tantrums: not just the terrible twos rachel j. valleley, ph.d. assistant professor, munroe-meyer...
TRANSCRIPT
Tantrums: Not Just the Terrible Twos
Rachel J. Valleley, Ph.D.
Assistant Professor, Munroe-Meyer Institute
Licensed Psychologist
Behavioral Health Concerns in Primary Care
Behavior problems ranked #1 by pediatricians (Arnorfer et al., 1999)
Established link between medical and behavioral concerns (Wertleib et al., 1988)
ADHD evaluations increased three-fold in 1990s (Hoagwood et al.,2000)
In 24% of pediatric visits, behavior concern raised. Increases visit length from 11 to 17 minutes
Tantrums
Duration can be seconds to minutes typically Most common for ages 2 to 4 but can occur
at any age (80% of children)
Tantrums
Why do kids throw tantrums?– Frustrated with a task
Trying to develop independence skills, do things on their own
– To get what they want Tangible Parental attention
– To get out of what they don’t want to do
When to be concerned about temper tantrums?
Lasts for long periods of time Involves aggression Occurs frequently Causes distress to family Interferes with daily living
Oppositional Defiant Disorder
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures that does not involve major antisocial violations.
Frequently gets confused with ADHD. Can have both.
Oppositional Defiant Disorder: DSM-IV Criteria
Loses temper Argues with adults Actively defiant or refuses to comply with adults’ requests or
rules Deliberately annoys people Blames others for his or her mistakes or misbehavior Touchy or easily annoyed by others Angry and resentful Spiteful or vindictive
Oppositional Defiant Disorder
Most common diagnosis given in our clinics in pediatric practices.
Can be setting specific Occurring more with parents or other caregiver Difficulties with sleeping, eating, and toileting. Increased risk for other problems
Dropping out, Abuse
Coercive Family Process
Oppositional Defiant Disorder
Misconception that “He’ll grow out of it”. – 67% at age 3 still have problems at age 9
Often leads to Conduct Disorders or antisocial personality disorder.
Effective early intervention leads to long-term positive outcomes
No medication that will effectively work
Oppositional Defiant Disorder
Empirically-Supported Treatments:
– Parent Training: Forehand & McMahon
– Parent-Child Interaction Therapy: Hembree-Kigin & McNeil
Treatment for ODD: Parent Training
1. Encourage/increase appropriate behavior Differential Attention
Child’s Game
Sticker Charts/Grab Bag Prizes
Treatment for ODD: Parent Training
Differential attention– Attend to average behavior– Praise exceptional behavior
Treatment for ODD: Parent Training
The Child’s Game:A relationship-building activity that makes children
want to earn your POSITIVE attention.
Treatment for ODD: Parent Training
DO– Describe– Reflect– Imitate– Praise– Touch
DON’T– Command– Reprimand– Question
Treatment for ODD: Parent Training
Sticker Charts/Grab Bag Prizes: – Bedtime routine, morning routine– Daily for overall behavior– Magic circle chart– Dot-to-dot’s– Grab Bag Prizes
Treatment for ODD: Parent Training
What is time out?
– Time out is the removal of attention, tangibles, or anything interesting to the child for a brief amount of time.
Treatment for ODD: Parent Training
Common mistakes parents make– Talking to child in time out– Having time out be too long– Not having child do what is expected following the
time out– Not expecting extinction burst
Treatment for ODD: Parent Training
Common uses for time-out
– Noncompliance – Aggression– Rule infractions– Tantrums
Summary
Tantrums can be very distressing to parents Good idea to assess for tantrums, noncompliance
– How often?– How long?– What causes tantrums?– How does the parent respond?– Is this behavior distressing to the parent?
If problem exists, good idea to refer to behavior therapist
Early intervention results in best outcomes