Terrible Twos Research Articles

Making it "EASI" for pediatricians to determine when toddler tantrums are "more than the terrible twos": Proof-of-concept for primary care screening with the Multidimensional Assessment Profiles-Early Assessment Screener for Irritability (MAPS-EASI).

Up to 20% of youth have impairing mental health problems as early as age 3. Early identification and intervention of mental health risks in pediatric primary care could mitigate this crisis via prevention prior to disease onset. The purpose of this study was to establish the feasibility and acceptability of implementing a brief transdiagnostic screening instrument in pediatric primary care for irritability and corollary impairment. Five pediatric clinicians in a Midwest clinic implemented the Multidimensional Assessment Profiles-Early Assessment Screener of Irritability (MAPS-EASI) for toddlers (24-30 months) and their families. MAPS-EASI (psychometrically derived from the well-validated MAPS-Scales) includes six items (scored 0-5) about symptoms (e.g., tantrums, grumpy mood), context, and frequency and two items (scored 0-3) assessed impairment. Positive screens (MAPS-EASI ≥ 5 plus impairment ≥ 2) were referred to an evidence-based parenting intervention. We assessed reach and outcomes of MAPS-EASI screening. Follow-up interviews with clinicians assessed perspectives on irritability screening and MAPS-EASI implementation. Of 201 eligible families, 100 (49.8%) completed the screener for a 24- or 30-month well-child visit. Mean MAPS-EASI scores were 5.8 (SD = 3.2), mean impairment scores were 0.9 (SD = 0.9), and 24 (24.0%) screened positive. Clinicians indicated that irritability screening for toddlers was aligned with their prevention-oriented, developmentally based practice. MAPS-EASI had face validity and increased clinician decision-making confidence. Finally, clinicians identified barriers and facilitators to large-scale implementation. MAPS-EASI proved to be feasible and acceptable in pediatric primary care. Further tailoring will be needed as the MAPS-EASI processes are scaled out to new contexts and populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Making It “EASI” for Pediatricians to Determine When Toddler Tantrums Are “More Than the Terrible Twos”: Proof-of-Concept for Primary Care Screening With the Multidimensional Assessment Profiles–Early Assessment Screener for Irritability (MAPS-EASI)

Supplemental Material for Making It “EASI” for Pediatricians to Determine When Toddler Tantrums Are “More Than the Terrible Twos”: Proof-of-Concept for Primary Care Screening With the Multidimensional Assessment Profiles–Early Assessment Screener for Irritability (MAPS-EASI)

Developmental Trajectories of Irritability across the Transition to Toddlerhood: Associations with Effortful Control and Psychopathology.

Preschool-age irritability is a transdiagnostic marker of internalizing and externalizing problems. However, researchers have generally been reluctant to examine irritability within a clinically salient framework at younger ages due to some instability during the "terrible twos" period. Developmentally sensitive and dense measurements to capture intra- and inter-individual variability, as well as exploration of developmental processes that predict change, are needed. This study aimed to examine (1) the trajectories of irritability at the transition to toddlerhood (12-24months of age) using repeated measures, (2) whether effortful control was associated with individual differences in level and growth rate of irritability, and (3) whether individual differences in the irritability trajectories were associated with later psychopathology. Families were recruited when the child was 12-18months old (N = 333, 45.65% female). Mothers reported on their toddler's irritability at baseline and every two months until a follow-up laboratory assessment approximately one year later. Effortful control was measured at baseline. Clinical internalizing/externalizing symptoms were measured at the follow-up assessment. Hierarchical linear models revealed an increase in irritability over time, yet there was relatively little within-person variability. Effortful control was only associated with the level of irritability and not growth rate. Level of irritability was associated with internalizing, externalizing, and combined symptoms, but growth rate was not. Findings suggest intraindividual stability in irritability at the transition to toddlerhood and the possibility that screening for elevated irritability at toddler age is meaningful.

The terrible twos: How children cope with frustration and tantrums and the effect of maternal and paternal behaviors

Experimental Frustration Procedures with 158 children (15-39months) of two-parent families were conducted, with each parent separately involved. We examined diverse characteristics of children's frustration and focused on specific behaviors of how children coped and parents supported them. In addition, external observers measured child attachment security (via Attachment Q Sort) toward the mother and the father during two home visits. Children with high attachment security became frustrated later and for a shorter time, and fathers, as compared to mothers, relieved these frustration patterns and reduced them. Although 22.2% children exhibited intense frustration responses up to tantrums, levels remained unaffected by child gender, but decreased with child age. Time-lag analyses revealed that children's self-comforting behaviors reduced frustration responses only by around 20%, but self-distracting (in younger children) and pretend-playing (in older children) by around 50% and 70%. Of the parent behaviors, demonstrating reduced children's frustration by up to 40% whereas distracting and reframing by around 60% (mothers) and 80% (fathers). In general, mothers tended to protect the child from distress, whereas fathers assisted the child in coping with frustration. However, if mothers soothed and fathers encouraged, children's frustration intensified.

Talking Tots and the Terrible Twos: Early Language and Disruptive Behavior in Toddlers.

The goal of this article is to investigate the association between the 2 most commonly reported parental concerns about young children-disruptive behavior (e.g., irritable, aggressive, and noncompliant behaviors) and language delay in toddlers. To test for salient subgroup differences, individual differences by the sex of the child and family poverty status were examined. Participants included 1259 mothers of children between 18 and 36 months of age. Mothers completed questions about their child's language development and disruptive behavior. Information regarding poverty status as well as child age and sex were also collected. Stronger language skills were associated with fewer disruptive behaviors for children between 18 and 36 months of age. This negative association was stronger for females than for males (b = -0.243; t[1251] = -3.555; p < 0.001) and stronger for children living in poverty than for those above the poverty line (b = -2.04; t[1251] = -2.531; p = 0.011). Findings from our study suggest a developmental co-occurrence pattern that begins at a very early age. Individual differences suggest that there is substantial heterogeneity in these patterns; longitudinal investigation is needed to uncover causal pathways and underlying mechanisms. Awareness of the association between these 2 developmental domains, about which parents frequently express concerns, is critical to maximizing early detection and intervention.

Can Infant Temperament Be Used to Predict Which Toddlers Are Likely to Have Increased Emotional and Behavioral Problems?

ABSTRACTThe 'terrible twos' are often associated with increased temper tantrums, noncompliance and aggression. Although some expression of these behaviors is normal, whether early individual factors can predict which children are most at risk of frequent or prolonged emotional and behavioral problems is of increasing interest. The current study of 6,067 toddlers found that their 9 month scores on a new brief measure of temperament—the Infant Behavior Questionnaire – Revised - Very Short Form (IBQ-R-VSF)—were associated with both difficult behaviors and prosocial behaviors at age 2, measured using a preschool version of the Strengths and Difficulties Questionnaire. Controlling for a range of demographic, maternal characteristics and contextual factors, we found that infants higher on the trait Negative Emotionality and/ or lower on Orienting Capacity and Fear were more likely to develop hyperactivity, emotion, peer and conduct problems and less likely to demonstrate pro-social behaviors at two years of age. Temperament aged 9 months explained an additional 1 - 6 % of the variance in toddler behavior. These findings suggest that infant temperament is associated with the behavior strengths and difficulties of 2-year-olds and provide the first longitudinal validation of the new 5-factor structure of the new IBQ-R-VSF.

Terrible Twos or Early Signs of Psychopathology? Developmental Patterns in Early Identified Preschoolers With Cochlear Implants Compared With Hearing Controls.

Cochlear implants (CIs) have dramatically improved the lives of children who are deaf or hard of hearing; however, little is known about its implications for preventing the development of psychiatric symptoms in this at-risk population. This is the first longitudinal study to examine the early manifestation of emotional and behavioral disorders and associated risk and protective factors in early identified preschoolers with CIs compared with hearing peers. Participants were 74 children with CIs and 190 hearing controls between ages 1 and 5 years (mean age, 3.8 years). Hearing loss was detected using the Newborn Hearing Screening in The Netherlands and Flanders. Parents completed the Early Childhood Inventory-4, a well-validated measure, to evaluate the symptoms of DSM-IV-defined psychiatric disorders, during three consecutive years. Language scores were derived from each child's medical notes. Children with CIs and hearing controls evidenced comparable levels of disruptive behavior and anxiety/depression (which increased with age in both groups). Greater proficiency in language skills was associated with lower levels of psychopathology. Early CI and longer duration of CI use resulted in better language development. In turn, higher early language skills served as a protective factor against the development of disruptive behavior symptoms. This longitudinal study uniquely shows that improvement in language skills mitigates the development of early signs of psychopathology. Early identification of hearing loss and CIs help children improve their language skills.

From The Invisible Thread

from The Invisible Thread Rick Hilles (bio) As I write this, a team of Egyptologistsseems on the brink of unearthing Nefertiti'stomb (behind the far wall of Tutankhamun's,allegedly) and the less ancient but no less vexing disappearance: Peter the Great'sAmber Room (which vanished in the last daysof The Third Reich) seems ready to reappear,though it will be weeks, months, before we know what the Polish vault contains; among that era'sunsolved mysteries is one I've tried to solve for years,the question arising like a serpent's head from a story told by a Shoah survivor, my childhood physician,who somehow withstood seven concentration camps*to tell this story, written down nowhere else but here: where I begin. But how to take you backinside that time? My small town, Ohio,where just an hour away, in Seven Hills,retired Ford mechanic John Demjanjuk— [End Page 105] found guilty of being "Ivan the Terrible,"the notorious Nazi guard of Treblinka,a verdict overturned on evidence withheld—that summer, new charges are filed against him. Reading Robert Jay Lifton's two-decade studyThe Nazi Doctors, which tells how SS doctorsmade underling physicians complicit in atrocities, forcing them to finger prisoners "unfit for work."As the man I'd not seen in two decades revealed:"You learned to say—what wasn't a death sentence!" When asked how long an inmate needed to recover—even from a broken limb—he'd say: "Two weeks."Anything more meant one-way to blue-black smoke!The retired physician had been a kind of tutelary spirit of our home through my childhood and adolescence.Mom loved to tell the story—we always asked her totell it again—of bringing me, in my terrible twos,with my then infant brother. (She couldn't get a sitter!) And how, when he was done examining me, he said:"Well, since the baby's here, I'll take a look at him!"He opened our blue-eyed boy's near constant grin only to discover "an ulcerated case of strep throat—fatal in one so young." Mom, horrified, said: "The babyhasn't cried—or given any clue"—a Stoic even then. Then he gave Mom a choice: she could take the babyto the hospital, or she could keep him at homeand bring him in to see the good doctor every dayand he'd administer the remedy to the baby himself. [End Page 106] "And eef anythingk happen—Day or thee Night—you cole mee, I put on my Pants & thee Shoozeand I come right over to thee house, immediately!"Almost as soon as the good doctor's words vaulted his lips, he became our presiding household spirit.But now, seeing him over three decades later,our shadows lengthening on his walls, behind us the light of sunset hitting the big picture window,turning the white walls red-orange, our faces flushed,I wondered: Might other, darker truths now surface? Reading Nazi Doctors, my eyes lit on one source—a Jewish physician—quoted only as "Tadeusz S"—could this possibly be our good doctor, I'd wondered?"Yes!" he cried, "that's me!" but there were statements attributed to him, he said, "that weren't quite right."(I'll have to leave these corrections for another time.)Then he spoke of SS holding batons over windpipes."There was no saying no—or you'd get the next bullet!" But how to tell you of this next rumbling fault lineI stood on in his company—the now octogenariangeneral practitioner who'd retired mere months after prescribing for Mom's recurring migraines a medicine"contraindicated" by her psychotropic trove of meds,*which landed her in a psych ward. Then a coma. [End Page 107] My first semester of grad school, studying English,of all the classes, I chose to drop Modern Poetry.(We'd barely begun to scale the walls of Roethke.)I'd then learn of a woman, the mental hospital's near lifelong resident, a ward of Massillon State,who only a week or so before had decked Momwhen...

The Fourth Reich: Ishmael's Reed's The Terrible Twos and the Triumph of Celebrity Culture

AbstractDonald Trump's rise to the U.S. presidency was foretold in many 20th century works of dystopian fiction as well as Western Marxist scholarship written during and after the Nazi era. The most prescient modern dystopian novel, Ishmael Reed's The Terrible Twos (1982), has much in common thematically with earlier American dystopian fiction while also sharing the bleak vision of U.S. mass (media) culture postulated by Frankfurt School theorists such as Theodor Adorno and Max Horkheimer in The Dialectic of Enlightenment (1947). But Reed's novel diverges dramatically from these earlier writings, whether fictive or scholarly, through its farcical and absurdist postmodernist depiction of a future neo‐fascist America in which popular (media) culture reigns triumphant even as spaces of resistance take shape amid the seemingly overdetermined ideological and cultural landscape.

Debating the future of the ‘Responsibility to Protect’: the evolution of a moral norm

R2P is neither a dying norm nor a functioning roadmap towards more effective interventions. As argued by Pinar Gozen Ercan, R2P is a moral norm that is a useful tool, but its lack of effectiveness mirrors the currently dysfunctional international intervention regime which is in need of dramatic reform. Although the first few chapters of Ercan's book may be familiar to those immersed in R2P debates, they offer a solid backdrop for the reasoning behind the argument for the need for larger UN reform. Against this, the second part of the book painstakingly traces the institutionalization of R2P and discusses some of the relevant reports and cases. However, it is the final section of the book, an examination of current proposals for change and a way forward, that is the most original and offers insightful contributions for scholars and practitioners. The United Nations, and specifically the Security Council, is notably ill-equipped to address the most difficult conflicts of our time. As the book observes, the current emphasis on prevention attempts to bypass the need for change. Ercan argues that ‘R2P lite’, or narrowing the scope of R2P and the emphasis on prevention, is unrealistic and faint-hearted (p. 148). The fundamental problem is the divided Security Council. Ercan depicts the Security Council as a ‘toddler going through its “terrible twos” and into its “horrible threes” … when the interests of the members of the Council are not affected or when there is something not to like, no one (or no grave humanitarian concern) can make it do what ought to be done’ (p. 147).

On the Challenge of Maladaptive and Impulsive Aggression in the Clinical Treatment Setting.

[Author Affiliation]Daniel F. Connor. Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut.Address correspondence to: Daniel F. Connor, MD, Department of Psychiatry/MC 1410, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-1410, E-mail: dconnor@uchc.eduClinicians working in the mental health setting have long been challenged by children and adolescents with many different types of psychiatric disorders who are often referred for treatment because of frequent, intense, severe, and maladaptive impulsive aggression. This type of clinical presentation occurs commonly in every type of pediatric mental health treatment setting: Outpatient, inpatient, residential, and/or partial hospitalization. Impulsive aggression is often chronic, but waxes and wanes in response to multiple shifting internal and external factors, and may be extremely stressful for parents and other family members. Although normative in the young toddler and preschooler (the terrible twos), with development, the child begins to achieve emotional and behavioral competence and regulation such that by school entry aggression becomes increasingly verbal and not physical. With school entry, aggression is increasingly associated with understandable and recognizable antecedents, goals, and objectives.Maladaptive aggression is defined as behavior with intent to harm another person; is elicited by minimal or routine environmental cues; is less linked to recognizable and understandable social goals; is characterized by its explosive nature, high frequency rate, and severe intensity; and is associated with significant functional impairment for the child and the child's family (Connor 2002). Impulsive aggression is behavior that occurs rapidly without a delay (a short fuse) that would otherwise allow the child to consider an alternative and more adaptive response to frustration or perceived threat (Jensen et al. 2007). Impulsive aggression is driven by low frustration tolerance or fear of threat (Dodge and Coie 1987).Maladaptive and impulsive aggression in psychiatrically referred children and adolescents is common, denotes illness severity not illness specificity (Connor and McLaughlin 2006), and represents a significant public health problem with high societal costs (Foster and Jones 2005). Aggression is a major cause of referral to outpatient and inpatient child and adolescent psychiatry services (Bambauer and Connor 2005) and emergency psychiatric services (Gabel and Shindledecker 1991), predicts longer stays in psychiatric hospitals, and predicts rehospitalization in youth discharged from inpatient settings (Blader 2004). It is associated with child and adolescent psychiatry staff injury (Cunningham et al. 2003), is associated with off-label pediatric antipsychotic use (Olfson et al. 2015), and predicts combined pharmacotherapy (polypharmacy) use independently of diagnosis in referred children (Connor et al. 1997). Youth with moderate to severe impulsive aggression with and without comorbid attention-deficit/hyperactivity disorder (ADHD) are a major challenge for clinicians working in the clinical setting, as few evidence-based treatments are currently available that address these issues.Progress in developing effective treatments for impulsive aggression has been slowed by the multiple ways of clinically identifying and characterizing the aggressive child. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM 5) diagnoses such as oppositional defiant disorder (temper tantrums), conduct disorder (physical aggression), bipolar disorder (aggression and irritability), intermittent explosive disorder (explosive aggression), and/or disruptive mood dysregulation disorder (irritability and temper tantrums) all may have aggression as part of their symptom criteria, yet are nosologically construed as separate and non-overlapping psychiatric diagnoses (American Psychiatric Association 2013). …

Childhood in a Sri Lankan Village. Shaping Hierarchy and Desire By Bambi L.Chapin. Brunswick, New Jersey and London: Rutgers University Press, 2014 ISBN 978‐0813561653, 211 pp, £25 (pb)

Childhood in a Sri Lankan Village is a beautifully written account of childhood, child rearing and the daily lives of children from infancy through marriage and adulthood in a small community outside Kandy. The book examines how local child rearing practices and ethno-theories of parenting have an impact on the ways in which children are treated and how they subsequently behave, and the author discusses whether certain developmental stages such as ‘the terrible twos’ are universally significant. Chapin examines the everyday practices of these children, looking at how they are fed, where they sleep and how they interact with their mothers, fathers and others in the wider community and captures the daily, often unnoticed, activities that are central to child rearing. Woven into this is a comparison with Western (particularly North American) ideas about child rearing and adult/child relationships and the contrast between the two is both fascinating and revealing. Here, childcare practices are not simply the mechanical processes of keeping the young fed, clothed and warm but are understood in their widest symbolic and cultural sense and used to reveal deeper patterns of meaning. The links between the subtle, intimate emotions of infancy and the more public and sometimes conflicting ideas of shame, envy and desire that children have to contend with as they grow older are superbly developed and, on finishing this book, written after several periods of fieldwork conducted over a decade, the reader is left feeling they too have watched these children grow up and seen them turn from infants for whom nothing is denied to the shy, self-effacing people so prized in this community. How this change occurs and how children are actively shaped and disciplined, even when there appears to be little overt socialisation, are explored and explained in depth. The role of hierarchy is central to the book and the discussion of the problems involved when trying to do research with children as equals, when this is not how they are seen locally, is very well done. I enjoyed her discussion of the difficulties of trying to interview children directly in a culture which emphasises modesty, subordination and shyness in children and where children were reluctant to take part in her research. Chapin comes to understand that there are many other forms of agency and to be junior or subordinate in a relationship is not necessarily to be powerless. Running alongside the account of how children in Sri Lanka become socialised is a discussion of the author's own process of unlearning and of starting to see her own parenting practices through the eyes of others. One of the books’ greatest strengths is Chapin's own presence within it and her frank descriptions of how her perceptions of herself as a mother were called into question and how she came to understand how her performances of motherhood were seen by others. She is frank about her own sometimes laboured path to understanding what was occurring and this book should be read by everyone interested in what really happens during fieldwork. It should also be read as a corrective to almost all childcare manuals which promote the ‘right’ way to parent children, based on profoundly ethnocentric notions of children's role in society and ‘proper’ behaviour in childhood. This is a nuanced and subtle book which places ethnographic description at its heart, but which draws on work from developmental psychology (particularly attachment theory) and from childhood studies. I found it enthralling: while it is theoretically sophisticated it is also completely jargon free. It should be of interest to all anthropologists and psychologists, whatever their areas of specialisation, as well as to anyone interested in the mechanics of fieldwork and the sometimes painful internal transformations that are the mark of the good social scientist. It is also a wonderful read which will inspire any student, practitioner or academic interested in childhood to want to carry out similar research and write it up so engagingly.

Sophie’s Terrible Twos by Rosemary Wells (review)

Reviewed by: Sophie’s Terrible Twos by Rosemary Wells Amy Atkinson Wells, Rosemary. Sophie’s Terrible Twos; and illus. by Rosemary Wells. Viking, 2014. [32p]. ISBN 978-0-670-78512-4 $16.99 Reviewed from galleys R 2-4 yrs. It’s Sophie’s second birthday, and the terrible twos are right on schedule. She doesn’t want to wear her pink dress (“No pink!”), her new fairy wings won’t fly, and her breakfast blueberry pancakes are inedible (“Sophie didn’t like to eat two things mixed together”). Luckily for both Sophie and her increasingly vexed parents, Granny knows just what to do. In this charming return appearance of her latest rodent heroine, Wells captures the good, bad, and ugly of being a two-year old with accurate specifics and amusing readaloud phrasing (“I know someone who has turned the corner onto Grumpy Street,” says Sophie’s mother). Watercolors, ink, and gouache lend themselves well to contained but highly detailed scenes, where the personalities of central characters and mere passersby alike vividly emerge, particularly through their nuanced sartorial choices. Wells’ sweet but smart drawings flesh out the well-paced text and provide additional humor, as when Sophie’s blocks stray into the page gutter during one of her temper tantrums. The size and detail of the pictures make this a good lap read, with plenty to talk about with those young readers who will sympathize with Sophie and covet her winning birthday present—in a lovely nod to Max and his wolf suit, a sabretooth tiger costume that displays the wild thing within every toddler. [End Page 384] Copyright © 2014 The Board of Trustees of the University of Illinois

Toddler Fatalities: The Terrible Twos

The majority of childhood deaths investigated by medical examiners and coroners are under the age of one, and medical examiners and coroners are well-versed in the challenges involved in investigating these fatalities. As infants mature to toddlers, there is a paradigm shift with a decrease in both the number of fatalities and the number of undetermined causes of death. A subset of these, however, remain undetermined, causing frustration for both the parents and medical examiner/coroner. In an effort to facilitate a differential diagnosis in these cases, death certificate data from the New York City Office of Chief Medical Examiner for deaths from one to four years of age over a five year period was examined. Of the 230 deaths investigated by the New York City Office of Chief Medical Examiner, the manner was natural in 39%, accident in 32%, homicide in 19%, therapeutic complication in 5%, and undetermined in 5%. Diligent scene investigation and a thorough histologic examination are key components to the investigation. While the lack of a cause of death in a portion of these undetermined deaths is due to limits in current postmortem techniques, a differential diagnosis for these deaths should include channelopathies, seizure disorders, and accidental injuries involving asphyxial mechanisms and inadvertent drug/toxin ingestion.

“Terrible Twos” and “Terrible Teens”: The Importance of Play

In the process of individuation, toddlers and their adolescent parents share similar dynamics; that is, both are involved with anxiety-laden preoccupations about difference and separateness and about bodily changes, loss of control, and containing aggression. Both experience internal struggles between emotional vulnerability and a sense of invincibility; both make fierce self-assertive bids coupled with a powerful need for guidance. When synchronized, such teen-toddler similarities can create a bond of mutual excitement; when their intentions clash, however, a terrible battle of wills erupts, fuelled by furious frustration or intense despair. It is suggested that play can provide an essential bridge between teen parent and toddler, enabling each to work through his/her anxieties and passionate reactions of love and hate. Joint play increases reciprocal understanding. However, a teen deprived of play in childhood, or one who resents her/his own playtime being curtailed by parenthood, may become intrusive or controlling, projecting disowned aspects of her/his self into their mutual play. The parent thus breaks the play frame, creating confusion in the child between pretence and reality. By providing a safe space to explore conflictual feelings through joint play, thoughtful practitioners can foster better emotional awareness and mentalization in troubled young parents and their toddlers.

Opposition-Defiance in the Second Year of Life: A Population-Based Cohort Study

Recent epidemiological evidence suggests that even in the midst of the "terrible twos," frequent/severe oppositional-defiant behaviors (ODBs) are not common among toddlers and hence may be indicative of a significant opposition-defiance problem. The main objective of this study was to obtain a maximum likelihood estimate of the proportion of toddlers in the general population who are reported to exhibit ODBs on a frequent basis, and to test for gender differences therein. Data came from The Québec Longitudinal Study of Child Development, a survey of a representative birth cohort of children from the Canadian province of Québec. Multigroup latent class analysis was used to distinguish between toddlers who exhibit ODBs on a frequent basis and those who do so only occasionally or not at all. The results show that 12.4% of 17-month-old boys and girls exhibit ODBs on a frequent basis. Further, the results show a strong positive association between opposition-defiance and physical aggression early in life, with a great majority of physically aggressive toddlers exhibiting ODBs on a frequent basis. In contrast, the results show that only a minority of toddlers who may be experiencing a significant opposition-defiance problem exhibit physically aggressive behaviors on a frequent basis.

Changing cognitions in parents of two‐year‐olds attending Scottish Sure Start centres

The study examined how preschool intervention programmes set up by three Scottish local authorities changed parents’ cognitions. Quantitative parent outcomes were measured using Parenting Daily Hassles Scales (N = 88). A matched comparison group of parents (N = 55) recruited from the same areas of disadvantage but whose children did not attend the intervention programmes also completed questionnaires. Qualitative outcomes were evaluated using semi‐structured interviews (N = 30). A significant group × time interaction effect was found for daily hassle cognitions, Parenting Task–Intensity, Challenging Behaviour–Frequency and Challenging Behaviour–Intensity, with comparison group parents showing an increase in their experience of hassles during the ‘terrible twos’ compared with intervention group parents. Complementary qualitative data indicated that intervention group parents had gained valuable new insights into their children’s behaviour, changing how they thought about their role as parents and their behavioural and developmental expectations of their children. Implications for parental engagement in preschool programmes are discussed.

Providing Developmentally Based Care for Toddlers

ediatric patients are not just small adults; each child is a unique individual. Even during the “terrible twos,” as many refer to the toddler years when children are actively engaged in learning about their world, however, similarities do exist in perioperative care based on the child’s developmental level. From a developmental perspective, toddlerhood lasts from a child’s first birthday to his or her third birthday. It is a time during which the child throws temper tantrums and demonstrates negativism, passionate exploration, and assertiveness. Parenting a toddler often is demanding and challenging. The prospect of a surgical procedure creates additional stress for the child as well as his or her family members, and this may exacerbate a toddler’s outbursts and hinder parental coping mechanisms. Developmental theories offered by Freud, Piaget, and Erikson can help provide a theoretical foundation for understanding children at each psycho social and cognitive level (Table 1). Nurses who understand these theories may be better equipped to provide holistic, family-centered care. Nurses also must be aware that all humans have the potential to regress developmentally when under stress. The developmental theories presented in this column are intended to help nurses care for patients at this stage of development; if a toddler does regress, developmental interventions that are appropriate for infants should be considered.

The not so terrible two’s

Do you fear the day when the children in your care move into their thirteenth month and enter that period often referred to as ‘the terrible twos’? You really have no need to, as Marlene Rattigan explains.

An Open Letter to Lou Wynne

Dear Lou, You and I have spoken often about the damage done to the field of psychology because of its uncritical acceptance of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its imitation of psychiatry. We've discussed how mainstream psychiatry's insistence that problems in living are mental illnesses explained by chemical imbalances in the brain or other biological factors has produced a field best described as a pseudoscience and a humbug. Finally, we have agreed that psychiatry's reliance on powerful brain-altering methods including ECT and various chemicals as treatments has produced enormous damage and very little real help for those seeking better relationships, more effective ways of living, and the means to be happier, healthier, and more creative people. However, I've just come across a story that reveals just how dangerous, nonsensical, and flat out immoral the mental health field has become because of its reliance on and uncritical acceptance of psychiatry's medical model. I think it is high time that we attempt to redirect our field's basic ideas concerning humanity and the means we employ to help people change their behavior. I feel strongly that we must employ concepts that are totally free of all vestiges of psychiatry and convince as many professionals to join with us in the transformation of the field. The story that has so deeply affected and outraged me involves the death of 4-year-old Rebecca Riley who, at the age of 2, was diagnosed as having bipolar disorder and placed on a cocktail of chemicals including clonodine, Depakote, and Seroquel. It appears that Rebecca revealed "symptoms" of a serious mental illness including temper tantrums, mood swings, and being disorganized. It turns out that Rebecca's parents were able to obtain large numbers of these pills, none of which have been approved for children, and keep her heavily drugged with them for the final 2 years of her short life. Her teachers, relatives, and other caretakers were fully aware that she was like a rag doll but were unwilling and/or unable to interfere with this process. The parents have now been charged with first-degree murder, and while the treating psychiatrist has been criticized by some for being aggressive in her treatment of Rebecca and had her license temporarily suspended, her colleagues support her and her attempts to regain her former status. It seems to me that this tragedy represents a new low in the failure to think about real human beings living actual lives in the context of real families. It is also a failure to account for the natural developmental processes that define individuals at various stages of their development. Just how could a child psychiatrist not remember that Rebecca was going through what we refer to as the terrible twos? What level of organization do we require of a 2-year-old, and what is the standard to diagnose? Have you ever known a 2-year-old who would not be likely to weep hysterically one moment and be totally happy the next? Finally, it seems to me to be a total failure of what might be called common sense when trying to understand the behavior of this baby! I think what incenses me as much as anything else is our field's collective failure to rid itself of the use of make-believe illnesses that are in reality bad names used to judge and condemn rather than to understand and explain. Until this is done, psychiatry and its imitators, of which clinical psychology is one, and the huge pharmaceutical companies that provide the chemical handcuffs used to control children will continue to damage individuals and our society as a whole. We will continue to have to fight TeenScreen and other government-sponsored programs that seek to evaluate every man, woman, and child in the United States for mental illness, and to watch as our legal system is further degraded by the so-called expert witnesses who see to it that real criminals go free while those labeled mentally ill are incarcerated without trials and treated against their will. …