How do you teach self-control?

I found your blog while looking for info on excessive anger in children and the person’s post on June 23 is where I am as well.  I am a “retired” Pediatrician who now home schools and the angry child is the youngest of 4.  I’m at my wit’s end and also looking for therapists. My child is bright, even precocious, and he’s always “hated being the youngest”.  I know his older brothers like to tweak him, too, and that’s normal, but his response is not.   The thing is, I feel like I’ve tried most of what I see suggested online. He does get physical, though, and I often have to pry him off of his sibling before I can send him to his room or talk to him.   I also know how sweet the child is after he’s calmed down, alone in his room.  Is my child going to be any more likely to try the “control methods” because a therapist suggests it?  Will going to an outside, objective person be more effective?  We just want the yelling/outbursts to stop—we’ve given him so many alternatives to that. 

I’ve heard there are some who “enjoy the rush of their anger”.  I struggle with anger, so I have some understanding of what this may mean, but a child?  I remember this child at around 2yo, with a viral illness, giving a guttural yell in an attempt to not vomit…which of course ultimately failed.  It was funny at the time.  I was sitting with him and the bucket for a few hours---and he did it every time the urge to vomit came.  So this makes me think some of this is “innate” and not a learned/developed behavior.  Am I looking for excuses?

This child is in his room today, grounded all day, which means he lies in his bed, no books (the height of torment in our house), staring at the ceiling.  This was my husband’s idea and I rejected it at first (the length of time, not the punishment), but maybe this will get the point across.  He is out for meals and some chore work only.  I just worry that an angry child will stew and get angrier with this, though—as opposed to something immediate and short.  But besides spanking, I don’t know of anything else like that.  I’ve been toying with a calendar of anger-free days with a large-ish reward at the end of a month.  Is that reasonable?  The only way it would work is if it restarted after each “failure”, but I honestly think this child would just give up—it would be “too much”.   One month to create a habit, right? 

I saw your blog and the opportunity to email.  I have a list of counselors but honestly am scared stiff about finding a “good fit”.  It seems more like a parenting/spiritual development issue which we should be able to handle at home.  I appreciate you taking the time to read this and would be interested in any comments or suggestions.   Thank you.  

Hi, The problem with rewards and punishments is that once in the overload phase, most children are not thinking rationally; that is their emotional brain (the limbic system) has temporarily overwhelmed their rational self-control mechanisms ( "powered" by the prefrontal cortex).  In order for rewards and negative consequences to work, a child would have to think to himself:  I've got to control this outburst because I don't want to lose this privilege or potential reward.  Most children in overload will be extremely emotional and not be thinking this way.  Even adults when highly emotional say and do things they later regret.

So the key is to build up a child's self-control mechanisms over time and to focus on techniques that can be used early in the anger sequence when a child is thinking more rationally.  I realize this is not always possible because children can "heat up" so fast.  In my parent's manual, I outline ways to pick up signals that a child is close to "blowing up" and I suggest ways to "re-route" a child's thinking and behavior.  First, it is important to  observe what happens before a child explodes.  Try to identify some of his triggers (though sometimes the outbursts will come out of the blue).  You mention that his brothers "tweak" him.  When you see this happen, one approach would be what I call in my book "emotional distraction."  You try to come up with a remark or an activity that your child finds amusing, stimulating, or in some way grabs your child emotionally. It is hard to get angry if you are laughing or excited about something else.  This strategy works best if you can catch the "frustration" before your child is in the overload phase.  Once a child is in overload, it is usually best to say or do as little as possible until the child is calmer.  You do not want to inadvertently "reward" the outburst by giving your child a lot of attention at that time.

Other techniques that parents can use (and that I explain more about on the blog and in my manual) are a) change the sequence to avoid the anger-arousing stimulus, b) lower expectations (if anger comes from high expectations that a child has), c) create a relaxation station in your house, d) teach your child a jingle that helps him change his mood, e) intervene with your older children when they "tweak" your younger son.  All these approaches are initiated by the parent.  I'm not sure how old your child is, but as he gets into his pre-teen years (and sometimes before that) you can teach him ways a) to change his perspective (or to consider other people's perspectives in addition to his own), and b) to use "cue words" or a "mantra" to help him relax, and c) to work on compromise with other people.  The second half of my manual explains how to help children develop techniques that they can use themselves when adults are not around to prompt them.

Basically, what all the techniques are designed to do is stimulate the self-control centers of the brain.  It is like exercising a muscle in a sense.  It takes time and continued practice, but you can help your son develop self-control.  Once he sees he can have some success, he will feel better about himself and he will be more engaged in the process.  So start with the techniques in the first half of the manual (that are directed by the parent) and then after a few months when you see some progress,  consider moving to the second half of the manual (where you teach him techniques to use himself).  

All the best, Dr. Dave Gottlieb

Finding a therapist who knows about anger overload

I have been struggling to find out what causes my 8-year-old's anger issues since he was a toddler. I recently discovered an article written by you about "anger overload" and it seemed like you were writing this about my son. I have never felt like anything else has explained his behavior before so reading your article really helped me feel like we're not alone. I also just purchased your manual on amazon and I should receive it Wednesday.

I am emailing you for advice because after my son's anger outburst last night I have realized that our family needs help. It's not fair to our family or my other son (10 years old) to spend our lives walking on eggshells because we're afraid to set off our 8-year-old son. Therefore, I'm now online researching therapists or counselors who can help us get a handle on the situation. None of the ones I see use the words "anger overload" in the descriptions of the types of issues they treat. How do I find a therapist who knows about anger overload??? I really feel like that 'diagnosis' is 100% accurate. It's uncanny to me how on the money it is.... But if a therapist hasn't heard of it, I wonder if they can help?

Any advice is appreciated.

Hi, I coined the term "anger overload" about 15 years ago after seeing a number of children with this problem, and finding that there were no books to help parents with this issue.  It has not been covered in the mental health manual put out by the American Psychiatric Association, though the new 2014 diagnostic manual comes closer with the diagnosis of "disruptive mood dysregulation disorder" (abbreviated as DMDD).  You could ask if the therapists in your area have worked with children who have this diagnosis or with children who have "repeated angry outbursts."  In my manual I explain the difference between anger overload and disruptive mood dysregulation disorder, but the psychological treatment approaches would overlap.  

Also, I would suggest showing the therapists my manual and ask if they use some of these strategies in their work.  Most child and family therapists who have some background in "cognitive behavioral therapy" will be familiar with some of these techniques.  It is important that you pick someone who strategizes with parents (or with the entire family)  in addition to talking with your son, because children often have trouble implementing the strategies on their own at home.  Their anger occurs so quickly and so intensely that they need assistance for a number of months in order to learn to change their mental set quickly before their anger reaches the overload phase.  

You will see in my manual that the first half teaches parents how to implement strategies without the direct involvement of the child in the planning stages.  The second half of the manual has strategies that parents and children work on together.  All the best, Dr. Dave Gottlieb

Is anger overload a biological problem?

Hi, I have a now 8 yr old son with every year becoming more aggressive and angry. He shows signs of ODD (oppositional defiant disorder) and by learning just now of this anger overload I believe that is a factor. He has had rages since toddler yrs. He would bang his head in tantrums progressing by age 2 to throwing chairs in fits. He is brilliant and the loving one when not angry. He cannot simply say no. He will scream in your face, sassy, and not a care of earning or losing anything. The rages are continuous throughout the day and just had one episode ever in a school when a girl knocked down stuff of his: he screamed right in her face till she cried and he knocked all of her things down. He said it is very hard to keep control throughout the school day. At home there is no control. I have been working in behavioral health with children and cannot help my own child. Is this a chemical thing or just plain rage? Thank you.

Hi, When anger overload has been an issue for years, it is likely that there are developmental delays in the brain such that there may be a) "weak" communication between the emotional centers of the brain and the self-control centers of the brain, or b) the emotional centers of the brain may be overactive, or c) the control centers of the brain may be underactive.  The amygdala is one part of the brain that is aroused when we get angry, while the prefrontal cortex is a part of the brain that helps us exercise self-control.  We do not know yet exactly which part of the brain is not responding adequately in children with anger overload.  With new imaging equipment (like CAT and PET scans) we hope to know more in the years to come.

However, "exercise" can help brain development.  That is why it is important to work with your child on self-control strategies.  In my parent's manual, I explain ways to help children develop better self control.  It takes time and practice, since we are dealing with brain development and with strong emotions.  But it will make such a difference in your child's life once he can control his anger better.  Look through other posts on my blog or check out the strategies I describe in my parent's manual, and see which ideas make the most sense for your child.  Sometimes it also helps to consult with a mental health professional in your area to rule out any other issues and to fine tune the strategies for your situation.

All the best, Dr. Dave Gottlieb 

Punching bag and violent cartoons

Hello,  I am the mother of an 11 year old daughter.  Her diagnosis included ADHD and Auditory Processing Disorder. She has a severe reading disability with a reading level 2 years behind her class.   She is a sweet, well mannered, animal loving girl, with difficulties negotiating social interactions. 

 

My daughter has had difficult emotional outbursts through out her life.  Usually they are an explosion of built up anger, typically a month or two. They include screaming, hitting the bed, crying and then an utter break down and last about 1/2 hour.  She discusses these episodes frankly and asks "Why am I an angry girl?"  We have many discussions about anger control and management.  She has come a long way.  But, she is one of the biggest girls in her 5th grade class and strong.   And, when she is in her rage,  she talks about hitting people in the face.  Although, she knows this is wrong, and has thus far been able to control it, my concern is mounting as she approaches Jr High. 

 

Yesterday she saw a boxing match on TV and decided she would train to become a boxer to release her anger.  (much to her parents dismay)  She has found Pokemon, Teenage Mutant Ninja Turtles and Power Ranger as her favorite TV shows and often acts them out in her alone play times. 

 

Your article about Anger Overload sounds like my daughter.  Thank you so much for describing this issue in such clear terms.  I will be getting your book on Anger Overload.

 

My question is:

 

Are the fighting cartoon shows an acceptable outlet for her emotions, or are they to her detriment? 

After the outburst this week, she told me she wants a punching bag for the basement.  Would this be helpful, like an in home OT session? 

 

I would really appreciate your help.  Thank you so much.

Hi, A key issue is helping kids understand that feelings are okay but hurtful actions are not.  I help children understand what caused them to feel angry and also help them feel that anger is a normal emotion, but I also explain that while it can be hard to control, it is very important that we work on ways to control it.  We then talk about alternative actions that are socially acceptable. For some children, a physical outlet is helpful, while others prefer to talk out their feelings, and still others prefer to distract themselves with music or computer games.  I try to help children think of several possible actions and empower them to pick the one that they want to try on a particular day.  So their reaction can vary depending on the circumstance.

 

Boxing and a using a punching bag are socially acceptable alternatives.  It is important though that your daughter understand  that it is not okay to use punching against other people in school or at home.  It is okay to practice and let out tension so long as no one is hurt.  Then I would monitor her behavior over the next month to determine whether there is a change in her acting out her anger against others.  As long as there is not an increase in aggression (and hopefully it helps her with self control), then continue to allow her to use the punching bag. Maybe she can learn to use it effectively as a tension reliever before she gets to the anger stage, and thereby lessen the likelihood of her reaching anger overload.

Fighting cartoons are a favorite of many children.  Some studies suggest they do not increase violent behavior of children, and other studies say there can be an increase in aggression for some children, particularly children with poor self control to begin with.  Since your daughter has not been overly aggressive towards other people, I would lean toward letting her watch the shows she wants.  You might also talk with her sometimes about a cartoon, and discuss why the character reacted the way he/she did.  Then you could talk briefly about the difference between fantasy (cartoons) and reality (school), and discuss what she could do if threatened is some way in school.  I generally suggest parents be aware of what their kids are watching on television and join them sometimes, because then after the show parents can sometimes talk about the theme of the cartoon and how it might relate (or not relate) to everyday life.  Do not overdo the discussions though, or your child may only want to watch her cartoons alone!  See how your child reacts (don't push it if she doesn't want to talk sometimes)  and pick cartoons that seem more relevant to everyday life.

All the best, Dr. Dave Gottlieb

Bipolar disorder? 6 yr.old outbursts since age 2

Hi Dr. Dave,

My son is 6 years old and trying to complete his first year of kindergarten. He was diagnosed with ADHD and ODD in September 2014 after a series of issues he was having in the classroom.

Some history: He was asked to leave several preschools since the age of 2. Many discussions were about his inability to control his impulses, and was simply too much to handle. He started becoming more violent over the last 2 years, picking up chairs and throwing them across the room, turning over book cases, throwing anything he could get his hands on in the heat of the moment. It does not seem that he is trying to hurt anyone, he just looses it.

Recently, he has been suspended from school because of an angry outburst. His outbursts at school range from yelling, ripping up his classwork, throwing chairs, throwing his shoes, etc. Teachers have struggled trying to figure out what triggers him. He does express this behavior occasionally at home, but we have only seen him triggered by something that gets him angry; his little brother getting something that he wanted, loosing at a board game, getting privileges taken away if he had a bad day at school, etc. We have also seen him triggered by being embarrassed or asked to go into a large and loud crowd of people (i.e. school plays). We as well as multiple teachers have seen him get a glazed over look, like he isn't there when he is going through a rage. The rage will last less than an hour. Typically after it seems like he looks around at a destroyed room and doesn't know what happened; that he did it. He can't express why, even when asked to draw a picture of what upset him; his answers are always "I don't know". He will start to trigger again if we press the issue, as if he is getting increasingly upset that he did the things we are telling him.

We tried Ritalin and Concerta, but he would be extremely tired and over emotional (crying for no reason). We stopped the meds and have been to multiple physiologists/psychiatrists and behavior therapy and have found little help. The school seems to be loosing their patience and it feels like they are giving up on him. We don't know where to go from here.

Any advice would be more than helpful.

Hi, I can see you have been working on this issue for several years with little success.  It does sound like anger overload, and I can suggest some strategies, but you would also want to rule out additional diagnoses:  a mood disorder, high functioning autism, and fetal alcohol syndrome.  The latter two are unlikely, but make sure the doctors have ruled them out.  It is possible that your son has a mood disorder, namely pediatric bipolar disorder, and while this is not a very common disorder, it can occur along with anger overload.  With bipolar disorder, the changes in affect (such as angry outbursts) alternate throughout the day with periods of calm or periods of dysphoria ("down" mood).  The bipolar child is impulsive and wants his needs met immediately.  Often these children are "revved up" and on the go.  So it is not unusual for doctors to first consider ADHD, because it is a more common diagnosis and is also marked by impulsivity and hyperactivity.  Since your child did not respond to ADHD medications, it is possible that there is a different underlying biological pathway, such as what can occur with bipolar disorder.  Some studies of bipolar children have found weaker connections between the amygdala (one of the emotional centers of the brain) and the frontal cortex (that helps to control emotional responses).  Several major medical centers in the country have pediatric mood disorder centers investigating this diagnosis and its biological underpinnings.  The University of Illinois in Chicago is one such center. 

Whether or not your child has pediatric bipolar disorder, there are strategies that I outline in my parent's manual and in this blog that can help.  But if there is the additional bipolar diagnosis, medication may be helpful too.  You have observed some triggers at home, and it would help if the teachers could record what is going on before an outburst happens in school.  The idea is not to try to interpret what is going on at school right away, but just record what is going on in the classroom before an outburst occurs.  Then look back over several weeks, and try to notice patterns.  The reason is that if you can avoid some triggers, or at least see early signs, interventions will be more effective.  As you have noticed, once a child is in the overload phase, it is extremely difficult to reach them, and then it is usually best to say or do as little as possible, as long as the child is safe and not hurting anyone else. 

For young children, in my manual I write about a) changing the sequence to avoid a trigger, b) lowering expectations (as high expectations can lead to frustration and then to an outburst), c) emotional distraction, and d) developing a calming station.  You can read more about how to implement these strategies in my parent's manual and in other posts on this blog. 

All the best, Dr. Dave Gottlieb

8 yr old's frequent tantrums affecting marriage

Hi Dr. Dave,

I am a stay at home mom of a 3 year old boy and 8 year old daughter. I am at the end of my rope and losing hope.  My son for the most part is a very a calm, mellow, obedient child who can entertain himself and this bothers her. She is a beautiful loving child and mostly only acts out at home. My daughter has had anger issues since she was about 2. I have tried everything, behavioral therapist, psychologist, I've done Total Transformation, and brought her to a Pediatric Neurologist. She was tested for ADHD and does not have it. We go to church on Sunday and have always been on top of discipline with our kids. I am trying a new Behavioral Therapist next week. Nothing has helped and it seems to be getting worse. It has put a huge strain on my marriage which is crumbling and disrupts my day, everyday when she is home. I have bad anxiety, cry when they finally go to bed and can't eat most of the days.  My husband works long hours so basically I am alone Monday-Friday except for the mornings.

My daughter's anger is so out of control she yells, has tantrums, throws things, kicks and screams. Homework is absolute torture with tantrums and timeouts, and takes almost 2 hours everyday. She picks on her brother and fights with him constantly. She says things like: hate, die, dead which is so upsetting. Whenever she acts out she is put in her room for a time out but has to be dragged there, refusing and yelling the entire way. When she doesn't stay in her room I close and lock the door, which the lock is on the outside to keep her in,  when I eventually get her off the door knob. I open the door when time out is over and she comes out but not for long. Bedtime is a huge issue: she doe not like to go to bed or sleep alone so now she has told her brother if he sleeps alone he will have nightmares and bad dreams so he now cries and is afraid at bedtime. She undermines me and goes in his room and tells him to come sleep with her. She also cries a lot at bedtime and says she's sorry for her behavior and i feel bad because I know she can't control it, or doesn't want to.  We have a set schedule for everyday and she battles with me everyday to brush her teeth get dressed, get out the door for school, do homework, eat dinner..... She does not want to participate in any activities and says they are boring, I had her try soccer, girl scouts and summer camp. I can't take on the battle again of getting her ready and out the door for activities. Currently she is in dance but that's a battle every Friday. My kids want for nothing and maybe that's part of the problem but when she's home she says she is bored and walks around aimlessly and eventually starts an issue.  I am embarrassed to go out to eat with them or even have people over because they eventually end up fighting, misbehaving and creating a scene.  I could go on and on.........

I am very close with my Mom and just wanted that with my daughter but I feel like we have missed out on so much because she spends a great deal of time in her room because of her behavior and I have become a prisoner in my own house. This is not fair to my son. I love her dearly and just want my little girl.

Any advice is welcome, anything.....

Hi, It does sound exhausting to deal with.  I would try to strategize for one problem situation at a time, a) homework, b) bedtime, and c) going to activities.  For homework, I wonder what the difference is for her to do the work at home compared to school.  You mention that she does not cause problems at school.  I would talk with her teacher to see how she works with your daughter and then try to do similarly at home.  You may even meet with your daughter and the teacher together to talk about homework, and have the teacher reinforce her for completing homework in a timely way (you would fill out a brief check sheet for the teacher each night to let her know the basics of how it went).

For bedtime, I would consider having her sleep in the same room with her brother since it seems she is scared to sleep alone or she dislikes being alone at night.  Rather than get into a struggle each night, try to re-arrange the situation (if possible) to avoid conflict.  Unless you feel it is not a good idea for them to sleep in the same room, I would try it and see whether that makes a difference.  In my parent's manual, I write that sometimes you can avoid a tantrum by re-arranging situations to avoid some of the triggers.  

Regarding after school activities, I would talk about the importance of picking one activity, and let her pick the activity she wants.  By giving her some control, it may help avoid a struggle.  Also, be sure to do something fun after the activity if she gets ready on time; for example, maybe stop for ice cream some nights, or go to a favorite park to play after the activity.  If something fun comes afterwards on the days she gets ready on time, it may help her learn to cooperate.

Remember that during a tantrum, say nothing, or as little as possible.  Any attention during a tantrum tends inadvertently to reinforce it.  In my parent's manual, I describe other strategies, and see if your new behavior therapist can help you implement these at home.  On the positive side, you said she does not show these behaviors in school.  That tells me she can control herself better if you can figure out some of the triggers at home.  

My guess is one other issue might be that it is hard for her to do things at home by herself; she doesn't sound like she likes solitary time.  The basic idea then will be to try to give her some time with you or someone else when she cooperates (can she join you in the kitchen or in some way help you?) but not when she tantrums. And think about whether there is a hobby (artistic or musical maybe) that you can start out working on together and that she can then do sometimes alone (and show you later in the day what she accomplished).  Be sure to check out other blog posts or my parent's manual for other strategies.

 All the best, Dr. Dave Gottlieb  



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8 yr old hits parents

Help!  A friend of mine sent me one of your articles and I felt like you were in my family room watching my daughter have one of her tantrums.  It’s getting so hard that I don’t know what to do.  She becomes incredibly violent and yells, kicks, punches, hits and then hits some more until she is at a point when she is ready to calm down.  She only will do it for me (her mother) or sometimes her father.  It never happens at school, camp or a friend’s house – just when me or my husband are around.  If she doesn’t get exactly what she wants when she wants it, if she gets frustrated or even if we look at her in a way she doesn’t like…she goes from 0 to 80 in half a second and there’s no stopping her.  We’ve tried everything…remaining calm, yelling back, ignoring her, hitting her back, locking her in her room, locking us in our room, hugging her and holding her tight, making her laugh…I mean everything and nothing works until she’s ready.  These can last anywhere from 20 minutes to an hour and a half.  It is completely destroying our family!  Imagine walking on egg shells whenever she’s around so she won’t get started.  We’ve been to 3 therapists and nothing seems to work.  We’ve done the rewards and punishments…that works a little, but not enough.  

Recently she created a list of 10 things she can do to calm down and I would give her a point for each one she does.  When she gets to 10 points she gets a reward.  Sounds great, right?  When she’s in the throes of her tantrum, she wants nothing to do with the list and would rather just keep hitting me.  I cry because it’s the most horrible thing to just sit there and take the abuse.  It’s also very difficult because after she’s done hitting me, I have to be the one to calm her and snuggle her and love her – talk about having to turn your emotions around and sometimes I just don’t want to.  And then I’m so incredibly hurt, on the inside and out, that I don’t want to be around her and don’t talk to her.  When she’s good, she is the best child a parent could ask for.  When she’s in one of her tantrums, you just want to run away.  This has been going on for several years and has seriously taken a toll on our family dynamic.  My poor son (11 years-old) loses out because we can’t go places because of her or she will go after him and start hitting him for no reason.  It hurts him very much to see the way that she treats me.  Again, at school she is the perfect angel and her teachers don’t believe me when I tell them what happens at home.  Any suggestions???!!!

Thanks for letting me tell my story.

Hi, It sounds so hard on everyone in your family right now.  As you noticed, when children rev up, rewards and consequences do not work well.  Children with anger overload are not thinking rationally during the overload phase.  During this time, when your daughter is striking out against family members, I would recommend restraining her, rather than letting her hit you.  I know this will be difficult and may take two of you.  But I would bear hug her and lie on the floor, or one of you grab her arms and the other parent grab her legs.  I know she will hate this and fight you, but you are then making it clear to her you will not allow anyone to be hurt.  Do not talk to her while you are restraining her, and let her go once she has calmed down.  You may have to hold her again if she revs up immediately after you let her go.  

If you let her hit you and then hug her when she calms down, you have in a sense rewarded the negative behavior.  I know this is not your intention, but too much love after a tantrum may inadvertently send the wrong message.  I would recommend instead talking about something totally unrelated to the tantrum after it is over.  Sometimes it helps to talk later in the day about what happened when she got mad and explain how important it is to work on anger together.  The second half of my manual describes ways to talk with children about their anger.

  

Since she tantrums mostly with you and sometimes other family members, I would consider hiring someone outside the family (if you can) or have a relative come by if you and your husband can't be there together.  That way you have someone to help if she tantrums, and furthermore it may discourage her if another adult is present.  I would only do this temporarily to try to break the cycle.

Another idea is to make a list of what preceded each tantrum, and then try to think of a way around some of those situations.  Granted you will not be able to predict many of the tantrums, but if you can avoid some of them, it will help you keep your sanity!   Look for patterns: are there times of day when she mostly tantrums, or during certain activities (or when stopping a favorite activity)?  In my parent's manual, I talk about "re-arranging the sequence" to avoid some triggers.  If you can't avoid a trigger, then sometimes predicting out loud that some chore  or activity is coming up that she will not like and then saying that "you  don't think she will be able to do it without a tantrum so you are getting ready to restrain her"--this may cause her to show you she can do it without a tantrum.  Just try this last idea once or twice; it may or may not work.  For children who are extremely oppositional, it sometimes helps to predict a tantrum because that can motivate them to show their parents that they can control themselves.

Once you reduce the frequency of tantrums, then the other strategies in my manual will be helpful.  But first she has to see that tantrums "do not pay."  And it will be a struggle for a few weeks, so wait until you and your husband are ready to try to break the cycle.  Even after a few weeks, there will sometimes be tantrums, but if you cannot reduce the frequency, get a psychiatric consult to rule out pediatric bipolar disorder. and/or check with a psychologist who works with parents on how to deal with angry children. Also, keep in mind that biological factors often play a role in extreme anger, and that as your daughter grows, the brain structures that deal with anger should also grow.  So hang in there.  I can tell you are trying really hard.  

All the best, Dr. Dave Gottlieb