Expert: Norm Bishop - 10/13/2009

Question
I need some advice or input about my son's behavior.  He has anger management issues...the slightest thing can set him off & he begins cursing, slamming, throwing whatever is in his reach.  He has always had a temper but he is at the age where he needs to learn to control it.  He is destroying property & just gets so mad.  He does not do this at school & I have never had any bad comments from his teachers except that he does not speak up enough in class...he is on the shy side & I think lacks self-confidence in some ways.  I was always that way too & still am & would like to get him help for that.  He started out in elementary school doing very well but his grades have been sliding.  Sometimes he seems to have a hard time concentrating...he has made comments to me about classmates being too loud.  He has a hard time sitting down & watching a movie all the way through.  There are a few that hold his interest.  Since he was a young child the short movies that did hold his interest were more reality shows about construction equipment, big trucks, etc.  He does not get out of line at school as far as not being able to stay in his seat so I feel like it is not ADHD.  I have noticed in the car when a friend is talking to him & it is not something that interests him he just kind of ignores it & rudely changes the subject.  He is basically a good child but I am worried that there is a problem.  I have recently taken him to an adolescent behavioral psychologist but would like other opinions.  Could it be ADD or is it just that he needs to learn to control his anger & what if he can't?  I do have to say that depression & anxiety does run in my family very prominently & there is history of bad temperament.  I just need some advice, suggestions, whatever you have to offer.  I love my son very much & just want to do what is right for him & get the situation under control before he loses it in the wrong place & really gets into some trouble.  Thank you.

Answer
There are two types of Attention Deficit Disorder and all persons who have an ADD or ADHD problem are unique within those two types.  ADD with Hyperactivity, ADHD, is what people typically think.  However, most are not ADHD, rather, ADD, which is an attention problem, not necessarily a behavioral or over activity problem.  The attention problems are with such things as not being able to concentrate for long periods of time, being easily distracted, needing to change activities often, impulsivity, etc.  It sounds like that could be part of your son's problem, however, it takes a physician to make that diagnosis.  

The explosive behavior at home is probably reactive...in that, he holds his behavior in check everywhere he is, then relaxes the guards at home, and lets you have it.  You are correct in that he needs to learn to control the behavior.  

So, what can you do?  I would suggest that you open lines of communication around the explosive home behavior.  The more you and your son can discuss what makes him so explosive, the better both of you will understand its root causes.  You can avoid those things he tells you that set him off, he can understand why you need to do some of those things.  If it gets more severe, then you and he might do well with some counseling together (with a good counselor who understands adolescents#.  You have taken a good step in seeing the Adolescent Behavior Psychologist and I would trust that direction for determining whether or not ADD is part of the problem.  About half of the kids who take stimulant medication gain no observable change from it, so you want to make sure it is of benefit before you use it.  There are some side effects.

In the meantime, the biggest cause of this type of behavior seems to be sleep patterns.  Make sure you son gets a full nights sleep, 8 hours minimum and that he gets into what is called REM stage.  Deviations of less than 8 hours including deep sleep have huge impacts on behavior.  At this point, just observe...what time does he go to bed, how long does he sleep, does he get up during the night, does he sleep really late if allowed, what does the bedding look like after a nights sleep #thrashing about can indicate a problem)...and anything else abnormal.

That is where I would start...if you have further questions, don't hesitate.

Norm