Angry, agitated outbursts (AAOs) are a common precipitant of children's psychiatric hospitalization. In the hospital, AAOs present both management and diagnostic challenges, e.g., while they have recently been described as manic "rages", older studies suggest that they may be exacerbated temper tantrums. Factor analyses of 109 AAOs had by 46 hospitalized 4-12 year olds yielded 3 subsets of behaviors expressing different intensities of anger and 2 subsets expressing different intensities of distress (sadness). Cluster analysis of behavior time course supported the anger-distress distinction; the former behaviors are most probable at AAO onset and then decline while the latter are more evenly distributed across the outburst. Age trends, factor structure, and temporal organization of AAOs all indicate that they are exacerbated tantrums. The AAOs of children with anxiety or PDD diagnoses showed significantly more distress relative to anger. AAOs have clinical implications; their particular characteristics may have diagnostic significance.
Bibliographical noteFunding Information:
Acknowledgments This study was funded by an individual initiated award from Janssen Pharmaceutica to Dr. Carlson. Dr. Carlson is also a consultant to, and has received grant funding from, Janssen, Bristol Myers Squibb, Otsuka, and Eli Lilly, Sanofi-Aventis and NIMH. Dr. Potegal’s contribution to this study was supported by grants to him from the National Institute for Mental Health (R03-MH58739) and from the National Institute of Child Health and Human Development (R21 HD048426). We sincerely thank the staff of the inpatient unit without whose consultation and observations this study could not have been conducted.
- Disruptive behavior
- Emotion dysregulation