Thursday, June 3, 2010
Are temper tantrums a sign of trouble? Local experts discuss what causes temper tantrums, and when parents should be concerned.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. It can be one of the most embarrassing events in parenting a young child. It's that moment, in public, when your toddler crosses the line between being cranky into a full-blown temper tantrum. The screaming, the shrieking, the swinging arms and legs. It's not an experience anyone wants to repeat. But, child psychologists say it's how you handle that tantrum that could determine how often it gets repeated. This morning we'll examine temper tantrums, why kids have them and what to do about them. I’d like to welcome my guests. Christy Wise is a clinical psychologist with San Diego Family Services. Christy, welcome to These Days.
DR. CHRISTY WISE (Clinical Psychologist, San Diego Family Services): Thank you so much for having me.
CAVANAUGH: Robert Gray is a clinical neuropsychologist with Advanced Neurobehavioral Health of Southern California. Robert, welcome to These Days.
DR. ROBERT GRAY (Clinical Neuropsychologist, Advanced Neurobehavioral Health of Southern California): Thank you very much.
CAVANAUGH: And we invite our listeners to join the conversation. How have you handled your child’s temper tantrums? Do you think your child is having too many of them? Call us with your questions and comments. Our number is 1-888-895-5727. So, I guess the big question, Christy, is are temper tantrums normal?
DR. WISE: Yes, absolutely. Temper tantrums are a healthy part of development and they normally happen between the ages of 1 and 3, although some people with teenage kids would say they continue, but that’s normally between 1 and 3.
CAVANAUGH: And, Robert, how would you define a normal temper tantrum?
DR. GRAY: Well, I think that’s exactly one of the most important points here is to recognize that most of them are normal and so I think the definition that we think about is looking at two components and I think it’s anger and distress, and how kids at this young age sort of express their anger or their frustration when their sort of parents are thwarting their wishes, so to speak. You’ll see some kicking or throwing or stamping behavior, sometimes falling down, and whining, and so as you see the anger rise quickly it’s our – typically what we will see, we’ll see that peak in most normal children and then it’ll get into more of a distress presentation where they’re comfort seeking through crying or whining and so they’ve sort of – are trying to emotionally cope with that and at that young age they have some difficulties with that.
CAVANAUGH: And, Christy, you know, for the rest of us who are not dealing with a specific child having – going through this experience, the way we usually experience it is you’re in a store and all of a sudden you just hear this aaaah!, this shriek coming up and there’s a little child on the floor completely out of control. How else besides crying and shrieking, what are the other things that kids do during a temper tantrum, a normal temper tantrum?
DR. WISE: Some kids will hold their breath, become rigid and silent, but normally it’s the screaming and the crying and the kicking that are the most common.
CAVANAUGH: And, Robert, what is going on in a child’s brain during a temper tantrum?
DR. GRAY: Well, again, I think – Remember, we need to think of these things as normal developmentally.
DR. GRAY: But what’s going on is you have developing emotional control in the hippatory control systems that are kind of just starting to emerge and come online in these young children. And so a lot of what they’re doing, well, a lot of what’s going on in the brain is an immediate reaction to something that they can’t either get or something they can’t get to, and the frustration is not really handled well and then you see this eruption of these emotional symptoms and behavioral symptoms through the motor output, through the screaming, through the rigidity, through the holding their breath and the things that have been mentioned here. So I think what we need to keep on focusing on is that everything’s normal as far as what’s going on in the brain when you see these things, although it can definitely feel like something’s out of range of normal. But this is where, I think, clinicians like Dr. Wise and myself can help parents understand a lot of what you’re seeing is normal and when to start thinking about things that may be beyond the range of normal.
CAVANAUGH: You’re stressing that normal very much, Robert, because obviously when a child is this distressed it looks abnormal, it looks out of control, it looks unhealthy. But you’re trying to make the point that these tantrums are a healthy part of development. What role do they play in the development of a child’s brain and emotions?
DR. GRAY: Well, I think it’s a definite part of what we see when a child is trying to navigate how to cope with typical developmental stressors. And for kids at this age, your developmental stressors are how to get your needs met. You’ve just moved beyond sort of, you know, you’re now starting to walk and you’re getting just developing some language skills so this is part of how you’re trying to navigate your world. And I think that the reason I keep coming back to that normative description is, just as you mentioned, when you’re in the midst of it, when we talk about tantrums, durations that are quite normal to last between 1.5 and 5 minutes, 75% of kids, we think, will demonstrate that duration of tantrum. But at 1 and 2 minutes, when you’re a parent and you’re in the store or at home…
DR. GRAY: …it feels more like 30. But – So, when he starts, if you can step back and say to yourself, and utilize some parenting skills that I think Dr. Wise will talk about as well, and say to yourself, okay, this is part of that normal navigating, experimenting, trying to figure out how to cope with these feelings in the world, how can we, as parents, help them through this development stage? I think that can help you to some degree. It’s not going to help all the time because it’s very stressful, but it will help to sort of help you normalize this behavior.
CAVANAUGH: So, Christy, what are some of the ways that parents react to these tantrums that they really shouldn’t do?
DR. WISE: Well, this makes or breaks the learning curve for the child because if a child is having a tantrum, they’ve having these needs, they can’t quite figure out the language to get those needs met and then the parent loses it, it’s almost like snowball effect. It’s just going to continue and get worse and so how parents react is crucial to if they can teach the kid, you know, better coping skills and how to have their needs met or if the kid continues to learn that tantrums are worth it.
CAVANAUGH: Right, so what parents shouldn’t do, I would imagine, is hit a child?
DR. WISE: Right. Yes.
CAVANAUGH: And what are some of the other things that parents do that are just wrong?
DR. WISE: Yeah, hitting, screaming, also having a tantrum themselves…
DR. WISE: …so that they’re, you know, they’re a dual tantrum going on. Putting the child down. Punishing. Very punishing, abrasive acts are not going to help the tantrum.
CAVANAUGH: That would be the first thing that would come to mind a lot of the times, though, because the child is really acting very badly when you’ve told them not to.
DR. WISE: That’s right, and parents take it personal as if it’s a reflection on – of them or their parenting. So they become very angry and embarrassed and they take it out on the child.
CAVANAUGH: It’s interesting. We’re taking your calls at 1-888-895-5727. My guests are clinical psychologist Christy Wise, and clinical neuropsychologist Robert Gray, and we’re talking about temper tantrums. Joanna is calling us from San Diego. Good morning, Joanna. Welcome to These Days.
JOANNA (Caller, San Diego): Good morning.
DR. WISE: Good morning.
JOANNA: I had a comment. I have a little boy and he’s almost two and he has recently started to have the most terrible temper tantrums and I think it’s very easy to say to parents, you know, don’t scream, don’t get upset, and as a young parent myself one of the things I’ve found that works really well is I try to stay very calm with him and I try to sort of tuck into breathing myself and I take him away. I hold him by the arms and I take him away from the situation, so we might go outside and look at the snails or do something completely different, and it seems to work really well and he calms down and he forgets and he starts to breathe with me and it’s really helpful.
CAVANAUGH: Thank you for that. Thank you for that call, Joanna. So is Joanna handling this in the right way, Christy?
DR. WISE: Yeah, that’s fantastic. You know, first trying to figure out why the tantrum is occurring is probably the best step, if they’re tired, if they’re hungry or if they’re frustrated. But then implementing something like, you know, redirecting or distracting is a fantastic thing to do.
DR. GRAY: And further…
CAVANAUGH: Yes, go ahead, Robert. I’m sorry.
DR. GRAY: Yeah, I’m sorry. I was just going to say and, furthermore, an excellent thing that parent is doing is also thinking about consistency. And, you know, we need to establish a consistent way that we deal with the tantrum so that the child isn’t – the child sort of understands what to expect and you can sort of start to create that sort of self-regulation. When they know this is not going to get – not going to result in something negative but something positive, for instance we do see some parents use that same removal technique in an incorrect fashion when the child learns that I can just scream and yell and be removed from something and, unfortunately, that will then reinforce the idea that this is how you get out of things you don’t want to be into.
DR. WISE: Right.
CAVANAUGH: Right. I think most parents realize that they can’t actually reason with their two- or three-year-old child. But some parents do try to negotiate or maybe bribe a child out of a tantrum. What do you think about that, Christy?
DR. WISE: I don’t think that’s the appropriate way to handle it. The message is all wrong. However, what you can do is praise them when they are doing something right and reward them then for that behavior so that you get more of that behavior.
CAVANAUGH: But don’t give them something just to stop the tantrum.
DR. WISE: Absolutely not. No.
CAVANAUGH: Because that’ll make them just go – have another tantrum.
DR. WISE: Yeah, absolutely, right. I mean, not only are they getting what they want but they’re getting rewarded for having the tantrum so it’s kind of a, you know, an unhealthy approach.
DR. GRAY: And they’re very, very good learners at this age.
DR. WISE: Yeah.
DR. GRAY: They are very clear and they understand what behaviors result in what consequences so…
CAVANAUGH: Let’s take another call. Celeste is calling us from San Diego. Good morning, Celeste. Welcome to These Days.
CELESTE (Caller, San Diego): Good morning. Thank you for taking my call and I appreciate the topic. As I said to your screener, I’m of a different generation. I’m 65 and we raised our children in the late sixties, early seventies, and at that time we were all stay-at-home moms with husbands working. And to be honest with you, I don’t remember any of our children in a grocery store, in public, anywhere having the kinds of tantrums that I see today. And I’m wondering what has transpired in the last 50 years that children, to be honest with you, they’re obnoxious. And I – We had two children, a boy and a girl. We never had to spank our daughter. We spanked our son once because he was involved in, you know, maybe harming another child. We didn’t have to do that but we didn’t sit down and be our – their buddy and, you know, reason with them. It was just, it’s because I said so. And I’ll listen off the air. Thank you so much.
CAVANAUGH: Thank you, Celeste. A delightful call. Robert, I wonder, do we know if tantrums are becoming more common?
DR. GRAY: I think the evidence would say that kids’ brains haven’t changed over the last several hundred years that we know of. I think we still see the same types of kids. I do hear parents from different generations mentioning those sorts of things and I think it’s a matter of – I think we’re a lot more observant. We’re a lot more child focused now, and so I think a lot of these things have become more apparent. I think there probably would’ve been even less tolerance for children’s behavior in the past and maybe these things were where children weren’t even taken out into the community if they had any sort of tantrums at all. So I don’t think that kids have changed at all in the past several thousands of years.
DR. WISE: Right, I would agree with that but I also think that we involve our children in so much more than we had in the past, sports and clubs and games and, you know, so kids are really overscheduled. And so sometimes being overly tired can, you know, lead to tantrums. The other thing is, is that with both working parents, oftentimes parents have to take their children out even when they’re too tired, you know, to the grocery store and get food, and so kids are out and about and being dragged around a little bit more perhaps than they used to when they could have nap time at home.
CAVANAUGH: And that context that you were talking about grows where the children might be outside when they’re tired and hungry and susceptible to having this kind of a reaction.
DR. WISE: That’s right.
CAVANAUGH: Robert, we’ve been talking about, as you’ve stressed, normal temper tantrums. What are the sorts of things you might look for when trying to determine if a tantrum is abnormal in some way?
DR. GRAY: That’s a great question. So what we talk about is sort of the anatomy of tantrums and healthy versus maybe unhealthy development. And the markers that we focus on are a couple. Let me just mention them briefly. First of all, if there’s consistent aggression. So, for instance, you know, if more than half of the tantrums you’re seeing have some demonstration of aggression directed at either the caregivers or some sort of violent, destructive behavior towards either objects or other persons, that’s one big marker, so aggression. Second would be any self-injurious behavior during a tantrum. We really worry about the risk for developing mood disorders when we see self-injurious behaviors. Third, we talk a lot, again, about these sort of – the frequency. And so if you’re seeing more than, let’s say, five tantrums a day on multiple days in a period, that could be a very significant problem. And, of course, again, contact is important. If you’re on a, you know, a trip and you’re on vacation and you’re seeing them, then that’s not the same thing. But if in a regular sort of week you’re seeing more than five tantrums a day on multiple days, there’s concerns there. A fourth would be the duration of the tantrum becomes much more extensive than usual. So we talked about that sort of average between 1 and 5 minutes, we’re talking about some tantrums that parents will come in and say are lasting longer than 25 minutes on average. That’s a problem. And sort of the fifth variable we tend to focus on is recovery phase. So, you know, a pre-schooler or a child who’s not able to calm themselves and they need a lot of external assistance regardless of the tantrum intensity or the context, that’s – they’re at much greater risk, too. So, the recovery phase, you should see some recovery after that 5 minutes typically, that’s obviously parent-directed but also somewhat child directed. So those are the five things we think about in looking for markers for potential problems.
CAVANAUGH: And, Robert, if you could, what could abnormal tantrums be an indication of?
DR. GRAY: Well, the things that we see looking back at the research are depression, mood disorders, they can also be an indication of an emerging, what we call, disruptive behavior disorder, things like ADHD, other neuro-developmental disorders. So these are the things we’re looking for that can really affect a child’s behavioral and social progress and of course their progress in the academic and home settings as well.
CAVANAUGH: Let’s take another call. Walid is calling us from La Mesa. Good morning, Walid, and welcome to These Days.
WALID (Caller, La Mesa): Oh, good morning. Thank you so much for taking my call. I have a son with autism. He’s not 2, he’s 11 years old. And he has good days and bad days. There has been time where it is really difficult to deal with, especially if he doesn’t get what he wants. I mean, there are days where he’s really, really good and he pretty much understand what’s good, what’s bad. My question is, is there a different model dealing with kids with autism than normal kids or… If I can get some advice from these guests…
WALID: …I’ll appreciate it. Thank you.
CAVANAUGH: Thank you, Walid. And Christy?
DR. WISE: Yeah, what I was thinking is that, you know, yes, it’s a different situation, however, some of the techniques that you employ with kids with autism and kids having tantrums could be very similar such as redirecting and distracting. Something that would be very helpful would be like transition reminders. So, you know, in three minutes we’re going to brush our teeth. In two minutes, get ready, we’re going to go brush our teeth. Preparing them ahead of time eases that transition and makes it less confusing and frustrating for them.
CAVANAUGH: And, Robert, with children who have conditions like autism, are tantrums a way of life well beyond that age of three or four?
DR. GRAY: They certainly can be. And I can’t remember what the caller noted that his child’s age was…
DR. GRAY: Eleven, yeah. So with autism what we have to remember is there are significant language deficits, significant emotional and social deficits that really make it even harder. If you can think about that two-year-old trying to cope with stressors, you’re having an eleven-year-old with eleven-year-old expectations but very, very, very limited coping skills for dealing with these stressors. So there’s neurological underpinnings that exacerbate the potential for all types of tantrums. Now that’s not to say that they should be considered just a way of life, and I think there are very good techniques out there that, again, as Dr. Wise mentioned, are similar to what you’d see in younger children but there are also specialized techniques for autism that are behavioral techniques that can really be very effective in reducing some of these behavioral regulation problems.
CAVANAUGH: Let’s take another call. Ann is calling us from San Diego. Good morning, Ann, and welcome to These Days.
ANN (Caller, San Diego): Thank you. I’m a little concerned. I just wanted to put this out there as something. I have a niece who her language was a little bit delayed when she was born, when she was about a year. And then temper tantrums, just terrible temper tantrums. You know, hitting the closet, kicking the closet, hiding in closets, just everywhere. Everywhere we went. And as a teacher, I felt there was something wrong but, you know, nobody likes to listen to somebody about that. So but later on we did find out, at the age of four, that she was deaf.
CAVANAUGH: I see. So, and let me ask, Christy, could the tantrums, therefore, have been maybe an early indicator of that?
DR. WISE: Oh, yes. And the level of frustration probably great that, you know, she couldn’t communicate and, you know, get her needs met. Yeah, definitely. I would absolutely have been concerned, and it was good that you saw that ahead of time.
CAVANAUGH: I’m wondering, if a parent is concerned, what sorts of things should they bring to their healthcare provider? I mean, what kinds of words or descriptive words would be good for a parent to be able to bring to a psychologist to explain what it is that they’re concerned about in a tantrum. Christy.
DR. WISE: I would – First of all, I would make sure you speak up. A lot of people don’t speak up even when they have that gut feeling that something’s wrong. So I would certainly listen to that gut feeling. It’s your own child. You know. I would go to the provider and I would say this doesn’t seem normal and I’m very concerned. Please, can we check it out? I would be very straight about what your concerns are.
CAVANAUGH: And, Robert, I’m wondering, if, indeed, your child is beyond the age of 3 or 4 and still having temper tantrums, what – is this simply a behavioral problem or is it – does it really need to be checked out?
DR. GRAY: That’s a fantastic question. And I think what we need to think about as parents are a couple of things that you mentioned. What to bring to the provider, and, one, I think we always think about if a parent can keep track of a couple of variables, intensity, frequency, duration, time of recovery and the context that the temper tantrum happened in, that’s very important to bring in. But what you just mentioned is critical because you now have a child who’s four who’s still having tantrums, that needs to be brought to the attention of the providers. And the provider, our job is to then determine, okay, let’s do the proper evaluation here to determine are these tantrums simply being driven from context or parenting stress? Maybe there’s a lot of things going on. Is it purely behavioral? And we can treat it with a pure behavioral technique. Or are there underlying issues that the evaluation lets us see that need to be dealt with in different ways? Maybe there’s a different neurological component here, maybe their hearing hasn’t been checked, things like that, so the evaluation becomes very important. But it all starts with that parent trusting their instinct, coming in and bringing this to the attention of the providers.
CAVANAUGH: Now, I remember, I had a friend and I know that she is not listening to this program but who had temper tantrums because she didn’t want to go to school at age of six. And she would be on the floor and she would be screaming and she would be banging the floor. So does that kind of behavior last because it’s working for the child, Christy?
DR. WISE: Yes. Yes, absolutely. If she’s not having to go to school and it’s certainly throwing a wrench into their whole morning routine, then she’s getting what she wants. So…
CAVANAUGH: And how do you kind of break that cycle?
DR. WISE: I would likely say I would break it with some positive reinforcement, that even if you get a hair of, you know, positive reaction, she gets up out of bed and brushes her teeth, I would reinforce that with, you know, a hug and a smile and not take it away once she then hits the floor after that. So each positive step that she makes, I would reinforce like crazy.
CAVANAUGH: But it’s something for people to hold onto, Robert, that usually kids do grow out of these tantrums?
DR. GRAY: Oh, absolutely. In most kids, a large percentage of kids, these tantrums are normal developmental progression and you will see them go away as the child begins to self-regulate a little better.
CAVANAUGH: I’m wondering, my final question to you both, is it ever any good to sort of just leave the child alone, obviously not in a store, but in the context of a house? Just, you know, sort of walk away and just not let the child be the center of attention anymore when they’re having this temper tantrum. Christy.
DR. WISE: Yes, I think if they’re in a safe place and you let them know, I’m going to walk away for a few minutes, absolutely I would say it’s okay to walk away as long as they’re safe.
CAVANAUGH: Because, I mean, I know I like that option.
DR. WISE: Yeah.
CAVANAUGH: Would that work for you?
DR. GRAY: I think – I think the safe – I think that’s absolutely essential that the safety is there first.
DR. GRAY: But walking away can be helpful. The only thing I would reiterate is something that Dr. Wise has been talking about, too, is we can view these tantrums as learning and teachable moments and learning opportunities. So this is a time when a parent can sort of exercise those, here’s how I’m going to model behavior regulation for the child. So that depends on our abilities and our timeframe as parents. You know, we’re all stressed so sometimes walking away is what we need to do but other times we can try to use it as an opportunity for teaching the child.
DR. WISE: That’s right.
CAVANAUGH: Fabulous. Well, I want to thank you both so much for speaking with us. Christy Wise, clinical psychologist with San Diego Family Services. Thank you.
DR. WISE: Thank you for having me.
CAVANAUGH: And Robert Gray is clinical neuropsychologist with Advanced Neurobehavioral Health of Southern California. Robert, thanks a lot.
DR. GRAY: Thank you.
CAVANAUGH: If you’d like to comment, go online, KPBS.org/thesedays. Coming up, a chat with the new director of the San Diego Museum of Art, and the Weekend Preview. It all happens as These Days continues here on KPBS.