Temperament Theory and Research PDF

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STATE OF THE SCIENCE Temperament Theory and Research Sandra Graham McClowry zyxwvuts Astute nurse clinicians are constantly assessing the responses of their patients and then using that information to plan their subsequentinteractions and interventions.Nurses who adjust the manner in which they deal...

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STATE OF THE SCIENCE

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Temperament Theory and Research Sandra Graham McClowry

Astute nurse clinicians are constantly assessing the responses of their patients and then using that information to plan their subsequentinteractions and interventions.Nurses who adjust the manner in which they deal with patients recognize that individual characteristics need to be respected if the desired effects of intervention are to be achieved. However, unless nurses can articulate how those assessmentsand adjustmentsin their care are determined, their wisdom and experience cannot be communicated to other care providers, nor can they participate with their colleagues in a formalizedevaluation of the effectiveness of their approach. Temperament is a mid-range theory that identifies and classifies innate individualistic behavioral responses. Although the preponderance of temperament research has focused on infancy, the theory has been appliedto all age groups from infancy through adulthood. In this paper, temperament theory is offered as a framework that has the potential to explain, predict, and prescribe how the unique characteristics of individuals influence their responses to health, illness, change and other life situations. Current temperament theory is briefly described and its links with nursing science are identified. Published nursing studies which have been based on temperament theory are reviewed. The challenges awaiting nurses who choose temperament theory as their framework for intervention research are presented.

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Rothbart placed her emphasis on the biological expression of temperament that has a constitutional basis. With Derryberry (Rothbart & Derryberry, 1981), she defined temperament as the relatively stable, individual differences that are demonstrated through reactivity and self-regulation. Reactivity refers to the reaction of an individual to changes in the environment as demonstrated through motor activity, affect, autonomic, and endocrine responses. Self-regulationis the neural and behavioral processes that modulate (facilitate or inhibit) reactivity. Attention, approach, withdrawal, attack, behavioral inhibition and self-soothing are examples of such processes (Rothbart, 1989). Strelau (1989) emphasized the central nervous system in his study of temperament. From his perspective, there are two temperament traits-reactivity and activity-both of which are responses to environmental stimulation. Reactivity refers to the magnitude of reactions and the strength of the nervous system in response to excitation. Activity is the goal-directed behavior of the individual to approach or avoid stimulation. Goldsmith (1983) credited genetics as the underlying mechanism in the expression of primary emotions. With Campos (Goldsmith & Campos, 1986), he proposed that temperament is the initial expression of the primary emotions and arousal that predict later developing personality traits. From this theoretical perspective, although some dimensions of temperament are discernible at birth, others emerge later. However, once apparent, temperament traits are relatively stable (Goldsmith & Gottesman, 1981). Buss and Plomin (1975; 1984) agreed that traits that are enduring across time and situations are the only characteristics which should be considered as dimensions of temperament. They defined temperament as early developing personality traits that are biological in origin and appear in the first year of life. Limiting temperament to three traits, they discussed emotionality (distress), activity (tempo and vigor), and sociability. Their proposition is that temperament is inherited and resists modification by the environment. Other traits, aside from the three mentioned, are regarded as personality and can be expected to change based on environmental influences.

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Temperament Theory Although a universally accepted definition of temperament is unavailable, most researchers would agree that temperamenthas a biological underpinning and that it “is a rubric for a group of related traits and not a trait itseif’ (Goldsmith et al., 1987). In general, temperament is a term that acknowledges that, beginning in infancy, individuals have inborn characteristics which influence their responses to situations, particularly to those involving change or stress. Less encompassing than personality, temperament may be related to, but does not incorporate motivation, cognition and self-concept. Temperament theorists agree that temperament refers to a predisposition to behavioral response patterns that generally remain consistent over time, but they vary in the degree of importance that they place on the environmentand its influence on the expression of temperament.

SandraGraham McClowry, RN, PhD, Delta Mu, is Associate Professor, Yale University School of Nursing.CorrespondencetoYale University School of Nursing, 25 Park Street, Box 9740, New Haven, Connecticut 06536-0740. Accepted for publication April 3,1992.

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Kagan and his associates have focused on the biological etiology of childhood shyness as a manifestation of temperament. Their research has examined the initial physiological and social responses of infants to unfamiliar events presented in a laboratory setting (Garcia-Coll, Kagan, & Reznick, 1984). After following their subjects for several years, however, they reported that the continued expression of shyness in childhood is mitigated by the environment (Kagan, Reznick, & Snidman, 1988). The most clinically and environmentally focused conceptualization of temperament, and thus, the one most often used by practice disciplines, including nursing, comes from Chess and Thomas (1984). According to them, temperament is not a static trait or set of traits, but a particular reaction style that is constantly transacting and modifying, as well as being modified by the environment. Through their pioneering New York Longitudinal Study (NYLS) which began in 1953, Thomas and Chess (1977) identified nine dimensions of temperament: activity, rhythmicity, approach, adaptability, intensity, mood, persistence, distractibility and threshold. By grouping particular dimensions in constellations, behavioral profiles have been identified (Chess & Thomas, 1984). The most commonly discussed is a temperament that is labeled as “difficult” and consists of irregularity in biological functions, withdrawal from new situations, slow adaptability and an intense and negative mood. In contrast, the “easy” child is regular, approaches new situations with moderate ease, adapts easily and has a mild and generally positive mood. Although the “difficult” child is thought to be at-risk for the development of behavioral problems (Graham, Rutter, & George, 1973, Lavigne, Nolon, & McLone, 1988; Thomas & Chess, 1984), the environment is an important mitigator, as it is for all children. Chess and Thomas (1984) proposed that goodness of fit is the consonance of the child’s temperament to the demands, expectations and opportunities of the environment. Should families provide goodness of fit for their children, healthy emotional development is expected to occur. The influence of temperament on development does not end in childhood, but is thought to continue throughout the lifespan. Although the majority of studies have focused on infancy, some of the major temperament theorists have examined adult subjects (Goldsmith& Rothbart, 1991;Strelau, 1986;Thomas, Mittelman, Chess, Korn, & Cohen, 1982). In fact, Chess and Thomas (1990) have continued studying the original NYLS subjects during their adulthood. They found that those subjects who were “difficult” pre-schoolers were at-risk for adjustment problems during adulthood. Categorization of Temperament Researchers

Kohnstamm (1986) illustrates graphically that temperament researchers can be grouped into two categories. “Pure temperament scientists” tend to come from differential psychology, ethologyhiology and developmental psychology and are primarily interested in achieving a better understanding of human behavior as exhibited across situations and over time. “Applied scientists”, such as nursing, psychiatry, psychology, pediatrics and educational psychology, focus on clinical problems such as 320

health, education and the relationship of temperament to child psychopathology and social relationships. For them, the value of temperament research is in its ability to differentiate among children who are at risk for the development of problems from those who are not. The appeal of temperament theory for clinicians is evident in the literature. Bates (1989) reported that between 1984 and 1987, 62 percent of the 157 publications on temperament focused on practice-related topics. He anticipated that the percentage of publications with a clinical emphasis will not decrease in future years. Temperament Research Studies by Nurse Investigators

While the number of temperament studies by nurses is small in comparison with those who study other personal attributes, an increasing number of nurse researchers are incorporating the theory into descriptive studies. The Cumulative Index to Nursing and Allied Health Literature lists approximately 35 temperament articles published since 1983. The vast majority of those articles (89 percent) are empirical studies, and the remainder are literature reviews or discussions of clinical implications. Among the studies published in nursing journals are investigations into the relationship of temperament to development, the impact of temperament on social interactions, the role of temperament in influencing children’s responses to stressful situations, and measurement related contributions. The relationship of temperament to development. Three studies examined the relationship of temperament to various components of development, but with conflictingresults. Menzies (1984) studied the motor development of healthy infants who were between eight and 12months old. She found that babies who were highly adaptable had poorer motor development than those who were less adaptable. In contrast, Moller (1983) found that during the preschool years, “easy” children tested as more developmentally advanced. Cherry, Hayes and Feeg (1987) found that activity level and attention spadpersistence were not related to the cognitive styles of preschoolers as they had anticipated. One possible explanation for the discrepancies among the studies is that all three studies measured different aspects of development. Menzies (1984) measured the motor maturation, Cherry et al. (1987) examined cognitive styles, and Moller (1983) included a more comprehensive developmental battery of cognitive, verbal and motor evaluations. Another conceivable reason why the findings of the studies conflict with each other is that all three base their conclusions on low to moderate correlations and thus should be regarded as tentative until additional studies provide further clarification. A series of papers examined the temperament of very low birth weight (VLBW) infants as they developed through their preschool years. In these studies, the infants were compared to the standardized norms of age appropriate temperament questionnaires. During their first year, a disproportionately high percentage of the VLBW infants had difficult temperaments (MedoffCooper & Schraeder, 1982). Moreover, their negative mood and low distractibility (soothability) were associated with less maternal involvement and responsiveness. At six months, the VLBW infants were found to be less adaptable and more intense and, at

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12 months, they were less persistent than the infants in the normative sample (Medoff-Cooper, 1986). As toddlers and preschoolers, they continued to display lower persistence, in addition to being arrhythmic (Schraeder & Medoff-Cooper, 1983; Schraeder & Tobey, 1989). Low adaptability was also evident during the preschool years (Schraeder & Tobey, 1989). By the time the children were four years old, they exhibited a higher percentage of behavioral problems than would be expected. Those problems were associated with high activity, arrhythmia, low persistence and low threshold (Schraeder, Heverly, & Rappaport, 1990). The influence of temperament on night sleep has been examined in two studies. Jimmerson (1991) found that toddlers with sleep problems were less adaptable, more withdrawn and were more often described as having a difficult temperamentthan were toddlers who consistentlyslept through the night. In another sleep study that examined young single mothers and their infants (Becker, Chang, Kameshima, & Bloch, 1991),temperament was transactionally related to the baby’s variability in diurnal sleep patterns. While maternal stress had a stronger direct relationship to night sleep, a moderate interactional relationship was found between temperamentally difficult infants and mothers who had high levels of stress. Temperament was used as the conceptual basis for an experimental study in which various sensory programs were administered to full-term healthy infants when they were between four and eight months in an attempt to accelerate development (Koniak-Griffin & Ludington-Hoe, 1988). The experimental conditions were not found to affect development and, ironically, at the conclusion of the study, infants in the control group demonstrated the most optimal mood and distractibility scores. The researchers conclude that normal healthy babies who are in families that are naturally providing adequate stimulation do not need structured sensory programs, but acquire enough from their environment to foster their development. Temperamentand social relationships. Temperamenttheory acknowledges that even as infants, individuals contribute to the transactions that occur in social relationships. Nurse researchers have examined how temperament influences the quality of the relationshipsthat occur in the family and primarily in the motherchild dyad. Among those studies are several that have explored how the infant’s temperament influences parental behavior and attitudes. Studies examining the mother’s perception of the degree of temperamental difficulty of the infant or child have underscored the importance of that impression. Mothers who perceive their premature infants as difficult are less confident in their parental role (Zahr, 1991). On the other hand, mothers who had infants that they perceived as easy had higher levels of functional status by six weeks postpartum and continued to maintain those levels of activity throughout the six months followingdelivery (Tulman, Fawcett, Groblewski, & Silverman, 1990). However, another study did not find infant temperament affected parental management. Pridham, Chang, and Hansen (1987) examined the infant-related issues that might require mothers to use problem solving tactics. Mothers did not see their newborn’s temperament as requiring such an approach. Based on

that finding, the researchers posed that the mothers either recognized temperament as innate, and thus impossible to change, or that they were confident that they could foster development, no matter what characteristics the baby demonstrated. The infant’s temperament was expected to influence the environment in two other studies, but, again, with conflicting results. Houldin (1987) found that infants with high activity, low rhythmicity and negative mood often had less responsive childrearing environments. But, infant temperament was not related to marital satisfaction during the early transition to parenthood (Tomlinson, 1987). Since only the activity level of the infant’s temperament was used in the analysis, however, the researchers cautioned against over-interpreting this finding. The mother’s own characteristics have been shown to influence her perception of the child. Mothers with lower socioeconomic status more often perceived their full-term infants as more difficult than those with higher levels of education and financial resources (Menzies, 1984). Likewise, parents who were depressed or anxious described their infants as more difficult (Ventura, 1982). This finding was not supported in a replication when the responses of parents were examined separately by gender (Ventura, 1986). Instead, only depressed fathers showed this tendency. A change in a mother’s perception of her infant from easy to difficult was found to be accompanied by changes in maternal characteristics (Andrews, 1990). In such cases, an increase in psychological symptoms or a higher level of stress occurred concurrently. Such mothers also expressed a poorer attitude toward parenting. The mother’s own temperament also influences the parentalchild relationship. Adult adaptability and intensity were related to the maternal behavior of first-time mothers (Mercer, 1986). Moreover, compared to teen-age mothers, those who were older were more adaptable and less intense and were more competent mothers. Zahr (1987) found that the temperament of Lebanese mothers influenced their interactions with their two-month-old babies. Easy mothers with easy infants had the highest rates of interaction, while difficult mothers with easy infants had the lowest. Another transactional parent-child pattern was identified between school-age children and their mothers (McClowry et al., 1992). Daily hassles, a type of maternal stress, was a strong predictor of behavioral problems when it occurred in interaction with the child’s temperamental characteristic of negative reactivity. Maternal intensity, in turn, contributed to the mother’s perception of daily hassles. The role of temperament in response to stressful situations. Since temperament describes how individuals react to novel situations, its role in predicting responses to stress has intriguing possibilities. Temperament influenced how one-year-old infants responded in an unfamiliar situation designed to evoke attachment behavior (Kemp, 1987). Approach and mood were related to whether the children cried when separated from their mothers or responded positively to the stranger. Likewise, temperament was a strong predictor in explaining school-age children’s responses to hospitalization(McClowry, 1990). In another study of hospitalized children, Ruddy-Wallace (1989) found that pre-

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school children with high intensity received a greater number of postoperative analgesic medications than did those with low intensity. Thus, nurses appear to medicate children who display their pain more intensely than those whose expression may not be as visible. Children who have a chronic illness are thought to experience ongoing stressors in daily life. The temperament of the infants and toddlers with cardiac disease was compared to healthy children (Marino & Lipshitz, 1991).Infants with cardiac problems were more withdrawn and intense and had a lower threshold of responsiveness. Toddlers were less active, rhythrmc and intense, in addition to having a more negative mood. Temperament may also be related to other health related outcomes. Difficult children have been shown to have a higher proportion of accidents than those with other temperaments (Russell & Russell, 1989). Measurement related contributions. The credibdity of temperament research rests on the validity and reliability of the measurement of the construct. Nurses researchers have reported studies that focus on measurement related issues. In a comparison between maternal ratings of the temperament of toddlers, as calculated by responses on a questionnaire, and global impressions obtained by asking “How would you describe your child? Easier than average, about aver...