Rhythm of tantrums

Abstract

Temper tantrums are part of the normal course of development occurring most commonly in toddlers. There is a chance that these tantrums can become pathological, more so in case of dysfunctional family dynamics. And as it happens in the context of family, it can become a “family problem” as well. Early identification of abnormal tantrum behaviour and interventions directed to help parents handle these tantrums can prevent their long-term adverse consequences. The focus of this article is on why temper tantrums occur, what elements constitute a tantrum, stages through which they progress and simple methods of handling tantrums. It is done with the help of an example and some illustrations that can be useful in psychoeducation to families about tantrum behaviour.

Full text

J Psychiatrists’ Association of Nepal Vol .7, No.1, 2018
Sravanti L et al. Rhythm Of Tantrums….
Rhythm of tantrums
Sravanti L1, Karki U2, Seshadri S3
1. Senior Resident, Department of Child and Adolescent Psychiatry, NIMHANS, Bengaluru, India
2.Prof and Head, Department of Child and Adolescent Psychiatry, NIMHANS, Bengaluru, India
E-mail *Corresponding author : karkiutkarsh@gmail.com
Abstract
Temper tantrums are part of the normal course of development occurring most commonly in toddlers. There is a
chance that these tantrums can become pathological, more so in case of dysfunctional family dynamics. And as it
happens in the context of family, it can become a “family problem” as well. Early identification of abnormal tantrum
behaviour and interventions directed to help parents handle these tantrums can prevent their long-term adverse
consequences. The focus of this article is on why temper tantrums occur, what elements constitute a tantrum, stages
through which they progress and simple methods of handling tantrums. It is done with the help of an example and
some illustrations that can be useful in psychoeducation to families about tantrum behaviour.
Keywords: Temper tantrums, anger outbursts, tantrum behaviour management
INTRODUCTION
Have you ever noticed a child rolling on floor
and whining and wondered what exactly goes
on in the child’s mind while doing so? Well,
temper tantrums are universal and are
distressing to the parents all over the world.
They are part of the normal course of
development occurring most commonly in
toddlers.1 Improper parenting practices play a
role in accentuating these tantrums beyond the
range of what falls under normal development
leading to behavioural problems of childhood.
Early identification of what constitutes an
abnormal tantrum behaviour and interventions
directed to help parents handle these tantrums
can prevent their long-term adverse
consequences.
Generally tantrums exhibited by 1.5-5 year olds
on an average occur once a day lasting for less
than five minutes.2 Tantrums can serve as a
marker of underlying psychiatric disorder.3
Needlman et al reported that 52% of children
exhibiting severe tantrums had other non-
tantrum-related behavioral/emotional
problems.4 Bhatia et al studied 800 children aged
between 3 to 12 years attending a pediatric
department and concluded that they are most
common in children aged 3-5 years and the
prevalence decreases with age. Parental
overprotection, negligence and discord were
found to be associated with tantrum behaviour.
Children were found to have associated
behavioural problems such as hyperactivity,
thumb-sucking, bed-wetting and sleep
disturbances.5
The focus of this article is on why temper
tantrums occur, what elements constitute a
tantrum, stages through which they progress
and simple methods of handling tantrums.
TEMPER TANTRUM
Temper tantrums occur because toddlers cannot
regulate their anger that arises when they are
prevented from exercising autonomy. While
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J Psychiatrists’ Association of Nepal Vol .7, No.1, 2018
Sravanti L et al. Rhythm Of Tantrums….
they are more common in a determined child
with abundant energy,1 they can also occur
when a child is hungry or fatigued,6 bored or
ill.1 Children modify emotional expressions to
serve personal needs and exaggerate true
feelings of anger and distress to get attention.7
Parental responses and family environment play
a role in helping the child develop adequate self-
regulatory capacities. Various parenting
practices that accentuate and perpetuate
tantrums include inconsistency, excessive
strictness, use of corporal punishment,4
unreasonable expectations, overprotection and
overindulgence.1 Mother being the exclusive
caregiver, maternal depression and irritability,
low education and marital stress are some
psychosocial factors that have been identified to
be associated with tantrums.4
Young children find it difficult to regulate their
emotions. Self-regulation is the ability to
modulate attention, affect and behaviour to suit
a given context.8 Effortful control is one of the
important dimensions of temperament and
emotional self-regulation requires effortful
control of emotions. It improves gradually
during development as a result of the
maturation of prefrontal cortex and assistance of
caregivers during stressful situations. Executive
functions such as attention focusing, attention
shifting, inhibiting negative emotions and
behaviours and planning help in exercising self-
regulation.9
Components of a tantrum
Tantrum is an expression of two overlapping
emotional and behavioural processes. Its chief
components are anger and distress. Anger rises
quickly and peaks at or near the beginning of
the tantrum. Whining, crying and comfort-
seeking that are the sub-components of distress
slowly increase in probability across the
tantrum.2 Coping style is another component of
a tantrum. Eg: a child may “drop down” or “run
away”. It reflects the tendency to submit to
authority or escape from the situation.10
Stages of a tantrum
Research has shown that a typical tantrum
progresses and resolves over three stages viz.
the screaming and yelling, physical actions and
crying and whining.11 The three stages have
been illustrated using an example of a young
child demanding to ride on a giant wheel.
Stage 1: Child shouts and yells demanding his
parents to let him ride on the giant wheel in an
amusement park (Fig. 1). Parents think it is an
unreasonable demand as he is much younger
than the age limit that is specified for going on
it. They try to explain it to him, but he doesn’t
listen.
Figure 1: Screaming & Yelling
Stage 2: Child falls on the ground and continues
to scream (Fig 2). A study done by Potegal et al
concluded that if a child stamped or fell to the
floor within 30 seconds of the tantrum, it was
likely to be shorter and likelihood of subsequent
parental intervention was also less.2
Figure 2: Physical actions
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J Psychiatrists’ Association of Nepal Vol .7, No.1, 2018
Sravanti L et al. Rhythm Of Tantrums….
Stage 3: Child whines (Fig 3). By now, child has
expelled a lot of energy and is now fussing
about his demand not being met. Comforting
the child at this point, helps him feel better.
Figure 3: Crying & whining
Normal v/s Abnormal tantrum behaviour
Temper tantrums are normative during
toddlerhood and even in pre-schoolers generally
arising with the child’s resistance to comply and
frustration with external events. They typically
appear between one and three years of age,
when a child’s language skills to describe
his/her emotions and desires is still limited. As
the child develops emotional vocabulary, self-
regulation skills and emotional display rules
they reduce significantly especially by the age of
four – five years. During this period physical
aggression reduces, however verbal and
instrumental aggression begin to increase.12
While aggression of most two-year olds is
reactive in nature, it becomes more instrument
or goal-oriented and calculated between the
ages of three and four years.7 By about five to six
years of age, tantrum behaviours decrease
significantly as children also become good at
problem solving especially when exposed to
appropriate modelling by adults and peers.12
In clinical practice, often children present with
outbursts of anger and agitation that are so
severe that they pose danger to child and
others.13 These outbursts seem irrational and the
triggers could be trivial.14 They are sometimes
called “rages” and have been seen to occur in
association with conditions such as mania,15
intermittent explosive disorder conduct
disorder,16 Tourette’s disorder, autism and other
developmental disabilities.17
Also termed angry agitated outbursts these
could be the exaggerated versions of ordinary
childhood tantrums. They may contain
behaviours with a range of anger intensities and
may show a characteristic pattern of rise and fall
over time. They have a relatively steady-state
distress component.
Both internalizing and externalizing disorders
can present with excessive tantrums.18 Research
shows that anxiety about a perceived threat may
trigger a tantrum to avoid that situation.19 Thus,
intense anxiety might not only trigger tantrums,
but can also intensify distress.
PRINCIPLES UNDERLYING
MANAGEMENT OF TEMPER TANTRUMS
Disregard and ignore are a couple of strategies
that can be adopted by parents to handle temper
tantrums. To “disregard” is to ignore the
tantrum behaviour but not the child. Comforting
and soothing the child but not giving in to the
demand is a preferable approach. However, if it
does not work or is not feasible “ignoring” helps
in tackling the meltdown. But parents need to
nurture the child after the tantrum has subsided,
helping the child to learn to express negative
emotions in acceptable ways.1 Differentially
reinforcing appropriate behaviours, identifying
triggers and intervening early on can prevent
tantrum-behaviours.
In the previous example, since trying to explain
to the child did not work, parents chose to
ignore the tantrum. While doing so, they have
ensured child’s physical safety. They then
identify when he has calmed down a bit and
approach him (Fig 4). They try to soothe him,
explain to him again and offer an alternative
ride.
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J Psychiatrists’ Association of Nepal Vol .7, No.1, 2018
Sravanti L et al. Rhythm Of Tantrums….
Figure 4
Child is more amenable now and settles for a
different option suggested to him by his parents
(Fig 5). Distracting the child by guiding him to
adopt acceptable alternatives to the prohibited
behaviour or suggesting better ways to handle
his distress can be other methods of handling
such a situation.20
However, in this case parents’ negotiation skills
have worked. The timing of approaching the
child determines its success.
Figure 5
Psychoeducating the parents about tantrum
behaviours by doing a functional analysis and
helping them identify parental behaviours that
are encouraging and maintaining tantrums is
helpful. Parents must be sympathetic but setting
clear and defined limits by not giving in to
tantrums is equally important. Individual work
with the child can also be done with a focus on
anger-management techniques and social skills
training.20
CONCLUSION:
Temper tantrums are a normal feature in
toddlers and pre-schoolers that occur due to
poor regulatory capacities to inhibit negative
emotions. Later children learn to restrain
emotional expressions, understand emotional
display rules and substitute their behaviours
with more socially acceptable forms. It is
important to identify when a tantrum is not age-
appropriate or is an indicator of an underlying
emotional disturbance and intervene early to
prevent major psychiatric disorders.
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