The behavioral characteristics of preschoolers’ tantrums differed in relation to diagnostic group classification. Healthy children were reported to show significantly fewer violent, self-injurious, destructive, and orally aggressive tantrum behaviors than children with mood and/or disruptive disorders. Furthermore, healthy preschoolers had less severe, and shorter tantrums, and required less recovery time compared to children with DSM-IV diagnoses. Although replication of these findings is needed, results indicated that the “anatomy” of a tantrum in healthy preschoolers was significantly different from same age peers with mood and/or disruptive disorders.
Despite these robust findings, they do not suggest that a single or group of behaviors during a tantrum episode could definitively indicate whether a child had or was at-risk for a psychiatric disorder. In several behavioral domains, as many as 30% of preschoolers in the healthy group displayed the same maladaptive behaviors as those with a psychiatric disorder indicating that it was not uncommon even for healthy preschoolers to periodically display excessive or maladaptive tantrum behaviors. These findings underscore the notion that consideration for individual differences in emotion development as well as the enduring features of tantrum behaviors is of paramount importance. Based on the current findings, the assessment of preschoolers’ “tantrum style” is key to the determination of common/typical versus atypical tantrum behaviors that warrant a mental health evaluation.
Our results suggest 5 high risk “tantrum styles”. These styles and suggested cutoffs below were based on several quantitative characteristics of tantrum behaviors that most powerfully differentiated preschoolers in the healthy group from those in DSM-IV diagnostic groups. It is important to note that the clinical application of these tantrum styles and cutoffs as markers of early onset disorders has not been empirically established.
The five tantrum styles are as follows: First, preschoolers’ consistent (i.e., more than 50% the time during the last 10–20 tantrum episodes) display of aggression directed at caregivers and/or violently destructive behavior toward objects may indicate clinical problem. Second, when preschoolers intentionally engage in self-injurious behavior during tantrums, regardless of tantrum frequency, duration, intensity, or context, this behavior should be considered very serious. Self-injurious behaviors during tantrums were rarely reported among preschoolers with the exception of those in the MDD groups. Third, preschoolers who display 10–20 discrete tantrum episodes on separate days at home, during a 30-day period, or on average who have more than 5 tantrums a day on multiple days while at school or outside of home/school are at greater risk of having a serious clinical problem. Fourth, extended tantrum duration, lasting longer than 25 minutes on average, may indicate problems that are more serious. Lastly, preschoolers who are typically unable to calm themselves (i.e., frequently require external assistance from a caregiver), regardless of tantrum intensity, frequency, or context, are at a much greater risk of having a clinical problem. Based on the current findings, we propose that preschoolers who consistently exhibit the behaviors outlined may be in need of a referral to a mental health clinician for further evaluation. However, it is important to note that certain tantrum behaviors, such as a sudden onset of tantrums because of hunger, sleep problems, or illness should not be considered alarming.
The second finding of interest was differences in tantrum behaviors between depressed and disruptive diagnostic groups. Consistent with the core characteristics of depression known in adolescents and adults, preschoolers with MDD displayed more internally directed anger (i.e., self-injurious) than preschoolers in the healthy and DIS-no mdd groups. Depressed preschoolers regardless of comorbidity were significantly more likely to have engaged in self-injurious tantrum behaviors compared to all other groups. Although such behaviors are well known in older samples, this finding was particularly notable among young children. Conversly and less surprising was that DIS-no mdd preschoolers displayed more aggression toward others, more tantrum behaviors out of home and school, as well as a poorer capacity to recover from tantrums compared to the MDD-no dis and/or healthy groups.
Limitations of the current study include relying solely on parent-report to characterize preschoolers’ tantrums. A related concern is that both the diagnostic and tantrum data were derived from the same informant. The current study would have been strengthened by the inclusion of data about preschoolers’ tantrums from teachers, babysitters, or family friends. Furthermore, the inclusion of observational data examining preschoolers’ actual tantrum behaviors would have contributed additional support to the current findings. Therefore, an important next step for future research is to include multi-informant methods when examining preschoolers’ tantrums.
An additional recommendation for future research would be to examine the relation between tantrum behaviors, parenting practices, and children’s developmental and cognitive capacities. An additional and complicated issue that arose in the current study was whether it is accurate to equate the tantrums observed in “mentally healthy” children to normative/typical tantrums. Conceptually, children could easily be free of a psychiatric disorder but because of sensory integration dysfunction, cognitive, and/or neurological conditions could be prone to severe types of temper tantrums. In addition, age related differences should also be considered, that is, which developmental differences should be considered appropriate when comparing the tantrums of 3-versus 5-year-old children. In contrast to prior studies conducted by Potegal and colleagues10
the current results suggested no significant age differences between children’s tantrums styles. One explanation for these differing findings is that previous studies have included very young children (e.g., 1 year-olds). That is, age difference may be due to the inclusion of very young children compared to the more narrow age range of preschool age children used in the current study. An important next step in temper tantrum research is to develop an operational definition of a “normal temper tantrum” that takes into account sensory issues, age, and mental status.