11 Swanepoel A. Arch Dis Child Educ Pract Ed 2019;104:11–15. doi:10.1136/archdischild-2017-314020 BEST PRACTICE Fifteen-minute consultation: The angry child Annie Swanepoel Potters Bar Clinic, Elysium Healthcare, Potters Bar, Hertfordshire, UK Correspondence to Dr Annie Swanepoel, Potters Bar Clinic, Elysium Healthcare; annie.panzer@gmail.com Received 12 November 2017 Revised 11 February 2018 Accepted 29 April 2018 Published Online First 25 May 2018 To cite: Swanepoel A. Arch Dis Child Educ Pract Ed 2019;104:11–15. ABSTRACT Children who present with diffcult behaviours due to underlying anger are commonly presented to paediatricians for help and advice. This paper gives a basic structure of how to approach the subject, by exploring whether the problems occur at home, school or both, and analysing the behaviour by focusing on antecedents, behaviour and consequences. It is important to fnd the underlying causes in order to know what to recommend, as this can vary from medication, anger management strategies, school-based interventions, parenting programmes or family therapy. ANGER AS A FEELING AND ANGRY ACTIONS First of all, it is important to distinguish between anger as a feeling and angry actions. Anger is an important and normal feeling which informs us that something is not right and potentially harmful to us. It is fine to feel angry—however, it is not acceptable to lash out and hurt people or destroy property. When a child is presented with anger issues, it is often angry behaviours that are meant, rather than angry feelings. However, in order to address the behaviours, it is important to get to the bottom of why the child is feeling angry. It is also important to note that anger can be a defence to avoid painful underlying feelings of fear or sadness. FINDING REASONS FOR ANGRY BEHAVIOURS BY LOOKING AT WHERE THEY ARE DISPLAYED Anger mainly at school If the child mainly has anger outbursts at school, it is important to find out whether this happens in the classroom or play- ground and to get a few recent examples. For example, children with undiagnosed learning difficulties can get very frustrated when they are unable to do what the others can do and thus get very angry when they are asked once again to read or write or do Maths when they know that it is too hard. 1 Other children may be fine in class, but really struggle with unstructured play- time. This can be because they have social difficulties, for example autism spectrum disorder, and cannot make friends. Some children are very hyperactive and impul- sive, as is the case in attention-deficit hyperactivity disorder (ADHD). These children typically struggle to follow rules and often butt into other children’s games, which leads to being rejected and feeling angry as a result. 1 Also, children who tend to get angry easily can be a source of entertainment for others, who may wind them up for the fun of seeing them totally lose their temper. This is, of course, bullying and should be dealt with firmly by the school (see box 1 for reasons for angry behaviours at school). Anger mainly at home If the angry behaviours tend to be confined to home, but not at school, it is reasonable to consider that the parent–child relation- ship may need improving. Some parents have unrealistic expectations of their chil- dren, for example single mothers with sons who expect their sons to be chatty, helpful and conscientious, when they should be looking for that in a partner rather than in a boy. However, it is also important to remember that some children with neuro- developmental or temperamental difficul- ties will pull themselves together while at school, but then collapse and let it all out once they are home. Another common cause of anger only at home is when other family members struggle to manage their anger and emotions often run high, and this is seen as normal and acceptable behaviour (see box 2 for reasons for angry behaviours at home). If physical altercations occur between adults and children, it is important to get the history of the sequence of events. In these cases, there typically is a history of physical chastisement of the child in the past. The child then learns that if you are on June 11, 2020 by guest. Protected by copyright. http://ep.bmj.com/ Arch Dis Child Educ Pract Ed: first published as 10.1136/archdischild-2017-314020 on 25 May 2018. Downloaded from