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Do Tantrums Mean Trouble?

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by Heidi Green
January 02, 2008

Nearly all parents of preschoolers will tell you: Tantrums happen. They’re a normal occurrence of early childhood, and they’re frustrating for everyone while they last. But should they be a cause for concern? Maybe. A team of Missouri-based researchers believe they have identified five “red flag” traits of the tantrums of children at risk for mood and disruptive disorders.

Research
Researchers recruited 3-, 4-, and 5-year-olds from doctors’ offices, preschools, and day cares throughout the greater St. Louis area. Healthy children, as well as those with symptoms of depression, disruptive disorders, or both, were included in this study. Those with chronic illnesses, neurological problems, pervasive developmental disorders, and language and/or cognitive delays were excluded.

Researchers used the Preschool Feelings Checklist, DSM-IV criteria, and the Preschool Age Psychiatric Assessment (PAPA). Trained interviewers determined the number of tantrums by the child in the past three months, as well as the intensity, duration, frequency, context, behavior, and recovery after the tantrum(s).

This study included 279 preschoolers. The children were divided into four groups: healthy children (150); children with major depressive disorder (MDD) but no attention deficit hyperactivity disorder (ADHD), conduct disorder, and/or oppositional defiant disorder (21); children with ADHD, conduct disorder, and/or oppositional defiant disorder but no MDD (54); or children with MDD and a disruptive disorder (54).

Tantrums were classified as being normative (rarely escalating to excessive crying or shouting, and without destruction or violence); excessive without aggression (having crying, shouting, and/or directed flailing, but without aggression or violence); or excessive with aggression (having crying and screaming, as well as episodes of aggression and/or violence towards objects and/or people).

Results
In short, researchers found that long, frequent, violent, and/or self-destructive tantrums may indicate depression or disruptive disorders such as ADHD. If a child is regularly engaging in these types of tantrums, there may be a problem.

Five types of “red flag” behaviors were identified:

  1. Extreme aggression. If most tantrums include aggression towards a caregiver or destruction of an object (e.g., toy), then the child is more likely to be diagnosed with ADHD, oppositional-defiant disorder, and/or another disruptive disorder.
  2. Self-injury. If tantrums include the child intentionally injuring himself (e.g., scratching, head banging, biting), the child is more likely to have major depressive disorder.
  3. Many tantrums. More than five tantrums per day for several consecutive days signaled a problem.
  4. Long tantrums. While healthy children might have tantrums that last as long as 10 or 11 minutes, those who were found to have disruptive disorders averaged more than 25 minutes per tantrum.
  5. Inability to self-calm. Those who are unable to calm themselves seem to be more likely to have psychiatric problems, too.

Recommendations
First, this study shows that it’s normal for children to display excessive behavior sometimes. Even healthy children might have “red flag” behavior occasionally, especially if they are tired, hungry, or sick. Therefore, parents should not overreact if during one tantrum the child lashes out. However, it also means that they should pay attention.

Second, it means that parents of children of all ages should be concerned about signs of self-injury. The researchers advise parents to consult their child’s doctor or a mental health professional at the first sign of this behavior.

It’s important to note that this study relied solely on information provided by the preschoolers’ parents. The data were not verified by other means (e.g., information from other care providers, video of tantrums).

In this, as in so many other aspects of parenting, mothers and fathers should trust their instincts. Though some tantrums are a normal part of childhood, if your child’s tantrums cause you concern, talk to your child’s doctor right away.

  • http://www.ADDdiet.com Jane Hersey

    On first glance that sounds like good advice to tell concerned parents to “talk to their doctors.” But what does that really mean? Will the doctor say, “Let’s see if we can do some detective work and find out what is causing the behavior.” Will the doctor say “Perhaps your child isn’t getting enough of the important omega-3 fatty acids,” or “There are some vitamins that might be helpful in improving your child’s frustration tolerance,” or “Try removing the worst of the synthetic food additives that have been shown to cause such behaviors”? Unfortunately, most doctors are taught that when there’s a problem you look for a pill, and those who go beyond this quick fix are often in the minority. I’ve been helping parents of hard-to-raise children for over 30 years, and have found that those doctors who are best informed about how to best help these children recognize that what a child eats has a direct effect on how he behaves. I encourage parents who would like more information to visit http://www.feingold.org.

  • http://www.babygooroo.com Amy

    The concern that Jane raises is the subject of a “Frontline” report scheduled to air Tuesday, January 8, 2008 at 10:00 p.m. on Georgia Public Broadcasting. The report examines why approximately 6 million U.S. children are taking powerful psychiatric drugs. “It’s really to some extent an experiment, trying medications in these children of this age,” says one doctor.

  • Nancy Lara

    I have subscribed to Baby Center since my pregnancy, my child is 15 mos. old. Baby Center is a great resource, very informative, reliable and eye opening. I don’t know what I would do without you guys.

  • vicki

    I have a two year old boy who is having some problems. He was born three months early and had a brain bleed. For the last year his temper has been getting worse. He has never been a happy child. I thought his fits were normal for a premature child. Well what he is doing now is scaring me. He bites himself, bangs his head against anything he can find but the worst thing he does is he chokes himself. I don’t know what to do. I don’t know where to take him to have him evaluated. I am afraid that he will hurt himself. I live in Missouri and if you know of a good place to take him please let me know. Something needs to happen.

  • http://www.babygooroo.com Amy Spangler

    I would recommend that you contact your son’s doctor right away. If you don’t have a doctor, I contact your local health department or the hospital where your son was cared for after he was born. Hopefully, they can tell you what resources are available in your area and provide you with contact information. The behavior you’re describing isn’t normal and requires immediate attention. For the benefit of you and your son, please don’t delay in seeking help.

  • Heidi Green

    Hi, Vicki – My heart goes out to you and your son. I second Amy’s recommendation. Your local health department should be able to help. You might also think about contacting the people at this state office: http://dese.mo.gov/divspeced/FirstSteps/ They should be able to provide you with some assistance — or point you to the right authority. Please be as persistent as you need to be to get some help. Take good care.

  • http://tantrumtoddlers.blogspot.com Tantrum Toddlers Researcher

    Child Behavior Modification is so tough. There are moments that yelling at them is not enough. Tantrums in toddlers start when they want something which they cannot get or even when you do what they don’t want to.

    According to Tantrum Toddlers Researcher, the best way to deal with toddlers tantrums is to create the best activities that are fun and educational. You have to remember that at this is the stage, child adopts all things that happen around him. This is also the best time to allow your child into different activities.

  • Heidi Green

    Hi, Tantrum Toddlers Researcher – Thanks for jumping into the discussion!

    I find that yelling at a tantruming toddler is rarely adviseable. Children learn by what they see. If the problem with tantrums is that the child is responding to something in an excessively emotional way, we must consider that yelling itself is an excessively emotional response. It is modeling exactly level of behavior we don’t want. In instances of safety, it is warranted; otherwise, I can’t see it.

    Yes, organizing fun and educational activities are a great way to head off tantrums. Toddlers’ parents do spend a lot of their time entertaining and diverting their children. Of course, that’s not always possible. There will be times when the toddler just won’t be able to get something he wants (like that piece of broken glass my son picked up at the playground the other day) or won’t be able to have you do something he wants (like go home from his older brother’s school right away).

    Your research sounds interesting, but life–at least my life–doesn’t quite fit these particular suggestions all of the time. That’s why I find it helpful to keep in mind what signs might indicate that tantrums might be a warning sign.

  • Kristi

    My 14mth old daughter has tantrums where she will fall backward without bending her knees, smacking her head on the floor. She screams until she gets her way. I don’t give in so she’s having a difficult time right now. I have four older ones. It doesn’t get better by allowing negative behavior. Do I want them to be injured? No. Will I deal with that behavior at 2yrs, 3yrs, and so on? No. The buck stops here. You will never see me drag my kid around a store or beg them to stop. If they flare up in the store, I leave the cart and take them home to sit it out. They understand what is going on by six months. I know experts disagree with my 20yrs of experience with babies/children. The most important thing a human must learn is self-control. It seems harsh but the sad reality is that some adults have not mastered the skill of emotional control. You hardly ever get what you want in life so don’t lie to them as toddlers with coddling the nasty behavior. The trails of parenting are never easy. I’m unsure why people expect a solution. Children are people with personalities, thoughts, and feelings. They will stand their ground for what they want. They must understand to choose battles wisely and when to throw in the towel. Teach your baby early and often. We do not act like animals, but like a species of the highest intelligence with a great capacity to learn what is socially acceptable. No attention is given for negative behavior. Praise good behavior like you just won the lottery. At 18mths you can start real discipline (time out, take away fav toy, ect.) . Good luck in motherhood.

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