Yale helps parents, kids manage temper tantrums
NEW HAVEN — All young children will throw a temper tantrum from time to time. It’s a normal part of growing up, however upsetting it might be to both child and parents.
But when the behavior becomes too disruptive to family life or a child’s ability to interact with other children or to learn in school, the Yale Child Study Center’s mental health professionals are prepared to help.
The behaviors may or may not be rooted in a psychiatric problem. “Pediatric disruptive disorders can exist … along a spectrum of severity,” said Dr. David Grodberg, a child and adolescent psychiatrist at the center.
“At a certain point, where it starts getting in the way of school, social interactions … these kinds of behavior can cause upheaval in families and can play out in all kinds of stressful ways,” said Grodberg, who is director of the Child Study Center’s outpatient clinic.
“We don’t think of tantrums as a problem or a bad thing, because they are developmentally appropriate at certain ages,” said Dr. Andrea Diaz Stransky, an adult psychiatrist who is training in child psychiatry and is a clinical fellow at the Child Study Center. “It’s when they’re too frequent or intense or lasting too long or interfering with a child’s functioning that we think of them as a problem.”
Often, tantrums can be magnified in a parent’s mind far beyond their actual significance, said Denis Sukhodolsky, an associate professor at the Yale Child Study Center whose lab conducts researchin autism spectrum disorder, disruptive behavior disorder and other issues. A child may have “a gigantic tantrum once a year and they will remember that” or it may be “fairly mild and a parent is not overwhelmed by them,” he said.
“Between 2 and 4 years of age, tantrums are common,” Sukhodolsky said. “From 5 to 6 years of age, common tantrums tend to decline, then, from 7 and up, if a child continues to have tantrums like a 4-year-old, then you might think of those tantrums as an interference with a child’s life,” affecting relationships with family and peers and with schoolwork.
If tantrums continue over time, such as six months, “then it could be a signal that those emotional outbursts need to be discussed, first with a pediatrician and then with a mental health professional,” Sukhodolsky said.
It’s important to remember that a child’s behavior is influenced by family dynamics and how parents interact with their children, the Yale doctors said. Without intervention, the child may suffer emotionally. “They’re going to have lower self-esteem. They get identified as being problem kids,” Grodberg said.
Disruptive behavior, when it becomes a pattern, also has a negative impact on parents’ lives, Diaz Stransky said. At work, “the number of hours they have to spend taking calls from school or leaving earlier” leads to losses in productivity, she said, including absenteeism and “presenteeism,” meaning they are not able to be as effective in their jobs. This can lead to “higher rates of anxiety and depression” in parents and other caregivers, Diaz Stransky said.
“The main problem that we identified is that a lot of cases get to medications before therapy,” she said. Stimulants, used to treat attentiondeficit/hyperactivity disorder, and antipsychotics may bring unwelcome side effects. Cognitive behavioral therapy and other forms of therapy should be tried first, she said.
Acommon mistake for parents is to give in to a tantrum, rewarding negative behavior, and not paying attention “when they are doing appropriate activities,” such as reading or doing homework,” Sukhodolsky said.
Problems develop when a parent reinforces negative behavior by, for example, giving in to a demand for candy at the supermarket register. Instead, Grodberg said, “If you want to control the situation, maybe you can go (to) the cash register that doesn’t have the candy on the side” or have a snack available.