Temper Tantrums and Behavior Management
by Amanda Mazerall M.S. OTR/L

Temper tantrums are ‘behaviors’ that I see on a daily basis. Although Kids Place is an extremely fun and exciting place, it is common for children to get upset while present for therapy. There are a variety of reasons for these upset behaviors:

  • Seeking a toy, attention, or control over a situation
  • Being asked to do something that they do not want to do
  • Frustration over the inability to communicate wants
  • Responding to pain or discomfort

Although tantrums are quite normal for toddlers to experience, it’s important that caregivers understand how to manage such upsets by responding accordingly and teaching appropriate alternative behaviors/communication methods. Depending on the reason for the behavior, there are different prevention strategies and techniques to implement so that undesired behaviors reduce. Here are some examples:

Attention or access to something

Situation: A child yells and hits their parent because they are not given the phone following a therapy session.

What to do: Set up routines and schedule reinforcing activities throughout the day. Have the child’s new book available to open as soon as they get out of therapy so they have something to attend to while you and therapist discuss. If the child is upset but not at risk for hurting themselves or others, it is appropriate to ignore the upset behavior. Remain calm and encourage them to have a calm body and low voice before receiving it. Use this time to improve their language skills and use of full sentences. For example, after ensuring they are seated safely and calm, have them use their words by asking ‘Can I have it now please?’

What to avoid: Don’t reward their ‘negative’ behaviors by giving them the phone. They need to realize that making a scene is not how they get what they want. Avoid getting mad and telling them ‘no’. Instead, give them specific, simple instructions on what to do, such as ‘sit down and open the book’. It is also important to remember that tolerating boredom is an important skill for any child so there will be moments that neither a phone nor book will be available to them.

Escape/avoidance behavior

Example: A child cries at the end of therapy because they do not want to put away a preferred toy and transition out of clinic to put their shoes on.

What to do: Set up routines and schedules so that child is not surprised by the sudden change in activities. Give simple demands that you can prompt. Pair work area with high reinforcement (once shoes go back on, they get a sticker). Instead of ignoring the behavior, the therapist will likely provide assist in putting the toy away with hand over hand assist and transition them out with hand held assist. They will block access from reinforcement (sticker) until child complies by helping put shoes on. Use a calm voice with visual and physical prompts as necessary.

What to avoid: Avoid rewarding the child’s tantrum by giving them extra time in therapy or by giving them preferred stickers despite not helping with clean up. Consequences that the child views as enjoyable will increase the behavior. So if your child has a tantrum when asked to help clean, and you give them a sticker to quiet them, the tantrum is reinforced because they got something they wanted!

Child is unable to communicate effectively

Example: A child cannot express wants to play with a toy or desires to terminate activities.

What to do: Work with speech and language pathologists to find out what method of communication will work best. If your child is not yet speaking, encourage them to use sign language to communicate their desires. If the child is upset because he wants more toys to assemble in therapy, the therapist will likely use a visual model and/or hand over hand assistance for them to sign ‘more’. If the child is upset because they want to terminate a task, they can sign ‘all done’ before cleaning up from the activity.

What to avoid: Avoid rewarding tantrums by giving in to their cries/protests when there are more mature methods to communicate. Neither behaviors nor large advances in language will change overnight. Because of this, the people in the child’s life must remain consistent! Use of vocalizations, sign language, and picture exchanges should be implemented for making requests.

Child is expressing pain or discomfort

Example: A child is being pushed out of his comfort zone in terms of physical positioning (strengthening and developmental positions)

What to do: Trust your instincts! As a parent, you have gotten pretty great at identifying your child’s cries. Hunger, exhaustion, dirty diapers, and fear may all sound different. Keep this in mind when your therapist is pushing your child to complete a ‘just right challenge’. A baby working on tummy time may become a little fussy without actually being pained. Work with your therapist to find out their limits for therapy and to identify what is typical and what is atypical for each age. Work to find useful distractions and appropriate rewards to help improve tolerance.

What to avoid: Terminating all challenging tasks because your child becomes upset. Push them to the point where they are learning new skills, increasing strength, and identifying their own capabilities.

Remember; children will use the language that gets them what they want! Do not reward upset behaviors by giving into them. Work with your therapist to identify causes for tantrums and ways to better improve your child’s communication skills.