Temper tantrums in healthy versus depressed and disruptive preschoolers: defining tantrum behaviors associated with clinical problems.

OBJECTIVE: To investigate whether differences in the tantrum behaviors of healthy versus mood and disruptive disordered preschoolers can be detected.

STUDY DESIGN: Caregivers of 279 preschool children (3 to 6 years old) completed the Preschool-Age Psychiatric Assessment (Egger HL, Ascher B, Angold A. Preschool Age Psychiatric Assessment (PAPA): version1.1. Durham, NC: Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center; 1999), which was used to determine preschoolers' diagnostic classification and to measure tantrum behaviors. Preschoolers were placed in 1 of 4 diagnostic groups, healthy, pure depressed, pure disruptive, and comorbid depressed/disruptive, on the basis of the application of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition algorithms. Parametric and non-parametric analyses were used to examine characteristics of children's tantrums: intensity, frequency, context, and recovery ability.

RESULTS: Disruptive preschoolers displayed violence during tantrums significantly more often than the depressed and healthy groups. The disruptive group had significantly more tantrums at school/daycare than the depressed and healthy groups. The disruptive group had a more difficult time recovering from tantrums than healthy preschoolers. In addition, depressed preschoolers were more aggressive toward objects and other people than healthy children. Finally, depressed preschoolers displayed significantly more self-harmful tantrum behaviors than preschoolers in the healthy and disruptive groups.

CONCLUSION: These findings provide preliminary guidelines to parents, teachers, and practitioners in identifying tantrum behaviors that may be markers of a psychiatric disorder and therefore require mental health referral.