Dear Therapist:

Hi. We'd like your guidance regarding a challenging aspect of our 15 year old son. Our son...[is]...intelligent, articulate, and good-looking. He's musical, writes incredible stories and has a sense of humor. The challenge: he doesn't know how to properly regulate frustration/unmet expectations/dealing with things he disagrees with. When he gets upset, he has no control over what he says. If something ticks him off, he'll rant and rave as though he has no "off button" to the topic. He can complain about the same issue for 45 min...He pulls down the mood of everyone near him. We've been speaking to him for about 2 years about self-control with emotions, yet he won't/can't do it. We've been trying to teach him to focus on appreciation...for all the good. We've been telling him that challenges are ...to help us grow. But once something ticks him off, it's a downward spiral until something breaks the mood which sometimes it can be a few hours later. Our question is, are you able to help us help him, or can you guide us in how to get him the help he needs? (Background: he's extremely limited in what he'll eat. He won't eat any chicken, meat, (except for hot-dogs), fish. He doesn't easily handle smells of strong smelling food that he doesn't like. Perhaps there's a sensory issue that is at play re: his emotions as well? And if so, can we help him or does he need professional help? This issue is primarily at home and not in school. Thank you for offering your help!

 

Response:

Someone who witnesses your son’s reactions to things that bother him may assume that he has an “anger management” issue, and that he has a rigid personality. However, you gave us more context with which to work. It sounds like your son may generally not be rigid, and that he only reacts angrily at specific times. This doesn’t necessarily mean that the issue isn’t related to personality, but it does give me a sense that there may be something else going on.

What we often think of as depression (sadness, lack of motivation, crying, etc.) is not always the way in which clinical depression is experienced. Often, feelings of depression manifest as anger—and specifically in kids. The possibility that your son may be somewhat depressed should not be discounted.

Some of the issues that you described may be related to obsessiveness. People with obsessive-compulsive disorder, for instance, can have trouble dealing with things that force them to change their viewpoint. Your son’s picky eating and issue with smells may point to obsessive tendencies as well.

Another possibility is that the symptoms that you describe may be medically-based. Thyroid issues have been known to cause emotional issues. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections) is a relatively newly recognized disorder (in terms of its acceptance within the medical community). Some of the symptoms seen in kids with PANDAS are: moodiness and irritability, ADHD symptoms, trouble sleeping, trouble focusing, anger, oppositionalism, and sensitivity to touch, sound, taste, and smell. There are other medical issues that might cause the symptoms that you mentioned (like some neurological disorders).

My recommendation is that you mention your concerns first to your son’s pediatrician so that he could make a determination as to whether bloodwork or further testing may be necessary to rule out a medical problem. Once this route has been exhausted (or concurrently), a therapist can help your son to better understand his emotions, and can help him deal with them in a more adaptive manner. Regardless of the actual “cause,” therapy is a good idea for anyone who experiences intense feelings and has trouble dealing with them on their own.

                                 

Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Brooklyn, NY   |   Far Rockaway, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317