Temper Tantrums in Preschool Age Children with and without Autism Spectrum Disorder

Background: The presence of tantrums, aggressive behavior, and self-injury is related to significant parental stress and poorer long-term outcomes in children with autism spectrum disorder (ASD). Yet, very little is known about the frequency and nature of tantrums in young children with ASD and how they may differ from tantrums of neurotypical children.  

Objectives: This project sought to characterize the frequency and nature of tantrums in preschool age children with ASD as compared to a representative community sample of neurotypical preschool age children.   

Methods: This is a descriptive study of 25 children diagnosed with ASD (M age = 53.6 months, SD = 13.2 months; M IQ = 64.6, SD = 18.3) as compared to a representative community sample of 307 neurotypical children (M age = 40.8 months, SD = 14.4 months) recruited from pediatric primary care (percentages for the community sample are weighted back to the screened population sample of 1,073 children). Data collection is ongoing and additional data will be analyzed in the final study. The prevalence of non-destructive tantrums (i.e. episodes of temper, frustration, or upset manifested by shouting, crying, or stamping and non-destructive violence against property) and destructive tantrums (i.e. episodes of temper, frustration, or upset manifested by shouting, crying, or stamping and destructive violence or violence against oneself, other people, or property), mean frequency of tantrums, and content of tantrums were measured using the Preschool Age Psychiatric Assessment (PAPA), a well-validated parent interview used to assess psychopathology in children ages 2 to 5 years. Chi-squared tests and general linear models were used to evaluate differences between groups.   

Results: Thirty-three percent of neurotypical children versus 92% of children with ASD exhibited non-destructive tantrums over the three-month interview period (a significant difference at p < .0001). Twenty-six percent of neurotypical children versus 64% of children with ASD exhibited destructive tantrums over the same interval (a significant difference at p < .0001). Neurotypical children exhibited, on average, 9.3 tantrums over the three-month interview period, while those with ASD exhibited 49.8 tantrums over the same interval (a significant difference at p < .0001). The content of tantrums differed between groups, with children with ASD significantly more likely to engage in various behaviors (e.g., biting themselves).   

Conclusions: Significant differences in the frequency and nature of tantrums were found between the ASD and neurotypical groups. While children with ASD exhibited more tantrums of both types, the primary difference was seen in the prevalence of non-destructive tantrums. The content of tantrums also differed between the groups, with children with ASD exhibiting significantly more of nearly every behavior assessed. This preliminary characterization of tantrums in children with ASD, as compared to neurotypical children, offers insight into a commonly-occurring associated symptom of ASD. Frequency and type of tantrums have been found to be associated with higher risk for mental health disorders in typical children. Future research is needed to examine the extent to which these early challenging behaviors are associated with later mental health and other behavioral outcomes in children with ASD.