(Posted on ADDitude Magazine – January 10, 2020)

Transitions are more than tough. They are torture. Our daughter’s angry outbursts are tiring, hurtful, and persistent. For a long time, we felt alone in our daily battles. Then we learned about the connection between ADHD and explosive behavior, and some expert strategies for reclaiming calm for everyone in the family.

She wakes up screaming again. It’s the fifth, or sixth, time this week. I’ve lost count. My youngest daughter objects loudly to many transitions, but the most scream-inducing of all is getting out of bed. Going to sleep can end similarly in explosive, angry outbursts of loud demands: “Shut up!” or “Whatever.” Sometimes it’s a simply put, “Stop talking.”

Shouting is our morning routine and sometimes our night routine, too. We’ve tried many different tactics: talking quietly, whispering, ignoring, imposing consequences, switching off wi-fi but it still often ends and begins with screaming. Her explosive behavior is something we suffer through daily at home, and sometimes it leaks out at school, too.

When she was younger, distraction and redirection sometimes worked. Occasionally, we got creative, completely distracting her by singing or dancing or doing something incredibly silly to interrupt the explosion, defuse it, and move on through our day. Just as often, though, she continued.

For years, we thought this was her personality and her reaction to transitions mostly. But then I read that explosive behavior and ADHD sometimes go together. That got us wondering if other parents of children with ADHD experienced the same thing. If so, how did they cope with this and how did the experts suggest handling it?

Are My Child’s Outbursts Tied to ADHD?
“It’s really about poor frustration tolerance and the inability to control their emotions. This is often why they lash out,” says Vinay Saranga, M.D., of Saranga Psychiatry in North Carolina.

Getting ready for a school day involves a lot of individual steps, says Saranga. “You have to choose your clothes, eat breakfast, get dressed, pack up your school bag, maybe make a lunch, and be ready at the door. Add ADHD to that mix and dealing with all those pieces in the morning can be overwhelming.”

Sometimes, there’s more going on, Saranga says noting that explosive behavior can also be caused by anxiety, a learning disability, or oppositional defiant disorder (ODD).

“Not all children with ADHD have explosive behavior, however many do — and children with ADHD tend to be at a higher risk than other children their age for exhibiting or developing oppositional and disruptive behaviors,” says Emily C. Haranin, Ph.D., a licensed psychologist at Children’s Hospital Los Angeles.

Several common characteristics of children with ADHD put them at higher risk for developing and externalizing explosive behaviors. Poor impulse control, emotional dysregulation, irritability, and underlying mood disorders can all trigger explosive behaviors.

Karen Dawkins in Raleigh, North Carolina, has a son diagnosed with a communication disorder and ADHD. When he was young, he often exploded. During homeschooling, Karen and her son, now a 22-year-old college student, worked on reading people and understanding social cues, which helped with his frustration. When he struggled to manage social and academic expectations in high school though he had explosions. In college, he discovered that exercise and a strict schedule helps him manage stress. His mom says he will graduate on time and has become his own best advocate.

“It is important to work with medical and mental health professionals with expertise in assessing and treating ADHD. They can collaborate with parents to identify underlying causes in each unique case and be helpful in ruling out other potential causes,” Haranin says.

Remaining Calm in the Face of Outbursts
Jennifer Van Huss is mom to Hayden, 9, diagnosed with ADHD. When things are taken away or not carried out to his liking, or sometimes when he’s required to transition to a new activity, he screams, destroys property, runs away, or hits himself.

Saranga advises parents to do their best to stay calm in situations like this. If you lash out or take it personally, the conflict will escalate and often the child feeds off of that. Seize opportunities outside of the tantrum to praise good behavior, so you are not rewarding the negative behavior you want to stop with your attention, he says.

“While staying calm may sound easy, it can actually be one of the most difficult parts of parenting,” Haranin explains. “If parents respond to explosive behavior with frustration, yelling or anger, they inadvertently reinforce this behavior and see more of it in the future. Parents who are able to stay calm, ignore the angry words and behaviors, and also give attention to more positive and appropriate behaviors, help children learn to modify their behavior.”

Van Huss says soft talking, or occasionally ignoring the behavior, helps her family. Negotiating may work as well. Yelling, giving in, or rushing the situation have the opposite effect, she admits.

How to Reward Calm Behavior, Not Outbursts
Children with explosive behavior benefit from daily opportunities to spend enjoyable time with their parents or caregivers (i.e. singing in the car, story time at night, playing at the park). When your child is angry and yelling, it is important for both of you to have those positive experiences and memories to draw on, and to remind yourself of everything you love about your child.

Other strategies, such as having clear and predictable routines for challenging times, can be effective in reducing outbursts. Low- or no-cost rewards and prizes (i.e. extra book before bedtime, choosing favorite cereal) can be paired with successful completion of routines to help enhance motivation.

“Many children outgrow some of this behavior, particularly when parents respond with consistency and warmth. However, even if children do outgrow explosive behavior, children with ADHD, who do not receive best practice treatment, are at higher risk for developing a myriad of behavioral health conditions later including depression, anxiety, or substance use disorders. Current best practice research in treating school age children with ADHD indicates that medication and therapy combined are the most effective treatment,” says Haranin.

Putting Advice into Practice
When my daughter is screaming, it’s a constant challenge to avoid getting sucked into her angry outbursts. I know it’s important to remain calm and I try, but I don’t always succeed. Expert advice and tips from other parents of children with ADHD help me through these challenging times. I’ve learned some of the most effective strategies from those conversations.

When my daughter was very young, I used positive self-talk to calm myself down all the time. “I am the adult here,” I’d tell myself. “I’ve got this.” I find myself doing this a lot more since reaching out for help. Being calm when faced with explosions really does shorten the duration of the outbursts.

Lately, I’m trying to be more patient with myself as well. I remind myself to walk away or calm myself down first before addressing negative outbursts. Doing this is helping me manage her explosive behavior much better.

As Haranin and Saranga have suggested, I’m also working hard to seek out positive behaviors and to acknowledge them in some way. I’m pleased to report that doing this also makes a difference in my daughter’s outlook. My friend, Jennifer, helped me recognize (in a gentle and supportive way) that I’m often in a rush to resolve the situation, so I can get to work on time. That mindset can sometimes draw out these outbursts and make them worse. So, now I set aside the time needed to get through the task at hand in an appropriate pace, without stressfully racing through it. I used to ask myself: “How can I fix this fast?” Now I approach transitions and other challenges from a quieter space and ask instead, “What does she need?”

Last summer, as this behavior threatened to consume us, I sought out my daughter’s pediatric psychiatrist, who reviewed her medication again. He also reminded me that calm, consistent support makes an impact and that if she’s okay, and safe, it is sometimes fine to just leave the room.

Today is Monday and this morning was calm. In fact, nobody screamed waking up, or in response to an angry outburst. We’ve had a wonderful string of 3 or 4 days with no explosions. I still feel like we’re walking on eggshells, but this is progress, and I’ll take it.