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WHAT ARE "RAGE ATTACKS?"
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There is no formal diagnosis called "rage attacks" or "storms," but these terms are often used by parents to describe their child's behavior. These events are explosive outbursts that are generally out of character for the student, often leading to our sense that the child is like "Jekyll and Hyde." These attacks or "storms," as they are sometimes called, are not just temper tantrums, where the goal would be to manipulate someone into doing something you want.
Rage attacks or storms often occur in the home but not at school, a fact that often misleads teachers into thinking that the parents are doing something wrong in the home. While there are cases where the problem does relate to parenting skills, often the explosive outbursts are related to school demands (homework demands are a common trigger).
If your student is having explosive outbursts in the home but not in school, instead of harboring doubts about the parents, you should thank the parents for having taught their child to somehow manage the problem in school, and you need to support the parents.
You may want to start by surveying for organization, homework, and sleep problems, and consider what other assessments might be needed. If you don't feel the need because the child is not explosive in school, then remember that:
(1) school problems should not endanger the family unit or the safety of family members, and
(2) if you don't address the school's role in the explosive outbursts, sooner or later, that student may start becoming explosive in school.
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PATHWAYS TO "RAGE ATTACKS:"
The following are some things to consider as they may be contributing to a student's explosive behavior:
There seems to be an increased risk of anger, irritability, and explosive outbursts associated with the following conditions: depression, Bipolar Disorder, Obsessive-Compulsive Disorder, autism spectrum disorders, panic attacks, phobias, sensory integration problems, epilepsy, and Conduct Disorder. That doesn't mean, however, that if a student has one of these diagnoses that you have necessarily found the "cause" of the explosive outbursts.
Some medications produce side effects that can increase the risk of these outbursts. If a student suddenly develops the problem and there has been a recent change in medication, the first step may be to ask the parent to consult with the prescribing physician. Be particularly alert to emerging aggressive behavior in a student put on an SSRI (Prozac, Paxil, Luvox, Zoloft, Celexa), as the student may be developing hypomania or mania from the medication.
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PATHWAYS (CONTINUED)
Students who have OCD or autism spectrum disorders tend to get "stuck" or perseverate on activities. If interrupted or asked to stop, they may become explosive.
Students who have sensory integration problems such as hypersensitivity to loud sounds or particular smells may find the cafeteria an impossible place and may easily become dysregulated in such a setting. Crowded hallways may also be overwhelming.
Some students have unrecognized pragmatic communication deficits and cannot communicate their frustration or needs. With no way to express themselves, they "explode."
Some students have problems with executive functions. Such students generally cannot handle transitions well, and if given multistep tasks or asked to make transitions quickly, will get overwhelmed.
Some students may have unrecognized learning disabilities that are contributing to ongoing frustration in the classroom. Just because a student doesn't meet some semi-arbitrary cutoff for help doesn't mean that the problem doesn't have to be accommodated and addressed.
The preceding are just some of the possibilities, which is why assessment is the first and most important step in dealing with "behavior" problems.
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LEARN MORE ABOUT IT:
Ross Greene's book, The Explosive Child
Myles BS, Southwick J: Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Pub. Co., 1999.
"Rage Attacks" on the Tourette Syndrome "Plus" web site.
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STRATEGIES TO CONSIDER:
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Seldom does a child attack or harm anyone during an episode unless someone tries to restrain them.
School personnel need to work closely with the prescribing physician to determine if medication is needed or if medication is actually causing the problem.
Plan on making a lot of accommodations and changes in the student's environment and work demands. Reducing the triggers to the attacks is your first step.
If the student appears agitated and about to "blow," do not argue with them. Keep your voice low and validate how they're feeling (e.g., "I hear that you feel very frustrated right now that Jamie broke your favorite pen.") You are their last hope to restore some balance before they totally lose control.
Students may be able to calm themselves if they are allowed to go to a "safe place" or "safe person" in the building. Such students should have a way to make a "graceful exit" from the classroom.
Some students benefit from activities that allow them to gently calm themselves (e.g., an activity that is engrossing), activities that allow them to get kinesthetic feedback (such as lifting heavy objects or making large arm movements), or going for a walk.
If a student does have a "rage attack," the episode will need to run its course, and only the student will know when it's over.
Do not try to talk to the student about the episode right after it appears over -- you may "rekindle" something. Some students need to sleep after a "storm," and you should let them. Allowing the student to engage in a self-selected gentle and calming activity is a good idea.
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YOU GO FIRST!
If a student has 'rage attacks,' then change starts with you (not them).
Even though it is understandable that you want to help them modify their behavior, implementing behavior modification is generally counterproductive until other changes have been made first. It is the adult's responsibility to disengage and not push the student past their limits.
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