Temperament: Parenting, Pediatrics and Person Potential

Temperament can be described as an individual’s

underlying behavioral style and how an individual habitually responds to the events of daily living. In this article, let’s discuss background research in the field of temperament and how a knowledge of temperament can benefit parents, pediatricians and any individual.

In full disclosure, I do acknowledge there is some controversy regarding the science behind infant and child temperament. I am not a specialist in developmental or behavioral pediatrics. Rather, I am currently a newborn pediatric hospitalist at West Penn Hospital with subspecialty boards in pediatric emergency medicine and clinical interests in child abuse and critical care. I first delved into the topic of infant temperament during my 4th year Chief Residency at the Children’s Hospital of Philadelphia. Much to my surprise, one of the leading investigators on this topic was Dr. William D. Carey, one of my continuity clinic attendings, and during the three years we worked together he never referred to his pivotal role in advancing the field of behavioral pediatrics Dr. Carey believed: 1. Temperament is a reality, not just a "maternal perception.” 2. The child's temperament affects the parents and the care they provide. 3. Temperament predisposes to some physical problems. 4. Temperament predisposes to behavioral problems in childhood. 5. Temperament's impact on school performance is unappreciated. 6. Temperament affects responses to environmental stressors.

The traits of infant temperament were first characterized 1956. Researchers Thomas and Chess considered these traits 50% genetically determined and stable. My own view is that these traits are genetically hardwired and are lifelong unless altered by circumstances that disrupt neurodevelopment such as fetal alcohol/drug exposure, adverse childhood experiences, and/or traumatic brain injury. While temperament traits are hardwired, the expression of these traits can be modified. An individual’s ability to change outward expressions of

temperament requires a conscious effort to suppress temperament tendencies that would likely be a poor fit for a situation.

The following is a list of the 9 traits of temperament and a brief explanation of each: > Activity: the amount of physical motion during daily activities. > Rhythmicity: the regularity of physiologic functions such as wakefulness, sleep, and hunger. > Approach/withdrawal: the type of initial response when presented with a stimulus. > Adaptability: regardless of the initial response, the ease or difficulty of adjusting in a desirable manner. > Intensity: the energy level of responses regardless of quality or direction (think of a light bulb; a light bulb can be on all the time at 10 watts or 100 watts). > Mood: the amount of pleasant and friendly or unpleasant and unfriendly behavior in various situations on a day to day basis, the amount of time in positive versus negative thinking and behaviors. > Persistence/attention span: the length of time activities are pursued with or without obstacles. > Distractibility: the degree to which any type of stimulus may interfere with ongoing behaviors. > Sensory threshold: the amount of stimulation, whether internally or externally generated, necessary to create a response.

One of the keys to parenting and understanding child behavior is an awareness of the child’s temperament style and the child’s progression from concrete to abstract reasoning. A parent who appreciates a child’s temperament can customize parenting techniques to better fit the child’s temperament style. A child with a negative response to a new request along with the temperament traits of high intensity and persistence, will reflexively and emphatically say no. In this situation, the parent needs to identify the behaviors as a knee jerk, temperament driven responses rather than this is a “bad” child. With parental consistency and positive support, the initial negative response will fade away and the child is likely to follow the parent’s request.

Concrete thinking predominates until about 7 years of age. Beginning around 12 years of age and continuing to adulthood, most individuals are capable of abstract thinking. Prior to age 7 years, it is unproductive for a parent to respond to the child repetitive “why” questions with much detail. A child’s repeat questioning is unlikely to improve the child’s appreciation of the situation and instead is a child’s way to manipulate the parent. After age 7, the child begins to develop reasoning skills that progress to abstract thinking. During this stage, the parent should switch gears and explain to the child how temperament and behavior can positively or negatively influence outcomes.

Once the typical young adolescent achieves abstract thinking, they then can use cognitive strategies to suppress temperament traits that would lead to negative results. Also, by understanding one’s own temperament, a person is better able to make life decisions. For instance, someone with a short attention span will be ill suited for a career in neurosurgery and an individual who is easily distracted is a poor fit for a career in air traffic control.

An appreciation of temperament gives a window for the pediatrician to appreciate conditions like attention deficit disorder not from a psychiatric perspective but rather a constellation of temperament traits (short attention span, distractibility). Anticipatory guidance can then be customized to advise reducing distractions and allowing the child to shift between tasks. Temperament also influences a child’s response to injury or illness. For example, a child with a low sensory threshold - negative response to stimulation and low adaptability - is more likely to appear ill with a minor illness while a child with a high sensory threshold may lead to a delayed diagnosis of a more serious illness or injury.

It would be an interesting activity for the reader to write down the 9 domains of temperament and see where you fit. Then do the same for family members and maybe friends and co-workers. It’s likely that through a better grasp of temperament you will gain personal insight and be better equipped to manage the events of daily living and appreciate the behaviors of others.

Now that Pediatric Alliance is part of Allegheny Health Network, we’re moving from Patient Portal to MyChart.

MyChart is a secure online platform that gives you a quick and easy way to connect with our office: • Book appointments • View test results • Communicate with our care team • Request prescription refills • Review your child’s health history • Pay bills and view statements Follow these steps to register for MyChart now: 1. Visit mychart.ahn.org and click “Sign Up Now.” 2. On the next screen, under “No activation code?” click “Sign Up Online” and follow the onscreen prompts. 3. Once you’re logged in, click “Profile” in the top right and then “My Family Access.” 4. Based on your child’s age, follow the instructions to get proxy access.