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When Do Temper Tantrums Signal Something Serious?

Oh, temper tantrums, my old friends.

Exciting new research out of Northwestern University’s Feinberg School of Medicine takes a statistical approach to proving something that rings very, very true to me: temper tantrums can signal a major problem.

The study, led by  Lauren Wakschlag, Ph.D., also debunked the common belief that temper tantrums are rampant among young children. Although temper tantrums among preschoolers are common, they are not particularly frequent, the research shows. Less than 10 percent of young children have a daily tantrum. That pattern is similar for girls and boys, poor and non-poor children, and Hispanic, white, and African-American children.

The study found key differences between “typical” tantrums and “atypical” tantrums.

When “atypical” tantrums occur on a regular basis, that’s a red flag.

Realizing that tantrums aren’t nearly as frequent as they seem was an “aha” moment, said Dr. Wakschlag, who is a professor and vice chair in the Department of Medical Social Sciences at Northwestern University Feinberg School of Medicine.

“It gives a measurable indicator to tell us when tantrums are frequent enough that a child may be struggling. Perhaps for the first time, we have a tangible way to help parents, doctors, and teachers know when the frequency and type of tantrums may be an indication of a deeper problem.”

What is a typical tantrum? The study found that a typical tantrum may occur when a child is tired or frustrated or during daily routines such as at bedtime, mealtime, or getting dressed.

What is an atypical tantrum? An atypical tantrum may be one that occurs “out of the blue” or is so intense that a child becomes exhausted.  Either type of tantrum may occur in some children from time to time, but when these atypical forms of tantrums occur regularly, they become a red flag for concern.

What kind of concerns? Well, they’re working on that.  Researchers are now examining how these tantrum patterns are linked to a range of mental health problems and problems in daily functioning such as getting along in school, with siblings and general social skills. The study also is beginning to use brain-imaging techniques to uncover links between particular patterns of brain reactivity and these early problem behaviors. They’re also working on replicating their findings on a larger scale.

What the what? So, here’s the thing. I’m not a doctor, and I don’t even play one on TV, so this is not medical advice. But here’s how this exact situation played out in our house.

When my twins were toddlers, they had tantrums. Like most kids, they were break down when they were tired or hugry. They’d cry for a while, and then they’d get over it. My approach was pretty much to avoid the triggers (keep them fed and napping at regular intervals) and otherwise to ignore the tantrums.  And that was that.

Except.

One of my twins never stopped having tantrums. And although she would sometimes have a typical tantrum, more often than not, they were blow-out, screaming meltdowns that lasted for hours. I’m not kidding. It was hellatious. I tried comforting her and I tried ignoring her. I tried giving her hugs and giving her time-outs. These tantrums occurred daily or at least most days out of the week. When she was four, it reached a point where it was starting to dawn on us that this probably was not typical behavior.

It’s hard to get to that point. As a parent, especially a first-time parent, you know that kids have tantrums. Your pediatrician may even say, does she have tantrums? And you say yes, because she certainly is having tantrums. But it’s very unlikely that your pediatrician–even a great one like ours–is going to say, “Hey, why don’t you tell me all about those tantrums?”

So finally, when our daughter was four, I brought it up with our pediatrician. It had reached a point where her behavior was affecting our whole family. He had her undergo a complete evaluation for fine motor, gross motor, and speech delays. It turned out that she had a fine motor delay, which was frustrating her in preschool, and also a significant Sensory Processing Disorder.

A crapton of occupational therapy appointments later, and she was a much happier child. The tantrums subsided, for the most part. And then they slowly crept back. In fourth grade, she was diagnosed with ADHD, and in fifth grade, she was diagnosed with Asperger Syndrome. Since then, she has also been diagnosed with OCD. One of the major triggers to us pursuing the Asperger diagnosis, was that she was having meltdowns.

So yeah, I think these researchers are onto something.

But don’t worry too much! A crapton of therapy, school supports, and social skills sessions later, and she is amazing. She is so happy. She’s better able to express her emotions, and is much better able to know when to walk away from something that’s frustrating her, before she loses her cool. She is excelling in school and making (and keeping) friends more easily.

From my own experience, here’s what I’ve learned:

  • Tantrums that last for hours are not typical. That’s not about getting attention, it’s about the kid not being able to adequately process and express emotion.
  • Tantrums that continue past the preschool years are not typical. Lots of Kindergartners may have the occasional exhaustion-based freak-out, but generally speaking, if you’ve got a second-grader who’s regularly melting down, you might want to look into it.
  • There’s a difference between a tantrum and a meltdown. A tantrum is what these researchers call a “typical tantrum.” A meltdown, which is probably what these researchers would call an “atypical tantrum” is a complete breakdown of the child’s ability to cope with the world around him. Both of my kids on the spectrum tend to try to hide, or cover themselves up, during meltdowns. They’re likely to go under a bed or under a table to escape the sensory input around them.
  • There’s a certain physical, raging quality to a meltdown, or atypical tantrum, that I don’t see in a typical tantrum. If your child regularly hits, bites, or kicks you during tantrums, that’s something to mention to your pediatrician.
  • If the entire family is walking on eggshells trying to avoid triggering a tantrum/meltdown, that’s a huge red flag.

I consider myself a good parent. I read a lot about parenting, and I have a great support network of friends and family that I can turn to for advice. But one of the most important things I’ve learned in the past few years is that when you run out of good ideas and can’t figure out how to make the situation better, you need to call in some back up. If your child has behavior issues that affect the entire family, talk to your pediatrician, and get a referral for a counselor.

Please, please, please don’t be afraid to discuss this with your pediatrician. I know that many parents are afraid to bring up issues like this, because they either think their parenting skills will be criticized, or they’re afraid their child will be “labeled” with something. Getting to the root of these tantrums was the greatest thing that ever happened to our family. We are better able to parent all our children for it, and all of our kids are much happier.

Joslyn Gray is the mother of four children, including two with autism. Read more from Joslyn at Babble Pets and at her blog, stark. raving. mad. mommy. You can also follow her on Facebook and Twitter.

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