It does seem like enough is enough. This is not normal behaviour that anyone should be putting up with and yes the trigger and the reasons behind it need to be found and corrected or it will get even more out of control. Today's incident gives you the perfect reason for writing the letter. Include a synopsis of what happened, mention a couple previous incidents to show that there has been a pattern and then write what your consequences are going to be for continued negative behaviour and what timeline you plan to use.
You might also try for parent cooperation and ask them to take child and your letter to the doctor and ask for some help in which case you might be willing to work with them for a bit.

































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