Helping ADHD kids with anger

[Snow]

It's been a terrible day.

 

How do you handle your kids anger? I seem to be fueling the fire more than helping to put it out.

 

Any help would be appreciated.

[MomatHWTK]

In my experience, once the child reaches a level 6 or 7 on the angry scale, there is no turning back and you have to let it flame itself out.  We work toward acceptable ways of burning off the adrenaline burst.  If you want to avoid the meltdown, you have to nip it before it gets to those levels.  We also work on the child recognizing the signs himself, but that is very hard and takes a lot of self-control.  Sometimes I do have to yell to snap him out of his state but we are both working toward avoiding that. 

 

Textbooks such as Mind Up and anger management programs for kids may offer you some specific tips.  A good therapist can help.  A daily dose of Intuniv may help.  I would personally start with a therapist to help you identify and address triggers. 

Here are a few resources you might want to take a look at:

 

http://www.teacherspayteachers.com/Product/Free-Anger-Choice-Cards-for-the-Classroom-Choices-for-What-to-Do-When-Youre-Angry-Anger-Managem-240972

http://www.freeprintablebehaviorcharts.com/anger_management_charts.htm

http://store.samhsa.gov/shin/content/SMA12-4213/SMA12-4213.pdf

 

[Mandylubug]

At that point, I refuse to engage. Send them to their room to mellow out. If they come out, calmly say bummer, etc. Rinse and repeat. Later will be easier to identify the triggers such as tired, hunger, stress.

[staysee34]

At that point, I refuse to engage. Send them to their room to mellow out. If they come out, calmly say bummer, etc. Rinse and repeat. Later will be easier to identify the triggers such as tired, hunger, stress.

 

This is exactly what we do,too.  As soon as I see it coming, it's off to her room.  I would probably handle it slightly different if there were any sort of warning but there isn't.  She's either happy and easy going or miserable and ticked at everything and everyone. 

[PeterPan]

I got Mind-Up, but it was sort of zipping over my 5 yo and not really clicking.  Or maybe I just wasn't buying in?  I actually have a theory on another way to approach it (using prayer/meditation instead of the bell and listening, since something I read online said they do similar things to the brain).  Zones of Regulation, on the other hand, is much more straightforward to implement and INCREDIBLY insightful.  It cost a pretty penny, but I'm finding it helpful and worth it.  He just had another blow-up tonight.  When I asked his SLP about it, trying to sort out if I've got a language problem or this or that problem or what, she suggested I keep a *log* of the meltdowns.  I thought that was good advice.  That would give you dates and help you notice patterns.  Then with him, getting words onto it, well it doesn't him but it helps me and helps us change the topic.  

 

It seems like for him, the blow-up occurs because he's not able to handle the extremity of what he's feeling.  So with Zones of Regulation, you're trying to put words to how he's feeling and get him down using whatever helps him transition.  In his case, it's so overwhelming that just saying to transition doesn't exactly do it, lol.  Unfortunately, he'd feel free to destroy his room if I put him in there.  Tonight I used a youtube video on Camp Invention to distract him and get him to thinking about other things.  Dh will be back soon, and then he'll put him to bed.  Ds has been doing more school work than usual, and he's very tired, which I think is adding to his difficulty holding it together late in the evening.  Again, that's something the log might help you with.  

 

The SLP also suggested looking at food, etc. etc. as causes.

 

Well he's finally in bed with Jim Weiss.  Wasn't pretty (screamed through his bath, etc.) but he's in.  I was realizing I let him eat a cow milk yogurt today, so that could be it.  

[73349]

There's a great book called What to Do When Your Temper Flares. It has helped DS some (one time when he "lost it" when we were away from home, he "found it" again and was able to resume the activity instead of needing to leave).

[PeterPan]

This is exactly what we do,too.  As soon as I see it coming, it's off to her room.  I would probably handle it slightly different if there were any sort of warning but there isn't.  She's either happy and easy going or miserable and ticked at everything and everyone. 

See this was where Zones of Reg was interesting to me, because she helps you see the in-between (what she calls yellow) stages.  She has pages of emotion faces and you actually categorize them and study them.  He's expressions seemed so inexplicable to me, going happy to sad and back and forth, but then I realized that under ZoR what he'll do like that is basically just different feelings in red zone, that he never really got OUT of red zone.  So red or yellow isn't so much a moral statement as an indication of control...  Seeing the yellow and knowing when you're making progress helps.

[Jennifer-72]

I really both zones of regulation and mind up. Another good read is the whole brain child. I think there are lots of helpful strategies in that book. For us we generally dealt with more a gamut of emotions then angry outbursts but zones and mind up really helped for ds. Zones provides such a reliable framework for kids having trouble with emotional regulation.

 

Also, just to approach it from another direction, how is he at overall problem solving? When children have difficulty with the higher order language and thinking skills of problem solving, you are bound to have outbursts. I like the ideas from raising a thinking preteen and also used lots of materials from linguisystems to develop ds's problem solving abilities.

[PeterPan]

I really both zones of regulation and mind up. Another good read is the whole brain child. I think there are lots of helpful strategies in that book. For us we generally dealt with more a gamut of emotions then angry outbursts but zones and mind up really helped for ds. Zones provides such a reliable framework for kids having trouble with emotional regulation.

 

Also, just to approach it from another direction, how is he at overall problem solving? When children have difficulty with the higher order language and thinking skills of problem solving, you are bound to have outbursts. I like the ideas from raising a thinking preteen and also used lots of materials from linguisystems to develop ds's problem solving abilities.

Ok, I have the Raising a Thinking Preteen book sitting in my basket of stuff from the library, and I've been trying to figure out why, lol.  What should I be noticing in it?  

 

Problem-solving?  Like what? Just anything rational and with steps?  You're saying the actual EF issues curtail and efficient, rational approach to handling their problems and emotions?  I just sort of assumed it was sort of, um, well I don't know.  I just didn't think of it as having anything to do with EF and would like to be enlightened.  Emotional regulation is EF maybe??  So then anything working on EF will help emotional regulation??

 

I'll go look at RTP right now.  I certainly need the insights, and my innards are being a little odd this evening.  Why stream a nice movie on amazon prime when you can curl up with a fascinating book on emotional regulation...

[Jennifer-72]

For ds I have seen a connection between his problem solving and his emotional regulation.

 

A child with poor problem solving is going to stay stuck in a frustrated state, they are unable to shift focus and dont have that flexibility pillar of EF skills to do so. Children with good problem solving abilities are able to look at a situation and identify the problem, the cause, come up with many solutions and weigh those options. That child's flexibility goes hand in hand with good emotional regulation. That isn't to say it is the only piece of the puzzle to a child's emotional regulation. As problem solving are indeed higher order thinking skills, it is often something that children with learning challenges are facing. I like raising a thinking child and rasing a thinking preteen because she takes all of the really quite complex skills of problem solving and breaks it down nicely.

[PeterPan]

For ds I have seen a connection between his problem solving and his emotional regulation.

 

A child with poor problem solving is going to stay stuck in a frustrated state, they are unable to shift focus and dont have that flexibility pillar of EF skills to do so. Children with good problem solving abilities are able to look at a situation and identify the problem, the cause, come up with many solutions and weigh those options. That child's flexibility goes hand in hand with good emotional regulation. That isn't to say it is the only piece of the puzzle to a child's emotional regulation. As problem solving are indeed higher order thinking skills, it is often something that children with learning challenges are facing. I like raising a thinking child and rasing a thinking preteen because she takes all of the really quite complex skills of problem solving and breaks it down nicely.

Thanks for explaining that!  Turns out those are the books I got from the library, including a workbook for the child book I think.  Guess I better settle down and spend some time with 'em!  :D

[Bree]

I don't have advice just stuck in the same spot with my 7 year old right now...very trying at times :)

[Snow]

Thanks everyone. Will check out those resources! It's just so hard for me not to get wrapped up in his drama. Especially when he seems relentless about trying to rope me in. I really need some distance, for both our sakes. Hopefully some of these books will help. Thank you again!

[ondreeuh]

I had no idea that so many people were dealing with ADHD and anger.

 

My 6 year old was first dx with ADHD, but when we tried a low dose of Ritalin (5 mg, I think) it curbed his appetite and he said he had a stomachache. Then he would escalate into a rage, which previously had been unusual (he would scream and get mad, but not attack us or threaten to jump out his window). So his psychiatrist said that his reaction to Ritalin pointed towards a mood disorder. We stopped the Ritalin and tried Abilify. Pretty much overnight he was about 80% improved on the frustration/irritability side of things, and he was much calmer.

 

After 3 months he started to regress, and by January he was as bad as he was on the Ritalin. Zero-to-60 with lots of physical aggression when he got set off. So the doc said to wean him off the Abilify, and now that it's out of his system he is SO HYPER. I kept him home last week just in case he self-destructed, and yesterday was his first day back at school. He had a sub but seemed ok. His regular teacher was back today and said he ran around the room in circles for the first 30 minutes. When asked to sit on the rug and participate in the morning meeting he had a meltdown, but did recover. The rest of the day he was OK, but thank goodness his teacher is extra flexible and understanding. DS was amped up and flighty (his mind all over the place) this afternoon. At swim lessons he acted like it was one big party, and at one point had to sit out because he wouldn't stop splashing. It took him a half hour to come out of the locker room because he and another boy were throwing their wet swim suits at each other while they were nekkid. (Yes, I'll wait in line for the one family changing room from now on).

 

After reading everyone's comments, I'm wondering if ADHD *is* the primary dx, and the anger issues we saw were just related to frustration and poor regulation. He's also pretty bright, which can correlate with extra sensitivity. Maybe the anger itself isn't pathological. Maybe he had a harder time on the Ritalin because he wasn't eating enough - he definitely does have eat protein all day long to stay in the sane zone. Hmm...

[PeterPan]

Andrea, have you tried keeping a log?  That's what our SLP told us to do.  Might help you notice those patterns, since in the moment you seem to have hints of an explanation.  The question is whether that's the explanation EVERY time.

 

 

[IanSebast]

Is your dc taking any meds?

[SweetMissMagnolia]

my ds has certainly gotten better about it the older he gets (he's now 11).....but oh boy I can relate.....I think kids need to be allowed to have emotions but not to put those emotions into hurtful actions.....if that makes any sense...I picked up a couple of books from amazon about the issue (I'm not bad I'm just mad-can't remember the other ones).....I try to get him to stop what he's doing and to take a break.....take a walk outside---take deep breaths----talk about what's upsetting him.....I've noticed lately that he will come back and apologize for the outburst and for whatever he said in anger.......if it's really stressing him out and he just can't manage on his own,I've given him homeopathic relaxing help (child relief calm---rescue remedies).....

 

In the past I've tried a punching bag in the backyard and that worked until he tore it up and pulled the stuffing out of it.....

[Snow]

Thanks irpstn, that's an awesome checklist! Thanks sweetMM for the book recommendation.

 

No he's not diagnosed and not on meds. I'm just pretty sure it's a factor given his behavior and family history.

[Snow]

Thanks irpstn, that's an awesome checklist! Thanks sweetMM for the book recommendation.

 

No he's not diagnosed and not on meds. I'm just pretty sure it's a factor given his behavior and family history.

[DWHS]

I found this thread after searching "ADHD anger." After reading through all the great responses, I ordered MindUP and Zones of Regulation. MindUP just arrived and I'm excited to start with it next week. Just wanted to say thanks and best wishes to everyone as they work through these challenges.

[LMV]

My husband's godson and our foster son has ADHD which escalated with puberty.  His dad died in the line of duty when he was a young adolescent and his biological mom was not in any position to parent then (or really any time before or after sadly).  My husband definitely earned his parenting stripes but they both came out on the other side healthy, reasonably happy, and with a very strong healthy "father"-son relationship.  

 

Things which helped/a few thoughts:

-Effectively treating the ADHD (initially with stimulants now as an adult he is doing very well with a non-stimulant medication).  Kids with ADHD often really struggle with impulse control and just can't hop off their wave well in other cases.

-Ensure underlying depression is identified and addressed as ADHD increases the risk for depression in children/adolescents.

-Adequate outlets for physical activity and exertion.  DH, DSS, and DFS built many houses with habitat for humanity during the boys adolescent years.  It was a physical outlet for them, an opportunity for service (DFS's eagle project developed out of this as well) and something that they all looked forward to doing together which was really important at that time.

-Parental understanding of what was a reasonable expectation at what time.  DH did very well with setting up for success but also holding accountable when appropriate.

-CBT can be very effective at helping manage escalating anger issues.  With younger children (or amenable adolescents) it can be helpful if the parents learn the skills/and techniques alongside the child because then they can model and encourage skills use at home between sessions.  This definitely helps in terms of consolidation.  DBT can also be helpful as an adjunct and with older adolescents.  Our experience/bias is with DBT building on CBT which seems more successful but others may have a different experience.

-The therapeutic foster program we worked through taught parents motivational interviewing skills and my husband believes this was what made the biggest difference at least in helping him parent the child in front of him the way that child needed to be parented.  

 

[Guest jamlogan]

Once I had done all my reading on 'How to.....' and implimented what I could, things had improved for my son (now 12).  However more could be done but I couldn't do it.  We ended up seeking out a Christian Psychologist who worked with our son without medications, using Neurobiofeedback.  This has made a world of difference for our son, and us.  Most of all, we spent, and still spend, a lot of time in prayer over him.  He is doing so much better now and is in far greater control of his emotions. 

[Jennifer-72]

How are things going now OP? Hope you have been having lots of calm days.

[Snow]

Thanks to the last few posters for sharing your advice and experiences. Soaking it all in.

 

Things are okay. We've still had meltdowns, but I've gotten myself back to a better place mentally/emotionally and have been handling things much better. Yea! I've been listening to him more, involving him in problem solving more ala explosive child and I think he can tell. Thanks so much for asking.

 

I created another thread a few weeks ago when I made an appt with a psychologist. Things have changed a little since then - Dh wanted to meet with the pediatrician one more time to see if a child psych was the best route or if we should go directly to neuropsych. It was good we did since the Ped was perplexed by ds and said he didn't sound like a classic case, that there is more going on than just adhd (inattentive) and that Np testing was the way to go. So dh and I have our introductory meeting with them next week. In an act of divine providence, I had researched and made an appt with an NP prior to this appt that dh wanted with the Ped. As it turns out, the NP center I called is the place the Ped had glowing recommendations for. Double yea!

 

Oh, and I bought raising a thinking child, mislabeled child and whole brain child (major deals at half price books!) and have started soaking in those ideas as well. Definitely been living the "who is teaching who" adage lately!

[Jennifer-72]

Oh glad to hear things have been relatively calm. Great news about the np! Love it when things work out like that! Hope the testing goes well and gives you some answers and new direction.

 

J

[PeterPan]

My husband's godson and our foster son has ADHD which escalated with puberty.  His dad died in the line of duty when he was a young adolescent and his biological mom was not in any position to parent then (or really any time before or after sadly).  My husband definitely earned his parenting stripes but they both came out on the other side healthy, reasonably happy, and with a very strong healthy "father"-son relationship.  

 

Things which helped/a few thoughts:

-Effectively treating the ADHD (initially with stimulants now as an adult he is doing very well with a non-stimulant medication).  Kids with ADHD often really struggle with impulse control and just can't hop off their wave well in other cases.

-Ensure underlying depression is identified and addressed as ADHD increases the risk for depression in children/adolescents.

-Adequate outlets for physical activity and exertion.  DH, DSS, and DFS built many houses with habitat for humanity during the boys adolescent years.  It was a physical outlet for them, an opportunity for service (DFS's eagle project developed out of this as well) and something that they all looked forward to doing together which was really important at that time.

-Parental understanding of what was a reasonable expectation at what time.  DH did very well with setting up for success but also holding accountable when appropriate.

-CBT can be very effective at helping manage escalating anger issues.  With younger children (or amenable adolescents) it can be helpful if the parents learn the skills/and techniques alongside the child because then they can model and encourage skills use at home between sessions.  This definitely helps in terms of consolidation.  DBT can also be helpful as an adjunct and with older adolescents.  Our experience/bias is with DBT building on CBT which seems more successful but others may have a different experience.

-The therapeutic foster program we worked through taught parents motivational interviewing skills and my husband believes this was what made the biggest difference at least in helping him parent the child in front of him the way that child needed to be parented.  

Thank you for sharing, LMV!  What is DBT?  I know the term CBT but not DBT, oops.  I didn't realize CBT could help this, which of course just goes to show how little I know.  How do you know you have a good practitioner for these things?  And can you tell us more about motivational interviewing skills?

[PeterPan]

Kate-I'm glad to hear about your good changes and that you're able to get in with a neuropsych!  And yes, that's some Divine Providence that the one you found turns out to be highly recommended!   :hurray: 

[LMV]

Thank you for sharing, LMV!  What is DBT?  I know the term CBT but not DBT, oops.  I didn't realize CBT could help this, which of course just goes to show how little I know.  How do you know you have a good practitioner for these things?  And can you tell us more about motivational interviewing skills?

 

DBT stands for Dialetical Behavioral Therapy.  Technically it is actually a variant of CBT but it has evolved much into it’s own little branch now.  DBT aims to improve emotional regulation using taught and reinforced skills to improve concepts of distress tolerance, mindful awareness, and acceptance.  Most DBT now is delivered as a combination of individual and group.  Patients might have one individual session weekly with the therapist and then attend a group facilitated by the therapist one or two additional times per week.  Success with DBT (or really any skills based behavioral therapy) requires commitment to the approach, follow through and use of skills, and sufficient time for consolidation (probably at least 6 months with most standard individual/group scenarios).  Consolidation will be more difficult with treatment gaps, and is often harder with younger children.  Many people don’t use DBT until at least mid adolescence for this reason.  Some providers have offered DBT to younger kids with a concurrent parent DBT group as well and relied on the parents to encourage, model, and facilitate skills use at home.  I believe there are also a few therapeutic residential programs using this and relying on their house parents in this same role.  They probably also have additional groups but we don’t have any direct experience.  Even with all this sometimes you may need to accept that the patient just isn’t cognitively ready for this form of therapy.  DFS did DBT during mid/late adolescence so we didn’t run into this issue.  

 

Our experience with behavioral therapy with younger kids is more from our DD14 (when she was DFD11) and we were attempting TF-CBT for PTSD.  We maximized everything possible for outpatient success.  She had twice weekly sessions (which was really the most the therapist could accommodate) with a skilled therapist, DH and or I attended all sessions so we could model and encourage skills use at home.  We also videotaped sessions if both parents couldn’t attend and watched them after she went to bed.  She mastered skills she just couldn’t use them in the moment which was the problem.  Ultimately DH traveled with her to an out of state partial day trauma treatment program which was built around TF-CBT.  They did five sessions a week plus additional adjunctive art therapy, trauma processing group etc.  It was a difficult three months but that made the difference and then she was able to maintain and even progress further after our family reunited and she went back to working with the prior therapist.  

 

As far as finding certified therapists the ABCT website is a good resource and has a searchable directory. ABCT

 

Motivational Interviewing is a focused and goal oriented therapy.  I believe it originally emerged from the adult substance abuse world but can be individualized to situation and patient.  The therapist facilitates already existing (even if buried and unrecognized) intrinsic motivation for behavior change and then continually engages and supports towards the acknowledged goal.  Parents of adolescents in the therapeutic foster care program we were working through were also trained in these skills and used them at home.  The whole process is dependent on trust and a sense of genuine empathy and compassion so sometimes I think well trained parents may be better at reaching kids with this than therapists.  Of course therapists can be successful as well as long as sufficient rapport and trust exists in the therapeutic relationship.

 

I hope this helped. :)

 

[PeterPan]

Ultimately DH traveled with her to an out of state partial day trauma treatment program which was built around TF-CBT.  They did five sessions a week plus additional adjunctive art therapy, trauma processing group etc.  It was a difficult three months but that made the difference and then she was able to maintain and even progress further after our family reunited and she went back to working with the prior therapist.  

Just wanted to say I'm amazed at the lengths you went to to help your dd, and I'm glad it worked!  Thanks for sharing.  :)

[LMV]

Just wanted to say I'm amazed at the lengths you went to to help your dd, and I'm glad it worked!  Thanks for sharing.   :)

 

Thanks!  At the time, when we really thought about it, we realized we didn't really have a choice and we had to try. It was a difficult time but we all survived and, in time, she really thrived. She is doing quite well now and she really amazes us in good ways a lot of the time. Our family is definitely different, and better, because she is part of it and at this point DH and I can't imagine anything else.