Kids' tantrums as disorder concern docs

By Rachael Rettner, MyHealthNewsDaily 
Some doctors are concerned about new guidelines allowing children who frequently throw tantrums to be diagnosed with a mental health disorder, arguing that normal kids can act this way, but also caution that such behavior could signal several other mental health conditions.

The new diagnosis of "disruptive mood dysregulation disorder" will appear in the updated version of the psychiatric handbook the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), to be published in May. The American Psychiatric Association (APA) approved the final version of the manual on Saturday (Dec. 1).

Although detailed criteria for the diagnosis have not been released, an APA statement said the condition could apply to "children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year." The addition is intended in part to reduce the number of kids misdiagnosed as having bipolar disorder, who may be treated with powerful drugs.

But some experts say the new condition was added to the manual too soon.

"I think it's premature to put it in as a full diagnosis," said Dr. David Axelson, an associate professor of psychiatry at University of Pittsburgh School of Medicine, referring the condition's inclusion in the front of the manual with other well-accepted diagnoses, rather than in the appendix, which includes provisional diagnoses requiring further research.

Some are concerned that a label of disruptive mood dysregulation disorder would turn normal kid behavior into a medical condition. [ See Typical Toddler Behavior, or ADHD? 10 Ways to Tell.]

But Axelson said the diagnosis requires severe and frequent behavior problems, and if properly applied, kids without a true mental condition would be unlikely to be diagnosed. In addition to frequent outbursts for more than a year, children need to be at least 6, but younger than teenagers, to be given the diagnosis, according to early versions of the criteria.

However, parents might overestimate how often their child behaves badly, because they focus on recent outbursts, and inaccurately reporting behavior to a mental health professional may lead to mislabeling, Axelson said.

And although the diagnosis is intended to reduce misdiagnoses of childhood bipolar disorder and subsequent overtreatment, it could end up putting more kids on medication, Axelson said. That's because there are no treatments for the new condition, so doctors will likely prescribe medications for explosive anger — which are the same medications for bipolar disorder.

Research suggests the new disorder could become common among kids already diagnosed with other mental conditions. A study by Axelson and colleagues, published in October, found that more than half of children with oppositional defiant disorder or conduct disorder met criteria for the condition, and it was hard to distinguish the disorders from each other.

Also, the diagnosis was not particularly stable, meaning it was not repeatedly diagnosed in the same children over multiple evaluations. This counters the idea that the new condition is chronic, Axelson said.

Some are concerned doctors will diagnose children with disruptive mood dysregulation disorder without checking for other mental problems.

"Explosive behavior is like a high fever," said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine in New York. "If you have it, you know there's something wrong, but it doesn't tell you what's wrong."

The focus could be taken off other conditions that can lead to explosive behavior, including attention deficit hyperactivity disorder, obsessive compulsive disorder and autism, Carlson said.

But others see the move as positive. Lauren Wakschlag, a clinical psychologist at Northwestern University Feinberg School of Medicine who studies children's tantrums, said there are advantages to having this diagnosis for children's mood problems.

Traditionally, these children may have been given any of several diagnoses, because tantrum behaviors overlap with those of other conditions.

"Here, you have a unifying way to diagnose symptoms," Wakschlag said.

However, because children's behavior can vary substantially between ages 6 and the teen years, more research is needed to determine how to diagnose children of particular ages, Wakschlag said.

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When my kids were small I did not allow tantrums! They had to learn to use thier voice to communicate or else they were ignored and put in thier room to annoy themselves. I also set ground rules when out in public that they could not and would not get everything they saw and wanted. After the first few tantrums, I never had a problem. arents nee to grow a pair and remember that you are bigger and smarted than your kids. Meds are the wrong answer to parenting issues.

  • 19 votes
Reply#1 - Tue Dec 4, 2012 3:06 PM EST

Bingo. It's really no more difficult that than. The real problem here is that psychiatrists are generally as looney as their patients and make up ridiculous nonsense like this to justify their own existence and employment. We'd all be better off with a lot fewer psychiatrists and their polysyllabic justifications for disinterested and dysfunctional child rearing.

  • 6 votes
#1.1 - Wed Dec 5, 2012 12:55 AM EST
Reply

Poor parenting? Environment? Poverty? Abuse? Other childhood trauma? Or maybe just a kid who wants what he wants and has no limits or consistency? Might some of these be relevant to having excessive tantrums or is everything a mental illness? It's called childhood. Yeesh.

  • 15 votes
Reply#2 - Tue Dec 4, 2012 3:17 PM EST

SSS, couldn't have said it better myself. Years ago I work in the toy department for a store in our area. Can't tell you how many times I heard mom say, go play in the toy dept. and I'll come get you when I'm ready to go. The toy dept. IS NOT your baby sitter. Kids get back there and tear up every thing and then the workers have to clean up after them. Saw way too many temper tantrums because some child couldn't get the toy they wanted and mom didn't have the gumption enough to stand up to the little terror.

  • 5 votes
#2.1 - Tue Dec 4, 2012 5:07 PM EST
Reply

I never had a problem with tantrums as a kid. My parents had a surprisingly easy and effective technique:

1) Kid has tantrum.

2) Dad slaps kid so hard, the next thing he remembers is laying on ground.

3) Mom picks kid up off ground, and gives them some juice.

Too bad that is considered child abuse now.

My kids were in elementary school with a few boys who threw tantrums at least once a week, occasionally having to be dragged out kicking and screaming by cops or EMTs. All of those kids had ignorant futile parenting. The best was a neighbor boy who got expelled, the family looked "nice", the father was always at work (to get away from the mom) - and the mother was a not so closet alcoholic. There was no comprehensive parenting, and they have one of the most screwed up kids in town.

  • 6 votes
Reply#3 - Tue Dec 4, 2012 3:57 PM EST

Slap him hard enough to knock him/ger the ground, to bad that is considered child abuse?

I think you are the one that needs to be medicated.

You can spank your child a stern spanking without using the full force to knock him into the ground.

  • 4 votes
#3.1 - Tue Dec 4, 2012 4:44 PM EST

Walk, we got the switch and we had to pick it off the tree ourselves. I turned out pretty well adjusted despite the discipline. I had the "white wonder." It was a 2" wide, white leather belt. Most times I didn't even need to use it. My son knew, mom talked twice, period. The first time I explained why I didn't want him to do a certain thing (e.g. don't stick tweezers in an electrical socket, you will get shocked and probably badly.) The second time was a firm warning. If a third "talking" became necessary the belt came out. I can tell you I didn't bring that thing out more than twice. My son learned real quickly that I said what I meant and I meant what I said. He turned out to be an extremely wonderful and caring human being, who will tell anyone who will listen that he is "Moma's boy and proud of it."

Parents need to follow through on what they say they will do. Saw too many parents yelling "don't do that or else" and then they do nothing so the child learns they can get away with whatever and mom/dad won't do a thing.

I'm sure that I will get some negative comments to my post but I didn't warp my child by disciplining him and I can honestly say that I am a better human being even after getting the switch when needed.

  • 7 votes
#3.2 - Tue Dec 4, 2012 5:20 PM EST

WalkWithMeInHell.......excellent post!! I saw tantrums handled the exact same way with perfect results. Now days all kids are 'gifted' and 'special' and (fill in here with any other gaggy adjective) and the parents do nothing but talk talk talk...mommy doesn't like it when you do that...(this to a 2 year old that could care less nor understand what the H... you are talking about.

  • 7 votes
#3.3 - Tue Dec 4, 2012 10:50 PM EST

Ms.C1960, yes, but sadly, nowadays, your son would be in foster care and you would be in a cell.

  • 1 vote
#3.4 - Wed Dec 5, 2012 9:07 AM EST

Exactly 2little2late-7381371 a 2 year old does not "understand" many things, they comprehend things, but are not so good at figuring out consequences, hitting them does not make them understand. You do not teach your child respect by beating them. I respect the hell out of my boss even though I am not the least bit scared that she will hit me. Why not give your kids that same respect. I REFUSE to hit my child then tell them I love them, then explain to them that it's wrong if anyone ever abuses them (besides me)...........talk about confusing. You are teaching our future parents that abuse means love. My children can respect me & our family & our home without being scared.

Everyone wants to say things like "that's what's wrong with the world today, no one hits their kids, my parents hit me, blah blah blah." Well the last time I checked it's YOUR generation that was hit by their parents and you have raised the current generation of young adults. How's that parenting style working out for us now? Who raised these people that everyone is so quick to complain about?

  • 1 vote
#3.5 - Wed Dec 5, 2012 9:43 AM EST

Grendel, sad but true. Big Brother has taken discipline out of the hands of the parents where it belongs. Now don't get me wrong, I never left bruises or injuries on my child. Just spanked him hard enough to get the point across. Thankfully, I had a child that was easy to rear and it was not necessary to pull out the white wonder very often. I never just said "Because I'm the mom and I say so." I always tried to explain why I was saying no. I believe that was what helped with the discipline of my son; he always understood that mom was keeping him safe and that went a long way in helping him understand why I did what I did.

My heart goes out to parents who have stubborn children. My son learned quickly that mom meant what she said. I don't know how I would have handled having children like my brother and I. My mom was a paragon of patience. We fought like cats and dogs. I must say, though, we had our quarrels but we were also disciplined with a strong hand and turned out just fine. Had we not gotten the discipline we did we would have been really bad seeds.

  • 1 vote
#3.6 - Wed Dec 5, 2012 9:59 AM EST
Reply

There's probably a new drug for this "disorder" that begs for a reason to be on the market -- or the re-purposing of an old money-maker whose patent is about to expire, thus effectively renewing the patent. We are turning our children into drug addicts, which is good for Big Pharma's bottom line, but not so good for our culture.

Look at the rampant abuse of the ADHD drugs (which are highly addictive, being basically speed). There are no poor students, just poor teaching styles. No one really benefits here long term from the use of these drugs, except for Big Pharma.

This is a horrifying trend toward a zombified nation of people who are drugged if they exhibit any kind of behavior considered abnormal. It is just a step less drastic than the old Soviet Union that put anyone who disagreed with the government into mental hospitals.

Good parenting means teaching children to control their emotional expression themselves, not drugging them into obedient little androids. Pills are not a substitute for parental love and good parenting skills.

  • 13 votes
Reply#4 - Tue Dec 4, 2012 5:07 PM EST

Becoming, I had a nephew that is the perfect example of what you just posted. Mom was a drop-out mom who couldn't be bothered with the 6 children she birthed. Dad was an alcoholic who dumped the child on gramdmom who was too old to do the job. She took him to the doc and had him put on ritalin simply because he was active and acting out to get his parents attention.

I babysat him when grandma went on vacation for the first week, another aunt babysat him the second week. We both sat him down and explained the rules of our homes, what we expected of him, and let him know that we would not allow his tantrums. The child was a joy to have in both our homes, that is, until grandma came home. He pushed and she gave in. He did show us that he was able to behave without being medicated. This happened during the summer break and both myself and the other aunt decided that we would not give him the meds. Amazingly he controlled himself. Guess it was just because he got the attention he was so desperately craving and didn't get from other care givers in his life.

  • 8 votes
#4.1 - Tue Dec 4, 2012 5:45 PM EST
Reply

When a kid throws their first tantrum, just walk away and completely ignore it. They will learn very quickly that throwing a tantrum is of no use to them if there is zero response from the parent.

  • 10 votes
Reply#5 - Tue Dec 4, 2012 5:12 PM EST

oh puh-leaz. my now 31 year old, successful, engaged to his long time girlfriend, son still throws tantrums (albeit grown-up ones now). they never got him anywhere and they still don't. he just wanted (and still wants) his own way, and the people in his life ignore it. a strong will is not a mental illness.

  • 2 votes
Reply#6 - Tue Dec 4, 2012 6:19 PM EST

These folks in charge of diagnostic labels wanted to keep little kids from getting the diagnosis of Bipolar Disorder that was all in vogue a couple of years back. Big pharma made millions if not more off this diagnosis selling drugs like Rispperdal and Seroquel for "Bipolar Children". I fear this may have backfired just giving the pharmaceutical companies reason to invent new medications for "temper tantrums".

  • 3 votes
Reply#7 - Tue Dec 4, 2012 7:00 PM EST

There is a reason that they want so many young children, preeteens and adolescents to be on medication.

One, it makes for a LOT of money for the drug companies, doctors, schools, etc. Two.....now I could be wrong, but I suspect there is some sort of mind control thing going on here. They want the kids doped up, submissive, and obedient for some reason.

  • 7 votes
Reply#8 - Tue Dec 4, 2012 7:33 PM EST

If a child really needs med's for a mental disorder,tantrums not being a mental disorder,then they should be under the care of a pediatrician.It is rare for children to suffer from mental health issues unless they are or have been abused or mental health issues run in their family.Medicating kids just so that they don't throw tantrums or are hyperactive is abusive in my book.

  • 5 votes
Reply#9 - Tue Dec 4, 2012 7:53 PM EST

children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.

When I was a kid, this disorder was cured with a swat to the behind. Now they want to drug the kids.

  • 7 votes
Reply#10 - Tue Dec 4, 2012 9:23 PM EST

children who exhibit persistent irritability and frequent episodes of behavior outbursts three or more times a week for more than a year.

I don't agree that this constitutes a disorder. They just described every 2 and 3 year old on the planet. When you have a toddler, you quickly learn to expect at least one minor meltdown every day. If you handle it correctly with consistent, gentle but firm discipline and follow-through, you end up with a very sweet and obedient 5 year old!

  • 3 votes
#10.1 - Wed Dec 5, 2012 10:56 AM EST
Reply

Temper tantrum is usually a learned behavior,if it gets the kid what it wants the behavior is reinforced and the kid will do it again. Best not to reinforce/reward it when it first appears.

BTW I believe there really is something that was called "Asperger's Syndrome" and I do not think it is the same thing as autism.

  • 2 votes
Reply#11 - Tue Dec 4, 2012 10:01 PM EST

When growing up, we were NEVER allowed to act out with tantrums....ever. We were taught to be kind, gentle, and respectful. I really, REALLY don't see that taught today with the horrid behavior I see children display everywhere. Where and who are these ridiculous parents? Why is this allowed at any level? tantrums are a learned, allowed behavior to get what they want, because it works for them. I think the parents need to grow up and get some balls. I am so glad I don't have children!!!!!!!!!!!

  • 6 votes
Reply#12 - Tue Dec 4, 2012 11:03 PM EST

I agree that excessive tantrums can possibly be a symptom of something else going on, but shouldn't be considered a disorder by itself.

  • 3 votes
Reply#13 - Tue Dec 4, 2012 11:05 PM EST

Brat Syndrome

  • 3 votes
Reply#14 - Wed Dec 5, 2012 6:42 AM EST

Sooooo they are removing Aspergers Syndrom leaving millions of kids and their families helpless but they are allowing "tantrums" to now be included in the DMV??????? What a bunch pf quacks!!!

  • 2 votes
Reply#15 - Wed Dec 5, 2012 6:52 AM EST

Spanking anyone? Will solve many problems. I also recommend cold showers. :)

  • 2 votes
Reply#16 - Wed Dec 5, 2012 8:20 AM EST

I would beg to differ, I'd say it creates A LOT more problems than it solves.......

  • 1 vote
#16.1 - Wed Dec 5, 2012 9:45 AM EST

domewars, i am in your corner. in fact standing in the corner was my favorite behavior modification technique when my children were small. spankings were rare, but i did that sometimes too. the kids are all grown up, turned out great, and they still like me.

  • 1 vote
#16.2 - Wed Dec 5, 2012 5:43 PM EST

Cold showers are painful.

Besides thats the sort of BS they used to use in the 50s to stop "negative urges".......and now you want to apply it to tantrums? All that is going to do is cause your child to fear you, and become terrified of making a mistake.

    #16.3 - Thu Dec 6, 2012 12:50 AM EST
    Reply

    Temper tantrums are learned. Children learn from an early age that parents without discipline can be manipulated. This should be stopped at an early age. Children that master the tantrum learn that they can get whatever they want by yelling, screaming and in some cases threatening. Many of these children grow up to be successful democrats in congress. The behavior has worked well for them there.

    • 3 votes
    Reply#17 - Wed Dec 5, 2012 9:47 AM EST

    well no, i don't think that is correct. small children throw tantrums without ever having seen one before. sure, they may learn that they can get what they want by having one; but the ability to throw one is an instinct.

      #17.1 - Wed Dec 5, 2012 5:46 PM EST
      Reply

      I worked in mental health, and from my reading of the diagnostic manual, you cannot diagnose anyone under the age of 18 with bipolar disorder. Am I correct? Anyone know? You can diagnose them with "something like" bipolar disorder, but insurance companies won't pay to treat that. I was told that I needed to diagnose children with a "real" disorder so we could provide services for them, which I suspected meant, "get more money." It's a double edged sword. Many of these children need supports because they lack them at home and in their community. But slapping them with a diagnosis just so you can provide services, in the end, is a true disservice.

      • 2 votes
      Reply#18 - Wed Dec 5, 2012 9:52 AM EST

      And this is why all parents must be tested to see if they are actually up to the job of "Parenting". Place all children on permanent birth control (that takes care of big pharma making all the money) until they are ready to be married. Six months of mandatory counseling prior to marriage. All parties must be employed. Three months emergency fund. A roof over your head. And neither party requiring entitlement programs. I really hate lazy parenting, can you tell?

      • 2 votes
      Reply#19 - Wed Dec 5, 2012 10:18 AM EST

      First of all they're not talking about regular tantrums which are normal for a small child. They're talking about a child in which you could discipline them over and over and over and over for the same things and no positive result occurs. And if it's a symptom of another problem, like say autism, you simply cannot deal with it in the same way you would handle a non-autistic child. Ever try to feed an autistic kid who has tantrums because they don't want to eat ? They'll sit there and scream for over 45 mins. just to take a single bite of food. Autism isn't the only disorder that involves extreme tantrums. That's just a simple example. Depends on all of the other problems which present themselves as to how it's handled.

      The article suggested that there are no psychological based treatments for explosive behavior and that simply is not true. Try The Explosive Child by Dr Ross Greene. It does work until they get older and adapt to it. I have never seen personally an explosive child which did not have it as a symptom of another problem. I went to Dr Greene's seminar. I was the only parent there out of couple of hundred people that was there just as a parent. He didn't even know how to address my questions because he was so used to just talking with other professionals. What does that say ?

      They're just trying to name problems. If you don't name a problem you can't deal with it. How is the question. My concern is that this particular naming will lead to neglecting other real issues.

      I think they ought to have a Nanny program on TV specifically for children with legitimate mental health issues as opposed to just normal constructive disciplines so that people can see the differences between the two and collaborate on real solutions for alot of times desperate families.

      • 1 vote
      Reply#20 - Wed Dec 5, 2012 10:22 AM EST

      AGREED. I have a niece who is severely autistic. Her behavior requires a vastly different approach. I fear that lumping behavioral symptoms and making them a new diagnosis will cloud judgment and worsen treatment options for those children who legitimately need medical help.

        #20.1 - Wed Dec 5, 2012 11:02 AM EST
        Reply

        As many others here have indicated, most temper tantrums are the result of parenting that has no consistency and no consequences for the child. You HAVE to mean what you say, and say what you mean. If you are at the playground and your child starts misbehaving and you say "If you don't stop acting up right now we are never coming back here again" you'd better mean it and you'd better follow through and never go back to that playground with your child again if they don't stop. If your child is misbehaving outside while playing with friends and you say "If you don't stop that behavior you are going inside at once" you need to mean it and follow through and bring your child inside immediately if they don't stop. It's that simple; they will quickly learn and pretty soon you won't even have to say anything. Too many parents are not consistent and/or deliver no consequences at all; thus the child's temper tantrums are a successful tool for that child and they have no reason to stop doing it.

        • 6 votes
        Reply#21 - Wed Dec 5, 2012 10:36 AM EST

        hockymom1111, well said. I used to tell my son when he acted up "You are going to get attention but it will not be the kind you want." He learned not to try tantrums as a means of getting what he wanted. A child who does not have disabilities that hinder their coping abilities can and will learn that mom/dad mean what they say if you follow through. Say what you mean and mean what you say. It does work. And it pays to start at an early age. I'm not saying it is ever too late to teach a child, it is just easier if they learn from the beginning and haven't had years of manipuliting parents through the use of tantrums.

        • 1 vote
        #21.1 - Wed Dec 5, 2012 5:51 PM EST
        Reply

        When a child has a psychological or physical illness that prevents self-control, it's obvious. With a little time and attention, it's easy to tell the difference between a child trying to manipulate the parents, and a child who is in distress because of a condition that needs treatment. It happens, but it is extremely rare. Not every kid that collapses in deafening paroxysms in walmart has a disorder. Most behavioral problems can be dealt with through consistent discipline and follow-through.

        • 3 votes
        Reply#22 - Wed Dec 5, 2012 10:54 AM EST

        It just occurred to me also that preventing outbursts through medication might do more harm than good for very small children - I think tantrums are a natural part of toddler development. It's valuable for them to learn from their own experience how to regulate their emotions. With proper guidance, they learn how to regulate, channel, and deal with their feelings without violence or screaming. To put them on medication in an effort to bypass their natural development would be disastrous - akin to surgically extracting their baby teeth and putting in implants...

        If you're talking about an 8 or 9 year old throwing tantrums, I'd look first at the parents for problems, not medication. If you have a disabled child or one who legitimately needs medical attention, that is a whole different story. Their outbursts should not be put into the same category as a normal child's outbursts.

        • 3 votes
        Reply#23 - Wed Dec 5, 2012 11:00 AM EST

        I am a 33 year old woman with 3 small children. I am part of this generation that loves to "talk it out" with kids. I do not agree with that. I also do not agree with most forms of physical punishment. All three of my children have had tantrums at one point or another and I have responded the exact same way and have gotten the same positive result: ignore the child. Do not give them what they want. If they are old enough to understand, explain an immediate consequence that will occur if they do not stop (leaving the location, losing a toy, etc) It works. My older 2 outgrew their tantrum stage in a few short months because of this. They know not to even make whining noises with me or something negative will happen. My two year old still throws some fits, but they are short lived and do not give her what she wants, so they are becoming shorter and shorter. Parents need to remember that THEY are in charge, not the kids.

        • 1 vote
        Reply#24 - Wed Dec 5, 2012 11:01 AM EST

        Oh, and I thought it very amusing that there are several ads for pharmaceuticals on this page.....

        • 1 vote
        Reply#25 - Wed Dec 5, 2012 11:15 AM EST
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