Dr. Dave's new blog and book: What Preteens Stress About and How You Can Help: A Parent's Manual

 In this parent's manual, I offer 14 vignettes illustrating concerns that preteens often have.  Preteens (ages 9-12) are changing physically, emotionally, and cognitively.  Will they like how their body is developing? How will they handle the ups and downs of peer relationships? And what about the academic expectations of middle school: will they feel stupid if they have trouble with reading and writing assignments? Parents can play an important role in helping their preteen maintain a positive self-image and not suffer feelings of shame and self-doubt. There are four steps parents can take to help their teen: 1) empathizing, 2) sharing a similar experience, 3) explaining factual information, and 4) collaborating on a plan of action. I show you how to do this in my new parent's manual: "What Preteens Stress About and How You Can Help." I also answer parent's questions on my new blog: helpingpreteens.blogspot.com

Introducing Dr. Shira Gottlieb

Dr. Dave Gottlieb has retired, and Dr. Shira Gottlieb has taken over answering questions on this blog.  Shira co-authored the Anger Overload Workbook for Children and Teens.  She maintains an active practice working with children and adolescents and their families in the Washington, D.C. area.

Update on treatment strategies for 7 yr old

I've had a few questions about the last blog post:  why start with keeping track of your child's triggers and not working on calming strategies until later.  The reason is that most young children do not sense that their anger is about to reach the overload stage. Most young children are not aware of what is going on in their heads that is leading to an outburst.  So first parents need to observe what are their child's usual triggers, and then divert their child when a trigger is about to happen.  Emotional distraction is often an effective technique to head off an outburst.  If you can get your child to laugh, for example, it is less likely that your child will fly into a rage.

When you have been able to reduce the frequency of outbursts, then you want your child to develop a greater awareness of his emotional states.  I use color labels and encourage the child to use a label for his anger.  Red is hot, orange is warm, and blue is cool.  I recommend you go over an anger episode after it is over, and look at what the trigger was.  What color was his anger when you said something (like "it is time to turn off the game system") and then when he said something (like "not yet Mom")?  Review the script and help your child to label each step with a color.  By doing this, you are helping your child to become aware of the level of his anger.  Once he is getting the hang of this (after a month or more) then try to gently label his anger while an episode is happening.  Ask if he agrees with your label.  If your child has already reached the red hot level, it is less likely he will be able to have this kind of discussion with you.  Better to wait for another opportunity.

Once your child has some awareness of his anger then you would encourage him to learn calming strategies, like relaxation or mantras, to help himself calm down.  This step is outlined in my books and on this blog.  Remember you probably won't be successful with this step if your child is not yet able to observe his emotional state.  In that case, you would stick with emotional distraction, or try changing the situation from the start, to avoid an angry scene. 

Best, David Gottlieb, Ph.D.

7 yr old's intense outbursts

Hi Dr Gottlieb,

I've just been scanning through the Internet as I often do after we've had an 'outburst' from our son (7yrs old), usually in hope of finding some miracle advice. I have stumbled upon your page and read all about 'Anger Overload' and It is the only thing I've ever read that seems to fit 100% of our little boy's characteristics. 

I have danced around various self diagnostics over the months/years and have thought (amongst many) that he had ADHD, Bipolar, ODD, Depression, Anxiety, Border line personality disorder.... All of which he shows some characteristics of but not ever 'fitting' 100% of the profile. By the way its not a good place to be in when you're looking to pin a 'label' on your child just so you can make sense of their behaviour, but I'm constantly needing some reassurance that there's a reason behind his extreme behaviour. 

We have reached out to various people recently (school, doctors, professionals from various sources) but we have come to the conclusion that help and resources are extremely limited and this is something we're going to have to deal with alone, certainly for the time being until we're moving further up the queue. 

I'm writing to you to ask if in your opinion you agree that my little boy has the signs of Anger Overload? I fear that if I start putting things in place to treat the wrong thing, I may make the situation worse. I'll give you the details of today's out burst..... 

We simply asked him to sit at the table as dinner was ready. He firstly said he wasn't hungry, but then asked for a bowl of cereal instead. I explained he was not having cereal and he was to come to the table to eat with us (me & dad). He came to the table with his ipad which we do not allow, we asked that he put it away until we'd eaten and he could have it back after. He said no and that was the start of it. He punched his dinner (boiling hot meat pie) and this went all over the table and walls. We asked calmly that he stopped and this lead on to a barrage of abuse, we have become desensitized to this over the recent months as we've heard it all before, but he starts with nasty names aimed at me or his dad and when that doesn't work he threatens either us (saying he wants us to die) or himself (saying he wants to kill himself). We have on a few occasions seen him attempt harm on himself (trying to jump out of his bedroom window) but usually this isn't followed through. Today led to him trashing his bedroom and running away. It lasted in total around an hour or 2.

We have used various strategies to try and deal with these outbursts, we've been calm and understanding, we've been stern, we've used punishments and set boundaries, we've tried ignoring him in an attempt not to give him the attention we assume he's wanting, we've tried to get him to tell us what's causing these outbursts (after he's calmed down), we've done reward charts and reward systems and we're not seeing any improvement. 

The problem is, when he's good, he's very good and when he's bad it's catastrophic, there's no in between. We seriously fear for his well being at times as he now has started to run out of the house when he gets angry and we're currently running after him but we fear one day he'll run into the road in a rage. He throws his bedroom furniture around and how he hasn't managed to hurt himself doing this is beyond me. Hes tried to throw himself down the stairs (we had to pull him back over the banister) all of which starts out from a simple 'No' from either me or his dad. 

The problem is, even after he has finally calmed down and we try and ask him what just happened, why is he so angry and what is going on his his head, he always blames us. After today's instance, it was a good hour or two before he finally settled down, and I asked why he behaved like he did... He said out of nowhere "because you won't buy me a ukulele" which is the most random thing he has said yet (I almost laughed out loud, it's really not funny in the slightest but I think hysteria was setting in) To our knowledge he hasn't ever asked us for a ukulele, so where that came from is a mystery. 

I just have this awful feeling that we're missing something here. I also fear that unless we get this sorted sooner rather than later he will soon be a very tall 15 year old young man with a lot of strength and power. I fear he will end up in jail, if he continues with this behaviour into adolescent, surely that's what's going to happen. No parent wants to see their child unhappy. I want him to get this under control but I'm at a loss as to how to do this. All my efforts have so far been useless and unless he accepts his behaviour as being under his control then when will he ever get it under control?? 

He always blames someone else, or something else. He's never accountable. Will he grow out of this naturally? He's only 7, am I expecting too much from him? I'm just lost. 

Can you help in any way? 

Hi, I can see you have tried so hard to understand and help your son.  Firstly, I would try to get him in with a psychologist who deals with anger issues and who would strategize with you as well as meet with your son.  Family involvement is key with young children with anger issues because children will not usually use strategies on their own.

I would try to make a list of the type of situations when he is most likely to erupt:  is dinner time one of those times?  What are the themes, that is, what are the types of triggers?  Since your son is not invested or aware of when he will erupt, you would try to anticipate when he might be close to erupting, and try to divert him, or re-arrange the situation to try to avoid an outburst in the future.  For example if dinner time is sometimes a problem, make sure electronics are put out of reach until after dinner.  If he is a picky eater, I would recommend having an alternate in mind, but not struggle over his joining you.  You and your husband would have dinner and wait him out.  At some point that day or the next he will get hungry and eat.  I know this is hard to do as parents, but you would try to predict and avoid struggles around issues like food. 

Two other strategies I especially like to use with young children are emotional distraction and color labels.  Emotional distraction is trying to change a child's mood to prevent an outburst.  It is hard to have a melt down if he is laughing.  Make up a story about something that he might find funny, for example.  The story would come out of the blue, but if he is not too angry, he might listen and laugh.

Color labels are a way to try to get your son to observe his moods.  You would label everyone's anger in the family, not just his.  Blue is for low anger, orange for medium, and red for "hot" anger.  Then over time, you would introduce calming techniques and mantras to help keep anger below the red level.  I write about this strategy in my books and on this blog.  

But when it reaches the stage of jumping out the window, i.e. when someone could get seriously hurt, it would be important to see a mental health professional to see if other issues might be contributing to his anger or if any medicine might be needed to help him.

Best, Dr. Dave Gottlieb

Is birth order a factor?

Hi Dave,
Thank you for all of your information on the subject of anger overload.  It completely describes my youngest son (6.5 years old).  As the youngest of three (I have an 11 year old son and a 9 year old daughter), the frustration of being the youngest really seems to be a trigger for him.  He does not like when he can't do the same things as his siblings. For example, he had a 40 minute tantrum at an amusement park when he wasn't tall enough to ride a roller coaster, despite us preparing him that this may be a possibility.  I was just curious to know if you have found birth order to play a role in anger overload.  And, if so, how can we address this?

Additionally, do you suggest a therapist working with the entire family, including all siblings? I'm currently searching for a therapist and would like to have a good idea what to expect.

Hi, I have found a correlation with personality, but not yet birth order.  Some children are more insistent and more emotional.  These qualities put them at risk for anger overload.  But keep in mind that these qualities of determination and emotionality also have positive aspects. Determination correlates with assertiveness and with not giving up when challenged.  Emotional expression can make it easier for people to empathize with what someone is going through. 

But determination and emotionality can also lead to a tantrum when you are not tall enough yet for a roller coaster!  Is there another cool ride that he can go on while his siblings do their ride? Or have a special food treat?  Also try sharing with him if this happened to you when you were young. Empathize, in other words, about how hard it is to not be allowed on the ride.  These suggestions may help a little, but for big disappointments, you may have to wait until he is calmer to reason with him. You did a good job by trying to reassure him in advance.  

Family therapy can be done with the whole family or with part at a time.  It depends in part on what the issues are and on everyone's availability.  If there are conflicts with the siblings, it would be helpful to have everyone come. If the issues do not involve his siblings or if your son would feel embarrassed or out numbered, he may do better without his sibs being there.

Best, Dr. Dave Gottlieb

Brain development and anger

Dr Dave,
I am a grandfather of an 8 year old grandson
Much of his anger issues have been reflected in the your article online. 
Perhaps you can clarify a description relating to the diagnostic part of the article 
It refers to a “lag or deficit in their limbic system”
Does that mean with a development lag, a child may outgrow this issue with maturity ?
Alternatively, does having a deficit in his limbic system mean lifelong issues treated by behavioural &/or medication?
And can a diagnosis be made now if it is a “lag” or “deficit in the limbic system”?
Your response is much appreciated!

Hi,
You ask some great questions.  Scientists think there is a problem with the communication between different areas of the brain in people with anger overload.  Recent theories suggest connectivity issues between the amygdala, in the limbic part of the brain, and the prefrontal cortex, the outer area of the brain.  The prefrontal cortex helps with self control. 

To my knowledge there are no studies of anger overload looking at brain development from childhood to adulthood.  We think many children improve with age and with therapy, but why do some adults still have problems with self control while others do not?  Brain studies of adults only (not children) suggest problems with neurotransmitter communication between the brain centers that I noted above, the amygdala and prefrontal cortex.   Another recent study looked at miscommunication between the prefrontal cortex and the language center of the brain.

What would be real interesting would be to do an MRI study of the brain of children with anger issues before and post treatment to see what changes in the brain for children who improve. We do know many children improve and that strategies like those described in my parents' manual can help.

Best, David Gottlieb,Ph.D.

9 yr old has sporadic explosions

My 9 year old son is sweet, kind and calm most of the time.  However he has very explosive anger, which mostly we see at home. He will go months without any issues at school, and then have multiple episodes of anger in a row at school. For example this year, he was fine at school from August thru the second to last week of Feb. Now for the last few weeks he is having anger episodes  multiple times a week.

He had the same issue at his previous school, and we had to home school him on and off throughout the second half of the school year.  The last month of school, they threatened to suspend him due to an episode of rage.  At this point, it seems he is going to get kicked out of his new school as well, or they want some sort discipline plan?

We have no idea what to do...  The anger is sporadic, unpredictable and explosive.  How do we even find the right psychologist or resources in our area? Should we home school him or put him in private school? 

Any insights would be helpful.

Hi, Private schools generally do not have the mental health resources to help children with emotional problems, unless it is a special education type school specifically set up for children with emotional issues. Home schooling is a temporary option but I would not recommend it long term because your child would miss out on developing social skills with peers, and because home schooling puts a lot of pressure on the parents to be both teacher and parent.

What I would recommend is first making a chart of when your son loses control at home and at school.  What is going on right before he loses it?  Look over time for themes for some of the triggers.  Then think are there ways to work around the triggers, i.e. avoid them.  Or could you or the teacher forewarn your son that a potentially difficult situation will be occurring and help him think about it differently.  In my manuals I encourage parents to develop mantras, or sayings, that help the child to look at situations differently and to stay calm.  For example, if losing a game is a trigger, the mantra could be "everyone loses sometimes" or "even (the name of a person he admires) loses sometimes." 

Also if you can catch the anger before the overload phase, which is hard to do, you can use emotional distraction, which I explain in earlier posts and in my manuals.  Some children do better with a verbal label for their feelings rather than emotional distraction or mantras.  For example, if you catch it early, suggest to him "that's frustrating."  In other words, you would empathize and give him a word that is socially appropriate to use when we are angry.

See what works for your child.  If the outbursts don't slow down at all, ask your doctor for mental health professionals in your area that work with children and families.

Best, Dr. Dave Gottlieb