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Jeff Bostic, MD, EdD

MSDE SMHRP

(with help from)

Richard Mattison, MD &

Dana Cunningham, PhD

Managing Explosive Outbursts at School

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Disclosure Statements for:� �Jeff Bostic, MD, EdD�

This presentation will not include discussion of pharmaceuticals or medical products (unless you ask about them), and no medications or products are currently FDA-indicated for “explosive outbursts.”

“I have the following financial relationships with the manufacturers of any commercial product(s) and/or provider of commercial services discussed in this activity:

No Disclosures within the past 12 months

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Objectives�

At the conclusion of this presentation, participants will be able to:

Describe 3 characteristics of explosive outbursts
Describe 4 categories of explosive outbursts
Recognize 7 Stages of the Acting Out (Explosive) Cycle, and 2 Interventions for Each Stage of the Acting Out Cycle
Apply 3 core components for Collaborative Problem-Solving (CPS) with explosive student scenarios

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Managing Explosive Outbursts at School:

Definition

These Explosive Outbursts at School:

Escalate very rapidly (seconds to minutes)
Often do not respond to redirection by staff
Require significant post-event time (10-20 min or more) before the student can re-engage
Are not planned/anticipated maneuvers by the student

(Carlson, 2020)

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Managing Explosive Outbursts at School:

Impacts

Explosive Outbursts at School:

Account for nearly half of all office disciplinary referrals
About one-third of students with such behaviors fail to graduate from high school on time
These students remain at high risk for later life dysfunction

(Waschbusch, Breaux, & Babinski, 2019)

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Managing Explosive Outbursts at School:

Measures

Explosive Outbursts at School:

No current measure commonly used
Spring & Carlson (2021) have devised the Irritability Inventory (IRRI) to better categorize these outbursts, and a followup anchored measure (IRRIAM) has also been devised (Bostic et al., 2021).

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Managing Explosive Outbursts at School:

Measures: IRRIAM

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Amygdala

SAY: So what a child is exposed to influences what parts of the brain grow and mature. The Amygdala is the emotional part of the brain, and when fight-flight-freeze required in the child’s life, that’s the part they develop, since that’s what’s needed in that environment; so even when we act differently, their brain pathways fire in a familiar way, often turning us into threats, and reacting accordingly (escape, fight, shutdown).

So we have both young children who are not always strong with the frontal lobe skills to think through the consequences, but as they mature during elementary school, they become better learning, remembering, and following rules (or identifying others who don’t follow rules), BUT….then at puberty, the amygdala gets turned up so that students can become more emotional in their reactions---particularly to adults and those who establish rules/expectations. ANY IDEAS WHY THIS HAPPENS IN ADOLESCENTS ACROSS THE PLANET?

Developmental job of adolescents is to separate from family and to join peer group---for this to happen, teenagers need to want to be with their peers and let go of family somewhat---and for that to happen, the adolescent needs to feel like will be safe without parents protecting so much, and thus teenagers need to prove to themselves and everyone else that they can be okay being independent,

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Adult Brain: Disengaged Amygdala

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Youth Brain: Emotions Drive Processing

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Case 1

Jordan is a 6^th grader who doesn’t like being told what to do, readily argues with all adults, will stir up or encourage other students to resist teacher requests, and will escalate to slamming doors, books, etc., when staff correct Jordan, particularly in front of others.

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Managing Explosive Outbursts at School:

Explosive Outburst Aspects	Classroom Preparation to Decrease Explosions	School Staff Response to Outbursts
Behavioral	Provide specific positive behavioral expectations for student, and provide rewards & reinforce	Identify positive options, alternative behaviors (to cursing, arguing, destruction, etc.), reasonable consequences

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Case 2

Ryan is a 9^th grader who gets upset and cries easily or shuts down. When staff encourage Ryan to resume or attempt work, Ryan often escalates to screaming, running out of the room or refusing to speak or engage with others and makes comments like “can’t take it anymore.”

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Managing Explosive Outbursts at School:

Explosive Outburst Aspects	Classroom Preparation to Decrease Explosions	School Staff Response to Outbursts
Emotional	Minimize student triggers (readings about sensitive subjects), provide acceptable options if emotional (different tasks, breaks, staff support)	Provide student alternative places to regroup, staff to support calming techniques, alternative distracting activities (spreading fingers, breathing)

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Case 3

Jet is a 7^th grader who cannot recall routines, loses/misplaces items, rushes through work impatiently, is easily distracted by others, acts without thinking about options or consequences, and then will escalate as becomes frustrated when something doesn’t work as planned, and throw/turn over items.

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Managing Explosive Outbursts at School:

Explosive Outburst Aspects	Classroom Preparation to Decrease Explosions	School Staff Response to Outbursts
Impulsive	Provide clear structure for that day; preview transitions and tasks; identify appropriate actions to take if become frustrated	Empathize with distress, provide small number of appropriate options and invite student to choose, support student efforts toward better behavior

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Case 4

Jayden is a 4^th grader who struggles with any changes in routine, is very sensitive to noise, cannot tolerate being touched by others, avoids doing activities with others and wants to follow own interests and escalates when unexpected sounds or changes occur.

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Managing Explosive Outbursts at School:

Explosive Outburst Aspects	Classroom Preparation to Decrease Explosions	School Staff Response to Outbursts
Sensory	Optimize classroom stimulation for the student; provide alternative sensory experiences or regulating devices (e.g., cushions, headphones, quiet corners, touch items)	Reduce/remove sensory stressors; provide options to decrease (e.g., headphones, alternative foods); redirect student to other sensory activity

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Managing Explosive Outbursts at School:

School Accommodations

Behavioral: conduct/oppositional conditions

Emotional: mood (anxiety, bipolar, depression, DMDD, psychosis, PTSD)

Impulsive: ADHD, Intermittent Explosive Disorder

Sensory: Autism Spectrum, PTSD

(Bostic et al., 2021)

Behavioral: conduct/oppositional conditions that may include more manipulative, consistently hostile student behaviors surrounding the outbursts, but with limited distress or remorse following an EO

Emotional: mood (anxiety, bipolar, depression, DMDD, psychosis, PTSD) disorders that may include more emotional reactivity to events that spur outbursts, sometimes followed after EO by significant remorse

Impulsive: impulse-control difficulties (ADHD, Intermittent Explosive Disorder) conditions that may include difficulties navigating changes or transitions, or rigidity that fuels such outbursts, and difficult to recall/describe after the event

Sensory: hypersensitivity to stimuli (Autism, PTSD) conditions that may include intense reactivity or triggering by events, and avoidance of others or stimuli-rich environments, and followed by distress and avoidance of others/circumstances after an EO.

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Managing Explosive Outbursts at School:

School Accommodations

Behavioral: positive rules strongly reinforced

Emotional: stable environment to support different mood states; alternatives if triggered

Impulsive: Clear, consistent structure: preview; help organize, plan, follow through

Sensory: Attune environment to student; work with student efforts in correct direction

(Bostic et al., 2021)

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Managing Explosive Outbursts at School:

Interventions: The Acting Out Cycle

(used with permission from Colvin, G., & Scott, T. (2015). Managing the cycle of acting-out behavior in the classroom, Second Edition. Thousand Oaks, CA: Corwin.)

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Case 5: Application

Blake is a 7^th grade student who can get easily frustrated very quickly, and escalate to screaming and being destructive to property. Let’s examine options at each Stage of the Escalation Cycle to decrease these escalations.

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Escalation Cycle: Calm

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Calm	Teacher says, “Some of you are wandering around, like Blake, who needs to sit down now.”	Blake may feel singled out, challenged, or criticized, and feel a need to save face in front of peers.	Teacher says, “Many of you have your materials out and are ready to learn. Good job.”

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Escalation Cycle:

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Trigger	Teacher sees Blake not attending to the passage being read and taps Blake on the shoulder.	Blake has been frightened or harmed before by others sneaking up behind.	In this situation, the teacher might sit in front of Blake and quietly say/point to where they are currently reading.

Trigger

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Escalation Cycle: Agitation

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Agitated	As Blake slams the book closed, the teacher says, “Doing that just cost you recess” (or elective period)	While the teacher likely wishes to help Blake recognize that such behaviors have negative consequences, Blake’s initial reaction of this consequence may make Blake feel hurt (unliked, treated unfairly) and hurt is very often beneath anger responses	In this situation, the teacher can walk slowly to Blake and comment “Sometimes these readings can be frustrating.”

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Escalation Cycle: Acceleration

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Accel	As Blake slams the book down, says “This sucks,” and then tears up the related worksheet, the teacher says “pick that up, we’re not proceeding until you pick that up and open your book back up.”	The teacher may be attempting to teach Blake that these behaviors only yield worse consequences for Blake and still having to do the task, but Blake is unlikely to suddenly switch from distress/anger to logic and snap out of this escalation.	In this situation, the teacher might walk over and say, “this task is frustrating right now, so would you like to take a minute to regroup maybe over there (corner in the classroom) and maybe just breathe some slow breaths for a minute? (while teachers fear that other students will now mimic Blake’s behavior, that’s uncommon, but if multiple students do need a break or are struggling, that may suggest that taking a break is needed for all.

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Escalation Cycle: Peak

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Peak	As Blake throws the book down, screams “this is stupid,” and pushes a chair over, the teacher grabs and holds the chair and stares down Blake to try to make Blake retreat.	This may be perceived by Blake as a challenge or power conflict, so fight/flight/freeze reactions may predominate over thinking through likely consequences of various actions, and Blake may flee the room, push the chair (and teacher) out of the way or down, or freeze (and say/do nothing) while waiting for the teacher’s next move.	In this situation, the teacher might move slowly toward Blake and indicate this task is frustrating, encourage Blake to take time in a calmer area (and address cleaning up much later); the teacher might further cue other staff present to help Blake remove self from this escalation and to calm down in a space where the other students are not disrupted (e.g., counselor office, etc.)

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Escalation Cycle: Deescalation

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Deesc	After Blake stops pushing chairs and screaming, the teacher says “Now you’re going to need to process this, so think about what you should have done while you clean up your mess.”	Blake is most likely slowly, over 5-20 minutes, deescalating from a fight/flight/freeze state, so added pressures and tasks in this same situation may again escalate Blake’s fear/resistance to this material/task, or overwhelm Blake at this moment.	In this situation, the teacher might say very little but nod affirmation for Blake taking steps to calm self down, and reinforce this effort (once Blake is significantly calmed down) by offering for Blake to have some water or stretch out in the classroom

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Escalation Cycle: Recovery

Stage	Teacher Behavior that May (Unintentionally) Escalate the Student	Explanation Of Teacher Response That May Escalate the Student	Alternative Teacher Behavior to De-Escalate Student
Recov	Blake has taken 20 minutes to calm down, and now is engaging in work; the teacher says “you still owe me that worksheet from while ago, so once you finish this, you can go back to that	The escalation event is still fresh in Blake’s mind, and now the current situation with Blake’s positive momentum is stopped to rekindle the previous escalating event.	In this situation, after Blake has continued and completed this next task, the teacher can talk with Blake alone, apart from classmates, and say “you regrouped well, and we’ll see if we can figure out some things to do so it’s not so hard next time—we can talk later today about our ideas.”

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When Nothing Works: The Johari Window

Something that is:	YOU KNOW	YOU DON’T KNOW
OTHERS KNOW	OPEN	BLIND SPOT
OTHERS DON’T KNOW	HIDDEN	UNKNOWN

The Johari Window is a framework for understanding conscious and unconscious bias that can help increase self-awareness and our understanding of others. It is the creation of two psychologists, Joseph Luft and Harrington Ingham, who named the model by combining their first names. It is composed of four quadrants in which people using the framework can identify what they know about themselves and what other people know about them. This results in four areas of understanding:

Open area: Anything you know about yourself and are willing to share with others

Blind area: Anything you do not know about yourself, but that others have become aware of

Hidden area: Anything you know about yourself and are not willing to share with others

Unknown area: Any aspect unknown to you or anyone else

Thanks to Rick Warrren, Maryland Teacher of the Year 2019

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Case 5: Application

Blake is a 7^th grade student who can get easily frustrated very quickly, and escalate to screaming and being destructive to property. Let’s consider the Johari Window approach to rethinking how to work with Blake.

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The Johari Window to Blake

Something that is:	YOU KNOW	YOU DON’T KNOW
OTHERS KNOW	Blake is easily frustrated	Blake does fine in math class
OTHERS DON’T KNOW	Blake acts like my annoying sibling	Blake’s parent disappeared last Summer

The Johari Window is a framework for understanding conscious and unconscious bias that can help increase self-awareness and our understanding of others. It is the creation of two psychologists, Joseph Luft and Harrington Ingham, who named the model by combining their first names. It is composed of four quadrants in which people using the framework can identify what they know about themselves and what other people know about them. This results in four areas of understanding:

Open area: Anything you know about yourself and are willing to share with others

Blind area: Anything you do not know about yourself, but that others have become aware of

Hidden area: Anything you know about yourself and are not willing to share with others

Unknown area: Any aspect unknown to you or anyone else

Thanks to Rick Warrren, Maryland Teacher of the Year 2019

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When Nothing is Working:

Consider Epistemology (How Know Something)

How do I know that?

Where did my idea come from?

Who benefits from this version of the situation?

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When Nothing is Working:

Consider Epistemology (How Know Something)

What do I actually “know” about this student?

Where did my idea come from?

Who benefits from this version of the situation?

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When Nothing is Working:

Consider Epistemology (How Know Something)

”I know this student destroys materials most school days”

”Idea came from my observations over many days”

“Benefits student as I leave alone, and me as know he does with others, so I’m not the cause of this”

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When Nothing is Working:

Consider Epistemology (How Know Something)

”I know this student destroys materials most school days, but why daily destruction?”

”Who else has relevant observations?”

“Current benefits just sustain this cycle--what approach/understanding might change this pattern?”

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www.thinkkids.org

https://www.cpsconnection.com

https://LivesintheBalance.org

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De-escalating Students:

Intro to Collaborative Problem Solving

Empathic Reach

“It’s so frustrating.”
“I hear you,” or “not doing this math– what’s up?”

Environmental Demand/Problem Definition

“We’ve got to get these problems done to know how to solve the next ones.”
Cleaner the air, the better (something the student (and parents) can’t argue with

Invitation to Collaborate (“Let’s figure out how to…”)

“Would you like to do the odd ones and I’ll start the even ones, or I’ll start #1, and you do the next step?” (doable, feasible, mutually satisfactory)

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De-escalating Students:

Biggest Problems w/Collaborative Problem Solving

Perfunctory Empathy

Lip service rather than really hear, or doesn’t reflect the true level of frustration

Shrifting the Steps

Go too fast or steps out of order
Anticipate will be 2 steps forward, 1 back, etc.

Dueling Solutions

Student vs. Our solution
Often a student resistant to hear our solution may have been in situation where theirs was rarely heard (used to dueling and losing)
If solution fails, revisit the problem definition (“Maybe more to this than thought.”

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CPS Application

A student is angry in the hallway, and resists every polite suggest from you to return to class. The student starts to escalate and starts pacing about, making “grrrrr…” sounds, etc. How might you attempt these CPS 3 steps?

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De-escalating Students:

Describe how you would manage this crowd.

“Let’s go talk about this over here where it’s quiet.”
Direct other adults to encourage the other students to resume (productive) school activities.

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De-escalating Students:

Describe an Empathic Reach for this Student.

“It’s really frustrating right now.”

“I hear how distressed you are.”

“You really don’t want to leave here—what’s up?”

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De-escalating Students:

How might you frame the returning to class.

“We’ll have to get you back into your class.”

“One can’t just stay away from the classroom for the class period.”

“Our situation seems to be that you’re distressed yet also need to be in class.”

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De-escalating Students:

Describe an invitation to collaborate sound like.

“Let’s figure out how to address your distress so you can return to class.”

“What might help ease you back in? Write you a pass, or go tell teacher you’re returning so less awkward as return?”

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Managing Explosive Outbursts at School: References

Bostic JQ, Mattison R, Cunningham D (2021). Explosive Outbursts at School. Child Adol Psychiatr Clin N Am. 30(3):491-503. doi: 10.1016/j.chc.2021.04.003.

Carlson, G. A. (2020). Presidential address: Emotion dysregulation in children and adolescents. J Am Acad Child Adol Psychiatr, 59:15-19.

Colvin G, Scott T (2015). Managing the cycle of acting-out behavior in the classroom, 2^nd ed. Thousand Oaks, CA: Corwin.

Herzinger CV, Campbell JM (2007). Comparing functional assessment methodologies: A quantitative synthesis. J Autism Dev Disorders, 37(8):1430–45.

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Managing Explosive Outbursts at School: References

Spring L, Carlson GA (2021). The phenomenology of outbursts. Child Adol Psychiatr Clin N Am. Feb;30(2):307-19. doi: doi.org/10.1016/j.chc.2020.10.003

Waschbusch DA, Breaux RP, Babinski DE (2019). School-Based Interventions for aggression and defiance in Youth. School Mental Health 11:92–105. https://doi.org/10.1007/s12310-018-9269-0

Wood BK, Blair KSC., & Ferro JB. (2009). Young children with challenging behavior function-based assessment and intervention. Topics in Early Childhood Special Education, 29(2), 68–78.