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Family Health

Got an Angry Child? Should You Be Worried?

BY CARRIE MACMILLAN March 21, 2022

Yale Child Study Center expert discusses when parents should seek professional support for their child.

Most parents are familiar with the infamous “terrible twos”—whether they experienced the trademark irritability and difficulties from their toddler only a little or a lot. 

But many parents are worried about difficult moods, protracted tantrums, or other forms of tension in children who are well past the age of two, sometimes even into their teens. 

Parents often have trouble determining what’s “normal” in terms of a child’s moods, since no two kids are alike. Some are more irritable or easily set off than others, and much of that is related to temperament. But our COVID-19 pandemic experiences have played a part, too. 

One study shows that last year’s shift from in-person to remote (or hybrid) learning led to more cases of kids “acting out.” In survey responses, parents said their children, while learning remotely, showed more aggression and withdrawal, had limited attention spans, and experienced difficulties switching between tasks compared to when they were in school.   

We talked with Denis Sukhodolsky, PhD, a clinical psychologist and associate professor at the Yale Child Study Center, about challenges parents face with anger, irritability, and aggressive behavior in children, especially during the pandemic. 

Below, he shares his insight and advice. 

What, exactly, is a tantrum?

Parents know a temper tantrum when they see one. But there is a medical definition, too. Temper tantrums are “distressing and disruptive emotional outbursts that often occur in response to frustration or because of unmet needs or desires," says Sukhodolsky. "Unpleasant though they may be, tantrums are a normal behavior during early childhood."

How can you tell the difference between a ‘normal’ tantrum and something else?

There are markers to look for, explains Sukhodolsky. “The terrible twos, for example, are a well-known period. But when families experience frequent or protracted tantrums, in which a child is inconsolable, it might signal that some extra support is needed to help a child feel better,” he says. 

The key to determining if you need help is in how long the problem persists, he adds. For example, at the beginning of a school year, children might have a difficult time transitioning to waking up early and getting ready on time. 

“Parents need to pay attention to how long this goes on for. If it’s a few days, that’s normal. If it’s a period of weeks or months in which they are very fussy when they are told to put down their video games and get going, then that’s different,” he says. 

Does a child’s age help determine if a tantrum is 'normal'?

"Yes, age matters," he says. "It’s not uncommon for young children to get teary-eyed or protest when they are told to do something they don’t want to do. But if a child older than 8 behaves this way consistently—for a month or longer—parents may want to seek consultation with a child behavioral health provider." 

Does frequency and duration of the tantrum play a role?

"Yes, these are also key. It’s not uncommon for parents to have an argument with their child once or twice a week. If an issue is resolved and the family can go back to what they were doing in 10 or 15 minutes, that’s fine,” says Sukhodolsky. “But if that argument ruins the whole day, and the problem lasts for several months, it may signal a need for greater attention.” 

In that event, a child and their parents might need help figuring out what makes them so frustrated and ways to better navigate these situations, he adds. 

When should you seek professional help for your child?

Sukhodolsky recommends seeking a comprehensive clinical evaluation for a child experiencing angry outbursts over a period of several months. To do this, parents can discuss these issues with their child’s pediatrician, who can make a referral to a mental health expert.

How does a Yale Child Study Center clinical evaluation work?

When a child comes to the Yale Child Study Center, the first step involves a clinical evaluation. If outbursts and high levels of conflict are the primary symptoms—and interfere with the child’s life in different settings, such as at home and in school—an evaluation can clarify what underlying mental health issues may be at play. 

A clinical evaluation typically includes tests and tasks that are conducted and scored by experts. A detailed history, including a child’s medical, developmental, school, and family information, will be taken at this appointment as well.

“We look for stress, anxiety, trauma, and the accumulated impact from childhood adversity,” Sukhodolsky says. “Behavioral difficulties, such as anger outbursts and low-frustration tolerance, can also occur with conditions such as ADHD, depression, anxiety, and autism spectrum disorder.” 

“Time is on your side. As children grow up, they go through considerable social and emotional changes that can help them develop emotion regulation skills—even if they might not have those skills at this moment,” says Denis Sukhodolsky, PhD, a clinical psychologist and associate professor at the Yale Child Study Center

If a child presents with symptoms of more than one psychiatric disorder or if a diagnosis requires specialized expertise, a further comprehensive evaluation could be conducted in one of several Yale Child Study Center Outpatient Clinical Services specialty programs.  

The information from the clinical evaluation can help behavioral health professionals decide what types of treatment may help your child. 

What are the possible diagnoses for anger and aggression?

Frequent anger outbursts and irritability could be symptoms of several psychiatric conditions:  

  • Disruptive behavior disorderswhich include oppositional defiant disorder and conduct disorder:
    • Oppositional defiant disorder (ODD) involves an angry or irritable mood, as well as argumentative or defiant behavior, that lasts six months or more. This is diagnosed if these “oppositional” behaviors interfere with your child’s ability to participate in age-appropriate activities at home, in school, or in the community. 

      For example, a child might have anger outbursts when asked to help clean up after themselves or to go to bed on time. However, if the parents don’t insist on expected behavior—and the child goes on to do what they want—the angry mood dissipates quickly. But what’s important is that the symptoms of ODD are interfering with the child’s development and family life, Sukhodolsky says.
    • Conduct disorder (CD) is diagnosed based on the presence of a persistent pattern of aggression toward others, as well as a serious violation of rules and social norms. These might include initiating physical fights in school, bullying other children, or running away from home. CD may occur with other serious mental health conditions, such as depression. It’s not uncommon for a child’s symptoms of CD to be a form of reaction to severe adversity, adds Sukhodolsky.  
  • Disruptive mood dysregulation disorder (DMDD) is characterized by frequent anger outbursts and irritable or depressed moods most of the time. “DMDD involves a more protracted form of angry or sad moods between anger outbursts than seen in oppositional defiant disorder,” Sukhodolsky says. For example, a child who can’t play his video game because it’s broken and then stays upset for the rest of the day might be an example of someone with DMDD. “This negative mood is accompanied by anger outbursts in younger children or screaming matches in older children and adolescents,” he says. 

What are treatment options for these disorders?

A number of treatments and coping strategies can help children who struggle with anger, irritability, and aggression. “One of them is a healthy lifestyle that includes exercise and good sleep," says Sukhodolsky. "As obvious as that sounds, it can help to have weekly therapy sessions with someone just to remind them to do those things.”   

Focused psychological or behavioral interventions can also be helpful. These include cognitive behavioral therapy (CBT), which helps children to recognize potentially frustrating situations and learn how to handle them with less disruption. 

There is also parenting (or family) therapy, which helps parents foster their child’s abilities to manage frustration in positive ways. During therapy, children and parents brainstorm new ways of thinking, consider alternates to existing routines, and make practical changes that help children adapt more easily to what’s being asked. 

“For example, problem-solving strategies can encourage children to think differently, recognize unpleasant thoughts, and learn to not dwell on things,” he says. “We can also work with kids using role-play exercises. If they have an argument with a friend, for example, we can use this as a learning opportunity and role-play alternative ways of acting, so the next time it goes differently.”   

Do treatments for anger and aggression disorders really work?

Research shows a success rate of approximately 65% in reducing the frequency and intensity of outbursts, Sukhodolsky explains, noting that new approaches are continually evolving. "With help, children can learn to recognize their emotions, anticipate and prepare for challenges, and respond to frustration in healthy ways," he says. 

In general, treatment is targeted to each child. "For example, if a child gets frustrated when they get a bad grade or if their mom is late to pick them up at soccer, we make a list of those situations and give the child tools for getting through those situations in the best possible ways,” he says. “That could mean talking in a calm voice instead of screaming or using relaxation strategies such as slow, mindful breathing.” 

What options are available for children who don’t respond well to established forms of psychotherapy?

Even the most established forms of psychotherapy for anger and aggression do not work for everyone. If cognitive behavioral therapy and family therapy don’t help enough, other options include psychiatric medication and intensive outpatient or home-based services

Some children whose challenges are more intense, such as those who pose a high risk of injury to themselves or others, may require inpatient psychiatric evaluation and treatment, he says. 

If parents are worried about their child’s anger outbursts, especially during the pandemic, what should they look for?

For parents who are wondering if their child’s anger or irritability is “normal” or appropriate to the levels of stress and changes imposed by the pandemic, Sukhodolsky advises keeping an eye on the number and frequency of anger outbursts and, more importantly, on the child’s overall emotional well-being. 

“Irritability might subside over the course of several months. And if things don’t improve, there are helpful treatments out there,” he says. “Time is on your side. As children grow up, they go through considerable social and emotional changes that can help them develop emotion regulation skills—even if they might not have those skills at this moment.” 

Note: The Child Study Center is conducting a treatment study of irritability in adolescents with autism spectrum disorder. Because teenagers on the autism spectrum may struggle with a wide range of social and emotional difficulties, this treatment teaches a highly individualized set of skills for coping with frustration; it is aimed to empower the teens to navigate increasingly complex social situations during the transition from childhood to adolescence. 

To learn more, visit the Sukhodolsky lab website on Yale School of Medicine.