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.  

  

3 yr old with high energy and melt downs

Good morning,

I am the grandmother to an adorable three year old girl. I am also a social worker looking for answers. There is a history of mental illness in my maternal family with ADHD, OCD, Bipolar Disorder, generalized anxiety, and Schizophrenia. My granddaughter is usually friendly, loving and kind. However, when she has her "melt downs," she rages and screams, uncontrollably for up to half an hour. They occur a minimum of five times a week.  She contorts her body, twists her fingers, and has extraordinary strength.  She does not injure herself or breaks things.  

Any little thing can trigger her.  For example, her sandals came off and she wanted to put them back on instead of me, or she wants her teddy bear, but she wants someone else to retrieve it although it’s right next to her.  It’s almost as if a switch goes off in her brain and she needs to go through the melt down.  Sometimes she becomes fixated on saying certain words during her melt down and keeps repeating them.   Her parents and I have tried to see if there is a pattern, like if she is sleepy, tired, hungry, had too much sugar, etc.  But there seems to be no pattern.  

We have done time out, ignored her, but nothing seems to diminish them.   We talked to the pediatrician who said these are tantrums and she will outgrow this behavior.  But….. it doesn’t seem like a regular tantrum.  Additionally, she is fearless and a risk taker in the playground and at home.  She has lots of energy and can spend hours in the park, or jumping in those party bouncing houses without taking a break.  When she is watching a video clip on my phone that she likes or listening to a song, she repeats it like 25 or more times. Any suggestions or strategies we might use?  At this young age should we see a child psychologist or psychiatrist?

Hi, Given your granddaughter's high energy level, intense tantrums, and family history, I would recommend you consult with a child psychologist or child psychiatrist.  Your pediatrician is also right that it is not uncommon for three year olds to have tantrums.  But the family history and her high energy level makes it possible the tantrums are an early sign of anger overload and may not remit in the next couple of years without working on strategies to help her self regulate.  You would want to consult with someone who sees young children and their families.  I doubt they would suggest medication at her young age but they might recommend strategies similar to what I outline in my parent's manual.  My manual is designed so that you can use it on your own or with a therapist. 

In the situations you describe, she wants things her way, and rather than engage her when she seems ready to get into a power struggle, I would recommend trying "emotional distraction" or a relaxation strategy, if possible, before she erupts.  Emotional distraction means that you come up with a song, saying, or activity that changes your child's mood from one of irritation to silliness or happiness. You can sing her favorite song, or you can change the mood by bringing up her favorite activity or doll and asking her or the doll to play together with you.  Basically you are re-directing her, but in a way that just doesn't distract her for a moment, but changes her emotional state.  

Relaxation strategies for this age child might involve her hugging a large stuffed animal or wrapping her in a blanket or having her lay down on her stomach and rubbing her back.  Sometimes a spray with a cool fragrance can help a child relax.  I realize all these suggestions take up time, and you may not be able to do them if you need to get somewhere or do something else.  

If she does tantrum, try to give her as little attention then as possible until she calms down.  Since she is not hurting herself or anyone else during the tantrums, you do not need to restrain her.  By ignoring her at this point, you will not stop the tantrum, but you send an implicit message that she will not get your attention this way.  Over time (weeks or months) the tantrums may lessen in frequency or duration.

Part of what may be feeding the tantrums is her high energy level and high activity level.  Children who react quickly and intensely to stimulation are also prone to react quickly and strongly to frustration, and hence are more likely to exhibit anger overload.  So it will take time (again months) to see improvement in many of these cases, but working on strategies, like what I outline in my manual, are important to help children develop self regulatory (calming) skills.

Best, Dr. Dave Gottlieb

7 yr old acts out in school

Hello. I was reading about anger overload and that is totally my 7 year old son.  Every year since kindergarten my son starts school and it's like 5 months of craziness before he gets settled in.  He acts out in class, get aggressive with other kids, and ends up miserable and with no friends and obviously upset about it. He says he's a jerk, everyone hates him, that I (his mother) think he's a jerk or an idiot.  He's always touching other kids and annoying them.  He gets angry when he feels like things aren't fair or he's not good enough.  He's really smart though. Has no problems learning. I would even say he's a little gifted.. 

I don't know what to do and it stresses me out daily. I work full time and so does his dad.  My mom watches them most days.  When he's at home or with one friend he's amazing! Totally nice, sweet, thoughtful, loves his mommy and family very much..  I'm used to when I do go to school to drop him off or pick up I get dirty looks from parents and already know the teacher is going to tell me something he did wrong that day.  I try not to yell at him at all, when he's in a rage kicking his closet and punching holes in the door I let him be until he calms down.   I take things away for short periods of time, he gets grounded for a day or two, sometimes it works and sometimes it doesn't. It's hard because he's really great at home but when he's at school it's a different story.  He does sports, swims, skateboards, and is very active.  What more can I do. I'm so tired of this and I know it hurts him that he doesn't have super close friends and relationships with peers.  I don't want him to have to feel this way anymore.
Thank you!

Hi, You point out several scenarios at school when he is likely to blow, e.g. a) he touches other kids and annoys them, or b) when he thinks things are not fair, or c) when he feels he is not good enough.  Work with the teacher to review when these types of triggers are likely to occur. That is, a) what is going on right before he touches other kids, b) what does he not think is fair, and c) what is he doing when he does not feel he is good enough.  Let's take the first scenario:  Young children often want more attention from peers and will touch them to get attention.  Does he seem to want interaction when he touches others?  If so, you could practice at home how to get someone's attention without annoying them.  Role play a situation in class.  Ask your child who he wants to interact with and then practice a way that uses words and does not intrude on another person's space.  Or if your child does not want to role play, then make up a story at bedtime that "shows" him indirectly how to get someone's attention in school.  In volume two of my parent's manual, I explain how to use imaginary stories and also explain other strategies for school.  

Self esteem issues are often another trigger.  You mention that he sometimes does not feel good enough.  There are different techniques you can use here.  In the first volume of my manual for parents, I write about lowering a child's expectations ahead of time, before anger is triggered.  The teacher may be able to intervene and use a "mantra" like "everyone makes mistakes" at the beginning of assignments that in the past have triggered your child's frustration.   .At home you can reinforce the message by telling your child that you hope he made at least one mistake today because that shows he is learning something new.  Ask him to tell you about a mistake and be proud of him for sharing this information with you.

Fairness is another trigger for many children..  Often these children have difficulty seeing other points of view.  Here I recommend helping your child to expect that things sometimes won't go his way.  Also, in the second half of my parent's manual, I explain how to teach child about other points of view.

The underlying principle of all these strategies is to try to alter a child's way of looking at things before he gets upset.  Once anger overload occurs, it is more difficult to intervene because a child is not thinking rationally then.  It is usually better to say as little as possible when a child is in overload, and work on strategies, like those mentioned above, while he is calm.  If you can catch anger early, you can also use emotional distraction:  the teacher could try saying something that can change your child's mood.  Something silly or funny often helps.  It is hard to be extremely angry while you are laughing!  There is more about emotional distraction and relaxation strategies in my original manual for parents.

Best, David Gottlieb, Ph.D.

Behavior charts do not work well with 5 yr olds

Hello, I am in desperate need of advice. I have a 5 year old son and over the last year we have had many issues with his anger. He got kicked out of 2 day cares last year. Towards the end, we found a great daycare that would take him aside when he would get angry and take him away from the situation and take him on a walk outside. The director really took him under her wing and he started doing a lot better. But school ended and I was at home all summer with him and my other 2 year old son. We worked on a behavior chart and spent a lot of time together and he seemed to be doing well. We saw a therapist who suggested no yelling or spanking him and implementing the behavior chart w rewards. He started a new daycare this week. The first day he was okay, the second day he got upset and pushed his chair at his teacher. Then yesterday he had a very good day and he was very proud of himself. Then today he scratched another kid and hit him in the face for not playing the way he wanted to and then was hitting and kicking the director. So now he has been kicked out of the daycare. He was supposed to start Kindergarten on August 24th. I have no idea what to do. The therapist I took him to said he's too young to tell if he has ADHD and that he should do fine at school....well obviously not. And now when I call back, they tell me he was only an intern and is now gone. I need help.

Hi, With anger overload, the outbursts happen so quickly that behavior charts are not often very helpful.  For a reward to work, the child has to be thinking rationally and be ready to try to earn the reward.  But when a child is in overload, he is not thinking rationally and is not thinking about the rewards.  Sometimes charts can help if they target early signs of frustration and help a child choose a calming technique in order to avoid overload.  But this requires early recognition of anger arousing situations, and young children will need adults to help them recognize their emotional triggers.  

So first it is important to keep notes of what is going on immediately prior to an episode, and see over several weeks what triggers emerge.  Then you (or the teacher in day care) can either "change the sequence" or "lower a child's expectations" in advance in order to prevent anger overload.  Or if you can pick up signs that your child is getting frustrated, then you (or the teacher) can also use "emotional distraction" or "relaxation activities". (I explain more about the above strategies, the strategies in quotation marks, in my original manual on anger overload in children and in other posts in this blog.)   Basically, the adult is helping to catch and re-direct a child before he reaches the overload phase.  It is unrealistic to expect five year olds to monitor their own emotional states, and that is why it is important for the teachers and  parents to implement strategies.  

Last year's day care director who took your child out of the situation was on the right track. Avoidance and distraction are key strategies.  I explain how to implement all these strategies in a school setting in my second recently published volume entitled Anger Overload in Children:  Additional Strategies for Teachers and Parents.  Both the original manual and the second volume with additional strategies for teachers can be found on online book stores.

ADHD can lead to impulsive behaviors, and can contribute to episodes of overload. Psychologists who specialize in working with young children can help you diagnose whether this is a contributing factor in your child's case.

Best, David Gottlieb, Ph.D.