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JANUARY 2008

Excessive Tantrums In Preschoolers May Indicate Serious Mental Health Problems 

By Jim Dryden

Certain types of tantrums in preschoolers may be  a sign of serious emotional or behavioral problems,  according to researchers at Washington University  School of Medicine in St. Louis. Although temper  tantrums are common and normal in young children,  the researchers found that long, frequent, violent  and/or self-destructive tantrums may indicate  the presence of psychiatric illness.

The research team reports its findings in the  January print issue of The Journal of Pediatrics  currently available online. Researchers compared  tantrums in healthy children to the tantrums in  children diagnosed with depression or disruptive  disorders, such as attention-deficit/hyperactivity  disorder. Most children have temper tantrums at  some point, but the researchers found healthy children  tend to be less aggressive and generally have  shorter tantrums than their peers with depression  and disruptive disorders.

“It’s clearly normal for young children to have  occasional tantrums,” says first author Andrew C.  Belden, Ph.D., a National Institute of Mental Health  (NIMH) post-doctoral research scholar in child psychiatry.  “Healthy children may even display extreme  behaviors if they’re very tired or sick or hungry. But  if a child is regularly engaging in specific types of  tantrum behaviors, there may be a problem.”

The researchers studied 270 children between 3  and 6 years old. They gathered the information about  tantrums from a parent. The children were divided  into four groups according to psychiatric symptoms:  no psychiatric diagnosis, major depressive disorder,  disruptive disorder, or depression and disruptive disorder.  All of the children were part of a larger NIMH funded  study of psychiatric illness in preschoolers.

“We’ve been following these children for several  years,” says principal investigator Joan L.  Luby, M.D., associate professor of child psychiatry  and director of the Early Emotional Development  Program at the School of Medicine. “It’s important  to find age-specific ways to diagnose depression and  other problems in young children because it can be  difficult to get very young children to tell you about  their feelings. We’ve successfully used narrative and  observational techniques, but characteristics of tantrums  when present might be another helpful tool.”

Luby, Belden and colleagues identified five types  of tantrum behavior that appeared to be connected  with depression or diagnosable disruptive disorders.  The first involves extremely aggressive behavior  during a tantrum. When a toddler displays aggression  directed at a caregiver or violently destructive  behavior toward an object such as a toy during most  tantrums, parents should be concerned. The study  found that these children tend to have diagnoses  of ADHD, oppositional-defiant disorder and other  disruptive disorders.

The second worrisome tantrum behavior is when  toddlers intentionally injure themselves—actions  such as scratching until the skin bleeds, head banging  or biting themselves.

“It doesn’t matter how long these types of tantrums  last or how often they occur, self-injurious behavior  almost always was associated with a psychiatric diagnosis  in this study,” Belden says. “Children with major  depressive disorder tended to hurt themselves. We  didn’t see that in healthy kids or those with ADHD and  other disruptive disorders. It really surprised us that this  type of behavior was emerging at such a young age.”

Other “red flags” involved children who had more  than five tantrums a day for several consecutive  days. Very long tantrums also signaled a problem.  Healthy children might have a tantrum that lasts  10 or 11 minutes, but several children in the study,  especially those with disruptive disorders, averaged  more than 25 minutes per tantrum.

Finally, when preschoolers are unable to calm  themselves following a tantrum, they appear to be at  much greater risk of psychiatric problems.

“If a child is having tantrums and parents always  have to bribe the child with cookies or other rewards  to calm him or her down, this may be something more  serious than normal toddler volatility,” Belden says.

It’s important, he stresses, to replicate these findings  in studies of other children and to more rigorously  classify what types of behavior may be problematic.  Since this study relied on parent reports  of children’s tantrum behaviors, future studies will  involve video analysis of them.

Belden, who has two young children, became  interested in tantrum behavior because of the very  different tantrum styles displayed by each of his  two children. His advice for parents is not to worry  when a child has a tantrum but to pay attention to  how the child is behaving during the tantrum.

“The best news from this paper is that it’s normal  for children to display excessive behavior sometimes,”  Belden says. “If a child lashes out at you, it  doesn’t mean, ‘Oh my gosh! They’re doomed!’ But  if they lash out and hit you every time, there might  be a problem. And if they hurt themselves intentionally,  I think it’s best to consult a pediatrician or  mental health professional.”#

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