Managing Anger in Children

Anger and rage disorders are something I used to treat often. Lots of therapists don't like these disorders because, frankly, they're scary. I like treating these because they make perfect sense to me and I think I know something that can be helpful.

Therapists often don't talk about their personal lives because it can blur boundaries and confuse what's going on in treatment. There's research indicating when self-disclosure occurs it can make the therapy better. Most people learn about how to manage angry feelings in childhood. Child abuse changes the normal developmental response to anger and does not allow the child to practice management of those feelings. As a past victim of child abuse I didn't get the opportunity to learn how to manage anger. I had to figure it out on my own when I was older.

When I treat anger disorders I differentiate anger that is from those types of developmental failings, to other more complicated forms of anger disorders. Anger is a normal emotion that ranges from fear, distress, anxiety, and irritation, to extreme rage and blackouts in a dissociative state. The distress and irritation part is normal and generally responds well to information on negotiation skills, psychotherapy treatment for anxiety and depression, and interpersonal communication skills.

Children learn how to manage rage around age 2 and generally get it mastered basically around age 4. By mastery I mean the child is no longer screaming at the top of their lungs, throwing themselves on the floor, and acting as if they are possessed. "I want the cookie. I Want It NOW. GIVE IT TO ME." The child gets exposed to basic negotiation and limit setting and deferment of gratification. "You can get the cookie after dinner." And the predictable response "NOOOOO."
Then the exposure to distraction as a coping mechanism. "Why don't you help me with making dinner?" Or "Go outside and play for awhile." Or social removal techniques "If you're going to cry and scream go in your room." Some parents try to introduce strategies for thinking "You don't need to be that angry. Try to calm down. Think about something else." I watched my brother mimic my niece's whining until she started laughing. That's a form of reflection as is "you seem very upset about not getting the cookie now."

Rage disorders can start showing up at this age. The child who not only tantrums but then starts injuring themselves or attempting to damage property or hurt others. They may threaten suicide or homicide. Limit setting and professional help with parenting skills can provide support and clarify techniques on what to do. Childhood mental illness such as autism, schizophrenia, and bipolar disorder, can start showing up in early childhood and require specialized assistance. The rage disorders that show up due to parenting issues may look similar. When I'm trying to differentiate an actual mental illness from a childhood rage disorder due to a parenting problem I see the child with the parent and watch what the parent does during rage attacks. I also listen to how the parent describes incidents. Some parents minimize the disorder. I had a parent tell me that sometimes her daughter "gets angry." I told the child she couldn't eat candy in my office. she dropped to the floor and laid there motionless. The mother stood back. I went over to the child who immediately became some version of the Tazmanian devil--all teeth and claws, no ability to speak but she could make animal noises. So I showed the mother safe restraint techniques and got the child calmed down. She was fine after she got calm and her ability to speak returned so we could talk about what happened. She will require help with parenting, but it's not likely this extreme behavior represents mental illness. The mother who brought in the child who "tantrums with any change in routine" didn't mention the difficulty with speaking, fascination with shiny things or the lack of eye contact. Seeing all these things together allows for clarity with a diagnosis of autism and suggestions for assistance in management and early intervention.

The reason child abuse complicates the development of anger management in children is because it trains the child that a fear reaction, coupled with violent behavior is appropriate. Anger is combined with a loss of impulse control. So the child gets to observe an adult getting frightened and feeling out of control, getting enraged, losing control, often feeling remorse, guilt, and sad, and often blaming the child for the lack of control. This becomes what the child thinks is appropriate. So the child will copy this behavior with pets, siblings, toys, peers, and this will persist into adulthood without intervention.

So here are some techniques that can be used for managing anger in children.

1. Have a schedule. The more the child can predict what is happening from day to day, the easier the child can manage their world.

2. Have clarity in what is acceptable and not acceptable behavior.

3. Provide a clear statement about behavior that is not acceptable. "I don't like what you are doing. That isn't acceptable."

4. Distract the child from inappropriate behavior at the very beginning of the behavior or if the child is approaching something that is off limits. "Careful." "No, no." "Come here." "Want to do this?"

5. Have time for play that is physical and active during the day. Lots of problems happen due to boredom.

6. When rage occurs, limit the child's ability to harm themself or others or damage property. Move the child to a safe place and stay near the child until the child calms down.

7. Have the child tell you what happened. What appears obvious to you as an adult may be completely at odds with the perception of the child. Repeat back what the child says. "Johnny took you're ball and you're mad at him because he always takes it and it isn't fair."

8. Clarify the rules of conduct for the family. "It's not okay to hit Johnny."

9. Supervise children who rage closely. Intervene early with separation and distraction.

10. Teach the child to calm down. "Slow down your breathing. Take some deep breaths." "It's not a catastrophe. What can you think of to make the situation better?" "You do not have to be so mad about this. You control how you feel." "Go for a walk and calm down." "Go write down everything that happened and why that made you mad." "What do you think you can do when this happens again?"

11. Show children what you do when you get angry that you want them to copy. "It made me mad when that person cut me off in traffic, but I want to get to where I'm going safely so that's what I'm going to focus on. I got scared so I yelled. I don't have to yell when I get scared."

If you're still having problems with an angry child seek professional help.