Temper Tantrums

 

Temper Tantrums and Behavioral Management Michelle Michell e Vo, MD PGY PG Y-2 Triple Board Morning Report March 15, 2010

 

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Developmental Factors related to Temper

Tantrums 

Anticipatory Guidance Related to Temper Tantrums and Behavior Management

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Helping Parents Anticipate Anticipate Disciplinary Problems

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Dealing with Temper Tantrums

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Time-in and Time-out

 

Why do temper tantrums happen? 

Young toddlers work towards independence/autonomy but still need security and nurturance

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Greater awareness of the external exte rnal world

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Language (especially receptive language) emerging

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Limited skills 

Attention span  Cooperation with playmates 

Motor dexterity

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Frustration tolerance

 

Tug-O-War

 

Probl roblem em Tant Tantrums rums and Possi ossible ble Contributing Factors

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Normal Development

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Temperment

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Medical Problems

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Developmental Disabilities

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Environment Parenting

 

Anticipatory Guidance: 15-18 months

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We expect the development of negative behavior in the form of emotional outbursts at this age

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Help parents view struggles for independence and mastery as a positive sign of a child’s emotional and social development

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Help parents anticipate disciplinary problems

 

Anticipating Discipline Problems 

Some parents find it difficult to understand toddler behavior and accept the “push-pul “push-pull” l” nature of the struggle for independence and mastery

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What am I trying to teach?

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Why is this important to me?

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How am I trying to teach it?

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What is my child learning?

 

Parents of Toddlers Should Believe in the No-Win Scenario

 

Anticipating and Short-Circuiting Excessive Frustration 

Help parents see temporal and situational patterns in which tantrums occur

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For example: excessive sensory stimulation, certain times of the day (morning? Dinner?) Dinner?)

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Toddlers require  consistency in all aspects of life (too much variability is confusing)

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For toddlers to understand consequences of an action, parental reaction/response reaction/response must be immediate

 

Dealing with Tantrums: Distraction 

Distracting the toddler from the situation may diffuse the frustration

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Most tantrums in a toddler-age child result from acute frustration

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Physically remove the child and place him in a safe place

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Offer an alternative activity with loving touch (body contact from someone familiar is often settling and reassuring)

 

An Attachm Attachment-ba ent-based sed Way Way to to Diffuse a Temper Tantrum: 

Remove the toddler Remove t oddler from the frustrating situation, settle her in a quiet place

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Hold the child closely and talk gently.

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Ask a question or make a statement reflecting the child’s feelings at the moment

Try using this approach at a well-child check. Not only is it often effective for negative behavior, but it is also a potential foundation for parent-child communication about feelings.

 

Time-Out (And Time-In!) 

Time out was initially i nitially called “time out from f rom positive reinforcement”

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Depending on the child’s developmental state, Time-In and Time-Out Time-Out can be effective from 1 year-early adolescence

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In the absence of good Time-In, Time-Out is suboptimally effective

 

Effectiveness of Time-Out Depends On: 

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Time-Out must be presented immediately after the negative Time-Out behavior Time Time-Out -Outbehavior must occur consistently after every instance of the negative

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Time-Out Time -Out must be in contrast to Time-In

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Time-Out should not be considered “over” until the child has Time-Out quieted down

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All warnings about using Time-Out should be carried out

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Completely ignore the child during Time-Out regardless of  how outrageous the behavior might become

 

Advanta Advantages ges of Time-In Time-In and TimeTimeOut: 

Provides the parents an effective alternative to nagging, yelling, or spanking

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Consistent use of Time-In and Time-Out also encourages children to develop self-quieting skills

 

Troubleshooting Time-Out: Common Mistakes 

Talking or arguing with the child after placing him in time-out

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Talking or arguing with the child before placing him in time-out

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Make the child apologize or promise to be good after time-out is over

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Threatening to use time-out instead of actually using it

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Trying to shame or frighten a child with time-out

 

Other Things to Consider with Behavioral Modification:

Extinction, Selective Attention, Active Active Ignoring

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Positive Reinforcement Job Grounding for older children Discuss Corporeal Punishment and Spanking

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Resources For Parents: 

SOS Help for Parents. Lynn Clark, Ph.D.

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http://www.healthychildren.org

For You: •

Parker et al. Developmental Behavioral Pediatrics: a nd

Handbook for Primary Care. 2   edition. 2005. •

Dixon, S. and M. Stein. Encounters With Children. 4th  edition. Mosby: 2006.  2006.