December 29, 2012,
A.S. asks from Portland, OR on June 13, 2010
Three Year Old: Rages with Aggression (Evaluate or Not)
This post is primarily directed toward parents of children who are intensely spirited who have considered or gone down the path of an evaluation. (Please note, we are not a family who will use any physical means of consequences/punishment. To date, we have not tried any token reinforcement systems such as a star chart, sticker chart, etc. though if need be, we are not opposed to it.)
My son can go from zero to sixty over situations such as requests to wash his hands, use the bathroom, etc. Basically, non-preferred requests. His rages involve a great degree of physical aggression (directed mostly toward me or my husband) and, while the actions are not hard - that is, they do not really hurt - they are very directed. When he rages it looks like the following: Pre-warning of request is made: "In 5 minutes, it will be time to use the bathroom". Time reminders are delivered in a non-emotional voice at three and one minute's time. When the five minutes are up he is given the choice to walk by himself or with me/my husband. (Even if we have tried to assist the transition by helping him find "safe" places for his current project, talking about the next fun activity that will follow the non-preferred task the following scenario will still occur.) This is when he screams and comes at me/my husband - hitting, kicking and spitting. He is permitted to take a break should he not desire to engage in the request but once aggressions have occurred he is instructed to take a time-out in his room. He will usually go to his room (a positive) but will continue to rage (screaming, kicking furniture) for 15 minutes to an hour. No amount of talking helps at this point. He has demonstrated he needs the space to "rage" until he is done. At which point, me/my husband goes in a checks in with him. We talk about what happened, what a safer choice would have been and practice calming techniques. We always model the following language, "When you hurt someone, you can say 'I'm sorry.' or 'Are you okay?' He usually chooses one of the phrases but apologies are never required.
On a good day, he usually has two episodes and on a bad, closer to six. I taught in early intervention rooms prior to obtaining my teaching license and taught a primary (K-2) behavior classroom for years before having my own children. I have read many a book and think my approach is solid and grounded. (Not that I am perfect but I feel like the manner in which I am addressing his needs is not the heart of the issue.) I provide clear boundaries, an appropriate level of choice, positive redirection, lots of cuddle time, etc.
We have had no big changes that have triggered this behavior. HOWEVER he did stop napping consistently around the time of the increased rages but I have tried everything possible to make naps happen and it is not working or worth it. Any quiet time or nap time is now met with more raging - lasting one hour typically. He has very developed linguistic skills. His diet contains a very limited amount of sugar. For example, he is allowed three vegan fig newtons per day if he remembers to ask. :) We get outside a lot and spend the majority of the day outside if possible. He has always been an intensely spirited child who has gone through three other phases of aggression. This one is more intense (perhaps because he is three?) in the degree of aggressions - approximately 20-25 on a bad day - and the duration that the episodes last. When he did attend daycare for a short while he did display similar intense behaviors yet not the level of aggression as that was not at the time he was in an aggressive phase.
Although this has been a very long post, I know as a specialist I would still have many clarifying questions. Here is my question: What would you do? Would you seek an Early Intervention evaluation? Would you look at diet? Would you just wait it out and appreciate that this could just be an intense child learning where the boundaries lie? Please advise.
J.C. answers from Chicago on June 13, 2010
I would look into Early Intervention. You are doing a great job, but sometimes you need someone who can look from an objective view.
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L.W. answers from San Diego on June 13, 2010
Wow. You must be really tired. Sounds like you are doing a lot of great parenting... and like you're in a very similar situation to what happened with us and our oldest daughter.
We adopted her from foster care as a toddler. The first year we wrote off as a time of bonding, healing from their trauma and building attachment. It was exhausting, but expected... Then year two continued in that same exhausting manner, despite counselors telling us we were doing everything really well and consistently in dealing with the rage and aggression due to transitions and directions (like the kind you mentioned).
To make a long story short, we got a full developmental evaluation at San Diego Children's Hospital when she was 3 1/2, and while they couldn't pin down a diagnosis, it did provide documentation of the problems. At 4 1/2 years old (before kindergarten), we had her evaluated by a child psychiatrist because I was really worried she's completely fail at school and with friends. Best thing we ever did. Turns out it was ADHD (and, in her case, bipolar as well). As soon as we started medications and high doses of omega-3 for mood stabilization, our daughter blossomed. I cried for months after that because it was like I finally got to meet my daughter for the first time and not live in post-traumatic stress mode of dealing with her overwhelming behaviors all day every day.
She's still a piece of work, 4 years later. :) But I would never change how we handled it. Sounds like you're doing your best and it's still bad for the family, so it's probably time to go see someone. Doesn't hurt anyone, and it can offer you direction in dealing with the tough transition behaviors.
I'd also recommend you have a place where you can feel how you do without parents judging you or your parenting. If you want a good laugh, come by my site. I've got two "spirited" kids (love the wording!) and I do a lot of laughing to thrive despite it all :).
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B.B. answers from Portland on June 14, 2010
My 3 yr old has meltdowns and they seemed to start right around his birthday. We found that giving him choices and time alone in his bedroom worked to difuse the meltdowns, which sounds like what you are doing. The other thing we did was require apology because physical aggression is NEVER ok. We also gave him consequences for his actions to teach him that while it is ok to say you are upset and to be angry, it is never ok to act like that. Consequences included, loss of a favorite activity, removal of toy, etc.. Rewards for acting appropriately included a sticker chart with a reward (city bus ride, trip to the park, etc) after filling the chart.
My son still has the occasional meltdown but nothing like before and he usually calms alot quicker. He has started verbalizing his anger or dislike for a situation rather than throwing a tantrum.
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E.M. answers from Denver on June 13, 2010
Our daughter had rages at that age and still has some pretty big temper tantrums at 4.5. We eventually had her evaluated at age 4 because of her short fuse and rages--that is exactly what I called them too. So it sounds like you are doing everything by the book and figuring out that typical discipline does not work, you limit his sugar and give him plenty of exercise. The story of my life! Our daughter was diagnosed with ADHD at just over 4 yrs. old. Extreme temper tantrums and rages are typical for young ADHD children because they have a very low tolerance for frustration--the littlest thing can set them off. I suggest you get the book the Explosive Child. While it is geared toward slightly older children, it will still help you understand your son and how and why he is reacting this way. Now, I am not saying your son has ADHD--I'm just saying what you've said so far sounds familiar. When we had our daughter evaluated, we weren't concerned with hyperactivity or attention span (what people associate with ADHD) we were concerned with rages. As we went through the evaluation process, we realized her hyperactivity and attention span for her age were WAY off for what is typical for a 4 year old--and of course, a certain amount of those things is VERY typical for most young children. An evaluation will only help give you more information about how to work with your son. If there is nothing to find, then you will be told he is a normal, healthy challenging kid. And even if this is the case, they may be able to offer you some parenting tips for his challenges. If there is something else going on, the sooner you find out the better!!
**Our daughter is finally mellowing out a bit and thanks to her diagnosis we are able to parent her in a way that helps her.
**We looked at our daughter's diet and like your son, she eats healthy fresh food and VERY little junk. But we did want to cover all the bases. Again, it can't hurt.
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M.P. answers from Portland on June 13, 2010
I think that you should get an Early Intervention evaluation. I am familiar with the process. My grandson has speech apraxia and behavior issues. He has also raged since he was 2-3. He's now 7. We thought the rages were the result of frustration over not being able to be understood. He started with speech therapy and preschool arranged by the Intermediate Education School District. He's been in a therapeutic preschool and is currently finishing first grade in special ed program. We're awaiting an appointment with a developmental pediatrician. He's been diagnosed with ADHD by his regular pediatrician who made the referral because of the multiple difficulties that my grandson has.
Beside the speech difficulties his most prominent and difficult to deal with issue are his rages. Like your son, he can be calm and having a good time just seconds before he flies into a rage and starts hitting and kicking. What has delayed his getting increased medical attention for his behavior is that at times he responds positively to intervention, such as calming down when sent to his room so that he has less stimulation. He has been pretty much aggression free, tho still easily angered for weeks at a time only to suddenly start hitting and kicking in a rage. Everyone gives a sigh of relief thinking that we, including him, have passed that hurdle.
He was not referred to a developmental pediatrician until a couple of months ago when his aggression increased and his teachers no longer knew how to help him. He's been suspended from school 3 times in the last few months because he's went into a rage, hitting and kicking when his teacher was unable to calm him.
As a professional you know that the earlier a condition is diagnosed and a workable treatment plan put into affect the more successful treatment is likely to be. I urge you to get an evaluation. Your son's rages are above and beyond the normal.
I empathize with you. Having a child that has such strong feelings tears at our heart strings. We want them to mature out of the rages but when they don't we feel perhaps it's our own failure to find the right way to parent. I am so glad that the medical field is improving in finding ways to treat these children. I see a difference in the help available in the 3 or so years my grandson has been in the system.
You have done and are doing the things that should be helping your son and they are not working. Your son is so fortunate to have you as his mother.
I don't know if this is helpful but I think I've stumbled on a way to work with my grandson. Keep in mind that I'm his grandmother and don't deal with him full time. He stays overnight with me one night/week. I take him to school the next morning. When he is the center of my attention the entire time he doesn't have meltdowns. When I want to do something else at the same time he wants my attention he has a meltdown that consists only of verbal anger and tears. When I immediately stop what I'm doing and spend 10 or so minutes with him before going back to what I want to do he mellows out again. If I ignore the tantrum, which is what works with most children, it escalates into aggression i.e. name calling, hitting, kicking. During those minutes I validate his feelings and get him started doing something such as playing with his "hot wheels" or I give him his stuffed animal Donkey or Bull Dog. He gave them names based on what animal they are. Sometimes he wants me to hold him. Sometimes he stays a couple of feet away from me.
His teachers, at different times, have tried to wean him away from the stuffed animals but they always allow him to go back to having them tho I think he's to keep them in his book bag. I sometimes wonder if he emotionally NEEDS to have one of them in his hands. At my house he has access to them anytime he wants them Some days he never takes them out of his book bag. Other times he holds them and wants them when he goes to bed. He can also have them anytime he wants at home. He does not have as many raging meltdowns at my place or home. Of course there are more demands on him at school. His routine at my house is very simple and child oriented. He is able to be uninvolved with anyone most of the time when he's at home. If he doesn't want to eat dinner, he only has to eat a couple of bites and then can get down to play. It's OK with him if he doesn't get anything to eat for the rest of the night until his and his sister's bed time snack.
I think we have adjusted our expectations of him so that less is required of him. Because of that when he is required to do something he perhaps has more ability to comply. I've heard his parents say to him, "I didn't ask you to pick up your toys. Now it's time to sit down at the table. You can go back to them after dinner." I, sometimes feed him as I would a toddler when he's not interested in eating. He nearly always eats most of his food when I do that. It feels to me that he needs some sort of one on one attention in order to stay calm when he's feeling stress. He feels stress much more acutely than the average child. He is pulled between wanting to play and wanting to eat. I can see the tension in his face. I'm not sure that this is the right thing to do for the long run but it does give all of us, including him, a feeling of success.
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J.C. answers from Chicago on June 13, 2010
I would look into Early Intervention. You are doing a great job, but sometimes you need someone who can look from an objective view.
1 mom found this helpful
A.T. answers from Portland on June 14, 2010
see dr. palmeri at portland family homeopathy. She's great with our kids allergies & it helped their moods improve. Good luck.... portlandfamilyhomeopathy.com
L.P. answers from Pittsburgh on June 14, 2010
**EDITED TO ADD**
The downside to having your son evaluated if there is no need for said evaluation, is that doctor's are very quick to label children, to quick to decide, based on limited information, that a problem exists, and far too quic to medicate (which undoubtedly, you'd scrutinize before agreeing to.) But my point is that I've seen far too many children slapped with a label that no more helped the childs behavior change than it explained it. To me, this is a learned behavior that needs to be unlearned. Labeling him as ODD, or ADHD, or Bipolar, or Intermittent Explosive, what would that serve? Regardless of the label, the interventions would largely be behavioral in nature, unless you are opting for medication.
Please do not take any offense to my response, because none is intended.
I worked with children with behavior disorders for years. And then I had my son. Eye opener. I would qualify my son as very spirited also. A high needs baby. He's now 4 1/2. The 3's were tough. He demonstrated the highest degree of opposition in his 3's, having frequent meltdowns when he didn't get his way, or when he couldn't complete a task that he set out to do. He didn't demonstrate physical aggression, but did have instantaneous and grand meltdowns. I even posted about it when it was happening, and there seemed to be a general concensus that this was not abnormal at age 3. I had a plan in place for dealing with this behavior, and now at age 4 1/2, he rarely has a meltdown due to anger/frustration, etc. Probably a combination of maturity and a consistent consequence for his behavior.
However, my humble opinion is that although you have a very sound and consistent plan in place for approaching your son and dealing with his behavior, it isn't working. Duh, right? That's the reason you posted here. What I'm saying is that I don't think you have taught your son that physical aggression is NOT ACCEPTABLE. You say that he is in his 4th cycle of aggressive behaviors, and that this is the worst. My concern is that until you teach him that physical aggression is not acceptable, he will continue to exhibit the behavior, and perhaps, in increasing intensity with age. I understand that intervening during the episode seems futile at the time, and that allowing him to "rage" in his room seems like what he needs. There were times when I told my son that if he couldn't calm himself down (using descriptive terms so I was sure he understood my expectation), then he had to retreat to his room until he could calm himself down. Then he was allowed to return to normal activity. But your son engaging in physical aggression takes this to another level. He needs to be taught firmly and swiftly that physical aggression will not be tolerated. He has been allowed to learn that he can be physically aggressive. I get that you are opposed to spanking. Ok, then you need to do something else because sending him to his room is not modifying his behavior. In reality, all it's doing is getting him out of your hair while he's throwing his tantrum, and diffusing the situation until the next time. I'm not suggesting that's your intention, I know you are doing what you think he needs. But the truth is, it's not changing his behavior and it's not teaching him that it's not ok to hit/kick/etc.
I have no reason to believe that your son has some "condition" that predisposes him to be physically aggressive. It appears to me that early on, he engaged in some aggressive behavior, probably purely developmentally testing boundaries, feeling out his world, and how he would be reacted to, and whatever the reaction was, it did not discourage the behavior. In fact, it encouraged it because he continues to engage in aggression to deal with frustration. Frustration and anger are normal. Responding aggressively may also be a natural response to those feelings. But young children have to be taught that is not acceptable. How do you teach them that? That's the million dollar question.
What we can say for sure is that being sent to his room and being allowed to continue the aggression in his room is not modifying his behavior. And to be perfectly honest, I am not sure why you do not require him to apologize for his behavior. I get that you want him to be sincere and 'choose' to apologize on his own, but seriously, he has committed a serious offense when he chose to hit his parents, and to me, that REQUIRES an apology. And that also needs to be learned. That when we hurt someone, we feel remorse and say we're sorry. End of story. Kids have to LEARN empathy.
You said that you are not willing to use physical discipline, but I'm wondering if you have considered passive restraint? There are ways to SAFELY and lovingly restrain a child when they are 'raging' that prevents them from being allowed to engage in any physical aggression. I think you are at the point that you may want to consider this. It is not punitive, and not punishment. It simply prevents them from being physically aggressive. Of course, they don't like it, and at first, your son will probably fight violently to be released. But after a few times of holding him until he relents, he will understand what is happening, and will begin to learn that he is NOT PERMITTED to be physically aggressive. And quite frankly, kids are not comfortable to be left alone when internally, they feel so out of control. They NEED to feel that there are boundaries, that there is someone out there that is more powerful than they are, protecting them, keeping them safe. Raging out of control, and being allowed to do so, sends you son the message that he's on his own. That he's alone to deal with his high level of frustration and anger. Think of it yourself. When you feel out of control, don't you internally desire for someone to help you feel more in control, and to help you feel safe and secure? So imagine that feeling, intensified by a 3 year old maturity, completly lacking in the ability to reason or think through why he feels the way he does, or how to help himself. When you think of it that way, it's actually not fair to him to leave him to his own devices to deal with all that emotion on his own. How it appears on the surface (that he needs to rage on his own) is deceiving. What he truly needs is your intervention. To be reassured that he is protected, he is safe, and that although HE FEELS OUT OF CONTROL, YOU ARE IN CONTROL.
To be clear, I DO NOT feel your son needs an evaluation. I think he is demonstrating age appropriate frustration. It's his response to his frustration that needs addressed and I honestly feel that if you don't address this behavior now, you will have much bigger problems on your hands as he grows. And I disagree with anyone that says this is normal for a 3 year old who is testing boundaries and if you ignore it, it will go away. There are behaviors that can, and maybe should be ignored to instinction, but physical aggression is not one of them. Yes, his frustration, testing limits, and even anger is probably developmentally normal at his age. But being allowed to demonstrate his frustration and anger with physical aggression is a learned behavior that has to be unlearned, and you as his parents have the ability and are charged with the task of helping him to unlearn it.
As always, positive reinforcement is always the most effective behavior modifier, so I'd encourage you to PRAISE, PRAISE, PRAISE any and all attempts to transition or make choices without melting down. I would implement a plan that includes choices, and a specific warning about hitting/kicking/etc. And prior to implementing this plan, I'd explain to your son briefly what will happen if he engages in any aggressive behaviors. Explain that Mommy or Daddy will hold him to keep HIM and YOU safe, until he's calm. When the time comes, for example, say "Johnny, in five minutes, you will need to brush your teeth. Would you like to use your blue toothbrush, or the red one?" When the time comes to actually brush his teeth, "Johnny, it's time to brush your teeth. If you hit/kick, Mommy will hold you until you are calm." Ordinarily, I'd say not to suggest the hitting/kicking prior to him actually doing it, so as not to give him the idea if he hadn't already thought of it himself. But with the frequency you describe your son's aggressive behavior, I'd say it's fair to assume he will become aggressive in response to his frustration. If he does engage in aggression, pick him up, hold him using a safe, passive physical restraint (which you'd have to research and learn the technique for, prior to implementing), and hold him until he's demonstrated that he's calm (no longer resisting the restraint, calm breating, regular heart rate.) While holding, do not engage in ANY conversation about the behavior. Provide gentle reassurance using calming, soothing words, i.e. "calm down, you're safe, Mommy's here." After the episode, simply state, "Mommy held you because it is not ok to hit/kick/etc." Repeat as necessary until he learns that the aggression will not be allowed. Once he begins to understand what will happen if he gets physically aggressive, you can start to teach him better ways to deal with and express his frustration and feelings. And hopefully, by that time, some additional maturity will be on your side, so he will have an easier time expressing himself and you can better work with him on positive approaches to his frustration.
Best wishes and luck to you. I know this isn't easy.
H.R. answers from Myrtle Beach on June 14, 2010
Seems your getting lots of advice to get evaluated. He is 3! He is a kid and kids seem to do what they want. If he is not getting the reaction he's looking for he'll eventually stop.
I think your doing a great job. Have you looked into natural health? Drugs are just going to cover symptoms. Did any of these episodes start after vaccines??? Just a few questions to ask yourself.
I wish you all the best! Being a parent is the hardest but most rewarding job.
C.D. answers from Los Angeles on June 13, 2010
Wow! I was blown away by your the techniques you were using--until you explained what your background was! It sounds like you're doing everything absolutely perfectly! You might want to try doing a reward system using positive reinforcement. They've worked wonders with my daughter, who has high-functioning autism.
It does sound like you should get your son assessed. It may be nothing, but if it is something, the earlier you get help, the better. My daughter also has a horrendous time with transitions. She didn't get aggressive, though, she would just have meltdowns.
I think Early Intervention is for children who are under 3 though. So, you'll either have to get your son assessed by your local school district or privately.
K.M. answers from Portland on June 19, 2010
It looks to me as if you have covered your bases with your son: you are giving him warnings before transitions, watching his diet, giving him plenty of outside time, and modeling appropriate behavior for him. After two months of this aggressive tantruming behavior, you and your husband must be exhausted (and your son, too). Maybe now is a good time to get some extra support from a family counselor and/or bring your son in for play therapy to help him learn to express his anger in a more acceptable manner. Hang in there!
B.M. answers from Eugene on June 13, 2010
Yes, I would seek early intervention. Go and have him evaluated. It does not hurt anything. It is very hard to deal with such aggression and if you are not sure why he is showing this behavior, you might not know how to over come it. As he gets older his aggression will get more hard to control. The best thing to do is to always keep all of you safe. It is very hard to stay calm if you have a child who stikes you or hurts you.
I think EI is such a great program and it is there for many reasons. Having him evaluated will give you an objective look at what is going on. My daughter has autism and is high functioning. I had no understand why she was sooooooooooooo aggressive with me even when she was so little. This past year has been so hard. She has had aggression at times where she is so out of control that she can hurt me.. I have had to learn how she works and what works for her. The main job as parents, besides the obvious of teaching them, is to keep them safe! I believe you have a great knowledge of your son, but it does take time or trial and error to figure out what might work for him. It is good that you are well read too, but remember, each child is different. That is so great that you have the background you have too!! This all helps! Since you are familar with the program, I would have him checked out and also talk to his dr! Wishing you the best. I feel for you...It is tough
N.D. answers from Portland on June 15, 2010
the big fit over something trivial sounds exactly like my daughter. never know what will set her off. when she took naps, she used to wake up crying inconsolably and needed up to a half hour of crying before she would calm down.
recently, we found out that she (and i) have celiac's disease and have removed wheat from our diet. her tantrums have improved and we've found that she only wets the bed when she's accidentally ingested gluten. so i would vote for looking into food allergies with a naturopath. we did the blood and skin tests with the regular allergist and wheat didn't show up.
D.W. answers from Roanoke on December 29, 2012
answers to comments mentioned above
M.R. answers from Columbus on June 14, 2010
Seek an evaluation. You have a very consistent and well though out dicipline plan that would work for a typical child, and you have seen typical children so you know that this is not typical. Start with a developmental pediatrician, and get the whole picture the in a comprehensive evaluation that will miss nothing.
For development, you should always error on the side of over reacting rather than under. What have you lost if you evaluate? It is the greatest possible win win situation. You either walk out of the evaluators office knowing that you have zero to worry about, or you walk out knowing what to do to help your son live up to his potential and be a happy little boy. Both are preferable to wondering what to do and waiting so see.