Tag Archives: Temperament

How Can Teachers Respond Optimally to a Child’s Temperament?

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How Can Teachers Respond Optimally to a Child’s Temperament?

Teachers’ concerns typically focus on young high reactive(HR) children’s withdrawn or constrained behavior – their preference to watch other children play rather than to join them; their hesitancy in physical games on the playground; their clinging to a parent at drop off; their reluctance to enjoy messy sensory stimulating activities; and their general reluctance to take risks, especially in unfamiliar situations. Often, teachers organize their observations in functional categories such as “separation”, or “peer relationships”. Of course, there can be many reasons why children cling to their parents at drop off or why they do not play with their peers (see below).

In order to identify a HR child, you must listen carefully to the parents. The first clue parents will tell you is that “I was very shy myself.” The second clue is “She is completely different at home – outgoing, active, playful.” The first clue is important, because as we noted in the first posting of this sequence, temperament has an important genetic component. The second is important because HR temperament is primarily about an excitable limbic system. That means that the child is more sensitive to the perception of threat, and the new, the novel, the unpredictable, are threatening. Home is usually familiar and unthreatening. Because of this important factor, I have begun to do home visits when I consult to teachers and parents of children whose teachers have these concerns.

One such child was a 4-yo girl I will call “Jessica”. Her parents described her as loving, sweet, empathic, and smart. She was also “really shy”, and they worried that she was “not comfortable in her skin”. At home, she was confident, free, and creative, but at school she didn’t show these traits. She preferred to play with the teachers instead of the other children. When she went to birthday parties, she retreated into her shell, hiding under her mother’s sweater. Her preschool teachers suggested the consultation because of their concern that she was not engaging with her peers.

“Melinda”, another child, was 3-yo when her teachers expressed concern to her parents that she did not play with her classmates but sat quietly doing activities on her own. Although she looked content, they could not really tell how she was feeling and what she was thinking. On the playground, she liked to swing on one particular swing and got quite upset if that swing happened to be taken by another child.

4-yo “Benjamin” was a quiet, pleasant child whose teachers had to place limits on the time he spent with a girl classmate, Hannah, since she began to look uncomfortable with the degree of physical contact between them, as he insisted on holding her hand and sitting so close to her that he was always touching her. Benjamin explained that he loved Hannah and wanted to marry her, but Hannah complained that she wanted to play with some other friends in addition to Benjamin. In response to the teachers’ limits, Benjamin slowly began to play with other children and has now made a number of friends. Even so, he was often found sitting quietly alone at a table, busy with an activity put out for the children that day.

In the case of each of these children, the teachers balanced their encouragement to take risks in the classroom against their acceptance of the children’s need to “take their time”. As time passed, each child became more comfortable in the classroom. Jessica became animated and playful with the other children. Melinda began to play with her peers and ceded her favorite swing to other children. Benjamin even began to assert himself when another child started to boss him around. It is unclear what precipitated the transformation in each child’s behavior, what allowed these children to be more comfortable in school. In one case the birth of a sibling seemed to introduce possibilities of greater competencies and higher status. In another case my home visit may have been reassuring to the parents. In the third case, the teachers’ more active coaching in social situations combined with acceptance to private school may have been instrumental. Most likely, a combination of these factors played a role. However, the easing of pressure of some sort plus the introduction of new positive possibilities for the future must have figured in all the changes. In any case, we will never know for sure.

Other Reasons for Children to Withdraw:

One important acknowledgement is that there is a large overlap between temperament and sensory processing. Most children with HR temperament have some sensory sensitivities. It is also that children may withdraw if they are sad or depressed. Finally, children with other processing difficulties – for example, auditory processing in which case they have difficulty making sense of verbal communications – may withdraw. In older children, learning disabilities may cause them to “give up”.

How Can Parents Respond Optimally to a Child’s Temperament?

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There is evidence that infant reactivity is related to the predisposition to have an excitable limbic system. There is also evidence that there is influence in uterine environment that can affect temperament. But biology is not destiny. There are ways that parents and teachers can help HR children moderate the effects of their high sensitivity.

The balance between protecting and promoting is a challenge for all parents to achieve, but it is an even greater challenge for parents of HR children. By protecting, I mean softening the bumps in the road of life – allowing the child to stay home from a birthday party or speaking for the child when he greeted by an unfamiliar person. By promoting, I mean insisting that the child take the risks that he needs to take to build a strong body and acquire necessary skills, such as eat healthy foods and engage in physical activity. Often the parents of HR children tone down their expectations of their child, either because they fear the child will fall apart when required to take the risk, or because they “know their child’s limits” and have rationalized a permissive parenting style. Other times, parents of HR children push the child beyond her limits and cause her to withdraw further or “give up”. Even good parents can err in either direction. Sometimes one parent takes one position and the second parent takes the other. This is particularly problematic because the polarization that results increases the stress on the whole family and erodes parental collaboration.

How can parents find this balance? First of all, there is not one balance to achieve. Each family must experiment until they find the “right” balance for their family – and since families and especially children are always changing – the trial and error efforts never really end. Snidman reported that researchers who did extensive home visits on 4 families – half HR and half LR babies – found that in the HR cases the mothers who set firmer limits on their children’s behavior helped their children feel more comfortable taking risks. In the case of the LR children, the mothers’ behavior made little difference. Of course, this is a study with a very small n despite the extensive observational data, but it is consistent with my clinical experience. By setting limits on their HR children’s behavior, parents communicate to their children their comfort with their children’s initiative. It is also true that setting limits can slip into a struggle pattern, and that is a problem to be avoided if at all possible. In my experience, it is easier to get into struggles with a HR child then with a LR child. That is because stress causes everybody to expend energy in order to manage it, and that drains energy, pulling everybody in the direction of simpler, more reactive behaviors. Struggles definitely involve simple, reactive behaviors. The HR child is always under more stress than the LR child, and this is especially true when faced with a challenge. Those of you with HR children will recognize the dread provoked by adding an additional demand to the morning routine.

The ideal to work towards is one in which you “choose your battles” and support a child in taking health-promoting risks up a point, then protecting him if he shows that it is too much for him. These caregiving behaviors are always evolving and frequently include corrections or “repairs”. Corrections and repairs are not something to be afraid of. They are what we learn from.

I will discuss the ways teachers can respond to a HR child in the next posting.

Why is Temperament Important to Parents and Teachers?

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Roughly 10-20% Caucasian children are shy and hesitant in unfamiliar situations. Another 10-20% are sociable and intrepid in response to novelty. The underlying features of these predispositions usually referred to as “temperament”, remain remarkably consistent over time. It has also been found that the caregiving environment in the early years can significantly influence the behaviors characteristic of these temperaments. That makes the study of temperament particularly relevant to this blog.

Nancy Snidman, a colleague of the pioneer researcher in temperament, defines temperament as a “predisposition to respond to the environment in certain ways” (lecture to UMB IPMHPCP, March 6, 2016). The baby comes into the world with certain temperamental qualities. These temperamental qualities may be due to genetics or epigenetics – influences from the environment in the womb. Children’s temperament influences the way they react to their environment – physical, social, and emotional. For example, a child’s temperament affects the way they react to novelty, sensory stimulation, or transitions. How does temperament at infancy translate to temperamental characteristics such as shyness in a preschool child? What does the “shy” infant look like as an older child or adult? Snidman and Kagan did a series of longitudinal studies to try to answer these questions.

Kagan and Snidman studied 400, 4-month old babies and classified them as high reactive (HR) and low reactive (LR) on the basis of their response to auditory, visual, and olfactory stimuli. They observed the babies’ responses in the form of heart rate increase, motor arousal (such as limb flexion and extension, motor tension, and back arch) and fretting or crying. They looked for the extremes of HR and LR babies and started to follow them.

They postulated that the HR children had inherited a low threshold of excitability in the amygdala; a part of the mid-brain called the limbic system, and the related limbic areas. The amygdala sends signals to the autonomic nervous system, communicating a sense of threat in the environment.

They studied the babies’ physiology and behavior in response to a number of laboratory procedures, from 9 months to 15 years. Some of these procedures were mild, such as puppets or tasting sweet and sour liquids, and some were more challenging, such as a toy robot and a stranger approaching wearing a lab coat and a gas mask. The two extreme styles of temperament, HR or LR, or behaviorally inhibited (BI) – shy, wary of novelty, slow to approach, or behaviorally uninhibited (BU) – sociable, comfortable with novelty, were remarkably consistent over the years.

Interestingly, the researchers found that as the kids got older the physiological markers were more important than the behavioral ones. This was because the children were taught to be polite. It was less the general behavior to strangers that distinguished the HR from the LR kids, and more the smiles and spontaneous comments. When children are presented with the same stimuli in repeated exposures, for example when they are shown invalid pictures (a horse head on a fish body), they usually habituate to the stimulus. That means their reaction becomes smaller with repeated exposures. In the case of HR kids, however, there is no habituation! That means that although they look more and more like their LR peers in terms of social behavior, their heart rate, pupillary dilatation, muscle tension, and stress hormones remain more reactive.

This is very interesting to me in my work with children and families. For more than two decades, Attachment Theory has dominated research in child psychology. This way of understanding child development minimizes the contribution of temperament. Yet, I have found temperament a very useful way of making sense of some of the problems that parents bring to me regarding their children’s behavior. It is also helpful to me when I consult to preschool teachers. In the next blog posting I will describe how I use ideas of temperament to help parents and teachers understand the children in their care.

Readings

Schwartz C, Snidman N, Kagan J (1999). Adolescent social anxiety as an outcome of inhibited temperament in childhood, JAACAP 38(8):1008-1015.

Kagan J (1997) Temperament and the reactions to unfamiliarity, Child Development 68(1):139-143.

Kagan J (1989). Temperamental contributions to social behavior, American Psychologist 44(4):668-674.

More About Orchids

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I am interrupting my blog progression again to talk about a recent infant parent mental health weekend, while it is still on my mind. We heard two terrific lectures last month about temperament and attachment, both subjects of particular interest to me.

The lecture on temperament was again given by Nancy Snidman, the temperament researcher. Nancy defines temperament as “predisposition to respond to the environment in certain ways”. There are many terms to describe temperamental characteristics – for example, introversion and extraversion, fearfulness, sociability, rhythmicity, thrill and adventure seeking, thoughtfulness or empathy, and many more.

One of the most important dialectics is the relationship between temperament and environment. In this case, temperament refers to inherited characteristics and the environment refers to experiences with family, friends, school, and life events. Nancy pointed out that there has been a long history of ways of thinking about temperament. In classical times, the Greeks and Romans thought of temperament in terms of the “humors”. In the 18th century, John Locke deemphasized temperament in favor of the influence of the environment, but then in the 19th century, Darwin focused on the importance of heritable factors in his evolutionary theory. The post World War II period again attributed the most powerful influence to the environment, for example in Freudian theory that gained widespread popularity. However, current research, such as in genetics and neuroimaging, has brought us back to a focus on temperament. Luckily, contemporary theories generally maintain a complex perspective by also including the important influence of the environment.

Some of the variables used by Nancy in studies of temperament deriving from Rothbart infant behavior questionnaire include approach, sadness, activity, perceptual sensitivity, fear, soothability. For example, does the baby get excited when given a new toy (approach), or how sad does the baby get when the caregiver goes away, is the baby easily soothed, does the baby enjoy cuddling?
Nancy reported on a longitudinal study of two styles of temperament – behaviorally inhibited (shy, wary of novelty, slow to approach), and behaviorally uninhibited (sociable, comfortable with novelty). They measured the time it took 31-month old children to accommodate to various novel situations, such as the time it took for them to enter a toy cloth tunnel, the time it took them to approach a robot. Some children behaved in relatively “inhibited” ways, and others were significantly less inhibited. The researchers wondered where this “shy” and “outgoing” behavior was coming from.
Starting with the hypothesis that people have different thresholds of excitability in the amygdala that create different sympathetic nervous system responses, resulting in different kinds of behavioral reaction to uncertainty, Nancy’s research team designed various kinds of auditory, visual, and olfactory stimuli to activate their amygdalas and test their hypothesis. In the lecture, Nancy showed films of 4-month old babies in the experimental situation. The babies were seated in a baby seat, and first one mobile figure was waved in front of him and then another, and then three at once. The first baby sat, attentively watching the moving figures, moving his fingers slightly, calm. The second baby started to fuss as the level of stimulation increased until he arched his back and began to scream. The experimenters studied the frequency and direction of every arm and leg movement, negative vocalization, arched back, etc. The babies sorted themselves out into high reactive babies with “high motor/high cry” and low reactive babies with “low motor/low cry”. Then they studied a group of children from 9-months to 15 years, to see what happened to them.
They were thinking of reactivity in terms of biology. If the amygdala fires, there is sympathetic nervous system activity – arousal, heart rate, respiratory rate. They believe that the biology of the children has a direct effect on their behaviors. If the amygdala is firing and the sympathetic nervous system is “Go!” it will produce behavioral responses. The hypothesis was that the babies who at 4 months were high reactive (high motor/high cry) by 2 ½ years became shy children, and that was because they had inherited a temperament associated with a low threshold of reactivity in the amygdala. These children were what I have referred to previously in the blog as “orchids”.
Across the years, they measured the children’s behavioral and physiological responses – at home at school, and in the lab – to situations that challenged them with different types of novelty or uncertainty. They found that the children moved from simple high reactivity in the youngest babies to a mixture of reactivity and shyness, or inhibition, in the older babies. This shift from high motor activity and high vocalization, to inhibition in the older infants reflects what we know about adults. In some high reactive older infants, when the experimenter changed the tone of her voice from pleasant to harsh as she invited the child to touch a toy, the child withdrew. Over the years, the researchers found remarkable consistency in the reactive style of the children. Some of the high reactive children became less shy, but the uninhibited children did not change. Interestingly, when the high reactive children became comfortable in their environments, they did OK. It was the transitions that are the problem. The high reactive children had more trouble with transitions.
The researchers concluded that there is “strong evidence that infant reactivity is related to a predisposition to have an excitable limbic system” and that this kind of reactivity is a “stable quality over time and situation” (Snidman, 2014). In addition, the research suggests that though these biological factors do not determine anything about the child’s future, and that environment can have an important influence on the child’s behavior and personality characteristics, these biological constraints remain as part of the child’s inherited predisposition.
From my point of view as a clinician, I would stress the value in helping parents understand their children, and teachers understand their pupils, so that they can take the children’s temperament into account when they make expectations of them. Children of all temperaments may be able to achieve the same accomplishments, but they may require different degrees and different types of support in order to achieve them. Earlier blog postings include information related to this subject.

photograph by Ginger Gregory

Snidman, Nancy, “Temperament: Importance, Influence, Impact”, Lecture given at Infant-Parent Mental Health Program, U Mass Boston, Sept. 19, 2014.

 

Being the Parent of an Anxious Child

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Recently I heard an author and editor of The Atlantic magazine, Scott Stossel, talk about his severe anxiety ( Stossel, 2014). What struck me about his story were two things – his description of having had serious problems with anxiety since he was two years old, and also how terrible his anxiety was. He said that the feeling of dread was sometimes so intense that he didn’t think he could go on living. In response to an interviewer asking him what he had found that helped, Scott spoke compellingly about how the first step was accepting the fact that there is no cure, that one has to develop a repertoire of coping skills to deal with the issue and recognize that sometimes you will be OK and other times you suddenly and drastically will not. He even referred to his condition as “temperament”. This rang so true to me.

I pondered on the sweet children I have seen over the years who have had severe anxiety. Some of them have gotten better, and some of them – “stubbornly”! – have not, or at least, are still up and down. Scott Stossel correctly described the problem as a spectrum. All of us have anxiety, but whereas for some it is typical nervousness related to environmental stressors, for others the anxiety is debilitating. I will discuss the treatment of these conditions in another blog posting, since I disagree somewhat with his sense of the limitations of treatment. Right now, I want to talk about the role and the experience of parents with an anxious child.

First of all, I agree with Scott that this problem – barring cases of posttraumatic stress – is largely an issue of temperament. Jerome Kagan and Nancy Snidman talk about how the newly recognized “sensory reactivity disorder” can be seen as a feature of temperament, since both the sensory disorder and also high reactive temperament, have significant heritable features. I don’t say, “inherited”, since we know that the matter isn’t as simple as that. Environmental (and epigenetic) factors have an important role even in the womb, and certainly after birth, when anxious caregivers have a powerful effect on the developing capacity for self-regulation in the infant (Nelson, 2013) (Beebe & Lachmann, 2013). Individual differences tend to be a “blend of temperament and environment” (Snidman, 2011). It appears that the part of the brain that registers threat in response to environmental stimuli – the amygdala – has a lower threshold of reactivity in these children. It is well known that high reactive temperament and the related insufficient development regulatory competencies may complicate a child’s attempts to cope with adverse life circumstances and even everyday transitions (Kagan et al, 2007, Kagan, 1989).

What I would like to focus on here is the effect of an anxious child on his parents. I am not referring to parents just getting anxious when their child is anxious. I am referring to complex patterns of emotional communication that are initiated in infancy and become established and then have a continuing influence on future development – both of the child and of the parents – so that over time, the trajectory of development and associated behaviors become increasingly distorted (Beebe & Lachmann, 2013) . And the people involved don’t even notice it, because they are so intent on staying connected. Many parents of super anxious children tell me that they “walk on eggshells”. What they then explain is that they are afraid of triggering an explosion in their child. But, what I think they really mean is that they are afraid of losing the connection, afraid of losing the child.

Also, they get worn down. When you “lose energy”, as in all living systems (which humans are) you tend to retreat to a simpler but less complex and effective level of functioning.  I don’t use the word “regress” because that could imply a global move to a previous level of functioning, whereas when I use the term “retreat” I mean that the idea that the higher level of functioning remains in the individual’s repertoire but he/she does not at that point have enough energy to attain and maintain it. In my practice, I sometimes talk to parents about “being on the front lines” in an attack. If things are not going well and you are in the front lines, you may tend to just shoot rather than – from the more protected position of the generals – plot new strategy.

So from the beginning, when the child cannot sleep or has trouble with feeding, the parents bend over backwards to help the child sleep – such as sleeping with the child – or eat – such as accommodating severely restrictive diets. These parents are trying to protect their child’s survival. However, what they can’t allow themselves to realize at the time is that they are contributing to the distortions that are developing. The child who will explode if you don’t accommodate his demands does not learn to tolerate frustration. The child who “only eats chicken nuggets” doesn’t learn to like other foods.

Before you begin to blame the parents, though, consider what it means to have a child who “will” not eat, “will” not sleep. Sooner or later, you give up and accommodate the child’s demands. That is, unless the parents have support in changing these pernicious patterns.

The support the parents need is in the form of relationships. There are many therapeutic techniques that are recommended, but I am skeptical of all of them that follow manuals and are short term. The children who get better from these techniques – and there are some that do – are on an “easy part of the spectrum”. The parents of children on the hard part of the spectrum need ongoing support to change their responses to their children. They need the support of a long-term therapeutic relationship that encompasses them and their child. I will continue with this subject in a future blog.

References

Beebe B, Lachmann F (2013). Origins of Attachment, New York: Taylor & Francis, pp. 95-139.

Nelson C A (2013). Biological embedding of early life adversity, jamapediatrics.com JAMA Pediatrics Published online October 28, 2013 E1

Kagan J (1989). The concept of behavioral inhibition to the unfamiliar, In Reznick, J, Ed., Perspectives on Behavioral Inhibition, University of Chicago Press, pp. 1-25.

Kagan J, Snidman N, Kahn V, Towsley S ( 2007). The Preservation of Two Infant Temperaments into Adolescence, Monographs for the Society of the Research in Child Development, 72 (2).

Snidman N (2011). Lecture on Temperament, U Mass Bos Infant Parent Mental Health Post Grad Certificate Program.

Stossel S (2014). My Age of Anxiety – Fear, hope, dread, and the search for peace of mind. New York, Random House.

 

The Challenge of Making Transitions

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Just before I left on vacation, a mother of a child in my practice asked me why it was so hard for her 6-yo son to make transitions. I was rushing to get ready to leave, so I sent her a quick email promising to respond more fully when I had a chance to think about it. I have had her question in the back of my mind and was especially struck by it when I arrived in Europe and experienced jet lag. It occurred to me that jet lag was a good metaphor for the kind of transition the mother was asking about.

First of all, her child is one of those highly sensitive children I refer to as “race horses”, of others in the literature have called “orchids”. He is extremely intelligent but sometimes retreats to infantile behavior patterns, and he often reacts with extreme distress in the context of transitions – even simple daily transitions such as getting up and getting ready for school in the morning or leaving play to go somewhere or do something else. This problem is interesting because it gets mixed up with all sorts of other categories of problems – such as problems with compliance (behavior problems) or sensory over-responsivity problems (SOR) (Ben-Sasson et al, 2010).

I think there are reasons for this confusion.As writers on “orchid” children point out, it is easier for children with certain temperamental characteristics to readjust to changes in their environment. (I chose the above photo of young Indian dancers because I imagined – though I do not know these children – that the girl on the left has an easier temperament than the girl on the right.) These delicate children are often much harder to parent than children with easier or more resilient temperaments (“dandelions”), and parents and child often initiate problematic interaction patterns early on that can influence the child’s developmental trajectory in an unfortunate direction. It then becomes the job of the child therapist to help the family (child and parents) correct this misdirection.

The kinds of problematic patterns that are characteristic of this situation typically involve mutual over-control. That is, children who feel highly stressed by demands for change (in other words, transitions) often try to exert a counterbalancing force by controlling their environment (their parents, included). Parents may respond either by engaging in a control struggle with the controlling child or by giving in, or by both (Granic, 2006). When these patterns are repeated, they become more firmly rooted in family behavior. I refer to this as building stronger infrastructure for the problem cities (metaphor for problematic relational patterns such as struggles in families) so that it is easier to get there and stay there. Of course, it is better for all involved to build strong infrastructure for the cities that represent more adaptive behavior patterns such as collaboration, but when people are stressed, they often choose the behavior that takes less energy (from the point of view of managing emotions and using reflective capacity) in the short run and more energy in the long run (having to repair the ruptures that struggles and fights cause in the family).

The job for child therapists is to work with child and family to “break the habits” of the problem behaviors and substitute more adaptive patterns. This is done by a variety of techniques including gaining insight into the meanings underlying the behavioral reactions of child and parents and supporting the emotional regulation of all concerned, and then … practicing the new more adaptive patterns again and again and again. I will write more about this important aspect of the topic in a future posting, but I will limit myself here to the mother’s question of “why?”

Let me return to the metaphor of jet lag. My intention is not only to respond to “why” a child has trouble with transitions, but also to offer a way of empathizing with the irritable child. (Often, a parent empathizing with the child allows her or him to better imagine the child’s mind and this can facilitate the parent’s choice of response to the child’s demanding or oppositional behavior). I found a good article on jet lag that describes it in terms of whole organism dysregulation (Vosko et al, 2010). Circadian rhythm – sleeping longer at night and less during the day – is one of the first organizations to emerge in the developing newborn (Sander, 2008). It is achieved through a series of oscillatory networks that include a master oscillatory network in the suprachiasmatic nucleus (SCN) in the brain and also sensitivity to environmental light cues (Vosko, p. 187). During jet lag, the paper continues, abrupt changes in the environmental light-dark cycle desynchronize the SCN from downstream oscillatory networks from each other, disrupting sleep and wakefulness and disturbing function (ibid, 187). This kind of “circadian misalignment” can lead to a series of symptoms, including major metabolic, cardiovascular, psychiatric, and neurological impairments (ibid, 187).  During this trip, as usual, my jet lag “took over”. Although I intended to stay awake and enjoy the company of my friends and the new landscape, I was compromised in my ability to do so. The feeling of dysphoria came in waves; sometimes I felt my old self again and other times I felt tired, irritable, and even sick.

The benefit of this metaphor is that it emphasizes the notion of whole human being “organization”. Many problematic behaviors result from a disorganization of adaptive patterns of functioning. The human organism is constantly working to keep itself on track and to accommodate small bumps and disruptions. It is when the reorganization does not happen smoothly, when things fall apart, that a “symptom” appears. The symptom can be physiologic as well as emotional, just as in jet lag. Children who have delicate temperaments or other developmental reasons for high sensitivity (such as children with ASD, uneven development, trauma, or SOR) are particularly vulnerable to this problematic disorganization.

Consider all the demands for reorganization that a child has to respond to on a daily basis: She has to wake up, changing from a sleep state to an alert state. She has to get up and get ready for school, requiring many transitions from the multiple small tasks involved in washing and dressing. She has to eat breakfast, even if she is not hungry at the time. She has to say goodbye to home and parents and make a big shift from a relatively dependent position to a more autonomous position in terms of initiative and compliance. When she gets home from school she has to deal with other important transitions. Don’t think for a moment that greeting a beloved parent is necessarily going to be a pleasant experience; the transition from a holding-it-together-at a higher-level-of-organization-state at school to a more relaxed and dependent one at home is often bumpy! In addition, often parents of sensitive children give them aids to help them keep organized in the transition, such as video games. As I have mentioned in another posting, these games work very well to keep a child organized because they provide an effective external regulator. When this external source of regulation is taken away abruptly, it can be expected to cause great distress. Even a book, a much more adaptive regulating activity, can cause distress when discontinued.

What is the answer to these problems? I will respond in a subsequent posting!

 

Read this blog in Spanish.

References

Ben-Sasson A, Carter AS, Briggs-Gowan MJ (2010). The development of sensory over-responsivity from infancy to elementary school, J Abnorm Child Psychol, DOI 10.1007/s10802-010-9435-9.

Granic I (2006). Towards a comprehensive model of antisocial development: A dynamic systems approach, Psychological Review, Vol.113, No. 1, 101-131.

Sander, L. (2008). Living Systems, Evolving Consciousness, and the Emerging Person, New York: The Analytic Press.

Vosko AM, Colwell CS, Avidan AY (2010). Jet lag syndrome: circadian organization,  pathophysiology, and management strategies, Nature and Science of Sleep, http://www.dovepress.com/jet-lag-syndrome-circadian-organization-pathophysiology-and-management-peer-reviewed-article-NSS.J

How to Talk to Your Child About Complex Subjects

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At a gathering of family and close friends recently, a young couple asked me a question about their almost 3-year old son. I had observed the child and had found him to be intelligent, charming, and warmly connected to his parents. He also seemed sensitive, perhaps one of Kagan’s “inhibited” children (Kagan & Moss, 1983). The child, whom I will call “David” (not his real name), had been anxiously asking his parents about whether he might be put in jail, about whether he was a “bad guy”. He seemed to associate these fears to bible stories he was hearing in Sunday school, particularly the stories of Daniel and the Lion’s Den, and the story of Jesus being arrested. This was confusing to his parents, because in their understanding of these narratives, it was the “good guys” who were arrested. His parents told me that they constantly reassure him that he is a good boy, that they love him, and that he is safe. David’s parents further explained that he seems to ask these questions about being thrown in jail whenever a stranger is in the house, asking whether that person is going to throw him in jail. His parents decided to avoid stories about jail and to limit the bible stories since many of the concepts seemed too complex for him to process at this age. They asked me what I thought.

This question is fascinating from several points of view. First of all, it highlights the difference between the meanings an adult makes of certain narratives and those made by a preschool child. Second, it underscores the often discrepant levels of maturation of different developmental capacities in the same child. Third, it reveals aspects of a crucial cultural context that forms the way narratives transmit important beliefs and values in a society. Consideration of these factors may help parents in their efforts to talk to their children about complex subjects. 

What about what Tronick calls the “age possible” meanings that two people of different developmental ages make of the same story (Tronick, 2007)? An example is offered by the 4-year old whose mother was trying to explain to her the generational relationship of people at a family reunion. The mother explained, “Your nana is your daddy’s mommy.” The little girl thought for a moment and then asked in wonder, “But how did she get him into the car seat?” I am also reminded of a little patient, a 3-year old who witnessed people jumping from the World Trade Towers on television and in a play session suggested to me that children could “jump big” in a playground because it is “softer” (Harrison & Tronick, 2007). I took her to be referring to a “soft landing”, though I knew that no number of soft mattresses at the foot of the WTT could have cushioned the fall of the jumpers. In David’s case, the meaning he derived from “being put in jail” was that you were a bad guy, period. He was not able to consider a nuanced meaning in which a good guy was unjustly jailed. It is clear that good guys and bad guys are on his mind these days. Remember the “terrible two’s”?. His age-typical anxiety about the result of noncompliance to parental demands (whether real acts of noncompliance or imagined ones) led him to fear that his “bad guy” feelings and thoughts would brand him as a bad guy and cause someone to throw him in jail. A “stranger” is a preferable enforcer of that terrible punishment, because a stranger can be seen as “all bad”.  If it were one of his beloved parents who threatened him with jail, how could he manage the stress of fearing one that he also loved and depended on? 

The second issue is that of discrepant developmental capacities. Human development is not a smooth, linear process. It occurs in a messy process of hits and misses, halts and bumps forward, and reiterative efforts to master. In many children, this messy process occurs at very different rates and in different ways in different domains of competency. For example, some children have precocious motor coordination but are slow to speak. Others speak sophisticated sentences early but struggle to do one rung of the monkey bars or are insecure about climbing and jumping. If you have significant discrepancies in your developmental capacities, you are left with a subjective sense of inner imbalance, sometimes even of incipient chaos, in the background. It does not always bother you, but when you experience a threat, it can emerge. This could be called “anxiety”, but that is a rather crude description of a complicated subjective experience. I do not know David well enough to guess about whether he has a discrepant developmental profile. The inheritance of “inhibited” genes is another possibility. However, I do know many children who fit this picture of uneven development.

Finally, there is the interesting factor of culture. In an earlier posting, I wrote about how another 3-year old sat through a 6-hour wedding dinner with a minimum of fuss. I described what I saw his French parents do in order to teach him to sit at the table for long stretches. In any culture many core beliefs are transmitted by narratives. Children hear these narratives repeated over and over from early on and learn the culturally shared meanings that their parents convey to them. However, the meaning is not transmitted by language alone. Peter Fonagy talks about this process. He says, “Human communication is specifically adapted to allow the transmission of cognitively opaque cultural knowledge, kind-generalizable generic knowledge, and shared cultural knowledge” (Fonagy, lecture IPMH, May, 2012). This knowledge is transmitted by what he calls “ostensive communication cues” such as eye contact, turn taking with contingent reactivity, and special vocal tones. In a study Fonagy cited, infants of 18 months old were asked by the researcher to pass an object, a doll. In the control group, the researcher gave no cues directed to the infant, but in the study group, the researcher first smiled and said hello to the infant. Then in both groups, the researcher smiled at one doll and made a disgust face at the other. At that point, another researcher came into the room and the baby was asked to give the second person a doll. Only in the group in which the experimenter had smiled and said hello, did the babies give the second person the doll the first experimenter had smiled at, the doll designated as desirable . In other words, the researcher had initiated a relationship with the baby and in that context, the baby attended to the “ostensive cues” (smiling or disgust face) she then gave him. The infant trusted the researcher who smiled and said hello and then judged the information she gave him to be reliable.  

So, in response to my young friends’ question, I would say that I support their decision to protect David from anxiety provoking bible stories for the present. In avoiding certain bible stories they are acknowledging a dysynchrony between the dominant contemporary middle class U.S. culture and a culture in which bible stories are a primary means of transmitting beliefs. In the latter culture, bible stories would not just be read but from early on would be told as stories, with accompanying “ostensive cues”. In that culture, the parent would communicate – with eye contact, turn taking rhythms, and tone of voice – who the bad guys and who the good guys are in every story, over and over.  In that way, David would learn the salient meanings – with associated values – of his culture. Of course, he might still have fears of being a bad guy, because of his age-typical struggles with his aggression and negativity. It is less likely, though, that his fears would focus on bible stories.

Harrison, Alexandra & Tronick, Ed (2007). Now we have a playground: Emerging new ideas of therapeutic action”, J Amer Psychoanal Assoc., 55/3: 853-874.

 Kagan, Jerome & Moss, Howard A (1983) From Birth to Maturity: A Study in Psychological Development, Yale University Press. 

Tronick, Ed (2007). The Neurobehavioral and Social-Emotional of Infants and Children, WW Norton.

 

photograph by Joshua Sparrow

 

 

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Orchids or Racehorses

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Orchids and Racehorses

In the conference I attended this week in Paris, IACAPAP, I heard many stimulating presentations; I will probably write about some of them in the coming weeks. One that comes immediately to mind was by a researcher named Marius van Ijzendoorn, from Leiden.  

He was talking about how in the age-old Nature-Nurture debate we need to move back to taking Nature more seriously (Belsky & Pluess, 2009).  (In addition to Dr. van Ijzendoorn’s presentation, I derived much of the information in this blog from the important paper of Belsky and Pluess noted above. A wonderful discovery was that many of the papers cited in this paper were available on the internet free of charge.) That is not to say that Nurture is not important – far from it – but that Nature prepares children to respond differentially to the nurture they are given, and that the kind of differential responses we are talking about is not that simple. That was an interesting idea to me. It fit with something I have been telling parents for many years.

I also have noticed an implicit presumption made by much of the research into the environmental influences on early development. The presumption is that all children are affected equally by adverse environmental circumstances – whether poverty, maternal insensitivity, neglect, abuse, etc. This is evident in the studies of children reared in institutions, for example (Bos et al, 2011) (Cicchetti & Rogosh, 1997). 

When attention has been paid to individual child characteristics that contribute to the outcome, it is usually to say either that some children are relatively more constitutionally vulnerable to adverse environmental factors, or that other children – the lucky resilient ones – are less vulnerable. These resilient children are distinguished by – among other things – having a high IQ, a sense of humor, or a mentor to support their healthy development in ways that their parents are unable to do (Garmezy, 1985), (Rutter, 1987), (Werner, 1997). 

Another way of looking at it is to focus on “plasticity”. Children who are “resilient” are less plastic, or malleable, in relation to their experiences with the environment than others (Belsky and Pluess, 2009, p. 345).  What comprises this “plasticity”? In general, it seems that individual children differ in terms of three important markers of differential susceptibility, or plasticity – (1) early temperament; (2) physiological reactivity; and (3) genes. 

What van Izjendoorn and others have proposed is that instead of assuming all children are equally affected by adverse life circumstances, or that some individual children are particularly vulnerable or resilient because of their constitutions, we should consider a new paradigm – that of differential susceptibility (Belsky, 1997) or biological sensitivity to context (Ellis & Boyce, 2008).  This new proposal contends that for temperamental, physiological reasons, some children actually are more susceptible than others to both positive and negative rearing influences (Belsky, Bakermans-K, & van Ijzendoorn, 2007).  Belsky suggest that from an evolutionary point of view it was more advantageous for parents to bear children varying in plasticity, given that our ancestral parents could not have known any more than we know (despite the dogmatic trends in theories of parenting) which child rearing practices would be the most successful in promoting the reproductive fitness of their offspring. That way, if one child rearing technique proved to be problematic, those children who were not strongly affected by parental behaviors would not be adversely affected. 

From the perspective of temperament, two recent studies cited in Belsky & Pluess, found that infants with difficult temperament at 6 months (rated by their mothers)had both more behavior problems in early childhood in conditions of “low quality”, but also display fewer problems and more social skills than other children in conditions of “high quality” caregiving (Belsky & Pluess, 2009, p. 347).

 From the point of view of biological sensibility, children showing high reactivity (blood pressure) during a stress test had higher rates of respiratory illness, while when they were in low stress conditions had a significantly lower incidence of respiratory illness (cited in Boyce & Pluess, 2009, p. 347). In an interesting study by Boyce et al, when 7- year old children scored low in reactivity as indexed by salivary cortisol at the beginning of a stressful evaluation, father involvement in their care failed to predict mental health at age 9, whereas if they were high reactive, low levels of father involvement did predict mental health problems at that age (Boyce et al, 2006). 

As mentioned, genes also feature as a marker of differential susceptibility. In two studies,  Caspi et al, and Taylor et al, found that university students homozygous for short alleles of the serotonin transporter gene polymorphism showed greater depressive symptoms when exposed to early or recent adversity than did individuals with the other allelic variants, but individuals with this apparently vulnerable genotype showed significantly less depressive symptomatology when they experienced a supportive early environment or recent positive experience (cited in Belsky & Pluess, 2009, p. 347). 

What does all this mean to caregivers? Well, what I often tell the parents in my practice is that their children are “race horses” – that they need specialized care but they also have special potential. Then I do my best to help the parents learn how to provide that specialized care. The metaphor van Ijzendoorn used was orchids versus dandelions. He said that orchids (high susceptibility) need specialized care to bloom, but they are prized for their beauty, whereas dandelions (the “resilient” ones) can bloom anywhere but are usually not considered as beautiful. Actually, van Izjendoorn did not devalue dandelions and mentioned some interesting reasons having to with genetic studies that he is partial to them. The real message to my mind, though, is the hopeful one. If you have a child with high susceptibility to environmental influence, it is possible to create a caregiving environment that can support his or her growth in a positive way and produce a racehorse, an orchid. And dandelions are also beautiful, as my French friend, Gisele, explained, they are the first flowers that appear in her French garden as harbingers of Spring.  

References

Bakermans-Kranenburg & van Ijzendoorn, (2008). Oxytocin receptor (OXTR) and serotonin transporter (5-HTT) genes associated with observed parenting, Soc Cogn Affect Neurosci, 3(2):128-134.

Belsky, J. (1997). Variation in susceptibility to rearing influences: An evolutionary argument. Psychological Inquiry, 8:182-186.

Belsky, J, & Pluess, M, (2009). The nature (and nurture?) of plasticity in human development, Assoc for Psychological Science, 4 (4): 345-351.

Belsky, J., Bakermans-Kranenburg, M. & van Ijzendoorn, M. (2007). For better or worse: Differential susceptibility to environmentalinfluences. Current Directions in Psychological Science, 16(6):300-304.

Bos, K, Zeanah, C, Fox, N, Drury, S, McLaughlin, K, & Nelson, C (2011). Psychiatric outcomes inyoung children with a history of institutionalization, Harvard Review of Psychiatry, 15-24.

Boyce, T., Chesney, M, Alkon, A., Tschann, J, Adams, S, Chesterman, B, Cohen, F, Kaiser, P, Folkman, S, & Wara, D, (1995), Psychobiological reactivity to stress and childhood respiratory illness: Results of two prospective studies, Psychosomatic Medicine 57:411-422.

Boyce, T., Essex, M., Alkon, A., Goldsmith, H., Kramer, H., Kupfer, D. (2006). Early father involvement moderates biobehavioral susceptivility to mental health problems in middle childhood, JAACAP, 45:1510-1520.

Cicchetti, D., & Rogosh, F. A. (1997). The role of self-organization in the promotion of resilience in maltreated children. Development and Psychopathology, 9: 797-815.

Ellis, B. & Boyce, W (2008), Current Directions in Psychological Science, 17(3):183-187. 

Garmezy, N. (1985) Stress resistant children: The search for protective factors. In J.E. Stevenson, ed., Recent research in developmental psychopathology, 220-227.

Rutter, M. (1987). Psychosocial resilience and protective mechanisms, American Journal of Orthopsychiatry 57:51-72. 

Werner, E. (1993) Risk, resilience, and recovery: Perspectives from the Kauai longitudinal study, Development and Psychopathology 5:503-515.

 

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March Infant Parent Mental Health Weekend: Temperament

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 We began the weekend with Dr.Nancy Snidman, a colleague of Dr. Jerome Kagan who talked to us about temperament. She defined temperament as “what a child brings to the interaction with the environment to create personality”, pointing out that nowadays we tend to talk about “individual differences” instead of temperament, but that individual differences tends to be a “blend of temperament and environment”.  Nancy talked to us about the differences in reactivity of children related to different thresholds of reactivity in the amydala. In their study of the amydala output effects, such as sympathetic responses, output to the larynx (crying), and output to the skeletal motor system, the research group identified a group of “timid” children who had inherited a low threshold of reactivity of the amydala.

It turns out that if you look at the sensory integration scale and the temperament scale, you find a lot of overlap, and some people think they are not so different. Nancy said that if part of your definition of sensory integration disorder is that there is an overwhelming response to sensory information that the child is born with, you could call it temperament. 

Nancy showed us videos of two 4-month old infants responding to a mobile. One baby was highly reactive to the stimulus, and the other was not. The research group chose babies who were high reactive and low reactive in terms of motor behavior and crying modes of reactivity and they followed them over time. Starting at 21 months the researchers saw a lot of consistency. 

The high reactive girls at 21 months started to look shy, a trait that diminished later on. As the children grew older, the best behavioral indicator of their status was spontaneous smiles and comments. The cognitive style related to high reactivity is associated with high levels of response inhibition and over control. The most cohesive group was low reactive boys. 

Socialization differences did have an impact. Interestingly, the low reactive boys tended to seek out risky behavior, whereas the (more “timid”) high reactive boys were often encouraged by their parents to get into sports, against their initial inclination. When these high reactive boys were older they would often end up in individual sports such as swimming, which is a team sport but may avoid some of the rough and tumble aggression characterizing the others.  As the kids got older, it was novelty that would trigger the threat. In preschool, when they became familiar with the school, they were fine. There were some high reactive boys who were doing very well in high school but couldn’t manage the transition (the novelty) to college. 

Nancy sees temperament as underlying all that gets created in the interaction between the individual and the environment. What is the environment that the child finds him or herself in?  If you were counseling parents, you might think – in the case of a high reactive child – to suggest that the parent take more time with transitions. In the case of a low reactive boy, you might try to protect the child against a tendency towards risky behavior. 

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