Providing parents with knowledge about the temper tantrum stage and strategies for assisting the child with emotional regulation is recommended at a health care maintenance visit between 12 and 18 months of age. Regular routines for sleeping, eating, and physical activity in a childproofed home (or day care center) provided by well-rested and psychologically healthy parents (or caregivers) usually result in a quick transition through this challenging period.
tantrum increases with the age of the child.
history is important, because family stress can exacerbate or prolong what begins as a normal developmental phase. The coexistence of other behavioral problems, such as sleep problems, learning problems, and social problems, suggests the possibility of a more serious mental health disorder.
The physical examination focuses on discovering an underlying illness that could decrease the child’s ability to self-regulate. A thorough examination of the skin to identify childabuse is recommended (see Chapter 22). The neurologic examination identifies underlying brain disorders. Dysmorphic features may reveal a genetic syndrome. Behavioral observations reveal a child’s ability to follow instructions, play with age-appropriate toys, and interact with parents and the clinician.
Laboratory studies screening for iron deficiency anemia and lead exposure are important. Other laboratory and imaging studies are performed only when the history and physical examination suggest a possible underlying etiology. Some children with excessive tantrums should have a formal developmental evaluation.
Most children who have temper tantrums have no underlyingmedical problem. Hearing loss and language delay may be associated with temper tantrums. Children with brain injury andother brain disorders are at increased risk for prolonged temper
Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder defined by symptoms of inattention, hyperactivity, and impulsivity. Clinical guidelines emphasize the use ofthe Diagnostic and Statistical Manual of Mental Health Disorders,Fifth Edition, criteria (available at http://www.cdc.gov/ncbddd/adhd/diagnosis.html) to diagnose ADHD. Diagnosis of childrenup to the age of 16 years requires the presence of at least 6 symptoms of inattention or 6 symptoms of hyperactivity-impulsivityfor at least 6 months in two or more environments. Children 17 years of age and older must exhibit at least 5 symptoms ofinattention or at least 5 symptoms of hyperactivity-impulsivity.Symptoms of inattention include: failing to pay close attentionto details, appearing to not listen when spoken to directly, failing to follow through on instructions or finish assigned work,having difficulty sustaining attention during tasks or play, having difficulty organizing tasks or activities, avoiding or dislikingactivities that require sustained mental effort (e.g., schoolwork),frequently losing things required for tasks and activities, becoming easily distracted, and experiencing frequent forgetfulness indaily activities. Symptoms of hyperactivity include: being fidgetyor restless, leaving a seat when expected to remain seated, running or climbing excessively in inappropriate situations, havingdifficulty in playing quietly, acting as if “driven by a motor,” andtalking excessively. Symptoms of impulsivity include: blurting out answers before a question has been completed, having difficulty awaiting his or her turn, and causing frequent interruptions or intrusions. In addition, several symptoms must havebeen present prior to 12 years of age; evidence of significantimpairment in social, academic, or work settings must occur;and other mental disorders must be excluded.