Advertisement

Current Psychiatry Reports

, Volume 11, Issue 2, pp 127–133 | Cite as

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

  • Michael PotegalEmail author
  • Gabrielle A. Carlson
  • David Margulies
  • Joann Basile
  • Zinoviy A. Gutkovich
  • Melanie Wall
Article

Abstract

Angry outbursts, sometimes called rages, are a major impetus for the psychiatric hospitalization of children. In hospitals, 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 had a preadmission history of outbursts, and to have 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 toward attention-deficit/hyperactivity disorder. 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.

Keywords

Risperidone Acad Child Adolesc Psychiatry Language Disorder Temper Tantrum Youth Care Forum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Gold J, Shera D, Clarkson B Jr: Private psychiatric hospitalization of children: predictors of length of stay. J Am Acad Child Adolesc Psychiatry 1993, 32:135–143.PubMedCrossRefGoogle Scholar
  2. 2.
    Blader JC, Abikoff H, Foley C, et al.: Children’s behavioral adaptation early in psychiatric hospitalization. J Child Psychol Psychiatry 1994, 35:709–721.PubMedCrossRefGoogle Scholar
  3. 3.
    Cole PM, Michel MK, Teti LO: The development of emotion regulation and dysregulation: a clinical perspective Monogr Soc Res Child Dev 1994, 59:73–100.PubMedCrossRefGoogle Scholar
  4. 4.
    Mick E, Spencer T, Wozniak J, et al.: Heterogeneity of irritability in attention-deficit/hyperactivity disorder subjects with and without mood disorders. Biol Psychiatry 2005, 58:576–582.PubMedCrossRefGoogle Scholar
  5. 5.
    Leibenluft E, Cohen P, Gorrindo T, et al.: Chronic versus episodic irritability in youth: a community-based, longitudinal study of clinical and diagnostic associations. J Child Adolesc Psychopharmacol 2006, 16:456–466.PubMedCrossRefGoogle Scholar
  6. 6.
    Budman CL, Bruun RD, Park KS, et al.: Explosive outbursts in children with Tourette’s disorder. J Am Acad Child Adolesc Psychiatry 2000, 39:1270–1276.PubMedCrossRefGoogle Scholar
  7. 7.
    Campbell M, Gonzalez NM, Silva RR: The pharmacologic treatment of conduct disorders and rage outbursts. Psychiatr Clin North Am 1992, 15:69–85.PubMedGoogle Scholar
  8. 8.
    Connor DF, McLaughlin TJ: Aggression and diagnosis in psychiatrically referred children. Child Psychiatry Hum Dev 2006, 37:1–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Sukhodolsky DG, Cardona L, Martin A: Characterizing aggressive and noncompliant behaviors in a children’s psychiatric inpatient setting. Child Psychiatry Hum Dev 2005, 36:177–193.PubMedCrossRefGoogle Scholar
  10. 10.
    Kronenberger WG, Giauque AL, Dunn DW: Development and validation of the outburst monitoring scale for children and adolescents. J Child Adolesc Psychopharmacol 2007, 17:511–526.PubMedCrossRefGoogle Scholar
  11. 11.
    Collett BR, Ohan JL, Myers KM: Ten-year review of rating scales. VI: scales assessing externalizing behaviors; J Am Acad Child Adolesc Psychiatry 2003, 42:1143–1170.PubMedCrossRefGoogle Scholar
  12. 12.
    Bambauer KZ, Connor DF: Characteristics of aggression in clinically referred children. CNS Spectr 2005, 10:709–718.PubMedGoogle Scholar
  13. 13.
    Bath HI: Temper tantrums in group care. Child Youth Care Forum 1994, 23:5–28.CrossRefGoogle Scholar
  14. 14.
    Mullen JK: Understanding and managing the temper tantrum. Child Care Q 1983, 12:59–70.CrossRefGoogle Scholar
  15. 15.
    Treischman AE: Understanding the stages of a typical temper tantrum. In The Other 23 Hours. Edited by Treischman AE, Whittaker JK, Bendetto LK. New York: Aldine; 1969:170–197.Google Scholar
  16. 16.
    Potegal M, Davidson RJ: Temper tantrums in young children: 1. Behavioral composition. J Dev Behav Pediatr 2003, 24:140–147.PubMedGoogle Scholar
  17. 17.
    Potegal M, Kosorok MR, Davidson RJ: Temper tantrums in young children: 2. Tantrum duration and temporal organization. J Dev Behav Pediatr 2003, 24:148–154.PubMedGoogle Scholar
  18. 18.
    Potegal M: Tantrums in externalizing, internalizing and typically developing 4 year olds. Paper presented at the Society for Research in Child Development. Atlanta, GA; April 7–10, 2005.Google Scholar
  19. 19.
    Masters KJ, Bellonci C, Bernet W, et al.; American Academy of Child and Adolescent Psychiatry: Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint. J Am Acad Child Adolesc Psychiatry 2002, 41(2 Suppl):4S–25S.PubMedGoogle Scholar
  20. 20.
    Fryer MA, Beech M, Byrne GJA: Seclusion use with children and adolescents: an Australian experience. Aust N Z J Psychiatry 2004, 38:26–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Garrison WT, Ecker B, Friedman M, et al.: Aggression and counter aggression during child psychiatric hospitalization. J Am Acad Child Adolesc Psychiatry 1990, 29:242–250.PubMedCrossRefGoogle Scholar
  22. 22.
    Vivona JM, Ecker B, Halgin RP, et al.: Self- and other directed aggression in child and adolescent psychiatric inpatients. J Am Acad Child Adolesc Psychiatry 1995, 34:434–444.PubMedCrossRefGoogle Scholar
  23. 23.
    Dean AJ, McDermott BM, Marshall RT: Psychotropic medication utilization in a child and adolescent mental health service. J Child Adolesc Psychopharmacol 2006, 16:273–285.PubMedCrossRefGoogle Scholar
  24. 24.
    Greene RW, Ablon JS: Treating Explosive Kids: The Collaborative Problem-Solving Approach. New York: Guilford Press; 2006.Google Scholar
  25. 25.
    Dorfman DH, Kastner B: The use of restraint for pediatric psychiatric patients in emergency departments. Pediatr Emerg Care 2004, 20:151–156.PubMedCrossRefGoogle Scholar
  26. 26.
    Joshi PT, Hamel L, Joshi AR, Capozzoli JA: Use of droperidol in hospitalized children. J Am Acad Child Adolesc Psychiatry 1998, 37:228–230.PubMedCrossRefGoogle Scholar
  27. 27.
    Vitiello B, Hill JL, Elia J, et al.: P.R.N. medications in child psychiatric patients: a pilot placebo-controlled study. J Clin Psychiatry 1991, 52:499–501.PubMedGoogle Scholar
  28. 28.
    Aman MG, De Smedt G, Derivan A, et al.; Risperidone Disruptive Behavior Study Group: Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. Am J Psychiatry 2002, 159:1337–1346.PubMedCrossRefGoogle Scholar
  29. 29.
    McCracken JT, McGough J, Shah B, et al.; Research Units on Pediatric Psychopharmacology Autism Network: Risperidone in children with autism and serious behavioral problems. N Engl J Med 2002, 347:314–321.PubMedCrossRefGoogle Scholar
  30. 30.
    Rapport MD, Pataki C, Carlson G: Attention deficit-hyperactivity disorder. In Inpatient Behavior Therapy for Children and Adolescents. Edited by Van Hasselt VB, Kolko DJ. New York: Plenum Press; 1992:239–274.Google Scholar
  31. 31.
    Baker L, Cantwell DP: Psychiatric and learning disorders in children with speech and language disorder: a critical review. Adv Learn Behav Disabil 1985, 4:29–47.Google Scholar
  32. 32.
    Beitchman JH: Therapeutic considerations with the language impaired preschool child. Can J Psychiatry 1985, 30:609–613.PubMedGoogle Scholar
  33. 33.
    Beitchman JH, Brownlie EB, Wilson B: Linguistic impairment and psychiatric disorder: pathways to outcome. In Language, Learning and Behavior Disorders. Edited by Beitchman JH, Cohen NJ, Konstantareas M, Tannock R. New York: Cambridge University Press; 1996:493–514.Google Scholar
  34. 34.
    Brownlie EB, Beitchman JH, Escobar M, et al.: Early language impairment and young adult delinquent and aggressive behavior. J Abnorm Child Psychol 2004, 32:453–467.PubMedCrossRefGoogle Scholar
  35. 35.
    Cohen NJ: Unsuspected language impairments in psychiatrically disturbed children: developmental issues and associated conditions. In Language, Learning and Behavior Disorders. Edited by Beitchman JH, Cohen NJ, Konstantareas M, Tannock R. New York: Cambridge University Press; 1996:105–127.Google Scholar
  36. 36.
    Mellesdal L: Aggression on a psychiatric acute ward: a three-year prospective study. Psychol Rep 2003, 92:1229–1248.PubMedGoogle Scholar
  37. 37.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  38. 38.
    MacFarlane JW, Allen L, Honzik MP: A Developmental Study of the Behavior Problems of Normal Children Between Twenty One Months and Fourteen Years. Berkeley, CA: University of California Press; 1954.Google Scholar
  39. 39.
    Bhatia MS, Dhar NK, Singhal PK, et al.: Temper tantrums: prevalence and etiology in a non-referral outpatient setting. Clin Pediatr 1990, 29:311–315.CrossRefGoogle Scholar
  40. 40.
    Vollmer TR, Northup J, Ringdahl JE, et al.: Functional analysis of severe tantrums displayed by children with language delays: an outclinic assessment. Behav Modif 1996, 20:97–115.CrossRefGoogle Scholar
  41. 41.
    Stoolmiller M: Synergistic interaction of child manageability problems and parent-discipline tactics in predicting future growth in externalizing behavior for boys. Dev Psychol 2001, 37:814–825.PubMedCrossRefGoogle Scholar
  42. 42.
    Caspi A, Elder GH Jr, Bem DJ: Moving against the world: life course patterns of explosive children. Dev Psychol 1987, 23:308–313.CrossRefGoogle Scholar
  43. 43.
    Stevenson J, Goodman R: Association between behaviour at age 3 years and adult criminality. Br J Psychiatry 2001, 179:197–202.PubMedCrossRefGoogle Scholar
  44. 44.
    Karsh KG, Repp AC, Dahlquist CM, Munk D: In vivo functional assessment and multi-element interventions for problem behaviors of students with disabilities in classroom settings. J Behav Educ 1995, 5:189–210.CrossRefGoogle Scholar
  45. 45.
    Carr EC, Newsom C: Demand-related tantrums: conceptualization and treatment. Behav Modif 1985, 9:403–426.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Michael Potegal
    • 1
    Email author
  • Gabrielle A. Carlson
  • David Margulies
  • Joann Basile
  • Zinoviy A. Gutkovich
  • Melanie Wall
  1. 1.Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisUSA

Personalised recommendations