Explosive Child Syndrome

The explosive child syndrome, identified and described by Ross W. Greene, Ph.D, (clinical psychologist at Harvard University) in his book "The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children," is a set of behavioral problems rather than a specific diagnosis. The explosive child syndrome may occur with various disorders, including Tourette's syndrome, autism spectrum disorders, bi-polar disorder, oppositional-defiant disorder, ADHD and obsessive-compulsive disorder. Therefore, Dr. Greene recommends a complete neuropsychiatric examination as a first step to determine and treat the underlying cause, including medication when indicated although there is no medication that is truly effective as treatment for the explosive child syndrome.

Characteristics

• The explosive child is profoundly inflexible and reacts violently to stress brought on by conflict or frustration of any kind, resulting in temper tantrums. The child's frustration level is low, and reactions are often unpredictable. Greene stresses that the explosive child wants to behave but is unable to think rationally during these episodes and lacks sociobehavioral skills to deal with stress.

Behavioral Patterns

• The child may exhibit three types of behavior during the tantrum. First, the child may be verbally abusive, screaming and using profanity, such as "I hate you, you bitch!" Second, the child may throw, smash or otherwise destroy items, such as toys, furniture, phones or books. Last, the child may be physically abusive, attacking family members, friends or schoolmates with feet, fists or weapons. A child may exhibit one or all of these types of behavior during a tantrum.

Consequences

• Because of the child's inability to think rationally about consequences, use of behavioral techniques like positive and negative reinforcement are rarely successful. Establishing consequences for actions, such as time-outs or loss of privileges, also has little effect. Punishment usually does not reduce the incidence of tantrums and, in fact, may increase stress and cause more tantrums.

Management

• Management of the explosive child begins with careful observations for two to four weeks to identify triggers for explosive behavior or influencing factors. For example, one child may explode in anger if told "no" while another may lose control if she is tired or hungry. The key to management is engaging all adults (family, caregivers and teachers) in anticipating problems and reducing stress before it occurs. For example, instead of "no," a parent or other caregiver may try, "Let's talk about that" to distract the child, and providing snacks to a hungry child may reduce stress.

Baskets

• Greene suggests using a three-basket system of prioritizing and managing behaviors, individualized for the child and the parent. Basket A comprises those behaviors that are not open to compromise, such as safety issues, regardless of the child's response. The child, for example, must wear a seat belt and cannot take a knife to school. Basket B comprises those issues that are negotiable. For example, if sharing toys causes a tantrum, then the child may be allowed not to share, but the adult will work with the child to help him gradually learn to be more flexible. The parent might ask the child during calm moments which toys he might be willing to share, and when, and build from there. The key is to help the child to learn alternative means of dealing with stress, but this may be a slow process, requiring time, patience and consistency. Basket C contains those issues that are not worth fighting over, such as allowing the child to wear the same clothes to school every day or to eat only one food. Ignoring minor issues reduces conflict and allows more stress-free time to help him learn to become more flexible.

Equity Issues

• Allowing explosive children to exhibit behavior that may not be acceptable to other children, such as walking about the classroom, may result in some inequities. However, Ruth Chaney, co-founder of the Northeast Foundation for Children, stresses that other children often recognize that the explosive child has special needs. Over time, he can learn to control his explosive behavior, but this requires a unified effort among the adults who are working with him.