Anger Overload in Children: Diagnostic and Treatment Issues

By David Gottlieb, Ph.D.

Cognitive Treatment Strategies

One important point which affects how a child responds to a provocation is the way he or she percieves the problem situation: does he feel embarrassed, humiliated or rejected? If the child feels an insult to his sense of pride, or feels as if he was treated "unfairly," he is more likely to exhibit rage. Teaching the child to respond assertively but in a controlled manner helps him not to feel humiliated or put down.

This approach is similar to cognitive therapy approaches, which aim to change the way a person experiences a situation. Sometimes the parent or therapist can suggest to an older child another way to look at the intentions of the other by whom the child feels put down. This is not always effective, as many children will insist on their interpretation of the situation. Instead, the adult helps the child to respond differently so that the child then "feels" differently about herself. By being assertive or learning new social skills, the child is less likely to feel embarrassed and upset.

Teaching the child one catch phrase is an effective cognitive strategy that can be used. For many children, one such phrase is, "everyone makes mistakes." Children with anger overload often have high standards for themselves without even realizing it. They generally are not obsessive-compulsive by nature, but they also lack the social sense about what normal expectations are for children their age.

For example, one child frequently got upset when he made a written mistake in school. Another child raged when he could not find a puzzle piece, and another when his team lost a baseball game. Teaching these children that "everyone makes mistakes" really helps. They learn to say this phrase to themselves at the time of a mistake. Often we role play this scenario ahead of time in the therapist' s office. This strategy, like the others we' ve discussed, takes time to work. The child may not remember to use it when he or she is upset, and once it is finally used, may forget it altogether. But over time, it will become more automatic.

Another useful phrase to use is, "Is this a good risk?" Since children with anger overload are often risk takers, they like to try new challenges, including those that are dangerous or likely to provoke a negative response from adults. One child liked to make jokes in class when someone made a "funny" mistake. His classmates would laugh louder, and the teacher would get angry and give him a consequence. The child felt this was unfair and reacted with anger. The therapist helped the child to see the cause and effect of his actions, and taught the child to evaluate the risk before making his remark. The child also learned to let others take chances and make funny remarks, rather than always taking the lead and getting punished.

Nonverbal cues can also be effective in some situations. A nonverbal cue, such as the adult putting up his hand like a policeman does to stop traffic, is more likely to work when the child is becoming upset rather than moving toward a full-blown rage. Also, the signal needs to be prearranged with the child when he is calm in order to increase the chances that the child will see the signal as benign, not as a punishment.

Future Research Ideas

For parents, a key factor in working with angry children is patience and practice. The techniques described above take time for parents and children to learn. The child' s problems are probably related to developmental lags or to subtle neurological deficits. In Emotional Intelligence (1995), Daniel Goleman summarizes research with adults which suggests that the limbic system of the person' s brain goes into overdrive when anger occurs, causing catecholamines to release. One neurological hypothesis which needs further testing for children with anger overload is whether there is a lag or deficit in their limbic systems, so that catecholamines are released more quickly or in higher concentrations than for other children. Building new behavior patterns is possible, but again takes time. Parents should notice gradual improvements towards the goal of self-control rather than feeling defeated if there is not an immediate change. It is not the parent' s fault if the child has problems with anger. Often if the parents review their family trees, they will notice some other relative, if not themselves, who had difficulty with anger as a child. In many cases, there most likely is a genetic component. This is not to say that anger overload cannot be changed. Internal mechanisms for self-control can be learned by the child. But the approach must be methodical and requires extreme patience. Parents will feel relieved once they begin using strategies that work and realize that their children are not destined to a lifetime of anger overload.

*The "DSM-IV: Diagnostic and Statistical Manual of Mental Disorders-IV," published by the American Psychiatric Association is the standard reference source for mental health professionals.

More information about anger overload in children can be found and answered at Dr. David Gottieb's blog.