Temper Tantrums and Meltdowns: AMA On Anxiety and Anger in Kids with Child Anxiety Specialist Kelsey Torgerson, LCSW

Kelsey Torgerson, MSW, LCSW
May 29, 2018

You don't know how to help your kid anymore...

When your phone rings, you get a sick feeling in the bottom of your stomach because you know it's their school, calling yet again. Whenever you try to help your kid calm down, they get defensive and blame you. 

That anger could be masking something.

And it's not that you're a terrible parent (no matter what that little voice in your head is saying!) 

Usually, those angry outbursts happen when your kid is overwhelmed, stressed out, and anxious. 

I'm Kelsey, and I help parents with angry, anxious kids in St. Louis, MO.

And for this AMA, I'm happy to answer any questions you have on temper tantrums, meltdowns, and anger management for kids.

Helpful Links:

Compassionate Counseling St. Louis

Instagram - CounselingWithKelsey

Facebook

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How does one go about choosing a therapist for their child?
Jun 4, 11:46AM EDT0

Hey Natalliakvitovska, this is a great question. The most important thing is to find a therapist who is a good fit, and ideally someone who specializes in what you're looking for. As an anxiety and anger management specialist, I love helping with anything related to stress - but I also know I don't love working with adults, and am not as effective at working with major depressive disorder, so I refer people to other therapists when this comes up. If a therapist says they work with everything, to me that sounds like they specialize in nothing - but that's just my take!

I typically recommend parents start with google or psychology today to see who comes up for child therapy in their area. Read a couple websites or bios, and then call or email a few therapists who seem like good options. Usually you can tell from an intake call if someone could be a good fit for your child, but you can always meet for a few sessions before deciding to go in a different direction.

I would also encourage parents to look out of network, if that's an option financially, so that they're not restricted in finding a great counselor. Many therapists in private practice, myself included, don't take insurance but do help you submit a receipt to get partial reimbursement from your company:  Using Insurance

Finally, you want someone who is open to your feedback and quick to answer questions - so make sure you figure out what you can before coming into an appointment during that intake call. 

Hope this helps! More info on my approach can be found on my bio page (a great place to look on other therapist website as well!): About Kelsey

Best,

Kelsey

Jun 5, 12:52PM EDT0
What are the questions you make sure to ask the parents to understand the home situation of a child?
Jun 4, 8:15AM EDT0

Hey Vicbellera, I always have parents fill out an intake form asking them about what's bringing them in for counseling, past histories, and family dynamics. Usually parents are pretty upfront if something going on at home is part of the reason why they're seeking counseling. 

When dealing with anger or anxiety management, it's really important for me to assess for any past trauma or abuse going on at home. If there are concerns about this, I try to keep questions really simple with the child, and I want to emphasize that lots of kids experience this.

More info can be found on this right here: Trauma-Focused Therapy

Thanks for asking!

Kelsey

Jun 5, 12:45PM EDT0
What is the best way to deal with disobedient children without being aggressive or doing any harm to their psyche?
Jun 3, 8:05PM EDT0

Hi John, while some parents do spank their children or use other forms of corporal punishment, I tend to recommend against it. It's much more impactful to utilize consequences tailored to the behavior and demonstrate the kidn of response you want to see in your child - so, rather than hitting your child because they hit another kid, you demonstrate calm and compassion while making them write an apology letter following their brief time out. 

Consequences should be logical, and they should be clear from the get go. I recommend utilizing an approach from Parent-Child Interaction Therapy. Give the request in clear terms, wait five seconds, and then say, "So-and-so, I asked you to ___. If you don't ___, you will have (this logical consequence)."

Waiting another five seconds for compliance, "Ok, so-and-so, you've chosen not to follow my direction. Now we'll (consequence)." 

Even if your child scrambles to then follow your request, you gave them two warnings, and it's important to follow through on the consequence when you say you will. Calm, clear, and concise - this is the best way to deal with disobedient children and help shape compliance.

Thanks for asking!

Kelsey

compassionatecounselingstl.com

Jun 5, 12:39PM EDT0
How should parents handle a child's anger issues that developed over his parents' separation?
Jun 3, 6:13PM EDT0

Hi F Carmona, this is a pretty common response! It definitely depends on the age, so I'm attaching a pdf with a few suggestions right here!

Generally, I recommend empathy and understanding above all else, while still making sure to set and hold your limits. Just because they're upset doesn't mean they should get their way, but maintain your own sense of calm while they're upset. And, spending lots of one-on-one time can be a big help as well.

Best,

Kelsey

Last edited @ Jun 4, 4:57PM EDT.
Jun 4, 4:52PM EDT0
What are your thoughts about parents who compare one child with another all the time? Does comparing siblings have an effect on the child?
May 30, 5:13AM EDT0

Hey Ann, thanks for asking! This can be pretty common, especially when one chid is seen as the "problem child" in my practice, with anxious outbursts, temper tantrums, fits, etc. and the sibling isn't experiencing anxiety at the same level. It's tough for parents, teachers, just adults in general not to compare. 

It has an effect on their child, though, when this comparison is brought up a lot in front of the kids. Questions like, "Why can't you act like your brother?" or "Your sister is calm - can't you calm down, too?" force a lot of unhealthy comparisons. Kids and teens can internalize this language, and it can really do a number on their self-confidence. Some kids might act out more after these comparisons, because it triggers more anxiety, sadness, and frustration.

If a parent catches themselves making regular negative comparisons, it can be fixed! Make sure to follow up any comparison with a few specific, positive praises later in the day. You want to aim for a 5 to 1 ratio of positive actions and words to every negative. You can read more about this Gottman couples counseling concept right here: More On the 5:1 Ratio

Hope this helps!

Kelsey

May 30, 9:37AM EDT0
Do kids with anxiety problems get medications just like adults?
May 30, 12:16AM EDT0

Hey Rhizzsy, I get asked this a lot as an anxiety specialist! Medication is always an option, but they great thing about anxiety is that it responds really well to just therapy. I tend to encourage parents to get an assessment from their pediatrician or a child psychiatrist if that anxiety is really getting in the way of functioning at home or at school. The medication used is the same as what we use for adults, just at a much smaller dosage - and typically, that dosage is increased as they get older, if it's needed. 

Sometimes, a combination of medication and counseling helps kids actually use the relaxation skills we practicre in session, and then parents with help from the psychiatrist can try weaning their child off of medication while continuing therapy with me.

Hope this helps! More info right here: Treating Anxiety Without Medication

Best,

Kelsey

May 30, 9:32AM EDT0
Is the middle child syndrome true? Are there really issues attached to being the middle child?
May 29, 11:29PM EDT0

Hi Jaustria, great question! I don't do a ton with birth order stuff, though I know other therapists can be really into it. I tend to take each child on a case by case basis. Sometimes, it does seem like the middle child gets less attention on both sides and feels stuck in the middle. Other times, you'll see this behavior with the oldest, or with the youngest. 

More important than birth order is parenting, and how parents approach each child in a sibling unit. So as long as parents are aware and recognize that they might be giving preferential treatment to the oldest or youngest, they can work to course correct!

Best,

Kelsey

May 30, 9:30AM EDT0
What’s most challenging about being a therapist for kids?
May 29, 9:59PM EDT0

Hey Nunnally, I love being a child therapist, though I know a lot of other counselors won't work with kids. It can be challenging compared to talk therapy with adults, since you have to keep it interesting - we're not just going to sit on a couch and talk, we're going to use art and play and storytelling and games to teach the skills we need. I really love having 10 things going at the same time, so for me it's a good fit!

Something that is challenging is working with the whole family and school system. Sometimes the kids I work with and I talk about what's inside our control and outside our control, and there's a lot outside of a kid's control. They can't change their brother being mean, or their parent being strict, or their teacher being rude - they just have to figure out how to get through it.

Thanks for asking!

Kelsey

May 30, 9:28AM EDT0
How would you know if a child is “just being a child” versus one who already has temper and tantrum problems?
May 29, 5:20PM EDT0

Hey Ae Elnar, this is a great question. Parents often ask, "Is this part of just being a kid? Am I overreacting?" and yes, of course, there could be that possibility. But I would say, more often than not, if youwatch your child compared to other kids and feel like they're temper tantrums are larger, more frequent, or harder to come down from than their peers, there might be an anger management problem.

That's why I really recommend parents seek out a therapist who works with young children and, ideally, specializes in anxiety/anger management, to assess and see if there are other concerns besides just losing their temper. And, if a parent ever feels like they don't know what to do to help their child calm down, I would encourage them to reach out to a counselor - even if it turns out that their kid is just "being a kid," it's so helpful to know what to do.

Hope this helps! (And, this might be useful as well! Child Stress Responses)

Best,

Kelsey

May 29, 7:07PM EDT0

Hi Kelsey. You specifically mention anger issues, but do parents bring their children to you for issues such as lack of confidence and difficulties in socialising?

May 29, 2:31PM EDT0

Hi Patrick! Kids come in for a lot of different reasons, and as an anxiety specialist I definitely work with that whole range of anxious reactions. A lot of times, though, parents don't realize that they kid they're bringing in for "anger management" is experiencing just as much anxiety as the socially withdrawn child.

With confidence issues and social anxiety, we'll also focus on a lot of relaxation skills building. Plus, having one-on-one time in session with me, children who have difficulties socializing will have a ton of time working on that social piece, and we take turns modeling appropriate and inappropriate social behaviors. Once kids become more comfortable with, say, making eye contact with me, it's a lot easier to take that skill to the playground.

Thanks!

Kelsey

May 29, 4:55PM EDT1
Do you also offer therapy for parents who have problems with their kids?
May 29, 10:35AM EDT0

Hey January, thanks for asking! I only work with kids, teens, and college students, so I have a lot of therapists I've met with who specialize in working with adults and parents. Depending on what's going on and what goals are for counseling, I give parents two or three options tailored to them if they're looking for their own therapist. Always happy to consult and see what recommendations I have - and sometimes, it can be really helpful for the kid to be in counseling at the same time.

However, I do set up my session times to spend the first 10/15 minutes one-on-one with the parent, and the remaining session time one-on-one with the kid. Sessions are 45-50 minutes on a weekly basis, so I have a lot of time to talk with the parent and provide some coaching. There are also lots of tools to use at home to help, including a few here: Tips to Build a Better Relationship With Your Teen

Thanks for reaching out!

Kelsey

Last edited @ May 29, 2:31PM EDT.
May 29, 12:23PM EDT0
Some child therapist are comfortable addressing the immediate problem, while others want to focus on the deeper issue. Which are you?
May 20, 12:59PM EDT0

Hey Kathleen, thanks for asking! This largely depends on why a person is coming in for counseling, and how long we have together. I like to let kids and parents take the lead on why we're meeting - has something just occurred at school, or is this a pattern of behavior we've been seeing for awhile. 

I will say, some therapists who work with young chilren really like to dig into parenting styles, family therapy, or other family histories. I focus more on the child as an individual while still giving parents tools to help out, and end up spending the majority of session time one-on-one with the kid to help them build a relationship with me. Any helpful info I have I'll then pass to the parent, since I want to make sure they're leaving with relaxation skills even after just our first session.

More info on my approach with younger kids can be found right here: Therapy for Young Kids

Best,

Kelsey

May 22, 4:00PM EDT0
From your perspective, what exactly constitutes anger management in kids?
May 20, 9:53AM EDT0

Hi Roma-Kaya, anger management means helping kids find the tools needed to manage their anxiety, frustration, and temper. I typically utilize CBT to help kids figure out how their thoughts impact their feelings, how their feelings lead to different behaviors, and how they can change that cycle.

Frequently, children aren't aware that they have "hot thoughts" that make them more angry, or that they can calm down with "cool thoughts."

Let's say they walk into the cafeteria and a table full of kids start laughing. They might have a hot thought pop into their head, like, "I can't believe those kids are laughing at me!" That thought would lead to them feeling more angry, and they might storm up to the table and start yelling.

But what if, instead of assuming those kids were laughing, they told themselves, "Maybe they're laughing at me, maybe they're laughing at something else." That would make them feel more calm, maybe even curious. And they could then walk up to the table and ask what's funny, or go on with their day.

Kids often don't realize they have so much power over their reactions (ha actually, a lot of grown ups don't realize this, either!), which is why anger management can be so helpful - and why I love specializing in childhood anger/anxiety management. Specialty: Kids Who Get Angry

Best,

Kelsey

May 22, 3:54PM EDT0
How differently does anxiety manifest itself in girls versus boys? What accounts for such differences?
May 20, 7:33AM EDT0

Hey Marinaperin, based on my experience, I often see more boys with anxiety brought in for "anger management" than girls, though both boys and girls can express their anxiety in this way. Speaking in very broad strokes, a lot of times girls are very quickly corrected for temper tantrums, and boys are usually permitted to a little more.

A lot of times, the way we show our anxiety is based on what is modeled for us, so for kids who experience anxiety and have anxious parents, they might model how their parent expresses that anxiety. Your dad yells? You probably will, too. Your mom gets really tearful? That might be more likely for you.

Of course, sometimes boys and girls are brought in because their anxiety is so different than how their parents express it. More info on that right here: Is Your Child Anxious, or Just Bratty?

Best,

Kelsey

May 22, 2:54PM EDT0
Anxiety is the most common disorder among young people, even more than ADHD and depression. Do we know why it is so common? Is it more prevalent in more recent generations and if so, why?
May 20, 7:05AM EDT0

Hey Ceome, great question!

When I talk with parents about anxiety, I explain there are two components: biological and environmental. The outside stressors of school expectations, homework, and tests significantly impact any anxiety that is already there on a neurological level.

Stress has lead to an increase in anxiety concerns for children, but not all anxiety disorders are caused by stress alone. Really, we conceptualize this as predisposition plus stressors (the "diathesis-stress model"). 

Imagine a line graph that dramatically slopes upward. The farther along the line you start, the likelier you are to be pushed upwards towards an anxiety disorder. So, while there are probably the same amount of children who are predisposed to anxiety disorders as before, the increase in stress for all children means that more and more anxiety disorders are being diagnosed, because more and more children are pushed up the slope towards this mental illness.

Best,

Kelsey

May 22, 11:01AM EDT0
How can a parent prepare his/her teen for his/her first session? What information is good to share with them if they are worried or reluctant?
May 20, 5:47AM EDT0

Hi Apam, you're not the only one worried about this  - Noor12 below had a similar question! Coping from below:

I see this come up more for teens, especially for teenagers who don't have many friends already in counseling. So on the parent side, I recommend just telling your teen (or hesitant child) that counseling is something a lot of people do, and it's usually just an opportunity to build tools and get stuff of their chest. I would also encourage parents to use the "eat your vegetables" rule - try it out for one or two sessions, and then your teen gets to decide from there.

It's also helpful to review confidentiality, and how the therapist will keep information private unless it's info about hurting themselves, hurting someone else, or someone hurting them. Otherwise, the specifics will say private (that way, your teen feels comfortable telling me how much they dislike your parenting style without being worried that I'll go and tell on them, AND I have an opportunity to help them process this while giving you separate parenting suggestions on our end).

More info on what sessions look like can be found right here: What Is Counseling Like?

It's also important to let them know that counseling is a process, so it might take a few times for that therapist to feel like a good fit - but, if that therapist doesn't feel like they're super helpful, maybe they should try meeting with someone else to see if that works better. That therapeutic fit is crucial.

Best,

Kelsey

May 22, 10:58AM EDT0
How effective are cognitive behavioural therapy and medications for child anxiety treatment?
May 20, 3:47AM EDT0

Hey Bharatisarkar, one of the reasons I love working with anxiety is because it responds so well to cognitive-behavioral treatment. Depending on the severity of the anxiety, medication might be recommended as well. Most pediatricians and child psychiatrists recommend trying just counseling first, and then re-evaluating to see if medication is needed in addition to the counseling.

It's always on a case by case basis, so it's important to check in with your pediatrician! And, I would also recommend meeting with more than one counselor if you feel like you haven't found the right fit. That counseling relationship is even more important than the type of therapy being used. 

I use Feedback Informed Treatment in counseling to help track that relationship, and you can read more right here: Symptom Reduction or Well-being: What Outcome should Matter Most in Psychotherapy

Best,

Kelsey

May 22, 10:55AM EDT0
If parents mention therapy, it might hurt their child’s self-esteem and make them even more anxious. How should one go about it?
May 20, 2:41AM EDT0

Hey Noor12, this is a great question! Some kids are a little embarrassed to have to go to therapy, but nine times out of ten they become more comfortable with it after the initial session. On top of that, in my professional experience, younger children are super excited to go to counseling because they view it as an opportunity to play and hang out one-on-one with a safe grown up, and through counseling they learn the skills and tools needed to help manage their anxiety.

I see this come up more for teens, especially for teenagers who don't have many friends already in counseling. So on the parent side, I recommend just telling your teen (or hesitant child) that counseling is something a lot of people do, and it's usually just an opportunity to build tools and get stuff of their chest. I would also encourage parents to use the "eat your vegetables" rule - try it out for one or two sessions, and then your teen gets to decide from there.

It's also helpful to review confidentiality, and how the therapist will keep information private unless it's info about hurting themselves, hurting someone else, or someone hurting them. Otherwise, the specifics will say private (that way, your teen feels comfortable telling me how much they dislike your parenting style without being worried that I'll go and tell on them, AND I have an opportunity to help them process this while giving you separate parenting suggestions on our end).

More info on what sessions look like can be found right here: What Is Counseling Like?

Best,

Kelsey

May 22, 10:52AM EDT0
Are there positive trends in child rearing and the way kids are being thought about and worked with by parents? How important is parent's role in dealing with the personal issues?
May 20, 12:56AM EDT0

Hi Kamaa, in my experience, parents today are a lot more willing to take their child to counseling than before, and are more open to proactive counseling approaches rather than reactive (so, helping your child build skills before they need them).

Parents play a huge role when it comes to their child's emotional regulation and mental health, and can really help their children by effectively modeling healthy coping skills and emotional regulation. 

This blog post might shed some more light on how parents can help their children with personal issues: How to Help Your Child Be OK With Failure

Best,

Kelsey

May 22, 10:46AM EDT0
Earlier they said that kids’ behavior problems could be traced to problems in the parents’ marriage. What do you think of that now?
May 20, 12:14AM EDT0

Hey Joshua, parents definitely have a huge role in their child's behaviors, but there are a lot of other factors as well. If a couple consistently fights in front of their child, argues, or gives the other partner the silent treatment, kids quickly pick up on that. It might cause the child some stress, and then that stress can come out a few different ways - such as sadness, anxiety, or anger, which can all lead to different behaviors.

I would recommend that parents who are concerned about how their marriage might be effecting their child's behaviors reach out to a child therapist, to get a second opinion. The behaviors might be stemming from something totally unrelated, so it's always good to check with a professional.

Hope this helps!

Kelsey

May 21, 2:50PM EDT0
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