RAGE 4 TAKING ON RAGE: PREPARE A PLAN

Rage/Neurologicallygifted.com

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

Rage/Neurologicallygifted.com

Rage tends to make family members feel hopeless and out of control.  We began our discussion in Neurologically Gifted’s article, Rage 1:  About Rage.  Preparing a plan to deal with rage in the home puts an end to those feelings of hopelessness.  With a predetermined plan, you will have responses and strategies that you and your family can rely on.  You will now have something you can do about it.

When preparing to take on rage in our home, we stepped back to observe carefully what was happening.  We watched for triggers for our son’s rage, how it occurred, and how we responded.  In doing so, we were able to uncover our own (ineffective) default behaviours.  (See Neurologically Gifted’s Article:  Rage 2:  Look, Listen and Focus)  Once we had identified the behaviours in our family (rage, triggers and responses), we sat down with our son to discuss those patterns.  We openly and honestly discussed our feelings.  With care and support, we helped our son explore what he felt before, during and after a rage episode.  We made it clear to him that this was a family problem and that as a family we could find solutions and improve our situation.  (See Neurologically Gifted’s Article:  Rage 3:  Talk About Rage)  With this critical step completed, it was time to for us to make a family plan to get control over rage in our home.

Make House Rules

Make rules with your child.  Ask them what rules they think should be included.  Prompt them by letting them know that the rules will apply to everyone in the family.  Ask them how they would NOT want to be treated by others.  Ask if there are things they would like to change by making a rule.  Discuss with your child why the rule is important and the natural consequences of non-compliance to the rule.

Guide your child through the rule making process.  Keep rules simple and concise for easy recall.

Do not over-burden the process with too many rules.  Choose your battles, picking only rules that apply to your greatest challenges. Over time, your child will become better able to self-regulate their emotions and responses.  As your family begins to experience progress, you will be able to change your focus and rules to address other priorities.

Keep rules obtainable and focus on safety.  For example, a rule prohibiting swearing is not realistic for a child with coprolalia.  A rule prohibiting anger or frustration isn’t appropriate either as we all have feelings.  In such a case, the family rule could outline acceptable ways (and places) to express anger and frustration.   You want your child to be successful, gain confidence and learn to apply skills for managing their emotions throughout this process.

Keep copies close by for quick reference.  Having the rules posted in their personal space will allow the child time to review expected behaviours and natural consequences of prior behaviours.  In our home, we placed a copy in our son’s bedroom, and referred to them at bedtime when we debriefed the day’s successes and challenges.

When referring to the rules:  Give kind and gentle reminders.  Reminders could include what the family (including the child) agreed would promote a safer and more peaceful environment.  Referencing the rules on paper takes the blame/authority away from the offender/enforcer and places it on the family rules.  A child is less likely to express anger towards a predetermined rule, rather than to being told to stop what they are doing by a parent.   Avoid trying to catch your child breaking the rules or to use the rules in a punitive manner.  You are attempting to use the rules to guide them in a predetermined way to modify/control their rage, not to punish them.

RAGE 4 TAKING ON RAGE: PREPARE A PLAN

The Plan

Make a plan for what will happen when the child (or any other family member), is unable to comply with the rules.  The rules clearly set out the expectations for behaviour and the plan will clearly state the consequences that will follow non-compliance.  Consequences must be consistent, fair, logical and natural.  For example, if a child is acting in a threatening manner, they must go to their room, (or other predetermined safe area) so the family members will be kept safe.

Again, involve your child in this discussion and try to have them help to come up with ideas for helping them regulate their own behaviour.  We found that our son had great ideas for how we could help him regain control, or how we could take control for him when he was unable.  When you are making the plan with your child, try to put yourselves in the moment.  Ask your child,  “What would you do if this happened?”  “What do you think you would do next?”  “How could we help you in this step of the rage?”  Our son was excellent at imagining the scenarios for us.

The plan should consist of step-by-step interventions with increasing increments of taking control for your child.  Each step will provide your child with an opportunity to succeed in regaining control.  For example, our first step was a friendly reminder about the undesired behaviour using positive language.  (see Neurologically Gifted’s article:  Using Positive Language for Success)  “You need to speak in a calm and kind way to everyone in our family.”  If the child cannot regain control with the reminder, then the next step of the plan would be used and so on.  Our next step was to ask our son to remove himself from the situation.  This allowed him an opportunity to be successful by being able to continue his behaviour but doing it someplace else.  The final step of the plan would be used only if the child, given each opportunity, could not regain control by themselves.  In the last step the parent would take control for the child. “Nathan, if you cannot take yourself to your room to calm down (and be safe), I will need to take you there.” Remember:  This is for helping, not punishing.  It is done with care not anger.

Our Plan for Rage

With our help, our son guided us through what the steps of the plan would be. First we would give a friendly warning using positive language.  Next, we offered a suggestion to leave the room and take some space.  If necessary, the next step would be the instruction to go to his room.  The toughest part of our original plan would be getting him to his room.  At this point he told us we would need to take him to his room if he didn’t go on his own.  I’m fortunate that as a special education teacher who specializes in challenging behaviours, I have training in using physical restraint.  I DO NOT recommend anyone restrain a child without training.  The training not only teaches you to calm your child (to prevent the need for restraint), it also teaches you to stay calm in the face of calamity as well.  It’s important to understand how and when to restrain someone who is in a fit of rage.  In addition, it teaches you how to safely restrain without causing injury to the child.  It is far too easy for a grown up to use their strength advantage over a child, and injure them.  It also helps you stay in emotional control, preventing you from acting out of anger. So, in our case, I would physically take him to his room.  We also discussed a plan for when only his mom was home and he needed to be physically taken to his room.  In this case, we made it clear that for safety, mom would need to call for help – even if that meant calling 911.  He also suggested that he might not stay in his room, so we problem solved for a lock on his door to keep him inside.  Together we made a trip to the police station to discuss our plan of helping our son regain control, to stay safe, and to keep our family safe.  Involving him in every part of the plan was essential.  Together we set his room up so that upon entering the room, there were comforting items within his sight.  We removed everything that could be dangerous.  We provided soft balls for throwing and devoted a drawer in his dresser for calming stress-reducing toys.  With those calming toys, we discussed how Nathan could use these things to redirect his anger (like punching his pillow or mattress and hugging his stuffed toys).

By the end of making the plan, our son knew exactly what would be happening if he lost control to rage and that knowledge made him feel safe.  Having a clear understanding of our process eliminated unpredictability, and made our son feel safer.  We signed, witnessed and distributed copies throughout the house.  Signing the rules together, we reinforced the commitment to a family effort to help keep our home safe.

For more on rage from Neurologically Gifted:

Rage 1:  About Rage

Rage 2:  Look, Listen and Focus

Rage 3:  Talk About Rage

Coprolalia Part 3: Taking Action on Coprolalia

Coprolalia Part 3: Taking Action on Coprolalia

Coprolalia can be a particularly distressing symptom and a lifelong struggle for an individual with Tourette Syndrome.  Stigmatization, shame and isolation must be reduced by the efforts of the individual, their families, their community and society.  Strategies to manage coprolalia will target improving the acceptance and understanding of this difficult symptom which will in turn reduce the frequency and the intensity of it’s expression.

Understanding the nature of coprolalia is essential to understanding strategies for the management of coprolalia.  (Please see Coprolalia Part 1:  The Nature of Coprolalia and Coprolalia Part 2:  Coping With Coprolalia)

Here are some strategies that take action on coprolalia to reduce it’s impact on well-being.

Use positive language

Planned ignoring of coprolalia is not just ignoring the symptom altogether especially if the behaviour is having a negative or harmful impact on the individual or other members of the family.  Be sure to define what negative or harmful impact means for your family.  An individual can contribute to the family’s well being whilst consistently ticcing “F**k, f**k”.  It is not harmful just because you or someone else does not  particularly want to hear it.  In fact, a tic as harmless as this example may actually be helpful in directing the individual’s attention away from more harmful forms of coprolalia.  When helping to redirect behaviours that are harmful or have  negative impact, use positive language at all times.  (See Neurologically Gifted’s article:  Using Positive Language for Success – coming soon).  If coprolalia is loud enough or involves another person you can use positive language to help modify the behaviour or make it less hurtful.  For example, “You may say “F**k” but you need to increase the distance from your brother’s ear when you say it”.  If coprolalia hurts another person’s feelings you can use positive language to teach responsibility.  For example, “You looked at your brother and called him a name.  You didn’t mean to, but you hurt your brother’s feelings.  You should apologize and ask if  he is okay.”  Note:  this is not apologizing for having Tourette Syndrome and for having tics, it is an apology for having potentially hurt someone’s feelings (a natural consequence).

Use substitution words

Substitution words are words or phrases that can be strategically placed to modify coprolalia.  The important aspect of this technique is that the child must be involved in its development and the word or phrase must satisfy the tic.  The individual using this technique must also be highly motivated to attempt to modify the behaviour.  If they are not invested, this strategy  will not work.  Always investigate motivation and the ability to invest mental energy into this task.  A child who suppresses tics all day and is mentally exhausted will not benefit from mom or dad saying, “Now Johnny, say Fruit Cake, not F***.” Willingness and readiness is essential and it is okay to put this task aside indefinitely if necessary.  If there is enough motivation and investment from the individual, involve them  with coming up with words that are similar enough to satisfy the tic but may be less offensive.  For example, “Shitake” or “Fruit cake”.   If the tic is not satisfied the individual is essentially suppressing the tic, causing more focus on the actual tic and increasing stress.  Increasing stress on the individual is counter-productive to managing coprolalia.

Here is an example of my son substituting counting from 1-10, (his own idea) to prevent coprolalia from recurring.  Caution:  Clip contains Coprolalia.

Be Accountable and Responsible

At first glance, being accountable and responsible for your own or your child’s symptom,  coprolalia, may seem harsh.  Coprolalia is an uncontrollable symptom of a neurological disorder.  This is true.  They can’t help it and it is not their fault.  However consider that being accountable and responsible does not involve finding fault or laying blame.  For example –  you step on someone’s toe while waiting in line.  It was an accident, the other person will assume it was an accident and it wasn’t done on purpose.  You would naturally apologize and ask if the other person was okay.  You take responsibility and you are accountable for the action however unintended and unwanted.  If you sneeze, you may apologize or excuse yourself, if you trip and bump someone you would apologize, if you were startled and screamed and scared someone else you would apologize and or explain.  The same should apply to tics and coprolalia which have an impact on others.  It does not imply that the individual is willfully or maliciously doing the act.  For example, my son has a screaming tic and when his screaming tic and his coprolalia occur together he is screaming profanities.  Everyone in our home knows that it is unintentional and an uncontrollable symptom of his Tourette Syndrome.  However, sometimes it hurts!  It can hurt our ears, it can startle us, it can shock our neighbours and it can hurt our feelings.  As a mom with a young son who has a “f***ing b**** a**hole” tic, being barraged daily with these words, I can say that it hurts, it wears me down, and it sometimes makes me sad.  No harm is intended and no blame is laid but if he apologizes, it does a few positive things for us all.

Being responsible and accountable for his neurological symptoms gives him power!

  • He can teach others about his symptoms and his disorder and promote understanding.  “Sorry,  I didn’t mean to scare you.  I have Tourette Syndrome and that was something I can’t control.  I can tell you more about it if you would like.”
  • He can control the effects of his symptoms on others.  He can change how others feel and think about him.  “Sorry, that was an accident.  I have Tourette Syndrome.  I sometimes do things I don’t mean to do.  I didn’t mean to do that”
  • He will become a powerful social thinker!  He learns to care about what others see of his actions and how they feel about him.  Being accountable and responsible means “I know I did something that may have affected you negatively, I care, I am sorry and I did not mean to do that to you”.  He will grow to be a caring and kind adult.

Being responsible and accountable for his neurological symptoms makes others feel better!

  • Just like stepping on my toe, my sonsaying sorry to me for saying “F**k you” makes me feel better.  I know he can’t help it but by apologizing I also know he didn’t mean it and that he cares about my feelings.
  • Apologizing or acknowledging the coprolalia alsoenlightens others, makes them smarter and more tolerant of others.  They probably didn’t know it was unintended until there was the apology and explanation.  How could they?

For the complete documentary see:  Neurologically Gifted’s article,  Learning From Kids with Challenging Behaviour:  The First Day (coming soon)

Be sure to see our other articles about coprolalia

Rage 3: Talk About Rage

Rage 3: Talk About Rage

Rage triggers a biochemical change in a person which pre-empts choice, reasoning, rational thinking and self-control.  Through observation, as described in Neurologically Gifted’s article:   Rage 2:  Look, Listen and Focus, we found that it was possible to achieve an excellent understanding of the dynamics of rage in our home.

Through observation we learned about the triggers for our child’s rages – the events, situations and patterns that would usually lead up to a rage.  We also recorded what would calm some situations – strategies we already used throughout the day that helped to deescalate volatile situations.

We developed some ideas about what we, as a family could do when stressors occurred that might lead to a rage.  Stress and frustration can be managed with love, support, communication, and planning.

We practiced disengaging from the rage.  Disengaging can help by not escalating the situation and by watching (to keep our child safe during an episode).

After completing our observations we then decided it was time to sit down with our child to talk about rage.

How to Talk About Rage

Before any discussion begins, it is important to remember that a child with neurological disorders may have difficulties in focus and attention.  Gaining self-insight to behaviour is challenging.   It will be important to keep the child’s limits in mind when moving forward with the discussion.  For example, memory and learning are both severely impaired in the time immediately before and during a rage.  Our son Nathan would often have very little recollection of events (even hours before a rage).  Once a rage has begun, talking will escalate the rage (even words that are intended to help).  Nathan often misinterprets words or hears things that were not even spoken.  Even saying “I love you” can be inflammatory for him during a rage.

It will require many weeks of ongoing conversations to communicate how rage occurs with your child.  We would wait until Nathan was receptive and able to learn and absorb what we were saying.  Once he would start to shut down or if the interaction became negative (a battle) we would stop.  We would provide a short wrap-up that would include support, encouragement and praise.  Always leave it on a positive note.  At the next opportunity, we would briefly review the last discussion to gauge what had been retained, and carry on the conversation from there.

Beginning the Discussion

Impact of Rage on the Family

Be kind, caring, supportive and non-judgmental.  Make your child aware of how the members of the household feel about rage occurring in the home.  Feeling mad, scared or frustrated are normal responses to rage, and they deserve to be acknowledged.  Be sure to let them know this is a problem in the family (not just in them) and there is no blame laid on them.  The reason for this discussion is to teach your child the natural consequences of their behaviours.  You, as a family are going to help the child make changes for the better.  Be supportive and encouraging.  It is important for your child to know that you as a family can make this change together.

Your child may be struggling with their neurological disorders and with delayed emotional development. In most cases, they may never have thought about what his/her rage is doing to others.  With all that a child may be dealing with from their disorders, it is likely they have not stepped outside their own brain to wonder about what they look like to others when he/she is raging.  During a rage the child is trapped inside a brain that is out of control.  This child doesn’t know what others feel about it.

Tell your child about it.  Tell them if other family members cry about it, are scared about it, are worried for their future.  Their response may initially be defensive.  “Are you trying to make me feel bad?”  “Do you want me to hate myself more?”  “Maybe I should just leave?”  Reassure them that this is not the case.  Reassure them that you love them and you just want to make home a better place. They are only able to make change, when they know how things really are.  You must be realistic and honest.

Making a child aware of how others feel can provide them with powerful motivation for taking charge of their rage.  Reassure them that with the whole family’s support they can change their default behaviours.

Impact of Rage on your Child

Next, discuss how your child feels about his rage episodes.  What does it feel like before during and after a rage?  Is he scared about losing control?  Is he scared he will actually hurt someone?  Intense guilt and shame are common after a rage.  Not being able to take back what they have said or done can become toxic.  Feelings of guilt and shame occupy some of a child’s mental resources, making them even more susceptible to subsequent rage episodes.  Explain this to them and tell them that as a family you can help make things better for him.

For our son Nathan, when his rages were more frequent he would often scream “I’m sorry” and cry during his rage and then emotionally swing back into verbal abuse, followed by more tears and apologies.  This could happen over and over.  His remorse was filling his bucket and tipping it over (back into rage) again and again.

Discussing these feelings of fear, shame and guilt with your child will provide more motivation for them.  They can make a change and as a family you can work together to minimize or stop rage episodes.

A New Starting Point

Bringing to light everyone’s unspoken feelings and fears will be useful when taking on rage.  You will have a common understanding that you now share with your child.  You will be able to say, “Im feeling anxious (or frightened)” or “you look scared (or angry)” and your child will understand what you mean – without having to go into detail.  You will be on common ground with a better understanding of what is happening.

A person who experiences frequent rages is usually easily overwhelmed.  Coping and managing symptoms of neurological disorder takes much mental energy.  With so much of their mental energy already occupied, your child may be unable to see what may motivate them to make positive change.  This is especially true for children.  Remind them frequently of your previous discussions.  They will be motivated to make things better but they will frequently need explicit reminders.

Continue to talk about rage in your home.  Discuss your goals for the family with your child.  Let them know what you are going to be working towards together.

–A peaceful, respectful co-existence where every member of the household wins.

See Part 1, Part 2 and Part 4 of Neurologically Gifted’s Series on Rage