Temperament
In the past several decades, the body of research on individual differences in child and adolescent temperament has grown substantially. Temperament, defined as a person’s innate and stable style of experiencing and responding to the world, encompasses individual differences in a wide range of traits [1]. Such traits include affective reactivity, which refers to excitability, responsivity, or arousability; regulation, or the executive capacity to control attention and behaviors that operate to modulate reactivity [2]; and sociability, commonly defined as a preference to interact with others rather than to be alone [3, 4].
Leading developmental scholars argue that temperamental predispositions lay the foundation for the observable manifestation of personality [5, 1]. Furthermore, findings demonstrate continuity between early temperament styles and the development of personality across the lifespan. For instance, in a longitudinal study following a cohort of 14-month-old infants across three decades, Tang and colleagues examined whether behavioral inhibition, a core component of temperament, may predict long-term personality, as well as social relationships, education, and mental health outcomes in adulthood [6]. On average, inhibited infants in this study grew up to become more inhibited adults, who also exhibited lower levels of social engagement (i.e., fewer number of reported close friends, lower amount of time spent with friends and family) and poorer mental health outcomes than did individuals with low behavioral inhibition. These findings demonstrate a pattern of stability across infant temperament and adult personality.
Theorists have proposed several frameworks, which Fu and Perez-Edgar described thoroughly [7], to conceptualize temperament (see [8, 9, 10, 11, 12] for reviews). Among those that have received the most empirical support is one that Rothbart and colleagues proposed and have developed over the last several decades [1, 10, 13]. This model defines temperament as individual differences in positive affect (PA), negative affect (NA), and self-regulation [i.e., effortful control (EC)]. Positive affect, or the propensity to have frequent positive experiences and reactions, such as excitement, joy, and interest [1], has been linked to positive outcomes and functioning across the lifespan [14]. The other dimensions of temperament (i.e., negative affect and effortful control) show fewer associations with desirable mental health outcomes (e.g., lower attentional and emotional regulation or disinhibition) for children as they develop into adolescents and adults. Their relations to dimensions of psychopathology (e.g., risk for higher levels of anxiety, depression, or aggression) are the focus of the present study.
Temperament And Child Psychopathology
A substantial proportion of children and adolescents meet the criteria for at least one or more psychological disorders across the lifespan [15], and many more exhibit psychopathology, or behaviors or emotions that are maladaptive and cause distress or impair daily and adaptive functioning [16], but do not cross diagnostic thresholds for a disorder [17]. The etiology of child psychopathology is complex and multifactorial [15, 18, 19], and depends on the influence of numerous risk and protective factors [20, 21]. However, as a broad range of findings show, temperament is a consistent contributor to the manifestation and maintenance of varied forms of psychopathology in youth [15, 22, 23, 24]. Connections among temperament, personality, and psychopathology are frequently reported, although substantial work still needs to be done to help us better understand the nature and implications of these relationships (see 18 for review). In light of the well-documented stability of individual differences across the lifespan, there is growing interest in empirically evaluating associations between childhood individual differences and multiple dimensions of developmental psychopathology [4, 25].
Temperament And Internalizing Versus Externalizing Psychopathology
Since the late 1970s, psychologists have worked to understand the structure of child temperament and how individual differences on multiple dimensions may correspond in distinctive ways with varied forms of psychopathology. In the New York Longitudinal Study (see Thomas & Chess, 1977 for review [8]), researchers identified nine dimensions of temperament. These included activity level, approach/withdrawal, intensity, threshold, adaptability, rhythmicity, mood, attention span, and distractibility. Over time, these categories have been refined to include the defensive reactions of fear and anger, approach reactions of pleasure and intense stimulation, and attentional scales of effortful control [1, 26].
More recently, two broad, higher-order dimensions of temperament (i.e., negative and positive temperament) have proved particularly useful to examine in efforts to distinguish among different forms of psychopathology [26, 27]. Negative temperament encompasses heightened negative emotional and behavioral reactivity (e.g., fear, sadness, anger, frustration), while positive temperament refers to reward sensitivity and sociability [24]. Extreme levels of either of these dimensions of temperament may relate prospectively to psychopathology across the lifespan; depending on the degree to which an individual deviates from normative ranges on each dimension, different patterns of psychopathology may emerge.
Historically, psychopathology has been defined categorically, such that it constitutes discrete clinical conditions that can be distinguished from each other and from normative functioning according to natural boundaries [28]. Categorical nosologies, however, have notable limitations (for review, see [29, 30]). It is thus not surprising that efforts to identify and treat youth who are at risk for psychopathology have been impeded by current categorical schemes of psychiatric diagnosis [31, 32].
Of the limitations to categorical diagnostic systems, the one of most relevance to this paper is that many ostensibly discrete disorders commonly co-occur; researchers have long noted that high rates of comorbidity are particularly common among youth [33]. High rates of comorbidity suggest common core processes underlying diagnostic categories, and the presence of such shared mechanisms is inconsistent with the idea that disorders are discrete entities [34]. In response to this problem, alternative, dimensional models of psychopathology have emerged that are grounded in efforts to identify patterns of covariance across psychiatric symptoms [35, 36].
Research examining the latent structure of common mental disorders supports a conceptualization that comprises two broad, higher-order dimensions: internalizing (INT) and externalizing (EXT; [36, 37, 38]). This structure is supported in samples of all ages [39, 40]. Dimensional models have the advantage of accommodating correlations between internalizing and externalizing dimensions. They also include a wide array of predispositions and risk factors, which allows for a more accurate representation and understanding of individual differences in vulnerability to childhood psychopathologies across the spectrum [30, 41].
Conditions within the internalizing dimension are characterized by negative affect, which may manifest as low mood, anxiety, fear, distress, and/or panic [42, 43, 44]. Thus, the internalizing dimension typically includes anxiety disorders (e.g., generalized anxiety disorder, separation anxiety disorder), major depressive disorder (MDD), phobias (e.g., specific, social), and eating pathology [43, 45]. Conditions within the externalizing dimension, in contrast, are characterized by disinhibition, aggression, rule-breaking, and antisocial behaviors, among others [4, 46, 47]. The externalizing dimension typically includes oppositional defiant disorder (ODD), conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD) [4, 35, 46].
Negative Affect And Associations With Psychopathology
Theories of temperament have consistently emphasized the relevance of negative affect in the manifestation of child psychopathology. Negative affect (NA) – sometimes referred to as negative emotionality or neuroticism [42] – reflects a stable and pervasive propensity to experience aversive emotions [48]. Furthermore, it is a powerful and well-supported determinant of psychological adjustment and outcomes [14, 49]. Widiger and Oltmanns asserted that high NA is associated with a diminished quality of life, excessive worry, and increased risk for mental health problems [49]. Indeed, children with high NA respond poorly to environmental stress, interpret ordinary situations as threatening, and may get overwhelmed more easily than children with low negative affect [43, 49]. As such, children with high levels of negative affect possess an increased risk for emotional and behavioral disorders due to both their propensity to focus on negative cues and their restricted engagement with the environment [38, 50]. Robust findings support the notion that high NA is associated with both internalizing and externalizing disorders [31, 42, 51, 52].
Decades of studies have demonstrated links between NA and internalizing psychopathology, specifically [24, 42, 53]. NA frequently contributes to anxiety and depressive symptoms, which may confer risk for internalizing psychopathology, such as mood disorders [54]. Previous findings indicate a moderate positive relationship between NA and internalizing symptoms that are observable from preschool age through adolescence (anxiety/depression; [18, 19, 43, 55, 56]. This pattern of association suggests that NA is an important contributing factor for internalizing psychopathology; however, because correlations are typically moderate, there are likely many additional factors that contribute to internalizing psychopathology. Internalizing symptoms have the potential to turn into debilitating emotional disorders with significant implications for cognitive and interpersonal functioning, as well as physical health [57]. Furthermore, within the context of the internalizing dimension, research suggests strong associations between NA and distress disorders (e.g., depression, generalized anxiety disorder, posttraumatic stress disorder), and moderate associations between NA and fear disorders (e.g., social anxiety, social phobia, panic disorder [58].
Additional research indicates an association between NA and externalizing behaviors [59, 60, 61]. These associations, however, are less robust than those for internalizing symptoms. Singh and Irwin acknowledge that considerable portions of the genetic and nonshared environmental influences underlying externalizing symptoms are shared with NA [60]. Further, Tackett and colleagues (2011) found that NA may explain genetic influences on the presence of conduct disorder in children and adolescents [62].
All told, robust findings provide evidence of a high correlation between NA and both internalizing and externalizing symptoms. This is especially true in childhood, given the tendency for youth to express high NA (e.g., frustration) outwardly (e.g., tantrums). Notably, the associations between NA and psychopathology are moderate in nature, suggesting the presence of additional contributing factors. Thus, examining the influence of possible moderating constructs (e.g., effortful control) may help us better understand risk for varying manifestations of psychopathology.
Role Of Effortful Control In Psychopathology
According to Rothbart’s temperament model, one of the precursors to emotional and general self-regulation is effortful control [3, 23, 22]. Effortful control (EC) is a small element of the more complex process of emotion regulation and executive functioning and is relatively stable over time. Effortful control has received increasing research attention as an important transdiagnostic dimension that underlies both internalizing and externalizing symptomatology [31, 63]. Effortful control can be characterized as the ability to direct attention to inhibit a dominant response and activate a sub-dominant response in service of goal-oriented behavior [3, 26]. Measures of effortful control often encompass lower-order traits of attentional control, or the ability to maintain and shift attentional focus upon task-based stimuli, and inhibitory control, or the capacity to effortfully suppress inappropriate approach response [15, 64, 65]. Effortful control can be assessed in childhood through parental report and laboratory tasks [61] and is credited with playing a large role in the development of emotion regulation capacities and skills [26]. Shifting attention changes perception of a stimulus field (e.g., inhibiting a dominant response [61, 66]), which impacts how a child perceives and responds to their environment. There is evidence that effortful control strengthens throughout the lifespan via the development and integration of reactive and regulatory mechanisms in response to personal values and social norms [67, 68].
Effortful control can influence adjustment and can contribute to the modulation of behavior within an individual in ways that can yield positive or negative outcomes. Children who struggle with EC may be at heightened risk for psychopathology via poor emotion reactivity and regulation skills, which can also increase adjustment problems and create the possibility of more serious problems emerging in adolescence [23, 69]. Poor effortful control, especially behavioral dysregulation, is a key temperamental factor underlying both dimensions of psychopathology [70]. More precisely, high behavioral inhibition is associated with internalizing psychopathology, and low behavioral inhibition is more closely associated with externalizing psychopathology.
These associations made EC a potential moderator of particular interest for the present study. High correlations between internalizing and externalizing problems might be explained by the presence of high NA in both types of condition; however, individual differences in EC may contribute to whether an individual's feelings of negative affect are expressed inwardly, as in internalizing conditions, or outwardly as in externalizing conditions. Many studies have focused on specific findings about particular forms of psychopathology, rather than taking a more comprehensive, multivariate perspective of the temperament/psychopathology relationship in children [18]. Therefore, the present study seeks to examine both reactive (i.e., NA) and regulatory (i.e., EC) facets of childhood temperament in efforts to more accurately determine risk for dimensions of psychopathology.
Risk Vs Resilience
Although NA and EC may be independent predictors of internalizing and externalizing behaviors, the ways in which these characteristics manifest in tandem in children may promote either heightened vulnerability or resilience to different forms of psychopathology [50, 59]. For example, although individuals with high NA are predisposed to focus on the negative, possession of strong effortful control capacities may protect against the development of psychopathology. In contrast, individuals with disrupted effortful control capacities often lack the ability to inhibit their negativity, which poses a risk for the emergence of psychopathological symptoms. Ultimately, the presence and on-going duration of high NA during childhood increases risk for emotional and behavioral disorders. However, the influence of NA as a reactive temperament factor may be buffered by effortful control. Strong effortful control may provide children the ability to practice flexible and effective coping strategies [51, 71].
Aim And Hypotheses
The primary aim of this study was to test whether associations between NA and dimensions of child psychopathology may be moderated by EC. In addition, we examined consistency between self-report and task-based measures of EC. Based on the literature, we hypothesized that high NA and low EC would be independently associated with both internalizing and externalizing problems. We expected that NA would be positively correlated with both dimensions of psychopathology and that effortful control would be negatively correlated with both dimensions of psychopathology. We also predicted that high NA, in combination with low levels of EC, would be associated with high levels of child psychopathology
Our main hypothesis focused on the relationships among all three target variables. We predicted that temperamental effortful control would moderate the relationships between negative affect and both internalizing and externalizing child psychopathology. Specifically, we hypothesized that high levels of negative affect and low levels of effortful control would serve as a risk factor for the development of internalizing and/or externalizing child psychopathology. In contrast, we expected that low levels of negative affect and strong effortful control capacities would serve as a protective factor against developing internalizing and/or externalizing child psychopathology. Pre-registered hypotheses can be viewed on the Open Science Framework (https://osf.io/98phf).