Tantrums: Not Just the Terrible
Twos
Rachel J. Valleley, Ph.D.
Assistant Professor,
Munroe-Meyer Institute
Licensed Psychologist
Behavioral Health Concerns in
Primary Care
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Behavior problems ranked #1 by pediatricians
(Arnorfer et al., 1999)
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Established link between medical and behavioral
concerns (Wertleib et al., 1988)
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ADHD evaluations increased three-fold in 1990s
(Hoagwood et al.,2000)
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In 24% of pediatric visits, behavior concern raised.
Increases visit length from 11 to 17 minutes
Tantrums
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What are tantrums?
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Screaming, crying, kicking
Pleading
Pointing fingers
Pouting
You are the meanest mommy in the
world!
Tantrums
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Duration can be seconds to minutes typically
Most common for ages 2 to 4 but can occur
at any age (80% of children)
Tantrums
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Why do kids throw tantrums?
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Frustrated with a task
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To get what they want
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Trying to develop independence skills, do things on their
own
Tangible
Parental attention
To get out of what they don’t want to do
I want, I want, I want
Pay Attention To Me
I can’t hear you so I don’t have to do it!
Tantrums
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Occur anytime, any place
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At home
Store
Car
How parents feel after tantrums
When to be concerned about temper
tantrums?
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Lasts for long periods of time
Involves aggression
Occurs frequently
Causes distress to family
Interferes with daily living
Tantrums
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Can lead to or be a sign of more serious
difficulties
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Oppositional Defiant Disorder
ADHD
Oppositional Defiant Disorder

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Enduring pattern of uncooperative, defiant,
and hostile behavior toward authority figures
that does not involve major antisocial
violations.
Frequently gets confused with ADHD. Can
have both.
Oppositional Defiant Disorder:
DSM-IV Criteria
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Loses temper
Argues with adults
Actively defiant or refuses to comply with adults’ requests or
rules
Deliberately annoys people
Blames others for his or her mistakes or misbehavior
Touchy or easily annoyed by others
Angry and resentful
Spiteful or vindictive
Oppositional Defiant Disorder
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Most common diagnosis given in our clinics in
pediatric practices.
Can be setting specific
Occurring more with parents or other caregiver
Difficulties with sleeping, eating, and toileting.
Increased risk for other problems
Dropping out, Abuse

Coercive Family Process
Oppositional Defiant Disorder

Misconception that “He’ll grow out of it”.
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67% at age 3 still have problems at age 9
Often leads to Conduct Disorders or
antisocial personality disorder.
Effective early intervention leads to long-term
positive outcomes
No medication that will effectively work
Oppositional Defiant Disorder

Empirically-Supported Treatments:
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Parent Training: Forehand & McMahon
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Parent-Child Interaction Therapy: Hembree-Kigin
& McNeil
Treatment for ODD:
Parent Training
1. Encourage/increase appropriate behavior
 Differential Attention

Child’s Game
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Sticker Charts/Grab Bag Prizes
Treatment for ODD:
Parent Training

Differential attention
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Attend to average behavior
Praise exceptional behavior
Treatment for ODD:
Parent Training

The Child’s Game:
A relationship-building activity that makes children
want to earn your POSITIVE attention.
Treatment for ODD:
Parent Training
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DO
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Describe
Reflect
Imitate
Praise
Touch
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DON’T
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Command
Reprimand
Question
Goal is to like each other again
Treatment for ODD:
Parent Training
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Sticker Charts/Grab Bag Prizes:
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Bedtime routine, morning routine
Daily for overall behavior
Magic circle chart
Dot-to-dot’s
Grab Bag Prizes
Treatment for ODD:
Parent Training
2. Decrease inappropriate behavior
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Time out
Treatment for ODD:
Parent Training

What is time out?
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Time out is the removal of attention, tangibles, or
anything interesting to the child for a brief amount
of time.
Treatment for ODD:
Parent Training
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Common mistakes parents make
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Talking to child in time out
Having time out be too long
Not having child do what is expected following the
time out
Not expecting extinction burst
Treatment for ODD:
Parent Training
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Common uses for time-out
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Noncompliance
Aggression
Rule infractions
Tantrums
Summary
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Tantrums can be very distressing to parents
Good idea to assess for tantrums, noncompliance
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How often?
How long?
What causes tantrums?
How does the parent respond?
Is this behavior distressing to the parent?
If problem exists, good idea to refer to behavior
therapist
Early intervention results in best outcomes