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


Practitioners in several disciplines incorporate temperament concepts into their professional practices...
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 Applications of Temperament to Infants and Children
 
Temperamental characteristics can be measured by researchers and clinicians in several ways, including interviews, behavioral observations and questionnaires.

In 1968 William B. Carey, M.D., a practicing pediatrician, developed the first practical measure of temperament, the Infant Temperament Questionnaire. Since then he and several associates have authored a series of temperament questionnaires assessing the nine NYLS temperament characteristics in infants as young as one month of age and in children through the end of the twelfth year. Collectively these are known as the Carey Temperament Scales, and are published and distributed by B-DI.

Knowledge about temperament and individuality can be useful in several ways.

First, educating parents, teachers and professionals about the existence of individual differences in temperament and ways to deal with these differences can be valuable. Differences are not necessarily the result of a condition or disorder. Many parents feel responsible for, and guilty about having a spirited child, and are relieved to know that their child is normal and they are not responsible for causing the child's behavioral patterns.

Second, it is helpful to know the specific patterns of behavioral individuality to allow those working with the youngster to 'tune in' to their behavioral style. Often caregivers have a general idea about the child's temperament, but ratings on a standardized temperament measure can improve everyone's focus, and there are often surprises (for example, the inability to adjust quickly is often seen as high persistence rather than gradual adaptability). Furthermore discrepancies between perceptions and actual behaviors are important to understand.

Third, with an accurate assessment of the child's behavior, specific changes can be planned and implemented by those working with the youngster. These interventions can improve the 'fit' between the youngster and environment, reducing stress and improving adjustment.

Several of the readings in the parent and professional sections of the Links deal with applications of information about temperament.
 
 Avoiding Unnecessary Labels in Infants and Children
 
The similarity of some normal temperament traits to symptoms of ADHD (especially activity level, distractibility and persistence) has led to confusion about the dividing line between normal and abnormal behavior. The current definition of ADHD contains lists of behavioral characteristics and possession of these is often thought to constitute the disorder. However careful reading of the DSM-IV diagnostic criteria indicates that the person must 1) have the characteristics, 2) the characteristics must be causing significant impairment in adjustment and 3) must be present in two or more settings. All of these conditions must be met before a diagnosis is justified. This is important because ADHD is considered to be a neurobiological disability and many transient adjustment problems can be mistaken for ADHD if the criteria are not strictly applied. Even so, there is no evidence that every child who meets the criteria for diagnosis has something wrong with their brain. Studies are not yet conclusive on the relationship between the disorder and behavioral characteristics.

It is important to help persons in need, but mislabeling a child with a neurobehavioral disability when the issue may be their behavioral individuality is potentially damaging to that child. Recognition that normal behavioral style exists and is not pathological is essential if unnecessary labeling is to be avoided, especially in early childhood. If the problem is the child's temperamental 'fit' with their environment, then the problem should be recognized as such. Many of the behavioral recommendations for dealing with temperament are similar to those for dealing with ADHD, but do not imply that there is a disorder or disability involved.

For further information the Readings link in the Professionals section should be consulted, especially Coping with Children's Temperament: A Guide for Professionals. For further information about the behavioral characteristics of ADHD consult the CHADD Web page
 
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   Examples:
 
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...
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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.
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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...
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Temperament & ADHD
Understanding normal variations
Many children show a few signs of attentional or activity problems. Most don't have ADHD.
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"At-risk" infants
Barbara Medoff-Cooper
Babies who are ill or need surgery
may have a 'difficult' homecoming.
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