Q My six-year-old son gets these anger attacks and his mind and reasoning completely shut down. These attacks last for 45 minutes to an hour and a quarter. They were shorter when he was younger, but the older he gets the stronger and longer they are. They last until he runs out of energy. He's kicking, biting, spitting, and scratching. This kid is super smart and asks questions appropriate for a 10 year old or older. He does not like to take orders and complains kids are always laughing at him, but in my opinion they are playing around.The trigger is either he's tired or refuses to take an order. I have to use force by pinning him on the floor or bed because he tries to hurt a parent or his sister. Two breakdowns ago he grasped a knife and I do not know if he was going to hurt himself or was going to hurt me. I never leave him alone on his outbreaks until he is back to normal.
When we see families with children who have extreme anger attacks at a young age, oftentimes the parents are feeling very overwhelmed and perplexed, so it is understandable if you are feeling that way. But I also want to say that it’s such a sign of strength in your family that you are able to describe your son’s gifts, like the fact that he’s really intelligent, and that you can observe his triggers. These two things— understanding the strengths your child brings to the table and being able to observe and reflect on family interactions — give you a really good start.
When it comes to handling anger attacks, for kids this young it can actually be more difficult to teach them coping skills than it is to teach their parents how to prompt and reinforce those coping skills over time. That’s why I’d recommend that you work with clinician who specializes in behavioral parent training.
Drawing on a cognitive-behavioral approach, this clinician can help you understand your son’s triggers, learn to notice and even anticipate when they occur, and change the things in the environment that either increase or decrease behaviors like anger attacks. Your clinician will also be able to give you useful strategies to help your son get through those tough moments. Your goals in treatment will be to decrease the length, frequency, and intensity of his anger attacks and to reinforce his ability to calm himself or deal with disappointment in a safer and healthier way.
Because it sounds like there are significant safety concerns in your house, it’s also important to seek treatment right away. In situations where safety is an issue, treatment is often more intensive, so ideally your clinician may be working with you more than once a week. In many cases, it can also be most helpful to be working simultaneously with both a clinician specializing in behavioral parent training and a child psychiatrist who can ensure close monitoring of any needed pharmacological treatment. Make sure that treatment is focused first on establishing safety in your home, especially around any anger attacks that might lead to physical conflict between parents and children or the endangerment of any family members. Once safety has been better established, then you can move through building those coping skills and promoting more positive family interactions.
For these kinds of evidence-based care, oftentimes the best places to start are with local colleges and universities. These schools often have mental health training programs, training hospitals, or clinics that offer lower cost treatment that is drawn from the most scientifically-sound approaches, and they are a wonderful resource.