Saturday, November 30, 2013
Handling Tantrums and Meltdowns: What's a Parent to Do?
By Caroline Miller
Editorial Director, Child Mind Institute
November 19, 2013
How to guide children to more adaptive behaviors.
The first thing we have to do to manage tantrums is to understand them. That is not always as easy as it sounds, since tantrums and meltdowns are generated by a lot of different things: fear, frustration, anger, sensory overload, to name a few.
And, since a tantrum isn't a very clear way to communicate (even though it may be a powerful way to get attention), parents are often in the dark about what's driving the behavior.
It's useful to think of a tantrum as a reaction to a situation a child can't handle in a more grown-up way—say, by talking about how he feels, or making a case for what he wants, or just doing what he's been asked to do. Instead he is overwhelmed by emotion.
And, if unleashing his feelings in a dramatic way—crying, yelling, kicking the floor, punching the wall, or hitting a parent—serves to get him what he wants (or out of whatever he was trying to avoid), it's a behavior that he may come to rely on.
That doesn't mean that tantrums are consciously willful, or even voluntary. But it does mean that they're a learned response. So the goal with a child prone to tantrums is to help him unlearn this response, and instead learn other, more mature ways to handle a problem situation, like compromising, or complying with parental expectations in exchange for some positive reward.
The first step is to get a picture of what triggers your particular child's tantrums. Mental health professionals call this a "functional assessment," which means looking at what real-life situations seem to generate tantrums—specifically, at what happens immediately before, during, and after the outbursts that might contribute to their happening again.
Sometimes a close look at the pattern of a child's tantrums reveals a problem that needs attention: a traumatic experience, abuse or neglect, social anxiety, ADHD, or a learning disorder. When children are prone to meltdowns beyond the age in which they are typical, it's often a symptom of distress that they are struggling to manage.
That effort breaks down at moments that require self-discipline they don't yet have, like transitioning from something they enjoy to something that's difficult for them.
"A majority of kids who have frequent meltdowns do it in very predictable, circumscribed situations: when it's homework time, bedtime, time to stop playing," explains Dr. Vasco Lopes, a clinical psychologist at the Child Mind Institute.
"The trigger is usually being asked to do something that's aversive to them or to stop doing something that is fun for them. Especially for children who have ADHD, something that's not stimulating and requires them to control their physical activity, like a long car ride or a religious service or visiting an elderly relative, is a common trigger for meltdowns."
Why Do Kids Have Tantrums and Meltdowns? They may look manipulative, but these outbursts are better understood as behavior children resort to when they lack skills to regulate their emotions. READ MORE
Since parents often find tantrums impossible to tolerate—especially in public—the child may learn implicitly that throwing a tantrum can help him get his way. It becomes a conditioned response. "Even if it only works five out of 10 times that they tantrum, that intermittent reinforcement makes it a very solid learned behavior," Dr. Lopes adds. "So they're going to continue that behavior in order to get what they want."
One of the goals of the functional assessment is to see if some tantrum triggers might be eliminated or changed so they're not as problematic for the child. "If putting on the child's shoes or leaving for school is the trigger, obviously we can't make it go away," explains Dr. Steven Dickstein, who is both a pediatrician and child and adolescent psychiatrist.
But sometimes, we can change the way parents and other caregivers handle a situation—to defuse it. This could translate into giving kids more warning that a task is required of them, or structuring problematic activities in ways that reduce the likelihood of a tantrum.
"Anticipating those triggers, and modifying them so that it's easier for the child to engage in that activity is really important," says Dr. Lopes. "For example, if homework is really difficult for a child, because she has underlying issues of inattention, distractibility, hyperactivity, or a learning disability, she might have outbursts right before she's supposed to start her homework.
So we say to parents, 'How can we make doing homework more palatable for her?' We can give her frequent breaks, support her in areas she has particular difficulty with, organize her work, and break intimidating tasks into smaller chunks."
Another goal is to consider whether the expectations for the child's behavior are developmentally appropriate, Dr. Dickstein notes, for his age and his particular level of maturity. "Can we modify the environment to make it match the child's abilities better, and foster development towards maturing?"
It's important for parents to understand two things: first of all, avoiding a tantrum before it begins does not mean "giving in" to a child's demands. It means separating the unwanted tantrum response from other issues, such as compliance with parental requests. And second, by reducing the likelihood of a tantrum response, you are also taking away the opportunity for reinforcement of that response.
When kids don't tantrum, they learn to deal with needs, desires, and setbacks in a more mature way, and that learning itself reinforces appropriate responses. Fewer tantrums now means...fewer tantrums later.
Stop Yelling! By keeping their cool, parents can teach their children self-control and make for a calmer, happier home. READ MORE
Responding to Tantrums
When tantrums occur, the parent or caregiver's response affects the likelihood of the behavior happening again. There are lots of very specific protocols to help parents respond consistently, in ways that will minimize tantrum behavior later. They range from Ross Greene's seminal approach, Collaborative Problem Solving, to step-by-step parent-training programs like Parent-Child Interaction Therapy and Parent Management Training.
They have in common the starting point that parents resist the temptation to end the tantrum by giving the child what he wants when he tantrums. For outbursts that aren't dangerous, the goal is to ignore the behavior, to withdraw all parental attention, since even negative attention like reprimanding or trying to persuade the child to stop has been found positively reinforce the behavior.
Attention is withheld from behavior you want to discourage, and lavished instead on behaviors you want to encourage: when a child makes an effort to calm down or, instead of tantruming, complies or proposes a compromise. "By positively reinforcing compliance and appropriate responses to frustration," says Dr. Lopes, "you're teaching skills and—since you can't comply with a command and tantrum at the same time—simultaneously decreasing that aggressive noncompliant tantrum behavior."
"One thing you don't want to do is try to reason with a child who is upset. Don't talk to the kid when he's not available."
One thing you don't want to do is try to reason with a child who is upset. As Dr. Dickstein puts it, "Don't talk to the kid when he's not available." You want to encourage a child to practice at negotiation when he's not blowing up, and you're not either. You may need to teach techniques for working through problems, break them down step by step for kids who are immature or have deficits in this kind of thinking and communication.
And you need to model the kind of negotiation you want your child to learn. "Parents should take time outs, too," notes Dr. Dickstein. " When you get really angry you need to just take yourself out of the situation. You can't problem solve when you're upset—your IQ drops about 30 percent when you are angry."
Being calm and clear about behavioral expectations is important because it helps you communicate more effectively with a child. "So it's not, 'You need to behave today,'" Dr. Lopes says. "It's, 'You need to be seated during mealtime, with your hands to yourself, and saying only positive words.' Those are very observable, concrete things that the child knows what's expected and that the parent can reinforce with praise and rewards."
Both you and your child need to build what Dr. Dickstein calls a toolkit for self-soothing, things you can do to calm down, like slow breathing, to relax, because you can't be calm and angry at the same time. There are lots of techniques, he adds, but "The nice thing about breathing is it's always available to you."
at 7:52 AM