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The purpose of this study was to describe clinician-observed, naturally occurring temper tantrums in preschoolers diagnosed with severe behavior problems characterized by negative hostile and defiant behaviors (American Psychiatric Association [APA], 2000 ), with the intent of providing empirical evidence that might be useful to clinicians working with this population.
Background
Temper tantrums are considered a normal and common occurrence during early childhood, but they are often a source of parenting distress and a common complaint of parents seeking mental health treatment for their children (Belden, Thomson, & Luby, 2008 ; Breitenstein, Hill, & Gross, 2009 ). However, temper tantrums can also be a component of developmental psychopathology during the preschool years (Degnan, Calkins, Keane, & Hill-Soderlund, 2008 ; Wakschlag et al., 2012 ), and it is difficult to identify "meaningful cut points" where normative misbehavior extends into the realm of clinical significance (Belden et al., 2008 ; Wakschlag, Tolan, & Leventhal, 2010 ).
Wakschlag et al. (2012 ) suggested that tantrum behaviors be viewed on a continuum so that even normative misbehaviors may become clinically significant when exhibited frequently. For instance, opposition and negative behavior associated with temper tantrums are expected as preschoolers assert their independence and become frustrated when parental limits are imposed. However, when the same behaviors become more frequent, exaggerated, and violent, and when they interfere with a child's developmental and social functioning, they become symptomatic of an underlying psychiatric disorder (Belden et al., 2008 ; Österman & Björkqvist, 2010 ; Potegal & Davidson, 2003 ; Wakschlag et al., 2007 ).
Belden et al. (2008 ) identified five high-risk tantrum styles indicative of clinical problems: (a) aggression toward caregiver(s); (b) self-injurious behaviors; (c) 10 to 20 discrete tantrum episodes on separate days at home during a 30-day period, or more than five daily tantrums occurring on multiple days in school or outside of home/school; (d) extended tantrum duration (more than 25 minutes); and (e) inability to calm self. A child exhibiting any of these tantrum styles is viewed as being at risk for developing behavioral disorders and may require mental health referral and treatment.
Attempts to describe tantrums through research, although informative, have been somewhat restricted by their reliance on retrospective parent report of...