Temper Tantrums

Temper tantrum refers to an emotional outburst that is characterized by stubbornness, crying, screaming, yelling, defiance, or angry rants.

• Temper tantrums can be triggered by feeling tired, hungry, frustrated, or unable to verbally express feelings or desires.
• They can be learned behaviors and can also be an attempt to get one's own way or get attention.
• Temper tantrums are not meant to convey disrespect to the parent and they are not simply "misbehavior." They are a developmentally normal way for children to seek independence, gain ownership over their own choices, and learn emotional and behavioral self-regulation skills.
• They are common in younger children, but tend to decrease in frequency and intensity as children get older.
• Temper tantrums are equally common in boys and girls.
• A child can often stop a temper tantrum if he gets what he wants.
• For children and adults with Cognitive, Learning and Developmental Disorders, temper tantryms may be more frquent, intense, or difficult to manage (see meltdowns, below). However, the baic principles of tantrums typically still apply to these individuals. Tantrums are a way to express frustrations, needs, or desires that the person does not feel able or is unable to communicate verbally.

A meltdown refers to the temporary loss of control over one's own emotional response to something. Meltdowns may be more commonly experienced by indivduals with developmental or cognitive problems like Austism Spectrum Disorder or Fetal Alcohol Spectrum Disorder.

• Meltdowns often include intense emotional outbursts and may also include a physical response that is difficult to manage.
• Meltdowns may not have a specific or identifiable cause, though they often occur in response to being overstimulated by environmental factors or experiencing an unexpected or unwanted change in routine.
• A meltdown will not necessarily stop if the person gets what they originally wanted.

Parents are their children's first teachers, and communication between caregivers is important.

• Help parents and caregivers to see that it is their role to teach children by using positive discipline and by encouraging healthy communication between children's parents and caregivers. See Chapter C-7: Parenting.

Reassure parents that temper tantrums can be a typical part of child development. PArents can improve their responses to tantrums by slowing down their reactions and being aware of their own emotional responses when their child has tantrums. Encourage parents to:

• Pause and take a few deep breaths before reacting to a tantrum.
• Recognize the child may not have the vocabulary to express their feelings verbally.
• Take time to try and understand why the child is upset.
• Help the child to verbalize the feelings appropriately.

Sometimes, children have temper tantrums because their parents have been overindulgent (e.g., the child is used to being given a lot of attention or gifts and becomes upset when those things are withheld).

• Remind the parents that it is important to implement limits and consequences in a consistent and predictable manner. Consistent, predictable, healthy parenting skills foster strong relationship attachments and support healthy cognitive and moral development. For more about parenting approaches, see:Chapter C-7: Parenting.

Help parents learn how to verbalize the child's experiences and feelings in order to model this for the child. Teach parents to:

• Be directive. For example, say “It is time for bedtime now,” not “Would you like to go to bed now?”
• Give choices. For example, say “It is time for bed; would you like to brush your teeth first or go to the bathroom first?"
• Reframe the tantrum behavior into a desired behavior. For example, say “In our home, we use walking feet. We can run and jump when we are outside."

Encourage parents to take steps to reduce the frequency of tantrums. For example, they can:

• Keep unsafe or valuable items out of reach of small children to avoid power struggles, tantrums, or property damage.
• Establish healthy routines and traditions to give the child structure.
• Proactively learn skills to use when their child is having a tantrum.
• Learn what triggers anger in themselves and their child and how to effectively self-regulate their own moods and reactions.

For parents or caregivers managing a person with a cognitive or developmental disability who is having tantrums or meltdowns.

• Provide the cargiver ample support and encouragement. Acknowledge they have a difficult job to do.
• Teach and remind caregivers about the ways in which the disabled person’s experience may be different from their own. For example, noises or textures that most people don’t notice might bother a person with a disability a great deal.
• Remind caregivers that people with disabilities may respond to situations in ways that are similar to a person younger than their chronological age.
• If possible, seek to connect parents of people with disabilities with additional support, information, and resources. It may be especially beneficial for them to connect with other parents or caregivers of a person with disabilities.

The child and family may need additional support if the temper tantrums get worse, increase in frequency, or cause damage to property or injury to other people.When helping parents change or modify behaviors in the home to reduce tantrums, explain that the child will probably react initially by increasing the frequency and severity of the tantrum behavior before starting to comply with new expectations.

It is important for parents to “catch” their child doing something positive and acknowledging positive behavior. For example, “I like how you took your shoes off at the door.” This can create positive behavioral momentum and encourage further good decisions.

Parental moods and reactions impact children, and it is important for parents to use healthy self-regulating skills when teaching children how to self-regulate.

Keeping a journal about the tantrums (including the date, time and circumstance) may be helpful for identifying patterns and triggers.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history, related to sensory functioning, development, and psychological history.

Treatment Plan, including a history of presenting problem and recommended course of treatment.

General concerns

• Experiences developmental delays (see Chapter C-1: Development Across the Lifespan for typical development)
• Limited language skills for age
• Has a developmental disorder
• Has a learning disorder
• Has a cognitive disorder
• Poor nutrition
• History of child abuse or neglect
• Feels lonely or craves attention from caregivers
• Has experienced a traumatic brain injury
• Low tolerance for change
• Often overstimulated by environment
• Exposure to domestic violence (past or present, against self or others)
• Poor sleep hygiene or sleep disorder

Tantrum behaviors

• Extreme fits
• Especially stubborn
• Excessive crying for age and situation
• Screaming more than normal
• Yelling more than normal when upset
• Especially defiant
• Angry rants
• Hurts self or others when they do not get what they want
• Resists being soothed during a tantrum
• Uses emotional outbursts to get their way
• Has emotional outbursts when sad, has low energy, or is not receiving attention from others
• Manipulative

Family/home environment

• Parents lack critical understanding of:
  • Parenting skills
  • Child development issues
  • Healthy boundaries
• Caregivers are often too busy to spend time with child
• Limited supervision, structure, routines, consistency, and predictability
• Spends time with different caregivers who have different rules or expectations of the child’s behavior
• A lot of change in family dynamics or environment
• Rigid or controlling home environment
• Excessive use of electronic devices and television to occupy the child

Questions to the caregiver

• Describe your child’s daily routine.
  • What activities do you do with your child?
  • Have there been any recent changes to their routine?
  • How does your child respond to changes in their environment?
  • How do you prepare your child for changes in their daily routine?
• How would you describe your child?
  • Do they get easily frustrated?
  • Are they very independent?
• Describe your child’s tantrums.
  • Does the child tantrum dangerously (e.g., hitting their head against the walls or floor, running away from you in public, throwing things at you or others, etc.)?
  • How does the child respond to your efforts to calm them down during their tantrums?
  • What has worked to calm the child down during his tantrums?
  • Are there any triggers you have noticed?
• Decribe your response to your child's tantrums.
  • How do you respond to the tantrums?
  • How do you correct your child’s behavior?
  • What has worked to calm the child down during their tantrums?
• How many people are living in the home?
  • How much time do they spend with the child?
• Has your child been diagnosed with a developmental disorder, learning disorder, or FASD ?
• How would you describe your child's sleep hygiene?
  • Does the child have difficulty falling asleep or staying asleep?
  • Does the child experience night terrors, nightmares, or other interferences with sleep?

• Additional questions to the caregiver of an adult with a disability:

  • How well is the person able to communicate with language?
  • If they struggle to communicate with language, what are some other ways that they communicate their needs?
  • Have they experienced changes in their medical condition that might cause physical discomfort?
  • Have they had recent medication changes?
  • Have they had recent dietary changes?
  • Are you aware of any recent substance use?
  • Are their particular situations or environmental factors where tantrums occur more frequently?
  • Can you identify specific triggers to their tantrums or meltdowns?

Routinely review Chapter C-4: Common Treatment Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, you mayconsider:

• Educational counseling related to child development and parenting skills.
• Social support services, including Infant Learning Programs or an Individualized Education Plan.
• Individual counseling or family counseling focused on child development and healthy discipline practices.
• Referrals to a clinician or child therapist who is especially skilled in working with children.
• Additional resources such as 1:1 caregiver, funds to support additional training and activities, or additional education and support for caregivers may be beneficial for children and adults with disabilities.

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Abuse or neglect of a vulnerable adult.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.