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Temperament in pediatric practice
with Stella Chess, MD
Clinical applications
Using temperament concepts with clients/patients

Practitioners in several disciplines incorporate temperament concepts into their professional practices...
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 Temperament & ADHD

Can temperament variations be confused with ADHD?

Attention Deficit Hyperactivity Disorder is a neurobiological disorder that is characterized by serious impairment in attention and organization as well as poor self-regulation. The two subtypes, inattentive type and hyperactive-impulsive type, are the most commonly diagnosed behavioral disorders in the United States.

Temperament, on the other hand, refers to normal variations in behavioral style along a number of separate dimensions, including several that appear to overlap with ADHD: activity level, distractibility, persistence and adaptability. Dr. William Carey, Director of Behavioral Pediatrics at the University of Pennsylvania School of Medicine believes that temperament differences are being misdiagnosed as ADHD, leading to the treatment of normal children with powerful stimulant medications.

There are a number of reasons for overdiagnosis, including the annoyance that parents feel when children are inflexible, distractible and nonpersistent, the desire of pediatricians and other health care professionals to help parents, and the frequent use of the diagnosis of ADHD in spite of the absence of all the markers needed to make the diagnosis.

Part of the confusion rests with conceptual deficiencies in the Diagnostic and Statistical Manual (DSM-IV) definitions of normal and abnormal. Dr, Carey believes that "many normal variations of temperament are overdiagnosed, such as an inattentive child who is functioning normally, but who is supposed to be given the 'subthreshold' diagnosis of 'attention-deficit/hyperactivity disorder, not otherwise specified,' rather than simply being considered normal.*"

Behavior is based on interactions between the child and environment, and can be problematic even though there is no 'disorder' causing it. The solution advocated by Dr. Carey: "If the friction is coming from such a disharmonious interaction, the appropriate management consists of (1) recognition of the true nature of the dissonance, (2) revision of the understanding and management by the caregivers, and (3) some suggestions to the parents and others on how to find relief from their own feelings of stress.*"

* Quotes above taken from (Carey et al. (eds.): Developmental-Behavioral Pediatrics, 4th Ed. Philadelphia. Saunders. Elsevier. 2009). Read articles by Dr. Carey on temperament and ADHD here and here.
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Normal vs. Abnormal
Temperament or Psychopathology?
Temperament can be confused with symptoms of clinical conditions or thought to be indicative of severe emotional or behavioral problems. Learn the difference...
Preventing Problems
Dr. Jim Cameron's
program provided anticipatory guidance to predict behavioral issues...

Studies showed that the process helped families and conserved professional time.
Taming a preschooler
A Case Study
More than 10 percent of preschool teachers have reported expelling a preschool-aged child. Grounds for expulsion were largely aggression toward other children-hitting, kicking, biting, hair-pulling...
Temperament & ADHD
Understanding normal variations
Many children show a few signs of attentional or activity problems. Most don't have ADHD.
"At-risk" infants
Barbara Medoff-Cooper
Babies who are ill or need surgery
may have a 'difficult' homecoming.