In Part One of my series on ADHD and aggression we talked about some of the possible contributing factors to your child's aggressive outbursts. Some of these factors may include anxiety, an inability to deal with anger and frustration, impulsivity, sensory processing difficulties, and difficulty with understanding consequences. No matter the cause of your child's aggression most parents agree that they want to stop this behavior. A child who is aggressive will have great difficulty at school, making friends, and fitting into most social situations. This is a behavior you need to act upon quickly so that it does not escalate to the point where your child loses control and hurts someone.
The following are some suggestions of how to decrease aggressive behavior. Note: (Use discretion in how you use this information. What will work for one child may not work for another. Your child's age, diagnoses, temperament, and communication skills all play a huge factor in how to best help your child. What may work for decreasing aggression in a toddler may be very different for treating a six foot tall teen who feels rage and is acting upon that emotion. You always need to tailor your treatment plan for the unique needs of your child.)
1. Determine the conditions or settings where most of the aggressive behavior occurs.
In my previous post we talked about doing an A-B-C recording where you write down the antecedents-behaviors-and consequences for the aggressive behaviors you observe. It usually only takes a little bit of time to figure out some patterns of when your child acts out. For example you may find that your child shows more aggression during unstructured times at school such as recess or waiting for classes to begin. It may be a situation where these times need to be more controlled or structured for your child. In this instance your child could be paired with a buddy during these times, a peer who gets along with your child and can assist him or her with the schedule. Your child could be given a list of fun activities to complete during those times when there is less formal structure. The teacher could enlist your child as an aide to help with putting away equipment or setting up the classroom for the next lesson. There are many possibilities for keeping your child busy and occupied so that they don't have time to get into trouble.
2. Teach your child if-then strategies.
The A-B-C data you collect may also tell you something about your child's triggers for aggressive behavior. For example, your child may be more prone to act out when they feel frustrated that something is not working as they expect. You could teach your child that if something is broken or malfunctioning that this is a time to ask for help. Perhaps your child becomes aggressive when they feel criticized in some way. You could role play such a situation and brainstorm ways your child could respond without aggression. The key here is to list all your child's known triggers for aggressive behavior and teach alternate ways to handle the situation.
3. Teach your child how to identify their feelings and stress triggers.
Before your child acts out there may be warning signs with how they feel internally. A website for special needs children called do2Learn has many printable data sheets about emotions. I use their Emotional Check-In and Emotional Check-Out data sheets with my son so he can record how he is feeling. They also have self monitoring data sheets to help your child describe their level of anger and frustration which are nicely illustrated with either faces depicting emotions, a volcano, or a thermometer. The goal of these worksheets are to get your child to determine their stress triggers so that they can be aware of when they are escalating towards aggression or an explosive outburst.
4. Teach your child sensory integration and self calming techniques.
As I have talked about in previous posts, many children having ADHD or autism may also have a sensory integration disorder. In simple terms this means that your child may have difficulty regulating and processing incoming stimuli through their senses. This difficulty managing the bombardment of sights, sounds, textures, tastes and smells of a typical day may cause your child to feel overwhelmed, stressed, and more prone to aggression. Your child's teacher may be able to help by offering your child a break in a quiet room with no distractions when they become upset. Some children respond well to learning breathing techniques to learn to relax.
If your child becomes upset at home you can try using aromatherapy, swinging, soft music, and warm baths with Epsom salts. Create a "menu" of activities to calm your child for home and at school. Teach your child that when he or she gets upset that they may choose items from this menu to calm down.
5. Teach your child how to wait.
One of the hallmark symptoms of ADHD in children is impulsivity. The problem many children have who act out or become aggressive is that they lack the control to curb their impulses. I know with my own child, I have seen him escalate from zero to a hundred in what seems a heartbeat. The key is to catch them when they are just beginning to show warning signs of an impending outburst and to slow their response down. One way to elongate that time and create a stop-gap between your child's impulse and the actual behavior is to teach them to wait enough time so that they can assess their own warning signals and change course.
6. Help your child learn empathy.
One of the common challenges for children having special needs is being able to predict how others may feel or act. Empathy, the ability to feel what someone else may be feeling, can be difficult for anyone but particularly so for some children having ADHD or a related disorder. Some children have a hard time understanding their own emotions let alone the emotions of others. Teaching your child about empathy can help them to predict things like, "If I push this person in line they are likely to feel upset or angry." Then they may take it to the next level and be better apt to predict the person's behavior as in "If I push this person in line they may get angry and push me back." Empathy is another one of those critical life skills you want to teach early on.
7. Channel the aggression to other outlets.
There are numerous creative and physical outlets for a child who needs to expend physical and emotional energy. Pounding clay, running, jumping on a trampoline, or playing a sport may help divert negative energy into something they enjoy. The creative arts such as writing, music, or drama may also be ways for your child to explore their feelings and passions in a socially acceptable way.
8. Research medication choices to treat the symptoms underlying aggressive behavior.
I have saved this option for last and for good reason. You always want to use the least risky methods for changing behavior first. Why go the medication route if a behavior program works for your child? It is my personal opinion that the non-prescription techniques should be used first and then if you have exhausted these methods a thorough research of medication options may be in order. In some cases aggressive behavior has more of a biological cause than an environmental one. The underlying biological causes of aggression can include the symptoms of ADHD, anxiety, or a mood disorder. It makes sense that if you treat your child's psychiatric conditions, the aggressive behavior may decrease. We have a lot of information on ADHD Central about ADHD drugs which can decrease the symptoms of ADHD such as impulsivity.
I wrote recently about our experience with Risperda, a medication which has many uses, one of which is to treat the symptoms of irritability, aggression, and sudden mood changes in autistic children. The decision to medicate your child is a very serious one and cannot be taken lightly. Please read everything you can to understand the risks vs. benefits of using medication to decrease your child's aggressive behaviors.
We would like to hear from you now. Do you have a child who has shown aggressive behaviors? How do you cope? What works best in curbing your child's impulses towards aggression? Tell us your story. We greatly value your thoughts and opinions.