As an occupational therapist I frequently get called in to work with families whose primary concern is their child’s tendency towards meltdowns and temper tantrums. Now, tantrums and meltdowns are one of the biggest challenges of parenting, as they are hard to understand, hard to prevent, and even harder to respond to effectively when they're happening. Though developmentally they are expected at around 24 months of age — the terrible 2's — when they occur with frequency and extreme intensity, particularly past the age of 2, it becomes a big problem for not only the parents who endure them, but the child who experiences them.

So, let’s look at tantrums. According to Dr. Vasco Lopes, a psychologist at the Child Mind Institute, not all children have the same kind of temper outbursts. Researchers divide tantrum behavior into two types. The first is called "distress tantrums" and they are characterized by whining, crying, screaming, yelling — behaviors that express distress. Distress tantrums are associated with anxiety. The second type is "anger tantrums," and involve more explosive, aggressive behaviors like hitting, kicking, punching walls, attacking people and throwing things. Anger behaviors are linked to defiance and, later, conduct problems. Dr. Lopes states that some children only exhibit distress tantrums while others display both types. To determine the difference between the tantrums, you need to look at the types of behaviors that your child is demonstrating while they are in the midst of one.

To complicate this further, we need to draw the distinction between tantrums and meltdowns. Tantrums tend to be milder outbursts, and the child still retains some measure of control over their behavior. As such, tantrums often subside if no one is paying attention. A child in a meltdown, though, has lost control so completely that the behavior only stops when they wear themselves out.

Now, a good deal of tantrum behavior looks to parents as if it's intentional or manipulative, but it is much less voluntary than parents realize, states Dr. Steven Dickstein, a psychiatrist at the Child Mind Institute. Children with serious temper problems aren't consciously calculating throwing tantrums, but they may have learned over time and through reinforcement from adults that tantrums get results.

Anger is the primary emotion that causes a child to lose their cool and become unregulated. The child feels they deserve or need something that is being deliberately withheld from them, and is overwhelmed by frustration and a sense of injustice. Anxiety is another big trigger. Due to a sense of fear, a child becomes unregulated and they are unable to see that their anxiety is out of proportion to the situation. Regardless of the trigger, a child who has frequent emotional outbursts is lacking the skills that would help them better handle situations that cause them frustration, anxiety or anger. The kinds of skills lacking include impulse control, problem-solving, delaying gratification, negotiating, communicating wishes and needs to others, knowing what's appropriate or expected in a given situation, and self-soothing, according to Dickstein. These skills, as well as emotional regulation, are typically developed when a child is of toddler and preschool age.

As a child gets older and a child resorts to tantrums when they encounter a problem, over the course of time these tantrums can become a learned behavior. "It becomes a vicious cycle," Lopes said, "because instead of honing and practicing the adaptive skills that kids normally learn to solve problems collaboratively, these kids are learning maladaptive responses when they get frustrated. And by continuing to practice those skills, they are strengthening these behaviors over time and using them in a greater number of situations."

Keep in mind: Though you might want to get to the underlying cause when your child is demonstrating a tantrum or meltdown, it often is not so easy to figure out. For instance, a child who melts down at the supermarket might be overwhelmed by all the people in the store, or they might be resisting the confinement of being in the cart, or being told “no” when they can’t have what they want. They may have sensory processing problems that cause them to be overwhelmed by stimulation, or they might lack the language and communication skills to express what they want or need. Maybe there is an underlying medical concern (reflux or ear infections, to name a few), so consult your pediatrician. There could be many contributing factors. Whatever the cause, remember these behaviors are most likely not planned or as intentional as they appear (don’t confuse predictable with intentional). Your young child has a limited repertoire of behaviors, and they are only responding the way they know how. Help them develop and learn new skills. If you know the supermarket is tough, create a social story you can read to them, shop at a time the store is not too crowded, give them a “job” to do or a toy to play with while in the cart, etc. Deal with your child’s tantrums and meltdowns now, before they become learned behaviors. You and your child will be glad you did.

Bob Trapani is an occupational therapist and owner of Thrive By 5, an early intervention and preschool service provider in Cayuga County, as well as chair of the New York State Occupational Therapy Association Central District and a certified DIR Floortime provider.

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