How do you handle rages?
 

I'd really like to know how you handle rages. My little guy is still having impulse issues and tonight had another rage. It's been a little while since he's had one--probably a month or more so it took me by surprise.

I picked them up from school and had ordered pizza for carryout. We usually do delivery but I wanted something different tonight. They didn't know about the change. When I told them in the car we had to go pick up the pizza, he freaked out. I mean calm to rage in a split second. He was screaming that he hated that pizza place and didn't want to go, he wanted delivery or he wanted to go home and me go back out. I thought I could calm him but it got worse. He was kicking at the seats, hitting on the windows, throwing things around, sliding out of his car seat (he's 7 and still in a booster). I had to pull into a parking lot and stop because he wasn't safe. He wouldn't listen, continuing to scream and thrash about and say ugly things to me (which he does not do normally). He got out of his seat and climbed into the back of the van. Then he was screaming that he hated his car seat. I had to step out of the van to talk to his father on the phone and he climbed into the front seat still screaming. (I had taken the keys with me). I finally calmed him down, agreed to take him home and go back out for the pizza. He still argued about the carseat but we weren't budging until he got back in. Told him he had the 2 choices, go get the pizza or go home but either way he had to get into the car seat. I eventually got him calmed down but the whole ordeal probably lasted 20-30 mins and we headed back home (about 5min trip). He was almost completely calm by then and said calmly to me that he would eat the pizza but he didn't want to go get it. When I asked him why he got so upset he just said he didn't really like that pizza and he didn't want to go get it and he got really mad and couldn't control it. He had a good day at school and afterschool but said he was really tired. BTW, he did eat the pizza and said he liked it.

I remained calm and just kept talking to him and explained the "have to's" like using the carseat but gave him choices about going home or going with me to pick up food. But he was so irrational at that point that it took forever for him to calm down enough to consider it. He was so totally checked out. This was a typical rage for him. Thankfully, they are less frequent than they used to be but they do still happen. We did just start another trial with Tenex due to impulse issues at school. He's currently taking 0.5mg at night and morning for a slow ramp up. He'll move to 1mg evening/0.5mg morning on Monday and then may go to 1mg AM and PM. It's supposed to help these issues so hopefully it didn't cause this.

I just feel so helpless when these happen because he is so irrational that I don't know how to help. After he was calm, we discussed what happened and how it was not acceptable behaviour. He understands but he truly cannot always control himself.

Re: How do you handle rages?
 

Been there, done that. It will get better.

Talking calmly during the outburst was really good because this avoids further escallation (believe me it can get worse). During a calm period tell him that when he is angry, it is hard to solve the problem that made him angry until he can calm down and talk appropriately. Then when the rage starts again, tell him that when he calms down you will be happy to discuss and solve the problem. His stated reasons for things may not make sence to you but that is because he is upset and also he can't comunicate things as fast as they are going through his mind so you only get fragments.

They can be so ridgid that any change in plan can upset them. My youngest (who used to have violent rages) will have a plan in her mind how her day will be. It is difficult for her to adjust her plan because she has problems re-ordering the plan in her mind. I let her know early what we will do and try not to throw last minute changes at her. She has become much better over the years as she matures (she is now 13) and can tolerate the shifts in schedule much better. Guanfacine (tenex) and concerta were very good during this time. We increased guanfacine slowly until she was getting 2mg in the morning and 2mg at night with the posibility for 1mg after school if she had a challenging social schedule. We would also add the mid day dose for family holiday gatherings.

We went (age 8) from daily violent rages, running away from home, etc to a pleasant though ridgid child with much better expression of anger in about 6 months. During this time, the rages kept reducing in severity and frequency which told us we were on the right track helping her. Currently, she is not on meds and doing really good.

Hope this helps and hang in there.

Re: How do you handle rages?
 

With us, when Steven was younger my husband would sit him in his lap and hold him until he calmed down. I think the record was just under two hours. :rolleyes: Since that clearly wasn't working (or helping for that matter) I just ignored him. I would send him to a place that was safe, and we would talk once he calmed down.

As he's gotten older, gotten the correct diagnosis, gotten therapy, gotten the right medications he's gotten better (every little step helps). He's much better now at controlling his anger, and therefore controlling his rages. In fact, I don't think he's had a meltdown since....well last year *knock on wood*

The absolute thing to remember is to stay calm. If you're upset, yelling back, etc it only feeds the beast.

Re: How do you handle rages?
 

There are a lot of ways of handling rages from gently holding to finding a safe place and letting them have at it.

The key, as Lady Lark said, is to remain centered and speaking calmly. This puts it back on the kid. Very often the purpose of a tantrum is for the child to gain some feeling of control over the situation. If they can get you upset then they have gained the control they want. If you get upset, they win, if you don't you do. It really is that simple.

At times you can walk away and they will follow you to continue the tantrum. They really can want some control.

Do keep in mind that sometimes the kid will loose it and cannot calm down without some time to pull back together.

If you can, give choices. In this incident, for example, you did well with the car seat issue. A "might have" would to have given a choice between going with you but choosing not to have pizza and choosing something else to eat home. The going with you is not an option.

What the choices do is give the child some feeling of control. You set the choices however not the child.

There is lot to working with tantrums but this should give you a couple of ideas.

Dizfriz

Re: How do you handle rages?
 

Re: How do you handle rages?
 

Thanks for all the replies. It appears I did the "right" things by staying calm and giving him some choices. I guess in the end, he felt like he had some control in the matter with the choices and that helped him calm down. He had been doing much better so this one caught me by surprise. We've had a meltdown like this at after school care and of course at the end of last year and the beginning of this year with separation anxiety at school. We live each day on pins and needles waiting to see if the school will call about an impulse issue because we all know the schools opinion is that these are discipline issues with the parents. ARRGGGHH!!! We are hoping the guanfacine will help.

Thanks again for all the input.

Re: How do you handle rages?
 

Sometimes it's about trying to get control (tantrums), but sometimes I think it's about a level of frustration, and an inability to express that in a more verbal "grown-up" way (rages). I've seen both.

That's why we worked so hard with Steven (when he was calm) to help him learn how to handle his anger and frustration without letting it handle him. I think that simply getting older helped too.

I understand the pins and needles all too well. It was so annoying to never know if this would be the time that asking him to put his shoes on so we could leave would be the time for him to blow, or if we'd just have his say, "OK" and go do it. One thing that help a lot was letting him know of changes to the routine before they happened.

"OK Steven, we're going to have to leave to go to the store in about 10 minutes, so you'll have to stop what you're doing and get ready to go."

"I know that you normally go to school first thing, but tomorrow we have a dr appt, so we'll go there first, then take you to school."

From there, we worked on little things that he had to change on the fly, so he was better able to handle sudden changes. making him sit somewhere different when eating dinner, changing the order of the bedtime routine a little. Once he saw that the world really wasn't going to come crashing to a halt if he got dressed before taking his meds, he was better able to handle sudden changes.

Steven also likes to negotiate, so I let him, sometimes. He knows though, on matters of safety, I will not bed, but because I let him makes deals in other areas, or let him have his own choice flat out in areas, that when I say no, that's it, but something will come along where he does get a choice. It makes those no moments more bearable.

Re: How do you handle rages?
 

To develop on what Lady Lark posted (this applies both to ADHD and Asperger's kids) ADHD kids do not do well with transitions. If you make an abrupt change they are likely to get upset. You need transition plans. As an example, it is getting close to time to leave an activity; give a notification "we are putting up the toys in 5 minutes and getting ready for supper. You can have a small closure ritual-OK it is time to put the game up for now....put it in the box and wash for supper. Let them know they can play the game later that day or tomorrow whichever is appropriate. Younger children, especially, may see putting up the game as a "gone until eternity" issue.

The big thing here is to plan for transitions and give as many choices as you can keeping in mind is you who sets the choices but it is the child's right to then choose among the alternatives.

A feeling of control is important to all of us as adults but we sometimes forget that it is also very important to children, with these children perhaps more so. So no transition plans or choices, an explosion waiting; transition plans and choices, they may not like it but are much more likely to comply.

As parents try this they should be aware that the child will really test you thoroughly to see if you mean it. You can negotiate but if you give in to tantrums, crying, whining or any other technique of a kid wanting control, you set yourself up for more testing tantrums etc until the child sees that you mean it. Also be aware that the kid will test you again periodically to see if you still mean it. Be ready for it because it will happen.

Dizfriz

Re: How do you handle rages?
 

When my daughter rages, I have not found anything to help during the rage. She is totally illogical, and trying to reason with her just makes her get more upset. Basically, all I say is that I love her. I know that only time will end the rage, not reasoning. I check my watch at the beginning and know that it will be over in about 20-30min. My goal is just to make sure that she does not hurt herself or any property.

Rages are associated with bipolar. Meds that trigger rages in bipolar kids include; stimulants, and SSRI antidepressants. Lexipro is an SSRI. There is medicine that can control the rages. You should try and get them under control with medication and/or removal of meds that trigger them. With a doctors guidance of course.

Re: How do you handle rages?
 

Thanks again. I realized when the rage started that I had messed up his "Friday Routine" with an unplanned.....and unannounced.....change. I do work really hard to give him transition time and announce changes like dinner, bed, homework, time to leave. I guess I just didn't think this "little change" in plans was a big deal but boy was I ever wrong!!!

And MGDAD, you are right. In his rages, nothing makes sense. He is totally irrational. I'm not sure how I finally got him to calm down enough to get back into his car seat. Maybe it was because he was in the front seat and I sat on the running board to talk to him, he was more focused on me? I don't know.

We will continue to make every effort to give transition/change warnings so that should help. And perhaps the guanfacine will help when we get up to dosage. We will start one 1mg at night and 0.5mg AM tomorrow night (up from 0.5mg am and pm). I just breaks your heart to watch them. They seem so helpless. And it affects everyone--my 9yo daughter was upset saying she was afraid he was going to hit her or make us have a car accident. Praying we can help him deal with all of this.

Re: How do you handle rages?
 

When was his first rage? Was he on medication at the time?

Re: How do you handle rages?
 

MGDAD, no he wasn't on medication then.

Honestly, pinpointing the start is hard because he has always had issues with control even as a baby. He cried alot as an infant and I mean alot!!! He had major separation issues with daycare as a toddler and young boy which we chalked up to age. Knowing what we know now, I believe these issues have always been there.

He seemed to mature and really didn't have any major issues from the age of four until this past spring just before turning 7. He did really well with school in kindergarten and also in 1st grade until May of this year when he really started having rage issues again. These were major meltdowns when transitioning to school in the mornings. These were what got us to the psychiatrist over the summer where we got the diagnoses of ADHD, severe anxiety and depression.

The dr doesn't want to do stims if at all possible due to his age and the anxiety issues. If the stims would make the rages worse, I DEFINITELY don't want to try them!!! He is taking Lexapro and it did seem we had a rage when we tried to increase his dosage. She wants to see some history with other patients on the new SR guanfacine and if she likes it, she might try that down the road.

I hadn't really thought about bipolar and the dr hasn't mentioned it. Might be curious to ask.

Re: How do you handle rages?
 

Excessive separation anxiety from the parents is another indicator of bipolar. My 11yo was unable to go on the 6th grade overnight camp because we (and she) knew that she would not be able to handle being away for so long. She did a 3day trip last year and took two days to recover. Exactly like PTSD when she got home.

Rages are a sign of a mood dissorder. Anxiety is almost always comorbid with bipolar. Current treatment protocol for that combo of symptoms is to treat with a mood stabilizer first, although most psychiatrists dont seem to know that. None of the meds your son is taking are mood stabilizers. Although it is good that your doctor is hesitant to try stimulants.

Re: How do you handle rages?
 

Chris didn't get his Vyvanse today. His brother was rushing me out the door because he wanted to leave early for some unknown reason, and I completely forgot to give it to him, didn't even realize it until he told me this afternoon.

He has been ok most of the night, up until he started eating raw sugar. Needless to say I didn't know he was eating it since I wasn't in the kitchen and I thought he was just eating a piece of toast leftover from dinner that he asked for. I put the sugar up out of his reach when I found out and then asked him to sweep the floor since he got sugar all over it. He started to, halfheartedly, so I showed him how to sweep, just so he couldn't say he didn't know how, which is something he is very fond of saying to get out of doing things. Next thing I know he is sitting down sweeping and I told him that wasn't the way to sweep, and had to tell him several times in quick succession to get the broom off the table.

At this point my husband gets involved and things just escalate from there. He had a full blown screaming, kicking, hitting, meltdown. We told him he needed to go to bed and I actually had to go in there and hold him down so he wouldn't tear up the room. Getting his PJs on was another fight, but he had been playing in mud and paint all afternoon, so I didn't want him sleeping in those filthy clothes.

Once he settled down I allowed him to get up and get something to drink, but told him beforehand he had to come right back to bed when he was done. He got up to get a book out of his closet, and I asked him what he was doing. It took me a few tries to get more than a whine, but I didn't know if he was planning on shutting himself in the closet or what. One never knows with him. Once he got his book (a children's bible, ironically) and read for a little while, he was fine, and got up to tell me he finished it and asked if he could give us a hug before he went back to bed.

Does anyone think I could have handled this differently? If so, I welcome your feedback.

Re: How do you handle rages?
 

Kids prone to rages generally do it when they are "cornered". He had two people standing over him telling him to do something he did not want to do. Classic cornering. Of course, you were perfectly reasonable in expecting him to do it, but it is not surprising that he raged about it.(since he is prone to raging)

While I would get crap from people nearby when I would not punish my daughter, because I knew she would rage, I just would not do it. People would say it is just a tantrum, but it is not. They become completely illogical. The bipolar people would say that you cant really punish them for things like that until they are "stable." Meaning, medicated enough so they wont rage, or go "manic" in those type of situations.

That opinion might seem a bit out there for parents of kids on this forum, but it is my opinion.