All children (and many adults) have temper tantrums on occasion. These outbursts are particularly frequent during the toddler and preschool years and usually begin to decline in frequency and intensity by age 5. However, for some children, these tantrums persist, causing continued difficulties throughout childhood. Below are answers to some of the most commonly asked questions from parents of these children.
"When should I be concerned about my child's tantrums?"
Temper tantrums are considered to be part of normal development for young children, particularly those under the age of 5. However, some children continue to exhibit severe tantrums past this age. These tantrums may be:
- Difficult to control or soothe
- Prolonged, lasting more than 15-20 minutes
- Frequent, occurring several times per week
When tantrum behaviors interfere with your child's typical functioning and/or the functioning of the family, there may be cause for concern. For example, children who exhibit severe temper outbursts often have difficulty making and keeping friends, succeeding in school, and getting along with family members. Frequent, out-of-control tantrums can cause a significant amount of family distress, and can result in the family changing their lifestyle in an effort to prevent or reduce the tantrums. Such modifications may include:
- Changing daily home routines, such as mealtimes, transitions, waking up, getting ready for school, or bedtime
- Avoiding public venues, such as restaurants or supermarkets
- Declining to participate in social activities, such as birthday parties or play dates
"Why does my child have severe tantrums?"
We don't really know why. We do know that children with severe temper outbursts often have difficulty with attention, impulsivity, anxiety, and mood regulation. At the NYU Child Study Center, we are conducting research to examine possible neurological bases for severe tantrums.
"How can I better manage my child's tantrums?"
Fortunately, there are things that you as a parent or caregiver can do to help reduce your child's tantrums in the family environment.
What parents can do
1. Don't "give in" to your child's tantrums
Many, though not all children exhibit tantrums when they don't get their way or when they are required to do something they don't enjoy. When children have tantrums, the intensity of their emotions and behaviors makes it difficult for parents to handle, and it's tempting to give in to the child's demands in order to stop the tantrum. When this happens, the child is reinforced for her tantrum — it was effective at getting the desired result. Thus, "giving in" to your child's tantrum behaviors can make the outbursts likely to continue; the child quickly learns that a tantrum can help her get what she wants.
When you "give in" to a tantrum, you may have stopped your child's behavior in that moment (which may be a temporary relief). But you have set the stage for your child to continue having tantrum behaviors in the future. With this in mind, we suggest the following:
- Do not let your child get what he wants out of the tantrum. Although this may be a difficult feat to carry out, consistently saying "No" despite the tantrum will likely cause the outbursts to get better over time.
- You must follow through on saying "No" consistently. If your child even occasionally gets his way as a result of a tantrum, he is likely to keep having them.
- Planned ignoring: Leaving the room where the tantrum is occurring can help stop the behavior.
- Do not try to convince or negotiate with your child during a tantrum. This will likely prolong the tantrum.
- Make sure your child understands that you will not listen to his demands when he tantrums. This is best discussed at a time when the child is not upset.
2. Offer extra incentives
Often children will tantrum in an effort to get out of doing something they don't like. In these cases, offering extra incentives to complete the avoided behavior can be helpful. For example, if your child throws a tantrum whenever it's time for her to complete her homework, consistently offering incentives (i.e., watching her favorite TV show, playing a game) after she's completed her assignments may motivate her to finish the job.
It is important to note that rewards must:
- be motivating to the child
- be carried through every time the child completes the desired behavior
- be consistently denied when the child does not complete the behavior
- not be replaced with comparable rewards if the behavior is not completed (i.e. "You cannot watch TV but you can still play video games").
3. Catch your child being good (Positive Parenting)
Parents of children with severe tantrums may feel like they are always giving their child negative feedback, or giving attention mostly when their child is acting inappropriately. And unfortunately, this is likely the case. This cycle can cause your child to continue acting out in order to get attention, and create strain and hostility in the parent-child relationship.
As parents, you can help counteract this by looking out for, and specifically praising, your child's efforts at positive behavior.
Example: Putting your hand on your child's shoulder, and saying "I really like the way you shared your toys with your brother," when you notice that he is giving his brother a turn with his toys.
Be sure to praise specific behaviors or efforts, not your child's general behavior or temperament.
Example: "David, thank you for putting all your toys back in the container when I asked you to." Not: "Thanks for being good."
This type of praise:
- Shows your child what behaviors you want to see from her.
- Gives her attention for positive behaviors.
What can I do if these tips aren't working?
If you are using these strategies consistently and your child's tantrums are not getting better, you may want to consider getting help from a mental health professional.
Parent Management Training (PMT): PMT teaches parents how to approach their child's tantrums and disruptive behavior as well as modify her environment to reduce the frequency and severity of these behaviors. PMT focuses on teaching parents behavioral management skills, and less emphasis is placed on working one-on-one with the child in therapy. Techniques typically included in the training include effective ways to use positive reinforcement; how to establish consistent rewards and consequences; planned ignoring of misbehavior; and proper use of time-outs.
Parent-Child Interaction Therapy (PCIT): Designed primarily for parents of children between 3 and 6 years old, PCIT teaches parents specific skills to interact positively with their child, including how to ignore minor misbehavior, and how to offer appropriate directives and consequences for misbehavior. PCIT sessions usually involve the parent and child interacting together in a room, while the therapist is watching from another room and giving parents specific tips (through a headset). Parents typically benefit from the opportunity to learn and practice these concrete strategies during the sessions.
Cognitive-Behavioral Therapy (CBT): CBT for children with temper tantrums and other disruptive behaviors, when combined with parent training, can produce long-term improvement. In CBT, greater emphasis is placed on teaching children skills to help them cope with their emotions. Treatment is best served when parents are included, in order to reinforce CBT skills at home. Skills typically taught in CBT include learning to be aware of when you feel angry, understanding others' perspectives, decision-making, and social problem-solving skills.
Stimulant & non-stimulant medications: These medications, which are often used to treat ADHD, can help improve tantrum behaviors in children with this disorder. As impulsive behaviors decrease, the child may no longer try to avoid situations that his ADHD previously made very difficult. Common stimulants include: Ritalin, Concerta, Adderall, Metadate, Focalin, Vyvanse, Dexedrine, and Dextrostat. Currently, Strattera is the only non-stimulant drug used to treat ADHD and impulsivity.
Medications for reducing severe aggression: Recently, other medications have been used to treat aggressive behaviors and temper tantrums in children. These include mood stabilizers (Lithium, Depakote), SSRI-anti-depressants (Prozac, Zoloft), and atypical anti-psychotics (Risperidone). These medications, especially Lithium and anti-psychotics, generally have greater side effects, and are usually only indicated when children show severe bouts of chronic aggression.
Additional Resources for Parents
Research Study of Young Children with Severe Temper Outbursts
The NYU Child Study Center and Fordham University are currently conducting a study of brain function in children with temper outbursts that are difficult to control. If your child has these types of difficulties, and is between the ages of 5 and 9, he or she may qualify for this research study, which provides a free evaluation and a summary report. Participation is voluntary and you and your child will be paid for your time. Please contact Rachel Chizkov at 212-263-3692 or Rachel.Chizkov@nyumc.org for more details.
Children and Adults with Attention Deficit/Hyperactivity Disorder:
Resources for families of individuals with ADHD
Society of Clinical Child and Adolescent Psychology:
Information on understanding and treating childhood mental health disorders, including evidence-based treatments
American Academcy of Child and Adolescent Psychiatry:
Information on understanding and treating childhood mental health disorders, including recent major research
Information for parents about advocacy and your child's legal rights to special educational services
Parenting the Strong-Willed Child, by Rex Forehand and Nicholas Long
The Explosive Child: A new approach for understanding and parenting easily frustrated, chronically inflexible children, by Ross Greene
1-2-3 Magic: Effective discipline for children 2-12, by Thomas Phelan
Taking Charge of ADHD: The complete authoritative guide for parents, by Russell A. Barkley
The Kazdin Method for Parenting the Defiant Child, by Alan E. Kazdin
This article was originally published in April 2012.