Emotional regulation has been difficult since toddlerhood. Early episodes included head banging and throwing her head backward. As she grew older and demands increased, frustration could become aggression. During the most severe periods, she punched holes in walls. She also became increasingly aware that school, speech, memory, and social situations were harder for her than for peers. She has asked why she has problems that other children do not, and teasing about her stutter added to the pain of feeling different.
Anxiety, irritability, moodiness, impulsivity, obsessive interests, and depressive symptoms have all been part of the family’s concerns at different times. She began psychiatric care in 2018. She frequently needs reassurance that people love her or like her and can be very sensitive to perceived rejection.
Fatigue is one of the clearest triggers for escalation. When sleep has been poor, frustration may rise into crying, anger, pushing or hitting, breaking objects, or hyperventilating. Small comments can feel enormous once she is overloaded. Her family has learned to notice the change early, reduce demands, choose words carefully, and help her settle before the episode reaches that point.
Firm touch can sometimes help. If she is receptive, a hug or massage to the neck or back may provide the deep pressure she seeks and help her regulate. At other times, she does not want anyone close to her, and space is more helpful. Her family has become skilled at reading which response she can tolerate in the moment.
These episodes were more frequent and severe when she was younger. They have improved substantially with age and with the family’s ability to anticipate fatigue, pain, sensory overload, communication breakdown, and medication timing. They have not disappeared completely, but they are now less common and more often interrupted before they become dangerous.