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Key Takeaways:
- Intermittent explosive disorder in children manifests in mild to severe aggression, verbal abuse, property damage, and episodes of rage.
- Children are more likely to develop intermittent explosive disorder due to genetic factors, a poor or abusive upbringing, and exposure to substance use.
- You can support a child with intermittent explosive disorder by teaching coping skills, working with a therapist, and collaborating with teachers.
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Tantrums in childhood are normal, but what if your child is showing signs of violence? Frequent aggression, verbal arguments, and physical abuse all point to intermittent explosive disorder in children, which can be a challenge for parents to manage.
In this guide, you’ll learn what intermittent explosive disorder is, what the signs are, and what you can do to support your child.
What Is Intermittent Explosive Disorder?
Intermittent explosive disorder (IED) manifests as frequent, impulsive outbursts of anger and aggression. The episodes may occur as “spells” or “attacks” and can last anywhere from a few minutes to several hours.
Children with IED might throw tantrums, fight with others, and even cause physical harm to people or animals. They may also exhibit verbal aggression by calling others names and using slurs.
IED typically manifests in late childhood or early adolescence. In the United States, the lifetime prevalence of IED is 3.1% [*].
Signs and Symptoms of IED in Children
The main sign of IED in children is out-of-proportion anger outbursts. These outbursts are unplanned, cause significant distress, happen immediately, and disrupt daily life.
However, IED in children can manifest in three ways:
Behavioral:
- Property destruction, such as punching holes in walls or breaking toys
- Aggression toward people through threats, shoving, and hitting
- Mild outbursts occurring 2-3 times per week
- Impulsive acts, such as sudden eruptions with no warning
Psychological:
- Intense anger, irritability, and fury
- Racing thoughts, nervous energy, and other forms of emotional arousal
- Sense of loss of control during episodes
- Sudden guilt, shame, and embarrassment after outbursts
Physical:
- Shaking, tremors, pounding heart, flushing before an outburst
- Crying, screaming, or hyperventilating during the outburst
- Extreme fatigue and sleepiness after an outburst
- Somatic complaints, such as headaches and stomachaches
Causes and Risk Factors
While researchers have yet to pinpoint a single cause of intermittent explosive disorder, there are a few risk factors that make it more likely for a child to develop the condition.
Genetic and Biological Factors
IED is often a biological disorder, with studies suggesting a 44% to 72% likelihood of a child developing it when a parent has it [*]. Studies also show that individuals with IED have an affected amygdala, which is what regulates a person’s emotional functioning.
People with IED also produce less serotonin, a neurotransmitter and hormone playing a key function in a person’s mood.
Environmental Factors
Environmental factors like verbal and physical abuse in childhood can increase the probability of developing IED. Inconsistent parenting can also be a “gateway” to developing IED, especially when kids act out for attention.
Traumatic events, such as the death of a family member or an accident, can also increase the chances of developing IED.
Other Factors
Substance use can significantly impact a child's ability to manage their emotions. For example, alcohol, which is a depressant, can reduce self-control and amplify emotional reactivity. Kids who drink alcohol in excess might have more aggressive outbursts, act paranoid, and experience mood swings.
Watching a parent use substances can also contribute to IED-like behavior [*]. If a child witnesses their parent being aggressive, erratic, and violent, they may perceive this behavior as acceptable.
Children with other behavioral diagnoses, such as conduct disorder or oppositional defiant disorder, are more likely to develop IED. These particular mood disorders are already characterized by aggressive behavior, which can lead to violence.
Treatment Options for Children with IED
Treatment for intermittent explosive disorder typically involves a combination of psychotherapy, medications, and specific lifestyle changes. The goal is to eliminate symptoms or minimize them to a mild intensity. Here’s what you can expect from a comprehensive treatment plan.
Psychotherapy
The most common psychotherapy for IED is cognitive behavioral therapy (CBT) [*]. This treatment is structured and goal-oriented, with therapists helping children reflect on their thoughts and emotions.
CBT helps children manage negative daily situations without having outbursts. Specific techniques may include cognitive restructuring, which involves changing faulty assumptions and redirecting unhelpful thoughts toward more positive and productive ones.
Therapists may also equip children with calming techniques, such as deep breathing or grounding exercises, which can aid in relapse prevention by helping to eliminate impulsive behaviors.
Another form of psychotherapy for IED is parent-child interaction therapy (PCIT), which equips parents with positive learning skills [*]. Through PCIT, parents can find more effective ways to manage challenging behaviors, such as giving consistent and appropriate consequences and setting clear, reasonable boundaries.
Medications
If your child displays moderate to severe symptoms, a child psychiatrist might prescribe medications to prevent outbursts and minimize anxiety.
Many psychiatrists prescribe fluoxetine, which is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin production in the brain [*]. This effect reduces the frequency and intensity of outbursts.
Depending on the child’s symptoms, a psychiatrist might prescribe antidepressants, anti-anxiety medication, antipsychotics, anticonvulsants, or mood regulators.
Lifestyle changes
Simple lifestyle adjustments can make for a world of improvement for children with IED. Regular physical activity, for example, provides an outlet for excess energy and can improve their mood throughout the day.
Other lifestyle changes, such as adopting a healthy, balanced diet, can support brain health and help children achieve better-quality sleep, ultimately making them feel more mentally well.
Social support
Providing your child with a safe and predictable environment can help them emotionally regulate when they’re feeling overwhelmed. By offering parental support, such as comfort and open discussions about their emotions, children will feel more secure in seeking help.
In a school setting, children with IED may thrive with individualized support or a 504 Plan. These provide specific accommodations, such as one-on-one tutoring, modified assignments, and designated safe spaces to help the child focus.
Caring for a Child with IED
Parenting a child with IED can be challenging, but the right strategies can put them in an excellent position to thrive. Here’s what you can do:
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Stay calm during outbursts: Yelling at your child while they’re having an outburst can escalate the situation into something dangerous. Instead, remain firm but calm. Stay in control of your emotions so as not to aggravate your child’s aggression and fear.
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Avoid giving in to demands: It can be tempting to give in to what your child wants to get them to stop the aggressive behavior. However, doing this will enable them to use violence and aggression to get their way. Don’t reward the outburst. Give it time to burn out.
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Use de-escalation aids: Consider what helps your child calm down and utilize these techniques. For example, if they respond well to sensory objects, give them a stress ball or weighted blanket to help them calm down.
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Use visual schedules: Utilizing visual aids, such as posters and charts, can help guide your child’s behavior. You can use steps to calm down or positive affirmations for anger to help your child relax.
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Build emotional awareness: Some children have outbursts because unfamiliar emotions scare them or leave them feeling frustrated. With greater emotional awareness, they can better understand complex emotions. Use a feelings list to expand their emotional vocabulary.
The Bottom Line
Intermittent explosive disorder can be disruptive and disheartening, but a little compassion can go a long way. Early intervention is crucial, and parents should seek professional help as soon as they notice symptoms.
Help your child manage their intense emotions with our anger management worksheets.
FAQs About IED in Children
When do symptoms of IED usually start?
Children start displaying IED symptoms in late childhood or their early teens. Diagnostic criteria prevent children from being diagnosed with IED below the age of six, as most of their behaviors at this age fall within typical developmental tantrums.
Can a child outgrow intermittent explosive disorder?
With help, a child can outgrow intermittent explosive disorder. How well a child manages their symptoms depends on factors like whether they have access to early intervention, have an underlying behavioral or medical condition, and have a stable family environment.
Sources:
- A. Al‐Hamzawi, Al‐Diwan JK, Al‐Hasnawi SM, et al. “The prevalence and correlates of intermittent explosive disorder in Iraq.” Acta Psychiatrica Scandinavica, 2012.
- McLaughlin KA, Green JG, Hwang I, Sampson NA, Zaslavsky AM, Kessler RC. “Intermittent Explosive Disorder in the National Comorbidity Survey Replication Adolescent Supplement.” Archives of General Psychiatry, 2012.
- Coccaro EF, Fridberg DJ, Fanning JR, Grant JE, King AC, Lee R. “Substance use disorders: Relationship with intermittent explosive disorder and with aggression, anger, and impulsivity.” Journal of Psychiatric Research, 2016.
- McCloskey MS, Chen EY, Olino TM, Coccaro EF. “Cognitive-Behavioral Versus Supportive Psychotherapy for Intermittent Explosive Disorder: A Randomized Controlled Trial.” Behavior Therapy, 2022.
- Thomas R, Abell B, Webb HJ, Avdagic E, Zimmer-Gembeck MJ. “Parent-Child Interaction Therapy: A Meta-analysis.” Pediatrics, 2017.
- Liu F, Yin X. “Psychological and pharmacological treatments of intermittent explosive disorder: a meta-analysis protocol.” BMJ Open, 2024.
