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Understanding Tantrums in Autism Spectrum Disorder
Joshua Feder, MD
Editor-in-chief, CCPR
Dr. Feder has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Review of: Mayes S et al, J Dev Phys Disabil 2017;29(4):587–596
Why do children with autism spectrum disorder (ASD) have tantrums? One theory is that these tantrums are due in part to children’s frustration with not being able to express themselves. This theory has led to a treatment approach called “mand training.” A mand is a verbal request, and mand training seeks to help children with ASD make simple requests more effectively. In theory, therefore, the improvement in communication would decrease the likelihood of frustration-induced tantrums. A recent study, however, reported results that are at odds with the tantrum-as-miscommunication theory.
In this cross-sectional cohort study, 240 children ages 15–71 months with confirmed diagnoses of ASD were administered the Early Intervention Developmental Profile and WPPSI-III or Bayley verbal and nonverbal IQ tests depending on their level of function. Parents then reported on both tantrum frequency and speech intelligibility using the Pediatric Behavior Scales. ANOVA and ANCOVA analyses showed that expressive language, receptive language, and nonverbal IQ each accounted for 2%–3% of the variance in tantrum frequencies. Moreover, children with expressive language age equivalent ≥ 24 months had more tantrums than those < 24 months, with a moderate effect size (d = 0.4).
CCPR’s Take
Although the study was limited by its reliance on parental reports of tantrums, the main finding is that impaired speech was not the primary cause of tantrums in these children. The article underlines the need to understand behavior from a more holistic perspective, rather than focusing on a single aspect of behavior. Include an assessment of sensory sensitivities, motor planning problems, and rigidity of thinking and expectations as well as the parent-child relationship. In addition, sometimes children resist behavioral training efforts because they may prefer to interact in ways that feel more meaningful to them.
Child PsychiatryWhy do children with autism spectrum disorder (ASD) have tantrums? One theory is that these tantrums are due in part to children’s frustration with not being able to express themselves. This theory has led to a treatment approach called “mand training.” A mand is a verbal request, and mand training seeks to help children with ASD make simple requests more effectively. In theory, therefore, the improvement in communication would decrease the likelihood of frustration-induced tantrums. A recent study, however, reported results that are at odds with the tantrum-as-miscommunication theory.
In this cross-sectional cohort study, 240 children ages 15–71 months with confirmed diagnoses of ASD were administered the Early Intervention Developmental Profile and WPPSI-III or Bayley verbal and nonverbal IQ tests depending on their level of function. Parents then reported on both tantrum frequency and speech intelligibility using the Pediatric Behavior Scales. ANOVA and ANCOVA analyses showed that expressive language, receptive language, and nonverbal IQ each accounted for 2%–3% of the variance in tantrum frequencies. Moreover, children with expressive language age equivalent ≥ 24 months had more tantrums than those < 24 months, with a moderate effect size (d = 0.4).
CCPR’s Take
Although the study was limited by its reliance on parental reports of tantrums, the main finding is that impaired speech was not the primary cause of tantrums in these children. The article underlines the need to understand behavior from a more holistic perspective, rather than focusing on a single aspect of behavior. Include an assessment of sensory sensitivities, motor planning problems, and rigidity of thinking and expectations as well as the parent-child relationship. In addition, sometimes children resist behavioral training efforts because they may prefer to interact in ways that feel more meaningful to them.
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