Behavior Problems/Rage Attacks
I specialize in child and teenage behavior problems that involve difficulties with transitions, following directions, frustration tolerance, unexpected changes in plan, and rigid thinking. At times, these difficulties can lead to episodes of anger that are called explosive outbursts or rage attacks. Rage attacks are particularly common in individuals who have Tourette Syndrome, ADHD, and/or OCD. There are a several different cognitive-behavioral (CBT) approaches that can be effective for the described behavioral difficulties. The two treatments that I tend to use are Parent Management Training and Collaborative Problem Solving.
Parent Management Training (PMT) involves weekly therapy sessions with one or multiple caregivers of a child with behavioral difficulties. Session time is spent training caregivers in various skills that are then applied at home. Core skills in PMT include how to successfully give directions, administer praise and rewards, effectively use time-outs, when to give attention versus when to ignore, and teach positive behaviors using small steps (shaping). Many parents who decide to try PMT have tried similar approaches in the past, either as part of their general parenting or as part of behavioral plans directed by well-intentioned psychotherapists. PMT tends to be more effective than other behavioral plans because it focuses on specific details that make strategies such as praise or time-outs effective. As parents learn how to use these strategies well, they will also understand why they did not work in the past.
Collaborative Problem Solving (CPS) is an ideal approach when explosive outbursts or rage attacks are a common occurrence. It is the behavioral treatment of choice when rewards programs and consequences have proven unsuccessful or when outbursts are clearly out of a child's control. CPS focuses on identifying lagging skills that cause outburst behaviors. For example, some children have a lagging skill in the area of flexible thinking; when something happens that is different from their expectation, they may quickly become upset. CPS teaches parents how to anticipate when outbursts are likely to occur and what causes them. Once problem areas are identified, CPS focuses on teaching both parents and children a specific style of communication that leads to mutually agreed-upon solutions. The approach is designed to lower the number of outbursts while teaching the child skills in the areas where they are lagging. The ability to teach the child needed skills while reducing family tension brought on by outbursts makes CPS a powerful treatment option.