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Published: Sunday, 2/24/2008

When tantrums mean trouble

BY MACKENZIE CARPENTER
BLOCK NEWS ALLIANCE

Timeouts? Forget it. Spanking? Nope.

When Marianne Peterson s toddlers went into meltdown mode, she had a simple method for stopping them cold.

I would lie on them, said Ms. Peterson, 57, of Ashland,Va., noting that her children, now grown, have turned out fine.

The weight and novelty were enough to distract them, she added, and I swear to God, they actually smiled a few times, I suppose, at my ingeniousness.

An extreme measure? Perhaps, but throughout human history toddler tantrums have driven parents wild and perhaps even a little crazy. When the kicking, back-arching, fist-pounding, and shrieking erupts just when Mom gets to the head of a supermarket line of grumpy, disapproving shoppers, it s hard for a parent to remember that the terrible 2s are just part of a young child s healthy emotional development.

Now, a new Washington University study is weighing in with a cautionary note: particularly severe, long-lasting and frequent tantrums may not be a sign of normalcy but possible red flags for deeper psychological disorders.

Tantrums that last more than 25 minutes, or tantrums that more than half the time involve aggression against a caregiver or violence toward objects as well as self-injurious behavior and frequent tantrums from 10 to 20 a day over a 30-day

period may be a sign that professional intervention may be needed, said Andrew Belden, a postdoctoral fellow of psychiatry at Washington University s school of medicine, and one of the report s co-authors.

The study, published in the December issue of the Journal of Pediatrics, is part of a larger, long-term project by researchers at Washington University examining depression in preschoolers, about which relatively little is known compared with disruptive disorders such as attention deficit hyperactive disorder (ADHD); oppositional defiant disorder, and conduct disorder, which are defined in a diagnostic manual for psychiatrists as aggressive or destructive behavior.

The findings on tantrums come at a time when, anecdotally at least, caregivers are reporting an increase in behavioral problems among preschoolers, for reasons that aren t quite clear. Some blame the new focus on academics in preschools, others blame poor day care or untrained caregivers or a society where family ties are increasingly strained.

There do seem to be more stresses on parents now, but I also think there is a lot more information available to parents about child behavioral problems, and parents feel a pressure to get it all right that 20 years ago we didn t feel, says Sue Berman, a Pittsburgh psychologist, parenting coach, and founder of ProParent, which helps parents devise strategies for coping with difficult children.

I m not certain whether you re seeing more acting out, or whether it s just that parents don t tolerate it as much.

Thirty or 40 years ago, we had the authoritarian parenting style, where it was completely accepted and acceptable to give a kid a swat on the tush. Fear-based parenting has been replaced by a very different approach, where we allow children to express themselves, but there s a price to be paid for that.

Normal vs. abnormal

Tantrums by themselves shouldn t worry parents it s how many, how long and how severe, said Dr. Belden.

The take-home message here is about consistency. If a tantrum lasts longer than 30 minutes every time, or 90 percent of the time, then attention must be paid, as opposed to such random, sporadic episodes that are much more typical of what we would expect to see in healthy kids.

While Washington University and other academic institutions are trying to unlock the secrets of depression in children, the notion of mental illness in toddlers even infants has been a tough sell to the public in recent years, and a number of researchers remain skeptical that such disorders as depression can be ever diagnosed in very young children.

We have much more understanding about how it presents in adults, but in children, we re not convinced we know what it looks like to begin with, said Amanda Pelphrey, clinical psychologist at Children s Hospital Child Development Unit.

Developmentally children change over time, and it s hard to characterize one moment in time for being a comfortably reliable indicator of how that child will be, she said. If you have a diagnosis, you assume that there s a certain stability about that person, but among children there s a very wide range about what is normal.

The Child Development Unit at Children s has seen 1,500 youngsters over the years for a variety of problems, but not one has been diagnosed with depression, she noted.

Diagnosis difficult

Small children aren t good at regulating their emotions, she added, especially preschoolers, and that s normal, too. Much of the challenge is, how confidently can we accurately label them and assume that a psychiatric illness is involved?

Heather Ditillo, a former Head Start teacher in Altoona, Pa., remembers children with very, very severe tantrums. While in some cases they were normal developmental things you could see, there were a few children whose tantrums had crossed the line from anger to rage. It was obvious to me as a teacher that these weren t normal, she said. They were regularly happening, where they were attacking other kids and throwing objects around the room.

Later, after psychological intervention, it was discovered that one child with severe tantrums had been abused and tortured and another was sexually abused. It was heart wrenching.

Dr. Belden knows that the whole inquiry into depression in preschoolers is controversial, but be believes it s worth pursuing. Still, he doesn t want to give parents one more thing to worry about.

It s not like you need to have a stopwatch ready when your child has a tantrum, he said, noting that the study s findings are aimed less at parents and more at providing teachers, caregivers and other professionals with a tool to detect any underlying problems earlier.

Still, parents should stay vigilant. If a child has more than three or four tantrums a day for five consecutive days outside the home, for example, and parents are pretty confident it s not because of sleep, hunger, or sickness, he said, they should discuss the matter with their pediatrician because such behavior is not all that typical, not all that common in healthy kids.

The Block News Alliance consists of The Blade and the Pittsburgh Post-Gazette. Mackenzie Carpenter is a writer for the Post-Gazette.

Contact her at: mcarpenter@post-gazette.com.



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