What if Your Preschooler is Out of Control?
By S.C. Torrington
There’s typical preschool behavior…and then there’s true problem behavior.
We’ve all been witness to a young child’s meltdown. All that yelling and
screaming and thrashing in the middle of a busy store makes you just want to
turn around and duck down another aisle.
Especially if that child is your
Embarrassment aside, however, when should you worry whether your child is
showing typical preschool behavior or behavior that is anything but typical?
“Tantrums in preschoolers are common and, in most instances, are considered a
normal, even healthy, expression of intense emotions, disagreements, and
dislikes. Experienced parents usually don't get alarmed or panicked. Instead,
they stay empathetic and compassionate,” says Dr. Mahmood Jahromi, a
psychiatrist who specializes in treating children and adolescents in private
practice in Towson and Bel Air. “However, frequent and intense tantrums could be
a sign of an underlying emotional discomfort, especially if it’s associated
with other symptoms like repeated head banging, unsafe or self-harming
behavior, hitting, kicking, biting others, cruelty to animals, or running
A Study of Tantrum Behavior
According to researchers at the Washington University School of
Medicine in St. Louis, certain types of tantrums in preschoolers may be signs
of serious emotional or behavioral problems. Their findings, reported in the
January 2008 issue of The Journal of Pediatrics, indicate that long, frequent, violent, and/or self-destructive
tantrums could indicate the presence of psychiatric illness.
The St. Louis researchers studied 270 children between the ages of 3 and 6
years old and gathered information about their tantrums from the children’s
parents. They divided the children into four groups, according to psychiatric
symptoms—no psychiatric diagnosis, major depressive disorder, disruptive
disorder, and depression and disruptive disorder. All of the children were part
of a larger study funded by the National Institute of Mental Health on
psychiatric illness in preschoolers.
Researchers compared tantrums in healthy children to the tantrums in children
diagnosed with depression or disruptive disorders, such as attention
deficit/hyperactivity disorder (ADHD). While most children have temper tantrums
at some point, the researchers found that healthy children tend to be less
aggressive and generally have shorter tantrums than their peers who have
depression and disruptive disorders.
“In my own work with families with younger children that tantrum, there’s
typically little doubt that the tantrums are of sufficient severity to cause
realistic concern to the family,” says Thomas L. Baumgardner, Ph.D., who
practices clinical psychology and pediatric and adult neuropsychology in
Towson. “However, taking a careful family and problem history is vital when
providing consultation and treatment to these families.”
What Sets Them Off
Baumgardner explains that, when he consults with parents, he
conducts a careful interview of the family members to clarify several issues.
The family members—mother, father, siblings, and
grandparents—specify the problem and the effect that the tantrums have on
them. Whether cause or effect, there’s often a “problem sequence” that takes
place repeatedly, either preceding or following a tantrum or recurring at
particular times of the day such as mealtimes, or when Dad or Mom gets home, or
at bath- or bedtime.
“Through careful history-taking and interview, we might discover that some
children begin to display inherited temperamental traits that are contributing
to tantrums,” notes Baumgardner. “For some children, these traits may signal
the presence of significant mood or behavioral problems that need to be
identified, understood, and treated. For other children, their temperamental
characteristics are different from those of their caregivers, and this mismatch
can be a challenge for parents and children alike.”
Jahromi points out that evaluating moods in a child who is just a few years old
can be complicated, partly due to the child's limited speech. Therefore, he
says that it's important to look at other signs and behaviors that indicate the
child’s mood and general disposition, such as how the child normally deals with
conflicts through non-verbal communication, which could be observed through the
child's play and artwork.
“Mood disorders, ADHD, and PDD [pervasive developmental disorder] are not the
only possibilities [for what causes this behavior],” adds Jahromi. “Medical,
neurological [such as intra-uterine exposure to drugs], ongoing abuse, and
other causes should be considered.”
If any of these issues are found to be present, it’s important that parents
seek professional pediatric mental health advice. In extreme cases, medication
along with behavioral modifications and psychotherapy could be considered. And,
in some extreme cases, hospitalization might be indicated.
Treating the Behavior
However, as Baumgardner tells parents, few
medicines have been approved for the treatment of severe tantrums in very young
children. Therefore, it is the parent-child relationship that provides the most
potent vehicle for treatment.
“I approach the treatment of younger children who display troublesome tantrums
through consultation and therapy with parents, with parents and children
together, or with the larger family,” describes Baumgardner. “Viewing video
recordings of family events that illustrate tantrums can be useful, or even
home and school visits. Even in children whose tantrums are part of a mood and
behavioral disorder or other inherited temperamental traits, understanding the
family environment and relationships is vital to understanding the child and
his tantrums and to collaborating with parents in developing solutions.”
That said, Jahromi reminds parents that children are very sensitive to their
environment. The presence of unpredictability and instability increases their
susceptibility to fears, anxieties, and tantrums. In other words, many times,
extreme behavior can be avoided when a child is provided a safe and stable
Finally, Jahromi emphasizes that parents should be consistent with the messages
and expectations that they give their children. Children need clear and firm
directions and need to be held accountable for their decisions as well as
understand and experience the consequences of their behavior. In the absence of
these things, he explains, children feel the lack of structure, which causes
them to worry and be fearful, thus opening the door to tantrum behavior. BC
Five Troublesome Tantrum Behaviors
In a recent study, researchers at
Washington University School of Medicine in St. Louis found that certain types
of tantrums in preschoolers may be signs of serious emotional or behavioral
problems. The following five tantrum behaviors appear to be connected with
depression or diagnosable disruptive disorders. If you have concerns about your
child’s behavior, be sure to discuss them with your pediatrician.
1. Displaying extremely aggressive behavior directed at a caregiver or violently destructive
behavior toward an object such as a toy. The study found that children who act
this way tend to be diagnosed with ADHD, oppositional-defiant disorder, and
other disruptive disorders.
2. Intentionally injuring him- or herself through actions such as scratching until the skin bleeds, head
banging, or biting.
"Children with a major depressive disorder tended to hurt themselves,”
says Andrew C. Belden, Ph.D., one author of the preschool study. “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
3. Having more than five tantrums a day for several consecutive days.
4. Having very long tantrums.
Typically, children might have a tantrum that lasts 10 or 11 minutes. However,
several children in the study—especially those with disruptive
disorders—averaged more than 25 minutes per tantrum.
5. Being unable to calm him- or herself following a tantrum.
According to the researchers, the best news from this paper is that it's normal
for children to sometimes display excessive behavior. If your child lashes out
at you, it doesn't necessarily mean that something’s wrong. However, if he or
she lashes out often and hits you every time or if your child intentionally
tries to hurt him- or herself, there might be a problem. At that point, it is
recommended that you consult a pediatrician or mental health professional.
This research was supported by the National Institute of Mental Health. The
entire article is also available at the Washington University in St. Louis,
School of Medicine website,
What Type of Professional Do You Need?
Titles can sometimes be confusing. Here’s
a quick rundown of what different mental health professionals do and the type
of care they provide for their patients.
Counselor. Mental health
counselors work with individuals, families, and groups to address and treat
mental and emotional disorders and to promote mental health. They are trained
in a variety of therapeutic techniques used to address issues, including
depression, addiction and substance abuse, suicidal impulses, stress, problems
with self-esteem, and grief. Mental health counselors often work closely with
other mental health specialists, such as psychiatrists, psychologists, clinical
social workers, psychiatric nurses, and school counselors.
Social Worker. Mental health
social workers assess and treat individuals with mental illness. Such services
include individual and group therapy, outreach, crisis intervention, social
rehabilitation, and teaching skills needed for everyday living. Mental health
social workers are likely to work in hospitals, individual and family services
agencies, or local governments. These social workers may be known as clinical
psychologists study the physiological, cognitive, and social development that
takes place throughout life. Some specialize in behavior during infancy,
childhood, and adolescence, or changes that occur during maturity or old age.
Developmental psychologists also may study developmental disabilities and their
effects. Often, clinical psychologists consult with other medical personnel
regarding the best treatment for patients, especially treatment that includes
Clinical psychologists generally are not permitted to prescribe medication to
treat patients; only psychiatrists and other medical doctors may prescribe most
Psychiatrist. Psychiatrists are
the primary caregivers in the area of mental health who assess and treat mental
illnesses through a combination of psychotherapy, psychoanalysis,
hospitalization, and medication.
Psychotherapy involves regular discussions with patients about their problems.
The psychiatrist helps them find solutions through changes in their behavioral
patterns, the exploration of their past experiences, or group and family
Psychoanalysis involves long-term psychotherapy and counseling for patients. In
many cases, medications are administered to correct chemical imbalances that
cause emotional problems.
These definitions are provided by the U.S. Department of Labor, Bureau of
Labor Statistics, www.bls.gov
© Baltimore's Child Inc. November 2008.