Which personality aspect would a child with a difficult temperament display?

How Do We Measure Temperament?

Temperament assessments in early childhood often rely on structured observations of temperament-related behavior or information collected from the caregiver. Observational measures of newborns and young infants include assessments of reactivity to multiple modes of stimulation, whereas observations of older infants, toddlers, and preschoolers also permit evaluation of attention-based regulatory capacity. Observations of young children are frequently carried out in the laboratory, following a structured set of procedures; however, such observations can also be conducted in the child’s home or the hospital. Caregiver report methodology consists of asking parents, or other care providers, questions about the frequency of behaviors related to child temperament characteristics. A variety of questionnaires, based on caregivers’ observations, have been developed for this purpose, providing researchers with tools for assessing temperament from birth into the preschool period and beyond.

At least three major goals have been pursued in the assessment of temperament in early childhood. One has been to measure individual differences in reactivity and self-regulation under controlled conditions, typically through observation in a laboratory setting. More recently, it has involved the development of laboratory marker tasks, tests that assess variability in children’s behavior in the laboratory that has been associated in adult imaging studies with the activation of specific brain regions or networks. A second goal has been to identify the structure of temperament via parental responses to paper-and-pencil questionnaires addressing multiple child attributes. Information provided by caregivers is sometimes presented together with data from additional sources (e.g., home observations or other temperament measures) because caregiver report possesses both unique strengths and potential weaknesses, as do other methods (elaborated on in the next section).

The third goal has been to adapt temperament measures to clinical uses. Clinical adaptations have included the informal use of questionnaires or observations in clinical diagnosis and treatment, as well as a means to encourage parents to pay attention to their children’s behavior patterns. Measures of temperament have also been used in studies of the development of behavior problems, and have been linked to adjustment in adulthood. Measures developed for the assessment of temperament in early childhood have not yet achieved the measurement qualities necessary for predicting future problems for specific individuals, but they have been helpful in our general understanding of the development of behavior problems.

Recent studies have begun to include physiological measures such as assessments of children’s vagal tone, cortisol levels, and hemispheric asymmetry, yielding results of interest in relation to caregiver reports and observations of children’s temperament-related behavior. The use of these methods along with other temperament assessment approaches (e.g., caregiver-report) may allow validation of each method, and provide valuable information regarding the processes involved in the development of temperamental individual differences. Consistent patterns of findings across different measurement modalities would also provide conclusive validation for each of the approaches involved. The use of physiological tools in concert with behavioral measures provides an added benefit of allowing researchers to identify mechanisms underlying individual differences in temperament.

Temperament and Adolescent Behavior

Temperament is often thought of as a person's disposition, characterized by their drive, affect, and emotion. These aspects of behavior are influenced by a biologically-based system that is fairly consistent across the life span: Measures of infant temperament tend to correlate with measures of adult temperament and personality. Temperament is also related to many of the systems implicated in bipolar disorder, including emotion regulation, arousal, and affect. Certain temperament styles may be risk factors for developing mood disorders.

One temperament framework describes four affective temperament styles – cyclothymic, hyperthymic, depressive, and irritable. Not everyone with an affective temperament will develop a mood disorder, nor do all individuals with mood disorders have an affective temperament style. However, studies have shown that the two do often cooccur and that the presence of an affective temperament may be a major risk factor for developing bipolar disorder.

Of the affective temperaments, hyperthymic and cyclothymic temperaments are most often associated with bipolar disorder. Individuals with hyperthymic temperament are often characterized as energetic and outgoing. They tend to be goal-oriented and of high energy, which may predispose them to manic states. Additionally, they are often gregarious and disinhibited. Although their somewhat socially aggressive nature may be off-putting to others, people with hyperthymic temperament are generally successful at school and work.

Cyclothymic temperament is not as adaptive as hyperthymic temperament and, as a result, has been studied more often. Individuals with hyperthymic disorder are much less likely to seek treatment, as the symptoms they experience are often conducive to personal gains. People with cyclothymic temperament tend to exhibit behavior more similar to the mood episodes seen in bipolar disorder. They are often very irritable and moody, with drastic shifts from good-natured hyperactivity to irritable depression. Cyclothymic temperament is associated with poor interpersonal skills, passive–aggressive behavior, and high emotional reactivity. People with cyclothymic temperament tend to be more prone to substance abuse and suicidality.

Cyclothymic temperament may be one of the best ways to predict future bipolar disorder. Cyclothymic temperament is highly prevalent in the offspring of parents with bipolar disorder, and the trait increases bipolar risk above and beyond that associated with heritability or temperament alone. Additionally, young people with depression and cyclothymic temperament are much more likely to convert to bipolar disorder than young people with depression alone. Identifying adolescents with cyclothymic temperament could offer a good opportunity for early intervention. Unfortunately, temperament is not typically assessed outside of research settings. Furthermore, many of the traits associated with both hyperthymic and cyclothymic temperaments are also considered ‘normal’ adolescent behavior. Depending on the individual, it could be very challenging to distinguish cyclothymic moodiness from the moodiness often brought on by hormonal shifts in adolescence. Similarly, the high energy and impulsivity seen in hyperthymic temperament may not be qualitatively different from ‘typical’ excitability and poor judgment exhibited by teenagers.

The differentiation of temperament from normal adolescent behavior is also complicated by the fact that one of the key ways for identifying bipolar disorder – episodicity – works against the identification of temperament. Temperamental traits are, by nature, more chronic. Adolescence may amplify the effects of a person's temperament, yet they will have likely ‘always’ had some or all of the behaviors of interest. So, although noticing a change in behavior can aid in the diagnosis of bipolar disorder, temperament recognition may be hard for the people who know the adolescent best.

Those with both an affective temperament and bipolar disorder are likely to have a more difficult, chronic course of illness. Individuals with uncomplicated bipolar disorder often achieve remission and experience periods of balanced mood and good functioning. In contrast, those with an affective temperament tend to experience some mood symptoms even when their bipolar disorder is in remission. Furthermore, features associated with affective temperament – such as emotion dysregulation, limited social support, and tendency toward erratic behavior – may actually trigger or prolong mood episodes. Studies in adults with bipolar disorder are finding that personality traits may influence what types of treatment people seek and how able they are to adhere to complex treatment regimens. People with bipolar disorder often have lower levels of trait conscientiousness, making it more likely that they will have difficulty following through with taking medication, keeping appointments, or completing tasks from therapy.

2.2 Child Temperament

Temperament theorists believe that early child temperament is of etiological significance to the later development of childhood anxiety. ‘Behavioral inhibition’ is the term used to describe one particular pattern of childhood temperament that has been most frequently linked with childhood anxiety problems. It can be defined as a relatively stable temperament style characterized by initial timidity, shyness, and emotional restraint when exposed to unfamiliar people, places, or contexts. This temperament pattern is associated with elevated physiological indices of arousal and has been shown to have a strong genetic component. Most importantly, children exhibiting a temperament style of behavioral inhibition demonstrate an increased likelihood of developing child anxiety (see Kagan 1997 for a review of this area). Other temperament theorists argue for the existence of three stable factors: positive affectivity/surgency (PA/S), negative affectivity/neuroticism (NA/N), and effortful control (EC) (Lonigan and Phillips in press). According to this theory, high NA/N combined with low EC places children at risk for the development of anxiety problems, and there is some tentative evidence to support this proposition. However, as not all children exhibiting an early temperament style of behavioral inhibition, or high NA/N combined with low EC, go on to develop an anxiety disorder, the presence of moderating or mediating variables appears to be likely. In particular, attachment style and parenting characteristics (see Sects. 2.3 and 2.4) are likely to interact with early childhood temperament to determine the development of anxiety problems.

Although the literature regarding childhood temperament is interesting, it tells us little about the exact mechanism of action. It remains to be determined whether temperament impacts upon anxiety through greater susceptibility to conditioning processes, greater emotional and/or physiological arousability to stressful events, or through cognitive processes. For example, it is feasible that ‘at risk’ temperaments have their impact though greater tendencies to detect and attend to threatening stimuli in the environment, or expectations regarding the occurrence of negative outcomes. It has been shown in several studies that anxious children are more likely than others to think about negative events and to expect negative outcomes from situations.

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