Upfront

Parents may think a 3-year-old's frequent tantrums are normal in early childhood. But new research shows daily tantrums only occur in less than 10 percent of preschool children, regardless of gender, socioeconomic status or ethnicity (Journal of Child Psychology and Psychiatry, 2012). Researchers say daily tantrums could be signs of looming behavioral problems that should be addressed before they escalate.

In the National Institute of Mental Health-funded study, Northwestern University Feinberg School of Medicine researchers surveyed nearly 1,500 parents of preschoolers ages 3 to 5 about their children's behavior over the past month. While 84 percent of parents reported their children occasionally had tantrums, only 9 percent reported daily outbursts.

These findings are derived from a new tool, the Multidimensional Assessment of Preschool Disruptive Behavior, designed to provide parents and health-care professionals with a developmentally specified empirical knowledge base for when to worry about young children's misbehavior and to enable early identification and treatment of emerging mental health problems, says the study's lead author, Lauren Wakschlag, PhD, professor and vice chair of medical social sciences at Feinberg.

The study's results will allow researchers to rate children along a dimension of behavior from typical to atypical rather than focusing only on extreme behavior, such as traditional categorical mental health diagnoses. Having a continuum will allow mental health professionals to intervene before there is a serious problem or watch and wait if a child is in the middle range. It also provides a barometer for determining whether a child is improving.

Wakschlag, University of Connecticut developmental epidemiologist Margaret Briggs-Gowan, PhD, Northwestern University developmental neuroscientist Joel Voss, PhD, and other collaborators are also working to link tantrum patterns to their underlying brain structures, using brain-imaging techniques such as event-related potential and fMRI. Their eventual goal is to widely disseminate the study's questionnaire in a brief computerized form for parents to fill out in pediatric waiting rooms, with the computer generating immediate feedback to pediatricians before a child's appointment.

"There's been a real danger of preschool children with normal misbehavior being mislabeled and over-treated with medication," Wakschlag says, adding that it's also common for pediatricians to suggest watching and waiting because they don't have clear guidelines for when something is amiss behaviorally. "That's why it's so crucial to have tools that precisely identify when worry is warranted."

—Amy Novotney