and wants to have better control.  If she is motivated to work on it, the second half of my book describes strategies parents can work on together with their children.  

 

Consequences do not work on a consistent basis for anger overload.  It is as if the brain is overheated, and the person is not thinking entirely rationally at that point.  This is why I tell parents not to take what their children say seriously when they are in overload.  It is also why I recommend ways for parents to catch their children's anger early, when possible, and suggest ways to change their children's expectations (it is often some kind of disappointment that precedes the angry outbursts) or change the sequence of events that sometimes lead up to an outburst.

Consequences sometimes help after everyone has calmed down if you are trying to stop one specific kind of behavior during the overload phase.  In other words, consequences do not generally work to stop anger, but if your child says a particular word, or throws things, you can target one of these extreme behaviors, and if the consequence is meaningful to your child, she may try to avoid it by stopping herself from saying the words you want to extinguish.  But sometimes this backfires, and the child says the "dreaded" words even more so.  Thus, the more useful approach is to teach your child strategies that will help her control herself before she reaches the overload phase.  Check out other blog entries or my book for other ways to limit anger overload.  All the best, Dr. Gottlieb

Making a Diagnosis: Hyperactivity, Oppositional, or Anger Overload

Dr. G,
I just happened across your blog while researching my son's behavior. You have described him almost to a tee. He has been diagnosed as hyperactive and also as oppositional defiant. Although he has showed some behavior relating to those disorders I have never felt like they were spot on. My question is:  How would I go about getting a proper diagnosis? (I am positive he has anger overload) and How do I help my son?
Thank You! I feel you are an answer to my prayers.

Hi,   A diagnosis can be made by a medical doctor (M.D.) or a doctor of psychology (Ph.D. or PsyD. degree) or a licensed clinical social worker (LCSW).  You would want to see someone in your area who has experience with children who have anger issues.  You could ask who your school or family doctor recommends, or check with your state's psychological association.  My book on defiance in children explains to parents the characteristics of the diagnoses you mention (oppositional defiant disorder, hyperactivity, and anger overload) and gives suggestions for what to do for each diagnosis.  My book on anger overload focuses on that issue and has a step-by-step guide for parents.  Ultimately if you are trying to decide on a diagnosis and there are several possibilities, it would be wise to check with a clinician who has experience seeing children with these diagnoses, so he or she can help you decide what is going on and what to do.

It is possible your child has aspects of two or more diagnoses.  It is not unusual to have a couple of things going on.  Furthermore, in the real world, people do not always fall perfectly into one diagnosis or another.  Your child could have some aspects of oppositional defiant disorder for example and not meet full criteria for this diagnosis.  To fully meet the diagnosis of oppositional disorder, the a child's argumentativeness with authority figures needs to be frequent and persistent over time (6 months or more), and must affect the child's performance in school, or social situations.  In other words, the child is oppositional  even in situations where it hurts his performance in something where he ordinarily does well:  in school, or in a sport, or in some other extracurricular activity, or affects his social standing with people outside the family.   If a child just argues frequently with his parents in the home, but not with other authority figures, there are some oppositional features but the child would not meet criteria for oppositional defiant disorder.

For more information on this or other diagnoses, read my book "Your child is defiant:  Why is nothing working?"  My book will help you think about what is going on and have suggestions for you.  But you can't really make a diagnosis yourself; it's best to check with a professional in your area to decide among the diagnoses you are considering.  Take care, Dr. Dave Gottlieb

4 year old has daily tantrums with people he knows

I found your site tonight while Googling for the thousandth time about the issues we’ve had with our son for the past few years.  I’m surprised I haven’t found it before, but better late than never.

We have just turned 4-year-old boy/girl twins and have had no real issues with our daughter over the last few years outside of what I consider normal 2/3/4 year old minor tantrums and defiance…testing limits and such.  But our son started having severe tantrums really early…somewhere around 10 or 11 months if I remember correctly.  It has just gone downhill since then.  We did work with a counselor (MSW,LCSW) who came to our home for a couple of months, but told us we really didn’t have an issue.  She told us to put him in timeout and simply wait for him to calm down, but we’ve been trying that for two years now with no improvement.  The problem is that until he is comfortable around someone, he actually behaves quite well.  It is the same each new year at preschool.  He’s great at the beginning of the year and then as he gets more comfortable the anger issues start rearing their heads.  He is a very smart, sensitive, loving kid half of the time, but the next minute he is mean and hurtful and screaming and kicking.  I’ve wondered if he was bipolar since it does run in my family, but I’ve called child psychiatrists who say he’s too young to be seen!!  He has multiple bad tantrums a day usually and even more shorter angry outbursts.  Once he “loses it” there is no talking to him, no calming him down, and he doesn’t know how to calm himself either.  And afterwards, we cannot talk about the behavior that sent him to timeout or the transgression at all, or it send him right back over the edge. 

I’m lost on what to do.  I am going to buy your book on defiance and also the one on anger overload, because they both seemed to hit a few nails on the head, but in the meantime, does this sound like something your book will help with?

He also has some mild sensory issues, but we’ve been working with an Occupational Therapist on those.  I was hoping it would help his behavior, but it has not significantly.

Thanks in advance for your response!

Hi, My book on defiance looks at various causes of defiant behavior in children.  The book helps parents identify the cause and then suggests strategies for each cause.  My book on anger overload is a parent's manual focusing on children who have severe meltdowns--tantrums that can last for minutes or hours--but who otherwise behave well.  The anger overload manual outlines specific strategies for you to try.  For four year olds, I recommend parents focus on the first half of the book:  the first two sections are "what is anger overload?"  and "parents as the agent of change."  The defiance book discusses anger overload but also other behavioral and personality issues.  There is a section on bipolar disorder in children, which you may find helpful, for example.  Yes, doctors do not usually diagnose and treat bipolar disorder in four year olds, because the brains of these children are still developing, and the children may develop better self control in the years to come.  Also the medications for bipolar disorder can have significant side effects, and most are not approved yet for young children.

     In the anger overload manual, I encourage parents to first observe the patterns, and if there are some situations that are more likely to trigger outbursts, I explain how to approach your child before he has an outburst.  You can change the sequence of events, lower your child's expectations in advance, use "emotional" distraction (I explain in the book that the distraction technique must grab your child emotionally in order for it to work.), or sometimes calming techniques can help.  Once your child is in overload, he is not thinking rationally and it is usually better not to say or do anything at that time, unless someone is being hurt.  Sometimes consequences can help later in the day when he is calmer, particularly if he uses some words that are not acceptable in your house, or if he broke something.  The consequence is not for anger overload per se, but for certain behaviors that you want to try to extinguish.  I explain more about these topics in the book.

     The last part of the anger overload book "teaching your child new skills" works better with older children--preteens and teens--however some young children benefit from using labels for the level of their anger.  The idea of the labels is to help children begin to be aware they are angry before they lose it.  Then they can be guided to use a calming technique before they explode.  Sometimes a fun activity works better than a relaxation technique to help a child calm down, but neither usually works well once a child is already in overload.  So you can see that the key is early intervention, when possible.   Otherwise you wait out the storm and try to not respond to mean or hurtful comments a child typically makes during overload.

All the best, Dr. Dave Gottlieb

Is it anger overload or manipulative behavior?

Hello Dr.,

I have been coming to the conclusion that there is something going on with my 5 soon to be 6 year old son. I want to give you a bit of background on our particular situation and I would like to have some insight from you. My husband and I decided in 2010 that he would join the military to better our family as a whole. My mother in law did not like the idea nor did she stand behind my husband and the choice he made. Two days prior to my husband leaving for basic training she told my husband "you are taking the easy way out." My husband was hurt by that and we did not think that what happened next would ever happen.

After my husband left my son was 3 turning 4 and she was all I had to help me out with my children. She started coming by just about everyday and she would take the kids for a walk or we would all go for a walk and she would tell me "stay here do your laundry or whatever you need to get caught up  on." I did not think anything of it until one day my son hit my daughter and I told him to sit for a time out. When I told him that he looked at me and said "Well I know I can get a new mommy that will treat me a lot better than you do." And that broke my heart. Not thinking of where he would have heard that I allowed him to get up and do what he was doing. This had gone on for a few months.

About 2 months into this all my best friend had come over and sat me down and told me there had to be something going on with my son, but he would not talk to me so she talked to him. And in his words "Well Nanny told me if I tell mommy that I can get a new mommy then she would let me do what I want, and I want to do what I want." I never thought in a million years that my own mother in law would do this to me. I knew that she did not like me but to hurt my children like this. I did not have the heart to tell my husband that something was up because he needed me to be his rock at this point in order to get him through basic training....

If I had told him no to playing a game or watching a particular movie or anything really he would get very mad at me. Then the time came that we were moving with my husband and I thought everything was going to get better. And there for a while it did. It was really good. My son is very bright, very intelligent and wonderful until he has these what we call breakdowns. When we went to Korea he did not have a breakdown from June all the way until October....

In Feb of this year we moved to Texas where my husband is now based. My son gets upset and rages out when someone doesn't listen to him or does not want to play with him or if he just feels like someone does not like him. He gets loud with me, his dad and his sister. He hits his sister and he starts school this year and I am very afraid that he is going to have a lot of social issues. I know he will do well in class but worried about the interaction if he gets pushed out of a group of kids or something. Now my question for you is do you think that he would have "anger overload"? If you can message me back would be great. I am just a mom worried about her son. I never thought that I would have to medicate my child or get them help for any reason like this. It is breaking my heart and I have finally come to the conclusion that I am not the reason he is like this. I do everything I can for my children, they are my life and since I know that there is something going on with my son it is killing me.

Hi, It is important that all parenting figures, including grandparents, if they are in regular contact with the children, work together when it comes to discipline.  I'm sorry that your mother-in-law coached your son to disobey you.  One question I have is what do you think changed with the move from Korea to Texas, because it sounds like your son's behavior regressed this year when you moved again.  Why do you think he stopped misbehaving in Korea, and can you re-capture what you were doing there?

Anger overload lasts from minutes to hours.  So my question for you is:  once your son gets angry, does he usually get out of control and stay upset for a while, or does he get loud to get his way, but cuts it out as soon as he wants?  The former is more consistent with anger overload, and the latter is more typical of a child who uses his anger to get his way, but does not lose control.   If the problem is anger overload, then my parent's manual and other posts on this blog explain a number of strategies to help your son develop self control.   If the problem is the latter (your son uses anger to get his way, but not to the point of overload), then you will need to apply behavior modification strategies (incentives, consequences, ignoring, and timeouts) to make sure that you son does not get a lot of attention nor get his way when he gets angry.  There are a number of books for parents that help teach behavior modification, including a chapter in my earlier book about defiant children.  And remember what your son told you earlier:  grandma said to say this so that he would get his way.  He does not really want a new mother, so try to act like you are deaf and do not react to comments like that, as best you can.  

Also, if your mother-in-law is going to have contact with the children again, you and your husband will have to set firm limits or stay in the house when she is there.   This is assuming your son is accurately describing what the grandmother told him.  You and your husband may want to talk with her more about what your son said and how it has affected his behavior, or you may want to contact a family therapist in your area about how to proceed with her.   All the best, Dr. Gottlieb

4 year old twins egg each other on

I have 4 year old boy/girl twins. Both are fairly good and independent of each other but they play off of each other when they get rowdy. In other words, I feel like I have no control if I try to discipline them when they are playing together. They have their own built in playmate who eggs them on when I'm telling them no. I have a harder time with my son than my daughter. He will hit, have attitude, look me in the eye and do exactly what I tell him not to do, etc. We have tried time outs but I feel like my anger escalates to yelling and spanking and personally, I don't like myself like that, nor do I feel like it's effective. If he doesn't get his way, he will scream and tell me I'm a bad mommy or that he doesn't love me which of course breaks my heart. Any advice on how to handle this situation? It is affecting our whole household. Thank you!!

     Hi, Twins can have a special relationship and support each other, which sometimes makes it difficult if they are misbehaving.  In general, their close relationship is a good thing, but if they are misbehaving, I would separate them and give them each a time out or other brief consequence, even if one of them is more defiant than the other.  If one child is egging the other on, then both are involved, and both should receive a consequence.  This will encourage them to not support the other's misbeavior or risk a consequence.

     In order for consequences to be effective, they must be something that the children care about.  Some possibilities include time outs, loss of television time, loss of a favorite activity, or earlier to bed.  What do your children care about more?  Whatever you choose, it should be brief.  The next day everyone should start with a clean slate.

     You can also use brief incentives for self-control or cooperative behavior.  If you do this, give concrete examples of what you are looking for.  Incentives can be extra television or computer time, or an extra game with you. 

     Sometimes it is helpful to use your hand like a stop sign if the children are misbehaving and count slowly to three.  If they stop by the time you get to three, they earn a point, and if they get two points over one or two days, they earn the incentive.  (I  would also give them a point if they do not need you to put up your hand on a given day because they have behaved well.)

    When your son screams and tells you are a bad Mommy, remember that he is angry and will say whatever he thinks might hurt you at that point.  I would not use your hand as a stop sign nor impose an immediate consequence at that point.  You child sounds like he is in anger overload then.   Do not take what he says (when angry) as truth.  Try your best not to respond, as he is just trying to get your goat.  If you can ignore these comments, they are likely to lessen in the coming months.  You could later on that day impose a consequence if he was misbehaving prior to his angry comments, but do not talk about consequences while he is in overload, as this will lead to a longer tantrum.

     All the best, Dr. Dave Gottlieb
    

5 year old tantrums at home

Hi Dr. Dave,
My five year old has been acting out at home and sounds to have what you describe as anger overload. He does not act out at school or for anyone else but at home with us. He has meltdowns if I ask him to help pick up his toys or if he gets frustrated at a toy he can't work or if he gets in trouble for messing with his little brother. Lately it worse with starting kindergarten and not really napping like normal. He has been screaming at the top of his lungs and hitting himself in the face, throwing stuff and just acting crazy. We've tried time outs, talking, and sending him to his room. Usually it escalates to spankings which don't help either. He usually calms down 15 minutes later after being sent to his room. He then acts loving and sweet. I don't know what to do, but I'm emotionally exhausted and would rather stay at work everyday than to come home with him. I'm worried my two year old will soon start acting like his older brother!!! Help please???

Hi,  With kindergarten starting and with less sleep, it is not unusual for five years olds to have some melt downs.  Your son will probably do better with more sleep, and you should see a decrease in his overload behaviors as he matures in the coming year.  However, here are some suggestions to move things along--to help him develop greater self-control:

1) Try to catch your son's frustration in the early stages, if possible.  It is easier to re-direct a child if the anger is not so intense.  So if you see him starting to get into it with his brother, try to distract one of them, or invite your older son to do something or show you something--it has to be something he really likes to do. 

2) If your son is getting frustrated with a toy, try to help him (if he will let you) or empathize by saying something like "Ugh is that toy being a pain in your butt?"  Your son will be less likely to explode if your comment strikes a chord in him. 

3)  When he is in full anger overload, try not to say or do much of anything unless he is hurting himself or someone else, in which case you may need to bear hug him, or restrain him in some way.  Anger overload does take some time to wind down because your son's brain is "overheated" at that point.  It takes time for the chemicals in your son's brain to return to normal.  Until that happens you do not want to talk with him because that will likely prolong the outburst and may inadvertently reinforce his negative behaviors.  You can either send him to his room, walk away yourself, or just sit there and act like you are deaf, whatever is easiest to do in your family situation.  When your son calms down, then talk with him about something of interest to you both.  That reinforces his efforts to be in self-control.  Furthermore, once children calm down, most act normally, as if their explosion is way in the past.  It often takes parents longer to relax after these explosions, and it can be a trying time for parents to get through them without feeling like they've been through the ringer! 

If there is not a decrease in the frequency of outbursts in the coming couple of months, check with your doctor or teacher to see if they would recommend you get a psychological consult.  All the best, Dr. Dave Gottlieb

4 year old rages only with his parents

About 7 weeks ago my daughter and her family moved from another state to live with us temporarily.  My daughter and son-in-law are loving, intelligent, and all around great people.  Their 6-month old baby girl is an absolute joy all the time; beautiful and so very happy.  Their 4 year old son can be such a wonderful boy to be around, but those moments seem few and far between.  By this I mean that not a single day has gone by when he hasn't screamed several times during the day, sometimes for hours, because he gets so angry about something; I can't even categorize his anger triggers because everything seems to trigger him.  The only thing that doesn't make him angry is if the people he is directing do exactly as he says with no variation, the moment he says it with no delay, and basically allow him to do whatever he wants.  But even then, sometimes he gets mad.  At least 5 times since they've been here, the screaming has escalated to screaming, biting, hitting, spitting, kicking, hair-pulling bouts and they are almost always against his mother.  My kids read countless books on spirited children (i.e., raising them, setting limits, etc.), but I'm concerned that this could be something more than just spiritedness.

The reason I feel this way is that on a few occasions they have let me babysit both children; once they were gone for only 90 minutes, a second that I recall they were gone for about 3.5 hours.  On both of these occasions, my grandson was a loving, fun, reasonable, 4-year old with absolutely zero outbursts let alone a complete melt-down. He was disappointed when I said I could only read two books instead of his usual 4 and then again for some other reason, but both times, he kept his disappointment to nothing more than the usual 4-year-old-expected-whine, and then he got over it as we moved on to other activities.  Also, at bedtime, he gave me no grief.  Bedtimes and naptimes with his parents are daily battle/war/big bang with him.  When it's just him and his sister with us (me and my husband), we love being around him as he really is quite pleasant, fun and funny.  When he's home with his parents, we've taken to hiding in our room (luckily it is quite spacious and relatively sound-proof.)   

We've offered to help but they don't really want our help, so we try to remain respectful of this as long as our grandson isn't hurting our son (who has autism), destroying any of our property, or being disrespectful to us.  One night, after a few too many glasses of wine, we recommended that the kids look into professional help - if not for their son then perhaps for them because they are getting worn down whether they choose to see it or not.  They haven't done this and I'm not sure if it's because we had wine and they thought we were just being silly, or perhaps because they don't yet have medical insurance, or maybe they truly believe that the books they are reading are going to help them.  They've read these types of books for about 6 months, btw with no change.  If anything, he seems to have gotten worse.  During one period my grandson went two days with just his usual, daily multiple screaming fits.  The following day he had one of his screaming, biting, hitting, etc. fits.  His dad commented on how it was a "...bummer because he'd been having such good days."  I didn't know what to say.  I thought, wow, so our bar (our limit) is when he turns violent.  

 

I bought your book and am eager to read it (too bad it's not on Kindle I would have downloaded immediately!)  I'm wondering if this is some sort of situational anger overload?  Does it sound remotely bi-polar? Oppositional defiant disorder?  I know you can't diagnose since you know nothing other than what is in this email.  I just feel so sad and helpless and reading the synopsis on your book made me reach out to you.  Thank you.

 

Hi,   As you wrote, I can't diagnose without doing an evaluation in person, but the fact that he did not erupt with you and your husband when the parents were away makes me lean towards anger overload rather than bipolar or oppositional defiant disorder.  The latter two diagnoses generally occur in multiple settings and regardless of which adult is in charge.  If the outbursts occur only with the parents, it sounds more like anger overload.

A question many parents ask is why does a child usually erupt more often at home with them.   Often parents are targets of anger overload 1) because their children know they will be loved no matter what, 2) because their children feel so close to their parents and therefore more easily disappointed if their parents do not respond to their wishes,  and 3) sometimes also because the parents (in their love for their children) have had a hard time sticking to their rules, and their children know that.  It is usually best not to respond at all during anger overload (except to keep someone from being physically hurt), because the more you talk and/or compromise at that point, the more likely the child will continue screaming you, and in addition the child will be more likely to rage the next time he is disappointed because "it worked" (in the sense that he got a response, even if it is not exactly what he wanted).

In my parent's manual, I outline strategies parents can take early in the sequence in anger.  The first part of the book is what parents do (without their child's direct participation) and the second part of the manual describes interventions parents work on together with their child.  It will take time (often several months) to see a lot of progress; how smoothly things go depend on the child's biological make up, as well as on the parents' emotional energy and motivation to stick with the new strategies (when change takes weeks or months, rather than days). It is worth the effort though, and parents are relieved when they see improvement. 

 

If you or the parents have questions after reading the manual, feel free to write again, Dr. Gottlieb