The new edition of the DSM, modern psychiatry's bible for mental disorders, gives a medical diagnosis for what others just call bratty behavior. How parents can recognize the difference.
BUENOS AIRES – Marina, a mother of a three-year-old, has a confession.
“When a restaurant doesn't have a kids menu with some kind of toy included, it's a big problem for me. Joaquín always starts to cry," she explains. The boy will often then wind up throwing himself on the floor, screaming and throwing things. "I don’t know how to stop people from seeing me as either a mother who is too strict or a mother who just crosses her arms and doesn’t know how to say “no” to her son," Marina says. "I don’t know how to deal with his tantrums."
It is true, that if tantrums become repetitive and uncontrollable with your child, it isn’t a bad idea to seek advice from a psychologist, a pediatrician or an expert in child development or parenting. Nevertheless, the American Psychiatric Association has catalogued tantrums in its DSM-5 manual as a “potential mental disorder in childhood” when irritability is persistent and these “burst of behavior” are repeated three or more times a week for more than a year.
The scientific name today for an old-fashioned tantrum is: “disruptive mood dysregulation disorder.”
In Argentina, psychologist Montserrat Ballvé Caride says: “Many professionals like myself ask ourselves if the criteria used to “pathologize” these behaviors respond to economic interests of certain laboratories. It is striking that upon every new “disorder,” a laboratory appears with a new numbing pill that makes us think it will cure people, when, in reality, it gives the impression that it only masks the symptoms, turning children into zombies and generating more problems than it solves”, Ballvé Caride says. “There is a dangerous trend in “pathologizing” childhood, calling certain reactions in children that come from human conditions and not sickness, as “disorders.”
She says the risk of medicating characteristics that are original to our species is a "normalization that approaches more the ideal of a machine than a human being.”
Regarding tantrums, Caride chooses to name it infantile angst or anxiety, where the child is attempting to communicate. “The content of the message is not universal and cannot be generalized: every child suffers in a unique way. Two options are then available for the adult: to ask what is happening to the kid and try to interpret the origin or cause of the angst; the other is to not ask themselves anything, and avoid the situation, which implies to tacitly stop listening,” she explains.
It is all about interpretation, trying to answer questions about the recurrent situation of angst: if the child was always this way, if it started after a particular event or change in the family or surroundings, or to consider how parents react when faced with the tantrums and in what context they happen. “You can also consult a professional or ask friends and family for advice on how to face the issue”, says Montserrat.
More and more, these consultations extend to the Internet, where parenting specialists like Silvia Solá offer advice. “When babies start to walk, tantrums begin, a new issue for parents to deal with. So then they come to us for help," she says. "Apart from the consultation, we suggest to parents to calm down in order to understand the message the child is trying to express, which doesn’t mean to enable the tantrum, but to understand what it is that he is trying to say.”
Who's in charge?
Tantrums tend to disarm adults, leaving them without any tools to face them. “The problem begins when the adult seeks barely-sustainable strategies and stops being an adult and the child doesn’t know where he stands,” says Solá.
These are age-old dilemmas for parents, but it is the new classification of the DSM-5 manual that is causing controversy. Psychologists from parenting institution Momento Cero, Adriana López and Emilia Canzutti weigh in on the categorization of tantrums as a pathology.
“It is necessary to attend a professional consultation only if the child has finished preschool and the tantrums persist even when parents have not yielded to them and they have understood the emotional situation of their child. If there is the need to medicate them, this should be determined by a professional, even though in our experience, we would advise it infrequently.”
At Momento Cero, psychologists say that tantrums are expected behaviors between two and four years, when the separation-individualization stage happens. “The “no’s” appear as a form to express their opinions and they want to exert their will with full force. Yet, they cannot express what they feel or think. Tantrums are a manifestation of non-conformity, frustration and lack of control,” says Canzutti. “If tantrums continue after the age of four, it is because parents have yielded to them too often. Then it might be necessary to seek professional consultation.”
López concludes: “Many times kids and parents have the feeling of loss of control. But we must always remember that we are the adults, so the child can accept what he must do or stop doing a certain thing.”