Temperamental and Theoretical Contributions to Clinical Psychology.

This review considers two themes. The first section describes the influence of two temperamental biases detectable in infants that render children vulnerable to maladaptive behavior if the rearing environment invites such responses. Infants who display high levels of limb activity and crying in response to unexpected events are likely to be shy and fearful as children and are at risk for an anxiety disorder. Infants who display little limb movement and crying are susceptible to assuming risks and vulnerable to asocial behavior if the rearing environment invites these actions. The second section criticizes three common research practices: failure to examine patterns of measures for predictors and outcomes, an indifference to the power of the setting on the evidence recorded, and the distortions that semantic terms in questionnaires impose on replies.

Kinds of individuals defined by patterns of variables.

This paper argues that investigators should consider replacing the popular practice of comparing individuals varying in gender, social class, and/or ethnicity on one or more continuous measures with a search for kinds of individuals defined by patterns of properties that include not only their values on outcome measures but also their gender, social class, and ethnicity. Investigators who believe that a particular predictor contributes to an outcome independent of the gender, class, or ethnicity of the participants often implement statistical procedures that promise to remove the contributions of the above categories. These analyses lead to misleading conclusions when the controlled category is correlated with the dependent measures. The final sections summarize the properties of genders, classes, and ethnic groups that make distinctive contributions to many psychological outcomes. The paper ends by noting that a society's ethical beliefs constitute a defensible basis for ignoring the biological properties associated with these categories in order to allow members of these groups access to whatever educational or occupational goals they desire.

Effect of Maternal Distress on Perceptions of Infant Behavior May Differ in Chinese-American and European-American Mothers and Infants.

OBJECTIVE: This study examined the associations between maternal distress (symptoms of depression and anxiety) and observer and maternal ratings of infant temperament in Chinese-American (CA) and European-American (EA) 4-month-old infants (N = 114 dyads). METHODS: Maternal distress was obtained through self-reported symptoms of depression and anxiety. Mothers reported infant temperament (distress at limitations, soothability, and fear) through the short form of the Infant Behavior Questionnaire-Revised. To obtain observer-rated infant reactivity, infants were administered a battery of visual and auditory stimuli in the laboratory, in which infant behaviors (fret/cry, limb activity, and arching of the back) were coded. RESULTS: Maternal distress accounted more for the maternal perception of her infant among EA mothers than among CA mothers, but the relation was only observed for soothability. Higher maternal distress was associated with maternal report of lower soothability for EA mothers. Observer-rated infant reactivity, but not maternal distress, was positively associated with EA and CA maternal report of distress at limitations. Observer-rated infant negativity was associated with somewhat higher ratings of infant fear for EA mothers, although this association for EA mothers was not significantly different from CA mothers. CONCLUSIONS: Potential biases in maternal report of infant behavior due to effects from maternal distress may not be generalizable across cultures but may vary because of cultural norms for emotional experience and expectations for infant behavior. EA mothers' ratings of infant distress and soothability, but not fear, may be influenced by maternal distress.

In defense of qualitative changes in development.

The balance between the preservation of early cognitive functions and serious transformations on these functions shifts across time. Piaget's writings, which favored transformations, are being replaced by writings that emphasize continuities between select cognitive functions of infants and older children. The claim that young infants possess elements present in the older child's concepts of number, physical impossibility, and object permanence is vulnerable to criticism because the inferences are based primarily on the single measure of change in looking time. It is suggested that investigators use unique constructs to describe phenomena observed in young infants that appear, on the surface, to resemble the psychological competences observed during later developmental stages.

Using the proper vocabulary.

This paper makes three points. First, inferences from biological and psychological evidence pertaining to psychological constructs must use distinct vocabularies because they represent different phases of a cascade of processes. Second, there are necessarily indeterminate relations between phases of the cascade that begins with an incentive evoking a brain state which, in turn, may generate a psychological reaction and/or action. Finally, all biological and psychological phenomena occur in particular species and specific contexts; hence it is useful to append to every conclusion information on the agent and the setting in which the evidence was gathered.

Three Unresolved Issues in Human Morality.

This article discusses three major, but related, controversies surrounding the idea of morality. Is the complete pattern of features defining human morality unique to this species? How context dependent are moral beliefs and the emotions that often follow a violation of a moral standard? What developmental sequence establishes a moral code? This essay suggests that human morality rests on a combination of cognitive and emotional processes that are missing from the repertoires of other species. Second, the moral evaluation of every behavior, whether by self or others, depends on the agent, the action, the target of the behavior, and the context. The ontogeny of morality, which begins with processes that apes possess but adds language, inference, shame, and guilt, implies that humans are capable of experiencing blends of thoughts and feelings for which no semantic term exists. As a result, conclusions about a person's moral emotions based only on questionnaires or interviews are limited to this evidence.

Perspectives on two temperamental biases.

This paper describes the contribution of two infant temperamental biases to variation in behaviour and biology over the first 18 years in a sample of middle-class Caucasian children. One bias, called high reactive, is defined by frequent display of limb activity and crying in four-month-old infants to unexpected or unfamiliar events. The other, called low reactive, is defined by the opposite pair of behaviours to the same incentives. High reactive infants are likely to display cautious, avoidant responses and signs of an excitable amygdala to unexpected experiences. Low reactives are characterized by a sociable, emotionally spontaneous profile to the same experiences and a minimally excitable amygdala. However, each bias is a better predictor of the future traits that are unlikely to develop than the ones that do. The final pattern of traits is a function of the person's temperaments, life history, and current circumstances.This article is part of the theme issue 'Diverse perspectives on diversity: multi-disciplinary approaches to taxonomies of individual differences'.

A Neurobehavioral Mechanism Linking Behaviorally Inhibited Temperament and Later Adolescent Social Anxiety.

OBJECTIVE: Behavioral inhibition (BI) is a temperament identified in early childhood that is a risk factor for later social anxiety. However, mechanisms underlying the development of social anxiety remain unclear. To better understand the emergence of social anxiety, longitudinal studies investigating changes at behavioral neural levels are needed. METHOD: BI was assessed in the laboratory at 2 and 3 years of age (N = 268). Children returned at 12 years, and an electroencephalogram was recorded while children performed a flanker task under 2 conditions: once while believing they were being observed by peers and once while not being observed. This methodology isolated changes in error monitoring (error-related negativity) and behavior (post-error reaction time slowing) as a function of social context. At 12 years, current social anxiety symptoms and lifetime diagnoses of social anxiety were obtained. RESULTS: Childhood BI prospectively predicted social-specific error-related negativity increases and social anxiety symptoms in adolescence; these symptoms directly related to clinical diagnoses. Serial mediation analysis showed that social error-related negativity changes explained relations between BI and social anxiety symptoms (n = 107) and diagnosis (n = 92), but only insofar as social context also led to increased post-error reaction time slowing (a measure of error preoccupation); this model was not significantly related to generalized anxiety. CONCLUSION: Results extend prior work on socially induced changes in error monitoring and error preoccupation. These measures could index a neurobehavioral mechanism linking BI to adolescent social anxiety symptoms and diagnosis. This mechanism could relate more strongly to social than to generalized anxiety in the peri-adolescent period.

Posttraumatic Stress Disorder Diagnosis in Young Children With Burns.

The primary aim of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) in young children hospitalized for burns. A secondary aim was to assess partial PTSD in this population. PTSD diagnosis and symptoms were evaluated utilizing both the diagnostic interview for children and adolescents (DICA-P) module and the PTSD semistructured interview and observational report (PTSDSSI). PTSD symptomatology was assessed from parent interviews at 1 month after discharge from a major pediatric burn center. Four of the 42 participants who completed the DICA-P met full criteria for a diagnosis of PTSD (10%).Of the 39 who also completed the PTSDSSI, 1 (3%) met full criteria for PTSD diagnosis on that measure. Twenty-seven percentage of subjects met partial criteria on the DICA-P vs 16% on the PTSDSSI, without impairment. Furthermore, 67% of subjects met DICA-P criteria for the re-experiencing cluster and 54% met the PTSDSSI re-experiencing criteria. Although only a small percentage met full PTSD diagnostic criteria by either measure, a high percentage of young children with burns manifested some posttraumatic symptoms 1 month after discharge. Because PTSDSSI diagnosis is strongly linked to the diagnostic and statistical manual-5 (DSM-5) criteria for "PTSD in children 6 years and younger," these results may offer clues to current diagnoses of PTSD in young children. Future research is needed to improve care by determining the risk factors and course of PTSD to further refine the diagnostic criteria for identifying children most in need of intervention, such as those hospitalized for burn injuries.

Young burned children: the course of acute stress and physiological and behavioral responses.

OBJECTIVE: Symptoms of posttraumatic stress disorder (PTSD) are a focus of much research with older children, but little research has been conducted with young children, who account for about 40% of all pediatric burn injuries. This is a longitudinal study of 72 acutely burned children (12-48 months old) that assessed the course of acute posttraumatic symptoms and physiological reactivity. METHOD: Parents were interviewed shortly after their child was admitted to the hospital and 1 month after discharge. PTSD symptoms were measured with the Diagnostic Interview for Children and Adolescents (DICA) module. Nurses recorded the child's physiological data throughout the hospital stay. The child's physical and behavioral responses were assessed in a laboratory at about 1 month after discharge. RESULTS: Reduced social smiling in the children was related to PTSD symptoms, as measured by the DICA, and heart rate at 24 hours and 7 days. Reduced vocalization was related to the child's rating of pain at 24 hours. Smiling and vocalizations were also related to some DICA cluster scores but not avoidance. CONCLUSIONS: Preschool children admitted to a burn unit demonstrated PTSD symptoms and physiological reactivity. There was a relation to the frequency of smiles and vocalizations.

Association of behavioral inhibition with hair pigmentation in a European sample.

Behavioral inhibition, a temperamental trait signalling a predisposition to childhood and adolescent anxiety disorders, is slightly more frequent in America among Caucasian children having blue irises. This paper examines a community sample of 101 German toddlers assessed for behavioral inhibition in a standardized laboratory procedure. Hair pigmentation was found to be significantly associated with behavioral inhibition in the sense that blond children exhibited higher fear scores. As in American samples, blue-eyed children had a higher fear score than did other children, but this difference was not statistically significant.

An Overly Permissive Extension.

In this article, I describe how the current practice of classifying as a stressor any event that is accompanied by a change in any of a number of biological or behavioral measures-even when it is not accompanied by a long-term compromise in an organism's health or capacity to cope with daily challenges-has limited the utility of this concept. This permissive posture, which began with Selye's writings more than 65 years ago, is sustained by the public's desire for a simple term that might explain the tension generated by the threat of terrorists, growing economic inequality, increased competiveness in the workplace or for admission to the best universities, rogue nuclear bombs, and media reports of threats to health in food and water. I believe that the concept stress should be limited to select events that pose a serious threat to an organism's well-being or discarded as too ambiguous to be theoretically useful.

Why Stress Remains an Ambiguous Concept: Reply to McEwen & McEwen (2016) and Cohen et al. (2016).

This reply to the commentaries by Cohen, Giannaros, and Manuck (2016, this issue) and McEwen and McEwen (2016, this issue) acknowledges investigators' reluctance to relinquish the term stress, despite the lack of agreement on its meaning and the evidence that is a sign of its presence. This brief reply urges scientists studying the exemplars of this ambiguous concept to search for robust relations that specify the type of event, the properties of the agent, the agent's circumstances, and the behavioral or biological consequences. The accumulation of these relations will reveal that the word stress adds little to our understanding.

The corticotropin-releasing hormone gene and behavioral inhibition in children at risk for panic disorder.

BACKGROUND: Behavioral inhibition to the unfamiliar (BI) is a heritable temperamental phenotype involving the tendency to display fearful, avoidant, or shy behavior in novel situations. BI is a familial and developmental risk factor for panic and phobic anxiety disorders. We previously observed an association between BI and a microsatellite marker linked to the corticotropin releasing hormone (CRH) gene in children at risk for panic disorder. To evaluate this further, we genotyped additional families for this marker and a panel of markers encompassing the CRH locus. METHODS: Sixty-two families that included parents with panic disorder and children who underwent laboratory-based behavioral observations were studied. Family-based association tests and haplotype analysis were used to evaluate the association between BI and polymorphisms spanning the CRH locus. RESULTS: We examined a set of markers which we found to reside in a block of strong linkage disequilibrium encompassing the CRH locus. The BI phenotype was associated with the microsatellite marker (p=.0016) and three single nucleotide polymorphisms (SNPs), including a SNP in the coding sequence of the gene (p=.023). Haplotype-specific tests revealed association with a haplotype comprising all of the markers (p=.015). CONCLUSIONS: These results suggest that the CRH gene influences inhibited temperament, a risk factor for panic and phobic anxiety disorders. Genetic studies of anxiety-related temperament represent an important strategy for identifying the genetic basis of anxiety disorders.

The relation between reactivity at 4 months and Behavioral Inhibition in the second year: Replication Across Three Independent Samples.

This paper examines the predictive relations between two infant temperamental biases assessed at 4 months and inhibited behavior during the first two years of life in three independent samples from two research laboratories. Although each sample used slightly different criteria for classifying infants, the results across samples were consistent. Infants of both genders who displayed high levels of motor activity and distress to unfamiliar events were more inhibited at 14 months of age. By 24 months there were significant sex differences: boys identified as high reactive were more inhibited than high reactive girls.

Differential amygdalar response to novel versus newly familiar neutral faces: a functional MRI probe developed for studying inhibited temperament.

BACKGROUND: As a prelude to future studies of subjects with different temperaments, we sought to develop a probe to measure differential amygdalar responses to novel versus familiar stimuli. Prior neuroimaging studies of the amygdala in humans to date have focused principally on responses to emotional stimuli, primarily aversive, rather than to novelty per se. METHODS: Eight normal subjects aged 22.4 +/- 1.3 years were scanned using functional magnetic resonance imaging (fMRI) during passive viewing of novel and familiar faces. RESULTS: Using this newly developed paradigm, we found greater fMRI blood oxygenation level dependent (BOLD) signal response within the right amygdala to novel versus familiar faces--all with neutral expression. Furthermore, although a new facial identity was always presented in the novel condition, signal in the amygdala declined over time as it did for the familiar condition. CONCLUSIONS: These results suggest that at least one primary function of the amygdala is to detect and process unexpected or unfamiliar events that have potential biological import, of which stimuli symbolic of fear or threat are but one possible example. We propose that this experimental paradigm will be useful for examining brain responses to novelty in different temperamental groups, as well as various psychiatric disorders.

Association of a genetic marker at the corticotropin-releasing hormone locus with behavioral inhibition.

BACKGROUND: Behavioral inhibition to the unfamiliar (BI), a heritable temperamental profile involving an avoidant response to novel situations, may be an intermediate phenotype in the development of anxiety disorders. Corticotropin-releasing hormone (CRH) is a key mediator of the stress response through its effects on the hypothalamic-pituitary-adrenal axis and limbic brain systems. Transgenic mice overexpressing CRH exhibit BI-like behaviors, implicating this gene in the development of the phenotype. METHODS: We genotyped a marker tightly linked to the CRH locus in 85 families of children who underwent laboratory-based behavioral assessments of BI and performed family-based association analyses. RESULTS: We observed an association between an allele of the CRH-linked locus and BI (p =.015). Among offspring of parents with panic disorder, this association was particularly marked (p =.0009). We further demonstrate linkage disequilibrium between this marker and single nucleotide polymorphisms encompassing the CRH gene. CONCLUSIONS: These results are consistent with the possibility that variants in the CRH gene are associated with anxiety proneness.

Neural and behavioral substrates of mood and mood regulation.

A review of behavioral and neurobiological data on mood and mood regulation as they pertain to an understanding of mood disorders is presented. Four approaches are considered: 1) behavioral and cognitive; 2) neurobiological; 3) computational; and 4) developmental. Within each of these four sections, we summarize the current status of the field and present our vision for the future, including particular challenges and opportunities. We conclude with a series of specific recommendations for National Institute of Mental Health priorities. Recommendations are presented for the behavioral domain, the neural domain, the domain of behavioral-neural interaction, for training, and for dissemination. It is in the domain of behavioral-neural interaction, in particular, that new research is required that brings together traditions that have developed relatively independently. Training interdisciplinary clinical scientists who meaningfully draw upon both behavioral and neuroscientific literatures and methods is critically required for the realization of these goals.

Maternal panic disorder: infant temperament, neurophysiology, and parenting behaviors.

OBJECTIVE: To determine whether 4- and 14-month-old infants of mothers with panic disorder (PD) would be more likely to show differences in temperament, neurophysiology (salivary cortisol and sleep), and relationships with their mothers than controls. METHOD: Two cohorts were recruited: 4-month-old infants with PD mothers (n = 25) and 4-month-old controls (n = 24), and 14-month-old infants with PD mothers (n = 27) and 14-month-old controls (n = 18). Mothers completed diagnostic interviews and questionnaires concerning infant temperament, sleep, and parenting. Infant salivary cortisol samples and standard observational procedures to measure infant temperament, sleep, attachment, and parenting were also used. RESULTS: Infants with PD mothers did not show more high reactivity, behavioral inhibition, or ambivalent/resistant attachment but did demonstrate different neurophysiology (higher salivary cortisol and more disturbed sleep) than controls. PD mothers also displayed less sensitivity toward their infants and reported parenting behaviors concerning infant sleep and discipline that have been associated with child problems. CONCLUSIONS: While infants with PD mothers did not show early behavioral differences from controls, they did display neurophysiological divergences consistent with higher arousal/arousability. Such neurophysiological divergences (elevated salivary cortisol and disturbed sleep) might be important early indicators of risk. Helping PD mothers parent their more highly aroused/arousable infants could reduce the development of psychopathology.