Our only child, who is 10, has had regular, uncontrollable temper outbursts for the past four years. She was bullied at school for nearly two years by three “friends”, between the ages of six and eight. We were unaware of all of this. At home we were seeing sustained tantrums, often from the minute we got back after school. Unfortunately, we didn’t know what to do at the time and would often shout back at her and threaten to withdraw treats.
When she was about seven we realised we needed considerable help and were even starting to think she had a condition such as attention deficit hyperactivity disorder. A friend who works with young children in a psychiatric capacity told us there was nothing wrong with her and asked if she was being bullied. We said no. We decided to go to our GP but went to the school first to see if they could offer advice. They told us only then about the past year of bad behaviour and the bullying by the three friends.
We were shocked – these girls came for tea and were her three closest school friends. We were also relieved as we believed we had found the answer to her behaviour.
The bullying continued. She is a clever girl but was producing little or no work in the classroom, often folding her arms and refusing to work. She started to try to stay off school. On more than one occasion, I returned home with her to calm her down.
As she grew older she started to tell us things, describing feeling alone most days and how other children poked fun at her. She had started to answer back to teachers and play the class fool.
I read everything I could find on bullying and the effects it could have on neural development. I was convinced her behaviour, which the school was now very concerned about, was a result of bullying. The school didn’t agree, saying the bullying had stopped. Her behaviour at school was now the problem.
At home we reversed our approach and reaction to her behaviour and stopped fighting fire with fire. We asked for a Child and Adolescent Mental Health Services (CAMHS) referral and she started a course of weekly, private counselling. We were also successful in getting her a place on a day course by Kidscape. It was a great day and helped her to see she was not alone and was not, in her words, a freak.
The CAMHS referral didn’t go beyond the initial triage on the two occasions on which we were referred (a year apart). It was acknowledged that she had a high level of anxiety about school and friends but that she was able to function normally. The counselling lasted a year and the conclusion was that though she was a happy, well-balanced, thoughtful child, she was “highly anxious” about friends and friendships.
Her tantrums at home are getting worse and she is becoming increasingly physical, though she is very articulate about the tantrums. She feels remorse and shame after an outburst. She explains that when she feels hurt or upset she holds it in until she gets home; it then bursts out without her having any control. She describes her brain as having two sides – a happy side and an angry side. Sometimes the angry side takes over and she cannot control it. She tries very hard to stay in the happy side and not let the angry side win.
She is extraordinarily sensitive to criticism and sees offence at every turn. Sometimes there is an outburst because I smiled at the wrong moment and she thinks I am laughing at her.
I contacted three specialists: professionals in child psychotherapy, child bullying and autism. No one can diagnose your daughter from a letter, but the professional in autism thought it was worth you exploring autism/Asperger syndrome and pathological demand avoidance as possibilities. But the only way of knowing is for your daughter to have a formal diagnostic assessment.
You may know that girls on the spectrum present differently and can be very hard to diagnose. Many health and education professionals can miss it because girls learn to mimic “how to behave” socially. I have put some links at the bottom here, which I’d like you to look at, including how to get a diagnosis. Certain things made me wonder: the explosions as soon as she gets home from school, the seeming inability to read your facial expressions, the high anxiety over some social situations. Children with autism can also be bullied because the way they communicate and interact may be different from their peers, and they may misinterpret social situations.
Your very much longer letter told me of the many avenues you have tried in an attempt to help your daughter, although there was nothing about her early years. But I see some routes were not fully explored because other professionals offered you alternative theories. I also wonder if the bullying has become the sole focus and so stopped one, perhaps, seeing anything else that might be going on?
Ben Lloyd, a child and adolescent psychotherapist (childpsychotherapy.org.uk) also wondered if the bullying was a symptom or the cause.
Leaving aside the autism for a moment, Lloyd explains: “A task of parenting is to help channel ordinary, healthy aggression and help a child to regulate their own emotions that are in the first place unfamiliar to them. It sounds as though your daughter has not been able to develop a way of tolerating ordinary enough frustrations that are necessary for emotional development to take place.”
It certainly doesn’t sound as if your daughter has learned to modulate her emotions or has emotional containment. But we don’t know why. Obviously a child with autism would find this much harder.
I would search the autism.org.uk website for sections on autism spectrum disorder, Asperger’s, pathological demand avoidance, women and girls and getting a diagnosis. Then I would go to your GP and start again to find help for your daughter (or you can do this privately if you prefer). I would also recommend you get some counselling (aft.org.uk; bacp.co.uk) to support yourself.
This article first appeared in the Guardian Family section on 24 July 2015.