Explosive Tantrums - 11 year old Jared

This is an e-mail from a mother of one of my clients, an 11 year-old boy prone to frequent explosive tantrums. This e-mail is from a period early in therapy.  When I received this e-mail, we had only had three or four sessions by that point, and we were still at the stage of explaining a developmentally supportive treatment framework and therapeutically supportive responding.

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Jared’s behavior has been escalating like mad. Please refer to the email from this teacher below.

Jared’s psychiatrist, Dr. Johnson recently switched Jared from Daytrana to Straterra and then at the next appointment he added Prozac. Jared’s behavior has escalated and deteriorated since then.  He is volatile, aggressive and extremely hyperactive, almost to the point of complete out of control screaming and impulsivity.  He has become very hostile and angry. Clearly this medicine combination is not working, much to my disappointment.  While the Daytrana suppressed his appetite, which was not desirable, and it was not a 24-hour solution, his overall behavior was slightly more controlled.

I am really worried about these outbursts and his emotional fragility and I am wanting to take him off these medications and move to something different.

Dr. Childress, this, obviously, will be key point to talk about during our next session as I am having a very difficult time managing and working with and controlling his impulsivity and would love your guidance.

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Here is the e-mail from Jared’s teacher:

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Jared had a tough day today. He upset several children by calling them names (stupid, dumb and some other foul language) and ultimately was involved in a physical altercation with another boy who punched Jared in the privates. Both boys were sent to the principal’s office for counseling and a consequence. Jared was assigned "community service" at lunch for Friday (today), Monday, and Tuesday.  Wanted to let you know.  We hope Jared will make better choices and use kind words to others here at school. Thank you as always for your support.

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Here is my response from a developmental psychotherapeutic framework:

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Behavior is a symptom, the brain is the cause.

My question is why Jared acted the way he did in the classroom.  Far too often we simple focus on behavior suppression without understanding how and why the behavior emerges (i.e., the cause).  If we don’t understand the cause then we can't address the cause, and we will find ourselves forever chasing symptom suppression without effective resolution.  If, however, we understand the cause then we can treat and resolve the underlying cause of Jared’s behavioral symptoms, and so eliminate them.

It appears as if his emotions become inflamed, and he then acts on the pain of the inflammation.

In its early state (infancy), the emotional system is explosive-expressive, what's called "catastrophic emotion."  At this early stage of development, emotions are simply expressively discharged (this sounds like what Jared is doing).  

In infancy, when we respond to the child's catastrophic explosive-expressive emotional discharges "as-if" the emotional discharge has communicative value, the young infant-child gradually begins to recognize that someone is listening, that his or her emotional expressions have socially communicative value.

At that point in development, the emotional system undergoes a transformation from "catastrophic emotion" to "emotional signaling" in which the infant-child begins to use emotions within the communication systems.  

When emotions are brought within communication networks (as opposed to remaining "catastrophic" explosive-expressive discharges), then a set of additional brain networks runs from the communication systems BACK to the emotional networks and inhibits the intensity of the emotional networks.  The intensity of the emotional experience becomes less (thereby allowing the child to bring emotions into the communication systems rather than just expressing them in explosive discharges - it's a cyclical process of communication of emotions inhibiting the intensity of emotional experience - and the inhibition of intensity allowing increased communication of emotions).

It sounds like Jared's emotional systems remain in a primitive state of catastrophic explosive-expressive discharge rather than being used within communication-relationship networks. So he doesn't have the inhibitory networks available to reduce the intensity of his emotional experience.  When he feels angry, or sad, or anxious, the feelings probably feel similar to rage, despair, and terror, which overwhelm his ability to remain emotionally-behaviorally regulated.  His brain then goes into a chaotic disharmonious state expressed behaviorally as calling people bad names, getting into fights, etc.

His teacher indicates that she believes this is a "choice" he makes.  It's not.  Choice is a product of the executive function system, a different more advanced brain system having to do with planning, foresight, and reasoning.  At more sophisticated levels of development, the executive function system can also act to inhibit emotional experience, but not when the emotional system is in a primitive, catastrophic, explosive-expressive level of development.

When his emotional system dysregulates, Jared doesn't have access to the higher-order thought processes, brain systems, and behavioral self-regulation available from the executive function system (an activated emotional system can actually inhibit the executive function system – executive function and emotion actually cross-inhibit each other).  Jared doesn't have a choice, his emotions are simply discharged expressively and explosively, and his behavioral expressions similarly reflect an impulsive discharge of motivation.  

He acts impulsively, he flails about in a rageful tantrum, he’s non-responsive to reason or dialogue, he doesn’t consider consequences or other people’s needs, because his brain’s organization is being overwhelmed by a poorly developed emotion-regulation system that remains in a primitive explosive-expressive organizational state of catastrophic emotion.

That's the way his brain, his emotional system, works at this point.

Trying to activate higher-order thinking (executive function), more regulated emotional states (consideration for other’s needs), or simple behavior suppression approaches (punishment to activate dominance-submission networks) are all likely to fail. 

He won’t have a sufficiently strong executive function system to challenge a primitive emotional system until the full executive function system comes on-line at young adulthood (and sometimes not even by that point – consider explosive-expressive tantruming adults).  


He can’t access the sensitivity of a regulated emotional system necessary to be sensitive to the emotional experience of others --- the “volume” is too high on his own emotional state to “hear” the emotional needs of others, and his own explosive-expressive motivational press overwhelms his ability to suppress his motivations and adopt the motivational needs of others.

And simple behavior suppression techniques of punishment to activate dominance-submission networks can work, but it will require a brutal level of punishment in order to achieve sufficient activation of dominance-submission networks to overcome this high a level of emotional activation, and in today’s society and culture we’re simply not comfortable brutalizing children to that extent.

The inherent failure of these approaches is why you feel so frustrated.  Nothing works. What works for other kids (who have a more maturely developed emotional system), doesn’t work for Jared.  The emotional systems of his brain are immaturely developed relative to other children his age.  He has tantrums (explosive-expressive emotional-behavioral discharges) that are developmentally more appropriate for a 2 or 3 year old child, or even an infant, rather than an 11 year-old child.  His emotional system is immaturely developed.  The brain is the cause, behavior is a symptom. 

We need to help his emotional system mature.  So how do we do this?

We first need to bring his emotions into the communication-relationship systems.  As we’re able to accomplish this over time, we’ll activate inhibitory networks that will lessen the intensity of his internal experience of the emotions.  He’ll go from rage to annoyance, from despair to sadness, from terror to anxiety. 

We do this by responding "as-if" his emotional discharges have communicative value, prompting the transformation of his emotional system from a state of “catastrophic emotions” to “emotional signaling. “  As we respond more frequently as-if his emotions are communications, he will gradually come to recognize that we're trying to understand (i.e., we bring him our "intent-to-understand” his inner experience from his perspective) and he will begin trying to make increasingly elaborated efforts at communication.

Currently, we’re likely doing exactly the opposite.  We likely define his emotional discharges as “problem behaviors” and we try to motivate a suppression of these annoying-problematic emotional-behavioral displays.  Our intent is an “intent-to-change” his outward expressions rather than an "intent-to-understand" his inner experience.  Facilitating communication emerges from our intent-to-understand (children won’t communicate if we’re not listening, or at least making a sincere effort at listening, to their experience from their point of view).  If we’re just listening in order to tell them that they shouldn’t feel or act that way, that they need to change their experience, then they won’t make the effort to communicate with us, so their emotional system remains in a primitive explosive-expressive state.

As we continually respond “as-if” his emotional expressions have communicative value, he will gradually bring his emotions increasingly into the communication-relationship systems.  Inhibitory networks will reduce the intensity of his experience of his emotions, further allowing him to increasingly use his emotions in a socially communicative, socially organized way.  This represents the social maturational process of the emotional-communication-relationship networks.  It does take some degree of time, we’re building brain networks, not simply suppressing current behavioral expressions.

Developmentally, this process occurs primarily between the ages of 2-3, with further advances between the ages of 3-7 years old.  So Jared is a behind in the maturation of the integrated system of emotions-communcation-relationship.  But once we get him back on track we should be able to catch him up substantially.  These brain systems want to mature if we give them the right interpersonal context.

The maturation of Jared’s emotional-communication-relationship integration occurs at the "point-of-therapeutic-opportunity," right when he's having the emotional experience.  Talking about it later, once he's calmed down, won't do it.  Right when he's having the emotional experience, that's when we need to approach with an intent-to-understand his inner experience from his perspective (bringing our "eyes-of-the-other" to his inner experience), thereby supporting his ability to bring emotions into communication-relationship systems.

Jared's meltdowns are not "problem behaviors," they're "points of therapeutic opportunity."

I wish he'd have those meltdowns in my office.  As a psychologist, I want to be at the point of therapeutic opportunity, right at the point when his brain is beginning to move into a chaotic, disorganized state.   Just as he begins to enter a disorganized state, that’s when helping him regain an organized-communicative state will build all of the brain networks used in the process, including the social networks of using us as a helpful resource for helping him achieve emotional-behavioral regulation when he's in distress.  Unfortunately, children tend to remain well-behaved and well-regulated in my office.  You and his teacher are the ones who are at the point of therapeutic opportunity, which is why it's important for you to understand how to respond in a therapeutically supportive way.

With the brain, we build what we use.  As we continually use these pathways, they will become stronger, more sensitive, and more efficient, so that, by the time he's 35 years old, he'll be able to ask nicely for things...  :-)

It will take time, but hopefully not that long.  I would hope for visibly significant progress in a matter of months, with "mostly resolution" in 18 months (the issue is, what is "mostly resolution" - kids are designed by nature to be annoying, it's what they do... so we can't parent-out all of their annoying, but we can move from non-social emotional tantrums and explosive-expressive discharges to socially organized communication of differences in a bi-directional respectful way).

So, what does anger communicate:

"you hurt me - so I hurt you."

Anger is the "I hurt you" side of that communication.  What we need to listen for, and listen to, is the front half of the communication, the "I'm feeling hurt" part.  So, the question becomes, what was Jared feeling hurt about in the classroom that provoked the angry discharges?  

Interestingly, anger also contains a third level that is typically hidden and so is often unaddressed.  The hurt comes from a frustrated desire to love and be loved.  So the actual complete communicative message of anger is “l love you (you are important to me, you make me happy, I want to be with you) – you hurt me – so I hurt you.”  As we shift the communication from the back half of “…so I hurt you” to the front have of “I’m hurting” we may want to expand our own and the child’s understanding a bit more to include the deeper communication, that the reason the child is hurting is because he or she loves us and wants our love and approval.

In responding therapeutically, I care less about Jared’s behavior in the classroom than I do about his inner emotional experience.  This communicates that I care more about Jared as a person (who he is) rather than as an object (what he does).  

When we care only about the child's behavior (stop being so rude, annoying, disrespectful, disobedient, etc.), this communicates that we care more about the external of what the child does (you're an object), rather than about who the child is as a person; i.e., the inner experience of the child.  Being treated like an object provokes pain and psychological loneliness, being treated like a person feels good, provokes understanding and relaxation, and promotes social bonding and mutual respect.

Do I approve of his classroom and social behavior?  No, of course not.  And we'll communicate this in due course of the complex communication exchange.  But my first concern is about Jared as a person.  The intensity of his anger is communicating the intensity of his pain.  

We need to respond first to his pain and help him stop suffering.  Then we can prune his angry-hostile expression of pain with a small dose of our own anger-rejection, or by inducing suffering in him (i.e., punishment) because he induced suffering in us (through his mean, hostile, rude, disobedient, whatever kind of explosive-expressive discharge of anger, rather than communicating with us... because, if he communicates with us then we're listening... children won't communicate if we don't listen).

Inducing suffering in Jared (i.e., punishment) is not because he did something "wrong," punishment is a social communication of relationship.  He annoyed us, so we annoy him.  He makes us suffer, so we make him suffer.  Simple.  It's personal.  

My diagnosis of Jared's issues, however, is not that he is experiencing too little suffering.  So, in general, I'd tend to shy away from inducing more suffering.  A little suffering can go a long way, so I'd tend to use it gently and sparingly.  I'd use it, because he's annoying.  But I'd use it sparingly and in the context of an active "intent-to-understand" of his inner experience from his perspective... then, I'd give him a dose of suffering in a social communication exchange of "but, little fella, much as I can understand what you're going through, you annoyed me rather than communicating with me, so I'm now going to annoy you with some form of punishment... so, in the future, please stop being so annoying and communicate with me instead.  If you communicate, I'll do my best to help you... because I love you and your joy is my joy, and your suffering is my suffering.”

Punishment (inducing suffering) can take any form you want.  Removing good things he enjoys (e.g., no play date, no TV, etc.,), social isolation/rejection (e.g., time outs, room restrictions, grounding, etc.), anger (e.g., the withdrawal of love-approval and inflicting social rejection), physical pain (not recommended) and a variety of other forms such as extra chores, lecturing (what I call the "intention infliction of excessive boredom"), etc.  

But since all punishments, at their core, involve inflicting suffering on another human being, all punishments will have negative side effects.  One of the primary side-effects of punishing children is that it requires that we make someone whom we love suffer.  This means that we have to shut off our psychological connection with the child, the connection in which our child’s joy is our joy and our child’s suffering is our suffering.  We have to harden our compassion for our child’s suffering.  So punishment, by its very nature, brutalizes both the recipient and the perpetrator.  

When we have inflicted suffering (through anger or punishment), it is important to ultimately repair the relationship with warmth, affection, and understanding, and re-establish our bond of connection (your joy is my joy; your suffering is my suffering).

One other complicating factor in all of this, is that we're pouring various brain chemicals (medications) into Jared’s brain that will affect the operation of brain systems.  So, it can be hard to differentiate the effects of the normal operation of brain systems from a response to medication effect.

We'll talk more about all of this when we meet.

Craig Childress

Explosive Tantrums - 10 year old Michael

This is an e-mail from a mother of one of my clients, an 10 year-old boy prone to frequent explosive tantrums.

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Hi Dr. Childress,

Since yesterday there have been countless times (already about a dozen times today) that I've had to remind myself not to focus on behavior but to focus on Michael’s inner experience. I get it!  However, practically, I’m having trouble with how to respond.

An example: we were all doing chores to get the house cleaned up. I had Jonathon put away kitchen towels (with protest, but ok, he's 3), Mary unloaded the dishwasher, but then went on to do much more (I heaped on praise), but Michael flat out refused.  He sat on the kitchen chair, rocking back and forth, saying, "I caaaaaan't. I caaaaaan't. I just want to play my gaaaaaameees."

I said, over-exagerated, "aw, Michael, sure you can. We all don't like chores, but we still have to do them."  His behavior then escalated. He "fell" down to the floor, rolling back and forth sayihg "I caaan't, I caaaan't, I'm not going to, I'm not going to.  You can't make me. You can't make me." And all of this being mixed with fake laughing and fake giggling, you know, the really annoying fake loud laugh and giggle meant to annoy.  And this annoying behavior sent me into a fit of wanting to lay in and scream at him for being so rude and obstinate and defiant.

I didn't punish him and his chores did not get done (well they did...Mary did his for him) and he's now upstairs playing his video games.

I feel like he "won", he got away with bad behavior, he didn't help with chores, he's upstairs playing his video game, and I did nothing to focus in on his needs.

What should I have done? This is really, really tough and makes me feel like a horrible, ill-equipped mother, being totally truthful.

Help :-)

Sarah

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Here is my response:

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Hi Sarah

I’m going to offer commentary during your description of the therapeutic opportunity.

An example: we were all doing chores to get the house cleaned up.

Commentary:  Three children one mom.  The ratio of relationship to child is stretched thin.  In a well-regulated family this could go okay.  But in a family of high relationship needs this is likely going to be too thin.  So already I’m expecting some trouble.

One thing you may want to consider in the future is to “scaffold” Michael doing his chores one-on-one, while the other kids do other stuff, so that your complete focus can be on Michael.  If it was just about task completion, you might as well do the tasks yourself, but the goal is to scaffold Michael in doing the task.  Gradually, over time you’ll begin to reduce the extent of scaffolding support you provide to Michael.

Your initial intent:  An intent-to-task. This is understandable, the goal is the household chores.  But the relationship needs of a child are likely going to request an intent-to-be-with (perhaps emerging through an intent-to-understand).

When the child communicates a challenge to the parent’s intent-to-task (if we are trying to respond therapeutically) we need to shift to an intent-to-understand / intent-to-be-with that re-establishes relationship, that organizes the child’s inner experience (through our “eyes-of-the-other” recognition/definition of this inner experience), and that fosters increased development of sophistication in communication (from protest behavior to emotional signaling initially, then to increased verbal communication as the process progresses over repeated cycles).

I had Jonathon put away kitchen towels (with protest, but ok, he's 3),

Jonathon is spot-on the age of attachment system activation.  He presents with high protest, but in a gentle way, but he nevertheless demands attention.  This draws parental focus (love) away from Michael (and Mary – I worry about Mary).  Michael can’t compete with Jonathon on developmental immaturity (at 3 years old, Jonathon has him beat hands down), so Michael may develop “symptoms” of incompetence to compete with Jonathon.

Mary unloaded the dishwasher, but then went on to do much more

Sweetie.  Mary appears to be trying to carve out her own niche of parental bonding through being the angel.  Jonathon has immature-baby wrapped up, Michael has a problem child version of immature-baby… so what’s left for Mary… wonderful angel.  Michael needs to develop into more angel and Mary needs to develop into more problem child… come-on children, let’s share…

(I heaped on praise),

Deservedly so.  Praise is often used as “reinforcement,” based on studies training lab rats.  Doesn’t work with children.  Human children are immensely complex and social.  I’d recommend doing the same thing but changing how you think about it to… “I heaped on lots of loving.”  Praise is for what we do (intent-to-task), love is for who we are (intent-to-be-with).  Humans are social animals, make it personal.  She wasn’t well-behaved, or responsible… she was nice to you.  It’s personal.  “Thank you so much sweetie, I really appreciate your help.” <big hug and smooch>

but Michael flat out refused.

Protest behavior.  Therapeutic opportunity.  Shut down your intent-to-task and shift to intent-to-understand in order to bring organization to his inner experience and to begin the process of facilitating a longer-term increase in communicative level.  Use the task to organize the focus of your intent-to-understand, but shut down your internal press toward task completion in order to give increased time to Michael’s relationship needs (i.e., an intent-to-be-with).

Approach Michael with a positive emotional tone and an intent-to-understand his perspective from his point of view.  Your tone can include a mild challenge to his protest behavior (i.e., a gentle intent-to-change; making your response a “complex communication” of nurturance and challenge), but any intent-to-change should be only the slightest hint and should be dwarfed by a nurturing positive emotional tone and the intent-to-understand (we’ll turn up the volume on the intent-to-change later in the communication dialogue).

“Michael?  What’s going on, sweetie.  I need your help in getting some things done.” <make it personal… I need your help>.

He sat on the kitchen chair, rocking back and forth, saying, "I caaaaaan't. I caaaaaan't. I just want to play my gaaaaaameees."

Stay with his experience.  Help him organize the meaning of his experience.  Let’s explore what this is really all about.  We’re about to embark on a voyage of discovery.  Is he afraid he’ll be unsuccessful and that he’ll lose your loving?  Are his brain systems currently captivated by the happy of the game and he’s experiencing intense disappointment at having to stop happy and do un-fun?  Does he simply want your loving or your special attention apart from Jonathon and Mary, does he need to be special to you?

Depending on your read of his current emotional state, you may want to feed some positive happy emotion into him by offering an affectionate gesture.  In this case, I might offer a soft rub-rub to his upper back or shoulder, all the while maintaining a calm, nurturing tone of concern for his communicated distress (i.e., his emotional signaling).

I said, over-exaggerated, "aw, Michael, sure you can. We all don't like chores, but we still have to do them." 

Ouch. This  response is a denial of his experience and it represents an intent-to-change / intent-to-task, which ultimately communicates that he’s an object, you care about what he does, not who he is.  This will hurt more and will likely provoke further deterioration in his emotional functioning.

Stay with his experience for a few more relationship beats (called “relational moves”).  You can offer this intent-to-change and prompt to task, but do it toward the end of the communication-relationship sequence.  At the early phases, the therapeutic goal is to help him understand the meaning of his inner experience and to provide him with relationship support for his distress.  Three relationship beats on an intent-to-understand his experience from his perspective.

"I caaaaaan't. I caaaaaan't. I just want to play my gaaaaaameees."

“Really?”  <our surprise communicates a gentle challenge that his reality is odd – this is enough of a denial of his experience.  We then need to repair even this ever-so-mild a breech in our psychological connection with him (called the “intersubjective field”) by entering his world from his point of view.

“You’re having a lot of fun playing that game, aren’t you.”  Which one are you playing?” <joining with his experience – providing our “eyes-of-the-other” to his inner experience – followed by a question to foster increased communication.  Taking the time to ask a question related to his activity also communicates that we’re not in a hurry, i.e., an intent-to-be-with on our part.>

<smile – rub-rub – feeding affection/positive emotion into his emotional system – which will help relax his emotional locking up> “I know, you really like playing those games, don’t you?”  <psychological bonding with his experience, synchronizing our nervous system to his through our mutual mirror neuron networks, which may help him maintain the organization of his nervous system when we transition our nervous system back to an intent-to-task – because his nervous system will be in a supportive synchrony with ours.

So far, we’ve offered Michael two beats of an intent-to-understand with a dose of positive emotion; and the gift of time we give to him in doing this communicates an intent-to-be-with.  Now let’s shift to another gentle breech – make it personal – and continue a positive emotional tone.

“but sweetie, I need your help to get some stuff done.”

"I caaaaaan't. I caaaaaan't.” <I’ll just pretend he continues this kind of response. However, often times the child will become cooperative as we engage in relationship supportive dialogue.>

Repair the breech in the psychological connection (breech-and-repair sequences).

<Continuing with a soft nurturing tone> “Oh honey, you’re really having a hard time with this, aren’t you.” <bringing our “eyes-of-the-other” to his inner experience while also communicating a nurturing response to his distress; i.e., when you’re in pain come to me for loving.>

“What makes you think you can’t do it?”  <intent-to-understand – this has to be an honest intent-to-understand.  The false intent-to-understand seeks the child’s response so that we can then invalidate the child’s experience and convince the child to do what we want.  The key is our response to the child’s response.  Do we maintain an intent-to-understand (i.e., and authentic intent-to-understand the child’s experience from the child’s point of view), or do we shift to an intent-to-change by invalidating the child’s reasons?> 

"I caaaaaan't. I caaaaaan't.”

“So, you’re just having a hard time getting yourself to leave the games.  You know what I think, I think you’re just having so much fun playing your games that you find it hard to stop doing something that’s so much fun, especially if you have to do something un-fun.  Is that it?”  <continued intent-to-understand by defining his inner experience for him – offering him our best guess as to his inner experience.>

"I caaaaaan't. I caaaaaan't.”

<rub-rub>  “Hmm.  So what can we do about this?”  <the goal is to develop a mutual intent>  “Hey, I have an idea, how about you help me do two things, I’ll give you a big hug, and then you can go back to your games.  Will that work for you?”  <will that work for you is my favorite phrase in developing a mutual intention.>

"I caaaaaan't. I caaaaaan't.”

“Really, you can’t help me?”  <a slightly more adult, slightly less nurturing tone.  Mild social guilt induction – make it personal.  “Really” communicates an expectation of cooperation, “you can’t help me” makes it personal and applies “moral suasion” (a mild sense of guilt arising from feelings of social responsibility – moral: right and wrong; suasion: like persuasion – moral suasion: persuading based on issues of social right and wrong.)>

"I caaaaaan't. I caaaaaan't.”

<adopting a more adult tone – but not angry>  “But you know what sweetie, I need your help, so you need to put the game down now and come join me in the kitchen.”  <a calm and confident communication of adult authority – adult tone of voice – authority but not angry – but we’re definitely moving the situation forward.>

"I caaaaaan't. I caaaaaan't.”

<sharper tone>  “Michael, listen.  I need your help.  Jonathon is helping, Mary is helping.  I love you.  But, if you’re not going to help me you’re going to have a punishment for disobedience.”  <calm and direct adult tone – major breech – seeking to activate the dominance-submission networks of the authority system.>

Can be followed by an immediate repair of the breech, “Come here, sweetie, give me a hug”  <smile, soften the tone into nurturing again (breech-and-repair sequences) encourage cooperation – hopefully he’ll move forward into cooperation at this point>

If he doesn’t move into cooperation at this point, then proceed with punishment.  Anger? Send him to room?  Take away his game?  Its up to you, they’re all pretty much equivalent. He’ll cry and tantrum.  That’s the way of things.  Return to complete your task.  Calm and confident adult authority.

When the punishment is over and you’re in a more even place, maybe later in the evening, review the sequence of events with Michael, offering a nurturing positive tone and an intent-to-understand, bringing your “eyes-of-the-other” to the sequence of his experience.

His behavior then escalated. He "fell" down to the floor, rolling back and forth sayihg "I caaan't, I caaaan't, I'm not going to, I'm not going to. YOu can't make me. You can't make me."

If it gets to this point, repair the breech as above.  He’s more important than chores.

But ultimately, we’re going to move forward and he either needs to cooperate and help, or bad things will happen (i.e., a punishment).  But we’re going to add a therapeutic phase ahead of the authority-punishment phase.

And all of this being mixed with fake laughing and fake giggling, you know, the really annoying fake loud laugh and giggle meant to annoy.

Anxiety.  Not really positive emotion.  Anxiety because you’re going to get angry. 

I suspect he’s afraid that he’s not going to be able to do the task because he’s locking up emotionally-behaviorally already, and you’re going to become angry and everything is going to deteriorate.  And he’s right, that’s exactly what happened.  He needs help getting through the current lock-up and his fear that his current lock-up is going to lead to angry and a deterioration in your relationship.

And this annoying behavior sent me into fit of wanting to lay in and scream at him for being so rude and obstinate and defiant.

Understandable.  Do your best in the early going to offer a positive emotional tone, an intent-to-understand his experience from his perspective, and the gift-of-time (an intent-to-be-with), this is the therapeutic period.  But once you’ve done this, it’s time to move on.  Make it personal – mild social guilt induction (moral suasion), intent-to-task; intent-to-change (activating the dominance-submission networks of the authority system; punish-induce suffering, he cries and tantrums and we wait for it to resolve. Offer love at the end, a final dose of mild frowny face for the tantrum, love again and move forward.

I didn't punish him and his chores did not get done (well they did...Mary did his for him) and he's now upstairs playing his video games.

Okay.  That’s fine.  I’d go and talk to him in a parent-adult firm-stern disappointed tone (tinge of anger but not overt – just stern).

“Michael, I’m really upset that you didn’t help me.  Mary had to do your chores, and that’s just not right.  Do you think it’s right that Mary should do your chores while you play your games?  I don’t.” 

“Do you think you should be punished for making Mary do your chores? --- I’m going to have to think about it.  But at the very least, I want you to apologize to Mary and thank her for doing your chores.  If you do that, I may decide not to punish you.”  <social guilt induction –right and wrong – we do things because we love people, not to avoid punishment.>

Punishment is personal.  You annoy me so I annoy you.  He was mean to you by not helping, he was mean to Mary by making her do his chores.  Seemingly merits suffering if you want.  He’ll cry.  Your message to him: then don’t annoy the big gorilla.

Mary deserves a big hug-n-snuggle and a treat.  Arrange a mother-daughter time when grandmother is watching the boys to go get a frozen yogurt or some treat with her (my daughter would choose a Starbuck’s drink).

One thing I did with my kids is to wave my hand in the air in a sprinkling motion while I said “Brownie Points.”  Brownie Points weren’t really anything specific, it just meant that for a kid who had been earning a fair amount of Brownie Points I would be more likely to change a “no” to a “yes” when they asked for something.  It’s not a formal reward, it’s a social acknowledgement of appreciation.  Sometimes my kids would bring this up when asking for something, “dad, can we go get a smoothie” --- “no, not today” --- “I’ve been earning a lot of Brownie Points.” --- “Yea…. You’re right.   Okay”

I feel like he "won", he got away with bad behavior, he didn't help with chores, he's upstairs playing his video game, and I did nothing to focus in on his needs.

We want to move away from win and lose, and it’s not bad behavior.  His brain systems got scrambled and we weren’t able to help him unscramble them.  In terms of power, we have all the power.  We can do all sorts of things to make him miserable, take away his TV and games, yell at him, fail him in school, put him in jail, reject him, fire him from work, all sorts of bad things can happen for the kids who are disobedient of adult authority.  Believe me, these kids are not happy campers.  They’re miserable.  We have all the power.

He was mean and un-loving.  Ouch.  That’s not right.  You love him, why does he treat you and Mary so mean?  That’s not right… that’s the long-term coercive press of our social communication that we’re going to use with him.  When he is captivated by fun and has difficulty getting unstuck to do un-fun, we want him to activate his love for us to help un-stick himself from the fun, and to help overcome his aversion to un-fun.

We need him to cooperate because he loves us, because it makes him happy to make us happy, because we love him and he wants to maintain our love (we want to establish and use our psychological connection; i.e., the synchrony of our brain systems can support the organized functioning of his brain systems).  And, if he needs a little bump from the dominance-submission networks of the authority system to help him over that final hurdle, we can help him with that.  Don’t annoy the big gorilla because the big gorilla will make you suffer.

But first, we want to provide Michael with a therapeutic response to help him define the meaning of his inner experience (through our approach with a positive emotional tone and our intent-to-understand his experience from his perspective – our “eyes-of-the-other brought to his inner experience – the formation of a psychological connection) and the therapeutic opportunity to communicate this inner experience to others in an ever more elaborated and sophisticated ways.

It’s a three-step process

1)   Approach with an intent-to-understand – at least three relationship beats

2)   Orient him to the social context of other people’s needs, and external rules, limitations, and restrictions

3)   Negotiate a mutual intention – not necessarily what you want – not necessarily what he wants – but what you can BOTH agree on

Once we move through this process (we can cycle several times through steps one and two – but we shouldn’t spend too long with step three – offer one, maybe two potential solutions… then move forward), if a mutual intention cannot be developed, then we’re the big gorilla, we’re the adults, it’s up to us to decide what needs to happen and to then make it happen.  If this involves a punishment for annoying us, then so be it.  But the punishment is not for “bad behavior” (people have a right to have a different opinion or different wants-needs-desires), the punishment is personal – you annoyed me, so I’m going to annoy you. 

It’s simply about power, and that’s fine.  I have the power (I’m the big gorilla) and you need to do what I say or I’m going to use that power to make you suffer (punishment).  That social communication of hierarchy status should activate the dominance-submission networks of the child’s brain, which will then turn off the child’s personal motivational press and allow the child to adopt our motivational agenda.  If it doesn’t, deliver a punishment (anger, removal of something pleasurable, lecturing, restricting freedom – time out/room restriction, whatever…)

In this way we build three brain networks with Michael,

1)   self-awareness

2)   other-awareness

3)   social cooperation and negotiation to get his needs met within a socially organized context of other people’s needs

By sequencing these steps, we also build (we build what we use) the transition networks between these three systems, so that over the course of time (months and years) we will build, through use-dependent processes, Michael’s ability to become aware of (and communicate in language) his inner experience --- then transition --- to his looking around to take in the needs of others and any relevant rules and restrictions that affect his needs and desires --- then transition --- to developing a way to get his needs and desires met within the context of the social needs of others and the rules and restrictions of the setting.

We build what we use.  So, right now, we want to “scaffold” Michael’s use of these processes.  Behavior is the outward symptom, but behavior is not the focus of intervention.

What should I have done?

Right now, I’d suggest having a cup of hot cocoa (or glass of wine) and a nice hot bubble bath.

This is really, really tough and makes me feel like a horrible, ill-equipped mother, being totally truthful.

Children are designed by nature to be annoying… children are supposed to annoy us… and they can be pretty good at it, can’t they.  Deep breathe and smile.

Sometimes it helps to go into our children’s bedroom when their asleep and watch them sleeping.  They look so angelic that all our frustrations just seem to lift away.

Angry Tirades - Asperger's Spectrum 10 year old William

This is an e-mail from a client’s mother.  The client is a 10-year old boy who was diagnosed (by others) variously as ADHD or Asperger’s Disorder or Bipolar.  I can understand these diagnoses, and I frequently run into these type of previous diagnoses for the type of issues displayed by my client. 

However, my diagnostic interpretation of the symptom pattern places it more in the DSM-IV category of an anxiety related disorder secondary to disruptions in his capacity to metabolize emotions through the communication-relationship systems.

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Hi Dr. Childress,

I'm in the throws of one of William’s meltdowns and could use your advice on how to respond and discipline right now.

Background: I had asked William not to take his glass of ice water into the living room for fear it would get knocked over and broken. As he crossed the threshold from the kitchen into the living room, not minding me, he tripped and the glass flew out of his hand, shattering in pieces on the floor.

My response: in my admittedly not happy voice and in my punishing, yelling and reprimanding voice I said, "Damn it William, this is exactly what I was warning against and exactly why I said not to take your glass into the living room.  You chose to disobey me and in doing so dropped the glass on the floor, causing it to shatter.  Please go sit on the sofa while I clean the broken glass up."  

He screamed back at me, "No, I don't have to.  Glass doesn't fly this far.  I don't have to listen to you."  So this back and forth tit-for-tat tirade ensued (again, I'm not proud of it, but it was the impulsive response from both of us).

I said, "William, I need you to listen and follow the rules.  If you choose not to listen you will lose a privilege."  He started yelling and saying that my rules were stupid and that he hated me and that I was the worst mother ever and then he got up off the sofa and started walking, barefoot, on the floor where the broken glass was, knowing doing so would make me upset.

I responded by telling him his friend Joseph could not come over and play because of his tantrum, so he replied with, "Yes he can.  I'm not listening to you," and he stormed outside to play (I knew Joseph was not home from school yet, so going outside was not an opportunity for him to disobey and go find Joseph).  He came back in and said, "Please mom, please let Joseph come play."  And I said, "No, I'm sorry. You were rude and disrespectful and you are not going to have playtime with your friends when you show this behavior."

He replied back that I was horrible and mean and that I didn't know how to raise children and that he hated me and would never speak to me again.  He started to go outside and I told him he was not allowed, now, to go outside because his disrespect was continuing and he was being defiant.  I asked him to go upstairs and he screamed, "No. I don't have to!" and kicked a wooden basket across the living room and then threw an umbrella across the living room.

I don't know how to implement your suggested technique here... I don't know how to be a disciplinarian in this situation, and be admittedly angry, and at the same time show love and concern for his frustrations.

Can you provide any guidelines?

Cynthia

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According to his mother, these type of interactions happen on a daily basis, often multiple times during a day.

This is my response: 

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Cynthia,

This is a very difficult situation, particularly in shifting from one response approach to a new response approach.

First, it is okay that you are angry with him for the broken glass.  He disobeyed your wishes and bad things happened.  You now need to clean up a mess and someone could get hurt with the broken glass.  You are not happy that he did not listen to you're wishes regarding the glass, because there are reasons you said not to take the glass into the living room.  So this will be the core of the message that will be conveyed... but it may take 30 minutes, 2 hours, or a day and a half to finally get to this message.

The first issue is to express your frustration with his disobedience, then when he further "dysregulates" into excessively angry defiance, the immediate task-at-hand becomes to help him restore some degree of interpersonal and emotional regulation so that he is capable of incorporating your anger (rejection), frustration, and disappointment without it becoming overwhelming for him.

His expressions of "I hate you, you're the worst mother" are actually "I adore you and it is far too painful for me to have you be angry (rejecting) toward me.  I'm overwhelmed by my emotional pain and I don't know how to repair our relationship.  You're a wonderful mother, and so your anger means that I'm a horrible person.  You're rejecting me because I'm a horrible person.  I'll never be able to be good enough to get your love, and that's too painful for me (that "I'm a horrible person and I'm in soooo much pain” is why he started to walk on the glass; self-punishment for being horrible and an outward expression of his inner pain).  I'm in so much emotional-psychological pain and I don't know how to make it stop, I don't know how to find your love again when this happens.  AHHHHHHHHH!!!! Help me!"

Anger is "you hurt me - so I hurt you"

The degree of his anger is the degree of his hurt.  He's extremely angry and rejecting, so he feels extremely hurt and rejected.  But he's communicating this in the second part of anger "... so I hurt you" rather than in the first part "you hurt me."  When he broke the glass and you yelled at him, he should cry.  Crying draws nurturance to heal the pain.  Instead, he responds with anger and provokes greater anger (rejection) from you, and things spiral out of control.  He doesn't know how to stop this process when it starts...

You're the adult, so it’s up to you to help him escape this downward spiral.

When he starts to dysregulate even more, saying crazy things like he hates you and you're the worst mother ever (whenever he says this type of crazy stuff you know he's gone off the deep end and he needs the loving mom to bring him back rather than the angry-disciplining-instructing mom --- we can get to that mom later, but not when he's in such excessive pain of "I hate you, you're the worst mom ever, I don't have to do what you say.”  At that point he needs emotional rescuing).

So, once he goes off the deep end... take a few moments for yourself, maybe walk away, collect your thoughts and emotions, and realize that he is in horrible, horrible emotional pain because he feels you don't love him anymore.  He's so God awful lonely and scared and wants his gentle nurturing mom to help him... but he doesn't know how to find her.

Collect yourself, and bring him the nurturing mom.  Help him understand that his apparent anger is the second half of his experience (... so I hurt you) but that he also has the first half (you hurt me).  Nurture him.  

In a soft, compassionate tone of voice that understands his emotional pain, "Oh, sweetie, I think you're feeling sad and afraid, because you're saying awfully mean things.  Did I do something that makes you sad or hurt?"

"Yeah, you’re mean."

"Was it because I got mad at you?"

"Yeah."

"So you don't like me to be mad at you, do you?"

"No"

<Very soft-nurturing tone> "Oh sweetie, I'm sorry.  I love you so much.  Come her and give me a big hug."

If a hug happens, then... in a calm and nurturing tone, explain how the broken glass is a mess, and that you asked him not to do that.  Stay nurturing.  If he tolerates this... then flash him a scowl, but then give another hug.  At bedtime tonight, maybe revisit the issue of his disobedience and how you set limits to keep things safe.  He needs to listen to you because you know what you’re talking about... then give another hug or a rub-pat-pat.

If he rejects the offer of a hug, consider disengaging for a few minutes, then go back and try to re-engage with love around giving and receiving a hug.  The goal is to maintain relationship and build the strength of the relationship so that it can tolerate an ever-increasing intensity of your anger (rejection) without falling apart into crazy-angry emotional tirades.

Ultimately, over the course of 30 minutes, several hours, several days, communicate the message of --- he disobeyed your wishes and bad things happened.  You needed to clean up a mess and someone could have gotten hurt with the broken glass.  You are not happy that he did not listen to you're wishes regarding the glass, because there are reasons you said not to take the glass into the living room.  

<with a mild but stern tone> "Don't do that again!  <continuing a tone of authority without anger> When I say stop, you needs to stop.  If you disagree you needs to talk it over with me, but you are not to simply disobey me... Okay, William?" <with a smile but also with a slightly stern tone of voice and/or an upraised eyebrow of disapproval, offering William a mixed complex communication of nurturance and authority>

Then give him a big hug and abundant affection.

We'll discuss this some more during our session.  Give him some loving.  He's more important than water on the floor... 

Help him to find ways to find his loving mom when bad things happen.  You can, and will, return to the angry (slightly) and disciplining mom later.  There'll be time enough for that.  But first respond to William's pain and psychological loneliness.  Once the relationship is fixed and positive and strong and stable, then we can infuse some anger-rejection (in small tolerable doses - gradually increasing the doses as he is able to tolerate and integrate them into his nervous system).

Best of luck,

Craig Childress, Psy.D.

Clinical Psychologist, PSY 18857

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30 minutes later, this was the mother’s response:

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Goodness what fabulous advice.

I asked William to come see me.  I gave him wide open arms and he came scurrying over and gave me a big giant hug.  I said, "William, you know, I love you tons.  You said some pretty mean and hurtful things."  True to what you typed he said, "Yeah because I was angry."  And I replied back by asking him if he felt that I didn't love him and if my anger made him feel rejected by me?  He, with big huge eyes, said yes.  He asked if he could call his friend Joseph and I said no, explaining that Joseph not coming to play was a consequence of his disobedience, but that (in the middle of big huge 2nd hug squeeze from him) I loved him so much, that I thought he was an amazing big brother and a wonderful baseball player and a great son.  And that was that.

Great advice, thank you.  I'll spend more time on this over the next few days, too.

Cynthia