(p. 105) On Being Mad, Sad, and Very Young
Interest in children’s temper tantrums has been renewed in the context of childhood irritability and the new diagnosis of disruptive mood dysregulation disorder (DMDD) in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as chronicled by the other chapters in this volume. This chapter, with a side of data, is intended to place tantrums in broader cultural, behavioral, neurobiological, and evolutionary contexts. It describes what is known about the emotional/behavioral organization of tantrums and what remains unknown about their ontogeny, highlighting some of the lesser known, curious phenomenology. One aim is to note lines of investigation to be explored and discoveries yet to be made about young children’s emotions and behavior. Sources for these musings include observations conveyed by parents in a number of tantrum research projects and/or seen on home videos that were collected, edited, and used to train parents to identify and record behaviors of interest. Some of my own personal observations are also included. What follows is mostly a meditation on tantrum emotions and behavior in typically developing children, with a few comments about parent guidance in tantrum management made along the way. Issues of psychopathology are addressed in the last section.
What Is a Tantrum?
Absent a generally agreed upon definition, Potegal (2000) defined tantrums operationally as transient episodes of affectively negative emotional behavior, usually a variable mix of anger and distress, with the negative affect shown by the child’s facial expression. As is generally true, anger can lead to aggressive behavior. Some children in forager and village groups scream, throw things, and hit with hands and objects, often targeting the mother (Gorer, 1943; Hill & Hurtado, 1996; Maretzki & Maretzki, 1963) as do some children in industrialized societies (p. 106) (Belden, Thomson, & Luby, 2008). Crying as part of tantrums appears universal. Tantrums typically involve interaction with parents, but because it is the children who have the tantrums, their emotions and behavior are the main focus of this essay.
Tantrums Are Common Across Cultures: Are They Universal?
Tantrums are a common phenomenon of early childhood. Surveys of young North American and British children published between 1954 and 1984 found that 50–83% had tantrums (Einon & Potegal, 1994). Based on an analysis of tantrum frequency distributions, the mean prevalence in these children from 18 months through 3 years of age was around 70% (Potegal & Archer, 2004). Tantrums are prevalent among young children in sites in the Netherlands (53%; Koot & Verhulst, 1991), rural and urban areas of China (59–71%; Li, Shi, Wan, Hotta, & Ushijima, 2001, Luk, Leung, Bacon-Shone, & Lieh-Mak, 1991), Canada (83%; Giesbrecht, 2008), and Finland (87%; Österman & Björkqvist, 2010). In a more recent community survey of almost 1,500 American preschoolers, parents reported that 84% had tantrums (Wakschlag et al., 2012).
According to Ward’s (1970) remarkably detailed account of public tantrums in Kau Sai, a fishing village east of Hong Kong, it was common in 1952–53 and later, to see red-faced, kicking, screaming children (especially 5- to 10-year-old boys) lying on the public sidewalk with no one paying attention.
Although such detailed behavioral descriptions are often lacking, there are multiple reports of children’s tantrums from non-Western cultures around the world; for example, in forager groups including the Aché in Paraguay (Hill & Hurtado, 1996), Matsigenkas in Peru (Johnson, 2003), Chewong of the Malaysian peninsula (at least occasionally, Howell, 1989), !Kung San of the Kalahari desert in northwestern Botswana (Konner, 1972), Hadza of north-central Tanzania (Marlowe, 2005), Utku Inuit in northern Canada (Briggs, 1970), and the aboriginal peoples of Australia (Myers, 1988; Peterson, 1993). Among the tribal groups of New Guinea, children of the Kahili (Schieffelin, 1986), Kapauka (Pospisil, 1971), Kubo (Dwyer & Minnegal, 2008), Sambia (Herdt, 1986), and Telefolmin (Jorgensen, 1984) have all been noted to tantrum. More localized differences in tantrum prevalence have also been reported between Gujarati and English children living in Manchester (Hackett & Hackett, 1993), Black 6-year-olds in the United States versus those in Johannesburg (Barbarin, 1999), and among ethnic minorities in China (Li et al., 2001).
Correspondingly, queries of native language speakers/professional translators/language scholars suggest that there are words or phrases equivalent to the child-connoting English “tantrum” in the major languages of the world, including Arabic, Bengali, French, German, Portuguese, and Spanish. These words denote the emotion of anger and its concomitant behaviors, as well as crying and other indices of distress such as dropping to the floor. They are similar to English usage (p. 107) of “tantrum” in that, when applied to an adult, these words connote that the individual is acting childishly. This common usage in diverse language groups implies long experience with tantrums as a characteristic of children in many places around the world. A few of these words and phrases conjure visual images. The Spanish “pataleta” conveys a picture of stamping or kicking legs; “rabieta” evokes the madness of rabies. The most picturesque might be the Dutch “kinderlicht driftbui” with its image of a small childhood rainstorm that comes and goes. There are colloquialisms in Mandarin Chinese, Hindi, and Russian to denote/describe anger and tantrum behaviors, but they may be applied to adults and children equally and require adjectival or other modification to specify the childish nature of the behaviors.
Given that a number of major languages do have an equivalent of “tantrum,” might those that lack one be associated with cultural traditions that consider the doings of children as less significant or name-worthy than the affairs of adults? Or, are there societies in which children have minimal to few tantrums? Anthropologists and other observers have noted that infants in a number of non-Western cultures, like the former agro-pastoralist Gusii of Western Kenya, cry much less than babies in Western cultures. This is attributed to child-rearing practices that include close and continual proximity to mothers who immediately attend to any signs of distress. However, this level of attention is relinquished during and after weaning, at which point Gusii children do have tantrums (LeVine & LeVine, 1963). Alternatively, might tantrums be even more common than the prevalence figures suggest, viewed as a necessary part of emotional development? For example, respondents in only 7 of 24 societies listed tantrums as among the top 10 behavioral problems of preschool-age children (Rescorla et al., 2011). This is not to say that children are not having tantrums but that they may not be viewed as problematic.
Emotional/Behavioral Organization of Tantrums: The Anger/Distress Model
Anger and distress have been identified as the two major emotional/behavioral components of children’s tantrums. Factor analyses of parent-reported tantrum behaviors of 335 typically developing American 18- to 60-month-olds (Potegal & Davidson, 2003) as well as staff-observed 5- to 12-year-old child psychiatry inpatients (Potegal, Carlson, Margulies, Gutkovitch, & Wall, 2009) consistently differentiated and characterized separate anger- and distress-related factors. The anger-related factors include the vocalizations shout and scream and the behaviors stamp, throw, hit, and kick. Run away is an unusual anger behavior in that it involves avoidance rather than approach (Eisenberg et al., 1999), while arch/stiffen is an anger behavior that has apparent reflex-like properties, as noted later.
Distress-related factors include the vocalizations whine and cry and the behaviors down and comfort-seek. Down is mostly about dramatic drops to the (p. 108) floor but is scored to include any major/showy lowering of the head and/or slumping of the body. Comfort-seek includes verbal or physical appeals such as asking to sit on a parent’s lap, approaching and touching parent, and raising arms to be picked up. The major emotion in distress is sadness, but the term “distress” is used to cover behaviors that might not routinely be included in sadness, such as dropping to the floor.
The anger–distress distinction has been replicated in tantrums of Canadian 3- to 5-year-olds as the best fitting solution of exploratory-confirmatory factor analyses using oblique factors (Giesbrecht, Miller, & Muller, 2010) as well as in clinic referred 2.5- to 5.5-year-olds with behavior problems (Eisbach et al., 2014). Qualitatively similar findings in Prader–Willi syndrome (Tunnicliffe, Woodcock, Bull, Oliver, & Penhallow, 2014) suggest model utility in pathological populations. These confirmations of two independent emotional/behavioral processes retire older notions that tantrums may be driven by some single motivational process, with distress and anger behaviors being triggered at different levels of that process (Potegal et al., 2003).
Within the anger-distress model, the two emotions have been further factorially and temporally differentiated. Anger factors can be easily ordered into progressive levels of intensity based on their respective behaviors and their differential association with parent ratings of global severity and autonomic activation (Potegal et al., 2003). Low, intermediate, and high anger factors were identified in the tantrums of both typically developing younger children (Potegal & Davidson, 2003) and psychiatrically disturbed older children (Potegal et al., 2009); the individual behaviors included in each factor were similar in the two samples despite gross differences in age and psychopathological status (e.g., low anger included stamp, high anger included scream). Belden et al.’s (2008) destructive aggressive and nondestructive aggressive tantrum factors in clinical and nonclinical samples of 3- to 6-year-olds overlap with the high and low anger factors, respectively. Within distress, whine and down have been identified as indicating lower intensity sadness, whereas cry and comfort seek are associated with higher intensity sadness.
Discriminant analyses of the acoustic characteristics of tantrum vocalizations support these categorical and intensity classifications (Green, Whitney, & Potegal, 2011). Within the anger category, shouts and screams were acoustically similar, with steep frequency increases at onset reaching high peak frequencies. This pair of vocalizations differed markedly from the whines and cries of distress, which showed gradual frequency increase at onset and lower peak frequencies. Within categories, screams were more energetic than shouts while cries were more energetic than whines, consistent with the previous identification of behaviors indicating higher and lower levels of emotion.
Anger- and distress-related behaviors also follow different temporal trajectories. In general, anger peaks early in the tantrum, then declines, while distress remains (p. 109) relatively constant throughout. Variations on this theme include findings that the high, intermediate, and low anger behaviors of the older child psychiatry inpatients were all maximum at tantrum onset and declined in roughly exponential fashion (see figure 1 in Potegal et al., 2009). Cluster analysis of the slopes of the decline confirmed the factor-analytic grouping of anger behaviors by intensity. Slopes of distress behaviors were not different from 0. Distress behaviors in the parent-reported tantrums of 1- to 5-year-olds (Potegal et al., 2003) were distributed across the tantrum relatively evenly, but the comfort-seeking component increased as the tantrum neared its end.
More recently, the duration of all behaviors in 193 beginning-to-end videos of tantrums at home of 88 2- and 3-year-olds were measured to the nearest second; each brief behavior, like a hit, was assigned a duration of 1 sec (Potegal, unpublished data). Calculation of behavior rates as sec/min of tantrum further supported the anger-distress distinction. We found all anger behaviors to be brief and intermittent, whereas all distress behaviors were prolonged and semi-continuous. The mean rate of each anger behavior was less than 4.5 sec/min; the mean rate of each distress behavior was greater than 4.5 sec/min.
In these new tantrum video data, a cluster analysis identified three trajectory groups. Anger in one group was high and maximum at onset and declined substantially thereafter, as it did in the older child psychiatry inpatients (Potegal et al., 2009). In the second group, anger was lower at onset and rose to a major peak in the first half of the tantrum, as it did in the parent-reported 3- to 5-year-olds (Potegal et al., 2003). Anger in the third group declined slightly across the tantrum. Importantly, distress had the same flat profile in all three groups. In all cases, distress typically outlasts anger, so tantrums end when crying and whining stop. Temporal relations of anger and distress may be preserved independent of tantrum duration. We have incidentally observed micro tantrums in which a single brief anger display was followed by a single brief distress display (e.g., a shout followed by a head drop, with the whole sequence lasting only a few seconds).
While states of anger and distress expressed within a child’s tantrum function as independent factors, children who are irritable are also prone to sadness and to tantrums, so these traits are correlated across children (Bufferd, Doughtery, & Olino, 2017). This correlation speaks to generalized negative affectivity and deficits in emotion regulation that promote tantrums.
Back Arching as an Emotion-Gated Reflex
When restrained or picked up, angry and resistant children may stiffen, arch their backs, and tilt their heads back (technically, an axial hyperextension). Arching was the only child behavior to have a statistically significant association with parent intervention (Potegal et al., 2003); this is because arching can be triggered by contact. Back arching clearly depends on emotional state; children who are picked up when in a positive mood do not arch and may even cling or cuddle. In fact, contact-elicited arching loaded heavily on high anger in the tantrum factor (p. 110) analysis (Potegal et al., 2003). Parent report as well as my personal observations indicate that arching occurs quite rapidly. In typical parent–child ventral-ventral holding, back arching may seem to function as an escape response, moving the child backward away from the parent. However, videotapes of a standard experimental arm restraint situation show 15-month-olds arching backward even when briefly restrained from behind by their mother, although arching brought them closer to her (Potegal, Robison, Anderson, Jordan, & Shapiro, 2007). One mother reported having lost front teeth while holding her young son whose arching caused his head to strike her jaw. Arching in response to contact is not an escape response but a forceful reflex-like reaction with relatively fixed topography.
In its rapid triggering by contact, stereotyped topography, and dependence on emotional state, arching resembles the “state-dependent” reflexes of attack that have been demonstrated in several animal species. Normally, animals will withdraw from a touch on the lips or paw, but when aggression-related areas of hypothalamus are stimulated, lip contact will elicit a bite while paw contact will provoke a paw strike (for review, see Kruk, 1991). Aggressive motivation gates these reflexes into an operational mode so that attack responses can be executed quickly. Tantrum anger may similarly gate reflex arching.
Autonomic activation plays a prominent, if contentious, role in emotion (e.g., Levenson, 2014 vs. Quigley & Barrett, 2014). In tantrums, signs of autonomic activation may be visible on the child’s face. In the parent reported tantrums of the 18- to 60-month-olds, 26% involved sympathetic facial flushing with or without sweating (c.f., Drummond & Quah, 2001); parasympathetic salivation (drooling and spitting) and rhinorrhea (nose-running) were each reported in 6% or less of these tantrums (Potegal, 2000; lacrimation (tears) are certainly the most common parasympathetic response in tantrums but were not recorded separately from crying in this study). Tantrums with flushing were significantly longer, contained more elements, and were more intense than those without flushing. Flushing was most closely correlated with high anger behaviors (cf. table 1 in Levenson, 2014). Accordingly, flushing first appeared toward the beginning of the tantrum, as it would if associated with anger, rather than toward the end, as it would if it were just associated with vigorous and protracted physical activity. These effects were stronger for the younger children. Negative post-tantrum mood was predicted by greater autonomic arousal during the tantrum. Because facial indicators of autonomic activation do not require physiological equipment to measure and are easy for parents to assess, they have a potential use in parent-report studies as a marker of autonomic arousal.
Secretion of the “stress” hormone cortisol has been associated with sadness, but not anger, during infants’ reactions to goal blockage (Lewis, Ramsay, & Sullivan, 2006). In our small study of 3-year-olds who were having at least 1–2 tantrums/week lasting at least 2–4 minutes, salivary cortisol was measured under three (p. 111) conditions: baseline (at 9 am, 2 pm, and bedtime), post-tantrum (at 20, 40, and 60 minutes after a tantrum), and non-tantrum yoked time control (at the same times of day on the next day when the child did not have a tantrum; Potegal, 2003). Parents recorded all tantrums on a 6-week calendar. Mean salivary cortisol at baseline was correlated with tantrum frequency (r = .47) but not with mean duration. Cortisol secretion was increased by having a tantrum, as indicated by a 27% rise over the yoked control sample at the 20-minute point followed by an apparent drop below control levels at 40 minutes and a return to control levels at 60 minutes. These effects were stronger in boys than girls and in the morning than the afternoon. In these 3-year-olds, as in Spinrad et al.’s (2009) study of preschoolers, there were no specific associations of cortisol with anger or distress behaviors.
Measuring Tantrum Intensity
For any particular child, some tantrums appear more intense than others. Having a validated measure of tantrum intensity could prove useful in determining a given child’s sensitivities and triggers as well as in identifying psychopathological extremes in a population. How, then, to measure intensity? Longer duration would seem to indicate greater intensity (Wakschlag et al., 2012). For example, tantrums that included stamp or down (i.e., low level anger or distress) within their first 30 sec were shorter than those that did not (Potegal et al., 2003); a similar result was obtained with low anger push in the video data. But the intensity–duration correlation may be true only up to a point. Some analyses suggest that tantrums of typically developing children longer than 15, 20, or 25 min (depending on the dataset) are less intense (Potegal & Qiu, 2010); these may be primarily weepy tantrums (Einon & Potegal, 1994). Autonomic activation of the face is another obvious potential indicator of intensity. However, there are likely to be substantial individual differences in autonomic reactivity; some children may flush with the slightest anger, others, particularly older children, may not visibly flush no matter how angry they become.
Belden et al. (2008) identified three levels of intensity in 3- to 6-year-olds: (1) tantrums that rarely escalate to excessive crying or shouting and include no throwing, hitting, or kicking directed at property or people; (2) tantrums that include crying, shouting, and/or nondirected flailing but no aggression against property or people; and (3) tantrums that do include aggression against property or people. The most systematic work on intensity has been Wakschlag et al.’s (2012) development of a temper loss scale for 3- to 5-year-olds. Behavior characteristics specific to tantrums that are above the 95th percentile for the population sampled on this scale are listed here in descending order of severity:
Hit, bite, or kick
Tantrum from “out of the blue”
Break or destroy things
Tantrum until exhausted
(p. 112) Tantrum in the presence of a nonparental adult
Tantrum longer than 5 min
Stamp feet or hold breath
Indeed, hit and kick are high anger behaviors in the anger-distress model while stamp is a low anger behavior (it is a bit surprising that stamp made the 95th percentile cut). “Out of the blue” is reminiscent of psychopathological adult anger responses to little or no provocation in, for example, intermittent explosive disorder. “Tantrum until exhausted” is a relatively rare extreme that has been associated with anxiety in aggressively abused children (Furman, 1986). In contrast, a 5-minute tantrum is just the upper end of the average range in estimates of tantrum duration for younger children and may be in the middle of the average range for older children. The significance of tantrums in the presence of a nonparental adult is that most tantrums occur at home and involve the parents (Einon & Potegal, 1994; Potegal & Davidson, 2003).
When tantrums are part of aversive/coercive child–parent interactions, their severity is very likely to increase with repetition (Snyder, 2015). In any event, from a research perspective, tantrums at the upper end of their severity range provide a window onto emotions so intense as to be otherwise unavailable to routine scientific observation. (A short questionnaire to assess the severity of a child’s tantrums by their impact on family life is available from the author.)
How Behavior Classifications Might Be Used to Quantify Tantrum Severity
Grouping behaviors by level implies that stamping, pushing, and throwing are generated at lower levels of anger while screaming, hitting, and kicking are generated at higher levels. Under certain simplifying assumptions, this hypothesis predicts that a content analysis of sets of tantrums from individual children could be used to quantify intensity. To wit, as anger rises from its pre-tantrum baseline, it must pass through lower levels before reaching whatever maximum level it achieves during the tantrum. Similarly, anger must descend through lower levels during its return to baseline. Anger behaviors during a tantrum must therefore be a mix of those generated while anger is rising or descending through lower levels and others generated while anger is near or at the highest level it reaches in that tantrum. Consequently, if a tantrum features high anger behaviors, it is also likely to include lower level behaviors. However, a tantrum can contain lower level behaviors without including any higher level ones. Letting L = low anger and H = high anger behaviors, tantrums would be expected to contain L, or L and H, but not H alone. The assumption that sufficient time is spent at lower and higher levels for behaviors to be generated at those levels is justified by the long descent of tantrum anger. Suitable adjustment for different base rates of the various behaviors would need to be made. Because of individual differences, such analyses would need to be carried out on sets of tantrums for each child.
(p. 113) A more fully developed model, the anger intensity-behavioral linkage function model, fits the distribution of low and high anger behaviors across the tantrum by reconstructing the rise and fall of anger as a latent variable, Momentary anger [MA(t)], which reflects the intensity of anger at each time point in the tantrum, and a set of unique linkage functions through which MA(t) controls the probability of each angry behavior. MA(t) has been modeled as a beta function; the linkage functions were modeled as logistic-polynomial composites (Potegal & Qiu, 2010; Qiu, Yang, & Potegal, 2009).
Finally, intensity assessments must take into account when the child might be faking. Parents report children doing things that suggest they are not necessarily or always caught up in irresistible emotion. Before dropping to the floor, they may look around for a soft place to fall. They may reduce crying when parents leave the room and increase it when they return. Our home videos revealed a little girl who stopped wailing long enough to take a bite of her bread, then resumed where she left off. One particular 3-year-old boy appeared to be a master of tantrum-as-manipulation. In one video in which he was seated with his face buried in the crook of his elbow, the camera caught his surreptitious glance up at his mother. While kneeling on the floor during another tantrum with his back to his mother, he said “You can’t see the tears on my face.” Her off-camera voice could be heard acknowledging this (while trying not to laugh). Tantrums with such indicators of faking should get the lowest intensity score, obviously.
Tantrum Daily Timing, Motivations, and Functions
Goodenough’s (1931) pioneering diary study, Anger in Young Children, found what we would now recognize as a circadian rhythm in tantrums, with a morning peak (about 11 am) and a late afternoon/early evening peak (roughly 4–7 pm). A probability analysis of tantrum time-of-day data collected in 1994–95, more than 60 years later, replicated the morning and late afternoon/early evening peaks (Potegal & Kosorok, 1995, see Figure 7.1). A late afternoon peak in discomfort is not unique to toddler tantrums. Positive affect in healthy adults reaches a peak around 2 pm and declines steadily through the rest of the day (Hasler, Mehl, Bootzin, & Vazire, 2008; Miller et al., 2015). Processes underlying such mood shifts may contribute to similar, temporally localized distress in vulnerable populations across the lifespan, such as the late afternoon/early evening crying in colicky infants (White, Gunnar, Larson, Donzella, & Barr, 2000) and a 3–4 pm peak in “sundowning” agitation in individuals with dementia (Cipriani, Lucetti, Carlesi, Danti, & Nuti, 2015). (p. 114)
Emotional Functions and Emotion Dynamics
From an individual perspective, anger functions to forestall or limit a threat while sadness mourns a loss that has already occurred (Lench, Tibbett, & Bench, 2016). Other views stress the social interactional functions of emotions. Even when prompted by internal experiences of hunger, fatigue, or discomfort, the vast majority of tantrums involve the young child’s conflict with parents or siblings. From a social/emotional perspective, tantrum anger is about establishing or maintaining autonomy, demanding her way about this or that (or frustration about not getting his way), and/or resisting unwanted or intrusive demands. In this, it resembles adult anger, which has evolved as a more-or-less automatic reaction to fend off (p. 115) threat, forestall attack, and assert demands (Fessler, 2010; Sell, Cosmides, & Tooby, 2014). Anger mostly involves approach motivation, but angry adults actively avoid confrontation with socially dominant individuals and distance themselves from socially awkward encounters (Harmon-Jones, Gable, & Peterson, 2010; Kuppens, VanMechelen, & Meulders, 2004) much like the children who run away.
From a functional perspective, distress, which includes sadness, is about eliciting parental comfort-giving. Other things equal, we tend to comfort a child who is crying (Swain, Mayes, & Leckman, 2004). Because the distress components of a tantrum always outlast the anger, they function to generate child comfort-seeking and parental comfort-giving, repairing the social bonds broken by the child’s preceding anger. Analysis of recorded marital exchanges suggest that anger and sadness in adult conflicts occur in the same combination and sequence and function in the same way, with the expression of sadness and distress reducing the partner’s aggression and eliciting expressions of sympathy and support (Biglan, Lewin, & Hops, 1990; c.f. Katz, Jones, & Beach, 2000).
A noteworthy aspect of tantrum emotion dynamics revealed in the video recordings is the reciprocal relationship between anger and comfort-seeking. Although distress as a whole remained constant across the tantrum, the frequency of its comfort-seeking component accelerated in the last fraction of the tantrum as anger declined, suggesting that the decline in children’s anger disinhibits their seeking for, and acceptance of, comforting.
Reconciliation (or Not) at Tantrum Termination
The most typical tantrum aftermath is for children to simply resume their usual activities. In 29–35% of parent reports, a young child’s tantrum ended with a hug, cuddle, or other gesture of reconciliation, representing some intersection of child distress and parent comfort-giving (Einon & Potegal, 1994; Potegal & Davidson, 1997). In some cases, parents consoled children who passively accepted it. In others, reconciliation was solicited or initiated by the child who approached the parent (almost always the mother), leaned against her, raised arms up to her, or clutched her leg. Older children might apologize verbally. Various markers of stress and of physical separation between parent and child during the tantrum predicted reconciliation. Labeling such events “post-tantrum reconciliation,” Potegal and Davidson (1997) treated them as if they had occurred after the tantrum was over. It might be more appropriate to consider them as a last stage of the tantrum in which distress is resolved.
“Therapeutic Holding” and Reconciliation
Therapeutic holding is a controversial procedure for enhancing child–parent attachment that was popularized by Welch (1989) and advocated by some attachment therapists for use with children with autism. The most recent report, with the largest sample, of what is now called Prolonged Parent-Child Embrace (PP-CE, Welch et al., 2006) defines four stages: (1) during confrontation, the adult (usually (p. 116) the mother) holds the child face to face, demands the child meet her gaze, and begins to express and elicit talk about feelings. (2) If the child was not already agitated when the adult began, her or his discomfort and irritability escalates into resisting and struggling in the conflict (formerly, “rejection”) stage. During this stage, the adult forcefully holds the child no matter how strongly she or he fights. Parents are taught to tolerate the child’s strongest emotional outbursts, to persist through the rejection, and to express their own intense feelings of fear, anger, or hurt, communicating that “nothing can come between us.” Conflict/rejection stage restraint and struggling continue for 20–90 minutes, whereupon both mother and child reportedly experience (3) a sudden and profound transition to relaxation and strong feelings of bonding, marking the resolution stage of reciprocal embrace, caressing, kissing, and conversation. (4) Resolution is followed by synchrony, a state of calm arousal with attunement and reciprocity. “These latter stages were characterized by breathing in unison, deep mutual gaze, relaxation, reciprocal pleasure in each other’s embrace, and open verbal and non-verbal communication” (Welch et al., 2006, p. 6). To Mercer’s (2013) review of this literature should be added Stirling and McHugh’s (1998) single case report and Sourander, Aurela, and Piha’s (1994) report of nine child patients, all reportedly showing the four-stage sequence. Comments by a few Scottish adolescents who solicited therapeutic restraint by staff of the residential facilities to which they had been committed due to their aggressive behavior seem to confirm their experience of this sequence (Steckley, 2011).
Of course, physical restraint as in the PP-CE procedure is a classic trigger for tantrums (Watson & Watson, 1921). Indeed, the PP-CE Conflict stage is actually a tantrum. But, what is of greater theoretical interest is that the continuing restraint amplifies and prolongs the emotions of anger and distress such that reconciliation (the Resolution phase) then becomes more probable and more intense. This outcome is surprising. Perhaps forcing extreme and prolonged activation of neural networks that normally generate tantrum emotions and their associated behaviors creates some sort of opponent process situation in which the eventual exhaustion of intense anger against the background of continuing distress releases and amplifies impulses toward reconciliation, creating catharsis-like feelings.
To be sure, the methodology and reported successes of the published studies of therapeutic holding/PP-CE have been severely criticized, as have the ethics of such coercive procedures; fatalities have resulted from excessive restraint in related “therapeutic” situations (Mercer, 2013). While in no way advocating the use of therapeutic holding, the several reported replications of the sequence through the resolution phase imply that a complete theory of tantrum emotion dynamics must account for this striking phenomenon.
Are Tantrums Emotional Reactions, Behavioral Operants, or Both?
At first, tantrums may be primarily emotionally driven reactions over which the child has little control, an extension of infant crying. While retaining the (p. 117) emotional core, children learn through experience of outcomes to use tantrums as operants (albeit energetically and emotionally costly ones; McCurdy, Kunz, & Sheridan, 2006). Children may differ (or an individual child may differ from tantrum to tantrum) with regard to the mix of emotional push and reinforcer pull. Compare the tantrum in which the child stops abruptly when she or he is given what was demanded versus the one in which the child continues to tantrum after she or he is offered the originally desired item but then refuses it (Einon & Potegal, 1994).
In contrast to modeling tantrums as a mix of two emotions and the acts they engender, applied behavior analysis (ABA) treats tantrums as an operant, one among a number of undesirable/aversive behaviors that function either to obtain “tangibles” (preferred foods, objects, activities) and/or attention (negative attention being better than no attention; e.g., Harding et al., 2001) or to escape from unwanted demands (every second a child tantrums is a second he is not, e.g., getting ready for bed; Carr & Newsome, 1985; Ingvarsson, Hanley, & Welter, 2009). The functions just noted are listed in increasing order of their likelihood as tantrum motivators (Matson et al., 2011). Parenthetically, a tantrum in reaction to a demand to stop doing A and start doing B is better understood as an escape from demand rather than as a response to a “transition.” ABA analyses are not always successful in establishing function, and it might be that tantrums motivated by tangibles, attention, or escape differ in particular behaviors, anger–distress ratio, overall severity, or other observable emotional/behavioral characteristics that would help identify their function.
Although ABA is a branch of behavioral psychology that mostly deals with individuals who are developmentally delayed or autistic, these categories are applicable to typically developing children. They suggest the approaches of planned ignoring for tantrums for tangibles or attention but adult hand-over-child hand physical guidance for escape-driven tantrums (Kern, Delaney, Hilt, Bailin, & Elliott, 2002). Planned ignoring requires not talking to or looking at the child, which parents may find difficult to do. Inadvertent parental attention, positive and/or negative, may explain the maintenance of tantrums despite their seeming cost. When planned ignoring is first introduced, an “extinction burst” of escalated tantrums is likely to follow (Vollmer et al., 1998) consistent with their identity as operants.
Tantrums and Oppositionality
Deliberate disobedience increases in the second year of life (Baillargeon, Keenan, & Cao, 2012; Lorber, Del Vecchio, & Slep, 2015). Tantrums may be immediately preceded by a period of oppositional behaviors, as I saw with my own daughter and as reported by other parents (Einon & Potegal, 1994), and as Eisbach et al. (2014) observed to precipitate 52% of the tantrums of 2- to 5.5-year-olds in the clinic. These children’s oppositional behaviors included doing things they knew were against the rules as well as refusing to comply with specific parental commands. (p. 118) The oppositionality–tantrum sequence may be interpreted as reflecting a child’s escalating struggle for autonomy, irritable mood, or both. “Often loses temper” is one of the criteria for a diagnosis of oppositional defiant disorder (ODD), but how sensitive oppositional behaviors actually are as a predictor of tantrums (i.e., what percent of oppositional periods are followed by a tantrum) remains to be determined.
Tantrums can irritate parents and bystanders, too. Rhesus macaque mothers and their infants were attacked by other troop members more often when the infants were crying (Semple, Gerald, & Suggs, 2009). Although such attacks were rare, the mothers allowed infants to nurse significantly more often when around troop members who were likely to attack. Whining and crying can be aversive to human parents (Sokol, Webster, Thompson, & Stevens, 2005; Soltis, 2004), and the unpleasantness of tantrums for parents, especially mothers, has often been noted (e.g., Hill & Hurtado, 1996; Maretzki & Maretzki, 1963). In Western society, excessive infant crying can lead to infanticide, fantasied (Levitzky & Cooper, 2000) or actual (Porter & Gavin, 2010).
In a myth of the Yolngu of eastern Arnhem Land, a child having a tantrum was transformed into a sea-eagle (Morphy, 1989). When that doesn’t happen, parents may intervene. While mothers in some cultures fend off blows without restraining the child or retaliating (e.g., Gorer, 1943; Peterson, 1993), even the tolerant Chewong, who routinely ignore tantrums, may shout at the child to stop (Howell, 1989). The less tolerant Matsigenkas reportedly subjected toddlers who tantrumed frequently to scalding baths (Johnson, 1981) while Gusii and Okinawan mothers may hit them (LeVine & LeVine, 1963; Maretzki & Maretzki, 1963). In some groups, an adult dressed as a ghost or local folklore monster appears to the terrified children who are told that the apparition will get them if they don’t stop their tantrums (and other misbehavior; Maretzki & Maretzki, 1963; Nydegger & Nydegger, 1963).
In Potegal and Davidson’s (2003) study, parents reported intervening in 79% of tantrums. Intervention probability was unrelated to the child’s age or sex; it did increase with reported tantrum duration and intensity. Parent intervention was associated with higher rates of tantrum behavior, especially arch/stiffen, which is a response to being restrained, picked up, carried, or dressed (Potegal et al., 2003). These effects were confirmed in the video data by the finding that the tantrums in which anger rose and peaked during the first half all involved forcible parental intervention. The nature and consequences of parental action depend on culture, varying from those in which older children and adults may routinely tease younger children into tantrums (McSwain, 1981; Ward, 1970), to those in which parents ignore tantrums, to those in which children are punished for tantrums. In Western culture, harsh, punitive parenting is associated with child behavior problems, including tantrums, but these effects are moderated by the overall parent–child (p. 119) relationship and by subcultural context (Brenner & Fox, 1998; Deater-Deckard & Dodge, 1997).
Tantrum Ontogeny, Age Trends, and Cessation
Episodes of generalized emotional distress have been claimed to differentiate into recognizable emotions, including anger, as early as 4–6 months of age (Potegal & Archer, 2004; Lewis, 2010; but see Camras, 2011); anger as a distinct emotion becomes more readily elicitable through 16 months (Braungart-Rieker, Hill-Soderlund, & Karrass, 2010). Some of these episodes may become recognizable as tantrums during the second year of life. They may persist for a few years, with the majority of children studied giving them up by age 4 or 5.
Frequency and Duration
Among the younger children who have tantrums, estimates of mean frequencies range between 1–9/week (Bufferd et al., 2017; Van Leeuwen, Bourgonjon, Huijsman, Van Meenen, & De Pauw, 2009, Sullivan & Lewis, 2012, Belden et al., 2008; Potegal & Davidson, 2003); modal rates across several older studies were 3–6/week (Potegal & Archer, 2004). Complementary to the 3–6/week mode, several authors have cited the percent of children having 1 or more tantrums/day as a marker of more extreme subpopulations. According to Grover (2008), at least 20% of 2-year-olds, 18% of 3-year-olds, and 10% of 4-year-olds have at least one temper tantrum every day. These figures may overestimate percentages of daily tantrumers in the older groups; Wakschlag et al. (2012) reported fewer than 9% among 3- to 5-year-olds. Potegal and Archer (2004, fig. 1) estimated less than 5% for 4-year-olds. Establishing the 95th percentile for tantrum frequency might provide a useful cutoff for clinical purposes. Per Bufferd et al. (2017, Table 2), 1.5 tantrums/day is at the 95th percentile for 3- to 5-year-olds as a group. Taken together, these reports suggest that the 95th percentile for tantrum frequency might be around 2/day for 3-year-olds falling to 1/day for 4-year-olds.
Grover’s (2008) figures are consistent with the reduction in frequency with age reported in other cross-sectional data (Potegal & Davidson, 2003, see Figure 1 in Potegal & Archer, 2004). Reductions in tantrum frequency were accompanied by increases in mean duration, from 2 min in 18- to 24-month-olds to 5 min in 54- to 60-month-olds (Potegal & Davidson, 2003). The more accurate video data confirmed that the median tantrum duration for 2- to 3-year-olds was around 4 min. Such an increase in duration with age is consistent with mean durations of 12–16 min in studies that included children up to 6 or older (Belden et al., 2008; Österman & Björkqvist, 2010). However, an increase in mean duration with age in cross-sectional studies might result from children with shorter tantrums ceasing to tantrum earlier. A longitudinal study involving three reports at 6-month intervals by parents of 13- to 67-month-olds found both frequency and duration to decrease with age (Van Leeuwen et al., 2009; personal communication October 4, 2017). To (p. 120) complicate matters further, Goodenough (1931) found 1–4 min tantrum durations in children from infancy to 7 years, while Mireault and Trahan (2007) reported a mean 16 min duration in 3- to 5-year-olds. In these studies, standard deviations were large compared to means and/or a large percentage of tantrums were in the shorter end of the duration range, both effects being due to the long tails of the duration distributions (see Figure 1 in Potegal et al., 2003). Overall, tantrum frequency decreases with age while age effects on duration remain to be determined.
Tantrum Onset: Is There a “Transition Event?”
Episodes recognizable as tantrums emerge in the second year of life, for a few children as early as 12 months and for many more by 18 months. Three studies with direct home and/or lab observation or contemporaneous parent reports of children starting at 3–15 months found no or few tantrums before 15 months but numerous tantrums occurring from 18–30 months (Chen, Green, & Gustafson, 2009; Kopp, 1992; Minde & Tidmarsh, 1997). Chen et al.’s (2009) recordings of protest vocalizations against maternal prohibitions included no screams at 6 months but screaming in response to 34–35% of prohibitions at 12 and 18 months. If mothers count just screaming as a tantrum, then more children will be reported to tantrum at 12 months. This may account for mothers’ reports of a mean age at tantrum onset as 53–58 weeks in Sullivan and Lewis’s (2012) study. This interpretation is supported by a greater than doubling of the number of behaviors reported per tantrum from 12 to 20 months in this study. Tantrum frequency and the number of different contexts in which tantrums occurred also increased significantly from 12 to 20 months. Österman and Björkvist’s (2010) retrospective parent survey of 105 past or current tantrumers (out of 132 children) up to 13 years old also found few tantrums before 12 months. However, 65% of onsets were reported to have occurred between 2 and 4 years, with the latest onset at 7 years. Such reports of later onset may be influenced by a memory bias related to the longer periods over which these parents were asked to recall early child behavior.
An apparent emergence or noticeable increase in tantrums for many children around 18 months may relate to improved motor control and ability to maintain attention to desired but unavailable objects and activities. Wenar (1982) noted a “negativity” beginning around this time and lasting for a few years that may have to do with new frustrations associated with emerging awareness of the self (Kopp, 1992). However, there are anecdotal reports of children who had tantrums for only a few weeks, only a few times, or, in several cases, only once. These time-limited events reportedly occurred around 18 months of age. Such accounts, together with Sullivan and Lewis’s (2012) report of an increase in the number of tantrum elements from 12 to 20 months and observations of my own daughter suggest that various tantrum behaviors like hitting and dropping to the floor may come online and be practiced between 12 and 18 months (only after walking has become reliably independent at 13–15 months can parents discriminate voluntary dropping to the floor from accidental falling). Well-documented increases in physical aggression in the (p. 121) second year (Alink et al., 2006; Lorber et al., 2015) likely include the first appearance of intended/aimed aggressive hitting, kicking, etc. There then may be a developmental change indicated by a “transition event,” perhaps the first fully formed, longest, and/or most intense tantrum up to that point, which heralds a period of more frequent, longer, and more intense tantrums in which the more recently developed behaviors are added to the whining, crying, and arching of earlier infancy. The order of appearance of new tantrum elements and how tantrums emerge is an interesting and unexplored aspect of tantrum ontogeny. A timeline of events for a personally observed female child is shown in Table 7.1, with what would count as a transition event at 19.5 months.
Table 7.1 In-home observations of tantrum-related behavior onsets of a female child from 10 to 28 months
First Observation of the Behavior
Began walking at 47 weeks
Stamping when restrained
Ran away when upset
When angry, hit parent within reach. Hitting continued over several weeks then stopped and kicking became more frequent
Dropped to floor - a few times in same day
First clearly recognizable tantrum, triggered by taking something away from her. No new behaviors, but more intense and much longer (5 min) event
1) Use of verbal “No” (learned from children at daycare), 2) Clearly deliberate disobedience, 3) Approached parent from a distance to hit
Spate of longer and more intense tantrums with extreme arching during a viral illness
1–2 tantrums/day, most brief, a few prolonged, triggered by trivial or undetectable events (given the wrong color pacifier?), with directed hitting, arching, dropping
Head butts, perhaps intended as play but painful, never occurred in tantrums
Notes Toward a Study of Transition Events/First Tantrums
Behavioral characteristics that differ before versus after a tantrum transition event might include (1) an increase in the number/kind of stimuli that trigger tantrums; (2) a step increase in the frequency, intensity, or duration of tantrums; (3) a new overlap/co-occurrence of formerly independent behaviors; or (4) introduction of new tantrum behaviors around which the others become organized. Longitudinal data could be collected by having parents complete a checklist of tantrum behaviors they had seen most recently, beginning when their child was 12 months old and continuing at 1- to 3-month intervals up to 24 or 36 months. They might also be asked to contact investigators when they see a first tantrum and/or a particularly long or intense tantrum. To generate more detailed records over shorter periods, we had success in having parents maintain a tantrum calendar in which they entered the onset time, duration, and relative intensity (on a 1–5 scale) of (p. 122) each tantrum the child had over 1–2 months. Randomized weekly check-in calls asking about the most recent tantrum during the recording period provided reliability data for comparison to the calendars once they were turned in. The statistical challenge is to detect step changes in the frequency, duration, intensity, number, or type of behaviors within each individual record. Nonparametric approaches like those of Van Dijk and Van Geert (2007), which focus on reliably identifying discontinuities in development, might be useful in this regard. Identification of a tantrum transition event would lend credence to the idea of a neurodevelopmental program that comes on line at a certain point in time.
Tantrums and Language Development
It has been claimed that toddlers’ tantrums can be triggered by frustration with their language ability, which is inadequate to express their feelings and wishes. In most cases of normal development, however, parents understand what their children want or don’t want well enough. By 3, which can be as terrible as 2, typically developing children can understand what is said to them and can express themselves adequately. The lack of causal connection between communication problems and tantrums is true even for children with autism (Mayes, Lockridge, & Tierney, 2017; Sipes, Matson, Horovitz, & Shoemaker, 2011). Some older studies do suggest that children with delayed or abnormal language development are more prone to tantrum (Beitchman, 1985; Benasich, Curtis, & Tallal, 1993; Carlson, Potegal, Margulies, Gutkovich, & Basile, 2009; Caulfield, Fischel, Debaryshe, & Whitehurst, 1989; Vollmer, Northup, Ringdahl, Le Blanc, & Chauvin, 1996; but see Dominick, Davis, Lainhart, Tager-Flusberg, & Folstein, 2007). Whether these tantrums have to do with frustration around communication specifically or with more general emotional problems comorbid with problems in language development remains to be determined. This question notwithstanding, the “functional communication” approach of providing alternative modes of response to children with disabilities reportedly ameliorates tantrums and other undesirable behaviors (Durrand & Merges, 2001).
Tantrum Cessation or Another Transition?
The age at which children cease to tantrum is an interesting example of cultural influence on children’s behavior. In prewar Japan, when young boys were taught to be subservient to older male relatives but were dominant over all female relatives, boys of 4 and 5 reportedly committed serious aggression against their mothers in their tantrums, kicking, punching, and biting her, which the mothers were culturally inhibited to defend against. This only stopped when the boys began school at age 6 or 7 and all aggression was mocked and/or punished (Gorer, 1943). Similar age limits on villagers’ laissez-faire attitude to boys’ misbehavior, including tantrums, prevailed on the Japanese island of Okinawa in the 1950s (Maretzki & Maretzki, 1963). In that era and later, Chinese boys in Kau Sai had public tantrums up to age 10 (Ward, 1971). In contemporary societies tantrums may persist for a (p. 123) few years with the majority of children giving them up by age 4 or 5. Thus, tantrum prevalence reported for children 6 and older ranges from 11% to 30% (Barbarin, 1999; Bhatia, Dhar, Singhal, & Nigam, 1990; Carlson, Danzig, Dougherty, Bufferd, & Klein, 2016; Hackett & Hackett, 1993; Österman & Björkvist, 2010); the drop to under 50% prevalence occurred at age 7 in MacFarlane, Allen, and Honzik’s (1954) data.
We know even less about tantrum cessation than tantrum onset. Cessation in modern societies may be due in part to the noticeable increase in emotion regulation and its cross-situational consistency from 3–4 or 5 years of age (Kalpidou, Power, Cherry, & Gottfried, 2004; Ramani, Brownell, & Campbell, 2010). There was a significant decline in high anger behaviors and an increase in lower level anger behaviors in 3- and 4-year-olds in our tantrum survey (Figure 8.2 in Potegal, 2000). Alternatively, tantrums may never truly disappear but may morph into adult episodes of anger. Adults in the United States, Japan, and Russia report experiencing several episodes of anger per week, which typically last from a few minutes to about half an hour or, in more recent sociological surveys, up to an hour or more (Potegal, 2010; maybe longer in Romania: Kassinove & Broll-Barone, 2012). Although women (more than men) may cry when angry (Vingerhoets & Scheirs, 2000) adult episodes of anger are not typically thought of as associated with sadness. That is, the developmental changes include a major reduction in accompanying distress. But, the reduction may not be complete. Anger experiences facilitated facial expressions of sadness in 8- to 12-year-olds (Blumberg & Izard, 1991), while anger is often commingled with sadness in adults in Western societies (Scherer & Tannenbaum, 1986; Wickless & Kirsch, 1988) and in other cultures (Russell, 1991). Anecdotal inquiry suggests that some people’s episodes of anger may end with discernable feelings of remorse, guilt, and/or other emotions not unrelated to sadness as well as sadness itself. Some events that provoke adult anger may also elicit sadness, but the sadness may be masked until the anger has subsided, much like the situation with anger and reconciliation in children’s tantrums. Consider your own experiences of anger, dear reader, how often do they end with a tinge of sadness?
Tantrums in the Brain
A Conjecture About Lateralization of Tantrum Emotions
The apparent independence of tantrum anger and distress may take origin in separate specializations of the left cerebral hemisphere for anger and the right hemisphere for sadness and related emotions. There is evidence for greater left frontal activation associated with both state and/or trait anger in infants (Dawson, 1994; c.f. Baving, Laucht, & Schmidt, 2000) and adults (e.g., Harmon-Jones et al., 2010; Jaworska et al., 2013; Wang et al., 2016). Left hemisphere involvement is clearest for anger that is implicitly or explicitly allowed expression (i.e., that involves (p. 124) approach). Left hemisphere substrates for anger expressed in reactive aggression include the insula (Dambacher et al., 2014). Accordingly, left (but not right) frontal activity induced by transcranial direct current stimulation increases anger-related aggression (Hortensius, Schutter, & Harmon-Jones, 2011). When anger is associated with withdrawal, like running away in a tantrum, the right hemisphere becomes more active (Harmon-Jones et al., 2010).
Switching attention to that hemisphere, several lines of evidence suggest that relative right frontal activation is associated with a predominance of negative emotions that are most similar to the distress component of tantrums. Thus, stroke in left frontal cortex and/or basal ganglia may be acutely followed by depression (Robinson & Jorge, 2015; Shi, Yang, Zeng, & Wu, 2017), which has been interpreted to mean that the greater, unbalanced influence of the intact right hemisphere may predispose these individuals to emotional reactions including sadness. Such injury-related results have been disputed but are supported by studies of neurologically intact individuals, including children, in whom greater electroencephalographic (EEG) activation in right than left hemisphere is associated with sadness (Buss et al., 2003; Davidson & Slagter, 2000). In these studies, brain activation is indicated by EEG desynchronization, which is reciprocally related to EEG power. The right hemisphere has been specifically implicated in the motor act of crying (Parvizi et al., 2009; Wortzel et al., 2008).
Both hemisphere-emotion relationships were directly captured in a pilot study with 10 tantrum-prone and 11 non–tantrum-prone 4-year-olds whose resting EEG was recorded in one session and whose responses to anger-provoking (e.g., mild restraint) and sadness-provoking (e.g., disappointing prize) situations were behaviorally tested on a second occasion (Gagne, Van Hulle, Aksan, Essex, & Goldsmith, 2011). Right frontal activation was significantly associated with sad facial expressions across the groups. Left posterior temporal activation correlated with both parent-reported anger generally and with angry facial expressions in the testing situation; activation at this temporal site also differentiated the two groups (Figure 4.1 in Potegal & Stemmler, 2010). These results are consistent with evidence for simultaneous right ear advantage for anger detection and left ear advantage for sadness detection in dichotic listening studies in adults (Gadea, Espert, Salvador, & Marti-Bonmati, 2011).
Side and Sequence
Pulling together the various neurological bits and pieces, per Potegal and Stemmler (2010) and Potegal (2012), it may be that anger-related activity triggered in left temporal cortex is transmitted rostrally to orbitofrontal cortex (OFC) along the same pathways that seizures propagate from temporal to frontal lobe (Arain et al., 2016). Behaviors associated with OF “hypermotor” seizures resemble motor components of a tantrum (absent the corresponding emotional experience) with early autonomic activation (mostly flushing, as in tantrums) and vocalization (as in shouting and screaming) followed by bipedal movements (p. 125) (as in kicking, Alqadi, Sankaraneni, Thome, & Kotagal, 2016; Wong et al., 2010). Subcortically directed signals originating in left OFC may disinhibit anger-related behaviors while callosal transmission to right frontal cortex activates distress-related feelings and behavior (Schutter & Harmon-Jones, 2013).
Potegal (2012) proposed that OFC normally exerts inhibitory control over impulses to anger and aggression generated in the temporal lobe. As noted earlier, temper loss is a defining feature of ODD, so Fahim, Fiori, Evans, and Pérusse’s (2012) finding of a significant increase of gray matter density in left temporal cortex, together with a reduction in left OFC in 8-year-olds with ODD is quite consistent with the conjecture about emotion lateralization and within-hemisphere transmission in tantrums. OF cortex also processes effort/reinforcement contingencies, and it could be that the apparent emotional/energetic cost of tantrums does not fully register in immature OFC under conditions of high arousal. Perhaps the typical cessation of tantrums around 4 or 5 years results from an increasing inhibitory efficacy of OFC while their persistence in ODD and other conditions is associated with a developmental failure to increase such efficacy.
There are, of course, nonlateralized explanations for how the brain simultaneously maintains the opposing tendencies of anger, involving approach, and sadness, involving withdrawal (e.g., Petrican, Saverino, Rosenbaum, & Grady, 2015). One of these is the striking difference in the neural networks associated with anger, which are seemingly the most extensive and interconnected, versus those associated with sadness, which are the sparsest and least interconnected (Wager et al., 2015). Might tantrums involve the simultaneous activation of the dorsal anterior cingulate within the anger network and the rostral, precallosal cingulate within the sadness network?
Role(s) of Cingulate Cortex
The dorsal anterior cingulate cortex is also active in adult anger (e.g., Denson, Pedersen, Ronquillo, & Nandy, 2009), as well as in impulsivity and frustration. A specific role for the cingulate in tantrum circuitry is suggested by the reportedly intense tantrums of adults with seizures originating in this locus (Mazars, 1970) and recent findings of altered cingulate function and/or connections in disruptive children (Gavita, Capris, Bolno, & David, 2012) and, more specifically, those with severe tantrums (Roy et al., 2017). Loud vocalizations are a primary component of tantrums (Green et al., 2011), and cingulate control of vocalization, including crying, is well established (Holstege & Subramanian, 2016; Newman, 2007). As it does for other types of vocalizations, the cingulate likely generates tantrum vocalizations through a descending series of subcortical circuits, including those in hypothalamus (as suggested by dacrystic crying seizures associated with hypothalamic hamartomas) [Moise, Leary, Morgan, Papanastassiou, & Szabó, 2017]) and periaqueductal gray caudally to an inferred central pattern generator for crying in the basal pons (Wang et al., 2016). This description fits a tidy neurological scheme for control of emotion responses (Lauterbach, Cummings, (p. 126) & Kuppuswamy,2013), but it must be noted that the organization of circuitry for crying based on localization of rare dacrystic seizures is speculative at present (Moise et al., 2017).
A Neurodevelopmental Program for Tantrums?
Do transition events, if and when they occur, represent the emergence of a neurodevelopmental program for tantrums that comes on line, ready to be activated, with the blossoming of a final synapse that completes a neural circuit for tantrum behaviors around 18 months? Arguments for why such a program might have evolved are presented next.
Biological Roots of Tantrums: Intergenerational Conflict, Weaning, and the Terrible Twos
Evolution of Tantrums
Evidence that tantrums are quite common, if not ubiquitous, across cultures and that tantrum behaviors may be generated by dedicated brain circuits suggests that they may have deep evolutionary roots. Infant and juvenile monkeys (Li, Ren, Li, Zhu, & Li, 2013; Weaver & de Waal, 2003) and apes (Slocombe, Townsend, & Zuberbühler., 2009; van Noordwijk & van Schaik, 2005) engage in behaviors recognizable as tantrums to human observers. Rhesus macaque and baboon infants emit specific scream calls after being rejected by their mothers (Wallez & Vauclair, 2012); chimpanzees distinguish tantrum screams from other types of screams (Slocombe et al., 2009). Howler monkey tantrums include screaming, body jerking, and biting the mother (Pavé, Kowalewski, Peker, & Zunino, 2010); baboon infants repeatedly drop to a prone position on the ground during their tantrums (Wallez & Vauclair, 2012). Tantrums in Yunnan snub-nosed monkeys (Li et al., 2013) and baboons (Altmann, 1983) first occur and/or become particularly intense when infants are 5 months old, preceding increased maternal rejection 1–3 months later when the mothers resume sexual activity. The mother’s resumption of sexual activity, changes in her behavior during pregnancy, and the birth of new siblings trigger tantrums in the young of other primates species as well (Pavé, Kowalewski, Zunino, & Giraudo, 2015). Importantly, mothers in various monkey species, as well as chimpanzees often alter their ongoing behavior in response to their infant’s tantrum (Nishida, 1990).
Tantrums have been observed in laboratory-reared juvenile chimps that had no opportunity to learn how to tantrum by watching others (Hebb, 1945). Similar stories are told about singleton human children whose very first observed tantrum had the classic elements of crying, falling to the floor, and kicking. Are the formats for tantrum behaviors genetically programed? Trivers (1974, 1985) proposed that tantrums may be a solution to a basic intergenerational conflict between offspring who benefit by maintaining parental nurturance for as long as possible and (p. 127) their mothers, whose inclusive fitness would be better served, after a point, by spending less time with this infant and more time producing the next one. Primate youngsters tantrum when they cannot keep up with their mother’s travels, just as children in human forager groups do. But for both their progeny and ours, being denied the opportunity to suckle for milk is a major psychological and physiological stressor and a trigger for tantrums (Mandalaywala, Higham, Heistermann, Parker, & Maestripieri, 2014). In Trivers’s view, weaning was a crux of the intergenerational conflict in response to which tantrums evolved as the infants’ negotiating tool. However, tantrums appear to be optional, at least for some primate young. Thus, only 3 of 10 chacma baboon infants, closely observed in the wild for the first 2 years of life, including the period of weaning, engaged in tantrums (Barrett, Peter Henzi, & Lycett, 2006). Two of these did so only when their attempts at independent feeding were thwarted by a seasonal reduction in forageable food. Five other closely observed baboon infants living in a different, nutritionally richer natural environment were never observed to tantrum. Genetically programmed as their motor routines may be, tantrums are optional, not obligatory, for nonhuman primate infants. As Maestripieri (2002) argued, tantrums are an infant’s means of negotiating when necessary; tantrum insistence and persistence is a marker of infant need.
The Human Condition
The extensive recent or contemporary evidence that weaning triggers children’s tantrums comes from different places and cultures (e.g., African and South American forager groups; Fouts et al., 2005, Hill & Hurtado, 1996, Shostak, 1981), a pre-war Japanese village (Embree, 1939/2002), and so forth. For children in many nonindustrialized cultures weaning occurs during the mother’s pregnancy with the next child. Thus, the weaning crisis is subsequently exacerbated by family attention shifting from the child to the new baby. This can also be the point at which mother and older sibs begin to refuse to carry the child around, so she or he must keep up with family moves and activities on his or her own. These combined stressors can trigger a period of frequent tantrums that occur with little or no additional provocation (e.g., Maretski & Maretski, 1963; Shostak, 1981).
Historically, 2 years has been the age of weaning in Western culture. Although there is considerable variation, the typical age at the end of weaning in nonindustrialized societies is about 2.5 years (Tsutaya & Yoneda, 2015). Biochemical analyses of ancient teeth yields dates of 2–4 years for the weaning period in forager groups during the middle Neolithic in Sweden (Howcraft, Eriksson, & Lidén, 2014) and in the same age range for even earlier periods in central California (Eerkens & Bartelink, 2013) and at the Matjes River Rock Shelter, South Africa (Clayton, Sealy, & Pfeiffer, 2006). A disposition to tantrum which develops at an age when weaning occurred over most of human history might well reflect an evolutionary strategy to retain parental attention if not nurturance.
(p. 128) Screaming, hitting, and biting during tantrums may be angry/aggressive behaviors inherited from our hominid ancestry. We humans are inventive in aggression as in other domains. At 28 months, my daughter added head butts to her aggression repertoire (they hurt!). Although she was still in the throes of tantrums at the time, she never head-butted during a tantrum. If there is a neurodevelopmental program for tantrums, does it just include a restricted range of behaviors that developed in evolution?
The distress component of tantrums likely has evolutionary roots as well. In general, young children’s distress can elicit the parental succor and nurturance that is necessary for their survival. Among the specific distress behaviors, a noticeable lowering of head and/or body, which we labeled as Down, can be interpreted as a signal of submission. Ethologically, lowering the body is a sign of submission in many animal species including humans (e.g., in the subordinate postures assumed by adults; Burgoon & Dunbar, 2006; Tiedens & Fragale, 2003) and in the supine posture forced on the loser of play-fighting matches among human children in many cultures (Eibl-Eibesfeldt, 1989). Submission is also associated with the expression of infantile behaviors, which is the impression conveyed by a regression to the prone or supine crying and flailing of infancy.
End-of-tantrum reconciliation may not have evolved solely, or perhaps at all, in the context of parent–child conflicts that give rise to tantrums. Post-conflict reconciliation has been documented in species as diverse as ravens, domestic goats and wild sheep, spotted hyenas, and bottle-nosed dolphins, as well as in more than 24 species of nonhuman primates, in all major taxa within the primate order including prosimians, monkeys, apes, and humans. Different reconciliation styles among primate infants have been identified (Arnold & Aureli, 2007).
Thus, a neurodevelopmental program for tantrum behaviors and patterns may have evolved and be genetically programmed in contemporary humans. But, even if such a program exists, it need not be activated. A comparison between ethnically similar but culturally different Bofi farmers and foragers of the Congo Basin rain forest in the Central African Republic is instructive (Fouts et al., 2005). Among the farmers, mothers wean their children onto specially prepared rice gruels between 18 and 27 months of age by bandaging their nipples or painting them with red fingernail polish to imitate a wound and telling their children they can no longer nurse due to injury. The children respond to the abrupt weaning with “high levels of fussing and crying.” In contrast, mothers among the foragers allow their children to self-wean, which they do between 36 and 53 months without a fuss. Differences in weaning practices are embedded in broader contrasts in cultural schemas and social relations. The more general observation, that at least 15% of children pass through early developmental challenges without tantrums, shows that, for humans as for other primates, tantrums are an option, not a necessity. Various biological, environmental, and family factors, and their interactions, make the expression of these emotions and their concomitant behaviors more or (p. 129) less likely. In psychopathology, the neurodevelopmental program is more easily triggered and excessively activated, generating tantrums that are insistent and persistent.
Tantrums and Psychopathology, Neurodevelopmental and Central Nervous System Disorders
When Tantrums Mean Trouble
Older surveys of 1- to 3-year-olds found prevalence rates of 5–7% for tantrums that were frequent, severe, or found troublesome by parents (Earls, 1980; Needlman, Stevenson, & Zuckerman, 1991; Richman, Stevenson, & Graham, 1975). According to Goldson and Reynolds (2011) 5–20% of children have tantrums that are severe, frequent, and/or disruptive. Severe tantrums at age 3 predict adult antisocial behavior (Stevenson & Goodman, 2001). Complementary to the normal dropoff in tantrum prevalence at ages 5–7, tantrums persisting to ages 8–10 predict antisocial behavior in later childhood (Stoolmiller, 2001) and adulthood (Caspi, Elder, & Bem, 1987).
How Frequent Is Too Frequent, How Long Is Too Long?
Belden et al. (2008) proposed that more than 5 tantrums a day outside the home and/or more than 10 tantrums a day at home on multiple days were indicators for psychiatric referral of 3- to 6-year-olds. These are above the 95th percentile rates tentatively estimated earlier. Roy et al. (2013) found a mean of 3 tantrums per week in 5- to 9-year-olds whose tantrums were disruptive.
Many children have the occasional long tantrum; but how long is too long on average? Varley and Smith (2003) noted that anxiety-triggered tantrums are often “extraordinarily long,” while Carlson et al. (2009) recorded the mean duration of “rages” on a child psychiatry unit as 51 min. Cut points for duration at 5 min (Wakschlag et al., 2012), 15 min (Goldson & Reynolds, 2011), and 25 min (Belden et al., 2008) have been suggested. Given the mean tantrum durations reported for normal older children, a 25-minute cut point might be appropriate. In view of the developmental trends, both frequency and duration cut points need to be adjusted for age. At all ages, excessive aggression to property, to others, or to the self are likely indicators of externalizing disorder (Belden et al., 2008; Wakschlag et al., 2012).
Tantrums and Psychopathology
Tantrums are among the common reasons for a child’s referral to a psychiatric facility (Sobel, Roberts, Rayfield, Barnard, & Rapoff, 2001); for example, 40% of 58 consecutive referrals of very young children with developmental delays to a mental health clinic were for tantrums (Fox, Keller, Grede, & Bartosz, 2007); 55% of 130 consecutive admissions to a child psychiatry unit were for “rages” (p. 130) (Carlson et al., 2009). Conversely, almost half the children being treated in an outpatient clinic had severe tantrums (Carlson et al., 2016).
As these observations suggest, tantrums are associated with psychopathology (e.g., they are routinely included on checklists of externalizing disorders like ODD). However, they are also associated with internalizing disorder. That is, children who tantrum excessively are at increased risk for anxiety and depression (Mireault & Trahan, 2007; Roy et al., 2013; Wakschlag et al., 2015). Conversely, depressed or anxious children are prone to excessive tantrums. “A child with [social anxiety disorder] SAD may have a temper tantrum to avoid school; a child with [obsessive compulsive disorder] OCD may have a tantrum to avoid wearing clothes with buttons; a child with phobia to dogs may have a tantrum to avoid a park” (Varley & Smith, 2003, p. 1110).
The parents of 18 internalizing, 17 externalizing, and 16 typically developing 4-year-olds, selected on the basis of Achenbach Child Behavior Checklist (CBCL) scores, recorded every tantrum their child had on tantrum calendars over 27–81 days (Potegal, 2005). The two psychopathological groups had significantly longer and more frequent tantrums than did the typical group (p <.02). There were no differences in tantrum characteristics between the two extreme groups. Calendar-derived tantrum frequency and duration were significantly correlated with Total CBCL score and Emotional Reactivity Scale scores. So, both externalizing and internalizing disorders may be associated with increased tantrum frequency, duration, and severity. The finding that a lower ratio of tantrum anger to distress may specifically reflect childhood anxiety (Potegal et al., 2009) suggests that the anger-distress model may help elucidate issues of psychopathology.
By the late 1990s and early 2000s, children with juvenile bipolar disorder had developed a reputation for very intense and prolonged “rages” (Carlson & Glovinsky, 2009). This led to the mistaken belief that severe tantrums were diagnostic of bipolar disorder and to inappropriate treatment of children having such tantrums with antipsychotic medication (Leibenluft, 2011). This is, among other things, a base rate issue, with bipolar prevalence estimated at 3% or less (Van Meter, Moreira, & Youngstrom, 2011) while tantrums are much more common. Although severe tantrums are among the symptoms reported for youth later diagnosed with bipolar disorder (Hernandez, Marangoni, Grant, Estrada, & Faedda, 2017), most children with severe tantrums do not have bipolar disorder (Carlson et al., 2009; Grimmer, Hohmann, & Poustka, 2014; Roy et al., 2013).
Tantrums as Symptoms of Disrupted Mood
DMDD was introduced in the DSM-5 in 2013 to characterize more adequately the condition of children who were previously being misdiagnosed with pediatric bipolar disorder. DMDD is defined as chronic irritability interspersed with at least three intense tantrums a week in children at least 6 years old. This age minimum (p. 131) is consistent with the normal dropoff in tantrum prevalence. DMDD prevalence in the middle childhood population is 8–9% (Dougherty et al., 2014; Mayes, Waxmonsky, Calhoun, & Bixler, 2016) while 45% of 4- to 5-year-olds admitted to an early childhood psychiatric day treatment program exhibited DMDD symptoms (Martin et al., 2017). This prevalence in clinic is consistent with the percentages of admissions-with-tantrums noted earlier. Patients with DMDD had a median of 4 tantrums per week according to a chart review (Tufan et al., 2016). DMDD is associated with multiple comorbidities including ODD, anxiety, and depression (Freeman, Youngstrom, Youngstrom, & Findling, 2016, Mayes et al., 2016) and predicts subsequent psychopathology (Dougherty, Barrios, Carlson, & Klein, 2017).
Other Conditions Associated with Tantrums
Tantrums have also been reported in association with a range of neurological and medical conditions too numerous for citation. Noted briefly here are a few conditions for which research results relate to some of the issues raised earlier.
Children on the autism spectrum (ASD) are well known for tantrums. Three- to 16-year-old children with ASD scored higher than those with attention deficit/hyperactivity disorder (ADHD) on both anger (“Easily becomes angry,” “Destroys ones property”) and distress (Crying, tearful, and weepy”) aspects of tantrum behavior (Goldin, Matson, Tureck, Cervantes, & Jang, 2013). More severe ASD symptomatology is associated with more intense tantrums, especially with more distress behaviors (Konst, Matson, & Turygin, 2013a; 2013b). Anecdotal accounts from people who have worked with these children suggest that the comfort-seeking/reconciliation component of distress may be reduced or absent. While not surprising, such accounts remain to be validated by empirical observation.
The angry outbursts in Tourette syndrome reviewed in “Fits, Tantrums, and Rages in TS and Related Disorders” (Budman, Rosen, & Shad, 2015) do bear some similarity to tantrums as described; for example, a childhood onset of “episodes occur most frequently at home and are most commonly directed toward a parent, usually the child’s mother although less frequently toward siblings, pets, and property” (p. 275). However, these events are not reported to contain a distress component but may feature elements of anxiety or panic. If so, and then despite the paper’s title, these episodes may resemble anger attacks associated with adult depression and other psychopathologies (Painuly, Gover, Gupta, & Mattoo, 2011) more than childhood tantrums.
The developmental cessation of tantrums is delayed in individuals with Down syndrome, fragile X, Williams, and Prader-Willi syndromes (Rice et al., 2015). Tantrums are common in Prader-Willi syndrome, in which a failure of satiety mechanisms leads to hyperphagia and excessive demands for food, which is the motivation for some of their tantrums (Tunniclffe et al., 2010). Neurochemically, individuals with Prader-Willi syndrome who tantrum frequently have shown reduced cerebral γ-aminobutyric acid (GABA), which was associated with their (p. 132) outbursts (Rice, 2016). Parallel conclusions about the inhibitory role of GABA in aggression have been drawn from studies in rodents (e.g., Potegal, 1986; Potegal, Yoburn, & Glusman, 1983).
Tantrums may also be exacerbated in childhood medical conditions that result in discomfort or pain (e.g., reflux, headache, dental caries, and so forth). Thus, when a child’s tantrums are not ameliorated through appropriate behavioral intervention, a medical workup might be advisable.
Importantly, perhaps 10–30% of children in Western cultures never have tantrums or at least events that are intense and prolonged enough to be recognized by adults as tantrums. These non-tantrumers are typically described as temperamentally pleasant and easy going. Is the absence of childhood tantrums a marker of current, and perhaps future, emotional stability? Comparisons of temperament between children in the same families who do and do not tantrum would be of interest in this regard. Tantrums are sometimes a symptom of disorder; they are always a phenomenon of early childhood affect, exploration of which will increase our knowledge of processes and events in children’s emotional lives. Hopefully, this chapter may intrigue a reader or two into generating testable hypotheses in formal study designs to elucidate such processes and events.
For information about “tantrums” in their native language, I thank Nazan Aksan, Mohamad Anwar, Drishadwati Bargi, Nadya Clayton, Chuqing Dong, Erdenetsetseg Dorjgotov, Jie He, Sungok Hong, Zoltán Kövecses, Erik McDonald, Larisa Polynskaya, Uplabdhi Scott, Yana Taets, and Luba Wiese among others; they bear no responsibility for the conclusions drawn from the information they kindly provided.
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