Excessive tantrums in preschoolers may indicate serious mental health problems

Certain types of tantrums in preschoolers may be a sign of serious emotional or behavioral problems, according to School of Medicine researchers. Although temper tantrums are common and normal in young children, the researchers found that long, frequent, violent and/or self-destructive tantrums may indicate the presence of psychiatric illness.

The research team reports its findings in a recent issue of The Journal of Pediatrics. Researchers compared tantrums in healthy children to the tantrums in children diagnosed with depression or disruptive disorders, such as attention-deficit/hyperactivity disorder (ADHD).


Most children have temper tantrums at some point, but the researchers found healthy children tend to be less aggressive and have shorter tantrums than their peers with depression and disruptive disorders.

“It’s clearly normal for young children to have occasional tantrums,” said first author Andrew C. Belden, Ph.D., a National Institute of Mental Health (NIMH) postdoctoral research scholar in child psychiatry. “Healthy children may even display extreme behaviors if they’re very tired, sick or hungry. But if a child is regularly engaging in specific types of tantrum behaviors, there may be a problem.”

The researchers studied 270 children between 3-6 years old and gathered information about tantrums from a parent. The children were divided into four groups according to psychiatric symptoms: no psychiatric diagnosis, major depressive disorder, disruptive disorder, or depression and disruptive disorder. All of the children were part of a larger NIMH-funded study of psychiatric illness in preschoolers.

“We’ve been following these children for several years,” said principal investigator Joan L. Luby, M.D., associate professor of child psychiatry and director of the Early Emotional Development Program. “It’s important to find age-specific ways to diagnose depression and other problems in young children because it can be difficult to get very young children to tell you about their feelings. We’ve successfully used narrative and observational techniques, but characteristics of tantrums when present might be another helpful tool.”

Luby, Belden and colleagues identified five types of tantrum behavior that appeared to be connected with depression or diagnosable disruptive disorders.

The first involves extremely aggressive behavior during a tantrum. When a toddler displays aggression directed at a caregiver or violently destructive behavior toward an object such as a toy during most tantrums, parents should be concerned. The study found that these children tend to have diagnoses of ADHD, oppositional-defiant disorder and other disruptive disorders.

The second worrisome tantrum behavior is when toddlers intentionally injure themselves.

“It doesn’t matter how long these types of tantrums last or how often they occur, self-injurious behavior almost always was associated with a psychiatric diagnosis in this study,” Belden said. “Children with major depressive disorder tended to hurt themselves. We didn’t see that in healthy kids or those with ADHD and other disruptive disorders.”

Other red flags involved children who had more than five tantrums a day for several consecutive days. Very long tantrums also signaled a problem. Healthy children might have a tantrum that lasts 10 or 11 minutes, but several children in the study averaged more than 25 minutes per tantrum.

Finally, when preschoolers are unable to calm themselves following a tantrum, they appear to be at much greater risk of psychiatric problems.

“The best news from this paper is that it’s normal for children to display excessive behavior sometimes,” Belden said. “If a child lashes out at you, it doesn’t mean, ‘Oh my gosh! They’re doomed!’ But if they lash out and hit you every time, there might be a problem. And if they hurt themselves intentionally, I think it’s best to consult a pediatrician or mental-health professional.”