The goal of this study was to examine associations between temperament and psychiatric disorders in early childhood. We assessed the relations between a range of temperament dimensions using a comprehensive laboratory-based measure and a range of psychiatric disorders using a structured diagnostic interview in a large sample of non-referred preschoolers. Preschoolers’ observed temperament traits demonstrated small-medium sized associations with parents’ reports of their children’s psychopathology.
The pattern of these associations was generally consistent with prior research in older youth and adults and studies largely relying on parent-report checklists of temperament and symptomatology. Our findings extend this work to younger children and to other approaches of assessing temperament and psychopathology. It has been hypothesized that high NE, low approach-related behaviors, and high withdrawal-related behaviors are associated with internalizing disorders (Clark & Watson, 1991
; Tackett, 2006
). In particular, low-approach behaviors, such as low exuberance, have been linked to depressive disorders, and behavioral inhibition/shyness has been linked to anxiety disorders; nevertheless, there is some overlap among these associations (Anderson & Hope, 2008
). Our findings are generally, but not entirely, consistent with this pattern. We found that dysphoria and low exuberance were associated with depressive disorders, and fear/inhibition, low sociability, and low exuberance were associated with anxiety disorders in bivariate analyses. Contrary to the majority of findings in older youth and adults using inventories, our bivariate analyses indicated that low exuberance, rather than high dysphoria, was common to both depression and anxiety. More research is needed to elucidate associations between low exuberance, or low PA, and anxiety disorders and whether associations may reflect developmental factors or measurement differences. Moreover, associations between low exuberance and both depression and anxiety in early childhood may provide insight into the origins of the developmental pathways between anxiety and depression (Copeland, Shanahan, Egger, & Angold, 2009
) and the high comorbidity between the two disorders (Shankman & Klein, 2003
With respect to externalizing disorders, past research has reported negative associations between behavioral control/constraint, or effortful control, and children’s disruptive behavior disorders, including conduct problems (Eisenberg et al., 2009
) and ADHD (Martel, 2009
). Our findings are consistent with this work as ODD was correlated with disinhibition, which tapped low inhibitory control, impulsivity, and noncompliance. In addition, both ODD and ADHD were uniquely associated with disinhibition in the multivariate analyses. ODD was also characterized by higher dysphoria, which is consistent with findings linking anger/irritability to oppositional behavior problems (De Pauw & Mervielde, 2010
), and growing evidence for the role of negative emotionality and emotion dysregulation in the development and course of ODD (Stringaris et al., 2010
). The trend association between low dysphoria and ADHD in the multivariate analyses was unexpected, as ADHD has generally been linked to higher NE (Martel, 2009
). We are reluctant to interpret this finding, as it did not emerge in the bivariate analyses and could reflect a weak suppression effect of another temperament trait.
We also explored whether these relations varied as a function of other disorders and other temperament traits. There was no evidence for interactions between temperament dimensions in the associations with diagnoses. Moreover, only one significant interaction involving temperament and pairs of disorders emerged. We found that children with depression only showed higher levels of dysphoria than children with comorbid ODD and depression, children with ODD only, and children with neither diagnosis; children with ODD only showed more dysphoria than children with neither diagnosis. Our findings suggest that dysphoria is more strongly associated with depression than ODD and that the presence of comorbid ODD is associated with less dysphoria in depressed preschoolers. It appears that comorbid depression and ODD may be more similar to pure ODD than pure depression, which is consistent with longitudinal findings demonstrating that depressed children comorbid with conduct problems were at lower risk for depression in adulthood than depressed children without conduct problems (Harrington, Fudge, Rutter, Pickles, & Hill, 1991
We also investigated whether gender moderated temperament-psychopathology associations in preschoolers. Two significant findings emerged. Boys who were reported by their parents to have an anxiety disorder demonstrated more behavioral manifestations of low approach and high control. Specifically, boys with an anxiety disorder showed less exuberance compared to boys without an anxiety disorder and girls with and without an anxiety disorder. Boys with an anxiety disorder also showed lower levels of disinhibition than boys without an anxiety disorder. In contrast to boys, girls with an anxiety disorder demonstrated greater disinhibition than girls without an anxiety disorder. However, boys and girls with anxiety disorders exhibited similar levels of disinhibition.
These findings suggest that there may be sex-specific links between temperament and anxiety disorders. For boys, low exuberance and high control may predispose to anxiety disorders, or reflect a “shutting down”, or emotionally constricted/behaviorally overcontrolled, pattern of coping with anxiety. In contrast, for girls disinhibition may predispose to anxiety disorders, perhaps through effects on emotion regulation deficits. Girls with anxiety disorders may have difficulty disengaging attention from threatening stimuli, which may maintain and further exacerbate anxious and negative affective states (Lonigan, Vasey, Phillips, & Hazen, 2004
). This is consistent with findings in older youth demonstrating associations between lower levels of control-related processes, such as effortful or attentional control, and anxiety (e.g., Meesters, Muris, & van Rooijen, 2007
). Alternatively, it is possible that parents may be more likely to recognize and report anxiety in young boys and girls with these gender-specific patterns of behavior.
The distinction between temperament and psychopathology is a challenging conceptual and methodological problem (Frick, 2004
; Lahey, 2004
; Tackett, 2006
). However, efforts are being made to address these challenges. For instance, Rapee and Coplan (2010)
recently reviewed evidence supporting the distinction between fearful temperament and anxiety disorder, including the finding that many highly fearful children and adults do not meet criteria for an anxiety disorder and that psychological interventions may have stronger effects on anxiety disorders than fearful temperaments.
Our findings, along with previous research in older youth (e.g., Lahey et al, 2010
; Lemery et al., 2002
; Lengua et al., 1998
), suggest that there are systematic associations between the domains of temperament and psychopathology even after significant efforts are made to remove methodological confounds. However, some degree of overlap is inherent in the nature of the constructs. For instance, our observational assessment of temperament included positive affect, fear, sadness, anger, noncompliance, and impulsivity, all of which coincide somewhat with various psychopathological symptoms. Our diagnostic interview aimed to minimize this overlap by assessing whether symptomatic variants of these emotions and behaviors are present in multiple contexts, are intrusive/distressing, and cause impairment. Nevertheless, defining the boundaries between the constructs continues to be a problem that will not be easily resolved.
It is also important to consider that the associations between traits and disorders may vary depending on sample characteristics. For example, in treatment seeking samples of preschoolers with observed high levels of BI, studies have reported that as many as 90–100% met criteria for an anxiety disorder (Kennedy et al., 2009
; Rapee et al., 2005
). However, using similar observational methods in our community sample, we found small to moderate correlations between our factors capturing aspects of BI (low sociability and high fear) and an anxiety disorder diagnosis. This is consistent with research demonstrating that trait-psychopathology relations may differ depending on clinic referred vs. non-referred samples and may be stronger in referred samples (Van Leeuwen, Mervielde, De Clercq, & Fruyt, 2007
). Thus, more work on the relations between temperament and psychopathology is needed in both clinical and nonclinical samples across development.
Our study had several important strengths. We used independent methods to assess both temperament and psychiatric disorders in preschoolers. In addition, we used both a comprehensive laboratory-based assessment of temperament and a comprehensive diagnostic interview. The size of the sample was also much larger than most previous studies, allowing us to examine interactions between disorders and traits and with gender.
However, the study also had several limitations. First, laboratory observations of children’s temperament rely on a single occasion and setting, which precludes an assessment of traits across contexts and over time. However, findings have supported the validity of similar observational approaches in predicting behavior in naturalistic settings and at later points in development (Caspi, 2000
; Durbin et al., 2007
). Second, the taxonomy of temperament during early childhood remains unclear, which poses difficulties in comparing findings across studies. In this study, a PCA yielded five factors, which overlapped with the factors identified in previous reviews of the structure of personality and temperament in youth (Caspi & Shiner, 2006
; De Pauw & Mervielde, 2010
; Rothbart & Bates, 2006
). Third, the classification of psychopathology in young children is also a nascent area, and the diagnostic instruments used to assess preschoolers’ problem behaviors are fairly new and still being investigated. Fourth, the sample was largely white and middle class. Future studies should examine these associations in more diverse samples. Fifth, despite having a fairly large number of participants, the number of cases with some disorders was small owing to the use of a non-referred sample. Sixth, the study was cross-sectional and cannot untangle the direction of associations. Finally, given the limited literature on temperament and psychopathology in young children, the study was somewhat exploratory, and future research would benefit from a more theoretically driven approach.
Implications for Research, Policy, and Practice
Understanding the relations between temperament and psychopathology in young children is critical, as temperament appears to directly and indirectly influence social development, may contribute to the development and course of psychiatric disorders, and could be useful in treatment planning (Rothbart & Bates, 2006
; Tackett, 2006
; Zinbarg, Uliaszek, & Adker, 2008
). Moreover, greater understanding of these associations may be useful in identifying at-risk populations, guiding the development of preventive and early interventions, and elucidating the distinct and shared etiological factors between disorders and within the same disorder. For instance, research on temperament-psychopathology associations may elucidate the heterogeneity within disorders, which may allow us to develop more tailored interventions. Lastly, our findings suggest that the pattern of associations between temperament and psychopathology that has been reported in older youth and adults is also evident in early childhood, indicating that these relations may have considerable continuity over time.