ADHD & THE RAGE CYCLE

Rage attacks often appear to come out of nowhere for youngsters with ADHD. Often the individual doesn’t show that they are under stress or having difficulty coping. However there is usually a pattern of behaviours that precede a behavioural outburst. Situations which may precipitate the rage cycle are:

• Unplanned change
• Criticism
• Transitions
• Conflict
• Crowds
• Difficult assignments

Behaviours displayed by others that may escalate a crisis:

• Raising your voice
• Insisting on having the last word
• Preaching
• Using sarcasm or acting superior
• Using tense body language such as a rigid posture
• Using unwarranted physical force
• Using degrading, insulting, humiliating or embarrassing putdowns
• Making assumptions or unsubstantiated accusations
• Bringing up unrelated events or making generalised remarks
• Nagging
• Throwing a temper tantrum
• Making comparisons with others
• Mimicking the individual
• Commanding, demanding, dominating

The rages themselves will go through three distinct stages, of varying lengths, known as the ‘rage cycle’. Intervention at an early stage can often prevent these attacks.
The first stage is the ‘Rumbling Stage’ where the individual exhibits warning signs in the form of behavioural changes that may not appear to be directly related to a rage attack. These may include:

• Biting their nails or lips
• Lowering their voice
• Tensing their muscles
• Tapping their foot
• Staring
• Refusals
• Grimacing or otherwise indicating that there is a problem
• Complaining of not feeling well

There may also be some more pronounced behaviours such as:

• Withdrawal from others, emotionally or physically
• Lashing out at, or threatening others, verbally or physically
• Challenging authority by attempting to engage in a power struggle

At this stage it is essential that there should be an intervention without getting involved in a struggle. There are several strategies that can be used:

• Removal from the environment which is causing difficulty by sending the youngster on an errand – this will give them time to calm down
• Touch control – sometimes a gentle touch can stop disruptive behaviour. This needs to be used carefully to avoid inflaming the situation
• ‘Just walk and don’t talk’. An adult should walk with the youngster without talking, in order to avoid saying the wrong thing. The youngster can say whatever they like without fear of discipline or logical argument. The adult should be calm, show as little reaction as possible, and never be confrontational
• Safe place. This is a place where the youngster can go when they feel a need to regain control
• Humour can often be used to defuse tension as long as the individual is not used as the target of a joke
• Direction – acknowledging a problem, stating a rule and giving some instructions using a calm, firm voice can often move things on

The second stage is the Rage Stage when the individual loses control and acts impulsively, emotionally and sometimes explosively. This may involve screaming, biting, hitting, kicking, destroying property or self-injury. Occasionally the rage will manifest internally when the individual becomes so upset that they completely withdraw, unable to speak or act in a rational way.

Once the rage stage begins, it is likely that it will have to run its course. The best way to cope with the rage attack is to get the individual to a safe place where they can calm down and relax. The cycle ends with the Recovery Stage when the youngster may feel sorry for what they have done and may not fully remember the rage. They may become sullen, withdrawn or deny the behaviour that has occurred. Often they are physically exhausted. It is important that any interventions are made later, at a time when the individual is able to accept and understand them.

In order to minimise the possibility of a rage attack occurring, it is worth analysing the factors that have led to them in the past so that you can be alert to potentially dangerous situations. You should also be familiar with the particular danger signals that your son or daughter displays. Make sure that teachers and other care-takers who may have to deal with a rage, understand how and why they happen, and what to do. The easiest way to do this is to have a ‘crisis plan sheet’ which covers all the points raised earlier in this article and which is tailored to your individual child. If you would like an outline Crisis Plan, email me at caroline@addvancecoaching.co.uk