An 8-year-old boy is referred for explosive temper outbursts occurring 4-5 times per week for the past 2 years. Between outbursts, he is persistently irritable and angry. His outbursts are grossly disproportionate to the situation and occur in multiple settings. He has never had a distinct episode of elevated or expansive mood, decreased need for sleep, or grandiosity. A previous provider diagnosed him with bipolar disorder and started divalproex. His mother wants a second opinion.