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Temper tantrums can be so frustrating - for the child, the parent, the teacher, and everyone involved! On episode 20 of PsychEd4Peds, Dr. Joyce Harrison, child and adolescent psychiatrist at Kennedy Krieger Institute/Johns Hopkins, shares with us an "8 S" framework for evaluating kids with temper tantrums.

Q: What is on the differential diagnosis for a 4 year old with temper tantrums?

A: Thinking alphabetically,

** A = ADHD, anxiety, and/or autism,

** C= communication difficulties,

** D = developmental delay/intellectual disability,

** T=trauma or adverse childhood experiences

Q: What questions could the pediatrician ask the parent to sort through some of these possible issues?

A: It can be helpful to use the "Eight S framework"

§ 1 - Safety first

· Is this child safe?

· Are the people around this child safe?

· Is this child safe to be treated in the setting that they're in?

§ 2 - Specific behaviors

· What is the child doing that makes the parent think something is wrong

· What is the most problematic thing?

· What are you most concerned about?

§ 3 – Setting

· Where are the behaviors happening? (childcare/preschool, home, out w/ other people)

§ 4 - Scary/trauma

· Has anything scary happened to this child/family?

§ 5 - Services!!!!!

· what kinds of services is the child getting now? (OT, PT, behavioral tx, meds)

§ 6 - Sleep

· How well are they sleeping? Any nightmares?

§ 7 - Social interactions

· Does your child have friends?

· Does your child get invited to other things?

§ 8 - Speech problems
Dr. Joyce Harrison is an Associate Professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine. She is also on the Faculty at Kennedy Krieger Institute, a hospital serving children with developmental disabilities. She is a nationally-recognized educator in early childhood mental health and its integration in primary care. She is the Project director for Kennedy Krieger Institute’s Early Childhood ECHO programs, and Co-chair of AACAPs national Infant and Preschool Committee. She served as the founding Medical director of Maryland Behavioral Health Integration in Pediatric Primary Care program. She is President of the Association for Infant Mental Health, Maryland-DC chapter.

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