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Johns Hopkins Health - Too Much of the Terrible Twos?

Winter 2015
Issue No. 27

Too Much of the Terrible Twos?

Date: January 6, 2015

crying toddler

If you have a toddler, you’ve seen your share of all-out temper tantrums, complete with red face, shouting and uncontrollable sobs. Alas, it’s a normal part of growing up. To a point.

When these outbursts become so frequent and so severe that they affect your child’s daily life, it is time to get help, says Vanessa Howells, M.D., a child psychiatrist who leads the Johns Hopkins Preschool Clinical Programs. And if your child’s preschool teacher or day care provider expresses concern, take the warnings seriously, she says.

Howells treats children who have long and aggressive tantrums, often lasting up to 45 minutes. These behaviors may be influenced by attention deficit hyperactivity disorder, anxiety, speech-language delays, issues at home, or autism.

The program’s outpatient therapy begins with an evaluation by a licensed clinician, which includes a thorough psychosocial history and a diagnostic evaluation based on reported and observed symptoms and behaviors. Referrals are often made to the team speech-language therapist, occupational therapist and/or psychologist. The goal is to identify any speech, motor, sensory or cognitive issues that may be affecting a child’s functioning.

Treatments vary. For example, a child with sensory issues may need to skip music time at preschool and instead might find comfort in a weighted blanket. In all cases, it’s important to help parents adjust their expectations and manage tantrums, Howells says. “Parents can learn ways to help their children,” she says.

Expert Analysis

Therapy programs can be beneficial for preschoolers—and their families. Children needing a clear diagnosis, behavioral stabilization or a medication trial may be seen in the Johns Hopkins Therapeutic Learning Center for daily treatment with a parent or a caregiver. In addition to activities seen in preschools, such as craft projects and circle time, the center offers group and family therapy. While the children play, experts carefully assess and encourage socialization, verbalization and development of skills. The center also provides a daily parents group focusing on managing behaviors, stressors, coping and parent-child attachment.

For more information, appointments or consultations, call 877-546-1872.

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