Blog entry by Rcgp Learning
It is Anger Awareness Week during the first week of December, an event which aims to bring the issue of problematic anger out in the open and encourage people to manage their anger effectively. Whilst anger can be a significant problem for adults, it is also common in children. For many children and young people, anger is simply a basic emotion to navigate as they grow up, but for some it can develop into something more serious.
Anger is a powerful emotion and is considered a necessary tool for survival as it is closely linked to the ‘fight or flight’ response. It prepares the body for the ‘fight’ option by keeping the body and mind stimulated through the arousal of the sympathetic nervous system. The physical effects of this include an increase in heart rate, blood pressure, blood flow to voluntary muscles, blood glucose level, respiratory rate and sharpness of senses, which are all necessary when the body needs to be on high alert1. The feeling of anger is often brought on by a combination of factors; a trigger event, an individual’s personality and their perception of the situation2.
In children the behavioural expressions of anger can seem dramatic, with outbursts such as screaming, shouting and throwing objects. In young children this is a normal part of emotional development, as they start to become more independent and therefore frustrated by situations which challenge their autonomy3. As children get older it may become more apparent if anger is turning into a problem, where it starts getting out of control and harming the child and/or the people/things around them. According to the mental health charity Mind4, examples of unhelpful angry behaviour include:
- Outward aggression and violence – shouting, swearing, slamming doors, throwing objects and being physically violent or verbally abusive towards others.
- Inward aggression – self-loathing, denying basic needs (such as food or happiness), cutting off from the world and self-harming.
- Passive aggression – ignoring people, refusing to do tasks, deliberately doing things badly, late or at the last minute and being sarcastic and sulky.
If the anger starts having implications in a child’s daily life, such as school exclusions and physical fights, their parents may well approach their GP to seek advice. At this point it’s important to consider whether the anger is actually a symptom of an underlying health problem.
Anger plays a big part in conduct disorders which are relatively common mental health conditions in children and young people that cause defiant, aggressive or antisocial behaviour. Younger children may have ‘oppositional defiant disorder’ which is a type of conduct disorder that involves arguing and disobeying but exhibits less antisocial behaviour5. According to the NHS, conduct disorders are the most common reason that children are referred to mental health services and 5% of all children aged 5-16 years old are diagnosed with the condition, with higher rates of diagnosis in boys than in girls5. The NICE guideline on ‘Antisocial behaviour and conduct disorders in children and young people: recognition and management’ recognises the discussion around the possible social determination of these disorders and the risk of overmedicalisation. Nevertheless it argues that “advances in the last three decades have shown that in addition to social causes there are substantial genetic and biological contributions to conduct disorders/antisocial behaviour; therefore, the contribution of these factors needs to be assessed and factored into intervention plans”.
NICE recommends that any children or young people who are suspected of having a conduct disorder should be assessed by health or social care professionals. Referral to child and adolescent mental health services (CAMHS) may also be necessary if the condition requires a multidisciplinary team or if there is diagnostic uncertainty. The initial assessment involves checking for any coexisting mental health problems or a neurodevelopmental condition, such as attention deficit hyperactivity disorder (ADHD) or autism6. More information about conducting these assessments can be found here. If a conduct disorder is diagnosed or any other conditions are detected, it’s important to treat these issues first and assess whether there have been any improvements to the anger problems.
Whether there is an underlying cause or not, parents will need to be supported in dealing with their child’s anger. The NHS provides advice on how to tackle anger together with the child, helping them to recognise the triggers and then use strategies to manage it. This information can be found here. Young Minds also has a section about ‘Responding to anger’ which is aimed at parents who are struggling to deal with their child’s anger and aggression. Parent training programmes and resources may also help with developing skills to manage difficult behaviour. Links to more information about these programmes can be found below. 9, 10, 11, 12
1 Mental Health Foundation. 2008. Boiling Point: And What We Can Do About It. https://www.mentalhealth.org.uk/publications/boiling-point-anger-and-what-we-can-do-about-it
2 Mental Health Foundation. 2018. Anger and Mental Health. https://www.mentalhealth.org.uk/a-to-z/a/anger-and-mental-health
3 Royal College of Psychiatrists. 2017. Dealing with tantrums: for parents and carers. https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/information-for-parents-and-carers/dealing-with-tantrums-for-parents-and-carers
4 Mind. 2018. How to cope with anger. https://www.mind.org.uk/information-support/types-of-mental-health-problems/anger/
5 NHS. 2013. New guidelines on child antisocial behaviour. https://www.nhs.uk/news/pregnancy-and-child/new-guidelines-on-child-antisocial-behaviour/
6 NICE. 2017. Antisocial behaviour and conduct disorders in children and young people: recognition and management. https://www.nice.org.uk/guidance/cg158
7 Priory Education and Children’s Services. 2018. ADHD and when misbehaving becomes more than “playing up”. https://www.priorychildrensservices.co.uk/news-blogs/adhd-and-when-misbehaving-becomes-more-than-playing-up/
8 National Autistic Society. 2018. Information for general practitioners. https://www.autism.org.uk/professionals/health-workers/gp-info.aspx
9 YouTube. 2014. Parentchannel.tv https://www.youtube.com/user/parentchannelvideos/videos
10Family Lives. 2018. Parents Together Online course. https://www.familylives.org.uk/how-we-can-help/online-parenting-courses/parents-together/
11 YouTube. 2017. Parent-Plus TV. Anger & Aggression in children. https://www.youtube.com/watch?v=6-IafKUklUk
12 Care for the Family. 2018. Time Out for Parents: Handling Anger in the Family. https://www.careforthefamily.org.uk/courses/parenting-courses-time-out/time-out-for-parents-handling-anger-in-the-family