Q A child I closely mentor has been diagnosed with Intermittent Explosive Disorder. His legal guardian and I are taking action to get him CBT and medication. His triggers seem to any kind of peer conflict (ie disagreement with a peer about whether or not something is a foul when playing informal pickup games), change of plans without time to process, and being told "No." We’re working to avoid triggers while still allowing him to be a 12 year old boy. For example, now we give him time to process change of plans vs. telling him "in the moment" that plans have changed. When should I hold him accountable for his IED behavior and when should I give him a "pass"?
When attempting to change any behavior, it is important to identify triggers, but it is also important to identify “reinforcers” that increase chances the behavior will continue. We should remember that attention, whether positive or negative, is the strongest reinforcer of all behaviors. As adults, we may unintentionally reinforce behaviors we mean to punish, just by giving attention.
The first step to addressing a child’s behavior is to determine the timing, frequency, duration and intensity of these behaviors in multiple settings. Next, you want to understand what responses adults, peers and others may provide that could possibly reinforce his explosive aggression. After understanding triggers and responses, provide the child with information about patterns you’ve observed and with skills he could use in the moment to increase his chances of having positive interactions with others. Make sure everyone in the environment knows the information communicated to him about responding to triggers so they can also reinforce positive behaviors and ignore negative ones.
In terms of giving him a “pass,” I recommend using active ignoring for minor misbehaviors. Active ignoring is a technique in which you ignore a behavior until you can catch the child engaging in a positive behavior, even if it’s by accident. Once you catch that behavior, praise that behavior and move on. Active ignoring should be used as often as possible, and as long as the behavior is not destructive or aggressive.
I think it is a great idea to refer him for individual cognitive behavioral therapy, or more specifically, dialectical behavior therapy (DBT). In DBT, he can learn distress tolerance skills, emotion regulation skills, and interpersonal skills to address conflict and negative emotions. He might also benefit from opportunities to practice not getting his way with peers and adults in a controlled environment. After learning these skills, he will be more able to adapt and apply them in real life situations.