(WebMD) There are five warning signs that a small child's tantrums might signal an underlying psychiatric disorder, researchers find.

All child tantrums are excruciating to parents. But there are five tantrum styles that are "red flags" indicating a preschooler may have mental health problems, find Washington University researchers Andy C. Belden, Ph.D., and colleagues.

"If you have a child, you are going to have tantrums," Belden, a developmental psychologist with two small children, tells WebMD. "They happen, and one of the more important things for parents is to keep eye on them and think about what the child is actually doing."

Belden, Joan L. Luby, MD, and colleagues conducted long, structured interviews with 279 caregivers - nearly all of them mothers - of 3-to-6-year-old children. They also evaluated the children for psychiatric disorders.

They found that tantrums in children who truly had mental health problems tended to be different from tantrums in healthy children.

"Essentially, we found five tantrum styles. They were strongly associated with specific diagnoses," Belden says. "No one I have met can look at a tantrum and give a diagnosis, but these are definitely red flags worth looking into in terms of getting a mental health referral from a pediatrician."

Tantrum Red Flags

Belden warns that normal children may display every one of these tantrum warning flags from time to time. But kids with problems show these signs in nearly every tantrum:

• Aggression toward caregivers, objects, or both. If this happened more than half the time in the last 10 to 20 tantrums, it may signal disruptive disorders. "It is not uncommon at all for children to try to kick their moms because they won't buy them an ice cream cone. But if this happens 90 percent of the time, and you have to take cover to protect yourself during a tantrum, this may mean a problem," Belden says.
  
• Self-injury. Kids with major depression and kids with mixed major depression and disruptive behavior were much more likely than healthy kids to bite themselves, scratch themselves, bang their heads against a wall, or kick objects in an attempt to hurt their foot.
  
• Frequent tantrums. Preschoolers who have 10 to 20 tantrums a month at home, or who have more than five tantrums a day on multiple days outside the home, are at risk of a serious psychiatric problem.
  
• Very long tantrums. A five-minute tantrum can seem like a million years to a parent. But kids who consistently have tantrums that last more than 25 minutes may have underlying problems. "A normal child may have a tantrum that lasts an hour, but the next one lasts 30 seconds. These children with psychiatric disorders are having 25-minute or longer tantrums 90 percent of the time," Belden says.
  
• Inability to calm oneself after a tantrum. "These kids almost every time require some sort of external force to calm them down," Belden says. "You have to constantly remove them from the situation or bribe them or it will go on and on."

Tantrum expert Michael Potegal, PhD, of the University of Minnesota, says the Belden study is a welcome "step in the right direction."

"Everybody knows children throw tantrums, but remarkably tantrums have not been subjected to much study," Potegal tells WebMD.

During a tantrum, Potegal says, a child has two intense emotions: extreme anger, and extreme sadness or distress.

"My colleagues and I have found that hitting, kicking, and screaming during a tantrum is associated with anger, and crying, whining, comfort seeking, and perhaps throwing oneself down is associated with sadness," he says. "The Belden study focuses on anger; there is no mention of distress."

Worrisome Tantrums? What To Do

What should parents do if their child has "red-flag" tantrums?

"You can go two ways. One is to take the child to a pediatric neuropsychologist to get a broad assessment, including what is going on in the family, because some of this is absolutely in response to family difficulties," Belden says. "The other way is to go directly to a child psychologist who will focus on the child's emotional control and on the family circle."

If your child has tantrums, don't feel alone. Seven out of 10 18-to-24-month-old toddlers throw tantrums. And more than three-fourths of 3-to-5-year-olds have tantrums.

Belden and colleagues report their findings in the January 2008 issue of the Journal of Pediatrics.

By Daniel DeNoon
Reviewed by Louise Chang
© 2007 WebMD, Inc. All rights reserved.

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