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Anger Overload in Children: Diagnostic and Treatment Issues

Learn how prolonged, intense anger outbursts in children may be related to other disorders-or not-and how to cope.

By David Gottlieb, Ph.D.

Anger reactions in some children are quite frequent and troubling to parents and teachers who witness them. The child' s intense anger may erupt quickly and intensely in reaction to limit setting by adults, to teasing or to seemingly minor criticism by peers or adults. This is a distinct psychological problem in children which is separate from diagnoses such as attention-deficit/hyperactivity disorder, bipolar disorder, and oppositional defiant disorder. It can co-occur with AD/HD or learning disabilities, but may also occur separately from these diagnoses.

At this time, the diagnostic manual, DSM-IV*, does not consider anger disorders as a separate category like depression and anxiety. However, many mental health professionals feel it is a category unto itself and are devising treatment strategies for anger problems. Daniel Goleman (in Emotional Intelligence) and John Ratey and Catherine Johnson (in Shadow Syndromes) offer cogent reviews of this literature. Goleman uses the term "anger rush" to describe anger problems in adults, while Ratey and Johnson refer to a shadow syndrome for "intermittent anger disorder" in adults. Anger disturbances in children need to be classified as a discrete psychological problem as well, and they require particular treatment strategies. This article defines the syndrome and outlines effective treatment strategies.

Diagnostic Issues

The term "anger overload" is used to refer to the intense anger response which has been the presenting problem for a number of young children and preadolescents seen in a suburban outpatient practice. There is an intense and quick reaction by the child to a perceived insult or rejection. The rejection can seem quite minor to parents or others. For example, a parent saying "no" to something the child has been looking forward to doing can trigger an intense period of screaming and sometimes hitting, kicking or biting. Another common situation which can trigger anger overload may occur in a game with peers. It can involve a disagreement on how the game should be played or its outcome. Parents often explain to the mental health professional that these reactions have been going on since early childhood in one form or another. It is frequently reported that these children become sassy and disrespectful: they will not stop talking or yelling when they are upset. At other times, when their anger has not been stimulated, these children can be well-mannered and caring.

The problem is called anger overload because it is more severe than a temporary anger reaction lasting only a few minutes. With anger overload, the child becomes totally consumed by his angry thoughts and feelings. He or she is unable to stop screaming, or in some cases, acting out physically, even when parents try to distract the child or try to enforce limits and consequences. The anger can last as long as an hour, with the child tuning out the thoughts, sounds or soothing words of others.

Another significant characteristic is that these children are sometimes risk takers. They enjoy more physical play than their peers and like taking chances in playground games or in the classroom when they feel confident about their abilities. Other children are often in awe of their daring or scared of their seemingly rough demeanor. Perhaps most interesting is that these very same risk takers can be unsure of themselves and avoid engaging in other situations where they lack confidence. A number of these children have mild learning disabilities, and feel uncomfortable about their performance in class when their learning disability is involved. They prefer to avoid assignments where their deficits can be exposed, sometimes reacting with anger even if the teacher privately pushes them to do the work with which they are uncomfortable.

One diagnostic fallacy is to assume that these children have bipolar disorder. Dr. Dimitri and Ms. Janice Papolos recently devoted a full book to the disorder (The Bipolar Child, 1999). The rages of children with bipolar disorder are more intense and lengthy than for the children we are currently discussing. The Papoloses describe (page 13) that for children with bipolar, these angers can go on for several hours and occur several times a day. In children with bipolar, there is often physical destruction or harm to something or someone. In children with anger overload, the outburst is often brief, less than half an hour, and while there may be physical acting out, usually no one is hurt. In addition, children with bipolar have other symptoms such as periods of mania, grandiosity, intense silliness or hypersexuality.

Anger overload is also different from attention-deficit hyperactivity disorder. Children with AD/HD have significant distractibility, which occurs regularly in school and/or the home. By contrast, children with brief outbursts of anger often pay attention well when they are not "overheated" emotionally. In addition, children with AD/HD may have hyperactive movements throughout the day; whereas children with anger overload only seem hyperactive when they are overstimulated with feelings of anger. Finally, children with AD/HD are often impulsive in a variety of situations, many of which have nothing to do with anger.

It is possible, however, for children to have symptoms of AD/HD and anger overload. This combination is especially difficult for parents to manage. Behavioral strategies for AD/HD are not as effective because the child becomes excessively angry despite efforts by others to focus his attention elsewhere. Sometimes, professionals then tell the parents or teachers that they are not applying behavior modification techniques properly. What may work for a child who has AD/HD may not be as effective for a child who also has the problem of anger overload.

Another diagnostic category which can be differentiated from anger overload is oppositional defiant disorder. Oppositional children have a continuing pattern of disobedience to adult demands, whereas children with anger overload are only defiant when their anger is stimulated. The situations which trigger their anger are more restricted. There are certain areas which have special importance to them, such as winning a game, buying a toy or being seen as successful in school. In most other situations, they are described by their parents as sweet and cooperative. Few, if any, oppositional defiant children are described by their parents in this manner.

Copyright © 2002 CHADD. All Rights Reserved. For more information visit CHADD


Comments from GreatSchools.org readers

06/5/2012:
"My 5 yr old daughter is violent when she is angry. If she fights with her younger siblings or is told to do something she doesn't like she gets very angry. I am not sure if she has a problem or needs to learn how to deal with being upset. If anyone has any advise I would be happy to hear it; I am not sure what else to do. "
04/23/2012:
"Hi my grandson is 4 yrs old and he is very smart-he's no problem at home but at school he has outburst and looks very different in the face when this happens. he throws things, hits children, screams and just has a terrible time I need help to find out what is goin on i don't want anyone to get hurt..Thanks "
03/13/2012:
"I have a 17 year old cousin named Yolanda she has anger issues such as mood swings,and major outburst which contain profanity every 2.5 seconds she also does ot know how to keep her alien fingers to herself....pleas somebody give me advice....I NEED HELPP!!!!!!!!!!!!!!!!!!!!!!!!!! "
03/8/2012:
"This sounds just llike my grandson. He is a sweet and wonderful child, but when he goes into his rages he kicks, hits throws things, turns over furniture. Now he is doing this at school. He is 5 yrs. old in kindergarden and he is already suspended for a wk. because of his anger outburst. This is the second time this yr. The teachers say he gets in trouble everyday. I know what a good kid he is I don't understand how he is doing all this at school and not so much at home. The teachers and principle are not helping at all. They just don't want to put up with him anymore they aren't interested in trying to help him. They already have labled him as a bad kid. I know there is something wrong somewhere with him. He has always had a temper but nothing like this past yr. I thought maybe juvenile dibeties I'm just struggling for answers looking everywhere. When I bring this up to the parents they just tell me oh there is nothing wrong it's just him. I know different, I have practill! y rasied him. They live here with us I spend more time with him. I need answeres.... "
12/5/2011:
"I wrote this article in 2002 for Attention magazine, and if you want more information, check for my new book on Amazon, or check my blog on blogspot or email me at drdavegot@gmail.com. There can be many causes of anger and disobedience, as my book points out. Some children have a short fuse. Their brain is not mature yet, and they have difficulty controlling their emotional reactions. I try to give parents ways to help these children. "
11/2/2011:
"It's very nice that 'professionals', many of them with prescription pads at the ready, can conveniently categorize children as having "anger overload" or "oppositional defiant disorder". Have these 'professionals' ever considered that these children might be routinely emotionally, physically, and/or sexually abused at home or by someone close to them? I was a "difficult", "angry" child in elementary school. Many times, I was punished by my teachers, NONE of whom ever guessed that I was my mother's "whipping boy" at home. I went to the same exclusive K-12 prep school as President Obama. My mother was also a single parent, who acted meek and distressed at the parent conferences she had to attend frequently when I was in 4th grade. NONE of my teachers at this expensive school ever guessed that this meek single mother was a psychotic, sadistic Narcissist at home to her only child. My experiences have taught me (1) that teachers are rarely worthwhile, and (2) that psychologists are worth even less. "
09/23/2011:
"For the last two years my son has been struggling at school, not so much with his school work, more so keeping up with the punishments he's been getting from the teachers. I of course, being his mother, am there to defend and protect him but mainly to get to the bottom of any problems that arise. I am always truthful and believe neither of my children are angels, well not all the time anyway, but I do believe he has been targeted by certain teachers at this school for the last two years. I haven't seen any encouragement or direction given from the teachers to my son and I believe this has hurt him, deeply on the inside. He has changed so, so much since the start of school 2010. I didn't like where he was placed in the beginning of 2010 and tried my damnedest to move him to another class and I was pretty much laughed at by the deputy principal!! Meetings and meetings have gone by, mostly requested by myself and I feel the teachers involved in these meetings manage to ma! nipulate my thoughts and twist the situation, I end up leaving thinking everything is going to be ok. But where is the change??? The only change I have witnessed is the change in my son. How angry he has become and how hurt he really is deep inside. I believe these teachers have A LOT to do with my 10 year olds behaviour, I don't doubt it at all and something needs to be done about it. I will do whatever it takes to get my boy back on track because that is more than what he deserves. I have read this article and it is a real eye opener. I have taken it on board, will try your strategies and hopefully get my happy boy back. As for the teachers at the school, I hope they are happy with the jobs they are doing and that they can rest easy knowing they have done everything and all in their power and ability to help the children that are in their hands. Our Children. Thank you "
03/21/2011:
"My husband and I have a 2 yr 9 month old. His anger began around 10 or 11 months. This article has enlightened the situation tremendously but we have already exhausted our options including the treatment section. We have spoken to several doctors and he is having a neuro scan in two days. We are so afraid if we do not get a grip on what is going on, we could fear him in a later age. We have been considered having another child, however we fear bringing one into the household with our son. He has been evaluated and screened by a developmental agency and has occupational, speech, and a behavior specialists working with him. The services have been conducted for 5 months now and we do not see a change. We thought it was lack of communication, now that that is improving, we don't know where to turn. I have been blown off by doctors and other moms with children this age. They have all informed me this is normal and will pass. I have been around small children my entire life and know something is wrong. Please, if anyone can advise us on something else to try, please tell me. We are exhausted and so worried. Please help us teach ourselves how to deal with this. Thank you."
01/10/2011:
"This article sounds just like my 11 year old son. About once a month or sometime even longer, son has a thirty minute rage fest. No one can calm him down. Kicks walls, tries to get away from people and throws chairs. The school usually calls me to pick him up and a two day suspension follows. This behavior did not happen last year and he was very successful. This behavior began when he was in second grade. A teacher held him down while another student hit him. (Yes teacher was fired.) He is on medication, but not adhd meds because of reactions to. (Anxiety med, Bi Polar Meds)He is very remorseful after the meltdown and say what a bad child he is. I know he is not. Dad and I take him to see his psychiatrist regularly. He is in a new school this year with a new behvior specialist with him. He does have an IEP for other health impairments. When I read your article, the meltdowns sound just like this. Behaviors only happen at school. Gets grounded regularly with no meltdowns. Says feels safe at home. "
09/7/2010:
"this is the same problem Ive had that I now see in my 12 yr old son,and its bad!I always knew that it was not psychological but abnormal brain function.I went through hell as a teenager and I desperately need to help him.!!thanks"
07/19/2010:
"Dear to anyone who is worried you do have reasons to be worried,i can answer why your son/daughter may have turened devilish.See ths is normal but may be very dangerous at a young age(17 or under) it is actually dangerous at anyage as well.In school you might want to have someone or a teacher keep an eye on them. during school may be the cause on when they start to behave extremley... well not themselves.It could be just anyone picking on them or making threats, or maybe just a 'friend' bothering them. Please please never leave them alone you might regret it even with older sybilings.I know from personal experence,my cousin once came up to me with a knife at his neck telling me wether he should do it or not, he has extreme anger problems. But he has changed so so so so much & im about to tell you why and how you can do this. But he still has alittle bit of anger but not so much.Ok to get them to change you must must tell them anything,trick them im not saying to lie im sayin! g to use their fears.And you know them you have got to make a change."
04/12/2010:
"This is my 9 year old to a T. He has ADD and was tested by s doctor out of his Psyciatrist office. He was then Diagnosed with Oppositional Defiant Disorder. He is on the patch for the ADD and recently has been perscribed Abilify for the Defiant. It is ager that is bottled up.. Talk to your childs Psych and recomend testing. My sons doctor dod the pictures that look like blobs to see what he sees in the pics. This isd how he was diagnosed. Extremely a right on dr. I was also tested and I have borderline personality and depression and anxiety. This same dr tested me and very accurate"
04/8/2010:
"I think that anger comes within a child when they go through a lot of things in life. If their parents got split up or his/her mother was abused by the father that can also cause anger. I agree with this article I think it give us a lot to think about and how to deal with this issue"
03/1/2010:
"everything is a disorder these days. PhDs have to put a label on everything so that they can diagnose and write about it, but that doesn't make some of these disorders anything other than normal mammal behavior. good thing we don't give drugs to all the animals in the wild every time they challenge their alpha male. geez"
01/25/2010:
"where do i start, my son was and is the most beautiful boy i have ever seen his smiles can light up the world!. but i have to admit from about 16mth old ( which i thought was coming in to the the terrible two's) he became very difficult to handle. not so that i was embarassed or anything it just felt i was telling him off all the time.As time has progressed i've noticed other things more talking and aruging with himself talking to an imaginary friend and gtting very angry! swearing and things sayings awful macarb things, he doesn't now understand been disaplined anymore he'll do the time out but it doesn'register what for even though u have told why . He will apologise then its back to the begining. I love my little man dearly but our relationship is in tatters and i'm now a single mum with a little daughter whom again is my apple and she nr 17mth old and showing the same tendices i'm hoping throught mimicing her brother, i wake dreading the day ,i'm not enjoying my children! i'm now shouting and screaming at them all day we have got into such a horrible routine, i feel like now its my job to be a demon mom, not at all what i want or am like i hate it,i have no energy left for the fun things now kyle will destroy the house his anger is flash here one min gone the next but inthat time his face changes its dam right evil and i'm scared (he's 4yrs)i know have his father saying he has to go live him because i can't cope, which is never gonna happen, cause i ahve coped since both were born, without any help, but i need to know why my angel is been taken over by the devil."
09/29/2009:
"Great information!! I have a son who just turned 3, ordinarily very well behaved and very sweet, lately he has these spurts of anger and physical violence. He has become sort of a dare devil so to speak lately also. As his mother, I am very frightened about this. Its almost like he is 2 different people, sorta like Jekyll and Hyde. It breaks my heart to see him this way and I am so disturbed by it. I don't know how to deal with this. At first I thought it was just toddler tantrums, but I am not so sure about that anymore. Does anyone have any advice. Thanks"
07/8/2009:
"my 8 yr old soon ha the symtoms of anger overload and bipoar but no one will liten how do i get help"
04/17/2009:
"I have read Dr. David Gottlieb's article 'Anger Overload In Children: Diagnostic And Treatment Issues'. I was pleased to note that Dr. Demitri Papolos and his wife Janice Papolos and their book, 'The Bipolar Child' was credited in Dr. Gottlieb's aritcle. 'The Bipolar Child' is now in its third edition. It has become my primary reference after several years of me, and the medical community, trying to figure out the cause of the 'explosive' behavior and rapid mood swings in my now 8 year old grandson. I am confident that I 'found my grandson' in the pages of 'The Bipolar Child'! In his article Dr. Gottlieb notes the following: 'In addition, children with bipolar have other symptoms such as periods of mania, grandiosity, intense silliness or hypersexuality'. To which I would respond, in very young children, 'Not necessarily'! Attempting to diagnose very young children using the DSM IV may, if one is lucky, get a non-descript 'mood disorder' or hesitant and equally nondescript Bipolar NOS. If one is not fortunate enough to get the Bipolar NOS the diagnosis may not come for years, until full-blown bipolar disorder becomes evident in the late teens or early 20's! Then one may be told, 'That doesn't mean that we missed anything' in the years earlier. May I suggest that after you read Dr. Gottlieb's informative article, you are not certain you have 'found your child' you may consider visiting the Juvenile Bipolar Research Foundation's website: www.jbrf.org Incidently Dr. Gottlieb, in my eight-year-old grandson's case: there is often physical destruction or harm to something or someone. We, and his teachers, have the bruises to validate the 'harm to someone' That 'someone' can even be, and often is, himself! "
04/2/2009:
"While searching articles and pathology of an agry child I came opon your website. This article on anger overload was a real eye opener. i have printed it out for my son and daughter-in-law in hopes that it will lead to a better understanding and create a need for further exploration of their eight year old's problem. Thank you for offering such a helpful website! Thank you for offering this site at no charge. I will pass this on to other parents and grandparents."
02/23/2009:
"Growing up with a learning disorder, specifically speech and language, has partly fueled my anger or 'sudden angry outbursts.' Partly from my father's verbal abuse and ocassional physical abuse. It surprised me how quickly how angry I got, over situations like a perceived insult or rejection. As a kid I was very sensitive and sweet, as I like to think but I was easily upset over the small things. I remember when I was in third grade, a geeky kid was being picked on and it bothered me to a point where I exploded with anger then later it turned into tears. Looking back on my childhood I see my anger had alienated me. I am 19 years old. I am declassified in speech and language delayed. I have been for the past 10 years, I got into all the colleges I applied to and made the Dean's List for the first semester. Although my grades are good, I still have occasional flare ups with my anger. It scares me to be honest. I never hit a person, I just scream and yell to the point where I lose my voice. (Then I cry) I want to have my anger under control, I have tried mostly everything but nothing seems to work. I am open to advice! "
02/11/2009:
"My son is in 3rd grade and has been having anger issues since 1st grade. This article describes him perfectly. We have done counseling at school and at a private counselor's office. I have even talked to his physician about his anger. I feel that we are at a dead end. He is such a caring and well behaved kid 90% of the time. It is just comes on so fast and it is very explosive when it happens. I am so afraid that he is going to not have a social life of any kind. When I go to the school to help out with a party or anything, the other kids in his class want to know what is wrong with him, because he does get so angry with them at what seems like small things. Me and his Dad are divorced. His dad was very abusive, mentally and physically to me. Never physical with either of my boys, just mentally he was very abusive to all of us. And still is I believe when the boys go over there for his visitation he is this way with them. My youngest son who is 6, does not show the same ange! r like his older brother. Any advice would be greatly appreciated. "
10/21/2008:
"Like this grandmother, I too was struck by how this article spoke to my kindergarten age son's problems with explosive anger. I actually was able to track down Dr. Gottlieb at his Illinois office. He suggested those of us interested in more on this topic read The Explosive Child by Ross Greene. While the book isn't all about anger overload, it does touch on the subject. He also suggested interviewing potential therapists/counselors by asking if they have read this book or are familiar with it. Also he suggested searching for therapists who deal exclusively with children and who have experienced in dealing with anger issues. We are fortunate to have a school that is very willing to work with us, despite my son's two extreme melt downs since school began. We are working on giving him words to use, like Stop and Listen, when he feels this anger overload coming on. The adults who work with him all know about this language and have agreed to pay special attention when he uses it ! and to step back and give him time to calm down. As Dr. Gottlieb says, it is an incremental journey but one well worth taking. I'd be interested in hearing from other parents with children who present the characteristics of anger overload. It may be that a website to share our stories is in order, as well as a call for more research into this condition."
10/21/2008:
"I would like more information about the author of this piece, as my son is having very similar episodes and has been expelled from kindergarten twice in a month. If anyone has more info on the author the anger overload, please reply,."
09/30/2008:
"Dr. Gottlieb, this article is wonderful. Sounds like my 4 1/2 year old grandson who is wonderful. Is there a doctor in Houston that you feel can work with us. I do not want him misdiagnosed with bipolor or something else for the rest of his life. I feel this is so important before he starts school next year to work on your suggestions. Max is so smart and sweet, but he does have these short outburst. Schools tend to put all children in label buckets and it sticks with them. I appreciate any help you can give. thank you for this article"
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