Teachers Triggering Temper Tantrums in Students

Mark-

I’m a middle school teacher. Actually I purchased your ebook to help me understand – and cope with – some of my unruly students. It has been an immense help. One question: How do you deal with a student who – out of the clear blue – slips into a temper tantrum?

Thanks,

M.

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Hi M.,

When a youngster reportedly has 'temper tantrums' in school, one of the first questions I always ask is whether this is also happening in the home. If it is, then is it only happening when homework or school-related matters arise, or is it happening in other situations as well? Thinking about under what conditions the kid loses control can help us determine where to start looking, what accommodations might be needed, and what other assessments and/or interventions might be needed.

Suppose that the kid is not having 'temper tantrums' at home, but is having them in school. While it is still possible that it is the kid's disability that is the primary contributor the problem (e.g., a kid with depression may "explode" in school when asked to concentrate or produce for long periods of time), we also need to look closely at how the school is handling the kid. Have they made enough accommodations? If there's a plan in place, have they followed it?


==> My Out-of-Control Teen: Help for Parents

In my experience, it seems that in some cases, school personnel have been responsible for triggering a temper tantrum or pushing the kid past his or her limits. Consider the following (and unfortunately true) example where a teacher knows a kid has Oppositional Defiant Disorder and that one of the kid's symptoms is that he "has to" finish something he is reading. On a particular day, the teacher instructs the class to put their books down as it is time to do another activity. The kid with ODD doesn't comply, and the teacher cues him again to put the book down and start the next task. The kid with ODD continues reading and tries to leave the room to go finish the book. The teacher refuses, blocks the doorway, and tries to take the book away. The kid with ODD "explodes," and swings at the teacher.

In the preceding example, one could argue that we should hold the youngster responsible for his behavior and that he has to learn that no matter what, he cannot take a swing at people. And on some level, I'd agree with that. The problem with the school disciplining the kid for it, however, is that such consequences may not reduce the likelihood of it happening again if the youngster's compulsion is that severe, and it fails to discipline the teacher who failed to respect the youngster's limits. If teachers "get in the face" of youngsters who are known to have behavior problems, then aren't they as responsible for what happens as the youngster?

In my opinion, when it comes to school, the teachers, as the adults, have the responsibility to manage themselves so that they don't engage in an escalating pattern with the youngster. And one of the most effective ways to help school personnel recognize the limits and what to do in particular situations is staff development. Teachers are often concerned that they will lose their authority with the class if they don't "discipline" an out-of-control child. The reality is that their "discipline" is often punitive and escalates a bad situation into a full-blown "temper tantrum."

Even when teachers are not provoking or causing the youngster's problems, they may be the youngster's last hope of restoring themselves to a calmer state. Learning how to stay calm, recognize the signs of impending explosions, and helping the youngster make a graceful exit so that they can calm themselves are important skills. Realizing that you are not "rewarding the youngster for misbehavior" if you allow them to switch to an activity that is inherently interesting to them and that helps them focus and calm themselves is also important. Maintaining your empathy for an explosive kid can make all the difference.

 

==> My Out-of-Control Teen: Help for Parents

Son getting excitement from the meltdowns...

Thanks Mark. I'm really excited about this program, and just watching the videos I did yesterday and doing the quiz has made me realize it's going to help immensely. My teens aren't out of control yet, but one of them certainly is an intense child and displays many of the traits you speak about. The explanation of that type of child getting excitement from the meltdowns is something I've thought for a long time but didn't know how to put in perspective. I am looking forward to this program and have already learned and implemented some of your ideas.

D.

Online Parent Support

Risperdol and the treatment of ODD...

Hello Mark, What do you know about Risperdol and the treatment of ODD?

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In choosing drugs for ODD, look for drugs that have been proven safe in children, have no long term side effects, and have been found in research studies to be effective in extremely aggressive children and adolescents or in Comorbid conditions which children with CD often have. Each drug has certain problems that need to be watched for. The current medical literature suggests three basic principles when using psychiatric drugs in children:

1. Start low

2. Go slow, and

3. Monitor carefully

Start low means that you do not start any of these drugs at the usual dose, or the maximum dose. When you have pneumonia, it can be a real emergency. You want to give people plenty of medicine right away, and if there are problems, then you reduce it. Unfortunately, many people use this same strategy in the medical treatment of ODD. The problem is that big doses can cause big problems, and when the problems affect your mind and personality, this usually means trouble for the person taking the medicines. So start with the lowest dose possible. For example, if you use a drug called Clonidine, for a boy about 60 lb., know that the dose that will probably work for most boys that size is two pills a day. If you gave him that to start out with, you might win and it would work. But if he happens to be sensitive to that drug, he could have big problems. Although they would be reversible problems, it would probably make most children and adolescents and or parents never want to take the drug again. So what do you do? Start with a half of a pill a day, about 25% of the usual dose. That way if the child is sensitive to the drug, it causes little problems. Many children respond to drugs at very low doses, far below the usual recommendations.

Re: go slow. ODD is not an acute illness. Less than 10% of the people I see with this need to be treated very quickly. Most people whom I see with this problem have had it for years. As a result, there is no need to increase the dose quickly. By going slowly, it is a lot easier to manage any side effects because things don't happen suddenly. Also, it is easier to find the lowest effective dose.

Re: monitor. For each of the medical treatments for ODD, there are specific side effects, which need to be checked regularly. Some common ones are monitoring weight so that people are gaining weight, watch for tics, watch for depression, checking blood pressure and pulse, checking blood tests and EKGs, and making sure parents know what the side effects are of the different medications. In this way, if there is a problem, you can pick it up early and avoid the horror stories, some of which are true, about the medical treatment of this problem.

The following are drugs which have been tested in adults and children who are violent and aggressive for a variety of reasons – from ADHD to brain damage, to Conduct Disorder, and of course ODD:

Atypical Antipsychotics—These drugs were first used for schizophrenia, and that is how they got this name. They are now commonly used for many conditions where people are not psychotic. As you can see, these are not benign medications. All of them can have serious side effects. As a result, they are not used for small problems.

Risperidone (Risperidal)—This drug was initially developed to be a safer drug for adult schizophrenia. It was then found to be effective in children with schizophrenia and other psychoses. Then it was found to be helpful in some children with Tic disorders. Based on those findings it has been used in Conduct Disorder and aggression. These studies are probably the most exciting news for the medical treatment of CD in 20 years. Risperidone is called Risperidal and comes in a variety of sizes; .25mg, .5 mg, 1mg, 2mg and liquid. It also helps Tourettes and psychosis. Usually this is given twice a day. This drug usually shows an effect within hours of a dose. There are more studies done on this drug than all the other atypical antipsychotics combined.

Olanzapine (Zyprexa)—This drug was recently approved for mania in adults. It has been studied less in children. However the early reports are positive. The usual dose is about 5-15 mg a day. It comes in 2.5 mg, 5mg and 10 mg. It is also called Zyprexa. It is more expensive than Risperidone and in adults is associated with more weight gain. This can be given once a day.

Quetiapine (Seroquel)—This drug is a little different than the above drugs as it seems to cause very little problems with things like tremor and stiffness. In adolescents it can lower the blood pressure so the dose has to be increased slower. The dosage range is 200-800 mg a day. There are only a few articles on its use in children and adolescents, but these have been quite positive for mood disorders. I do not know of any study on using in CD. It comes in a 25mg and 100 mg size and has to be given twice a day. It is called Seroquel.

Mark Hutten, M.A.

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