Severe anger and tantrums in 9 year old - who should we seek help from?

[diplodocus]

DD is 9 and has had trouble with anger and tantrums on and off since the end of year R. They used to be very much related to school issues (although she had them at home)- she struggles with friendships in particular and is very oversensitive. Things usually calm down over holidays, but this summer the opposite has happened - she is constantly angry and rude, and has at least one full on tantrum a day which involves screaming, pushing and shoving. She is very aggressive and angry towards her sister but also to her dad and I. She rarely shows her anger out of the home and is usually very polite to others (although this is beginning to change a little). We're at the stage we need professional advice, partly as I'm worried she'll hurt her sister. We've briefly seen an educational psychologist (mostly about her difficulties with friendships and lack of concentration) who really wasn't very interested as she's not a "failing child" and academically is well within limits. The implication was we were overanxious parents. We've had a consultation about how to manage her tantrums with a behaviour specialist and this hasn't really helped either - we've tweaked our approach a bit but basically we're not doing anything unusual. Sanctions do nothing - she just gets angrier. We try and praise the good (or even the OK) but to be honest there's precious little to praise at the moment. She can't articulate why she's so angry - blames everyone else and says everyone's mean to her and bullies her (they're not and they don't - this generally means they don't agree with her or she's not getting own way all the time). Most of the time she's defiant but occasionally she breaks down and is really contrite and sad, which breaks my heart. There have been no major changes in her life. Eats and sleeps well and is healthy.

Who would be the best professional to turn to? We will probably see a GP next week but I'm very aware that anything on the NHS will take forever and am happy to pay to see someone privately as this is making us all miserable and I'm worried for her future. I'm just at a bit of a loss as to who? I'm presuming some sort of psychologist but educational? behavioural? clinical? What approaches / qualifications should I be looking for? Any suggestions very gratefully received.

bump pls

Personally I would go back to a GP and request a CAMHS referral

They will then recommend who would be the best to refer on to, at which point you can go private if you still want to

Dd sounds very similar -a little older but 9 was when things really escalated -I wish I'd done something about it sooner

We are currently awaiting an ed psyc appointment

Thanks - I know the waiting list is very long for CAMHS where we live (and things have to be really bad before they take you). Might help by suggesting another pathway, though. Good luck with your DD.

I don't know whereabouts you are? where I work in England as a GP, CAMHS will bounce a referral of this kind back. They are advising currently (and have been for about the last 2 years) that they are a "tier 3" service. This means they only get involved with direct GP referrals in severe cases with clear mental health issue e.g. Suicidal behaviour/psychosis in teenagers or similar or where there is a previous diagnosis/CAMHS involvement. If you have concerns about your child's behaviour/ concerns around whether they may have an ASD or similar the advice we get from CAMHS locally is that the school need to perform an assessment - I think called a CAF to look at additional needs/support. Apologies if this is no longer the correct term, as I have less involvement in these cases now the terminology may have changed (yet again). The idea being that if this lower level assessment flags up concerns requiring CAMHS involvement then the child can be referred by the school team at that point. By all means see your GP for advice but I would suggest discuss it with your child's school too (although I appreciate that would mean waiting until after summer break). Hope you are able to get some support.

Hi - Thanks for your reply. I have discussed with school (and they know of the anger issues) and we had two sessions with an ed psych who basically washed her hands of us as again it's not severe enough to warrant their involvement. I don't think school would do a CAF as they don't see her needing much in the way of additional support. I think we'd probably be bounced back from CAMHS where we live too, which just leaves the private option - I don't mind that but do feel I need a bit of guidance on who would be best for her in terms of qualification and approach.

Ds is having similar issues. He is on the camhs very long waiting list due to dyspraxia - not officially diagnosed but ed pysch was pretty sure as was private ot. I think his anger comes down to frustration. Does your dd have any other problems that could mean she is frustrated and letting it out at home?

How about some counselling for your DD to help her find better strategies to cope with her anger?

That's a possibility boulie, but to be honest I'd really like to try and get to the bottom of why she feels so angry in the first place and address any underlying issues.

My dd same age is exactly as you describe but the situation is more extreme in that mainstream school has broken down as she is so aggressive there.

Camhs see her regularly but say there is 'no magic pill.' We have tried three different medications but they didn't help her behaviour. No therapy recommended, in fact the psychiatrist said talking therapies don't work for children.

Sorry to sound negative but I wouldn't hold your breath.

Thanks ivegottogo - sorry to hear about your dd. Mine doesn't have outbursts at school at he moment but I feel it may just be a matter of time.

This sounds so exhausting and destructive. Have you thought of recording her tantrums (may be covertly) and either playing it back to her when she is calm to ask her whether she has any ideas of how to avoid the build up or to show a professional?

How much responsibility does she have? Is she allowed to make decisions? Sometimes it's sheer frustration at having a feeling of no control in life.

How are your parenting skills? Has something happened that has changed such as father leaving/new partner arriving/school friendships strained?

Does she get enough sleep? Get out in the fresh air? What are her hobbies and interests?

She sounds like a lost soul screaming out in frustration, have you noticed the triggers? Is she jealous of her sister?

There are so many things that need to be looked at, this is tough on all of you and this may be just a phase but it's great that you are seeking help.

A homeopathic doctor. They are medically trained and interested in the whole person not just the symptom. An intelligent kid will be interested in their approach and although there may be placebo effect in the medication who cares if it helps?
It was miraculous for my DS to see someone like this - turned him around and cured his skin condition.

Have you actually RTFP Wotodoo?

OP sympathy and empathy. We are living with something similar

Sympathy from me too. I have an incredibly angry, controlling, aggressive 10 year old who's basiciay ruined these summer holidays for everyone so far this year. She's sweetness at light at school.

We made the decision this week after she tried to push me down the stairs that we're going to the gp when we come back from Our holiday and if they won't do anything then we'll self fund and assessment or something. School weren't interested in helping and said she was fine... That's great for them but not me when I've had to listen to two hrs of screaming stamping and her being generally vile at the top of her voice. She shouts herself hoarse at least once a week.

I look forward to reading some more helpful replies!

We had (have) similar issues with the ds's in Year 4. Turns out they have AS. Have you considered this as a possibility? Quite common apparently for it not to be picked up till juniors or even later as the gap between their social skills and those of their peers widens.

Might be worth reading up about ASD and trying to implement some of the recommended strategies to help calm down the situation. For instance having a relatively fixed routine in the summer holidays might help or timetable days out etc rather than being spontaneous or avoiding places that you know have caused problems in the past e.g. very busy playgrounds etc

Depending on your area CAMHS or a Community Paediatrician might be the best people to explore this possibility.

One thing I would say is that if you do get involved in assessment (for ASD or other cause) then avoid having your dd in the room whilst you discuss the behavioural difficulties - it's not necessary and in our experience just further compounded the problems.

I don't know anything about getting professional help but we had this with DS1 at 8/9yo.

He only had one tantrum as a toddler, which I ignored and was never repeated (polishes perfect mum halo) so the violent tantrums he started having at 8yo came as something of a shock.

Apparently they get a surge of testosterone at that age and it's not unusual.

Anyway after floundering with it for a while, I started sending him to his room to calm down and getting him to call me when he was ready to talk. Then we'd have a nice chat and a cuddle. It helped me to understand his "issues" and removed the conflict/violence from the rest of the household. Now (aged14) he takes himself off for a while when things are all becoming too much and (touch wood) we haven't really had any teenage tantrums (yet!)

I do think there is some professional help out there for you if you are able to pay. A child psychologist with a good record in helping families may be what you want. You have to be careful they all have their own ideas and methods.

I'd want a psychologist who had a good understanding of ASD (especially in girls) and not one of these ones who doesn't believe in it or whatever. I am not saying your dd has ASD but if she did you want it picked up on and good advice and support.

Could it be some sort of neurodevelopment problem. I have been doing courses dealing with this to help my little one. Seems a lot of our problems are anxiety. Things that most would not get anxious about. Have a look at the autism websites. I have found these helpful, especially reading about PDA and stratergies used to help.

OP, does your daughters school have a mentor? Often they have counselling or behavioral training, and crucially, anger management training.

If, academically, she's doing well, it might not have occurred to anyone there that she might benefit.

Certainly no harm in asking. I've worked with some fantastic mentors.

yes I have read wtf thank you, but it does sound as if the family dynamics are an issue here if there are no problems outside the home so just wanted to be extra sure.

With child mh it is rarely the child acting out in isolation of other influences/factors. If there is undiagnosed attention deficit disorder/ aspergers then knowing if those outside influences/factors act as triggers can help enormously in managing the problems

Thanks for all your very helpful thoughts and ideas. I certainly have considered mild ASD - mentioned to educational psychologist who pretty much discounted it and said if she did it wouldn't change anyone's approach to issues and it wouldn't be bad enough to warrant a diagnosis . She does, however, love spontaneity and doing interesting things - she'll give anything a go - the temper rises when she's doing more routine stuff at home. I try and give her more responsibility - she's baking downstairs at the moment and I'm staying away - but I do think this is part of it. No major changes to our family and we've discussed our parenting approach with a positive parenting specialist and it's pretty normal - not too controlling or laissez faire. She has a younger sister who she's always been extremely jealous of and this is certainly the root of much of her anger. I do think she has underlying anxiety but she doesn't seem to be able to articulate it (despite being very articulate most of the time).

Interestingly this morning has been the first in a while without any rudeness or tantrums - she's back to her lovely self. Not sure how long it will last but at least have something positive to praise her for. I'm trying to split the DDs up as much as possible (have some opportunity to do this next week) to spend one-to-one time with each of them which I think they both need at the moment.
In terms of school she has input from ELSA who are doing some anger management but haven't seen any real benefits to be honest. The school is pretty supportive on the whole.

I try and get her to go to her room - sometimes she will and sometimes telling her to go just escalates things. I do think she needs time on her own though when the anger is rising.

Have you read the explosive child or out of sync child? Both useful books with great practice advice.

My DD is similar, she has ADHD though so some slightly different behaviours - but definitely the tantrums and rage are part of it. We found that time-out or naughty step was physically impossible for her to achieve so have also resorted to sending her to room to calm down and to come and apologise when she has thought about what she has done wrong and how to improve her behaviour.
Does your daughter have a Paediatrician?

if her self esteem is low and the jealousy of her sister is the main root of her anxiety/rage then that is a good thing to concentrate on.

Doing activities that your dd enjoys, can gain confidence from and that do not involve her sister would be a very good start. I'm not sure what your finances are like but things like going for riding lessons is a great idea for children as a child can quickly gain enormous self esteem as well as gain an all consuming interest which keeps them outdoors, hard working, disciplined and having fun.

I know no other sport quite like it as a way for (in particular) girls to develop in a really positive, healthy and outdoorsy environment where there are penty of opportunities to meet likeminded people and therefore make friends. Ponies are even used as therapy so please look into it, the positive results can be spectacular.

Even if you don't have the £ for lessons, plenty of young girls go to stables and help out in exchange for lessons.