Constant anger in 4 1/2 year old

Posted by KimberlyW on May 04, 1999 at 20:38:15
my daughter wakes up angry, is very quiet at school (so quiet that the teacher says she whispers and becomes angry when she is not understood) and then comes home angry.  She yells what she has to say when she is home and whispers at school.  She is very timid around anyone outside her family-so much so that she hides behind me and shakes-even when she goes to places we normally go such as her coming to my work after school, she literally barks at people if they come up to her and says hi.  She is very defiant at home and demands for my husband and i to do things for her (which we don't do, we tell her that she can do it on her own because she tells us to do things like get her blanket which is two feet away from her)
She has been disruptive since birth.  She was colicky for months, it seems like she came out angry.  i spent many nights awake with her, rocking her and even driving her around in the car at 3:00 in the morning.  She was allergic to milk protein-not the lactose intolerance.  When her brother was born (she was 17 mos old) she would pinch him, hit him in the head, etc. She told me at 17 mos that i wasn't her mother anymore because i had him! As far as intelligence, she seems pretty bright she knew 250 plus words by the age of 18 mos. and knew how to discriminate colors and patterns by age 24 mos. She was potty trained by the age of 2, but has always wet at night (and still does at 4 1/2).
She had a baby-sitter starting at age four weeks, because i was in school full-time. She started pre-school this year and for four weeks cried and threw up. She was and still is very anxious about this.
Oh, also since she was born she has had bizarre night terrors.  She seems awake but her eyes looked glazey and very distant, screaming and no one can talk to her, she isn't responsive at all. The only thing she would allow is for me to hold her and it would last for 3 hours at a time.  i am talking about two hours of constant screaming and then about an hour of calming down and eventually being noticeably awake. i generally would talk in a very calm voice to her (even though she was screaming) and just over and over tell her that i was there, holding her.
My husband and i verbally praise our children regularly for their accomplishments. i think of them both as good children, but my daughter seems to be having behavioral difficulties.
Also at school she is in a group of girls that are kind of mean to kids who aren't in the "special group" They actually go around and put X's on the kids hands that aren't as she says "worthy" and dots on kids that are in.  Her and these girls sneak and punch and pick at the other girls when the teacher isn't looking and she brags about this.  A problem in this is that the teacher loves her and so when the other children go and say she did something, the teacher says, "she wouldn't do that she is so sweet".  i think it is important to note that her grandmother is her teacher's and any upcoming teacher's boss. i don't know what to do. She is four and 1/2 and slams doors.  We don't spank, we use time out and a token system for rewards (stickers on a calendar for targeted behaviors and they can turn them in-a period of one week-for five dollars if they completed it with 80%-which can be saved for something they want or they can use it)The anger continues, she is angry right now.
Any info would be appreciated.

Posted by HVM Ph.D. - KDK on May 06, 1999 at 13:49:45
Dear Kimberly,
You certainly have your hands full. First, let's take a look at your daughter's night terrors. Such episodes occur as part of normal development, though the duration of your daughter's episodes is longer than usual. These episodes are examples of partial waking, and they occur at the end of a phase of the sleep cycle referred to as Stage IV non-REM sleep. For a straightforward and useful account of childhood sleep patterns, consult Richard Ferber's Solving Your Child's Sleep Problems. In children younger than 5 or 6, these episodes do not usually represent any physical or psychological significance. They are best managed by assuring an adequate amount of sleep (11-12 hours for a child who is 4), assuring a sensible schedule and, as much as possible to keep the child safe, keeping your distance during the episodes (i.e., do not wake your daughter, limit physical contact to what is required). And do not question her about the episodes - she will have no memory of them.
Relative to your daughter's general mood and behavior, there are a couple of likely possibilities. She may display, by nature, a defiant/aggressive temperament or disposition - there is some support for this hypothesis, given your description of her life since infancy. Such a temperament requires sound behavior management, but may not be indicative of a mental or emotional disorder per se. Have you read The Challenging Child (Stanley Greenspan)? It describes five basic 'personality types' and offers useful guidance re: parenting. Another possibility is that your daughter is displaying an incipient mood disorder, and you are witnessing the early manifestations of this. Is there any family history of mood disorder (e.g., depression, bipolar disorder)? It's difficult to diagnose mood disorder vs. temperament in a pre-school child and, to a certain extent, it can be a moot point because you will respond in basically the same way at home and school re: behavior management. Relative to such management, you are doing some good things. But you might consider an adjustment in the reward system. Four-year-olds need immediate rewards and quite frequent 'rating' of behavior. The target behavior should be some example of her angry behavior (e.g., slamming doors, hurting her brother). She should be rated on the behavior during at least several time intervals during the day. Any sticker she earns should be followed immediately by some modest reward. In addition, any violation should be accompanied by a time out, in an adult-size chair, using a portable timer to track the time (5 minutes or so), and not commencing the time until she is in the chair and seated quietly.
Regarding her (and her peers') behavior at school - they need some firm limit-setting. As I can see you are aware, establishing other children as 'targets' of their aggression is worrisome. This deserves to be brought to the school's attention; a systematic plan is called for. You might do well to 'wrap' this into your reward system at home by receiving daily reports from pre-school about how your daughter is treating her peers, and rewarding her for 'safe' and reasonable behavior. In addition, though, the pre-school program needs to be assertive about this and protect the students from one another. The 'politics' of this may be difficult, with the familial relationship. But be persistent - it is worth the effort.
All things considered (i.e., your daughter's behavior and demeanor at home and at school), it would be wise to consult a pediatric mental health clinician for an evaluation.
This information is provided for purposes of general medical information. Please consult your health care providers for diagnostic and treatment options that pertain to your specific situation.
*Keyword: anger