Extreme anger in 5 yo: psychologist or psychiatrist?
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Anonymous
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[quote=Anonymous]I would go to neither. I would take her to a developmental pediatrician. First of all, she should see a medical doctor. I wouldn't assume this is purely psychological, especially in a child this young. There could be an underlying medical or developmental issue, even if it is "only at home." Our DD who has ADHD and mood issues used to keep it together very well at school, but melt down completely when she got home.
I am a huge believer in talk therapy but I think the folks recommending it didn't read that this child is 5 years-old. There is no way that a child that young benefits in the way an older child or adult does from talk therapy. She is way to young to be able to form the insights that is the point of talk therapy. Much more meaningful to identify the issue first (the developmental pediatrician, or maybe a psychiatrist). If there isn't an underlying medical issue a behaviorist is a better bet than talk therapy. And for the person who questioned why only with mom -- this is probably the person she feels most comfortable with, and most comfortable releasing the stress she has (for whatever reason she has that stress).[/quote] +1. Getting a global assessment is a good idea to rule out any developmental issues. I was like OP's DD growing up. Rages and tantrums only directed at parents. At school, I was fine, got along with everyone, lots of friends who I never fought with. My brother likes to tease me and say my childhood up to the age of ten was one long temper tantrum. I grew out of it eventually around 10. I think my issue had mostly to do with the relationship with my parents than anything. Even as an adult, I can be a whole different person around them. Our relationship was very stressful for me as a child. |
Anonymous
We had the same situation with my ds when he was five. He knew that if he hit me (mom) that I was "safe" to hit because I would remain calm and grounded. OP, I started with the pediatrician and got recs from her. We moved from there to a psychiatrist and a therapist. |
Anonymous
Ha ha, yes. FYI, OP, a developmental pediatrician is also an option although a there might be more of a wait b/f you get an appointment. If your kid is nearing 6, I would go straight for a neuropscyh eval to test for lds. |
Anonymous
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I, too, suggest you getting on a wait list for a developmental pediatrician because he can do a global evaluation (I think it's WAY to early to be thinking learning disabilities and nothing in your post suggests that it is a concern). But, I don't think you need to limit yourself to either a psychologist or a developmental pediatrician. Given the time it takes to get an appointment, I think you should get on a wait list for a dev ped and in the meantime start meeting with a psychologist. It's what we did and it was useful to have the psychologist's assessment when we went to see the dev ped.
You might consider the Keller Center http://www.inova.org/healthcare-services/inova-kellar-center/index.jsp . They were in-network for us but they sometimes aren't seeing new patients and don't have a wait list. You just have to keep calling. Good luck and lots of hugs to you. |
Anonymous
| agree with a pp: psychiatrist. while you don't want to medicate, you may need to to save your child. |
Anonymous
I agree that she probably feels the most safe with you. That's what I first thought when I read this. She maybe scared and frustrated too. Hang in there. |
Anonymous
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OP, my son has had terrible anger issues too, and only with us at home, not at school. We've been to several specialists (developmental pediatricians, therapists etc.) at Kennedy Krieger, therapists at Alvord Baker (group of children's psychologists/therapists in MD), a group that specialized in applied behavioral therapy in Herndon (Behavioral Directions -- they advertise they are an autism consulting firm but they work with children who aren't on the spectrum too), and an independant psychologist. At the age of 5 there's very little one on one working with a child, but more working with the parents to learn how to handle the behavior. We had people coming to the house, too, to watch our interactions and help us when the tantruming started. Mostly it was about structure and learning to respond to anger in a very neutral, consistent way. Consistency is huge, especially if you have a strong-willed child.
Our son turned out to have ADHD and anxiety. We have yet to try medications, though we anticipate that will happen. Haven't yet found a psychiatrist though we are looking for one on our insurance. Good luck. I know how exhausting it can be. |
Anonymous
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PP here - meant to add that the structured responses to outbursts have had an effect. But I also suspect maturity as he gets older has helped.
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Anonymous
| Hi - I don't have time tonight to read thru the posts, but I think the matter of meds has already been touched upon. If someone needs meds, you need a psychiatrist. I have personally found most psychologists worthless. Persoanally, for DH, DS, and DC - garbage. On the other hand I heard psychiarists are finding more money in the 20 min. in and out drug meetings so are more reluctant to take on a client for true therapy. If true, then back to a psychologist who will talk to you and the psychiatrist on top of the hours with the psychologist if you need meds. Its' a tremendous racket that needs to be reviewed and overhauled by the AMA. |
Anonymous
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DCUM is populated by people who take medication and give medication to their children. I am not a believer in medication. When a child is having tantrums, especially one so young, there is usually an organic cause -- that child does not feel well.
In the absence of some abuse or severe trauma, I would look first at your home environment: Do you have carpeting? Do you live in a new house/new furniture? Many new houses/furniture outgas formaldehyde and other toxic chemicals. Do you have any mold in your house? Have you had your child tested for allergies? What does your child eat? Does she drink soda? A lot of sugar/artificial ingredients/processed food? Many parents find it much easier to give their child a pill to control her behavior than to make the myriad changes that could be necessary if the child has allergies/sensitivities to materials in her environment and foods. I do have first hand experience with this. My child was having horrible tantrums directed at ME (mom) at age 5. His preschool teacher suggested taking milk out of his diet. I removed all dairy products from his diet and within days, the tantrums stopped. Just a week prior to this, I'd taken DS to a psychologist because the tantrums were driving me crazy. She suggested twice weekly play therapy to help my child work out his "anger," which she said (after one visit during which she barely spoke to my child) was causing his tantrums. Of course, your child could have some mental health issue that can only be addressed by medication, but you can't know that if you don't try dealing with some of these environmental/food issues first and see if you notice any changes. I'm absolutely shocked by how many children are taking medication to control their behavior these days. It's unnecessary, and if you dig deeper, you will find that many of the physicians promoting medicating children with drugs designed for adults have ties to the drug manufacturers who sell these very drugs. Giving medication to a 5 year old is unconscionable if you have not tried the approaches I suggest first. If your child is in danger, that's one thing, but if her behavior is just aggravating, it might be prudent to look at her environment/diet and make some changes. |
Anonymous
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No one is suggesting OP run out and medicate her DC. Its really the anti-medication folks who are having a knee jerk reaction. Most of us who suggested a medical doctor did so because there may be a medical basis for the behavior. there may be an issue that should be treated with medication down the road but I don't know any parent who jumped to that immediately. Most of who have kids on medication resisted and resisted and resisted and when we finally gave in and saw how much better our kids did, how much happier they were, regretted waiting.
But OP isn't there yet. I don't think anyone is suggesting medication is on the table at this point. She needs the best possible evaluation. I agree with PP who said psychiatrists tend to be better than psychologists. That has been my experience. The psychologists we've seen in our family have been mostly bad, I'm sorry to say. There have been one or two (especially those that practice CBT) who have been very helpful, but otherwise they've been a disappointment. The psychiatrists we've seen have been much better as well as our developmental pediatrician. |
Anonymous
| I'd start with a developmental pediatrician, then move to either a child psychiatrist and/or psychologist depending on what the developmental ped finds. BTW, I'm a psychologist so no ax to grind here. I just think there should be a diagnostic workup to rule out medical causes. If this is a behavioral issue (at least in part) then a good child psychologist can make a positive difference. |
Anonymous
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5 is young, but the longer this behavior persists, the deeper the habit becomes entrenched.
The fact is, a 5-year old from a good, happy family, surrounded by a gaggle of nice friends and warm extended families -- that child will not melt because she's a bad apple. She has some issues that need to be addressed. I second looking into environmental problems: - lead tests (there could be a source of lead anywhere, not just home. A favorite toy at daycare, which she used to mouth a lot could do the trick). Just do it -- and screen for other heavy metals as well. (Pediatrician) - allergies -- as someone mntionned, the carpets, pets, neighborhood trees -- they all cold be a the culprit. If you cannot isolate, you may simply try a few days with an over the counter allergy medication and look for changes. - Sleep -- does she get a good night sleep? Enough hours of actual shut eye? Free and clear airways? Sleep in her room a few nights, and listen in to her breathing. A down allergy may well mean that she gets congested in the middle of the night and has a compromised sleep. That is easily resolved. - Food -- we cut most sweets for a while, and still have a big interdiction on food coloring (especially blue) and artificial flavorings. Kid simply goes kaboom on those, can't afford to let her eat that stuff. Now that she's bigger, we let her eat *some*, rarely, but only after she eats something solid -- a cheese stick, usually -- before. We also have fish a few times a week and avoid white starches. - Physical activities. School is extremely confining for an anxious 5-year old. Some good old fashion social time after school at the playground will do miracles -- as long as a solid snack comes along and bedtime is respected. Miracles -- both to release energy, and to release anxiety. Expect to be there and help guide interactions so that they stay positive -- all kids are tired at that time. Or, try ballet, yoga, soccer. We did drama ("let your dramatic voice stay there!"), ballet and swimming. And lots of outdoor playtime. TV is for weekend movie night only during the school year in our home. - Routines -- this is where all those parenting books come in. I'm disorganized (yeah, I, too, have ADHD), but have to make an effort to guide DD through some fairly rigid routines (come downstairs for breakfast *after* you are ready for school and have brushed your teeth). Some activities, we just pass on, if they impinge on sleep or regular hours. - Parent education -- "Raising your Spirited Child" and the companion "Parents, kids and power struggles", both excellent. In addition, "The explosive child" -- which opened our eyes that it was really not our parenting that was the problem, and that it was not behavioral.; 1-2-3 Magic! worked well, "How to talk so kids will listen". - If she is in a full day K or preK, go have lunch with them. See how she interacts with her peers, how she eats, figure out is there is a source of stress at school. Try to get her some accommodations for a short rest period in the afternoon -- even if she goes to the clinic or the office for some quiet time. With all those in place, by all means, do get a psychological evaluation, something that includes anxiety and depression evaluation. It may or may not translate in medication, but at least it will let you make an informed decision. In the end, taking medicine for about 6 months have allowed us to just see the light. We're scaling back (DD is a very efficient absorber of medicine, so her dose was small to begin with), but now we're working on completely weaning her off, and it seems to be working well. While you will hear a lot of folks complaining that medicine has not been tested on children, the fact is, it *has*. Just not in the long term, which is how folks tend to take it. Contrary to what you hear, if ADHD is your nemesis, you won;t necessarily need to chronically medicate. But you do need to break the cycle somehow, and medicine can help. You will not know until you talk to the pediatrician and ask for a referral to have some tests. Having attended to the envoironmental factors on your own, and read some of the parenting books above will lend you a bit more credibiliy when inevitably someone will raise an eyebrow and ask about *your* parenting skills. And while we all can stand to become better parents, I agree with those who pointed out that stress accumulated during the day explodes when she feels safe -- in front of you. She and you will be all right in the long time. |
Anonymous
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-Agree with a trip to a developmental pediatrician.
-Look into the Dan Shapiro lecture series about raising challenging children. -A consult with a psychologist may be helpful if s/he is plug into the Raising Your Spirited Child/Explosive Child theory and will do family therapy. I think play therapy at that age is a crock and serves only to put money in the psychologist's pocket. -Forget about a psychiatrist - they will only want to prescribe drugs and you are years away from considering that. |
Anonymous
| I guess the main point is -- don;t just go to a therapist to talk you all through a solution. Instead be proactive about the elements you can control at home, and ask for a thorough physical and psychological evaluation. |