October 7, 2022 • 19 mins
Most children, at some point, will throw a temper tantrum. But if these outbursts happen frequently, or at an inappropriate age, parents will want to investigate to find the underlying cause. Diagnosis, says Dr. Saltz, can lead to successful treatment.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm Dr
Gale Salts. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Children can become emotionally
overwhelmed with anger, frustration, anxiety, sadness, and one thing that
can result is a temper tantrum. Tantrums are an explosion
(00:49):
or meltdown where your child loses emotional control and cries
or screams uncontrollably, which may or may not be accompanied
by physically melted down, for example, laying on the floor, flailing,
hitting things, growing things. During a tantrum, it can be
(01:09):
hard to reach your child and help them calm down,
which makes tantrums a difficult thing for parents to deal with. Today,
I am answering a question from a mom whose child
is throwing frequent tantrums. From a psychiatric perspective, Disruptive mood
disregulation disorder or d m d D is a childhood
(01:34):
condition of extreme irritability, anger, and frequent intense temper outbursts.
D m d D symptoms go beyond being a moody child,
because children experience severe impairment that requires clinical attention. D
(01:54):
m d D is a fairly new diagnosis. It has
appeared for the first time in the Diagnostic and Statistical
Manual of Mental Disorders number five, which was published in
two thousand and thirteen. The symptoms of d m d
D typically big in before the age of ten, but
the diagnosis is not given to children under the age
(02:18):
of six or adolescence over the age of eighteen. A
child with d m d D experiences irritable or angry
mood most of the day, nearly every day, severe temper
outbursts that are either verbal and or behavioral at an
(02:38):
average of three or more times per week that are
out of keeping with the situation and the child's developmental level,
and trouble functioning due to irritability in more than one
place so for example, home and school or with peers.
(02:59):
To be a diagnosed US with d m d D,
a child must have these symptoms ongoingly for twelve months
or more. So this is not a diagnosis if your
kid is going through a bad period for a couple
of weeks and has a bunch of tantrums. This is
an ongoing condition. It's not clear how widespread d m
(03:22):
d D is in the general population, but it is
common among children who go to pediatric mental health clinics.
Researchers are trying to figure out what are the risk
factors and brain mechanisms of this disorder. It is different
from other disorders that can look very similar, for example,
(03:44):
bipolar disorder or autism spectrum disorder oppositional defiant disorder, but
kids with d m d D can have certain disorders
at the same time that they have d m d D,
and that includes a tennin deficit hyperactivity disorder, depression, and anxiety.
(04:06):
Kids with d m d D also have a bigger
chance of developing serious depression or anxiety as adults, which
is why it's important to spot the issue and treat
it in childhood. The exact causes are not clear, but
there are a number of factors that are believed to
play a role, such as genetics. It does seem to
(04:28):
run in families, the temperament of the child, like what
they were like from the very beginning, and also other
mental health conditions that can affect the child, so for example,
depression and anxiety, and childhood experiences like early trauma. The
disorder appears to be more common during early childhood and
(04:51):
is likely to co occur with other psychiatric conditions depression,
oppositional defined disorder, and as I mentioned earlier, a child's
temperament maybe a rispector for developing it as well. Some
traits in the temperament that are commonly seen in kids
with this disorder include moodiness, anxiousness, irritability, and difficult behavior.
(05:17):
That is not to say that if your child is moody, anxious, irritable,
and difficult sometimes that they have d m d D.
It just means if this is the kind of kid
they are from temperament from the beginning, it increases the risk.
Other rispectors include low parental support, parental hostility and substance use,
(05:41):
a lot of family conflicts, and having disciplinary problems at school.
How can you tell if your child is just having
some temper tantrums or has d m d D. This
diagnosis has numerous components and they should meet them all.
So severe or current temper tantrums outbursts that involve yelling, pushing, hitting,
(06:08):
or destroying property. Next outbursts that occur three or more
times a week. You could still be diagnosed with d
M d D if you don't have three every single week,
But basically maybe you have a week where you have
them every day and then the following week you only
have one, but on average three times or more a
(06:31):
week is required for the diagnosis. Tantrums that are out
of proportion to the situation. So, for example, you might
expect a young child to get angry when they don't
get a toy they want, but a child with d
M d D will act out with physical aggression and
verbal outbursts that are really excessive and intense for the situation,
(06:57):
tantrums that are inappropriate for the child's age level. So,
for example, while you might not be surprised if a
very young child has a tantrum about not getting a
toy and falling to the floor and crying and screaming,
but it's not something that you would expect from a
twelve year old. Irritable and angry moods between tantrums, so
(07:21):
in between these bouts of intense emotional outbursts, the kid
with d M d D will have moods that are
ongoingly angry and highly irritable. And these moods are present
most of the time, and other people notice them at home,
at school, or peers, and symptoms happen in these multiple settings,
(07:44):
so the temperate outbursts don't just occur in one place,
like only at school or only at home. It's characterized
by having tantrums in at least two settings of school, home,
or with peers. How can I help with Dr? GAYL.
Salts will be back after this short break, so let's
(08:14):
get to my listeners question and see how can I help,
dear Dr Saltz. My son is ten, and he has
always been a sensitive child and as a result kind
of a difficult child. Many things bother him and he
gets easily upset. He has sometimes had a temper tantrum
(08:36):
when he gets really upset, and I have chopped these
up to you know, your typical kid temper tantrum, which
I assumed he would go out of. But now he
is ten and the other day he threw a doozy screaming,
punching the wall, cursing, and just completely over the top,
(08:57):
all because I said he couldn't play a video game.
This is starting to feel not so normal to me,
and I would think that by the age of ten,
he wouldn't be doing this anymore. What's more, his teacher
called home to tell me he really lost it at
school when some other kid told him he couldn't join
(09:19):
a game outside. Now, I totally understood his hurt feelings,
and it really wasn't nice of this other kid. But
according to the teacher, he screamed and he turned beat red.
He called this kid some horrific words and basically totally
lost control. The teacher was very uncomfortable when I talked
(09:44):
to him about it. He just says, once he gets
really upset and angry, he just can't control himself, and
he does feel guilt afterwards, but it doesn't seem to
be stopping it from happening again. I notice, generally speaking,
he is increasingly grouchy, short tempered, nervous, and I'm getting
(10:08):
concerned there is something going on here that I might
be missing. What can I do to check if my
son is doing okay or if there is a problem,
And what kind of problem could this be. It is
a little unusual to be tantraming at age ten and
you are noting the issue both at home and at school,
(10:30):
and it sounds like it is a problem enough at
school that the teacher is calling you, meaning it's interfering
with his functioning at school. This should be a prompt
to investigate what might be going on. Having him see
a school psychologist or an outside child psychologist of your
(10:51):
choosing or an outside child psychiatrist can help you figure
out what is happening and will likely be a relief
to him too. It's possible something is happening in his
life that you don't know about that is causing him
great distress, anxiety, or depression, and that this is what
(11:11):
you are seeing. It's possible, though, that he has emerging
symptoms of another issue commonly spotted at this age, like
attention deficit hyperactivity disorder, or an anxiety disorder, a mood disorder,
a learning issue, or even obsessive compulsive disorder. These disorders
(11:33):
do often emerge in around this age, and they can
cause great consternation for your child, and he could be
losing it all the time because he's so disaded by
symptoms that you don't know a lot about. But an
interview with a professional can really help narrow this down
(11:54):
because Another possibility is that he has an impulse control
problem combined with difficulty regulating his mood, and together this
may be what's called disruptive mood disregulation disorder. If he
meets criteria for this disorder, treatment can help him. Treatment
(12:16):
will be treatment of the symptoms themselves, his mood, his anxiety,
his loss of control. These treatments may range from various
types of therapies to particular medications if they're needed. A
therapist can help you and that will help him by
(12:36):
giving you ways to manage his symptoms at home as well.
So it's important to find a mental health professional that
treats children, and one who is familiar and takes care
of d m d D. Once his school understands what
is happening and how, they too can be told methods
(12:57):
of how to deal with an outpurse from him. Everyone,
but most of all, your son will feel better, which
will also decrease the number of outbursts. I hope that
was helpful. D m d D is a new diagnosis, Therefore,
(13:18):
treatment is often based on what has been helpful for
other disorders that share the symptoms of irritability and temper tantrums.
These disorders include attention deficit hyperactivity disorder, anxiety disorders, oppositional
defiant disorder, and major depressive disorder. If your child has
(13:41):
d m d D, it is important to seek treatment
because it can impair a child's quality of life and
school performance. It can disrupt relationships with their family and
with their peers. Children with d m d D may
find it hard to participate in activities or make friends.
It also increases the risk of developing depression or anxiety
(14:05):
disorders later in adulthood. While researchers are still determining which
treatments work best, two major types of treatment are currently
used to treat d m d D symptoms. They are
medication and they are psychological treatments. Psychological treatments should be
(14:26):
considered first, with medication added later if necessary, and psychological
treatments can be provided along with medication from the beginning
if this case is very severe, so it's important for
parents or caregivers to work closely with a doctor to
make a treatment decision that is best for their child.
(14:50):
When it comes to psychological treatments, we are talking about psychotherapy.
Cognitive behavioral therapy, a type of psychotherapy, is commonly used
treat children and teens deal with thoughts and feelings that
contribute to their feeling depressed or anxious. This technique can
be used to teach children to more effectively regulate their
(15:13):
mood and to increase their tolerance for frustration and the
therapy also teaches coping skills for regulating anger and ways
to identify and relabel the distorted thoughts that contribute to
having an outburst. Those are important skills when treating d
(15:35):
m d D. Also in psychotherapy is frankly parent training,
which aims to help parents interact with a child in
a way that will reduce aggression and irritable behavior and
improve the parent child relationship. Multiple studies show that such
interventions can really be effective. Specifically, parent training teach his
(16:00):
parents more effective ways to respond to irritable behavior, like
anticipating events that might lead to a child having a
temper outburst and working ahead to avert the outburst. Training
also focuses on the importance of predictability in terms of
your schedule with your child, being consistent so they know
(16:23):
what's coming and how to respond, and rewarding positive behavior.
Also in the psychotherapy realm is computer based training for
d m d D. Evidence suggests that irritable young people
with d m d D may be prone to misperceiving
ambiguous facial expressions and seeing them as angry, and there
(16:49):
is preliminary evidence that computer based training designed to correct
this problem can help young people with d m d
D or even just with severe irritability. Sometimes it is
true that medications may be needed in addition to psychotherapy.
One such medication maybe stimulants that are commonly used to treat,
(17:13):
for example, attention deficit hyperactivity disorder. There is evidence that
in children with irritability and a d h D, stimulant
medication decreases the irritability. One must pick and choose carefully
who one gives stimulants too, because of course it can
(17:34):
have particular side effects, so again this must be carefully
decided with a doctor. Another class of drug is antidepressants,
which are also used to treat irritability and mood problems
associated with d m d D. Testing whether these medications
are effective for this problem is being studied. It is
(17:59):
important to know that antidepressants are safe and effective for
many people, but because they can carry the risk of
suicidal thoughts and behavior in children and teens. A black
box warning, the most serious type of warning that a
prescription can carry, has been added to these types of
medications to alert parents and patients to this potential risk,
(18:22):
and for this reason, a child taking an antidepressant should
be monitored closely, especially when they are first taking the medication,
which is the time that they are at risk. Last
is a category of drug called atypical antipsychotics, which may
be prescribed for children with very severe temper outbursts that
(18:45):
involve physical aggression towards people or property. There are two
f d A approved medications that are used for the
treatment of irritability associated with autism and are times used
to treat d m d D. They do have side effects,
including concerns about suicidal ideation, weight gain, metabolic abnormalities, sedation,
(19:14):
movement disorders, hormone changes. So again this is reserved only
for severe cases where in fact the child is at
risk and other people are at risk of harm, and
so this again must be a decision one makes very
carefully with a doctor. Do you have a problem I
(19:36):
can help with? If so, email me yet how can
I help? At Seneca women dot Com, all centers remain
anonymous and listen every Friday too. How can I help
with me Dr Gail's Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm Dr
Gale Salts. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Children can become emotionally
overwhelmed with anger, frustration, anxiety, sadness, and one thing that
can result is a temper tantrum. Tantrums are an explosion
(00:49):
or meltdown where your child loses emotional control and cries
or screams uncontrollably, which may or may not be accompanied
by physically melted down, for example, laying on the floor, flailing,
hitting things, growing things. During a tantrum, it can be
(01:09):
hard to reach your child and help them calm down,
which makes tantrums a difficult thing for parents to deal with. Today,
I am answering a question from a mom whose child
is throwing frequent tantrums. From a psychiatric perspective, Disruptive mood
disregulation disorder or d m d D is a childhood
(01:34):
condition of extreme irritability, anger, and frequent intense temper outbursts.
D m d D symptoms go beyond being a moody child,
because children experience severe impairment that requires clinical attention. D
(01:54):
m d D is a fairly new diagnosis. It has
appeared for the first time in the Diagnostic and Statistical
Manual of Mental Disorders number five, which was published in
two thousand and thirteen. The symptoms of d m d
D typically big in before the age of ten, but
the diagnosis is not given to children under the age
(02:18):
of six or adolescence over the age of eighteen. A
child with d m d D experiences irritable or angry
mood most of the day, nearly every day, severe temper
outbursts that are either verbal and or behavioral at an
(02:38):
average of three or more times per week that are
out of keeping with the situation and the child's developmental level,
and trouble functioning due to irritability in more than one
place so for example, home and school or with peers.
(02:59):
To be a diagnosed US with d m d D,
a child must have these symptoms ongoingly for twelve months
or more. So this is not a diagnosis if your
kid is going through a bad period for a couple
of weeks and has a bunch of tantrums. This is
an ongoing condition. It's not clear how widespread d m
(03:22):
d D is in the general population, but it is
common among children who go to pediatric mental health clinics.
Researchers are trying to figure out what are the risk
factors and brain mechanisms of this disorder. It is different
from other disorders that can look very similar, for example,
(03:44):
bipolar disorder or autism spectrum disorder oppositional defiant disorder, but
kids with d m d D can have certain disorders
at the same time that they have d m d D,
and that includes a tennin deficit hyperactivity disorder, depression, and anxiety.
(04:06):
Kids with d m d D also have a bigger
chance of developing serious depression or anxiety as adults, which
is why it's important to spot the issue and treat
it in childhood. The exact causes are not clear, but
there are a number of factors that are believed to
play a role, such as genetics. It does seem to
(04:28):
run in families, the temperament of the child, like what
they were like from the very beginning, and also other
mental health conditions that can affect the child, so for example,
depression and anxiety, and childhood experiences like early trauma. The
disorder appears to be more common during early childhood and
(04:51):
is likely to co occur with other psychiatric conditions depression,
oppositional defined disorder, and as I mentioned earlier, a child's
temperament maybe a rispector for developing it as well. Some
traits in the temperament that are commonly seen in kids
with this disorder include moodiness, anxiousness, irritability, and difficult behavior.
(05:17):
That is not to say that if your child is moody, anxious, irritable,
and difficult sometimes that they have d m d D.
It just means if this is the kind of kid
they are from temperament from the beginning, it increases the risk.
Other rispectors include low parental support, parental hostility and substance use,
(05:41):
a lot of family conflicts, and having disciplinary problems at school.
How can you tell if your child is just having
some temper tantrums or has d m d D. This
diagnosis has numerous components and they should meet them all.
So severe or current temper tantrums outbursts that involve yelling, pushing, hitting,
(06:08):
or destroying property. Next outbursts that occur three or more
times a week. You could still be diagnosed with d
M d D if you don't have three every single week,
But basically maybe you have a week where you have
them every day and then the following week you only
have one, but on average three times or more a
(06:31):
week is required for the diagnosis. Tantrums that are out
of proportion to the situation. So, for example, you might
expect a young child to get angry when they don't
get a toy they want, but a child with d
M d D will act out with physical aggression and
verbal outbursts that are really excessive and intense for the situation,
(06:57):
tantrums that are inappropriate for the child's age level. So,
for example, while you might not be surprised if a
very young child has a tantrum about not getting a
toy and falling to the floor and crying and screaming,
but it's not something that you would expect from a
twelve year old. Irritable and angry moods between tantrums, so
(07:21):
in between these bouts of intense emotional outbursts, the kid
with d M d D will have moods that are
ongoingly angry and highly irritable. And these moods are present
most of the time, and other people notice them at home,
at school, or peers, and symptoms happen in these multiple settings,
(07:44):
so the temperate outbursts don't just occur in one place,
like only at school or only at home. It's characterized
by having tantrums in at least two settings of school, home,
or with peers. How can I help with Dr? GAYL.
Salts will be back after this short break, so let's
(08:14):
get to my listeners question and see how can I help,
dear Dr Saltz. My son is ten, and he has
always been a sensitive child and as a result kind
of a difficult child. Many things bother him and he
gets easily upset. He has sometimes had a temper tantrum
(08:36):
when he gets really upset, and I have chopped these
up to you know, your typical kid temper tantrum, which
I assumed he would go out of. But now he
is ten and the other day he threw a doozy screaming,
punching the wall, cursing, and just completely over the top,
(08:57):
all because I said he couldn't play a video game.
This is starting to feel not so normal to me,
and I would think that by the age of ten,
he wouldn't be doing this anymore. What's more, his teacher
called home to tell me he really lost it at
school when some other kid told him he couldn't join
(09:19):
a game outside. Now, I totally understood his hurt feelings,
and it really wasn't nice of this other kid. But
according to the teacher, he screamed and he turned beat red.
He called this kid some horrific words and basically totally
lost control. The teacher was very uncomfortable when I talked
(09:44):
to him about it. He just says, once he gets
really upset and angry, he just can't control himself, and
he does feel guilt afterwards, but it doesn't seem to
be stopping it from happening again. I notice, generally speaking,
he is increasingly grouchy, short tempered, nervous, and I'm getting
(10:08):
concerned there is something going on here that I might
be missing. What can I do to check if my
son is doing okay or if there is a problem,
And what kind of problem could this be. It is
a little unusual to be tantraming at age ten and
you are noting the issue both at home and at school,
(10:30):
and it sounds like it is a problem enough at
school that the teacher is calling you, meaning it's interfering
with his functioning at school. This should be a prompt
to investigate what might be going on. Having him see
a school psychologist or an outside child psychologist of your
(10:51):
choosing or an outside child psychiatrist can help you figure
out what is happening and will likely be a relief
to him too. It's possible something is happening in his
life that you don't know about that is causing him
great distress, anxiety, or depression, and that this is what
(11:11):
you are seeing. It's possible, though, that he has emerging
symptoms of another issue commonly spotted at this age, like
attention deficit hyperactivity disorder, or an anxiety disorder, a mood disorder,
a learning issue, or even obsessive compulsive disorder. These disorders
(11:33):
do often emerge in around this age, and they can
cause great consternation for your child, and he could be
losing it all the time because he's so disaded by
symptoms that you don't know a lot about. But an
interview with a professional can really help narrow this down
(11:54):
because Another possibility is that he has an impulse control
problem combined with difficulty regulating his mood, and together this
may be what's called disruptive mood disregulation disorder. If he
meets criteria for this disorder, treatment can help him. Treatment
(12:16):
will be treatment of the symptoms themselves, his mood, his anxiety,
his loss of control. These treatments may range from various
types of therapies to particular medications if they're needed. A
therapist can help you and that will help him by
(12:36):
giving you ways to manage his symptoms at home as well.
So it's important to find a mental health professional that
treats children, and one who is familiar and takes care
of d m d D. Once his school understands what
is happening and how, they too can be told methods
(12:57):
of how to deal with an outpurse from him. Everyone,
but most of all, your son will feel better, which
will also decrease the number of outbursts. I hope that
was helpful. D m d D is a new diagnosis, Therefore,
(13:18):
treatment is often based on what has been helpful for
other disorders that share the symptoms of irritability and temper tantrums.
These disorders include attention deficit hyperactivity disorder, anxiety disorders, oppositional
defiant disorder, and major depressive disorder. If your child has
(13:41):
d m d D, it is important to seek treatment
because it can impair a child's quality of life and
school performance. It can disrupt relationships with their family and
with their peers. Children with d m d D may
find it hard to participate in activities or make friends.
It also increases the risk of developing depression or anxiety
(14:05):
disorders later in adulthood. While researchers are still determining which
treatments work best, two major types of treatment are currently
used to treat d m d D symptoms. They are
medication and they are psychological treatments. Psychological treatments should be
(14:26):
considered first, with medication added later if necessary, and psychological
treatments can be provided along with medication from the beginning
if this case is very severe, so it's important for
parents or caregivers to work closely with a doctor to
make a treatment decision that is best for their child.
(14:50):
When it comes to psychological treatments, we are talking about psychotherapy.
Cognitive behavioral therapy, a type of psychotherapy, is commonly used
treat children and teens deal with thoughts and feelings that
contribute to their feeling depressed or anxious. This technique can
be used to teach children to more effectively regulate their
(15:13):
mood and to increase their tolerance for frustration and the
therapy also teaches coping skills for regulating anger and ways
to identify and relabel the distorted thoughts that contribute to
having an outburst. Those are important skills when treating d
(15:35):
m d D. Also in psychotherapy is frankly parent training,
which aims to help parents interact with a child in
a way that will reduce aggression and irritable behavior and
improve the parent child relationship. Multiple studies show that such
interventions can really be effective. Specifically, parent training teach his
(16:00):
parents more effective ways to respond to irritable behavior, like
anticipating events that might lead to a child having a
temper outburst and working ahead to avert the outburst. Training
also focuses on the importance of predictability in terms of
your schedule with your child, being consistent so they know
(16:23):
what's coming and how to respond, and rewarding positive behavior.
Also in the psychotherapy realm is computer based training for
d m d D. Evidence suggests that irritable young people
with d m d D may be prone to misperceiving
ambiguous facial expressions and seeing them as angry, and there
(16:49):
is preliminary evidence that computer based training designed to correct
this problem can help young people with d m d
D or even just with severe irritability. Sometimes it is
true that medications may be needed in addition to psychotherapy.
One such medication maybe stimulants that are commonly used to treat,
(17:13):
for example, attention deficit hyperactivity disorder. There is evidence that
in children with irritability and a d h D, stimulant
medication decreases the irritability. One must pick and choose carefully
who one gives stimulants too, because of course it can
(17:34):
have particular side effects, so again this must be carefully
decided with a doctor. Another class of drug is antidepressants,
which are also used to treat irritability and mood problems
associated with d m d D. Testing whether these medications
are effective for this problem is being studied. It is
(17:59):
important to know that antidepressants are safe and effective for
many people, but because they can carry the risk of
suicidal thoughts and behavior in children and teens. A black
box warning, the most serious type of warning that a
prescription can carry, has been added to these types of
medications to alert parents and patients to this potential risk,
(18:22):
and for this reason, a child taking an antidepressant should
be monitored closely, especially when they are first taking the medication,
which is the time that they are at risk. Last
is a category of drug called atypical antipsychotics, which may
be prescribed for children with very severe temper outbursts that
(18:45):
involve physical aggression towards people or property. There are two
f d A approved medications that are used for the
treatment of irritability associated with autism and are times used
to treat d m d D. They do have side effects,
including concerns about suicidal ideation, weight gain, metabolic abnormalities, sedation,
(19:14):
movement disorders, hormone changes. So again this is reserved only
for severe cases where in fact the child is at
risk and other people are at risk of harm, and
so this again must be a decision one makes very
carefully with a doctor. Do you have a problem I
(19:36):
can help with? If so, email me yet how can
I help? At Seneca women dot Com, all centers remain
anonymous and listen every Friday too. How can I help
with me Dr Gail's Salts
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Bookmarked by Reese's Book Club
Welcome to Bookmarked by Reese’s Book Club — the podcast where great stories, bold women, and irresistible conversations collide! Hosted by award-winning journalist Danielle Robay, each week new episodes balance thoughtful literary insight with the fervor of buzzy book trends, pop culture and more. Bookmarked brings together celebrities, tastemakers, influencers and authors from Reese's Book Club and beyond to share stories that transcend the page. Pull up a chair. You’re not just listening — you’re part of the conversation.