Survival Strategies

If you are having trouble with rages, check out our page on coping with rages.

While Waiting for Assessment

Change Your Mind Set

• Parents need to recognize that their struggling child is vulnerable and fragile.
• Offer compassion and realize that your child is walking around with a gaping, oozing wound, that no one can see.
• Be supportive. You don’t have to approve of your child’s behaviour. Simply disapprove, with support (i.e. “You seem to be very frustrated. Taking your frustration out on your baby sister is inappropriate, let’s think together how you could have dealt with your frustration differently”).

Set Realistic Expectations

• Until treatment has had an effect, you may have to tolerate behaviour from your child, that you normally would not allow. However, you must still keep in mind, the safety of your child and others.
• Realistic expectations mean that you may have to compromise and lower your expectations (i.e. if your child’s grades drop, you may have to accept it for the time being). Make sure you communicate these new expectations clearly to your child.

Establish Routine

• Remember that you are the parent in charge, so discipline and limit setting are still your responsibility and very important to the well being of your child and family.
• Establish routine, structure and consistency. This provides predictability in the child’s life, which helps to reduce their stress.
• Schedule regular weekly ‘dates’ with your child. They will be able to count on your undivided attention at these times. This time together is on the child’s terms with him/her choosing the activity. Consider having these dates away from home to avoid the usual distractions.

Understand ‘Triggers’ to Transitions and Rages

Understand what day to day ‘triggers’ provoke your child’s rages. Try to avoid these situations.

Transitions or Change as a cause of rages

• Realize that transitions can be any shift from one activity to the next. This change can cause instability for the child.
  • It helps to anticipate the transitions or changes and prepare your child for them (i.e. 5 minute warning).
  • Build in extra time for shifts between activities or locations. This will avoid rushing such routines as going to school, mealtimes, and bedtime.
  • Identify the triggers of your child’s rages such as: fatigue, a sequence of disappointments and too many options that overwhelm the child.
• Try to identify the early warning signs of your child’s rages (i.e. facial expression, hand movement).
• Attempt to ward them off with distraction (i.e. talk about that day’s activities, change the scene or activity, food, removal, art activities such as drawing or modeling clay and down time).
• Stay calm! The more agitated the child becomes, the calmer you need to be. Parents and other responsible adults who deal with the child, need to designate a person who handles this situation the best. This person needs to be able to remain calm when faced with intense emotion from the child.
• Refuse to get angry. This is difficult and sometimes impossible, you need to consciously train yourself to remain composed. Understand that the child will make every effort to get you angry. An angry adult who projects the same intense emotion that the child is feeling, satisfies a hidden need within the child. Children try to get adults to react with the same emotion they are feeling inside.

During Therapy

• Some children will respond favourably to counselling/psychotherapy alone, but many children need appropriate counselling AND medication for the optimal response. It may take some time and a number of trials to pick out the right medication and optimal therapeutic dose for each child.
• Once your child is responding to treatment, you may see a remarkable, favourable change. Some behaviours and traits will diminish. You may find that regular parenting skills are effective again (i.e. negotiation, logical consequences, problem solving and encouragement).
• Assess what behaviours or issues are left after treatment and deal with those, one at a time.

Provide Focussed Assistance During Transition Phases

• Children will often need a period of time where they can catch up on developmental tasks they missed in terms of behaviour, emotions, academics and social skills.
• Your child needs time to reconnect with his/her friends.
• Specialized tutors may be useful to help your child complete his/her school work and to catch up on work he/she missed.
• Schools that specialize in your child’s problem may be of assistance. There is an advantage to reintegrating the child into a familiar school environment (i.e. same school). You may also need an environment with specialized help. Do not change schools before consulting with your child’s therapist.

Concrete Approaches to Try

• Many counsellors use the behaviour modification model (reinforcement to encourage positive behaviour).
• Behaviour modification properly managed and negotiated with the child is a concrete approach that is effective when other methods fail.
• The counsellors will be able to guide you through negotiation with your child.

Other Approaches To Try

• Completely avoid engaging in power struggles.
• Offer limited choices where choices exist. “Would you like a ham sandwich or a cheese sandwich?” versus “What would you like for lunch?”
• Tell your child what you will do, instead of telling him/her what to do. “I’ll be waiting for you in the car.”
• Reframe by mentally stepping out of the picture and ask yourself “What does this child need most right now?” (i.e. Perhaps some understanding).
• Reflect back how the child is feeling. Help him/her name the emotion. “You look very angry (sad, frustrated, worried, scared, nervous).” or “I think if I were you, I’d be feeling ________.”
• Find something that they are good at or are interested in and pursue it. This may be achieved by removing roadblocks and helping them overcome obstacles in order to be successful in a chosen activity.
• If it helps, try physical touch such as hugs and foot or back massages.
• Encourage regular physical exercise of any kind.
• Summer camp is a great experience for some children.
• Make use of a cool down time “What is something you could do that will make you feel better?” “How about you go and take a bath and then see how you feel.” Establish this before hand at a friendly time then remind the child of what may help.

The Rest of the Family

• Family counselling is often needed because siblings and parents need help coping with the child’s behaviour.
• Make sure that you don’t get overwhelmed with the struggling child. Remember that siblings need nurturing and attention as well.
• Find one other person other than your spouse who can cope effectively with your child. Talk with them and see if they could spend time with your child, so that you can have a break or time alone with your partner or other children.
• Access and accept as many resources as you can for help and assistance.

Reviewed by M. Kodsi, M.D., Child and Family Psychiatrist.