Tantrums and ADHD: Is there a link?

Are tantrums a sign of ADHD?

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To an extent, tantrums are a developmentally normal behavior in very young children. For this reason, they are not a reliable indicator of ADHD.

Tantrums can begin as early as 12 months, and often peak when a child is between 2–3 years old. They can continue until the age of 5 years old.

While many children have tantrums at some point, it is especially common for children with ADHD to feel irritable. They may have trouble concentrating at school, managing their emotions, or controlling impulses, all of which can cause anger and frustration. This may contribute to tantrums.

Why do tantrums occur? 

Tantrums are emotional outbursts. They can occur in any child due to:

• feelings of fear, anger, or sadness
• difficulty expressing thoughts or feelings
• unmet physical needs, such as hunger or fatigue (lack of energy)
• a lack of alternative ways to manage emotions
• prior reinforcement, which occurs when caregivers have previously given in to tantrums

Children with ADHD can have tantrums for the same reasons as other children. There are also some ways ADHD symptoms can influence tantrums:

• Hyperactivity: This symptom of ADHD may make it difficult for children with ADHD to be still, quiet, or tolerate boredom. If they do not have an outlet for their energy, they may feel impatient or frustrated.
• Impulsivity: Difficulty controlling impulses may mean that children with ADHD face difficulty at school if a teacher or other classmates do not understand the behavior. This may cause the child to feel guilty, ashamed, or that things are unfair.
• Inattention: If a child finds it difficult to concentrate, remember things, or stick to deadlines, they may feel stressed or overwhelmed.
• Medication side effects: Stimulants are a common treatment for ADHD. But in some children they can cause headache, stomach pain, or difficulty sleeping. These additional challenges may make it harder for children with ADHD to manage their feelings.

Are there differences between typical and ADHD-related tantrums?

Tantrums in children with ADHD are not necessarily different from tantrums in any other child. But they may happen more often or cause children to become angry, defiant, or aggressive, particularly if the child has a lot of negative interactions with adults.

Certain tantrum patterns can be a sign that the tantrums are not typical for the child’s stage of development. These include:

• tantrums that regularly occur more than five times a day
• children over the age of 5 years frequently having tantrums
• tantrums lasting longer than 15 minutes
• extreme aggression, such as destroying household items or physical aggression toward others
• caregivers feeling unable to keep a child safe during a tantrum

If a child is behaving in this way, it is a good idea to consult a pediatrician or child psychologist for advice.

How to handle tantrums

Responding to a tantrum can be challenging. But there are strategies that can help. During a tantrum, try:

• Showing the child how to behave: Caregivers who become angry or aggressive can model tantrum-like behavior, which can escalate the situation. Instead, model behavior that the child should try to adopt. Remain calm, and use a firm, neutral tone of voice.
• Repeating the rules: Set a clear rule or expectation for the child, and do not back down from or argue about them. Instead, simply repeat the rule, and apply it consistently.
• Taking care of their needs: Take steps to meet the child’s physical needs and ensure that they and other household members are safe. If they ask for a hug or reassurance, give the affection freely, but do not go back on the original rule or expectation.
• Distracting the child: Sometimes, a change of environment helps stop a tantrum. Try going outside or into another room of the house.
• Ignoring the tantrum: If the child is having a tantrum in order to change or manipulate adult behavior, ignoring their behavior can send the message that this tactic will not work.

Caregivers can also use time-outs to encourage children to calm down. But overusing time-outs may reduce how well they work.

After the tantrum ends, do not punish the child for having one. They are usually a reaction to intense feelings, which may be especially hard to manage in children with ADHD. Do not use physical punishment, as it can cause tantrums to get worse. It also teaches children that hitting is an acceptable behavior.

Preventing tantrums 

It is not always possible to prevent tantrums in young children, but certain parenting approaches may help reduce ADHD symptoms and improve child mental health, which may result in fewer tantrums. These include:

Authoritative parenting

According to an older 2009 review, certain parenting styles can worsen ADHD symptoms. The three main parenting styles are:

• authoritarian, which focuses heavily on strict rules, control, and punishment
• permissive, which offers lots of love and warmth, but few limits or boundaries
• authoritative, which sets clear and consistent limits on behavior while also offering love and encouragement

Both authoritarian and permissive parenting styles may exacerbate ADHD in children.

Positive parenting

It is important for all children to receive positive reinforcement and attention from caregivers. This 2009 study found that “positive parenting” was also associated with fewer behavioral problems in children with ADHD.

Positive parenting involves focusing on the beneficial qualities and behaviors in a child. This reinforces those behaviors and promotes healthy self-esteem. Some ways to practice this approach include:

• Positive attention: This includes attention that is rewarding or that promotes bonding. Try reading stories together, playing games, or including the child in household tasks.
• Praise: Offer frequent praise for the things the child does well, even if they are small.
• Rewards and consequences: Talk with the child about the rewards and consequences for their actions, rather than framing behavior as “good” or “bad.” This gives children the opportunity to understand why a behavior is helpful or unhelpful for either themselves or others.

Consistency

The authors of this 2009 study note that of the elements of parenting that they examined, inconsistent discipline was the one most reliably associated with ADHD symptoms. This does not mean that inconsistency causes ADHD, but it may influence a child’s behavior and ability to regulate their emotions.

To establish consistency:

• proactively communicate rules to children so that they understand their boundaries ahead of time
• avoid saying “no” arbitrarily, and only draw hard lines when necessary
• establish a regular household routine, such as regular times for waking, sleeping, and eating each day
• try not to react out of anger or stress when something goes wrong

Therapies and medications for ADHD

ADHD is a long-term condition, but it does not have to be disruptive or lower a person’s quality of life. Some adults with ADHD feel it gives them unique strengths, such as energy, adventurousness, and spontaneity.

There are options for symptoms that are difficult for children or families to manage.

If a parent or caregiver believes their child may have ADHD, they should seek a comprehensive evaluation for the disorder. After an evaluation, they may be able to access:

• Parent training: This can help caregivers understand ADHD, its impact on child development, and specific skills for managing ADHD-related behaviors.
• School accommodations: It can help for schools to make accommodations for students with ADHD, such as allowing them extra time to complete assignments, giving out less homework, or allowing children to leave their materials in class so that they do not forget them.
• Behavioral therapy: Older children may benefit from behavioral therapy, which teaches children skills they can use to manage hyperactivity, impulsiveness, and inattention.
• Medication: A variety of stimulant and non-stimulant medications may help with ADHD symptoms or related complications, such as mental health conditions. But a review in Pediatrics advises that in children under 6 years old, doctors should weigh up the risks of prescribing medications with the risks of delaying treatment.

Summary

Tantrums are a difficult but typical part of caring for young children. Many children grow out of having tantrums, but if a child has ADHD, the frustrations caused by their symptoms may make tantrums more frequent.

If a child’s behavior is causing disruption and is outside the norm for their age, seek help from an understanding and knowledgeable pediatrician. Getting an ADHD diagnosis can allow parents and caregivers to access support, training, or medications, depending on the situation.