Once you have tried the various non-pharmacological approaches to aggression, you will have to turn to what is generally the second choice—using medications.

The DSM-5 proposed diagnostic criteria have been put out for public view, in advance of field testing, on www.DSM5.org. While the proposed changes are many, those most pertinent to child psychiatry are described in this article.

Dr. Connor, you have spent many years working with and studying aggressive children. Why don’t you give us a little background on your interest in these kids?

Child psychiatrists have a lot of kids come into our office with problems related to temper tantrums, explosive episodes, etc. You have developed a process for working with these kids. Tell us about it.

There has been debate over whether nonepisodic irritability is a symptom of bipolar disorder in children and adolescent (Biederman J, Biol Psychiatry 2006;60:901–902). Recently, a new study examined whether children with severe nonepisodic irritability had the same risk of manic episodes as those diagnosed with more narrowly defined bipolar disorder.

After reading these articles, you should be able to…