Friday, January 17, 2014

Anger Overload

I have a usually wonderful first grader, King Boo, who has high anxiety and is prone to fits. My BFF and I call him mini Sheldon Cooper from Big Bang Theory. He is incredibly smart, like crazy scary smart, but must have things just so or total meltdown will occur. When he was younger, meltdown usually looked like biting and hitting me. That's faded, mostly, and we're down to just screaming, yelling, tears and throwing things. Last week when we were stuck in the apartment after the blizzard, he had several fits of epic proportions beyond that which I had seen in months. He screamed in my face, cried, threw things, bit me, hit me, kicked me, it was awful. He looks possessed, the rage is all consuming and it is pretty close to impossible for me to stop him from raging. He has to let it all out and eventually he will calm down where we can talk. These usually last 20-60 minutes, a long utterly horrible 20-60 minutes that I eventually go hide in the bathroom until he calms down enough that we can talk. 

I have looked and looked for answers to why my child rages. I wondered about sensory processing disorder, perhaps he is raging because he simply cannot control the sensory overload and his higher brain functions have shut down. Sensory processing disorder is an extremely complicated situation with lots and lots of different signs and symptoms. Some of which he does fit. He does crave tactile contact, likes spinning and motion, is always in motion, has trouble sitting still, and has NO clue about personal space. And while I do think he might have a touch of SPD, it doesn't really explain his rage..

So I investigated ODD (Oppositional Defiant Disorder) and when you examine the symptoms (from mayoclinic.org) you can see he fits part of them:
  • Have temper tantrums  - YES
  • Be argumentative with adults - Sometimes
  • Refuse to comply with adult requests or rules - The ones he doesn't agree with
  • Annoy other people deliberately - Nope
  • Blames others for mistakes or misbehavior - Yep
  • Acts touchy and is easily annoyed - Yep
  • Feel anger and resentment - Yep
  • Be spiteful or vindictive - Not even a tiny bit
  • Act aggressively toward peers - Rarely
  • Have difficulty maintaining friendships - Nope
  • Have academic problems - Not academic, he's always top of charts
  • Feel a lack of self-esteem - Yes
So he does have some, but not all and he is not even a little vindictive but a sweet, caring child.  He genuinely hurts when people around him are hurting. The more I would read about ODD the less it felt like it really fit him. So I kept looking (isn't Google a wonderful thing!).. I finally stumbled across a blog which led me to an article on something called Anger Overload. It's not a recognized disorder but the article really spoke to me about King Boo. A brief excerpt from Dr. Gottlieb below (emphasis mine):
The term "anger overload" is used to refer to the intense anger response which has been the presenting problem for a number of young children and preadolescents seen in a suburban outpatient practice. There is an intense and quick reaction by the child to a perceived insult or rejection ...[section cut]... Parents often explain to the mental health professional that these reactions have been going on since early childhood in one form or another. It is frequently reported that these children become sassy and disrespectful: they will not stop talking or yelling when they are upset. At other times, when their anger has not been stimulated, these children can be well-mannered and caring.

The problem is called anger overload because it is more severe than a temporary anger reaction lasting only a few minutes. With anger overload, the child becomes totally consumed by his angry thoughts and feelings. He or she is unable to stop screaming, or in some cases, acting out physically, even when parents try to distract the child or try to enforce limits and consequences. The anger can last as long as an hour, with the child tuning out the thoughts, sounds or soothing words of others.
As I read that all I could think was O. M. G. THAT is King Boo!! He is a well-mannered and caring child when his anger has not been stimulated but when he gets upset BOOM! RAGE! And he cannot hear me when he rages, tunes out everything but the red that fills his head. Now that I had catchphrase I quickly scoured the internet for more information. One of the big things was visual cues to help the child cut the anger off before it hits rage stage, once you hit rage stage you've gone too far.

I had to think about it but we did find a visual cue. Last week we started a bead system. There is a listening and non-listening cup and a cup full of pretty beads. Since most of our rages occur when he is told to do something he does not want to do, I decided to make this an exercise on listening and being obedient even when we do not want to hence "Good Listening" jar and "Bad Listening" jar. For the last week, every time I asked him to do something if he did it immediately I would praise him profusely and have him put a pretty bead in his "Good Listening" jar. But if I had to ask him more than once, I would calmly tell him that I had already asked him to do this once and now he not only had to do it but I would put a bead in the "Bad Listening" jar. The act of me getting the shiny bead into the jar was enough of a cue to get him to do the item instead of starting to fight with me and eventually hitting rage stage. It worked wonderfully for the first 6 days... yesterday we had a loooong drawn out conflict about homework. He earned four bad listening beads and only 1 good listening bead BUT I did not yell, which I have been working very hard to not let myself escalate as that only escalates him. And he did get close to rage but we calmed the situation and then I sat with him and we did get his homework done. So I will still count it as a win  :)

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