Significance of extreme temperament in infancy for clinical status in pre-school years. II: Patterns of temperament change and implications for the appearance of disorders

Temperament and Problem Behaviour during Early Childhood

Some evidence exists for the phenotypic association of problem behaviour in early childhood with temperament in infancy, but little is known about the genetic and environmental mechanisms mediating this association. At the ages of 14, 20, 24, and 36 months, mothers of twins completed the Colorado Childhood Temperament Inventory (CCTI; Buss & Plomin, 1984; Rowe & Plomin, 1977). At age 4, problem behaviour was assessed using maternal reports on the Child Behavior Checklist (CBCL/4-18; Achenbach, 1991). The temperamental trait of Emotionality at all four prior age points correlated significantly with the CBCL Total Problem Score at 4 years as well as with the broad-band groupings of Internalising the Externalising. In addition, Shyness at all four ages correlated significantly with the broad-band grouping of Internalising. Longitudinal behavioural genetic analyses indicated that these phenotypic predictions from early temperament to later behaviour problems are largely due to genetic factors.

Influences of biological risk at birth and temperament on development at toddler and preschool ages

PURPOSES

This study aimed at investigating: (1) the effects of temperament and biological risk at birth on various developmental domains at toddler and preschool ages; (2) the interaction effects of the biological risk and temperament on development. Participants One hundred and ten full-term and 98 preterm children without significant physical or developmental disabilities and consisting of various biological risks were examined at toddler age (18-36 months) and preschool age (51-67 months).

METHODS

The Neonatal Medical Index was used to classify the biological risk level. Parental reports on the Chinese Toddler Temperament Scale at toddler age were collected and the temperament (easy, intermediate and difficult) of each child was assigned according to local norm. The Comprehensive Developmental Inventory for Infants and Toddlers was used for assessing child development at toddler and preschool ages. Other family variables were also collected as possible confounders for child development. Two-way ancova was conducted to analyse the predictability of biological risk and temperament, by controlling the potential family variables on child development.

RESULTS

At toddler age, higher biological risk had significant adverse effects on both the Perceptual-motor developmental quotients (DQs) (F(1,201)= 19.4, P < 0.001) and Social-adaptive DQs (F(2,200)= 22.5, P < 0.001), while easy temperament had positive effects only on the Social-adaptive DQs (F(2,200)= 7.7, P < 0.01). At preschool age, none of the two factors had effects on DQs of the Comprehensive Developmental Inventory for Infants and Toddlers. There were no significant interactions between biological risk and temperament on DQs at both ages.

CONCLUSION

The biological risk and temperament affected child development at toddler age but not at preschool age. No interaction of biological risk and temperament effects on the child development at toddler age existed. The effects of biological risk and temperament on child development were temporary for the children with relatively low biological risk.

Early risk factors and pathways in the development of early disruptive behavior problems

This study examined risk factors from infancy associated with the development of preschool disruptive behavior problems across child, parent, and sociodemographic domains. Risk factors that consistently were associated with the prediction of disruptive behavior at age 5 years included disorganized attachment classification at 12 months, and maternal personality risk and child-rearing disagreements during the second year. In addition, infants with disorganized attachment status at 12 months whose mothers perceived them as difficult in the second year showed significantly higher aggressive problems at age 5 years than those with only one of the two risk factors present. When pathways leading to clinically elevated aggression at age 5 were explored, infant disorganized attachment status, maternal personality risk, and child-rearing disagreements demonstrated equivalent predictive validity as child aggression assessed at age 3 years.

A developmental and clinical model for the prevention of conduct disorder: The FAST Track Program

This paper presents a developmental and a clinical model for the treatment of conduct disorder through the strategy of preventive intervention. The theoretical principles and clinical strategies utilized in the FAST Track (Families and Schools Together) Program are described. We indicate how the clinical model is derived from both our developmental model and previous findings from prevention trials. The FAST Track Program integrates five intervention components designed to promote competence in the family, child, and school and thus prevent conduct problems, poor social relations, and school failure. It is our belief that testing the effects of such a comprehensive approach is a necessary step in developing new intervention models for this population.

Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology

We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.

Temperament and physical performance in children with osteogenesis imperfecta

OBJECTIVE

Children with osteogenesis imperfecta (OI) must participate in therapy to achieve motor performance objectives. Their behavioral style may influence motor performance. For this reason, the temperament of children with types III or IV OI was assessed prospectively to 1) compare their temperament with that of nondisabled children, 2) investigate the relationship between temperament and gross motor performance, and 3) examine relationships among temperament, parental overprotection and coping, physical activity, muscle strength, and motor performance.

METHODS

Age-appropriate Carey Temperament Scales, Brief Assessment of Motor Function (BAMF), and the Vulnerable Child/Overprotecting Parents Scale were completed for 35 children 1 to 12 years old. Additional measures included the Childhood Health Assessment Questionnaire, Parent Daily Hassles Scale, manual muscle testing, Pediatric Activity Record, and a Summed Severity Score. Spearman correlations and multiple regression were used to identify and predict significant relationships.

RESULTS

Temperament of children with OI differed from age-based norms in only 1 domain: activity. Motor performance (BAMF) correlated significantly with 3 domains of temperament: persistence (r = -.48), approach (r = -.34), and activity (r =.40). Activity was also related to the ratio of head circumference to body length (r = -.45) and the number of fractures in the preceding year (r = -.35). Parents' reports of their daily hassles significantly correlated with several domains of the child's temperament. No significant relationships were identified between parental overprotection and temperament or motor performance.

CONCLUSIONS

The temperament of children with types III and IV OI does not differ from that of their nondisabled peers, with the exception of lower activity scores. Although it is considered a biological attribute, the expression of temperament, specifically activity, may be influenced by learned behaviors. Because gross motor performance is related to activity, persistence, and approach/avoidance, knowledge of an individual's temperament may enhance the child's ability to benefit from interventions to improve motor skill and activity levels.

The relationship between parental diagnosis, offspring temperament and offspring psychopathology: a longitudinal analysis

BACKGROUND

The study examines the relationship between child temperament and a diagnosis of anxiety and/or depression as an adult and what influence parent psychopathology may have on the temperament-diagnosis relationship.

METHODS

The sample consists of 151 offspring who were initially selected as being at high or low risk for major depression on the basis of the presence or absence of a lifetime history of MDD in their parents. The parents and offspring were independently interviewed with a modified version of the Schedule for Affective Disorders and Schizophrenia-Lifetime (Mannuzza et al., 1986) and completed a battery of instruments which included the Dimensions of Temperament Survey (Lerner et al., 1982). They were interviewed three times during the course of the study: Time 1, Time 2, and Time 10.

RESULTS

There is a similar distribution of offspring disorders in the same parental diagnostic groups. There is a significant temperamental difference between the offspring of parents with a single disorder in comparison to offspring of parents with comorbid disorder. The former is characterized by significantly greater levels of adaptability/approachability. Low attention span at Time 1 is significantly predictive of an offspring lifetime diagnosis of major depression controlling for ADHD in comparison to offspring with neither disorder. Greater irritability, higher activity level and lower adaptability at Time 1 were significantly predictive of offspring lifetime diagnosis of comorbid disorder in comparison to the MDD only group.

LIMITATIONS

This is a retrospective cohort study using a temperament measure from Time 1 versus lifetime diagnoses and consisting of a relatively small sample size for several of the diagnostic categories.

CONCLUSIONS

There appears to be a link between parental psychopathology and offspring temperament. The data also provide further support for the notion that comorbid anxiety and depression disorder is a distinct entity in comparison to MDD only and new evidence that it may be predicted by a specific underlying temperament profile.

Evidence for the continuity of early problem behaviors: application of a developmental model

Evidence of the continuity of early problem behaviors in young girls and boys was examined developmentally. Data were gathered on 104 mother-child dyads from low-income families when children were between 1 and 5 years of age. Difficult temperament, aggression, and noncompliance from 12 to 24 months, and externalizing and internalizing problems at 36 and 60 months, were assessed. The results provide evidence for the continuity of early behavioral and emotional problems and support for the early differentiation between internalizing and externalizing problems. Implications of the current findings for prevention efforts are presented.

A prospective study of stability and change over 2 years of affective temperaments in 14-18 year-old Italian high school students

OBJECTIVE

It is generally accepted that temperament is not entirely stable, and that it changes with development, particularly in juvenile subjects; also, some temperaments are believed to be inherently more unstable. There is a great deal of current interest in Kraepelin's thesis that temperamental dysregulation in juvenile subjects represents the constitutional foundation from which the more florid episodes of manic-depressive illness arise; the cyclothymic, hyperthymic, depressive and irritable temperaments under consideration might represent the first observable phenotypes of the genetic diathesis for bipolarity. The analyses on the temperamental attributes in juvenile subjects were undertaken within this theoretical framework.

METHOD

We evaluated 206 Italian high school students (14-18 years old) by means of a semi-structured affective temperament interview (TEMPS-I) at T0 and T1 two years later. Age, sex and psychometric properties of TEMPS-I raw scale score and weighted cut-off (as specially weighted linear combination of items) were used as predictive variables of stability.

RESULTS

Affective temperaments had a low to moderate level of stability, reaching 60% in the case of subjects with dominant cyclothymic temperament. The stability of the depressive temperament was primarily related to its weighted cut-off. The stability of the hyperthymic temperament appeared related to male sex, young age, and total scale score. Male sex represented the best stability predictor for the cyclothymic temperament as well. The group of subjects with an unstable depressive temperament showed a change toward the dominant cyclothymic temperament, whereas individuals with unstable hyperthymic temperamental traits moved on towards the dominant cyclothymic and depressive temperaments. The irritable construct was the least stable.

LIMITATIONS

The infeasibility of a multiwave design represents the main limitation in evaluating the predictors of stability. Furthermore, in the present analyses, the size of the cyclothymic subsample was small.

CONCLUSION

Our data indicate considerable fluctuation and instability in depressive and hyperthymic temperaments in mid-adolescence. The cyclothymic temperament appears to be the most stable. Interestingly, cyclothymic moodiness appears more persistent in juvenile males; likewise persistent hyperthymic traits appear more of a "male" attribute. CLINICAL AND PUBLIC HEALTH IMPLICATIONS: We submit that these sex-relevant traits could be important in the risk of developing juvenile bipolarity. Literature review indicates that clinical studies, albeit on small samples, have already provided some support for this thesis. Larger studies on epidemiological samples could be more informative from a public health perspective. A user-friendly affective temperament questionnaire, which is under development, is critical for the methodology of such studies. Our study indicates that the present version of the Akiskal-Malya questionnaire can be easily used post-pubertally. Age adjustment must be considered for younger subjects.

Temperamental origins of child and adolescent behavior problems: from age three to age fifteen

We assessed relations between early temperament and behavior problems across 12 years in an unselected sample of over 800 children. Temperament measures were drawn from behavior ratings made by examiners who observed children at ages 3, 5, 7, and 9. Factor analyses revealed 3 dimensions at each age: Lack of Control, Approach, and Sluggishness. Temperament dimensions at ages 3 and 5 were correlated in theoretically coherent ways with behavior problems that were independently evaluated by parents and teachers at ages 9 and 11, and by parents at ages 13 and 15. Lack of Control was more strongly associated with later externalizing behavior problems than with internalizing problems; Approach was associated with fewer internalizing problems among boys; and Sluggishness was weakly associated with both anxiety and inattention, especially among girls. Lack of Control and Sluggishness were also associated with fewer adolescent competencies. These results suggest that early temperament may have predictive specificity for the development of later psychopathology.

Relationship between patterns of infant temperament, child behavior ratings, and interactions during toddlerhood

This longitudinal study examined the relationship of temperament ratings during infancy, subsequent child behavior problems, and mother-child interaction. The authors considered the effect of change in mothers' perceptions of their infants' temperament during infancy (e.g., from easy to difficult or from difficult to easy) on subsequent developmental outcomes. Data from a predominantly middle-class Caucasian sample of 49 mother-child dyads are presented here. Findings revealed that children with discontinuities in 4 and 8-month ratings on the Revised Infant Temperament Questionnaire (e.g, Easy/Difficult or Difficult/Easy) had significantly higher problem and intensity scores on the Eyberg Child Behavior Inventory than those with stable temperament ratings (Carey & McDevitt, 1978a). No significant differences were found in maternal behaviors between mothers of children rated easy or difficult at 4 or 8 months. These results suggest that continuity of infant temperament ratings is an important factor for consideration in subsequent maternal identification of toddler behavior problems, and that difficult temperament alone may not predict such problems.

Longitudinal relations between temperament traits and behavioral syndromes in middle childhood

OBJECTIVE

This study tested Graham and Stevenson's 1987 hypothesis specifying links between EAS (emotionality-activity-sociability) temperament traits and behavioral syndromes of depression, hyperactivity, and delinquency in an unselected sample of 164 children in infancy and early childhood.

METHOD

Mothers completed the Colorado Child Temperament Inventory. Each mother also used the Child Behavior Checklist (CBCL) to report on her child's behavior problems after the child's completion of first grade. Scores on three CBCL scales, anxiety/depression, attention problems, and delinquent behavior, were examined in relation to the EAS traits.

RESULTS

For boys, high emotionality in infancy and early childhood was associated with high scores on both the anxiety/depression and attention problem scales. For girls, both high emotionality and low sociability predicted high scores on the anxiety/depression scale. There were no associations between EAS traits and attention problems for girls. There was little evidence for links between EAS traits and delinquent behavior for either boys or girls.

CONCLUSIONS

The results are discussed with respect to temperamental traits as risk factors for the emergence of behavior problems in childhood.

The stability of temperament by child and mother reports over two years

The stability of temperament dimensions in children, adolescents, and young adults was examined over a 2-year period through the use of multiple informants and a measure of temperament, presumably applicable to informants of all ages. The study is based on 220 children from 91 families at high- and low-risk for major depression by virtue of the presence or absence of major depression in their parents. The Dimensions of Temperament Survey was completed independently by the child and by the parents about their child. Results showed a fair to moderate stability for child self-report of temperament and moderate to good stability for mother reports of child temperament. Discussion focuses on factors that may influence the stability of temperament ratings such as age, sex, mother's depression, socialization pressures, and expectations of temperament held by others.