Are your Toddler’s Tantrums Actually ADHD?

Introduction

The toddler years – a time of discovery, giggles, and yes, tantrums. If you are a parent or a caregiver, you're likely familiar with the whirlwind of emotions that can accompany your little one's journey through the toddler stage. Temper tantrums manifest as brief episodes characterised by intense, unpleasant, and occasionally aggressive behaviours triggered by frustration or anger (Daniels, Mandleco and Luthy, 2012). The exhibited behaviours during tantrums tend to be disproportionate to the given situation. In toddlers, these behaviours commonly involve crying, screaming, going limp, flailing, hitting, throwing objects, breath-holding, pushing, or biting (Potegal and Davidson, 2003). On an average, tantrums occur once a day, with a typical duration of around three minutes for children aged 1year 5 months and may last up to the age of 5 years. (Potegal and Davidson, 2003).

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Understanding Toddler Behaviour 

Understanding toddler behaviour is akin to deciphering a unique language, where every gesture, expression, and action carries meaning in the fascinating journey of their development. It is a captivating stage characterised by boundless curiosity, endless energy, and a myriad of behaviours that can leave parents both delighted and, at times, perplexed. 

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Developmental Milestones

Developmental milestones for toddlers encompass a range of physical, cognitive, social, and emotional achievements that mark their growth and progress. In the realm of motor skills, toddlers typically refine both gross and fine motor abilities, transitioning from early steps and climbs to more coordinated movements (Carson et al., 2016). Language development observes toddlers expanding their vocabulary, combining words into phrases, and engaging in gestures for communication (Carson et al., 2016).

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Cognitively, toddlers become avid explorers, displaying curiosity about their environment and exhibiting rudimentary problem-solving skills (Carson et al., 2016). Social and emotional milestones involve the emergence of self-awareness, recognition of emotions, and the development of attachments to caregivers (Edwards and Denham, 2018). Emotional regulation takes its first steps, although tantrums may still be part of their emotional expression. These milestones collectively reflect the dynamic and diverse journey of toddlerhood, where each achievement contributes to their evolving sense of self and interaction with the world.

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Why Tantrums?  

Toddlers experience tantrums as a natural expression of their emotions and developing sense of self. These emotional outbursts are commonly triggered by a combination of factors such as communication challenges, the desire for independence, frustration, fatigue, hunger, sensory overload, and a need for attention (Einon and Potegal, 2013). Toddlers are navigating the complexities of the world around them, and tantrums serve as a way for them to cope with overwhelming feelings, test boundaries, and communicate their needs and emotions while their verbal skills are still developing (Einon and Potegal, 2013).

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Signs of ADHD in Toddlers 

Attention-Deficit/Hyperactivity Disorder (ADHD) in children is characterised by persistent patterns of inattention, hyperactivity, and impulsivity that go beyond typical developmental behaviours for their age. These aspects may manifest as follows 

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Inattention: Problems concentrating, remembering tasks, or adhering to deadlines can create stress and overwhelm children with ADHD. These difficulties may contribute to heightened emotional responses, potentially leadingto tantrums.

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Hyperactivity: Children with ADHD may struggle to stay still, remain quiet, or tolerate boredom due to hyperactivity. Without an outlet for their energy, they might become impatient or frustrated.

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Impulsivity: Difficulty controlling impulses may lead to challenges with waiting for turns and therefore result in frequently interrupting others.

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Difference between Typical and ADHD-related Tantrums 

All toddlers go through the process of learning to regulate their emotions. However, toddlers with ADHD face challenges in managing their emotions, resulting in more frequent and intense tantrums compared to their peers. These tantrums can occur three or more times a week, lasting for 15 minutes or more, with the child struggling to calm down independently (Shaw et al., 2014).

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Aggressive behaviour is notably more prevalent in toddlers with ADHD, occurring at least once or twice a week—far more frequently than in children without ADHD, who may experience such behaviours only one to two times a month (Ercan et al., 2014). Additionally, toddlers with ADHD may show a tendency to give up easily or react with frustration, including screaming, when corrected or assisted. In some cases, they might engage in self-harming behaviours, such as banging their head, a behaviour less commonly observed in toddlers without ADHD (Cook, 2005).

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Strategies for Parents

Managing tantrums in toddlers with ADHD requires a tailored and patient approach. Here are some strategies that parents can consider:

Consistent Routine and Communication: Establish and maintain a consistent daily routine to provide structure and predictability, which can help reduce anxiety and frustration (Mautone, Lefler, and Power, 2011). Use simple and clear language to communicate expectations and transitions. Visual aids or a visual schedule can be helpful for some toddlers with ADHD (Perrin, 2001).

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Positive Reinforcement: Reinforcing positive behaviours through praise and rewards has been found to be an effective strategy for children with ADHD.  Encourage and acknowledge the child when they manage their emotions effectively.

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Time-out Strategy: Implementing a time-out can be an effective strategy for mitigating negative behaviours in children with ADHD (Fabiano et al., 2004). Clearly communicate to the child that persistent negative behaviour will result in a time-out, and assure them that the time-out will conclude once their behaviour improves. Prior to employing a time-out, discuss with your child the specific behaviours that may lead to time-outs, the designated time-out location, and the purpose and process of time-outs.

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Establish Predictable Consequences: Clearly communicate and enforce consequences for specific behaviours. Consistency is key in helping toddlers understand expectations.

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Seeking Professional Guidance 

According to guidelines, diagnosing ADHD typically takes place between the age of 4 to 18 years. Diagnosing ADHD in children under the age of 4 presents challenges due to the rapid and frequent changes observed in younger children. Nevertheless, dealing with tantrums can be exasperating for parents.

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Therefore, you may book an appointment  with Rocket health’s qualified therapists to address patterns of your child’s behaviour, parenting strategies, techniques to soothe tantrums and most importantly, self care. Depending on the severity of your child’s symptoms, the therapist may recommend consultation with a psychiatrist to explore potential medication options; alternatively, you may also consult your paediatrician. 

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References

Cook, M. N. (2005). The disruptive or ADHD child: What to do when kids won't sit still and be quiet. Focus on Exceptional Children, 37(7).

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Daniels, E., Mandleco, B., & Luthy, K. E. (2012). Assessment, management, and prevention of childhood temper tantrums. Journal of the American Academy of Nurse Practitioners, 24(10), 569-573.

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Ercan, E., Ercan, E. S., Atılgan, H., Başay, B. K., Uysal, T., İnci, S. B., & Ardıç, Ü. A. (2014). Predicting aggression in children with ADHD. Child and adolescent psychiatry and mental health, 8(1), 1-10.

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Edwards, N. M., & Denham, S. (2018). Early social-emotional development. Baltimore, MA: Brookes Publishing.

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Einon, D., & Potegal, M. (2013). Temper tantrums in young children. In The dynamics of aggression (pp. 157-194). Psychology Press.

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Mautone, J. A., Lefler, E. K., & Power, T. J. (2011). Promoting family and school success for children with ADHD: Strengthening relationships while building skills. Theory Into Practice, 50(1), 43-51.

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McClain, M. B., Mills, A. M. H., & Murphy, L. E. (2017). Inattention and hyperactivity/impulsivity among children with attention-deficit/hyperactivity-disorder, autism spectrum disorder, and intellectual disability. Research in developmental disabilities, 70, 175-184.

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Potegal, M., & Davidson, R. J. (2003). Temper tantrums in young children: 1. Behavioral composition. Journal of Developmental & Behavioral Pediatrics, 24(3), 140-147.

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Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276-293.