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Author: Rachael A. Levine, PhD
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What’s Behind a Tantrum?

Author: Rachael A. Levine, PhD – Associate Director of Child Programs

It is common for children to have meltdowns, tantrums, and emotional outbursts when they are young. There are many potential contributing factors: being hungry, tired, hearing “no,” and experiencing something that feels “unfair” are only a few. People are rarely surprised to find a 4 or 5 year old on the floor in the grocery store upset about not getting candy or a toy. Children this young have not yet developed the skills to be able to adapt and cooperate when tired, hungry, distracted, or upset. However, there is a point that we all expect children to begin demonstrating the emotional/behavioral regulation that would allow them to better work through these difficult moments.  

Many of us learn the skills needed to maintain emotional and behavioral regulation by watching others, practicing in social settings, and experiencing successes and failures as guided by caretakers, siblings, and peers. However, in some circumstances children have difficulty learning these skills by watching and experiencing. In these instances, a child may continue to experience frequent “emotional dysregulation” as they get older, leading to increased difficulty across several domains in life. Parents might find themselves hearing about frequent problems at school, feeling the need to be present and ready to interject emotional/behavioral support during extracurricular activities, and experiencing a high level of disruption in their family schedule and routines.

These struggles can increase over time to the point of overwhelm. It becomes hard to know where to start and what to change. One of the first steps in problem-solving is determining what the child is communicating through their behavior. All behavior is communication. When children communicate through angry, defiant, oppositional, tantrum behavior, it can be challenging for the adults in their life to help them. Stopping to think about what a child is trying to say can sometimes help us gain perspective and provide the appropriate supports and treatment.

“If kids could do well, they would do well.” (i)

While it is often assumed that what appears as oppositional, defiant behavior is done “on purpose,” there are other factors to consider when these behaviors continue with high frequency across several months and after repeated attempts to intervene with discipline strategies. In these circumstances, there are a variety of potential underlying disorders and skill deficits that can lead to what appears to be oppositional behaviors. Several potential contributing factors include the presence of anxiety, ADHD, mood disorder, developmental delays, communication disorders, and learning disabilities. When viewed as a skill deficit, as opposed to a child’s choice, it allows for treatment of the underlying concern.

Anxiety. Anxiety disorders are among the most common mental health disorders impacting children and adolescents (ii). Anxiety can cause explosive outbursts as children attempt to avoid or escape the situation that is causing them to feel uncomfortable and anxious. In these cases, a child may be lacking the communication tools to alert someone that they need help, potentially feel embarrassed by their response, or experience a “fight or flight,” panic response.

Anxiety symptoms are natural across different points in development, and they can even be helpful as children learn, adapt, and determine parameters for safety and expectations within social settings. As toddlers grow and explore their surroundings, it is expected that they will experience separation anxiety and fear of unknown places, people, and things. However, when these symptoms increase or last beyond the expected age, it they can become inhibiting and debilitating. Untreated anxiety in children can lead to increased challenges as they grow through adolescence and adulthood. The following could be signifiers that your child is experiencing anxiety and would benefit from treatment:

  • Your child has significant trouble falling asleep or wakes frequently through the night
  • Your child is frequently complaining of stomach-aches, headaches, or other physical ailments.
  • Your child is avoidant of social situations in a way that impedes them from engaging with others.
  • You’re receiving reports that your child is having difficulty focusing at school.
  • Your child has frequent explosive outbursts

ADHD. Irritability is common among children with ADHD. Irritability typically involves the likelihood that a child will react disproportionally to a situation with excessive grouchiness, anger, or tantrum behaviors (iii). Irritability and emotional dysregulation is present in about 25-45% of children with ADHD (iv).

As of 2011, the National Institute of Mental Health determined that 11% of children have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) at some point in their childhood. ADHD symptoms include difficulty staying focused, paying attention, controlling behavioral impulses, and hyperactivity. Children with ADHD can often experience difficulty in school, developing and maintaining friendships, and moving independently through daily routines.

Furthermore, common deficits among children with ADHD can lead to increased frustration over time, to the point of potential development of symptoms of depression (v). This can also heighten irritability and emotion dysregulation.

Additional Disorders. Similar to Anxiety and ADHD, mood disorders (Disruptive Mood Dysregulation Disorder, Depression), communication disorders, developmental delays, and learning disabilities can all come with a subset of skill deficits that make it difficult for a child to function as expected under “normal” circumstances.

Under these circumstances, children may find themselves frustrated, irritable, and lacking the tools to navigate a situation that appears to others as easy. Behaviors can quickly turn into tantrums, and frequent tantrums can quickly turn into learned strategies and responses in difficult moments. Caregivers may also find themselves walking on eggshells or making accomodations to simply have a smooth evening. In these instances, there are evidence-based interventions and strategies for not only the child, but also caregivers. While the child may be lacking skills, it is also helpful for caregivers to build techniques that allow for success.

When we pause to think about “why” a child is struggling, it opens our eyes to consider what’s going on for a child beneath the surface of anger, irritability, and tantrums. “Kids do well when they can do well;” providing families with the supports and skills to do so can help children work through the difficult situations they’ll come across as they move forward.

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(i) This quote is borrowed from Dr. Ross Greene, clinical child psychologist, professor, and author of The Explosive Child. Dr. Ross Greene has worked to develop strength-based approaches to working with challenging behaviors in children and adolescents.

(ii) Higa-McMollan, Francis, Rith-Najarian, Chorpita. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child & Adolescent Psychology, 45(2), 91-113.

(iii) Stringaris, A., Goodman, R. (2009). Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of American Academy Child Adolescent Psychiatry, 48 (4), 404-412.

(iv) Shaw, P., Stringaris, A., Nigg, J., Leibenluft, E. (2013). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293.

(v) Spencer, T., Biderman, J., Wilens, T. (1999). Attention-deficit/hyperactivity disorder and comorbidity. Pediatric Clinical North America, 46(5), 915-927.