Potegal and Davidson³ found that common tantrum behaviors exhibited by 18–60 month olds included behaviors such as crying, hitting, and occurred once a day on average with a median duration of 3 minutes with (75%) lasting between 1.5 and 5 minutes. Researchers have also found that 70% of 18–24 month old children have tantrums.⁴ Others have noted that the highest incidence of tantrums occur in the 3–5 year old range (75.3% of children).⁵ A study of children exhibiting severe tantrums, found that 52% of children had other non-tantrum-related behavioral/emotional problems.⁶

In the current study, it was hypothesized that the three diagnostic groups would have greater tantrum frequencies, durations, intensities and have greater difficulty recovering from tantrums than the healthy group regardless of context. Specifically, it was expected that depressed preschoolers would display internally directed aggressive tantrums with higher frequencies, intensities, duration, and have more difficulty recovering from tantrums than children in the healthy group. It was also expected that preschoolers with a disruptive disorder (i.e., pure and comorbid) would have greater frequencies, durations, intensities and have more difficulty recovering from tantrums than preschoolers in the healthy and pure MDD groups.

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.