A recent study published in The Journal of Child Psychology and Psychiatry may have parents and doctors wondering when a temper tantrum their child has may be something more. Could it be an early sign of a serious mental health problem? Researchers from Northwestern Feinberg School of Medicine have decided to look into when parents and pediatricians should worry about temper tantrums or unusual behavior.

A survey developed by experts can help parents determine whether their child is acting like a normal kid or if their outlandish behavior is the result of something more worrying.

With this survey, it will be easier to catch a mental health disorder early on, therefore making treatment options available to the kids when they are young, hopefully avoiding a serious mental break later in the children’s lives.

The new method will also help with the misdiagnosis and treatment of normal misbehavior for something more serious.

Researchers were surprised to find that temper tantrums do not occur among kids as often as many think. Preschoolers are apt throw fits, however, under 10% of young children have a tantrum every day. These results were the same for white, Hispanic, African-American, poor, non-poor, and children of either sex.

Lauren Wakschlag, lead author of the study, a professor and vice chair in the department of medical social sciences at Northwestern University Feinberg School of Medicine commented:

“That’s an ‘aha moment. It gives a measurable indicator to tell us when tantrums are frequent enough that a child may be struggling. Perhaps for the first time, we have a tangible way to help parents, doctors and teachers know when the frequency and type of tantrums may be an indication of a deeper problem.”

Prior to this study, there were no diagnostic tools to determine behavior problems, other than ones focused on adolescents and teens who displayed more disruptive traits. Now, researchers are focusing on children of the preschool age.

The questionnaire, named the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), was given to 1,500 3 to 5 year old preschooler’s parents. The adults answered questions about how often their child had tantrums, how intense the tantrums are and how they managed their anger in the last month.

The findings helped the experts to determine if the preschoolers’ behavior was normal or if it was something to be concerned about. This knowledge will make it easier for physicians to tackle the problem before it gets worse, and if the child is somewhere in the middle – parents and doctors can keep a close eye on their behavior to report it if it continues to seem like a problem. The researchers note that the earlier a problem is detected, the more effective treatment is.

Wakschlag continued: “We have defined the small facets of temper tantrums as they are expressed in early childhood. This is key to our ability to tell the difference between a typical temper tantrum and one that is problematic.”

The trail found that if a child threw a tantrum when they were tired, for example, at bedtime, this was normal behavior. However, if they threw the tantrum out of nowhere, or it was harsh enough that it made the child exhausted, this may not be normal tantrum behavior.

The authors note that all children may display signs of out-of-the-norm tantrums here and there, but it is when they happen often that parents should be concerned.

The new method differs from the well-known Diagnostic and Statistical Manual of Mental Disorders (DSM), because unlike the DSM, the new method is age-specific. In DSM, one of the symptoms of problematic behavior is that the patient “often loses temper”.

Wakschlag said:

“The definition of ‘often’ may vary substantially for younger and older children and depend on family stress levels and other mitigating factors. Since most preschool children tantrum, this vague criteria make it exceptionally difficult for providers to determine when behavior is of clinical significance in early childhood.

“There’s been a real danger of preschool children with normal misbehavior being mislabeled and over-treated with medication. On the other hand, pediatricians are hampered by the lack of standardized methods for determining when misbehavior reflects deeper problems and so may miss behaviors that are concerning. This is why it’s so crucial to have tools that precisely identify when worry is warranted in this age group.”

To understand how important their findings were, Wakschlag, along with Margaret Briggs-Gowan from the University of Connecticut Health Center and their team are looking into how the tantrum behaviors are associated with the mental health of the children, how they are getting along in school with other children, with their families, and how they act in social situations. Now, the experts are working with Northwestern neuroscientist Joel Voss to being using brain-imaging as a way to find correlations between problematic behaviors in early childhood and brain patterns.

The questionnaire has grown to 118 questions since the experts started using the tool, and 2,200 children have been evaluated. The goal is to eventually have the questionnaire available in waiting rooms at pediatricians’ offices for parents to fill out on a computer while they are visiting the doctor with their children.

Written by Christine Kearney