Ared-faced toddler pounding her fists on the floor, wailing and screaming, seemingly inconsolable. It's a perennial occurrence in grocery stores and kitchens across the country.
But a temper tantrum may mean more than a child being hungry, tired or not getting their way. According to new research, the nature of a tantrum may help diagnose children with a number of mood and behaviour disorders.
Regular, tearful meltdowns are considered to be part of healthy development in toddlers up to the age of about 5. But Andrew Belden, a postdoctoral fellow of psychiatry at Washington University's school of medicine, has outlined five out-of-the-ordinary temper tantrum red flags that may indicate a child is at high risk of being either depressed or suffering various disruptive disorders. The study was published in this month's Journal of Pediatrics.
Dr. Belden hopes that with more research, parents may one day be able to interpret their child's tantrums and intervene early - in effect, heading them off at the pass.
"Literally, we could change their whole life trajectory," he says.
Dr. Belden and his team studied the tantrum behaviour of 279 preschoolers who had been screened according to the Diagnostic and Statistical Manual of Mental Disorders, and categorized as either healthy, depressed, disruptive or both disruptive and depressive.
They then looked at how often children had tantrums, how intense the tantrums were and where they happened.
According to the study, a child who consistently tries to hit a parent or caregiver during tantrums or who is unable to calm themselves down may be at a greater risk for a range of conditions including attention deficit hyperactivity disorder.
The children at high risk for disruptive disorders that can involve hostile behaviour toward authority figures, aggression and violence were more likely to melt down at least five times a day on multiple days at school or outside the home than the children developing normally.
"Children with disruptive disorders can't control their emotions, so those things are going to happen regardless of context. They can't regulate it. They can't help it," Dr. Belden says.
Tantrums that consistently lasted more than 25 minutes were another bellwether feature. And when a child hit himself or herself during tantrums, Dr. Belden was surprised to find a definitive link to depression.
"I was expecting differences between typically developing and disruptive kids - the depression component didn't occur to me."
Defining the anatomy of a temper tantrum is a relatively new and fertile area of study, says Harvard Medical School professor Ross Greene, author of The Explosive Child.
"That's the emerging wisdom about challenging kids in general," he says. "A lot of us have referred to tantrums as the 'fever' that tells you something is going on."
And many experts agree that the way a parent handles one has a direct impact on the nature of future tantrums in healthy and disordered children alike.
For children with disruptive disorders, reading the tantrum red flags is only a start, Dr. Greene says. Even if it leads to a diagnosis, it may only tell you what you already know: that you have a very tantrum-prone child.
"But can we keep it from getting really bad? The answer is yes," he says.
The key lies in determining the specific social, emotional and behavioural skills a child may be lacking and building them up, Dr. Greene says. Many of the disorders linked to tantrums can be improved with a method of parenting pioneered and recommended by Dr. Greene and a colleague. Instead of a parent imposing their will on a child, both parent and child offer their point of view and concerns - and together they search for a shared solution.
"It's hard, but living with challenging kids is hard anyway, you might as well do something that's going to get you somewhere," Dr. Greene says.
With preverbal toddlers, this may mean taking care to prepare children for moments when they commonly break down, such as going to daycare or to bed. Crisis prevention instead of crisis management, if you will.
"Don't wait until he's at daycare or bedtime to start solving the problem," he says. "Most challenging behaviours are highly predictable. Look for common triggers."
The biggest thing any parent can do is to stay calm, says Calgary mother of five and parenting educator Judy Arnall, author of Discipline Without Distress, who figures she's survived "987 tantrums, half of them in public."
After that, she counsels, "Don't punish. A lot of parents threaten spanking if they don't stop, which is probably why they continue."
But while early diagnosis and intervention is a goal of his, Dr. Belden urges parents who learn about his study not to fret if their child occasionally exhibits a number of the high-risk tantrum characteristics he has identified.
Even 30 to 40 per cent of healthy kids will hit mom on occasion, he says. But disruptive kids will hit their parent or caregiver multiple times during each tantrum.
"Most children have tantrums at some point in their life," Ms. Arnall says. "It's part of the process of learning how to handle anger."