Decoding tantrums

"I want that chocolate and I want it right now. If you don't get it for me, I will scream my lungs out, fall on the floor and do everything I can to embarass you."

One of the worst nightmare scenarios for parents of young children is a tantrum—especially if it involves angry outbursts and high-decibel crying in full public view. But what exactly are tantrums and if a child is prone to excessive tantrums, could it be a sign of a mental health problem?

We had a phone conversation with Dr Michael Potegal, pediatric neuropsychologist at the University of Minnesota, who has studied temper tantrums in detail, to understand this better. Read on...

Dr Potegal, you have spent the the past few years of your professional career observing children, talking to parents and understanding patterns of children’s temper tantrums. To begin with, can you tell us what exactly a tantrum is?

A tantrum is usually a short period of angry outburst or unreasonable behavior such as crying, screaming, shouting and throwing objects. The signs of tantrums usually begin to appear at the age of 12 months. By around the age of 18 months, tantrums are full-blown. Historically, weaning happens around age two and tantrums may have evolved as a means for the child to get the mother’s attention, if not her nursing.

Tantrums have two components:

• Anger: involves screaming and yelling. Behaviorally this may be displayed as hitting, throwing things, arching the back, etc.

• Sadness: whining and crying, falling to the floor, seeking comfort, etc.

Different parts of the brain are activated for both these components. In the case of anger, the left temporal lobe is activated, and in the case of sadness, the right frontal lobe is activated. A major finding from our study was that both these phases overlap in time, they occur more or less simultaneously.

When a child throws a tantrum in public, the parents are often judged for the child’s behavior. Is there any evidence that flaws in parenting style can cause tantrums?

No, not unless the parents are punitive or abusive and this in turn negatively impacts the child. Even in a normal household where neither of the parents are abusive, you will still find children throwing tantrums.

That leads us to our next question. Why do children throw tantrums?

Children normally throw tantrums for one of the following three reasons:

• Demand for attention

• To get something tangible (for example, a favourite food or toy)

• To escape from demands

In all of the above situations, the parent or caregiver usually knows why the child is throwing a tantrum. However, children may occasionally throw a tantrum for reasons that are not obvious. For instance, if the child is in physical distress (such as reflux, heartburn) and it is very hard for them to explain what is going on. These situations are not very common though.

How long do these tantrums typically last?

Young children throw one or two tantrums in a day and the duration of each of these tantrums is considerably shorter than 10 minutes. Occasionally the child may have a tantrum that lasts longer than 10 minutes. This is normal.

As children grow older, the frequency of tantrums reduces but their duration increases. In a majority of children, tantrums taper off by the time the child is five years old.

Sometimes, in about 25 percent of the population, tantrums continue into later childhood. Adult episodes of anger that end with more subtle forms of sadness such as guilt or remorse are a vestige of childhood tantrums.

When do you think tantrums are a cause for concern and need more looking into?

Excessive tantrums (if a child throws more than five tantrums in a day and if these tantrums last more than ten minutes on an average) could be a sign of an underlying psychological issue. In such cases, it is important to first rule out physical distress or illness and next, seek professional psychological help. If left unaddressed, these issues might manifest later as externalizing problems (such as aggression) or internalizing problems (such as depression and anxiety).

It is interesting to note that in boys, the behavior is usually exhibited as purely externalizing or purely internalizing or a combination of both. On the other hand, in girls, no signs of purely externalizing behavior have been observed – it is either purely internalizing (sadness, anxiety, depression) or a combination of both behaviors.

We know tantrums have no magic solution, but for a parent trying not to tear their hair out in a tantrum situation, what is some good advice?

Well, the standard advice is to not get mad. Kids always look for a reaction when they throw a tantrum. If I am a three year old, I don’t get to control many things in life. I don’t get to decide what I eat or what time I go to bed, etc. But by god, I can make mommy mad. That is in my control. Getting a reaction is the payoff that most young children will settle for. So if you can be prepared, stay calm and handle it objectively, that is half the battle won.

It is also important to know that children often mimic their parents' emotional repertoire. So if you are angry and anxious, don’t be surprised if the child models these behaviors too.

If the child is throwing a tantrum to seek attention or get something tangible, the best strategy is to ignore or if need be, try to distract them. Planned ignoring (time out, ignoring their whining, etc) is very effective especially. However if the child is throwing a tantrum to escape from a demand or rule (such as refusing to brush his teeth), then it is important to intervene right away and get the child to comply. You might want to say, “If you are not going to brush your teeth, then I am going to put my hands on your hands and then help you do it.” This takes away the child’s autonomy, most children don’t like that and if you are consistent the child will soon learn to comply with the demand.

However if you are in a rush and if the child refuses to comply, then it makes sense to give in. Because if you get into a power struggle and then finally let the child have it their way, this will lead the child to believe the longer they persevere, the greater is the chance they can have it their way.