The behavioral organization, temporal characteristics, and diagnostic concomitants of rage outbursts in child psychiatric inpatients

Abstract

Angry outbursts, sometimes called “rages”, are a major impetus for children's psychiatric hospitalization. In hospital, such outbursts are a management problem and a diagnostic puzzle. Among 130 4-to-12 year olds successively admitted to a child psychiatry unit, those having in-hospital outbursts were likely to be younger, have been in special education, have a pre-admission history of outbursts, and a longer hospital stay. Three subsets of behaviors, coded as they occurred in 109 outbursts, expressed increasing levels of anger; two other subsets expressed increasing levels of distress. Factor structure, temporal organization and age trends indicated that outbursts are exacerbations of ordinary childhood tantrums. Diagnostically, children with outbursts were more likely to have language difficulty and a trend towards ADHD. Outbursts of children with anxiety diagnoses showed significantly more distress relative to anger. Outbursts were not especially associated with our small sample of bipolar diagnoses.

Rages—What Are They and Who Has Them?

“…The first analysis was an ordinal regression of the number of rages on the chosen variables; the second was a Cox proportional hazards model of the time to first rage. Behaviors occurring during a rage were quantified but more specific analyses are described in another paper (Potegal et al, 2009). Between January, 2003, andJune, 2004, 130 children had 151 admissions (i.e., 21 children were readmitted).…”

What do we really know about PRN use in agitated children with mental health conditions: a clinical review

“…In order to evaluate outcome, we need a better understanding of the behavioural composition of outbursts and their natural history (ie, what does the child do during the outburst; how long does it take the child to calm down without any intervention). There is evidence that anger as opposed to distress outbursts have different trajectories 26. Some tantrums are shorter than others even in the absence of an intervention.…”

Fifteen-minute consultation: The angry child

“…For example, children with undiagnosed learning difficulties can get very frustrated when they are unable to do what the others can do and thus get very angry when they are asked once again to read or write or do Maths when they know that it is too hard 1. Other children may be fine in class, but really struggle with unstructured playtime.…”

“…Some children are very hyperactive and impulsive, as is the case in attention-deficit hyperactivity disorder (ADHD). These children typically struggle to follow rules and often butt into other children’s games, which leads to being rejected and feeling angry as a result 1. Also, children who tend to get angry easily can be a source of entertainment for others, who may wind them up for the fun of seeing them totally lose their temper.…”