By James Chandller MD FRCPC
One of the most common reasons a child comes to see me is that his behavior is out of control. Often they are easily frustrated, angry, or irritable. Often things are getting broken, or people are getting hurt, and usually there is lots of yelling. When parents look up information about this, it seems that the child could have symptoms of many illnesses, but right now the main question is whether or not they have bipolar illness. a google search of bipolar and temper tantrums in children yields 250,000 results!
You get the best results if you have the best diagnosis. Here is how we separate out the causes of rages and tantrums.
Children who have all the signs of bipolar disorder, which means mania, (See bipolar handout) and have it for at least a week. I have never seen a child under 10 with this. I see many 13-16 year olds who have this. This is quite severe, and usually leads to further bipolar illness as adults.
Right
now in 2011, this is called severe mood dysregulation
or SMD. These children are almost always
irritable, and never have a really high or elevated mood. They have huge anger outbursts with at least
3 signs of mania plus distractibility. These children usually end up having
depression and anxiety when they are older, and even though they do have a few
manic symptoms, they don’t turn out to have bipolar disorder. (1)
These
children can’t control their emotions. Little things make them very excited,
very angry, very frustrated, and very mad. All of their emotions, good or bad,
seem extreme. Besides this, they have signs of ADHD and can’t sit still, are
hyperactive, and do things without thinking. Their thoughts are also not under
control and they immediately do everything they think of, never consider the
risk to themselves or others, and never know why they did anything. This profile of dysregulation
of moods, behavior and thinking doesn’t really have a good name right now
except dysregulation profile. These children end up
with drug abuse, ADHD, depression, personality disorders, and anxiety, but not
bipolar disorder.
A
combination of different disorders of neglect and trauma can cause horrible
tantrums and moodiness, but the cause is totally different from bipolar
illness. These are described in the youtube videos on
attachment, PTSD, and dissociation.
When
autistic children get overwhelmed, they can decompensate in a way that looks
like bipolar illness or psychosis.
Exposure
to alcohol during pregnancy can lead to a host of problems that cause temper
tantrums, out of control behavior, no inhibitions, and aggression
What seems to be out of control isn’t always. Anger outbursts can be very useful for controlling others and getting your way.
This should be at the top of the list after age 13
Concussion, stroke, Intellectual disabilities, seizures, tumor, other rare medical problems
Most of the children I see don’t have one cause. Here are some sadly typical examples.
Drugs, Conduct Disorder, and being sexually abused
Autism and abuse related disorders
Fetal Alcohol Syndrome, Neglect, Abuse, ADHD
Full Bipolar Disorder, Drugs
No matter what the cause, out of control kids need treatment as soon as possible. The treatment usually requires the right medication, the right parenting techniques, changes in the environment, and counseling. The medical treatment will depend on the diagnosis, which is why I am seeing the child!
Althoff RR. Dysregulated
children reconsidered. J Am Acad Child Adolesc Psychiatry. 2010 Apr;49(4):302-5.