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Since turning two, the tantrums have increased. Sometimes it ends with your child collapsed on the floor, screaming. This is just the terrible twos, you tell yourself — but something makes you stop and wonder: Is this still in the normal range?
Search online and you will find claims that tantrums in children with ASD: autism spectrum disorder: a neurodevelopmental condition characterized by differences in social communication and restricted, repetitive patterns of behavior last longer, that children with ADHD: attention-deficit/hyperactivity disorder: a neurodevelopmental condition involving persistent inattention, hyperactivity, and impulsivity that interferes with functioning have more explosive meltdowns. Read long enough and the tantrum in front of you starts to look like a symptom. Then a different article says that tantrums in children ages one through three are completely ordinary. Both things cannot be fully right. What should a parent actually look at?
This article organizes the current evidence on what "normal" tantrum behavior looks like, and what features — when observed together — suggest it may be worth a professional conversation. It also tries to be honest about why distinguishing the two is genuinely difficult.
Tantrums happen in almost every young child
Start with the baseline. Tantrums are not a minority experience; they are a near-universal one.
Wakschlag and colleagues (2012) conducted a community-sample study of 1,490 preschool-age children. In the past month, 83.7% of caregivers reported their child had had a tantrum. Daily tantrums, however, affected only 8.6% of children [1].
That number provides essential context. Tantrums in general are a phenomenon shared by the vast majority of toddlers — their presence alone does not suggest a developmental concern. The same research argues that what kind of tantrum matters far more diagnostically than whether tantrums happen at all [1].
Potegal and Davidson (2003) analyzed detailed caregiver-reported tantrum data from 335 children aged 18–60 months. They found that tantrums have two distinct emotional components: anger and distress/sadness [2]. In a typical tantrum, anger rises sharply, peaks, then gradually subsides — with distress (crying) remaining after the anger dissipates. This time course is a pattern observed widely across children with typical emotional development [2].
Features that raise clinical concern
What, then, should concern a parent?
Belden and colleagues (2008) compared tantrums in 279 preschool-age children (ages 3–6) across three groups: typically developing, children with depressive diagnoses, and children with disruptive behavior disorders [3]. The following features were significantly associated with clinical problems:
- Repeated self-injurious behavior during tantrums (head-banging, hitting oneself)
- Frequent serious aggression toward others (striking a parent or caregiver forcefully) during tantrums
- Tantrums occurring outside the home — at daycare or preschool, not only at home
- Markedly prolonged recovery time after a tantrum
Children who showed multiple of these features were associated with significantly higher clinical risk compared to the typically developing group [3]. Self-injurious behavior in particular is, on its own, a clear reason to consult.
A note on duration: the guideline that tantrums lasting more than 10–15 minutes warrant attention is cited in the literature [2], but duration should not be used as an isolated measure — it needs to be weighed alongside the other features above.
What research says about tantrums in ASD and ADHD
How do tantrums in children with developmental diagnoses differ from the typical terrible twos? This is a genuinely hard research question, because the symptom overlap is large. Tantrum behavior alone cannot distinguish.
That said, the research does describe tendencies. In children with ASD, environmental change — disrupted routine, sensory overload — is frequently the trigger, and frustration arising from communication difficulties often escalates into intense outbursts. In children with ADHD, difficulties with impulse control tend to produce a faster, sharper emotional onset. But these tendencies are also seen to varying degrees in typically developing toddlers going through the same developmental period.
More importantly, the research suggests that what is most discriminating for identifying ASD early is not the form of the tantrum but the patterns of social communication: frequency and quality of eye contact, responding to one's name being called, and the use of pointing and shared attention: the ability to coordinate attention with another person toward a common object or event, a key early social-cognitive skill [4]. Zwaigenbaum and colleagues (2015) reviewed the evidence on early behavioral markers of ASD and highlighted absent or atypical eye contact, reduced sharing of positive affect, poor response to name, and weak coordination of gaze, expression, gesture, and vocalization as the most informative early signs — typically emerging between 12 and 24 months [4].
The reasoning to avoid: My child's tantrums are intense, therefore I suspect a developmental disorder. The more productive observation is to look beyond the tantrum itself — at the social and communicative picture in between.
M-CHAT-R/F: the standard screening tool
For the period from 16 to 30 months of age, the M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-up) is the most widely used validated screening instrument for autism spectrum disorder risk.
Robins and colleagues (2014) validated M-CHAT-R/F in 16,071 toddlers, demonstrating that it achieves practical levels of sensitivity and specificity when administered at the 18-month and 24-month well-child visits [5]. The tool is designed to be administered by the child's physician during routine checkups: a caregiver answers 23 questions. In Japan, M-CHAT is referenced in the context of infant and toddler health checkups (nyuyoji kenshin), including the 18-month checkup — a universal pediatric visit — and parents who wish to look at the tool on their own can find it under the name "M-CHAT."
An important clarification: a positive screen does not mean a diagnosis. It means the child is recommended for further specialist evaluation [5].
When to consult
At what point should a parent raise this with a professional?
"Let's keep watching" is a phrase used in clinical settings, but the cost of consulting is relatively low. Any of the following is a reasonable reason to contact your pediatrician:
- Self-injurious behavior (head-banging, hitting themselves) occurs repeatedly during tantrums
- Aggression during tantrums is severe enough that a caregiver has been injured
- Tantrums frequently last longer than 15 minutes
- Similar tantrums are reported at daycare or preschool, not only at home
- The frequency or intensity of tantrums is increasing over time, rather than decreasing
- There are also concerns about speech delay or poor response to name
When everything gets filed under "it's just the terrible twos," the window for a helpful conversation can quietly close. Even within the terrible twos, feeling that something is off is a legitimate reason to ask.
Keeping a log — in an app like Memori or in any form — of tantrum frequency, duration, and apparent triggers can also be practically useful: when you describe what's happening to a pediatrician or public health nurse, an objective record is more informative than emotional memory, for both the clinician and for you.
Summary
Tantrums are a near-universal phenomenon in preschool-age children, and their presence alone does not imply a developmental concern [1]. What raises the level of concern is a combination of qualitative features: repeated self-injury, serious aggression toward others, tantrum behavior occurring consistently outside the home, and markedly difficult recovery [3].
When it comes to identifying ASD or ADHD, the pattern of social communication development is a more discriminating signal than the form or intensity of tantrums [4]. If something feels off, bring it to your pediatrician before running a comparison against an average — the cost of consulting is low, and the value of acting early is not.
References
- Wakschlag LS, Choi SW, Carter AS, et al. Defining the developmental parameters of temper loss in early childhood: implications for developmental psychopathology. J Child Psychol Psychiatry. 2012;53(11):1099–1108. doi:10.1111/j.1469-7610.2012.02595.x. PMID: 22928674.
- Potegal M, Davidson RJ. Temper tantrums in young children: 1. Behavioral composition. J Dev Behav Pediatr. 2003;24(3):140–147. PMID: 12806225.
- Belden AC, Thomson NR, Luby JL. Temper tantrums in healthy versus depressed and disruptive preschoolers: defining tantrum behaviors associated with clinical problems. J Pediatr. 2008;152(1):117–122. doi:10.1016/j.jpeds.2007.06.030. PMID: 18154912.
- Zwaigenbaum L, Bauman ML, Fein D, et al. Early identification of autism spectrum disorder: recommendations for practice and research. Pediatrics. 2015;136(Suppl 1):S10–S40. doi:10.1542/peds.2014-3667C. PMID: 26430168.
- Robins DL, Casagrande K, Barton M, Chen CA, Dumont-Mathieu T, Fein D. Validation of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics. 2014;133(1):37–45. doi:10.1542/peds.2013-1813. PMID: 24366990.