Tourette

MENTAL HEALTH CHALLENGES IN NEUROLOGICAL DISORDER

Having a neurological disorder can present many welcome abilities. However, they can also present many challenges. Many neurological disorders increase the likelihood that a person will suffer from a mental health disorders. Some of these disorders can lead to intense feelings of anxiety and depression.

Stress and Mental Health

Stress (good or bad) can exacerbate symptoms and lead to “overload”. Because some people who have neurological disorders are poorly equipped to self-regulate themselves, they can unknowingly exhaust themselves physically as well as mentally. In such a case, poor mental health may come upon them slowly, without detection. Or, a sudden stressful situation may occur, and it may “tip” a person into a state of poor mental health very quickly. Regardless of the cause, judgment will be impaired and a sufferer may feel overwhelmed and unable to cope. In extreme cases, a sufferer may make harmful decisions (to themselves or others) in a failed attempt to cope with their situation, symptoms or fears. As someone with neurological disorders, I know I must be aware that my neurological disorders can pose challenges to my mental health and have the potential to lead to a state of mental ill-health. It’s a reality that I must be aware of and vigilance is required in order to reduce the risks. I know that the times of greatest risk to me often occur when I am subjected to external pressure. Pressure is perceived differently by each person, based on their personal strengths and weaknesses. Stress can come from work, family or stressful events such as having an ill friend or family member. To preserve my healthy mental health state, it is vital that I know what my weaknesses and my “triggers” are. Knowing what “stresses you out” will allow you to plan to avoid (if possible) the trigger or minimize its effect on your mental well-being.

Reactions to Stress

NeurologicallyGifted.com Mental Health shutting downNeurologicallyGifted.com Mental Health anger expression Contemplate how you naturally react to stressors. Do you “shut down” and become reclusive? Do you lash out in anger? Everyone reacts differently to stress. You must first identify and accept these reactions before you can make healthy changes.  Knowing your reaction to stress makes situations more predictable and thus more manageable through self-awareness.

Coping Mechanisms

After identifying your weaknesses, triggers and natural responses, you must then determine appropriate responses that will counteract or eliminate those triggers or have strategies to deal with their repercussions and your natural responses. Consider the things that help you cope with stress. Create a list of these strategies and keep it handy for times of stress. They could include outlets such as jogging, knitting, reading or whatever you truly enjoy and from which you obtain relief.   In my case, I discovered at an early age that running and weight training helped my get rid of ADHD and Tourette Syndrome energy. As a result, I was calmer. When I knew I was approaching a stressful time (university exams or giving a presentation), I would ensure I proactively went for a run to reduce my stress levels, in anticipation of the stress that I was about to experience. In effect, I was increasing my capacity to take on more stress than the regular daily amount.

I often share this analogy:

I think of myself as a clear glass bottle.

As stressful events occur, the bottle fills.  Highly stressful situations and events cause it to fill quickly.  Daily work and family stress fill it more slowly, over days and weeks.  Left unchecked the bottle will keep filling and eventually it eventually overflow.   By participating in stress reducing activities, I empty the bottle of some of the accumulated stress and I create more empty space in my bottle (body).  When I know I am heading into a stressful time or event, I make sure to first reduce my internal stress so I have more room for adding stress to the bottle, so it doesn’t overflow.  I can predict stressful triggers and my responses and also prepare myself to manage the pressures that follow.

In times when you are caught “off-guard” by a stressful situation and are unable to initiate your safe responses to counter a stressor, being aware of how your body reacts is critical. Being aware allows you to self-monitor and regulate your behaviour in challenging situations. With self-awareness and practice, you can become better able to control how stress affects you and reduce its impact on you (and your mental health). It is critical that you are aware of your strengths and weaknesses. Understand and anticipate situations that can “mess you up”, and prepare a plan to deal with challenges in a healthy way.

Rage 2 Taking on Rage: Look, Listen and Focus

LOOK, LISTEN AND FOCUS

Rage triggers a biochemical response which “over-rides” cognitive processes such as choice, reasoning, perception, rational thinking and self-control.  (See Neurologically Gifted’s article: Rage 1: About Rage for a full discussion about Rage).  By the onset of a rage episode, the sufferer is cognitively “paralyzed” by the body’s chemical and hormonal changes.  At this point, calming and coping strategies initiated by other people become ineffective.  Recurring rage tends to make families feel hopeless and out of control.  The individual with rage typically feels shame and guilt after they have calmed after a bout of rage.  Everyone can become fearful and feel powerless against the rage.

On the other hand, (and where hope lies) there are deliberate choices and coping strategies that can be used to prevent the onset of a rage.  Finding the right timing and the self-motivation to employ the coping strategies is a tremendous mental challenge that requires practice and support.  Learning and using strategies to prevent rage is a challenge for both the individual with rage and the family.  It takes time and effort, but through repetition and practice, rage episodes become less volatile.  When I explain this challenge in my presentations I draw upon my life experiences.

Stop, Look and Listen

In young children, rage can quickly become default behaviour.  By age 6, our son’s default behaviour was full-blown rage, and he would be very quick to attack his mother verbally and physically.  As he grew, he was getting bigger and eventually could no longer be tucked under the arm and carried to his room.  His mother’s default behaviour became fearfully tip-toeing around her son, in the hope that this would keep him from raging and protect herself.  She had a “safe room” in the house – a crawl space with a door that opened outward so he couldn’t kick it in, a phone to call for help if he was unsafe, tissues for her tears and book and a chair to wait out the storm.

The first step to changing the rage cycle is to scrutinize the way rage manifests itself in your family.  Carefully observe your family members reactions to rage.  What feelings does it elicit in each member of the family?  What are your family’s responses when a rage occurs?  Typically a pattern of behaviour will become entrenched along with the attached feelings.  These are your default behaviours which will need to change as you provide a new response to rage.

Carefully note what is occurring now.

What are your child’s default behaviours when rage occurs?  How does your child express his rage?  Is it verbal or physical or both?  Is their rage directed toward a certain member of the family?  Your child will tend toward these responses during a rage, so knowing what they are will be key in finding a way to intervene and make change.  Look for warning signs in their behaviour prior to a rage episode.  Are there clues that warn of an impending rage?

Know your child’s triggers.  Observe and record what brings on their rage.  Be aware that the rage may look to be triggered by a single event but usually this event is trivial and just the last drop in the bucket, so to speak.  Recognize the pressures unique to your child throughout the hours before the rage occurred.  If they have Tourette Syndrome of ADHD, have their symptoms increased?  Have they been trying to suppress their symptoms and are wearing down?  Have there been additional stressors in the recent past?  (See Neurologically Gifted’s article:  Mental Health Challenges in Neurological Disorders for clues to your child’s inner stresses prior to the rage – coming soon.)  Learn what predisposes your child to rage and conditions that can add up to outburst of rage.  Some common conditions that can add stress to a situation could include noises or specific sounds, temperature, crowds, certain people, being rushed, clothing sensations, frustration or simply mental exhaustion.  Note that stressor may be positive or negative.  A birthday party can be just a stressful as a losing a privilege.  (See Neurologically Gifted’s Article:  Emotional Dysregulation for more on this – coming soon.)

Once you have listed the possible triggers, think of strategies you already use to eliminate or minimize your child’s exposure to those triggers and conditions that predisposes your child to rages.  It is important to note that in minimizing triggers you cannot remove everyday normal activities.  That is not a realistic expectation.  You cannot create an environment that is impossible to maintain, and creates an unrealistic idea of daily life.  Keep in mind that you are preparing your child for life in the real world.

You will note that as you stop and observe how rage manifests itself in your family you will be forced to disengage your own feelings and reactions during the situation.  This will be an important strategy once you are prepared to take on rage in your home.  Practice disengaging now as you gather the information you need to proceed

Focus On Rage

As you develop goals to change your child’s default behaviours, (those that they always turn to) you must focus on the real problems, not your “wants”, (don’t sweat the small stuff).  You may have to set some things aside while you tackle rage.  Realizing we couldn’t fix everything at once, my wife and I spent two full years focused on developing my step-son’s social skills and skills of self-regulation to eliminate rage responses.  Academics took a back seat.

When required to choose between social skills and academic skills, choose social skills.  Social skills are required for peaceful coexistence and success for life on our planet.  As an educator, I believe that academics are of secondary importance if a child cannot function in society.  I have always stated that I’d rather have a well behaved, caring child rather than a horribly behaved one who had straight A’s.  Besides, a child will be unable to learn if they are constantly flying into rages (I’ve seen it).  Your focus must be the foundation on which all other skills are based.  Focus on positive, self-regulated behaviour.

With my own step son, his mother and I gave his teachers, principal, and support team consent to place social instruction before academic instruction.  In the past two years, my step son’s learning plan has been focused on developing his skills to :

• be aware of his own behaviour and see when he was not behaving appropriately, or about to lose control (taking personal inventory)
• know and use appropriate words to express his feelings in a controlled way to de-escalate potential rage situations (communication)
• know and use appropriate strategies to control his responses to frustrating situations (self-calming)

Another point for teachers and parents:  Don’t sweat the small stuff:  Do not “nit-pick” by expecting perfection in school work.  You must appreciate the student’s monumental accomplishment in overcoming their neurological weaknesses to complete school work.  Their success lies in the fact that they completed the task they were challenged to perform, not that is was done perfectly.

Going Forward

Rage is insidious and becomes a large part of your family’s dynamics and day to day functioning.  It is common to block out how things are occurring and to avoid  thinking about them.  Take time to observe what is happening and how it happens.  Give yourself plenty of time to prepare yourself to finally take on Rage.

See Part 1, Part 3 and Part 4 of Neurologically Gifted’s Series on Rage

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

Rage tends to make family members feel hopeless and out of control.  We began our discussion in Neurologically Gifted’s article, Rage 1:  About Rage.  Preparing a plan to deal with rage in the home puts an end to those feelings of hopelessness.  With a predetermined plan, you will have responses and strategies that you and your family can rely on.  You will now have something you can do about it.

When preparing to take on rage in our home, we stepped back to observe carefully what was happening.  We watched for triggers for our son’s rage, how it occurred, and how we responded.  In doing so, we were able to uncover our own (ineffective) default behaviours.  (See Neurologically Gifted’s Article:  Rage 2:  Look, Listen and Focus)  Once we had identified the behaviours in our family (rage, triggers and responses), we sat down with our son to discuss those patterns.  We openly and honestly discussed our feelings.  With care and support, we helped our son explore what he felt before, during and after a rage episode.  We made it clear to him that this was a family problem and that as a family we could find solutions and improve our situation.  (See Neurologically Gifted’s Article:  Rage 3:  Talk About Rage)  With this critical step completed, it was time to for us to make a family plan to get control over rage in our home.

Make House Rules

Make rules with your child.  Ask them what rules they think should be included.  Prompt them by letting them know that the rules will apply to everyone in the family.  Ask them how they would NOT want to be treated by others.  Ask if there are things they would like to change by making a rule.  Discuss with your child why the rule is important and the natural consequences of non-compliance to the rule.

Guide your child through the rule making process.  Keep rules simple and concise for easy recall.

Do not over-burden the process with too many rules.  Choose your battles, picking only rules that apply to your greatest challenges. Over time, your child will become better able to self-regulate their emotions and responses.  As your family begins to experience progress, you will be able to change your focus and rules to address other priorities.

Keep rules obtainable and focus on safety.  For example, a rule prohibiting swearing is not realistic for a child with coprolalia.  A rule prohibiting anger or frustration isn’t appropriate either as we all have feelings.  In such a case, the family rule could outline acceptable ways (and places) to express anger and frustration.   You want your child to be successful, gain confidence and learn to apply skills for managing their emotions throughout this process.

Keep copies close by for quick reference.  Having the rules posted in their personal space will allow the child time to review expected behaviours and natural consequences of prior behaviours.  In our home, we placed a copy in our son’s bedroom, and referred to them at bedtime when we debriefed the day’s successes and challenges.

When referring to the rules:  Give kind and gentle reminders.  Reminders could include what the family (including the child) agreed would promote a safer and more peaceful environment.  Referencing the rules on paper takes the blame/authority away from the offender/enforcer and places it on the family rules.  A child is less likely to express anger towards a predetermined rule, rather than to being told to stop what they are doing by a parent.   Avoid trying to catch your child breaking the rules or to use the rules in a punitive manner.  You are attempting to use the rules to guide them in a predetermined way to modify/control their rage, not to punish them.

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

The Plan

Make a plan for what will happen when the child (or any other family member), is unable to comply with the rules.  The rules clearly set out the expectations for behaviour and the plan will clearly state the consequences that will follow non-compliance.  Consequences must be consistent, fair, logical and natural.  For example, if a child is acting in a threatening manner, they must go to their room, (or other predetermined safe area) so the family members will be kept safe.

Again, involve your child in this discussion and try to have them help to come up with ideas for helping them regulate their own behaviour.  We found that our son had great ideas for how we could help him regain control, or how we could take control for him when he was unable.  When you are making the plan with your child, try to put yourselves in the moment.  Ask your child,  “What would you do if this happened?”  “What do you think you would do next?”  “How could we help you in this step of the rage?”  Our son was excellent at imagining the scenarios for us.

The plan should consist of step-by-step interventions with increasing increments of taking control for your child.  Each step will provide your child with an opportunity to succeed in regaining control.  For example, our first step was a friendly reminder about the undesired behaviour using positive language.  (see Neurologically Gifted’s article:  Using Positive Language for Success)  “You need to speak in a calm and kind way to everyone in our family.”  If the child cannot regain control with the reminder, then the next step of the plan would be used and so on.  Our next step was to ask our son to remove himself from the situation.  This allowed him an opportunity to be successful by being able to continue his behaviour but doing it someplace else.  The final step of the plan would be used only if the child, given each opportunity, could not regain control by themselves.  In the last step the parent would take control for the child. “Nathan, if you cannot take yourself to your room to calm down (and be safe), I will need to take you there.” Remember:  This is for helping, not punishing.  It is done with care not anger.

Our Plan for Rage

With our help, our son guided us through what the steps of the plan would be. First we would give a friendly warning using positive language.  Next, we offered a suggestion to leave the room and take some space.  If necessary, the next step would be the instruction to go to his room.  The toughest part of our original plan would be getting him to his room.  At this point he told us we would need to take him to his room if he didn’t go on his own.  I’m fortunate that as a special education teacher who specializes in challenging behaviours, I have training in using physical restraint.  I DO NOT recommend anyone restrain a child without training.  The training not only teaches you to calm your child (to prevent the need for restraint), it also teaches you to stay calm in the face of calamity as well.  It’s important to understand how and when to restrain someone who is in a fit of rage.  In addition, it teaches you how to safely restrain without causing injury to the child.  It is far too easy for a grown up to use their strength advantage over a child, and injure them.  It also helps you stay in emotional control, preventing you from acting out of anger. So, in our case, I would physically take him to his room.  We also discussed a plan for when only his mom was home and he needed to be physically taken to his room.  In this case, we made it clear that for safety, mom would need to call for help – even if that meant calling 911.  He also suggested that he might not stay in his room, so we problem solved for a lock on his door to keep him inside.  Together we made a trip to the police station to discuss our plan of helping our son regain control, to stay safe, and to keep our family safe.  Involving him in every part of the plan was essential.  Together we set his room up so that upon entering the room, there were comforting items within his sight.  We removed everything that could be dangerous.  We provided soft balls for throwing and devoted a drawer in his dresser for calming stress-reducing toys.  With those calming toys, we discussed how Nathan could use these things to redirect his anger (like punching his pillow or mattress and hugging his stuffed toys).

By the end of making the plan, our son knew exactly what would be happening if he lost control to rage and that knowledge made him feel safe.  Having a clear understanding of our process eliminated unpredictability, and made our son feel safer.  We signed, witnessed and distributed copies throughout the house.  Signing the rules together, we reinforced the commitment to a family effort to help keep our home safe.

For more on rage from Neurologically Gifted:

Rage 1:  About Rage

Rage 2:  Look, Listen and Focus

Rage 3:  Talk About Rage

Using Memory Strips For Success

Memory Strips

Memory strips are essential teaching tools to assist students who need support with memory recall,  organization, making good behavioural choices and using self-regulation strategies.  Memory strips can be used in the classroom and at home to reinforce routines and strategies used to regulate behaviour.  Memory strips put the student in control of their decisions and improve independence.  Typically, students who have difficulties with attention due to Attention Deficit Hyperactivity Disorder, Attention Deficit Disorder and Tourette Syndrome will benefit from this tool that is easy to create and put into action.  Adults and “neuro-typical” children may also benefit from using memory strips in their everyday tasks.

For children with difficulties with organization and memory recall:

Memory strips can provide visual cues for procedural steps for work completion and for improved organization.  For example, children who have difficulties starting or completing tasks may use memory strips to provide a visual checklist to guide them through steps required to complete or improve the quality of their work.  Children who have difficulties with organization can benefit from memory strips reminding them of the things they need to do.

For children with behavioural or self-regulation challenges:

Memory strips can be used to prompt appropriate behaviour choices or to provide cues to strategies that can be implemented by the student to ensure success.  Often children who have neurological differences tend toward unwanted behaviours when unsure of what they should do.  The memory strip can be a visual cue to give them positive choices and strategies during these moments and preempt the unwanted behaviour.

Here are some examples of simple memory strips I have used to effectively teach students with learning disabilities and/or neurological challenges.

Memory Strip:  Start and Finish Written Work

This strip comes from the book “Teaching the Tiger” by Marilyn P. Dornbush and Sheryl K. Pruitt, (Hope Press Inc., 2003).  It is used to remind students of basic routine information for starting and completing school work.  I have used this memory strip for my entire class, as a constant reminder.  It can be taped to a student’s desk, or posted at the front of the classroom for all.

Work Completion Memory Strips:  Neurologically Gifted

Frame 1:  Introduce yourself.  This image reminds the student write their name on the paper.

Frame 2:  The calendar image prompts the student to put the date on their paper.

Frame 3:  A large period prompt the child to check their work for proper punctuation.

Frame 4:  The capital C and lower case C prompt checking their written work for proper capitalization.

Memory Strip:  Morning Locker Routine

I created this memory strip for my organizationally challenged son.  Having profound difficulty organizing himself at school, I provided him with a memory strip that was posted inside his locker for his reference.  At the start of each day, he would follow these steps before entering the classroom.

Memory Strip Entry to Classroom:  Neurologically Gifted

Frame 1: Put your hat, mitts and scarf IN your locker.  (Especially important if you have to replace lost items frequently)

Frame 2: Hang your coat IN your locker.

Frame 3: Put on your indoor shoes.

Frame 4: Bring your agenda into class

Frame 5: Check your pant zipper (he often has his clothes on backwards too, but I wanted to keep it simple!)

Memory Strip:  Using Your Strategies

I created this memory strip for behaviour which prompts recall of strategies to help a student struggling with dysregulation.  This dysregulation may be due to suppressed tics, overwhelming stimulus, heightened emotions or even boredom.  It is typical for these types of situations to stimulate unwanted behaviour, aggression, provoking behaviour and disruption.  The strategies must be known to the student and have worked well in the past.  This particular strip was created for a grade 7 student who was profoundly challenged by Tourette Syndrome.  This memory strip was posted inside the student’s locker, and on the inside cover of his notebooks.  It proved to be very effective, and was consistent with his Behaviour Management Plan.  The memory strip provides a consistent reminder of his strategies and school behaviour expectations.

Memory Strip Positive Behaviours:  Neurologically Gifted

Frame 1:  Take a quick break outside the classroom door (1-2 minutes)  (provides an opportunity for a quick release of tics or stress).

Frame 2:  Take a walk around in the hall (provides an active release of energy).

Frame 3:  Take a time out at the office.  The student needs more time to decompress and possibly some distraction from the current situation.

Frame 4:  Say it or do it someplace else (leave here and do the tic in a safer place).  The student can choose to continue with their current behaviour but in a place where they are more comfortable and safe.

Frame 5:  Say or do something else (stay here, but change the tic).  The student can check in and choose to redirect their focus and energy.

Frame 6:  Take a time out (leave the area and go to the office for support).  The student needs to have some adult support to manage the situation.

Frame 7: Use the 3 steps to managing conflict (a process I created for schools).  The student chooses to appropriately manage the situation causing dysregulation.

Memory strips are easy to create, and should be created with the student.  All memory strips can be tailored to the specific needs of the student improving their independence and success.  The student takes ownership of the memory tool by searching online for icons that they “connect to” and pasting them into the frames.  By allowing the student to co-create the memory strip with you, they are more likely to remember and use the tool.

Consistent use of memory strips lead to these steps and skills being memorized and becoming “second nature” to the individual.  Be sure to share the strips between home and school as the student likely has the same challenges in both situations.

Memory strips give students power and confidence knowing that they can effectively use the guidance within the strip to be successful!

How to support your child’s learning at home through organization, structure and routine:

The importance of structure and routine is sometimes undervalued at home, in regards to its contributions to academic success at school. Success at school is the product of skills and knowledge learned at school and at home. In fact, learning acquired at school can be undone by poor habits at home (and vise-versa, of course).

Although the formal teaching is done at school, parents need to be mindful of the teaching and learning that occurs at home. A student’s learning environment extends to the home as well.

This learning environment is created by dedicating one or two areas of the house as “learning zones” where school work is to be done.

In addition to these zones, “learning hygiene” is also critical. That is, adhering to designated learning areas, and learning rules (structure).

To ensure the effectiveness of the learning zones and learning hygiene in your home, try these tips:

Learning Zone

When your children enter the house, have them place their backpack at front door, or in the designated learning zone.

All school work is done in the learning zone. Most frequently this is done at the kitchen table where parents are nearby to help when needed and/or coax the child through their assignments. For self-directed learners, the work can be done in the bedroom or an office area in the home.

The learning zone should maximize the student’s ability to focus.  The TV, the radio and siblings playing video games nearby may create unbearable distractions.  Our son, with profound Tourette Syndrome does his homework on the floor on his belly.  This learning zone eliminates the urges of tics to pound the table and lift and drop the chair and table.

Do not do math in the bedroom, science in the kitchen, reading on the couch etc. as this scatters school materials throughout the house. During the morning rush, you will be unable to collect all of the assignments and/or materials needed for the upcoming school day. Complete work in one or two spots (the same spots every day).

Learning Hygiene

Have a visual calendar in the house to record upcoming assignments and trips. In this way, parents will not be caught off guard by last minute announcements of assignments due the next day.

Remember, grown-ups can have organizational weaknesses as well.  I often recommend parents post organizational tools (for themselves) in the learning zones, to support their child’s learning at home. The most commonly used organizers are checklists. Create checklists and post them in an obvious place in the house (usually the fridge – if it isn’t buried under layers of paper already!).

Reduce clutter and distractions in the learning zone.

When all the work is done, have your child immediately put it in the backpack (not beside, on, or under because they may end up someplace other than in the backpack). Put the backpack at the front door. (To ensure I don’t forget items, I often put them in a spot where I virtually need to step over them as I leave the house. I will put my lunch bag on the floor in the kitchen doorway so I can’t leave the kitchen without my lunch, or I put things beside my car keys because I can’t drive to work without them.)

Have your child empty the backpack once per week and reorganize it. Ensure all necessary materials are present. Don’t be too frustrated by lost materials. It may part of your child’s neurochemical/neurological challenge. Make plans and anticipate that things will be lost. Have extras, and buy cheap if it’s likely to be replaced frequently.

Keep to these routines and rules daily. The assignments will change, and the amount will change, but the routines should not. Eventually they will become entrenched into the family’s routine.

Ensure Success

For some families who have greater challenges, there will be days when you must choose between getting homework done, and maintaining your family’s sanity (choose sanity). Be sure to have open communication with your child’s teacher and make them aware of these challenges, so they can support you and your child appropriately. When they are aware and appreciate your homework battles at home, they will be able to provide support at school and make accommodations to your child’s homework load.

This is a short clip of our son working well at homework time.

Things can easily become difficult and a reduction of workload and/or the length of time spent working will be adjusted accordingly.  It can easily become overwhelming to either parent or child resulting in meltdowns.  Once a meltdown occurs it is difficult to resolve.  The next homework session will come and both the child and parent will have increased anxiety at the onset of the session.  Ideally, homework time ends with the child being successful even if all the work needs to be deferred to another day.

There can be a fine line between pushing your child to get more done and pushing them over the edge.

In rare instances, I have heard parents tell me “I just can’t keep track of everything”. This is an indicator that you (the parent) are doing too much. With gymnastics, hockey, and soccer, etc. parents have little or no time to support learning at home. Keep it simple and prioritize.

Make choices about learning at home that will support scholastic success. Teaching isn’t only done by a teacher. It’s done by parents/guardians too.

For more about the school and home relationship see our post:  School Meetings:  How to Make Them Easier

For a list of all of Neurologically Gifted’s Articles:  CLICK HERE

Rage 3: Talk About Rage

Rage triggers a biochemical change in a person which pre-empts choice, reasoning, rational thinking and self-control.  Through observation, as described in Neurologically Gifted’s article:   Rage 2:  Look, Listen and Focus, we found that it was possible to achieve an excellent understanding of the dynamics of rage in our home.

Through observation we learned about the triggers for our child’s rages – the events, situations and patterns that would usually lead up to a rage.  We also recorded what would calm some situations – strategies we already used throughout the day that helped to deescalate volatile situations.

We developed some ideas about what we, as a family could do when stressors occurred that might lead to a rage.  Stress and frustration can be managed with love, support, communication, and planning.

We practiced disengaging from the rage.  Disengaging can help by not escalating the situation and by watching (to keep our child safe during an episode).

After completing our observations we then decided it was time to sit down with our child to talk about rage.

How to Talk About Rage

Before any discussion begins, it is important to remember that a child with neurological disorders may have difficulties in focus and attention.  Gaining self-insight to behaviour is challenging.   It will be important to keep the child’s limits in mind when moving forward with the discussion.  For example, memory and learning are both severely impaired in the time immediately before and during a rage.  Our son Nathan would often have very little recollection of events (even hours before a rage).  Once a rage has begun, talking will escalate the rage (even words that are intended to help).  Nathan often misinterprets words or hears things that were not even spoken.  Even saying “I love you” can be inflammatory for him during a rage.

It will require many weeks of ongoing conversations to communicate how rage occurs with your child.  We would wait until Nathan was receptive and able to learn and absorb what we were saying.  Once he would start to shut down or if the interaction became negative (a battle) we would stop.  We would provide a short wrap-up that would include support, encouragement and praise.  Always leave it on a positive note.  At the next opportunity, we would briefly review the last discussion to gauge what had been retained, and carry on the conversation from there.

Beginning the Discussion

Impact of Rage on the Family

Be kind, caring, supportive and non-judgmental.  Make your child aware of how the members of the household feel about rage occurring in the home.  Feeling mad, scared or frustrated are normal responses to rage, and they deserve to be acknowledged.  Be sure to let them know this is a problem in the family (not just in them) and there is no blame laid on them.  The reason for this discussion is to teach your child the natural consequences of their behaviours.  You, as a family are going to help the child make changes for the better.  Be supportive and encouraging.  It is important for your child to know that you as a family can make this change together.

Your child may be struggling with their neurological disorders and with delayed emotional development. In most cases, they may never have thought about what his/her rage is doing to others.  With all that a child may be dealing with from their disorders, it is likely they have not stepped outside their own brain to wonder about what they look like to others when he/she is raging.  During a rage the child is trapped inside a brain that is out of control.  This child doesn’t know what others feel about it.

Tell your child about it.  Tell them if other family members cry about it, are scared about it, are worried for their future.  Their response may initially be defensive.  “Are you trying to make me feel bad?”  “Do you want me to hate myself more?”  “Maybe I should just leave?”  Reassure them that this is not the case.  Reassure them that you love them and you just want to make home a better place. They are only able to make change, when they know how things really are.  You must be realistic and honest.

Making a child aware of how others feel can provide them with powerful motivation for taking charge of their rage.  Reassure them that with the whole family’s support they can change their default behaviours.

Impact of Rage on your Child

Next, discuss how your child feels about his rage episodes.  What does it feel like before during and after a rage?  Is he scared about losing control?  Is he scared he will actually hurt someone?  Intense guilt and shame are common after a rage.  Not being able to take back what they have said or done can become toxic.  Feelings of guilt and shame occupy some of a child’s mental resources, making them even more susceptible to subsequent rage episodes.  Explain this to them and tell them that as a family you can help make things better for him.

For our son Nathan, when his rages were more frequent he would often scream “I’m sorry” and cry during his rage and then emotionally swing back into verbal abuse, followed by more tears and apologies.  This could happen over and over.  His remorse was filling his bucket and tipping it over (back into rage) again and again.

Discussing these feelings of fear, shame and guilt with your child will provide more motivation for them.  They can make a change and as a family you can work together to minimize or stop rage episodes.

A New Starting Point

Bringing to light everyone’s unspoken feelings and fears will be useful when taking on rage.  You will have a common understanding that you now share with your child.  You will be able to say, “Im feeling anxious (or frightened)” or “you look scared (or angry)” and your child will understand what you mean – without having to go into detail.  You will be on common ground with a better understanding of what is happening.

A person who experiences frequent rages is usually easily overwhelmed.  Coping and managing symptoms of neurological disorder takes much mental energy.  With so much of their mental energy already occupied, your child may be unable to see what may motivate them to make positive change.  This is especially true for children.  Remind them frequently of your previous discussions.  They will be motivated to make things better but they will frequently need explicit reminders.

Continue to talk about rage in your home.  Discuss your goals for the family with your child.  Let them know what you are going to be working towards together.

–A peaceful, respectful co-existence where every member of the household wins.

See Part 1, Part 2 and Part 4 of Neurologically Gifted’s Series on Rage