Concern for stepson

My almost 7 year old stepson is having problems at his Mom's house (he is at our house 3 days per week).  We have heard from his mother and stepfather that he has tantrums about every 3-4 weeks, were he yells, screams, and sometimes hits himself.  His tantrums are getting so severe that he is starting to say violent things like "I am going to take revenge on you" or he tells his mother that he is going to punch her, or run away to our house.  He will also act this way (we hear) at the doctors office when getting shot or his throat cultured.  He has told the doctor that they were "killing" him and the last time he was to get his throat swabbed he threatened to kill himself.  Obviously this behavior is concerning and scary, but the odd thing is that he does not demonstrate this kind of behavior when he is with his our house or at school.  He does get into some trouble at our house and when he does, he does often cry a little, but seems to get over it quickly, but never has hateful things to say or tantrums.  He cannot tell us why he acts this way with his Mom or Stepdad. Could this all just be his reaction to the two different houses or styles of parenting, the violence of tv?  Could it be something more severe?  And why is it just happening at the one house and what can we do?

[Rebecca Resnik, PsyD]

Hello,
  it is very difficult to pinpoint exactly why a child displays such behavior, though it is safe to say that his behavior is a sign that he is emotionally overwhelmed. He is most likely feeling intense emotions that are too strong for him to manage without completely loosing control. I am not surprised that he can not tell you why he is doing this, as it probably happens when he is at his least rational. I would guess that this child feels very unhappy about his behavior and is desperate for an adult to help him 'put on the breaks.'

It may be that you and your husband are disciplining in a more effective way, or that your methods are a better fit for your stepson's temperament, though I doubt that is the only answer. The good news is that we know that under the right circumstances, he can exhibit self-control. The trick will be teaching him a way to cope in situations that trigger his unhappy feelings. Mothers often get the brunt of emotional outbursts and aggressive behavior in younger children. I believe this is because children see their mother's as 'safe' targets, and that the feelings are most intense between mother and child in many families (particularly in divorced families).

It would be a good idea to take your stepson to the pediatrician for a referral to a psychologist. The psychologist can conduct an assessment to learn more about why these problems are happening and can make a diagnosis of a mental health problem if appropriate. The psychologist can also provide much needed therapy to all parents involved as well as to the boy to help him learn better ways to cope with his emotional discomfort. The psychologist should also conduct a formal risk assessment to determine if the boy is a serious risk for self-harm.

Here are some books you (or his mother) may find useful:
The Explosive Child by Ross Greene
The Kazdin Method by Alan Kazdin
Difficult Questions Kids ask about Divorce by Meg Schneider

Best Wishes
Rebecca Resnik