Q My daughter is 5 and has been flying into a rage at the drop of a hat. She was always easily frustrated but now will lash out and it's getting scary. Like if she doesn't get a letter right she will scream, blame me, throw things and not stay in her room for times-outs. She is very sweet other times, and it's not predictable what will set her off. I saw a psychologist who suggested behavior modification — that is, ignore this behavior and flood attention to good behavior. This didn't work and she is getting worse. Do we see a neurologist? Psyschologist? She needs to talk to someone and often, I think. I just don't know where to begin and I am worried about her starting kindergarten.
What stands out to me about your daughter’s rages is the trigger. Flying off the handle if she doesn’t get a letter right suggests some kind of performance anxiety or rigid perfectionism, both of which are signs of underlying anxiety. It’s important to have your daughter assessed for an underlying anxiety disorder by a child psychologist or psychiatrist, as this may easily be causing her intense outbursts. Understanding the underlying cause of your daughter’s tantrums will be very important, as it will tell us what specific treatment she needs.
Ignoring tantrum behaviors and giving time outs are common parent management training skills that are effective in improving tantrums in situations in which children do not want to comply (such as starting homework). Given that your daughter’s tantrums appear to be caused by anxiety, and not defiance per se, I am not surprised to hear that parent training skills did not improve her outbursts, since it did not address her underlying issue.
If a diagnostic evaluation confirms that your daughter has an anxiety disorder, the best treatment for kids is a form of behavioral therapy called exposure with response prevention. That involves exposing her to the stressors that trigger her anxiety in a very gradual way in a safe environment until she learns to tolerate them without exhibiting temper outbursts. This treatment works best if parents are also trained, as coaches.
If her anxiety isn’t addressed it may continue to worsen, especially as she goes into school, and she will encounter anxiety-provoking triggers much more frequently.