just busting in here, i usually am in 'blended and stepfamily parenting' but your post struck a note with me.  while i struggled with my son in very similar ways as your sister sounds like she is dealing with her son. although my son did not shake his hands or they did not shake on their own. he did flap them sort of like autistic children and that caused me no end of worry. the hand shaking would seem to me to require some sort of neurological testing just to ensure that there is no physiological issue at hand. my son was also not an angry boy per se, but he had a short fuse and would go off on a tangent and fits to raise the roof over any little trigger, and while he was not angry during the day i found that regularly at night he would sort of half awaken in the midst of screaming angry night terrors, although he wasnt afraid, just screaming and inconsolable seemingly. it seemed to me that if we had a particularly busy or stressful day, whether good stress like shopping or a day at the park, but lots of stimulation, or if his father and i were not having a good day then the night issues were far more likely to occur. it seemed to me his way of dealing with and letting out his feelings of stress and emotional over load.
as for the myriad of temper tantrums throughout the day, the speech issues, small motor skills issues, bang on. for the night issues, we used rescue remedy during all his 'fits' and i would dose myself each time i dosed him. we also used a consistant bedtime ritual of shia massage when putting him down. by shia, if you are not familiar or if i have misspelled it, it is simply light stroking up and down arms back legs across the forehead and over the skull, i did this all the while sending him calming peaceful night sleep vibes and energy. this was usually a 20 minute ritual and all of our friends knew that bedtime was reserved for that in our home and no company was welcome during that hour.
we worked constantly with gentle discipline using a.s. neill's method of freedom vs license as a base. lots of gentle eye to eye contact, calm voice and sometimes when he was right out of control we would hold him gently yet firmly saying all manner of breathe darling and you must calm yourself and those sorts of sentences until he calmed himself down.
at night when we used the rescue remedy and quiet gentle talk, if that was unsuccessful i would run a warm bath and we would both get in and i would continue to comfort and calm him until he settled then a nice warmed in the dryer towel, warmed jammies and back in bed with the shia massage until he was well asleep.
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when he got older i had him tested for speech impediments and other issues that might cause him to be difficult to understand. we had his hearing tested too for the same reason. there was nothing wrong there, except he thinks really fast and cant keep up with his brain.he also has a tendency to skip small words like the and but and i guess they are conjunctions which join two or more thoughts together.
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i home schooled him till grade three to avoid any issues of attempted adhd testing or recomendations. he would not sit still to learn and i did not force the issue but allowed him to hang off his chair and jump about and filddle around as long as he was getting his work done. when it got to be to much for him to handle then it was time for a good half hour to hour break and then back to studies.
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when he went to public school he still had trouble speaking clearly and was tested through the school with the same results as before, so we implemented a program where he was required to slow down and speak clearly and work with a speech therapist to encourage ways of remembering to do this.
he is now 13 and an a student, he does well at sitting still and getting his work done. he still thinks best on his feet and although with the onset of puberty he has settled down a bit and is more likely to laze about a bit more, he still requires enough activity in the daytime to enable a good nights sleep. je also still needs reminding to slow down and speak clearly, and though it annoys him to be asked to repeat himself, he does so because it is to his benefit to be understood and finally at 13 understands that. he actually sort of got a hold of that around 11 or so, but as i said he still needs occasional reminding. he also still has issues with controlling his emotions. we have worked with his school team and him to find ways that empowered him to get hold of his emotions and to cope with them appropriately for his age group. we use breathing, counting and a mild form of meditation and it seems to be working. i know your nephew is younger but with my son, there is a subtle signal tht my son gives his teacher that he is having a difficult time and he is free to leave the room and get himself together.
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i forgot to mention, his sleep fits ended by the time he was about 3.5 - 4 or so.
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i hope this is some help to you or to your sister when she is looking for solutions. perhaps she is afraid to speak freely with his dr. because of the worry that some sort of adhd testing will be ordered or she may be recomended to medicate him. there are ways to deal with behaviour that dont require meds but she really needs to make sure that there is no physiological issues that are causing his troubles. then she can get on the road to helping him cope and move forward positively. behavioural issues can be devestating to a child in school, causing them to become the victims of bullys and lowering their self esteem at their own knowledge that they dont cope like their peers. best to get an early start and teach him the skills he can use to empower himself to cope with and feel in control of his own behaviour and extreme emotions.
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hth~
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