Updated! Normal or not? DD2 hitting/scratching herself

[twowhat?]

DD2 has always been our "hard" child and has always had trouble with controlling her emotions. Recently, when she gets angry, she has started to bang her fist into her head, and scratch her arms or legs, like she's punishing herself. She screams that she hates herself and that she wishes she weren't our daughter. She also says stuff like "I hate you" and "you're the worst mom". Her saying those things doesn't concern me too much, but in conjunction with everything else - normal or not? Should I be concerned? Hormones? She throws epic tantrums and is almost 10...we've come close to seeing a developmental specialist before.

She's a total angel at school, teachers absolutely LOVE her, she gets along well with others, no discipline problems whatsoever...she's never had to change her color or move her clip or whatever the warning systems are at school. At home is just a different story.

[California]

Going by what you've written, if she's self-harming as a coping strategy, I'd take her to see a therapist.

It's not unusual to have strong emotions at her age. If you've noticed the start of breast buds or a growth spurt in her feet that's a signal that her body is shifting into the beginnings of puberty. Her emotions are likely to get stronger in the next couple of years. A therapist can help her work on healthier coping strategies to deal with those strong emotions.

If she's an angel at school she may be dealing with some anxiety too, putting pressure on herself, and it all comes out at home where she feels safer to express it.

[mikala]

Going by what you've written, if she's self-harming as a coping strategy, I'd take her to see a therapist.

It's not unusual to have strong emotions at her age. If you've noticed the start of breast buds or a growth spurt in her feet that's a signal that her body is shifting into the beginnings of puberty. Her emotions are likely to get stronger in the next couple of years. A therapist can help her work on healthier coping strategies to deal with those strong emotions.

If she's an angel at school she may be dealing with some anxiety too, putting pressure on herself, and it all comes out at home where she feels safer to express it.I agree with this. One of my friends has a teenager going through a really rough patch and we were talking the other day about how she wishes she had recognized potential issues earlier and gotten her daughter help learning more positive strategies before her daughter became a teenager and her mom influence started to decline as her daughter became more independent.

[hillview]

neuropsych and therapist. so sorry

[jgenie]

I would take her to a therapist because of the self harming. That has the potential to escalate quickly. I wouldn’t worry about the I hate you stuff. I think it’s on the early side but not unusual for teens.

[mmsmom]

I don’t think it is necessarily abnormal but it does need to be addressed. We went through a similar phase with DS at 8-10 years old. Ultimately it was the school guidance counselor who helped most. She had a few sessions with him.... we had some back slide over the summer then this year she set up a group with DS and another child with similar issues. They would meet over lunch and work through a program and it helped so much. We haven’t ruled out seeking therapy but for now he is doing well.

[magnoliaparadise]

It must be so hard for you to see this and to know that your child is upset. I don't think children hitting themselves is as uncommon as people think. I know several families who are going through/have gone through this and I'm guessing that many families don't share it. I just googled 'child hitting self' and there were many articles about how/why kids hit themselves, though most focused on slightly younger kids. It sounds like it basically comes down to frustration/stress at the world, the emotion of which they execute against themselves because they have nowhere to 'put' their frustration/stress. I'm sure it's much more nuanced and complicated than that, but that was my takeaway.

I do think that a therapist and neuropsych might both be useful - especially if your DD is onboard. They have probably each seen this many times and the therapist could help your DD understand how to give words (or actions) to her emotions instead of hurting herself. And the therapist and neuropsych can put this into a context for you and help to resolve some issues. For instance, not saying this is the case for your DD, but maybe there is a stressor in school or a (even minor) learning disability or social issue (so important for girls at that age) that is causing the emotional outbursts. Or maybe it's just about learning how to regulate / soothe oneself and not explode. And I know you probably have already thought of this, but I also agree with the other posters that this could be just a reflection of her, for whatever reasons, having to hold it together so tightly during the day and then unleashing/unlashing at night.

The one thing about therapy that I would say is that a kid has to be on-board, or at least on-board after a handful of times. My parents made me go to a therapist when I was in fourth or fifth grade and I hated it and shared nothing and it was a big waste of time and frankly made me negative about therapy for years.

It's so hard seeing our kids unhappy. Hang in there.

[123LuckyMom]

I doubt the neuropsychology evaluation is necessary. This is a fairly normal but totally unhelpful coping strategy. There’s no question that you should take her to a therapist to help her develop healthier coping strategies. This will probably be a short-term and intermittent fix, not a developmental problem, but ignoring it will deny your daughter the help she needs to develop healthy thinking and behavior patterns. Intervention is important, because dangerous self-harming and the possibility of substance abuse to self-medicate, or just unnecessary unhappiness could be around the corner if she doesn’t have good tools for handling her anger and frustration. I agree that anxiety may be at Play. A great book for anxiety is Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children https://www.amazon.com/dp/0757317626/ref=cm_sw_r_cp_api_i_teC5AbXMZMAPS.


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[magnoliaparadise]

I just reread my response and what I meant to say more clearly is: IMHO, I think it's normal. As other posters have said, it's certainly not a helpful coping strategy or I'm sure not something that you want to see your kid go through. But I don't think it's considered 'not normal' or an indication in any way that your kid is off track for normal development. I just think it means that your DD needs a little support right now for a temporary amount of time.

I think most parents would start with the therapy. I only mentioned the neuropsych in case the stress and upset might be based upon something else - more school related/holding it together/feeling like she isn't keeping up. Not saying that is the case necessarily.

[squimp]

I think it is somewhat concerning for a 10-yo to have tantrums. To me it suggests that they are having a hard time managing their emotions, and it could affect them in school, activities or friendships.

[twowhat?]

Thanks all - called our pediatrician and he says she needs to be seen by a cognitive behavioral therapist and gave me a few names. He wants to know when she gets in to her first appointment or if we are unable to get an appointment.

[hillview]

great update you are on your way!

[NCGrandma]

Thanks all - called our pediatrician and he says she needs to be seen by a cognitive behavioral therapist and gave me a few names. He wants to know when she gets in to her first appointment or if we are unable to get an appointment.

Great! And very good sign that he wants an update (and presumably would be willing to intervene if you can’t get an appointment).


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[twowhat?]

His nurse also just called to give me one other option to try since he had apparently been thinking more about it during the day and said to definitely let them know if none of those work out and he will help get us in somewhere. I'm glad he is taking it seriously and also sad at the same time that it's a big enough "deal".

Slightly off-topic question - how do you bring questions like this up during a well-visit when you don't necessarily want to talk about it in front of the affected child? The latest scratching/hitting episode that concerned me actually came after her well visit (which was just a few days prior, and the nurse actually asked me when she called back if we had discussed it during the well-visit) so it was a moot point for us for this particular issue but it made me wonder...do you call ahead and let them know you have things you need to discuss privately, or set up a separate appointment?

[mackmama]

His nurse also just called to give me one other option to try since he had apparently been thinking more about it during the day and said to definitely let them know if none of those work out and he will help get us in somewhere. I'm glad he is taking it seriously and also sad at the same time that it's a big enough "deal".

Slightly off-topic question - how do you bring questions like this up during a well-visit when you don't necessarily want to talk about it in front of the affected child? The latest scratching/hitting episode that concerned me actually came after her well visit (which was just a few days prior, and the nurse actually asked me when she called back if we had discussed it during the well-visit) so it was a moot point for us for this particular issue but it made me wonder...do you call ahead and let them know you have things you need to discuss privately, or set up a separate appointment?

I totally understand the position of wanting to be taken seriously and then being bummed to hear it's something that needs to be taken seriously. Hang in there.

I call ahead and have a phone consult with the pedi about areas of concern that I don't want to discuss in front of my child. I've also brought a written list of things that I hand to the doctor if I want specific things checked during the visit that I don't want DC to overhear.

[KpbS]

I write a note when in this situation.

Big hugs, twowhat. :hug:

[bisous]

I totally understand the position of wanting to be taken seriously and then being bummed to hear it's something that needs to be taken seriously. Hang in there.

I call ahead and have a phone consult with the pedi about areas of concern that I don't want to discuss in front of my child. I've also brought a written list of things that I hand to the doctor if I want specific things checked during the visit that I don't want DC to overhear.

Yes to this. I’ve been there. In my experience doctors can be pretty subtle about stuff. We’re with Kaiser and can email the doctors and I’ve had great “conversations” through email before!

[hillview]

I have told my son to go wait in the waiting room that I need to speak with the doctor privately.

[♥ms.pacman♥]

sorry you are dealing with this! glad u are on track to see a therapist. and, sounds like you have a very amazing ped!

as PP said, i think the "i hate you" and "you're the worst mom" comments are 100% normal, but the scratching/hitting is not and would be way more concerning..would want to nip in the bud as i'm sure that gets harder with older kids and middle school challenges etx.

you have mentioned before your DD2 is very bright/advanced learner etc...i'm sure you probably already know this, but there is a huge correlation with kids who are very exceptional learners and this type of behavior. i was in a parent discussion group for parents of gifted kids and i would say half the parents there had their kids in some sort of therapy. Many of us could commisserate over behavior challenges, either at school or at home, and lot of it centering around being angry at thesmelves and not being able to control their emotions (very angry outbursts over seemingly unimportant little things, etc). Most said therapy was helpful, as it helped kids feel more in control of their emotions vs. a victim of them. I do think that kids who are the very well-behaved, very good and obedient students in school tend to be extremely hard on themselves but then tend to fall apart at home ,and don't really undestand why. My DS is sorta like this...though he doesn't throw tantrums, is EXTREMELY moody nearly every evening and lashes out/talks back as soon as he gets out of school . His teachers, on the other hand, say they wish they could clone him..and especially being a boy it is more obvious/surprising to everyone that he doesn't play around in class and he is very good about sitting still, etc. it's another story though when he walks in the door.

[magnoliaparadise]

Good luck with everything. Sounds like you are on your way. I can imagine it must be stressful, so I hope that you find someone you like to work with your DD and things get better quickly. It's interesting that your ped suggested Cognitive Behavioral Therapy and not other therapies. I wonder if CBT is the go-to therapy for children.

[twowhat?]

sorry you are dealing with this! glad u are on track to see a therapist. and, sounds like you have a very amazing ped!

as PP said, i think the "i hate you" and "you're the worst mom" comments are 100% normal, but the scratching/hitting is not and would be way more concerning..would want to nip in the bud as i'm sure that gets harder with older kids and middle school challenges etx.

you have mentioned before your DD2 is very bright/advanced learner etc...i'm sure you probably already know this, but there is a huge correlation with kids who are very exceptional learners and this type of behavior. i was in a parent discussion group for parents of gifted kids and i would say half the parents there had their kids in some sort of therapy. Many of us could commisserate over behavior challenges, either at school or at home, and lot of it centering around being angry at thesmelves and not being able to control their emotions (very angry outbursts over seemingly unimportant little things, etc). Most said therapy was helpful, as it helped kids feel more in control of their emotions vs. a victim of them. I do think that kids who are the very well-behaved, very good and obedient students in school tend to be extremely hard on themselves but then tend to fall apart at home ,and don't really undestand why. My DS is sorta like this...though he doesn't throw tantrums, is EXTREMELY moody nearly every evening and lashes out/talks back as soon as he gets out of school . His teachers, on the other hand, say they wish they could clone him..and especially being a boy it is more obvious/surprising to everyone that he doesn't play around in class and he is very good about sitting still, etc. it's another story though when he walks in the door.

This could be. She's bright but not enough for GT services (she was tested based on teacher recommendation and didn't qualify). This year is hard too with the state-mandated testing and I know it stresses her out. She's developing breast buds, gets super frustrated with her medical issues...poor kid. I'm having trouble getting an appointment with one of the recommended therapists so might have to get our ped to help.

[twowhat?]

So I finally found an available therapist, had our first call with her, and she seems great and everyone (me, DH, and DD2) is on board. I've explained to DD2 that everyone needs a little help sometimes, and that this therapist will help her figure out how to handle her frustration and I was a little surprised that she was totally on board with that. She's very bright and probably quite aware that she doesn't want to feel this way.

I'm not quite sure what to do about insurance - it will be billed out of network (if we choose to use insurance) but that requires a diagnosis. Obviously the diagnosis at this point is super mild but is there any concern with having that on her records? I don't feel like HIPAA is 100% protection.

Alternatively we pay out of pocket. Which we can afford to but it will add up...

In the meantime the therapist gave us a couple of concrete things we can do until our first in-person appointment so we're eager to get started!

[HannaAddict]

So I finally found an available therapist, had our first call with her, and she seems great and everyone (me, DH, and DD2) is on board. I've explained to DD2 that everyone needs a little help sometimes, and that this therapist will help her figure out how to handle her frustration and I was a little surprised that she was totally on board with that. She's very bright and probably quite aware that she doesn't want to feel this way.

I'm not quite sure what to do about insurance - it will be billed out of network (if we choose to use insurance) but that requires a diagnosis. Obviously the diagnosis at this point is super mild but is there any concern with having that on her records? I don't feel like HIPAA is 100% protection.

Alternatively we pay out of pocket. Which we can afford to but it will add up...

In the meantime the therapist gave us a couple of concrete things we can do until our first in-person appointment so we're eager to get started!

Seeing a therapist will still go with her medical records (even if not the details of sessions) even if you pay out of pocket. It is really tragic we have to worry about stigma or being excluded from coverage at a later date when seeking medical care. :( Glad you found someone good.


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[hillview]

both my kids have diagnosis and no issues with HIPPA stuff. We selectively disclose to school staff as appropriate.

[candaceb]

I have had experiences with therapists who said something when filling out paperwork about putting in a valid diagnosis that indicates therapy is warranted, without indicating the full severity of the issue.
For example, coding for "adjustment disorder" without adding in the anxiety and depression pieces that go with it. If you're concerned, you might see if the therapist is willing to do something along those lines.

[HannaAddict]

I have told my son to go wait in the waiting room that I need to speak with the doctor privately.

That or step outside in the hall briefly. Doctors don’t do much via email, some not at all, as he’s to comply with privacy regs. And don’t have time to schedule phone consults ahead of time. Our ped has a form parents can fill out before hand too with any areas of concern and if want to discuss without child. Teens get a form too.


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[HannaAddict]

both my kids have diagnosis and no issues with HIPPA stuff. We selectively disclose to school staff as appropriate.

Exactly, make sure you read any forms granting into and only disclose what is relevant. But insurance companies will always find a way . . .


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[MSWR0319]

My son goes to therapy for the same reasons (he sounds very much like your daughter and is 9) and we don't have a "formal" diagnosis. I'm quite honestly sure what it's coded as, but the EOB always just says Family therapy or something to that affect. Our school psych told me that because DS is gifted, his emotional maturity is WAY behind his intellectual maturity and it causes the type os issues you are seeing. She said that because they are smart, they are more aware of their emotions than most kids and they don't know how to react to it. DS has been in therapy for about a year and is much better! We were going every week for about a month or two, then down to twice a month for a few months and have been at once a month for some time. We still struggle a bit, but she said that's to be expected until his emotional maturity catches up.