Raising Rage Up The Flagpole
edited on 11/12/05 to update links
edited on 12/16/03 to add tips for coping link from CABF
Rage has been tossed around, discussed anecdotally and hotly debated countless times. Many will still incorrectly include *rage* in the TS bag. Clinically, rage has been documented, studied and published, and is generally accepted by knowledgable TS professionals to NOT be part and parcel to TS (please see the references cited at the end of this article.)
The definition of rage in the Random House Websters Dictionary is: violent anger; fury; a fit of violent anger. An online Merriam Webster dictionary defines rage as: violent and uncontrolled anger; a fit of violent wrath.
When *rage* is present, serious intervention is a must. If a child has significant behavioral issues, the cause needs to be weeded out. It should never be accepted as part of TS, OCD, ADHD or even bipolar disorder. If we had accepted our daughter's diagnosis as TS, OCD, ADHD with Major Depression and included her out-of-control behavior as part of these diagnoses, we would most likely still be on a very nasty road, and her bipolar disorder would have remained undiagnosed and untreated.
*Rage* is such an arguable word. Its definition has become so muddied that it no longer seems to be a meaningful description for sorting out serious behavior problems, in my opinion. There is no DSM IV diagnosis of *rage*. The DSM IV provides criteria for diagnosis of Intermittent Explosive Disorder or Oppositional Defiant Disorder.
*Rage* - violent anger, unacceptable wild behavior, out-of-control anger, destructiveness, inappropriate temper tantrums, violence towards people or property - needs to be evaluated carefully and sorted out in order to be effectively and appropriately managed.
It seems, however, that the word *rage* means many different things to different people. What one person finds explosive and unacceptable may to another person be just experiencing their child weathering a bad moment. In my own case, my husband and I are both very opinionated, and we have three very opinionated children. My children are all capable of and have on many occasions expressed their point of view, opinion or their unhappiness VERY loudly and with LOTS of anger. This happens even on a very good day around here. So, someone with usually docile, quiet, compliant children, who may be around my children, might term my childrens behaviors as *rage*. Or if one of their usually docile, quiet, compliant children pitched a big snit, that might be viewed by the parent as *rage*.
Causes
Ross Greene, author of The Explosive Child dedicates an entire chapter to Pathways to Inflexibility - Explosiveness. He details the following categories in this chapter: Difficult Temperament, ADHD and Executive Function Deficits, Social Skills Deficits, Language Processing, Mood, Anxiety, Nonverbal Learning Disability, Sensory Integration Dysfunction, and Other Factors Contributing to Cumulative Frustration. He describes at length how any or all of these factors may contribute to explosive behavior. However, the book also details how we can re-frame our thinking when managing our inflexible children. I believe The Explosive Child is an excellent resource for anyone dealing with an inflexible child. This book has been the single best help in teaching us how to better manage our daughter.
Here are some additional observations regarding *rage*:
Frustration - My oldest son needs time alone after school. If I push him with a rushed agenda at this time of day, the stress will cause him to really blow up. Usually it is a short storm/episode but definitely explosive. For him, quiet unstructured time after school is a release from the stress of the structure of school.
Rigid Influences = Explosive Child - My daughter has a consistently negative reaction to rigid domineering influences. To this day, my daughter can get backed into a corner by domineering personality types, and the stress of this causes her to be oppositional and sometimes explosive.
This rigid influence category could also include teachers who are inflexible and refuse to treat individuals as individuals. Repeatedly, I have heard of teachers who can and will back a child into a corner, inciting a child to react explosively. Many times this is how a child initially enters the criminal justice system. This could happen regardless of any medical diagnoses. My sister also sees this in the Special Education arena. Kids with autism, MR, etc., can be goaded by inflexible instructors into explosive behavior. I have read of this exact scenario countless times regarding bipolar disorder. Im NOT saying I believe the explosive behavior is OKAY, just that the management of it should be to remove the inflexible, rigid influences and protect the child from this style of person.
OCD perseveration - When OCD *needs* are thwarted, the child may exhibit meltdowns, which some might describe as *rage*. The Tamar Chansky book, Freeing Your Child From Obsessive-Compulsive Disorder, is very helpful at teaching a parent steps to helping a child in this area. My daughter is capable of having a meltdown over an OCD-ish need. I use the word meltdown here because although many would probably call it *rage*, this OCD-ish unacceptable behavior is vastly different than the SSRI-induced mania that she had in the past.
Learned behavior - Getting away with rudeness. A child using tears and tantrums to get what he or she wants. Parents modeling bad behavior. Parents excusing bad behavior. Parents in denial about their childs behavior. Parents walking on eggshells around their child because of sympathy for a disorder, resulting in excusing bad behavior.
Personality Type - Dramatic - Accepting a dramatic child may be particularly hard if a parent is a laid-back type.
Acceptance of Emotion - Mad can be Okay. Children should be allowed to be mad. Sometimes mad is good and appropriate and okay. It is never appropriate to hurt, hit, etc., but mad IS okay!
The above are probably *treatable* with parenting technique modifications or limiting exposure to the stressors. However, the following must be medically treated and no amount of behavioral intervention will treat the underlying medical problem:
Medical causes - Psychotic or seizure disorder-induced, medication-induced, blood sugar imbalance, mania. People in these states are not reachable. Intervention during the event is most probably fruitless. Ensuring the childs safety and the safety of others is probably the only attainable immediate goal. The person is out of touch and not reachable.
Sometimes getting to the root cause of *rage* requires us to take a very hard look at ourselves and our parenting techniques. Sometimes getting to the root cause requires dogged determination and persistence with medical professionals until all the questions are answered. I know of a case where it took a few years of persistence in seeking appropriate medical intervention for one mother to finally find the cause of her sons *rages*. The BEAM EEG - a newer technology for determining brain electrical activity - pinpointed electrical activity deep in her sons brain, which was undetectable by the older technology. Once this was detected, her son could start treatment for his previously undetected problem.
Whatever the causes, *rage* is never acceptable. Firmly defining the line for tolerance, observation, recognizing and accepting that the parent DOES have a role in how rage is played out and educating ourselves on how to better manage the behaviors are important factors in helping our children better manage their own behaviors. Ross Greenes, The Explosive Child, is the single best resource I have found for this kind of help, and I highly recommend it as a must-read for parents with inflexible children.
It is important to determine the cause of unacceptable behavior, so appropriate treatment can be pursued. Furthermore, it is important to teach a child that their behaviors have consequences, and they are responsible for the consequences of their actions. If they impulsively break something, they ARE responsible, regardless the cause of the impulsivity. If they destroy a door in a manic state, although they didnt have control of their behavior and couldnt prevent it perhaps, they are STILL responsible for it.
Forgiving the unacceptable behavior is also a very important process. Our children should feel forgiveness and unconditional love from us, and they need to learn to forgive themselves. This is probably an overlooked area. When problems are identified and sorted out and treated, the child needs to be able to look back on their actions and forgive themselves and know they have been forgiven.
Always,
TreadinWater
Websites with discussions of *rage* in relation to Tourette Syndrome:
Rage
About TS
Helpful Books:
The Explosive Child, by Ross Greene
The Explosive Child
Tamar Chansky's, Freeing Your Child From Obsessive-Compulsive Disorder.
Information about both of these books can be found in the Books section.
TS Books
Abstracts of journal studies cited below can be located on PubMed by typing in the PMID entry number:
PubMed search
The Bruun and Budman journal reports, from the Long Island Study on rage:
PMID entry 11026181
PMID entry 9862603
PMID entry 9862602
The journal reports from the Tourette International Consortium report:
PMID entry 10972415
More extracts from this journal report are included here:
The TIC database journal report
Tips for coping :
Managing Bipolar Disorder
{ezop note: edited to open links in new window]
edited on 11/12/05 to update links
edited on 12/16/03 to add tips for coping link from CABF
Rage has been tossed around, discussed anecdotally and hotly debated countless times. Many will still incorrectly include *rage* in the TS bag. Clinically, rage has been documented, studied and published, and is generally accepted by knowledgable TS professionals to NOT be part and parcel to TS (please see the references cited at the end of this article.)
The definition of rage in the Random House Websters Dictionary is: violent anger; fury; a fit of violent anger. An online Merriam Webster dictionary defines rage as: violent and uncontrolled anger; a fit of violent wrath.
When *rage* is present, serious intervention is a must. If a child has significant behavioral issues, the cause needs to be weeded out. It should never be accepted as part of TS, OCD, ADHD or even bipolar disorder. If we had accepted our daughter's diagnosis as TS, OCD, ADHD with Major Depression and included her out-of-control behavior as part of these diagnoses, we would most likely still be on a very nasty road, and her bipolar disorder would have remained undiagnosed and untreated.
*Rage* is such an arguable word. Its definition has become so muddied that it no longer seems to be a meaningful description for sorting out serious behavior problems, in my opinion. There is no DSM IV diagnosis of *rage*. The DSM IV provides criteria for diagnosis of Intermittent Explosive Disorder or Oppositional Defiant Disorder.
*Rage* - violent anger, unacceptable wild behavior, out-of-control anger, destructiveness, inappropriate temper tantrums, violence towards people or property - needs to be evaluated carefully and sorted out in order to be effectively and appropriately managed.
It seems, however, that the word *rage* means many different things to different people. What one person finds explosive and unacceptable may to another person be just experiencing their child weathering a bad moment. In my own case, my husband and I are both very opinionated, and we have three very opinionated children. My children are all capable of and have on many occasions expressed their point of view, opinion or their unhappiness VERY loudly and with LOTS of anger. This happens even on a very good day around here. So, someone with usually docile, quiet, compliant children, who may be around my children, might term my childrens behaviors as *rage*. Or if one of their usually docile, quiet, compliant children pitched a big snit, that might be viewed by the parent as *rage*.
Causes
Ross Greene, author of The Explosive Child dedicates an entire chapter to Pathways to Inflexibility - Explosiveness. He details the following categories in this chapter: Difficult Temperament, ADHD and Executive Function Deficits, Social Skills Deficits, Language Processing, Mood, Anxiety, Nonverbal Learning Disability, Sensory Integration Dysfunction, and Other Factors Contributing to Cumulative Frustration. He describes at length how any or all of these factors may contribute to explosive behavior. However, the book also details how we can re-frame our thinking when managing our inflexible children. I believe The Explosive Child is an excellent resource for anyone dealing with an inflexible child. This book has been the single best help in teaching us how to better manage our daughter.
Here are some additional observations regarding *rage*:
Frustration - My oldest son needs time alone after school. If I push him with a rushed agenda at this time of day, the stress will cause him to really blow up. Usually it is a short storm/episode but definitely explosive. For him, quiet unstructured time after school is a release from the stress of the structure of school.
Rigid Influences = Explosive Child - My daughter has a consistently negative reaction to rigid domineering influences. To this day, my daughter can get backed into a corner by domineering personality types, and the stress of this causes her to be oppositional and sometimes explosive.
This rigid influence category could also include teachers who are inflexible and refuse to treat individuals as individuals. Repeatedly, I have heard of teachers who can and will back a child into a corner, inciting a child to react explosively. Many times this is how a child initially enters the criminal justice system. This could happen regardless of any medical diagnoses. My sister also sees this in the Special Education arena. Kids with autism, MR, etc., can be goaded by inflexible instructors into explosive behavior. I have read of this exact scenario countless times regarding bipolar disorder. Im NOT saying I believe the explosive behavior is OKAY, just that the management of it should be to remove the inflexible, rigid influences and protect the child from this style of person.
OCD perseveration - When OCD *needs* are thwarted, the child may exhibit meltdowns, which some might describe as *rage*. The Tamar Chansky book, Freeing Your Child From Obsessive-Compulsive Disorder, is very helpful at teaching a parent steps to helping a child in this area. My daughter is capable of having a meltdown over an OCD-ish need. I use the word meltdown here because although many would probably call it *rage*, this OCD-ish unacceptable behavior is vastly different than the SSRI-induced mania that she had in the past.
Learned behavior - Getting away with rudeness. A child using tears and tantrums to get what he or she wants. Parents modeling bad behavior. Parents excusing bad behavior. Parents in denial about their childs behavior. Parents walking on eggshells around their child because of sympathy for a disorder, resulting in excusing bad behavior.
Personality Type - Dramatic - Accepting a dramatic child may be particularly hard if a parent is a laid-back type.
Acceptance of Emotion - Mad can be Okay. Children should be allowed to be mad. Sometimes mad is good and appropriate and okay. It is never appropriate to hurt, hit, etc., but mad IS okay!
The above are probably *treatable* with parenting technique modifications or limiting exposure to the stressors. However, the following must be medically treated and no amount of behavioral intervention will treat the underlying medical problem:
Medical causes - Psychotic or seizure disorder-induced, medication-induced, blood sugar imbalance, mania. People in these states are not reachable. Intervention during the event is most probably fruitless. Ensuring the childs safety and the safety of others is probably the only attainable immediate goal. The person is out of touch and not reachable.
Sometimes getting to the root cause of *rage* requires us to take a very hard look at ourselves and our parenting techniques. Sometimes getting to the root cause requires dogged determination and persistence with medical professionals until all the questions are answered. I know of a case where it took a few years of persistence in seeking appropriate medical intervention for one mother to finally find the cause of her sons *rages*. The BEAM EEG - a newer technology for determining brain electrical activity - pinpointed electrical activity deep in her sons brain, which was undetectable by the older technology. Once this was detected, her son could start treatment for his previously undetected problem.
Whatever the causes, *rage* is never acceptable. Firmly defining the line for tolerance, observation, recognizing and accepting that the parent DOES have a role in how rage is played out and educating ourselves on how to better manage the behaviors are important factors in helping our children better manage their own behaviors. Ross Greenes, The Explosive Child, is the single best resource I have found for this kind of help, and I highly recommend it as a must-read for parents with inflexible children.
It is important to determine the cause of unacceptable behavior, so appropriate treatment can be pursued. Furthermore, it is important to teach a child that their behaviors have consequences, and they are responsible for the consequences of their actions. If they impulsively break something, they ARE responsible, regardless the cause of the impulsivity. If they destroy a door in a manic state, although they didnt have control of their behavior and couldnt prevent it perhaps, they are STILL responsible for it.
Forgiving the unacceptable behavior is also a very important process. Our children should feel forgiveness and unconditional love from us, and they need to learn to forgive themselves. This is probably an overlooked area. When problems are identified and sorted out and treated, the child needs to be able to look back on their actions and forgive themselves and know they have been forgiven.
Always,
TreadinWater
Websites with discussions of *rage* in relation to Tourette Syndrome:
Rage
About TS
Helpful Books:
The Explosive Child, by Ross Greene
The Explosive Child
Tamar Chansky's, Freeing Your Child From Obsessive-Compulsive Disorder.
Information about both of these books can be found in the Books section.
TS Books
Abstracts of journal studies cited below can be located on PubMed by typing in the PMID entry number:
PubMed search
The Bruun and Budman journal reports, from the Long Island Study on rage:
PMID entry 11026181
PMID entry 9862603
PMID entry 9862602
The journal reports from the Tourette International Consortium report:
PMID entry 10972415
More extracts from this journal report are included here:
The TIC database journal report
Tips for coping :
Managing Bipolar Disorder
{ezop note: edited to open links in new window]
