What is A Temperament?

Here are a few examples of normal behavior for children with certain temperament traits, and the kinds of advice parents might receive from our temperament counselors:

Easily distracted: This child may not remember instructions given moments before. Make eye contact and give only one instruction at a time. Give praise when instruction is followed.

Sensitive: This child may be overstimulated by loud noises or an active play session. Let the sensitive child know it's okay to take a break away from the action and the noise.

Easily frustrated: This child often wants mom or dad around for help and requires extensive patience. Help the child organize and get started on an activity, but remove yourself as soon as possible. Set realistic expectations and encourage the child to work or play independently.

What's Normal?

Temperament Program Helps Parents Understand Their Children

Although Jimmy is only a toddler, he is already demonstrating problems with adaptability-the ability to adjust easily to new situations. He got quite upset when his mother hired a substitute babysitter to replace his regular one who became ill. He also gets upset over smaller things-a new pair of shoes or the introduction of an unfamiliar food.

Such behavior isn't really unusual in young children, but it can befuddle parents who aren't quite sure how to react to their youngsters. To address parents' concern over what they might consider "challenging" temperaments, Kaiser Permanente started its Temperament Program, which is celebrating its 10th year. The program helps parents better understand and accept their children's disposition and offers strategies "to manage, not change their temperament," says David Lee Rosen, MD, the program's acting director and retired chief of psychiatry at Kaiser Permanente's San Rafael, Calif., Medical Center, where the program began.

Parents participating in the program receive questionnaires about their child's patterns of behavior when the youngsters are about four months old. Besides targeting basic elements of a child's temperament, the program deals with issues related to the child's eating and sleeping habits and preferences, non-compliance and assertiveness.

The responses are computer-scored, and parents receive a narrative profile describing their child's temperament. In addition, the profile includes what behaviors they might expect from their child, and tactics for dealing with the issues that may arise over the next year. Stories about how other parents have successfully managed similar temperament issues are provided as well.

Although all temperament combinations are considered normal, about 5% of children fall into a category of "challenging" behavior. Their parents might need a little extra help-as a result, they are encouraged to obtain further counseling by phone or in person. Parents of older children (from 1 1/2 to 12 years of age) may take advantage of a separate consult program by referral from their pediatricians.

"By identifying some of these more challenging temperaments early on, it helps parents reconcile their expectations with what their children are really like," says Linda Bartlett, MD, of Kaiser Permanente's Santa Teresa Community Medical Center in San Jose, Calif., which adopted the program in 1992.

"Parents are so relieved to find out that what their child is doing is 'normal' although it may seem extreme, receive validation of their perceptions and go away with hands-on approaches to dealing with their children," Dr. Bartlett adds.

According to James Cameron, PhD, executive director of Preventive Ounce in Oakland, Calif., a preventive mental health organization which scores the questionnaires, about 12,000 Kaiser Permanente parents have taken advantage of the program since its inception.

Cameron hopes that the Temperament Program's questionnaires, assessments and guidance will soon be available online.