Citation

Carlson GA, Singh MK, Amaya-Jackson L, Benton TD, Althoff RR, Bellonci C, Bostic JQ, Chua JD, Findling RL, Galanter CA, Gerson RS, Sorter MT, Stringaris A, Waxmonsky JG, McClellan JM. J. Am. Acad. Child Adolesc. Psychiatry 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2022.03.014

PMID

35358662

Abstract

OBJECTIVE: Impairing emotional outbursts, defined by extreme anger or distress in response to relatively ordinary frustrations and disappointments, impact all mental health systems of care, emergency departments, schools and juvenile justice programs. However, the prevalence, outcome and impact of outbursts are difficult to quantify because they are transdiagnostic and not explicitly defined by our current nosology. Research variably addresses outbursts under the rubrics of tantrums, anger, irritability, aggression, rage attacks and/or emotional and behavioral dysregulation. Consistent methods for identifying and assessing impairing emotional outbursts across development or systems of care are lacking.

METHOD: The American Academy of Child and Adolescent Psychiatry Presidential Task Force (2019-2021), conducted a narrative review addressing impairing emotional outbursts within the limitations of the existing literature and independent of diagnosis.

RESULTS: Extrapolating from the existing literature, best estimates suggest that outbursts occur in 4 - 10% of community children (preschoolers through adolescents). Impairing emotional outbursts may respond to successful treatment of the primary disorder, especially for some children with attention deficit hyperactivity disorder whose medications have been optimized. However, outbursts are generally multidetermined and often represent maladaptive or deficient coping strategies and responses.

CONCLUSION: Evidence-based strategies are necessary to address factors that trigger, reinforce or excuse the behaviors, and to enhance problem-solving skills. Unfortunately, currently available interventions yield only modest effect sizes for treatment effect. More specific definitions and measures are needed to track and quantify outbursts, and to design and assess the effectiveness of interventions. We clearly need better treatments.

Language: en

Keywords

mood; reactive aggression; dysregulation; outbursts; phasic irritability