Temper Tantrums
Robert Needlman
I. Description of the problem. Behaviors comprising temper tantrums include crying, yelling, stamping, stiffening, attacking self and others, throwing things, dropping to the floor, and running away. Tantrums typically begin with anger (e.g., yelling or hitting) and then progress to distress or sadness (e.g., crying and attempts to gain proximity to the parent). Most tantrums last less than five minutes; the briefest ones tend to begin with stamping or dropping to the ground. Typical tantrums are normative; those predicting disruptive disorders are longer, more frequent, more violent, and persist past age four.
A. Epidemiology.
50% to 80% of 2- to 3-year-old children have tantrums at least weekly.
20% have at least daily tantrums.
60% of 2-year-olds with frequent tantrums will continue to have them at 3 years. Of these, 60% will continue at 4 years.
The prevalence of explosive “tempers” remains approximately 5% throughout childhood.
Severe tantrums are often accompanied by other significant behavioral problems, such as disturbed sleep or overactivity.
Tantrum frequency is variably related to gender or social class; severe tantrums are more common in low-SES boys.
B. Etiology/contributing factors.
1. Normal development. Tantrums reflect frustration when normal drives for autonomy conflict with parental prohibitions and limited competence, especially under stress (e.g., hunger, tiredness), in the presence of limited emotional self-regulation (e.g., through self-directed speech).
2. Medical problems. Consider (among others) recurrent URIs or otitis; respiratory or GI allergies; eczema; endocrine disorders (particularly androgen excess); obstructive sleep apnea and other sleep disturbance; hospitalization or invasive medical procedures; certain medications (e.g., most anticonvulsants, many antihistamines).
3. Disabilities. Consider autism spectrum disorders; cognitive disability; attention deficit hyperactivity disorder; traumatic brain injury (especially frontal lobe); unrecognized deafness or visual impairment.
4. Temperament. Predisposing traits include high intensity and activity; persistence; predominantly negative mood; low sensory threshold; and high sensitivity to novel stimuli. Irregular timing of sleep and hunger make it difficult for parents to anticipate the child’s needs.
5. Environment. Physical factors include overcrowding; limited access to outdoor play; and nonchildproofed homes that make frequent parental prohibitions necessary. Social factors include martial stress and verbal or physical violence; tensions arising from siblings or grandparents with behavioral problems or medical illness; parental depression, and alcohol and/or drug abuse.
6. Parenting. Tantrums may be reinforced either by parental compliance or, paradoxically, by the intense negative attention they elicit. Contributing factors include corporal punishment or abuse; inconsistent limit setting; over-permissiveness; intrusiveness; failure to recognize stressors (e.g., frightening movies or even the TV news); and unrealistic expectations for self-control or delay of gratification, particularly in children who look older and older children with cognitive delay.
7. Interacting factors. Tantrum persistence is predicted by either (a) high tendency to frustration plus high parental intrusiveness; or (b) low emotional self-regulation plus low parental control.
C. Recognizing the issue.
1. Signs and symptoms. Concerning features include the following:
a. A high degree of parental concern, anger, guilt, or sadness. Tantrums are a problem if parents think they are.
b. Parents are unable to identify positive things about the child, seeing the child as antagonistic and controlling. Such complaints may signal a toxic parent-child relationship, often associated with domestic violence and maternal depression.
c. Aggression (hitting, biting) with self (associated with depression) or others (associated with disruptive disorders).
d. Children aged less than 12 months or greater than 48. Tantrums, if present, tend to be mild and infrequent in these age ranges.
e. Tantrums occur more than three times a day and last 15 minutes or longer. Frequent, prolonged tantrums are associated with multiple behavior problems, for example, problems with sleeping, eating, or peer interactions.
f. Tantrums in school. Children typically “pull it together” in front of peers; tantrums in school may be due to social, academic, or emotional problems.
2. History: key clinical questions.
a. “What exactly happened the last time your child had a tantrum? What set it off? What did your child do first? How did you respond? Was that a typical episode?” Try to get a play-by-play account of a recent episode. Focus on the ABCs: antecedents, behaviors, and consequences. Look for triggers (hunger, tiredness, sources of frustration); unintentional reinforcement (e.g., increased attention); and delayed consequences, such as special treats the parents may offer to atone for their own feelings of anger.Stay updated, free articles. Join our Telegram channel
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