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Could your tantrum-prone child be anxious, rather than naughty? Here's a closer look at the anxiety disorders that cause temper tantrums.

Temper tantrums are near-universal during the toddler years [1], but could they also signify anxiety in children? If you are asking yourself this question, you are clearly suspecting that the answer is "yes". You would be right — but as always, there's more to the story. Let's explore. 

Temper Tantrums: What's Normal?

Temper tantrums are absolutely normal in children between the ages of one and four. They are triggered by frustration and the child's confrontation with natural or parent-induced limits. Unsurprisingly, independent-minded, energetic preschoolers are most likely to throw tantrums, but parental inconsistency, excessive strictness, or extreme permissiveness can also encourage outbursts. In addition, bored, tired, hungry and ill children are also prone to throwing tantrums. When temper tantrums are ignored but the child is offered solace afterwards, research finds, the child's outbursts of frustration will subside most quickly. [2]

Temper Tantrums As A Part Of Childhood Anxiety

While there is some research indicating that anxiety and temper tantrums are specifically correlated, the keyword parents who would like to find out whether their child's temper tantrums fit into a wider picture of anxiety — and possibly a diagnosable childhood anxiety disorder — really want to look at is "irritability". Irritability is among the diagnostic criteria for many anxiety and related disorders, and one study defined it thus:

Irritability is defined as a tendency toward negative affective states, usually anger, coupled with a propensity to exhibit temper outbursts. [3]

Separation anxiety in children is likely to trigger irritability, including temper tantrums, in response to being apart from the child's primary caregiver [4], for instance, while those with social anxiety disorder are likely to exhibit tantrums and clinginess in response to social interactions [5]. Children with generalized anxiety disorder, who are anxious about a wide variety of different things, may suffer from persistent irritability [6], and a third of those kids with obsessive compulsive disorder frequently throw temper tantrums [7]. 

Children who are suffering from post-traumatic stress disorder, which likewise induces anxiety, are also prone to irritability and angry outbursts. [8]

Interestingly, one study notes that "extreme temper tantrums", called angry-agitated outbursts or AAOs, are less likely in children suffering from anxiety disorders than in those diagnosed with other conditions such as ADHD. They add, however, that anxious children who do have AAOs tend to show extreme distress rather than anger directed at self, others and objects. [9]

This can provide valuable insights to parents whose children cling and cry during tantrums, but we also have to add that some children with anxiety do use aggression as a coping mechanism [10].

Could Your Child's 'Tantrums' Really Be Panic Attacks?

Another possibility to consider is that the anxious child whom you assumed to be throwing frequent temper tantrums is, in fact, experiencing panic attacks. These panic attacks, which form an integral part of the clinical picture of panic disorder, are best known for their physical symptoms — a racing heart, dizziness, chest pain, and sweating — along with profound fears of loss or dying. Children in the middle of a panic attack may scream or cry, and though they can appear at random times, they may also be triggered by specific situations. In some children, panic attacks look rather a lot like temper tantrums, in other words. [11]

What Do I Do Now?

A full evaluation would be in order if your child has not already been diagnosed with anxiety. Social workers, child psychologists, and child psychiatrists can all help, but your primary care provider (pediatrician or family doctor) is also a good starting point.

Evaluation is not just important in order to enable adequate treatment for your child's suspected anxiety disorder, but also to rule out other causes: children with ADHD, childhood onset bipolar disorder, oppositional defiant disorder, and conduct disorder are also all prone to tantrums [12], as are those on the autism spectrum [13].

Yet another possibility, for children whose temper tantrums are rather violent, is the fairly new diagnosis of Disruptive Mood Dysregulation Disorder (DMDD), the defining characteristics of which are severe, aggressive tantrums and an angry, irritable mood that impairs daily functioning. [14]

Parents whose children were already diagnosed with anxiety should continue with or obtain treatment, knowing that cognitive behavioral therapy is the the gold standard in relieving anxiety and that medication can also help [15].

Meanwhile, research suggests that anxious children do not benefit from the mainstream approach to tantrums — placing them in time-out. When a child worries about everything, being isolated from others during their most vulnerable moments could be perceived as rejection and add to pre-existing anxiety.

Rather, children suffering from anxiety need to be close to trusted caregivers during a tantrum, and require reassurance and the opportunity to talk through their emotions. [see 10]

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