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Child Temperament: New Thinking About the Boundary Between Traits and Illness

Nazerian Chorbadjian, Tamar, DO, MPH; Vanderbilt, Douglas, MD, MS

Journal of Developmental & Behavioral Pediatrics: January 2018 - Volume 39 - Issue 1 - p 45
doi: 10.1097/DBP.0000000000000531
Book Reviews

Developmental-Behavioral Pediatrics, Children's Hospital of Los Angeles, Los Angeles, CA

Disclosure: The authors declare no conflict of interest.

The boundary between behavioral traits and illness has long been questioned by professionals, patients, and their families. In this book, David Rettew takes a comprehensive approach to defining child temperament through history and outlines when different behaviors represent temperament versus psychiatric illness. As a child psychiatrist at the University of Vermont College of Medicine, Rettew provides clearly explained expertise on the fine line between temperament and psychiatric diagnosis for clinicians, parents, and all interested in child development.

The book explores fundamental aspects of child temperament, the degree to which and mechanisms of how temperament is linked to psychiatric disorders, and the trait-based interventions to treat disorders. The central thesis emphasizes the transactional framework that children have an inherent predispositions toward certain traits that can be shaped into adaptive functions. Most poignantly, Rettew describes the unfolding of temperament as follows: “a person's life is a symphony, then his or her temperament is the main key of that piece of music… endless possibilities can arise in the symphony… but it is always there… the key of a composition is detectable.”

Each chapter builds on the other starting with the historical background of evaluating child temperament, then moving onto the core principles and definitions, and then elements of temperament based on birth order, sex, and other factors. The first few chapters focus on the history of evaluating child temperament. He starts from ancient China, Greece, and Rome and then moves on to how Freud, Jung, and Pavlov looked at traits in relation to temperament and disease. He then brings us to the more modern research of Webb, Burt, and Kagan, where there is more emphasis on neurobiology, physiology, and genetics interacting with the environment.

He reviews several formulations in the temperament field. Chess and Thomas organized child temperament into 9 dimensions: activity level, rhythmicity, approach, adaptability, threshold of responsiveness, quality of mood, distractibility, intensity of reaction, attention span and persistence. They also organized a person-centered scheme of 3 temperament types: the easy, difficult, and slow to warm child. An alternative perspective discussed was Rothbart who sees temperament as constitutionally based on differences in reactivity and self-regulation that could be measured in the domains of surgency/extraversion, negative affect, and effortful control. Unfortunately, Rettew does not specifically mention the work of William Carey although he seems to value the same application of temperament for parenting and clinical assessments. Then, he ends the first half of the book with identifying which temperaments predict which psychiatric disorders.

The second half of the book explores the practical applications of using psychotherapy and parenting strategies for specific temperaments. Often in practice, children may not necessarily fit the clinical severity of a disorder; however, they may have unique temperamental behaviors that create problems for them in their environments. Rettew reassures the parent and clinician that there may not be pathology but differences can represent the unique but normal temperament of a child. Like other well-known parent-oriented books, he presents case examples to demonstrate clinical diagnostic approaches parents develop strategies. He discusses the enhancement of school environments to optimize the educational process with temperament-informed perspectives. Rettew then concludes with explaining how behavioral medications can improve symptoms of psychiatric illness through possibly altering temperament traits.

Overall, this book has a straightforward style with minimal scientific jargon, making it ideal for interdisciplinary professionals or lay audiences. This book could provide insights for any clinician interested in developmental-behavioral pediatrics, psychiatry, psychology, or related fields. Rettew succeeds in presenting a comprehensive historical background and explanation of temperament to optimize parenting and/or treatment that is unique to each child.

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The authors thank Pamela C. High, MD, for providing the book and opportunity to review.

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