out of control rages

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Dear jb -
     Thanks for your questions. I tried to answer your first letter - but perhaps my computer didn't send what I had written. Sorry...
     First of all, you're not crazy.  Fact is, you're a good mother trying to sort out your son's behavior. And that is not always easy.  
     With regard to your child's rages - know that many children have difficulty with impulse control and/or transitions. But regardless of the event - you have a responsibility for recognizing unacceptable behavior.  Feelings are real - but sometimes behavior needs to redirected.  About his rages - see if there is a familiar trigger - 'tho I think you said sometimes there is none.  Make sure your son is at his best - i.e., well fed and rested - so he feels well.  Then if he acts inappropriately, after the behavior has resolved - talk about what happened.  Talk about how he might redirect that rage - use words, not fists.  Offer inanimate objects to hit or bite if he has to have an outlet.  Praise him for good behavior - offer stickers or gold stars. A little bribery can go a long way.  Don't expect perfect behavior - aim for slow improvement.
     With regard to bedtime - establish a simple routine and hold to it.  Make sure the house is quiet, and that everyone else is settling down. Activities should be over - make sure your son isn't missing out on anything, About the middle of the night - you have choices.  I would ask you to think what your goal might be.  If you want your son to be in his own bed - you must return him to his space. And that can be difficult when you all are tired.  One technique my patients have used is to bring your child back to his bed - lie down with him for 3 nights - then lie next to his bed, on the floor for 3 nights, then by the doorway for 3 nights.... wean yourself slowly from his bed.  And then use a simple reward for compliance.  Don't go overboard, and again, expect some slippage.  But hopefully, the overall trend is good.
     You also mentioned concerns about focusing and/or distractibility.  Certainly AD would be a consideration - but only after careful consideration of definite criteria.  Know that a lot of children (and adults) have trouble focusing - or following through - and they all don't have AD.  Sometimes there are disorders is processing, learning - even other emotional concerns - and sometimes, there is a little bit of overlap one diagnosis with another.  This you might want to discuss with your son's doctor - as well as his teachers.  Sometimes a full learning evaluation through your son's school can also be very helpful.  But we're talking about longterm issues that do need full evaluation.
     You mentioned your doctor recommended an EEG.  I think it is a resonable plan to do that test - in case there might be a seizure disorder. But I think the likelihood of any seizure being present is probably low - and the probability of any seizure being the cause of your son's rages low, as well. But nevertheless - worth ruling out.
    Finally, make sure your son does not get secondary gain for unacceptable behavior.  Make sure you maintain your own calm as a good example - not always easy.  And make time to work through a difficult process. Follow your instincts - it will be worth it.      Good luck, EV.

  I just wanted to add a bit more info to my posting on 2/16.  We live a pretty normal life - his father works hard and I stay home with our children.  We are involved in school and other activies and do alot of family things together.  It just seems that he has a problem with authority, but not outside of the house.  If he hits his sister and is told to sit in time out to calm down and think about it he refuses and we start an episode all over.  If I physically try to place him in time out he tells me to get my hands off him and he can to whateve he wants.  Again he is very bright and seems obsessive about some things like a clean utensil for all his food or if he is drawing or writing he loses it if it isn't exactly they way he thinks it should be.  He his very creative and imaginative and seems to have a gift for drawing.  Also, he doesn't sleep well and putting him to bed is a nightmare that goes on all night.  He says he isn't tired and leaves his room a dozen times before I finally get him to stay in bed.  He will wake about the same time every night and come to our room and causes a scene if I try to take him back to bed, which disrupts the rest of the house and keeps everyone else up.  I don't know I just thought a little more informatin might help.  He really is a wonderful little boy who can make anyone laugh we just are trying to find help so we can help him grow to be an independant young person with self esteem and confidence to make good decisions.  Thank you, sorry this is so long again.  Any advice you can offer before we return to our doctor would be greatly appreciated.

[HVM M.D. - EV]

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