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Extreme bedtime refusal is a type of tantrum.

Bedtime threats of self-harm, suicide, school refusal, and running away are tantrum behaviors.

Bedtime tantrums are best treated by strategic inattention.

Failing to give attention to tantrums at bedtime helps your child learn to go to sleep without your help.

This is Part 2 of a series. Read Part 1 here.

Sometimes the simpler strategies I mentioned in Part 1 of this post are not enough. Perhaps your kid yells for hours when you try to make them stay in their room, or they keep banging on your door, or they threaten self-harm, run away, refuse to go to school the next day, or even threaten suicide? What then do you do? These behaviors can be overwhelming. You may even wonder if you should take your child to the emergency room for possible psychiatric hospitalization. Doesn’t this mean that something is terribly wrong when they behave this way?

The short answer is both “Yes” and “No.” “Yes” because your child has not developed or has lost their ability to self-regulate and put themselves to sleep, and “No” because they are having a tantrum, which is almost always a situation that can be managed by inattention, even if your child has a mental health condition, neurodivergence, or developmental delay. How you handle these challenging behaviors makes the difference. You might not realize it, but you can learn to do what inpatient and residential programs do and prevent the need for these services.

Recategorize bedtime yelling, crying, hitting, and threats to........

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