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Are My Kid’s Tantrums Abnormal?

Context. One of the great ironies of parenting is that your child is more likely to throw a tantrum in your presence because she trusts you and feels secure. Indeed, many children throw tantrums only with their parents or primary caretakers (such as a nanny); having a severe tantrum in the company of irregular caretakers, even strangers, can be a sign of a disorder, especially if your child is older than 3.

The trigger. “All kids have tantrums that are triggered by being hungry or tired or having a significant change in routine,” Dr. Egger said. “But with children who have clinically significant or potentially concerning tantrums, they’re triggered by anger or frustration.” She mentioned daily transitions as a common provocation of severe tantrums — for example, going from playtime to bath time, or bath time to bedtime.

Suddenness. Parents of children who have severe tantrums often say the episodes come out of the blue. As Dr. Egger puts it, “You think the day is going well, you ask if you want to wear your red shoes or your blue shoes, and you’re off to the races.”

Surprisingly, a tantrum’s duration was not tied to disorders in Dr. Egger’s research.

Your first step should be to talk with your pediatrician. While that doctor won’t be the person who ultimately treats your child for his behavior issue, she will be able to provide you with a personalized recommendation, one informed by her experience with other children experiencing similar disorders. You’ll likely be referred to a mental health clinician, specifically one with expertise working with younger children. This person could be a child psychiatrist or child psychologist or a social worker, depending on what type of treatment your child requires.

Severe tantrums are often a symptom of an underlying disorder. According to Dr. Sarper Taskiran, M.D., a child, adolescent and adult psychiatrist at Child Mind Institute in New York City, most of those causes can be broken down into three categories of disorder, each one related to the child’s ability to experience, process and express emotions:

Disruptive behavioral disorder. Essentially, a child suffering from this disorder is processing her emotions properly, but can’t regulate her response to those feelings. In the case of attention deficit hyperactivity disorder, or A.D.H.D., which falls into this category, a child might destroy something when she’s feeling angry. “Their brake system is not working efficiently enough to suppress these intense emotions,” Dr. Taskiran said. Another common disruptive behavioral disorder is oppositional defiant disorder, in which a child will defy adult requests and engage in behaviors that are not socially acceptable.

Mood disorder. In mood disorders, the child is struggling to manage his or her emotions, and often has a consistently difficult temperament. Disruptive mood dysregulation disorder, or D.M.D.D., is a relatively new diagnosis, Dr. Taskiran said, and often manifests itself in age-inappropriate tantrums, such as a school-aged child tantruming like a toddler. Children with D.M.D.D. also might misinterpret facial expressions — for example, thinking a parent or a teacher who is wincing from a headache is upset with them. Note that the American Psychiatric Association only permits diagnosis of mood disorders at age 6 or older, though it can be helpful to learn early on if your child is demonstrating traits consistent with these disorders.

Anxiety disorder. This is an umbrella term that includes generalized, social and panic disorders, in which a child is distressed about everyday things like school or sports. If your child’s severe tantrums seem to be caused by internal, rather than external, factors, such as putting pressure on herself to perform a backyard dance routine exactly right, they may be linked to anxiety.

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