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Friday, April 4, 2014

Angry Kids: Dealing With Explosive Behavior

From the Child Mind Institute's Blog Hot Topics

March 25, 2014

How to respond when a child lashes outWho can help, what to expect, and what questions to ask.

When a child—even a small child—melts down and becomes aggressive, he can pose a serious risk to himself and others, including parents and siblings.

It's not uncommon for kids who have trouble handling their emotions to lose control and direct their distress at a caregiver, screaming and cursing, throwing dangerous objects, or hitting and biting. It can be a scary, stressful experience for you and your child, too. Children often feel sorry after they've worn themselves out and calmed down.

So what are you to do?

It's helpful to first understand that behavior is communication. A child who is so overwhelmed that he is lashing out is a distressed child. He doesn't have the skill to manage his feelings and express them in a more mature way. He may lack language, or impulse control, or problem-solving abilities.

Sometimes parents see this kind of behavior as manipulative. But kids who lash out are usually unable to handle frustration or anger in a more effective way—say, by talking and figuring out how to achieve what they want.

Nonetheless, how you react when a child lashes out has an effect on whether he will continue to respond to distress in the same way, or learn better ways to handle feelings so they don't become overwhelming. Some pointers:
  • Stay calm. Faced with a raging child, it's easy to feel out of control and find yourself yelling at him. But when you shout, you have less chance of reaching him. Instead, you will only be making him more aggressive and defiant. As hard as it may be, if you can stay calm and in control of your own emotions, you can be a model for your child and teach him to do the same thing.
  • Don't give in. Don't encourage him to continue this behavior by agreeing to what he wants in order to make it stop.
  • Praise appropriate behavior. When he has calmed down, praise him for pulling himself together. And when he does try to express his feelings verbally, calmly, or try to find a compromise on an area of disagreement, praise him for those efforts.
  • Help him practice problem-solving skills. When your child is not upset is the time to help him try out communicating his feelings and coming up with solutions to conflicts before they escalate into aggressive outbursts. You can ask him how he feels, and how he thinks you might solve a problem.
  • Time outs and reward systems. Time outs for nonviolent misbehavior can work well with children younger than 7 or 8 years old. If a child is too old for time outs, you want to move to a system of positive reinforcement for appropriate behavior—points or tokens toward something he wants.
  • Avoid triggers. Dr. Vasco Lopes, a clinical psychologist at the Child Mind Institute, says most kids who have frequent meltdowns do it at very predictable times, like homework time, bedtime, or when it's time to stop playing, whether it's Legos or the Xbox. The trigger is usually being asked to do something they don't like, or to stop doing something they do like. Time warnings ("we're going in 10 minutes"), breaking tasks down into one-step directions ("first, put on your shoes"), and preparing your child for situations ("please ask to be excused before you leave Grandma's table") can all help avoid meltdowns.
What kind of tantrum is it?

How you respond to a tantrum also depends on its severity. The first rule in handling nonviolent tantrums is to ignore them as often as possible, since even negative attention, like telling the child to stop, can be encouraging.

But when a child is getting physical, ignoring is not recommended since it can result in harm to others as well as your child. In this situation, Dr. Lopes advises putting the child in a safe environment that does not give her access to you or any other potential rewards.

If the child is young (usually 7 or younger), try placing her in a time out chair. If she won't stay in the chair, take her to a backup area where she can calm down on her own without anyone else in the room. Again, for this approach to work there shouldn't be any toys or games in the area that might make it rewarding.

Your daughter should stay in that room for one minute, and must be calm before she is allowed out. Then she should come back to the chair for time out. "What this does is gives your child an immediate and consistent consequence for her aggression and it removes all access to reinforcing things in her environment," explains Dr. Lopes.

If you have an older child who is being aggressive and you aren't able to carry her into an isolated area to calm down, Dr. Lopes advises removing yourself from her vicinity. This ensures that she is not getting any attention or reinforcement from you and keeps you safe. In extreme instances, it may be necessary to call 911 to ensure your and your child's safety.

Help with Behavioral Techniques

If your child is doing a lot of lashing out—enough that it is frequently frightening you and disrupting your family—it's important to get some professional help. There are good behavioral therapies that can help you and your child get past the aggression, relieve your stress and improve your relationship.

You can learn techniques for managing his behavior more effectively, and he can learn to rein in disruptive behavior and enjoy a much more positive relationship with you.
  • Parent-child interaction therapy. PCIT has been shown to be very helpful for children between the ages of 2 and 7. The parent and child work together through a set of exercises while a therapist coaches parents through an ear bud. You learn how to pay more attention to your child's positive behavior, ignore minor misbehaviors, and provide consistent consequences for negative and aggressive behavior, all while remaining calm.
  • Parent Management Training. PMT teaches similar techniques as PCIT, though the therapist usually works with parents, not the child.
  • Collaborative Problem Solving. CPS is a program based on the idea that explosive or disruptive behavior is the result of lagging skills rather than, say, an attempt to get attention or test limits. The idea is to teach children the skills they lack to respond to a situation in a more effective way than throwing a tantrum.
Figuring Out Explosive Behavior

Tantrums and meltdowns are especially concerning when they occur more often, more intensely, or past the age in which they're developmentally expected—those terrible twos up through preschool. As a child gets older, agression becomes more and more dangerous to you, and the child. And it can become a big problem for him at school and with friends, too.

If your child has a pattern of lashing out it may be because of an underlying problem that needs treatment. Some possible reasons for aggressive behavior include:
  • ADHD: Kids with ADHD are frustrated easily, especially in certain situations, such as when they're supposed to do homework or go to bed.
  • Anxiety: An anxious child may keep his worries secret, then lash out when the demands at school or at home put pressure on him that he can't handle. Often, a child who "keeps it together" at school loses it with one or both parents.
  • Undiagnosed learning disability: When your child acts out repeatedly in school or during homework time, it could be because the work is very hard for him.
  • Sensory processing issues: Some children have trouble processing the information they are taking in through their senses. Things like too much noise, crowds and even "scratchy" clothes can make them anxious, uncomfortable, or overwhelmed. That can lead to actions that leave you mystified, including aggression.
  • Autism: Children on all points of the spectrum are often prone to major meltdowns when they are frustrated or faced with unexpected change. They also often have sensory issues that make them anxious and agitated.
Given that there are so many possible causes for emotional outbursts and aggression, an accurate diagnosis is key to getting the help you need. You may want to start with your pediatrician. She can rule out medical causes and then refer you to a specialist. A trained, experienced child psychologist or psychiatrist can help determine what, if any, underlying issues are present.

When Behavioral Plans Aren't Enough

Professionals agree, the younger you can treat a child, the better. But what about older children and even younger kids who are so dangerous to themselves and others, behavioral techniques aren't enough to keep them, and others around them, safe?
  • Medication. Medication for underlying conditions such as ADHD and anxietymay make your child more reachable and teachable. Kids with extreme behavior problems are often treated with antipsychotic medications like Risperdal or Abilify. But these medications should be partnered with behavioral techniques.
  • Holds. Parent training may, in fact, include learning how to use safe holds on your child, so that you can keep both him and yourself out of harm's way.
  • Residential settings. Children with extreme behaviors may need to spend time in a residential treatment facility, sometimes, but not always, in a hospital setting. There, they receive behavioral and, most likely, pharmaceutical treatment. Therapeutic boarding schools provide consistency and structure round the clock, seven days a week. The goal is for the child to internalize self-control so he can come back home with more appropriate behavior with you and the world at large.
  • Day treatment. With day treatment, a child with extreme behavioral problems lives at home but attends a school with a strict behavioral plan. Such schools should have trained staff prepared to safely handle crisis situations.
Explosive Children Need Calm, Confident Parents

It can be challenging work for parents to learn how to handle an aggressive child with behavioral approaches, but for many kids it can make a big difference. Parents who are confident, calm, and consistent can be very successful in helping children develop the skills they need to regulate their own behavior.

This may require more patience and willingness to try different techniques than you might with a typically developing child, but when the result is a better relationship and happier home, it's well worth the effort.

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