Childhood Temper Tantrums: Normal, or Part of a Larger Problem?

Almost every child has a temper tantrum at some point. Perhaps he or she is overtired, overstimulated or simply not getting his or her way at that moment, but regardless of the reason, the result is the same: Usually tears, stomping, flailing, hitting, kicking and other unacceptable behaviors that end only with some sort of punishment, sleep or (unfortunately) an adult giving in to their desires. Such behavior is perfectly normal in young children. Children are still learning boundaries, and learning effective ways to communicate their needs and wants. And most children outgrow the need to have temper tantrums by the time they hit school age, when they develop more effective means of communication. However, some children do not outgrow the temper tantrum phase — and in some cases the tantrums worsen, which is cause for concern.

When Tantrums Become a Disorder

For most children, temper tantrums can be stopped by a nap, a snack or redirecting from the source of the tantrum. In a small number of children, though, . Until recently, such children were often diagnosed with bipolar disorder, or another of a spectrum of mental or mood disorders. While such a diagnosis opens the doors for treatment, it’s not always accurate. In fact, the current mental disorder diagnostic handbook does not recognize pediatric bipolar disorder, so practitioners are forced to rely on the adult criteria in order to make a diagnosis. Most doctors agree, though, that the following tantrum-related behaviors are signs of a possible mood or behavioral disorder in children:

• Tantrums that increase or worsen after age four.
• Tantrums in which the child hurts him or herself or others and/or causes damage, i.e., breaking toys.
• Tantrums occur at least three times per week for a year or longer.
• Tantrums occur in a variety of settings, including home and school.
• The child experiences wild “mood swings,” between temper tantrums, either showing signs of depression, like a lack of interest in play, excessive sleepiness, sadness and pain without any assignable cause or mania, such as unusual happiness or excitability, lack of focus and an increase in risky or inappropriate behavior.

A small number of children with these symptoms and behaviors are actually accurately diagnosed with bipolar disorder, and many manage the condition with medication and behavioral therapies. However, due to some slight inconsistencies between the adult and childhood bipolar diagnostic criteria, recently doctors have developed a new clinical diagnosis for children who struggle with managing their moods and tempers.

Disruptive Mood Dysregulation Disorder

One of the hallmarks of bipolar disorder is manic episodes. While most people think of manic episodes as periods of extreme “highs” — and that is always possible — manic episodes can also manifest as extreme irritability. These episodes are generally clearly episodic, though, and the irritability may last a few days up to a few weeks, before shifting. It’s this clear distinction between episodes of irritability in bipolar patients and the near-constant irritability between tantrums in some children that has lead doctors to develop a new diagnosis: , or DMDD. Concerned about the fact that there were 40 times more bipolar diagnoses in children in 2003 than there were in 1995, doctors wondered if many children were being diagnosed simply as a means to clear the path to treatment, even if all of the criteria for bipolar weren’t being met. However, some doctors point out that all a diagnosis of DMDD means is that the name is different, as many of the treatment protocols are similar. In addition, some fear that even more children will be diagnosed and treated for the disorder, even though their behavior is normal for a child, albeit challenging.

Awareness Is Important

Living with an irritable child who has regular temper tantrums is challenging enough, but for parents, navigating the complex world of diagnosis and treatment can make the situation feel much worse. The first step, though, is to recognize when your child’s tantrums are a normal part of growing up, and when they may be a symptom of a much larger issue. Doctors recommend getting help when the tantrums are grossly out of proportion with the perceived cause, when they occur well after the child should have outgrown them, when the tantrums are not episodic, when the tantrums occur in multiple settings, and when the child’s mood is noticeably irritable most of the time. It’s also important to realize that a child must be over age six in order for the diagnosis to be made, and the symptoms must have been present before age 10. Younger children are generally developmentally still in the tantrum phase — although extreme cases are cause for concern — and older children and teens are more likely to be bipolar than have DMDD. Only about 2-5 percent of all children have DMDD or another mood disorder, so if your child is acting up, there’s a good chance that he or she is just “being a kid” and will soon outgrow the behavior. However, if that doesn’t happen, or if the behavior is worse than average, a visit to the doctor or mental health provider is in order.