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Ask the Mental Health Expert Archives 2001-2004

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Intermittent Explosive Disorder

Q. I have a student in my fourth grade classroom that has been diagnosed with Intermittent Explosive Disorder. I would like to know how to best handle his outbursts of extreme anger and misbehavior without making matters worse. Is there a plan for dealing with these disorders effectively?

A. I truly sympathize. In my view, you should not be in the position of having to manage these outbursts in the first place--at least, not without professional guidance and assistance.

One major problem is with the diagnosis of intermittent explosive disorder (IED)--a very poorly understood diagnosis that is most likely a hodge-podge of different underlying disorders. These may range from epileptiform conditions to undiagnosed bipolar disorder. Anything you can do to clarify this diagnosis with the student's psychiatrist--and I fervently hope he has a psychiatrist!--would be helpful. (Medications may sometimes help reduce these explosive behaviors considerably).

If you have a school psychologist, I would certainly insist that he or she be directly involved in any program aimed at dealing with this student's behaviors. Unfortunately, once someone is in the midst of an explosive outburst, there's not a great deal you can do that will not also disrupt your teaching. The issue is preventive treatment, and how best to realize that. Multi-modal treatment of extreme anger outbursts may involve problem solving, social skills training, relaxation training, anger management, and parent training (see Teichner et al, Rehabil Nurs 1999 Sep-Oct;24(5):207-11).

MH Kellner and BH Bry have described such anger management groups in day school settings, and you may want to contact them for more information (CPC Behavioral Healthcare, High Point Schools, Morganville, New Jersey 07751). Similarly, Dr. Steven Smith and University of Florida colleagues Ann Daunic and David Miller designed a 20-lesson anger management curriculum and tested it on 200 fourth and fifth graders in six elementary schools in Alachua and Bradford counties. Two years into the three-year multistage study of disruptive children and their better-behaved classmates, the researchers have found the lessons lead to improvements in all kids.

"When all kids get the instruction, there is a realization throughout the classroom that it's important," Smith says. "Not only do kids who are chronically disruptive start to act more like their well-behaving peers, but knowledge of problem-solving skills increases dramatically for everyone." [from an online article by [email protected] You can contact Dr. Smith at (352) 392-0701 Ext. 247, or at [email protected]].

In short, this is not a situation you should tackle by yourself. In the meantime, when an outburst occurs, immediately directing the student to a corner or quiet area of the classroom--or, if necessary--immediately accompanying him to the school nurse's office, may be the best you can do in the short term.

February 2003

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