5-year-old with rage attacks - bipolar?

I have a strong suspicion that my 5-yo son is bipolar. My mother was severely bipolar most of her life and my son's behavior seems to fit almost every description I've read of early onset pediatric bipolar disorder. We are working closely with a psychiatrist who is still in the diagnostic phase, and are also having a complete neuro-psychological evaluation done, so please don't worry about us rushing into a diagnosis or medication.

My question is, how in the hell do parents of bipolar or other rageful children survive on a day-to-day basis. My son's behavior is extremely disruptive and outrageous -- he has two to three ''rage attacks'' per day, which are usually brought on by nothing in particular. During these attacks, he screams, hits, bites, throws heavy objects, spits, froths at the mouth, soils himself, you name it. Our psychiatrist has recommended calling 911 and having him taken to Children's Hospital for a psychiatric evaluation during one of these attacks, but we're hesitant to do so.

Additionally, my son seems to have developed some type of social phobia where he refuses to go places where there may be other boys and girls (adults are fine). Unfortunately, he now dreads going to school (which used to be a refuge of sorts) and has had to be dragged kicking and screaming (literally) to school on several occasions. He refuses to go anywhere else, but is impossible to deal with at home.

Help! The psychiatrist says we can't hospitalize him and my husband and I are at our wits' end. We're suffering emotionally and physically from the constant stress of our son's violent meltdowns. I'd love to hear from other parents who have dealt with similar behavior about support groups, professionals or behavior management techniques that might have helped.

Thanks in advance. Desperate

It might seem boring to go to places that are all trees (the more trees the better), hiking trails, and grass, but learn how to have fun outside of the home. Take things you normally do at home with you, and do them outside at these places - meal, playing with cars/trucks, coloring, balls, reading, etc. Allow him a little freedom at these places. If he just wants to walk around or be by himself (and you can still see him), let him. You are lucky to live where there's a glut of hiking trails, regional parks, botanical gardens, etc.

These are all preventive measures to keep him on a more even-keel. My apologies that I cannot offer anything during the attacks, except to get him out for a walk. anon

To try to have some peace while you go through this diagnositc process, I hope your psychiatrist will prescribe something that might calm your son at least a little. Risperdal can be very effective for rages and can be started prior to deciding if he needs a mood stabilizer or not. This is a powerful medication, if it feels to scary to try until you have more information, somtimes an anti-anxiety med like ativan or buspar can be helpful. The key to having some peace in your family is to get him stabilized on medication, which can be a long process of trial and error. If you really think he is bipolar, do not let them give him an SSRI antidepressant (prozac, luvox, etc.) as these will trigger mania (rage) in a bipolar person. You also might want to have your son evaluated for temporal lobe epilepsy. My understanding is that it doesn't or may not cause visible seizures, but can cause huge behavioral issues. If you can't get a prescription for something, or don't want to until you are clearer on what is going on, you might try giving your son some Omega 3 oil. I think they come in flavored capsules or powders at Whole Foods. This is a supplement they studied at Harvard and found it to be very effective w/bipolar patients. Of course, they were giving megadoses. You can read more about it by reading The Omega 3 Connection or just googling Omega 3, Harvard & bipolar. Whatever is going on, you will want to educate yourself about medications. A good book for that is Straight Talk about Psychiatric Medications for Kids'' by Timothy Wilens, MD.

Another book that is helpful in just managing the behavior is The Explosive Child by Ross W. Greene, Ph.D. A large number of families w/bipolar children, including ours, have been helped tremendously by the suggestions and philsophy in this book. There is a wealth of information at www.bpkids.org , as well as online support. I am assuming you have already read The Bipolar Child by Papolos & Papolos. If not, you should. The authors do a lot of research in pediatric bipolar and also have websites at www.bpchildresearch.org and www.bipolarchild.com .

Make sure your psychiatrist is familiar with pediatric bipolar disorder. There is a pediatric bipolar clinic at Stanford run by Dr. Kiki Chang.

The hospitalization question is hard, especially with such a young child. You will just have to go w/your gut on this. Again, since hospitaliztion is so stressful, my vote would be for the doc to give you some med to calm things down while you're sorting this out, but only you and your husband can decide what is right for your family.

There used to be a support group for kids w/special needs that met in North Berkeley. The kids had all different kinds of issues from bipolar to epilepsy to tourette's. Behaviors were very similar. I think this still meets. I believe it has been posted w/in the last few months in the announceements newsletter of this network. NAMI (National Association for the Mentally Ill) also runs local support groups for families w/bipolar kids.

Hang in there, it can get better. My son is now stable and has been for quite a while. There are still difficulties, but nothing like what I know you're going through now. Best of luck! Been There

Six year old boy's explosive rage

My six year old son has been having such severe rage attacks that I am beginning to fear for our safety. He is very bright, very verbal, and normally a well behaved delight in every way. He is also doing very well academically. However, at times (more frequently lately) when he is frustrated or scared or has hurt himself accidentally he becomes completely out of control, like someone possesed.He talks of killing himself (and me) and lashes out physically with full force.Then just as quickly as it came on, it will pass and he will return to himself as if a violent storm has gone through him, and he seems really scared about what happened, asking what's wrong with me mom? He recently lashed out at his teacher (for the firsttime) and was temporarily suspended from school. He has been in therapy at the Ann Martin centeror almost two years but it is not working. I am going to have him tested at Kaiser soon but am not sure what they will be looking for.I had been attributing his pain to his confusion about my separation from his father who has some major ''issues'' (depression, in and out of recovery for alcohol abuse)and is very inconsistent in the role he is playing in my sons life. He is never abusive, and they spend time together every weekend, however he is sometimes too sad or exhausted to be fully engaged and does not contribute to our sons wellbeing in any practical way. I am losing hope and sleep and also fear losing my son, who is ofcourse, getting bigger everyday. I am aware of horror stories and don't need anymore. I am looking for practical suggestions and reasons to maintain any hope for his future. scared single mom

I took my daughter to talk with a behavioral pediatrician & he thought that she had either an anxiety disorder or possibly was bipolar...He started her on a low dose of risperal & within 3 days she was back to normal. It seemed like a miracle. We had the diagnosis confirmed by a psychiatrist. Along with the risperdal we see a family therapist who helps my daughter (& my husband & I!) learn new methods for handling her frustration. Hopefully we can eventually wean her off medications (you can't stay on risperdal long term).

At first I was upset & distraught over her diagnosis but eventually calmed down. I am thankful it got diagnosed early..the worse part was looking at my beautiful daughter full of anger & not understanding that what was going on was physically beyond her control. She also is happy not to have uncontrollable rages & understands that for now she needs to take medication to help her. Been there

I would also suspend the visit to his dad and see if that makes a difference. Alcoholics are notorious for being irresponsible. If dad is depressed, your son could be affected by that depression. Sometimes depression externalized is anger.

I think Kaiser does offer a developmental assessment. I would schedule that first. If therapy isn't working stop it. I would seek a psychiatrist at this point just to eliminate the possiblity there is some chemical imbalance like ADHD.

You can request a school psychiatrist or behavorial therapist to perform a school evaluation. Free couseling might even be available.

Good Luck and Best Wishes Mare

My four year old is usually cheerful, bright, affectionate and outgoing, but he has episodes that are not dissimilar from what you describe. They were at their worst during the ''tantrum years'' (occurring almost daily) and there's been improvement since we started him in speech therapy (he has a receptive language delay that was contributing to his overall frustration and he's also highly sensitive and picks up on stress in the house at the drop of a hat), but he still has explosive outbursts at least once or twice a month and sometimes more frequently when stressed himself or picking up on my or my husband's stress levels.

Here are some books that I've found helpful for gaining strategies to help my son and us, cope:

''The Explosive Child'' by Ross. W. Greene
''Raising Your Spirited Child'' by Mary Sheedy Kurcinka
''The Highly Sensitive Child'' by Elaine Aron

He's also about to undergo a new evaluation through the school district to address ongoing developmental issues and I'm hoping that we'll gain some additional information that will be helpful. Perhaps an additional evaluation might also be helpful in your son's case? His therapist might also have some additional resources to suggest.

I sincerely hope that you and your son will find the help that you need. Beth

Ask the doctors what they specifically plan to ''rule out'' in their testing- it should be a pretty long list of things given what you've described, and it will be a long list if they are doing a thorough evaluation. Don't start worrying about anything on that list before results are in and confirmed, just be sure that you are keeping yourself well-informed.

Before you go in, get as much information from his father as possible about his family's medical history- everything he knows about everyone in his family, not just about things that sound to you, a non-medical person, like they might be relevant.

Do the same for your own family. Both of you can call other family members to see if they know about anything that you don't. There are many things that could be causing your son's problems, and there may be several factors contributing to the picture. Just hang in there and take it one step at a time. I think that you're very wise to request 'no more horror stories', and that you are very wise to seek skilled medical help at this point- 2 years of therapy without any improvement is plenty long enough for that route.

I've had mostly very good experiences with Kaiser in recent years, and I've had some truly superior doctors. But there have been a few occasions when I've left one doctor and sought out another because I either wasn't confident that they were really on the ball, or I couldn't establish a good, communicative, working relationship with them. When I've done that and have kept looking, I've always found someone who I was very happy and satisfied with.

Finally, I'd suggest that you make an appointment for yourself with a psychiatrist and get a skilled opinion as to what might help you at this time- therapy? medication? a support group? I can very highly recommend Dr. Jeanne Leventhal at Kaiser Oakland. I found her through this digest, and she's helped me out of a very serious depression. Anon

Six year old's angry uncontrollable outbursts

My daughter will be six in several weeks but she has gotten a head start on the defiant behavior ''Your child at Six'' describes. I have read the book and feel understood by it. My question is what do I do now? She is angry in the morning about going to school. She is furious when I turn off the pbs morning television shows. She slugs me when I say say she needs to finish playing with her friends and come inside. When she is angry she pushes and shoves me; she tries to block me from moving around the room; she hits me as hard as she can. She was a much more easy going kid 6 months ago. This behavior is dramatically worse than it was 3 months ago and seems to be getting worse by the day. October is always her worst month. This time last year she was crying hysterically when I would leave her at the preschool she had happily attended for the 18 previous months. This October is particularly demanding because she has begun kindergarten. I know we have smoother times ahead but how do I respond in the meantime? I am a single mom so she only has me when she gets into this angry spot. I am beginning to implement an incentive system (stars on a calendar) and the television has been temporarily (at least) removed. Any other thoughts, ideas, sympathy? Bruised mom of slugger sue

6-year-old's out of control tantrums

I need advice about my 6 year old daughter's out of control tantrum. Last night I told my daughter to take a bath. When she said she was ''too tired'' (her response for things she doesn't want to do), I said, ok, then go lie down on your bed and get ready for sleep (it was an hour before her normal bedtime). This gradually escalated into a full fledged arguement and tantrum like I have never seen before.

She was enraged. Kicking, throwing, screaming. During this, I am threatening her with things like ''don't throw that or I will take (some toy) out of your room''. At that point she doesn't care what she's threatened with.....my husband had to literally hold her down for 20 minutes till she finally was exhausted. She yelled some pretty horrible things...She was beyond trying to logic with...

My daughter is very bright. She can be extremely loving but also very determined and sticks to her guns. I look back at the fight last night and of course analyze what I could have done better. She was tired - and always gets stressed about going back to school after vacation. Are there times when if a kid refuses to do something that you should just back down?

How much can this tantrum style be attributed to environment and how much to my daughter's intense personality? (By environment, I mean parenting styles).

I guess I am trying to figure out if we need professional help, or if an intense tantrum, while not common, is still within a ''normal'' range. My daughter was adopted (at birth), so I worry about how she will deal with that along with all the regular issues that kids face. Any input; would be appreciated.

Have you read ''The highly sensitive child''? You just gotta deal with them a little differently, but it doesn't sound likes it out of the norm. You may need support, so I suggest you go to therapy before your child then decide if she needs to go. Been There

As for personality vs parenting, I would say this kind of thing is 90% personality (i.e. temperament) & 10% parenting (meaning how the parent responds to the temperament). I do think the occasional tantrum is normal for very intense kids. If she is basically happy, doing well in school, etc. I wouldn't worry about it. So what should you do? Well, once the kid is melting down, no amount of firmness will help. What has worked for me is distraction, anything that will break into the mood. Sometimes rubbing her back and being sympathetic will help her calm down. Sometimes offering a drink of water will help -- I think I read this one in a parenting book -- a kid can't scream and swallow at the same time, so if you can get her to drink some water she'll have to stop screaming, and once she stops she may be able to stay stopped. 'Cause she's stuck & needs help to get unstuck. My daughter can work herself up into a 20 or 30 minute screaming fit over the most minor frustrations (the stuffed animals not arranged exactly right on her bed was the latest one). The hardest thing for me is not to lose my temper too, and sometimes I just have to walk away for a while.

By the way, my kids (14 & 10) are both adopted & haven't so far had any particular difficulty dealing with it. I think for most kids adoption is too abstract to worry about. If they are worriers they worry about more immediate issues -- will their friend sit with them at lunch, who will come to their birthday party, will they play well in their soccer game, will they ever get a puppy, why is their sister such a pest, etc. So I wouldn't assume it will be a problem for her. STSDT (Still There, Still Doing That)

6-year-old son is negative and angry

My 6 year old son seems to view the world from the ''half empty'' rather than the ''half full'' perspective. He tends to focus on the negative aspects of a situation and doesn't acknowledge or appreciate the good things that happened (e.g. spent the day at a birthday party having a great time and was extremely upset on the way home because his 3 year old sister received a multi-colored pen as a party favor and his was a single color). All of his negative emotions manifest as anger and he usually directs it at me. He doesn't seem to be able to express sadness, disappointment, frustration, or fear in any other way than being angry.

I am at a loss as to how to help him deal with his feelings and especially to redirect the energy he expends in anger. I have tried all kinds of different techniques, but nothing seems to help. I get very frustrated when I do nice things for him, things he wants, and his response is to complain about the thing he didn't get. I am beginning to think I should take him to a counselor familiar with anger management, but I'm not sure if I'm premature or overreacting.
Sick of hearing ''I'm mad at you''

1. Much of this is disposition and my job is to help her learn to deal with this disposition in a sympathetic way but also not to cave to it.

2. She does not respond well to being cajoled out of her moods but can in fact get herself out of these moods if she is left alone. I now do less - try to get her to her bedroom sooner and have her stay alone until she is ready to interact nicely with the family. Sometimes this takes 10 minutes and sometimes most of the day. But she likes being alone and is far better at handling her own moods than we are. Of course this was more difficult at 6.

3. When I suspect that the anger is really fear I try to talk to her about why she might be fearful (she says - ''I hate swimming and I'm not going!!'' I do not take the bait and discuss whether she ''has'' to go to the new swimming lessons she had said she wanted and are already paid for and instead calmly say - ''You must be pretty anxious about starting a new swimming class. It's usually hard for you to start new things but you usually come to love them. What do you think starting swimming will be like? Is there something that would make it easier?'' Miracuously this sometimes works and she can talk about what is bothering her and tell me some things that will help. She started doing this more after a few sessions of therapy.

4. In general, the calmer I stay and the more I ignore the ''I won't do this'' and ''that isn't fair'' the better things go. Sometimes I feel I ignore too much but . . .

In response to the meltdown about the pencil I would probably calmly say ''I'm sorry you're so upset about that'' and try to ignore repeated complaints. If they went on I'd sent him off to be alone until he felt better. Or I might try to explore if the party was stressful and talk about how difficult it can be to be in social situations and how maybe next time we should stay for a shorter period of time.

The reality is that many kids (and adults) have these issues. You're not alone. But it sure makes being a parent less satifying. I hope this was helpful and look forward to hearing what others have to say. Anon

1. Work on the positive. Take family time each day, at dinner or bedtime, to be thankful. Each person in the family should share a moment that happened that day that they are thankful for. For instance, ''My boss complimented my work today. (give more detail here) I am thankful that I have a great boss and a good paycheck.''

2. There are many many emotions. Get a chart or find a list on the internet. Take time each day to talk about how you feel and how you deal with your emotions. For instance, ''I felt happy when (someone said something, so I gave (that someone) a hug.'' ''I felt disappointed in myself when I broke the glass, so I went for a walk and then I felt better.'' Having a vocabulary can sometimes help the personality develop.

3. Don't make your son feel bad for his feelings. Everyone should be allowed to have ALL their feelings: angry, sad, frustrated. But it is the behaviors you should try to control. Give him time out for hitting, yelling, criticizing. Help him find a way to express his anger that is acceptable to you.

4. Tell him everyday that you love him no matter what. Try to start the day on a positive note. If you expect something to happen that will make him angry, talk to him about it and how he can react. sunsolsal

Angry 6-year-old daughter

I have a wonderful daughter, age six, who is the oldest child of three. She has a sweet and loving side, but also an angry and negative side. She is often angry at her friends (speaks very angrily and hostile to them) if things do not go her way or if she feels left out. She also has an extremely hard time with transitions (coming in for dinner, for example). She yells and screams at me and her dad (we do not yell at her). It is worse if she is tired, I have noticed. She is a sensitive child, which I know has a positive and negative side. How do we help her deal more appropriately with her emotions? I am so tired of feeling sad and worrying about her and how she will be when she is older. Will she grow out of this? How do I reward her good behavior and what do I do about the angry/negative behavior? Tired in Berkeley

I think this is a common aspect of being what we call a ''sensitve child.'' My gut also tells me (based on my own experience) that she is feeling a lack of control, especially since she has two younger siblings. I would suggest that anything you can do to make her feel like she has a little more control over her life would be helpful to her. Even something seemingly silly can make a difference - after my brother was born, my parents bought me a t-shirt with iron-on letters that said ''I'm the boss.'' My parents would joke in later years about that shirt and how proudly I wore it. When people on the street would ask who I was the boss of, I would say with conviction, ''the cat.''

Also, I would not hesitate to find someone outside the family for her to talk to (such as a psychiatrist). Not to suggest that there is anything wrong with her - but, as I might explain it to her, 'sometimes when you feel angry it helps to talk to someone... and sometimes it's easier to talk to someone outside your family and friends, someone who will just listen.'

And probably most importantly, I would suggest that you respond by comforting her more than reprimanding her. (Although I know there have to be reprimands as well). I would venture to guess that when she gets angry, she is aware that she should not be so upset and that she's acting in an unacceptable way, but that she feels like she can't stop herself from being so angry. I would try literally taking her in your lap (assuming she's not violent!), wrapping your arms around her, and just hugging her and talking quietly, telling her you love her and it will be ok in a minute. Even now as an adult, nothing makes me calm down (and be able to put things in proper perspective) more quickly than a little love. I think that, over time, the amount of time you'll sit there with your daughter will shorten, and soon you'll be able to talk about the anger more (and what to do when it arises - for example, walk away from the situation for a minute) and then , after that, she'll be able to take those steps by herself without having to retreat to you.

Best of luck, One sensitive and angry kid who turned out OK after all

He was not able to communicate these problems verbally. He is not the type to share the details of his days. But periodically he would say something that would alert me that his days included stressful events, more than he could cope with.

We have since changed his school and daycare situation to a much more soothing environment, and it is amazing the difference in his moods. He still gets upset at times from overtiredness, but his underlying mood is incredibly different--he is actually happy! It is wonderful.

I started re-reading How to Talk to Your Kids will Listen and Listen so your Kids will Talk, in an attempt to get to understand him a bit better.

Good Luck with your child. Jennifer

Temper tantrums in almost-6-yr-old

My five year old daughter (she will turn six in two months) has been having frequent temper tantrums. This behavior is not typical for her but seems to have become more commonplace in the last 4 months. She has always been a strong-willed and determined person who challenges limits, but it seems that now when things are not going how she wants(i.e. I am not doing what she is requesting/demanding or what she wants is not possible) she gets angry and starts crying and yelling. Once she starts she can't seem to stop and sometimes it can go on for an hour or even two! I have tried different interventions but I don't feel like I am being able to really get her to understand that this behavior is unproductive and disruptive. She does seem to get more set off when she is hungry or tired but she won't eat to raise her blood sugar or learn from her experiences that her mood is affected how she feels physically. I was wondering if other people have experienced this age as more volatile than others or have advice for things they have done to get a kid to learn different ways of coping with disappointment. I am a single mom so don't have anyone to spell me which makes it even harder. Exasperated

6-year-old is hitting, pinching, kicking, and calling us names

I have checked the website and all I found regarding hitting and name-calling refers to much younger children than ours. Our soon to be 6.5-year-old daughter has recently been hitting, pinching, kicking, and calling us names when she is mad. While we recognize that she is nearly always very tired when she does this, we still don't know what to do to get her to stop. ''Use your words'' doesn't work. Telling her it's completely unacceptable behavior doesn't work. We take away privileges, but it doesn't resolve the problem long-term. How can we help our daughter learn how to handle her anger and channel it effectively? We always tell her we love her no matter what, and we always tell her it's OK to be angry. We do tell her, of course, that it's never OK to hit, pinch, kick, and call names. Thanks for any advice you can provide. At my wit's end!

Defiant and uncooperative 7-year-old

On and off since she was 3, I have received feedback from my daughter's teachers that she is uncooperative and even defiant, will insist on doing things in her own way rather following directions. When she was a preschooler, I mostly chalked it up to ''normal'' developmentally-appropriate behavior. She has always been keenly aware of her environment, very observant, and has had since infancy a tendency toward reacting to stimuli in a big, often exaggerated manner. This goes, too, for any so- perceived insult or injury. She has a chronic genetic medical condition for which she must undergo frequent diagnostic procedures and examinations, to which her response is often uncomfortably ''over the top,'' eliciting anything from disapproving clucks to eye rolling to speeches on more effective boundary setting and accusations of poor parenting, whether implicit or explicit, from care providers. She takes a laundry list of medications to treat her medical condition. Her father and I separated when she was an infant; I am a chronic depressive ''in recovery''; her father is an alcoholic unwilling to recover, with whom she spends most weekends. I get little emotional input from him: his ability to perceive, analyze, and act upon matters psychological seems stunted. Our daughter is actually quite precocious, reads well beyond her class level, and exhibits many signs of above-average intelligence. Her current teacher has recently approached me to say that her in-class outbursts, lack of cooperation and outright antagonistic attitude have reached ''critical mass'' and that we need to take action. With all I do to maintain her physical health, the added stress of behavioral issues to be handled seems overwhelming! I wonder if she has ADHD or Oppositional Defiance Disorder, and would like a recommendation for someone to do a full psychiatric assessment, taking into account all the physiological and environmental factors in play. I am very reluctant to put her on yet another medication, so I'd prefer someone who is not a puppet of the Big Pharma! I look forward to your input... Mom with Plate Piled High

We tried being evaluated and treated by an occupational therapist (trouble in the ''occupations'' of daily life - not work therapy). We also looked at food or other allergies (negative). We spoke to a psychologist who knows child anxiety and have since seen a child psychiatrist. An eval from a psychologist or a developmental pediatrician would be a great start. If they feel it necessary, they can refer ''up'' to a psychiatrist.

The next hurdle would be where to go and how you can pay. Depending on your health insurance, or if you have a mental health benefit, you can look at a few different options. We obtained a referral to Oakland Children's Developmental and Behavioral unit - very highly recommended for things like ADHD vs ODD vs SID vs others. It took FOREVER to get the referral accepted (like 10 month). Then we had to get authorization from our health insurance. That took at least a month. With the time inbetween (my fault) and then the time it took to schedule an appt after receiving authorization, we have a total wait time of 14 months!!! However, the eval will be covered as well as the follow-up appt by our regular medical insurance. We opted to see the psych before this appt bcs things were feeling dire. And we sought out an OT outside of this group for the same reasons before. Things went a little out of order, but they seem to be coming together.

So, perhaps the first stop would be your pediatrician for a referral if you want to be seen by a develop/behavioral specialist or a psychologist. Or, you can seek out your own psychologist or develpmental ped. I would recommend trying to get to Oak Children's groups bcs I've heard from EVERYONE we've talked to that they are the best - and they will certainly be familiar with kids on other meds and will have access to specialists in those areas too.

Good luck!!! parent of sensitive kid

The various team members could be: 1) developmental behavioral pediatrician to lead the team; 2) pediatric psychiatrist to do the psychiatric/emotional evaluaton, 3) pediatric neuropsychologist to do a full assessment of her cognitive profile. The team should then create a plan TOGETHER that integrates and prioritizes her treatment. I am surprised the school psychologist has not been brought in to do testing. At this point, I would pass on this and go directly to a private neuropsych assessment.

So...where to start. Some suggestions:

1) Ann Martin Children's Center, 3664 Grand, Oakland 655-7880, www.annmartin.org.

2) The Development and Behavioral Pediatrics center (a dept. of Childrens Hospital) at 5220 Claremont, Oakland, 428-3351, http://www.childrenshospitaloakland.org/healthcare/depts/behavio r_overview.asp or

3) start with the neuropsych evaluation, Dr. Carina Grandison, 286 Santa Clara, Oakland, 763-9795. She can give you expert, compassionate advice and also do the full assessment.

I am wondering where your pediatrician is in all this and why s/he has not been guiding you in this. Perhaps you need a new pediatrician.

Also, a last piece of advice. Your daughter will probably have a combination of medical, cognitive and behavioral factors which are being demonstrated. Please remember:

1. Even if the majority of her problem is behavioral, it is not willful or under her control. She is behaving in the only way she knows in order to survive. She can't just ''stop doing'' something and making her feel bad will only make it worse. The moral judgements by teachers and others send her the message that something is wrong with her, as if it were her personal choice to behave that way. Her anxiety level is very high; when your anxiety level is high you don't have mental room left over to attend to what is going on (eg learning); so it looks like ADHD but in reality the anxiety can cause the inattention.

2. Know that she is working very hard to just cope with life. She probably comes home from school exhausted. Do what you can to comfort her, give her rest and relaxation, and plenty of time in a non-stressed environment.

3. Reassure her that you and she together will figure out what is going on, that you will help her, that everything will turn out ok, that you love her, and that she is a special, wonderful person. Tell her that every day! Good luck to you. anon

Weepy 7-year-old son

My 7 year old is very easily provoked into tears...by anger, frustration or hurt feelings. Often, I'm sure the issue is tiredness or needing to eat, but sometimes I'm just not sure that this is the issue. The other night, he was so upset that he threatened to run away up the street. I know that all of us have threatened to run away during our childhood, but I am still concerned. Any experience with this/advice for what I might do to address this issue with my son?

Seeking psycho-diagnostic work up for 8.5 year old

Re: 13-year-old's daily rages, may be bipolar - boarding school?
This is in response to the above titled thread. I have an 8 1/2 year old child whom I love dearly. However, I have struggled with him since day one, and his father and I divorced when he was 3 years old. In part because of our inability to co-parent, and find a path in our marriage that would keep us all together.

Instead of making things better, it's made things worst- adding only more layers to a problemed situation surrounding our son. He was kicked out of school at age 6, and is now in a new school, experiencing the same difficulties. It's been a struggle trying to identify what exactly the problem is.

We are now in the courts and he even has his own attorney to try and see if things can move forward in a more beneficial way for him. I think as parents we are both befuddled, myself (depressed, worried, exhausted). I've identified with this thread as I fear that this is the direction he will be going in if we don't receive appropriate diagnosis and help- and I can't see myself continuing this way through his teenage years/adulthood. I empathize with the fish oil, sensory integration dysfunction, high intellectual aptitude, IEP, and those who have shared how their children will not see a doctor or therapist. My son is terrified of any kind of medical/psychiatric professional, and will attack me, them, hide, etc. so as to not participate. His father has more success with this, however is difficult to engage as he does not experience this as a problem.

At this point we are seeking a psycho-diagnostic work up. I have spent thousands out of pocket as a single parent and am lookig for advice on how to choose an appropriate person, or whether this is appropriate. I am reading mixed reviews here. I am looking for the best way, and person, who can do a diagnosis of the problem. Ie: allergies, sensory integration, neurological functioning, early childhood trauma, custody recommendations, social, emotional disorders.

I am wondering if those who have shared about their teens can say whether their childrens' behaviors presented earlier in childhood, and how they worked with the myriad of professionals out there to find a solution. I am not interested in having my child cycle through medications that are inappropriate, or subjecting him to various therapists, groups, and treatments at his young age, that are unecessary, or ineffective.

Thanks for your advice.

8-year-old's tantrums - is it anxiety?

Has anyone had any experience with their child being diagnosed as ''anxious'' and having their ''anxiety'' result in being constantly irritated & having tantrums/rages?

My 8 year-old daughter has had issues with anger and throwing tantrums (I'm not sure if they are ''tantrums'' or ''rages''). I have started the process of having her assessed & the preliminary diagnosis is that she has some type of ''anxiety'' (I haven't had a chance to have a full discussion with her doctor yet).

I want to educate myself while I wait to speak with her doctor. I would agree with the fact that she is ''anxious''. But, can this cause a child to throw tantrums/rages? I haven't been able to find a connection in any of the articles on the internet about anxiety/generalized anxiety disorder and throwing tantrums/rages.

Also, I would appreciate hearing about how you dealt with it...medication, therapy? I am confident in her doctor, Brad Berman Anxious mom

We have major tantrums (daily) that are very difficult to handle. She will also tantrum over perceived injustices - anxious kids are more likely to have lower self-esteem, which makes it difficult for them to just let things bounce off of them. Look at the book 'Freeing Your Child From Anxiety' (Tamar Chansky) for ideas, and a better understanding of anxiety. Also, consider her school environment. If she is experiencing lots of stress (social or academic) at school and managing to hold it in, then she will likely let it out at home. My understanding is that CBT is the best way of handling anxiety disorders. However, you need to be motivated so it really depends upon the child - my child is still too young. Also, try some relaxation/self-esteem tapes - I find them annoying but my daughter listens to them every night and she finds them soothing (if you email me I can find the name for you). Good luck. berkomax

I was a very anxious child, diagnosed with GAD and depression as an adult. I really wish that there had been more knowledge about childhood anxiety when I was young, and that I had been treated for it ****anxious as a kid****

I don't know what type of medicine or therapy would work for an 8 year old. As a parent if you can help her understand that the rages are just a behavior and NOT who she is that will help a lot. It is scary to be that young and lose control. I have vivid memories of some of my rages and the feeling that comes is terror at the loss of control.

It is great that she has been diagnosed so early. Anxiety is very treatable. Good luck to you and your family. Almost Better

If you feel that you get an accurate diagnosis that your daughter is having her tantrums because of anxiety, then rather than putting her in therapy, I suggest you try Dr. Liebgold's course first. I really cannot recommend him highly enough. He is a terrific teacher and a great person, and very accessible, if you have questions before enrolling in the course. And you do not have to be a Kaiser member to take his relatively inexpensive course. I see that others on BPN have sung his praises before; see this post: http://parents.berkeley.edu/recommend/therapy/liebgold.html Ann

8-year-old's rages - is she bipolar?

Can I get input on what bipolar onset looks like? My 8 year old is starting to have that I would call ''rages'' - yelling, swearing, throwing things, hitting me. She fits some of the characteristics of bipolar - rages, instant mood changes, but not all - she doesn't have adhd like symptoms, does not have issues with sleeping. My question is, at the onset of bipolar is it possible to just have certain symptoms? I know that only 90% of bipolar kids have adhd symptoms, but is it possible to be bipolar without the sleep disturbance? My daughter has a variety of the other symptoms - violent dreams, occasional grandiose thoughts. Can someone give me input on what they saw when they realized that their kid was bipolar? Searching

I'm no expert, but I've been around long enough that when I was a kid through young adult I didn't know ANYONE with any of these disorders. The culture generally ate more healthfully than now and we ran around the neighborhood playing freely with friends whenever we could. It really makes me sad that (not you in particular) the cultural trend is towards seeing ourselves as sick and diseased, that medications are advertised so widely in the media, that if we let ourselves, we become victims of pharmaceutical marketing.

PS - I'm not saying these disorders don't exist - just very hard to believe that they exist in such astonishing numbers where they didn't before. Joan

You are describing bipolar symptoms but sleep usually is an issue. A child can be having sleep problems without you knowing about it, however. On the other hand, this could be a totally different problem. Do have her evaluated by a psychologist who specializes in such things, and be ready for the questions about family history.

''The Bipolar Child'' by Drs. Papalos is out in a new edition. If you can, get it and skim it before the evaluation. Mom of bipolar child

It may be that she is going through a stage or is really angry about something. In my family, I was not allowed to show any negative feelings and I could not confide in anyone. My father, who raised me, would have said, if you asked him, that of course I could confide in him and that we had an open line of communication. But I did not feel that way, and as a result, I would exhibit frequent changes of mood that he did not understand, but which were always related to something very tangible that had happened. This from a very young age. I have no idea what is going on in your family, but I think there is a very narrow field for what is acceptable behaviour and feeling in children, which is addressed in some places with harsh discipline, and in the Bay Area with diagnosis and medication.

8 is very young, it seems to me, and I can't imagine what would consistute ''grandiose thinking'' in a child so young. Some posters describe truly heartbreaking behaviour that is so unmanageable and beyond the average that a diagnosis and treatment seem reasonable. Your post, though it was brief, doesn't sound like one of those to me.

8-year-old can't control her anger

Can anyone recommend a good book to read about anger in children? Disagreements with my almost 8-year old seem to be escalating lately.

Trying to get her to do something she does not want to do can escalate into a yelling and hitting frenzy. This usually occurs when she is stressed (school starting!) or tired and her (and mine!) control is low. At this point, talking to her does not work. We always discuss it afterwards & she acknowledges that it is the wrong thing to do but feels that her anger is so strong that she can't control herself.

I need some help teaching her methods to contain her anger when the problem starts. Suggestions appreciated!

In Louise Bates Ames' ''Your Eight-Year-Old,'' she pointed out early and repeatedly that 8-year-olds tend to have great difficulties in their relationships especially with their mother, and that the success or failure of the relationship could affect their relationships with others later on in their lives. Yikes!

I have tried taking away privilegues (no TV for a week, no play dates for a week or sometimes a whole month, etc.) and giving immediate rewards of books, pretty clothes, CD-ROM games, etc. I've also tried telling her in advance, ''We're going to do (chores, homework, etc.) for 15 minutes, and I want us to do it together without fighting. OK?'' She would usually wholeheartedly agree, and hold her temper for about 5-10 minutes until she's so frustrated that she would just explode. Saying ''Remember you've just agreed to...'' would only make things worse, so I now remind her sternly, ''I know you're frustrated, but it doesn't mean that you're allow to be rude or to take it out on me.'' I've also learned to leave the scene quickly before I explode.

All these tactics have worked to a certain degree. I don't know if your 8-year-old behaves the same way, but mine is in general willing to try although quite strong willed and defiant at the same time. Still, she has become so easily frustrated and outraged that I have even thought about seeking profession help to provide her with skills for dealing with her frustration and anger. I look forward to other parents' replies as well. Mom of Another Angry 8-Year-Old

One, start a conversation when you are both calm and unrushed, in which your primary goal is to listen. For example, you might say, "I got that you were feeling really angry yesterday, would you be willing to tell me more?"

If she does not want to talk, accept that, and let her know you're not giving up and her, and that if it's okay with her, you'll ask again soon. She may resist, especially if this is a new approach! Please don't give up or take it personally, but do get support for yourself.

Two, if she does begin to talk, listen without expressing judgment, interpretation or analyses, positive or negative. When she pauses, you can ask if she wants to say more, or simply reflect back what you've heard, asking for confirmation: "It sounds like you were having so many feelings inside yourself, it was hard to keep still, is that right?" Keep breathing, and if it works for you, imagine your heart opening to receive her. It may take practice to stay calm and open.

Three, once you get that she feels heard, ask her, "What can we do when you're feeling angry that will meet your needs, and mine?" Listen for her ideas. Maybe she gets to beat the couch or thrash on the floor. Maybe you'll take ten deep breaths together. **The point of this part is that she gets a full say in determining something that works for both of you.** Ask, "Can I remind you of our agreement the next time this happens?" "What if any kind of help would it be okay for me to give you?"

I have seen that we support them to help self-determine their environment and set behavioral "protocol," young people rise to the occasion more often than not. I would love to hear how it goes.

Jill Nagle, Conscious Parenting Alliance, http://www.awakeparent.com P.S. Our next intro is Sept. 30th, 10AM at Epic Arts, 1923 Ashby, would love you see you and other BPN folks there! We'll be dealing with questions like these live and on-the-spot. Jill

8-year-old's angry attitude

I am so depressed that I am close to crying. I told my four year old today that I loved her, and she asked, ''What about Kelly?'', her eight year old sister. I said of course I loved Kelly, and my four year old replied, ''Then why are you angry at her all of the time?'' The fact is, she is right. Kelly is a very hard kid for me to parent, despite the fact that she does very well in school, respects rules and boundaries, is polite in public, and is well liked by peers. Her problem is at home, where everything seems to be a battle. We seem to fight about everything. In addition, her attitude is very negative. Her first response to everything seems to be negative or angry, even if it is something special or an activity picked especially for her. Every transition leads to an outburst, whether it is getting ready for school, sitting down for dinner, brushing her teeth before going to bed, ending a playdate, and so on. I thought she would grow out of this behavior, but it actually seems to be getting worse. Do I need help, or does she? I am starting to feel like an awful parent, in part because I don't know how to make things easier for Kelly, but also because I am starting to resent her behavior and attitude. HELP!

TLC (Link to Children) is a non-profit early intervention mental health service org. for families. They have therapists and interns (who are excellent) available who can help you understand why your older daughter may be angry and give you advise on how to handle her behavior in a positive way. I believe, however, this org. may only handle children up to age 5 or 6; if so, ask for a recommendation for organizations that handle older children. Bus. Ofc. 510/261-9586 or Therapy intake 510/247-2411 or linktochild[at]aol.com. Fees are sliding scale; very affordable. Anonymous

I have found two things recently that have been immensely helpful. I am reading the book ''The Explosive Child'' by Ross Greene which refers to some children as easily frustrated and explosive. Typical discipline techiniques: rewards, time-outs, etc. don't work with these children. The book talks about how to work more successfully with these children. I was referred to the book by a therapist I recently sought out to help me with this child. Her name is Diane Ehrensaft and her practice is in Oakland. She too has been very helpful in giving some advice in just a few sessions. aki

Anger in 8-year-old son

Over the last few months our almost 8 year old son has been having some difficulty controlling his temper and has had a few instances at school and his after care program where he's hit other kids. We've been having some difficulty getting to the bottom of what's going on since he doesn't find it easy to talk about his feelings. If this behavior continues, we've begun to wonder if it might help him and/or us to see a child therapist/counselor. I'd appreciate any recommendations anyone might have for someone who'd be good at addressing this issue. I'd also be interested if people have tried other strategies for helping boys learn appropriate ways to express anger and frustration. (Of course, we've had endless discussions about the importance of "using your words", never hitting, going to an adult for help, etc...) These issues tend to surface mostly on the playground when he and his friends are playing sports, a situation which seems to involve lots of opportunity for agression, frustration and hurt feelings. Thanks!

Replies posted in Recommendations: Therapists for Adolescents

8-year-old's noisy tantrums

There's currently a discussion going on about coping with ''older'' kid tantrums, and I'd like to expand the topic a little. Our 8-year-old still has rather frequent, extended, and loud tantrums. Anything can set them off (i.e., he wants to live in a house with stairs, he wanted to be served breakfast first, he wants today to be Christmas, etc.). He kicks things, throws, screams, squeals, cries and yells. We've worked with a behaviorist - and recently (and effectively) with a sand-play psychologist to give him the support he needs.

We love him dearly and he's a wonderful kid. My real problem is the neighbors and how they might react. We have several in close proximity, but one childless couple in particular seems to feel they run the neighborhood. Of course, their house is just steps away from ours. About a year ago, a cop showed up because an ''anonymous'' neighbor who heard a lot of crying reported that our kids were being abused. Fortunately, the tantrum they had heard had abated - and the cop was really cool - even saying that one of his kids had similar behaviors. However, I am constantly concerned that they'll call the cops again or even Protective Services

We've lived in this neighborhood for several years, but don't really know the neighbors. None of them have children. They're never in their front yards, so there's no opportunity for a casual conversation to get to know each other. Short of ringing doorbells, I have no way of striking up a conversation. And... even if I do... how do I introduce the topic and start explaining to them something that I consider to be very private?

We try really hard to be considerate neighbors - always telling the kids to lower their voices (even outside), no loud music, no outside play in the early mornings, etc. We're acutely aware that everything we say, even in a conversational tone, can be overheard if the windows are open. Any thoughts, though, on what to do if they kids' screams are misinterpreted? Mom with Ear Plugs

I would go to all of the neighbors close enough to hear my children. I'd introduce myself and just tell them a little about my family: i.e., we have small children who are noisy. I'd also ask them if they have heard the children and if the noise bothered them (they will be more approachable if they don't feel attacked and if you approach them from a position of trying to help improve their lives). Encourage them not to be polite and make them feel safe enough to tell you the truth. Let them say, ''Well, I go to work early and the screaming really interrupts my sleep'', etc. You can then assure them that you are working hard to keep the kids quiet, and you can educate them about how this is a developmental thing that your son is working through.

I'm sure that just allowing them to vent will keep them from causing you trouble by calling the police. You need to put a face to your little guy - if they know him and his well- intentioned parents, they may not be so eagar to make you miserable, because they can ruin your life if they begin calling child protective services repeatedly. Christina

Sometimes I use "holding time" with him during a tantrum if I have the energy to go through it (often it helps, sometimes it doesn't). When I hold him, he will squirm and wrestle to get away, and he will tell me I am hurting him (OK, I know that sounds awful, but it is actually a gentle but firm holding and it is a therapeutic intervention). This is when I really get worried about having the cops called, him screaming (in the room with the window) "You're hurting me!! Let go of me!!" etc.. During holding time, I sit behind him and hold his arms with my hands, and wrap my legs around his legs (OK, OK, really it is therapeutic). One time he jerked to the side and my leg ended up in his crotch . . . . "YOU"RE HURTING MY PENIS!!!!". I guess in some ways the scary thing is that nobody has called the cops . . . My son is adopted, I can only look forward with glee to the day when he adds the "You're NOT MY MOTHER!!" to his repertoire, especially if I am trying to manage an episode out in public . . .

There is a loose knit parenting support group that meets at Saul's in Berkeley every other week (I believe one of the members just re-posted in the announcements newsletter), and we recently discussed our fear of having the cops called when dealing with our children's explosive behavior. We decided that we should be issued cards from our kids' therapists :-)

The only suggestion I have, which I just realized I might try as well, is to write a brief note to your neighbors, giving them a very simple explination and thanking them for their patience. I mean if I had a child who was deaf or blind, I would want my neighbors to know of my child's difference. In some ways this is a similar situation.

Beyond that I can only offer reasurance, that if child protective services is called, they do not take children away without significant effidence that the child is in danger. Beyond the hassle and possible embarassment, there should not be any threat to your family from them. Good luck!!

PS: I would love to know who you use for play therapy if you are willing to email me that.