Temper tantrums are the most commonly reported behavioral problem in 2and 3-year-old children. The typical frequency of tantrums is approximately one per week, with a great deal of variability (Fig. 12-1). The duration of each tantrum is 2 to 5 minutes, and duration increases with age (Fig. 12-2). Helping the family identify the typical antecedents of the child’s tantrums is essential to evaluation and intervention. A child who has tantrums only when he or she misses a routine nap can be treated differently than a child who has frequent tantrums related to minor difficulties or disappointments.
The evaluation of a child who is having temper tantrums requires a complete history, including perinatal and developmental information. Careful attention to the child’s daily routines may reveal problems associated with hunger, fatigue, inadequate physical activity, or overstimulation. A social
No. of Tantrums per Week
Figure 12-1 Mean tantrum frequency per week. Children 1 to tantrum behavior (in terms of actual tantrum duration and continued manifestation after the normal tantrum age). These children include former premature infants and children with autism,traumatic brain injury, cognitive impairment, and Prader-Williand Smith-Magenis syndromes. Children with rare conditions,such as congenital adrenal hyperplasia and precocious puberty,also may present with severe and persistent tantrums. Childrenwith intellectual disability may exhibit tantrums when theirdevelopmental age is comparable to 3 to 4 years.
Intervention begins with parental education about temper tantrums, stressing that tantrums are a normal developmental phase. Parents may have unwarranted concerns about their 4 years of age who have tantrums typically have four to nine tantrums child’s mental health. The clinician can help parents understand per week. their role in helping the child move toward self-regulation of frustration and anger. The environment can be structured to limit toddler frustration; age-inappropriate demands on the 5.0 child; and hunger, fatigue, loneliness, or hyperstimulation. It 4.5 is important to review the child’s daily routine to understand 4.0 whether the child’s tantrums are communicating essential unmet needs. Children who behave well all day at day care 3.5 3.0 2.5 2.0 1.5 1.0 0.5
Figure 12-2 Mean duration of tantrums. The typical duration of a and exhibit temper tantrums at home in the evening may be signaling fatigue or need for parental attention. Identification of underlying stress is the cornerstone of treatment because many stressors can be eliminated. Parents may consider some changes in the home environment so that they do not have to say “No” to the child as frequently.
In some cases, parents inadvertently reinforce tantrum behavior by complying with the child’s demands. The child’s behavior can be seen as manipulative or simply as learned behaviorfrom a prior successful experience. Parental ambivalence aboutacceptable toddler behavior also may lead to inconsistent expectations and restrictions. Helping parents clarify what behavior isallowed and what is off limits can avert the temptation to give inwhen the child screams loudly or publicly.
Distraction is an effective means of short-circuiting impending tantrums. Physically removing the child from an environment that is associated with the child’s difficulty is sometimes helpful. Further behavioral interventions are recommended only after engaging in strategies to help the child gain control by meeting basic needs, altering the environment, and anticipating meltdowns. Recommended behavioral strategies include behavior modification with positive and negative reinforcement or extinction. During the first week of any behavioral intervention, tantrum behavior may increase. Parents must be warned that it will probably get worse before it gets better. At the same time that parents are working to extinguish or decrease the tantrums, it is important that they provide positive reinforcement for good behavior.