The aims of this study was to investigate the prevalence of maternal perceptions of difficult toddler temperament at 18-month follow-up of a birth cohort recruited from a culturally diverse and socioeconomically disadvantaged community, and to identify risk factors associated with report of a difficult temperament. The prevalence of difficult temperament in this population of toddlers was 7.3%, similar to previous findings in the general population (7, 17). To our knowledge, this is the first study to show associations between toddler temperament and family and home environmental determinants such as increased screen time, not being read to, and family history of mental health problems. The results from this study are important in identifying support needs for toddlers and parents raising children with a difficult temperament to prevent mental health problems in the future.
The current study showed that toddler screen time of more than two hours a day was related to difficult temperament. This is congruent with previous research which has shown a bidirectional relationship between effortful control and screen time in young children (34, 35). However, a recent systematic review concluded that child temperament is not a correlate of screen time based on three included studies (36). Therefore, future research is needed to determine whether there is a link between difficult temperament and screen time in toddlers or whether the relationship is compounded by sociodemographic factors indicative of psychosocial disadvantage and lack of stimulatory experiences and nurturing care. Behavioural interventions that address temperamental difficulties coupled with parenting support may be helpful for these toddlers and their families (37). Working with families to understand what factors influence excessive screen time could also help in the provision of relevant, focused interventions (38).
A difficult temperament was also found to be associated with children who were not read to. This finding may be explained by parents being overwhelmed with challenges that arise with children with difficult temperaments, which may result in parents having less capacity to spend time reading with their children (39). Previous research has shown that not reading to children is related to multiple risk factors, including child’s low task attention, maternal psychological distress, and low maternal warmth (40). Evidence suggests that early reading to infants with a difficult temperament can improve language and literacy skills in kindergarten (41). Early reading can also benefit the parent-child relationship, including decreased parental stress (42). Therefore, early identification of child and family risk factors, including difficult temperament, may help target families who might benefit from support for early reading, although it is unclear whether a causal relationship exists. Further, parent-child reading interventions which address psychosocial risk factors are recommended (40). It may be important for practitioners to ask about the barriers to reading to better inform individualised interventions (40). Future research is required to model the relationship between difficult temperament, psychosocial risk factors, and early reading in order to support early identification and intervention for temperamental difficulties in toddlers and their families.
A family history of mental health problems was also related to difficult temperament in this study. While previous studies have shown a relationship between parental mental health problems and child temperament, research is limited regarding family history (39, 43–46). This finding may highlight the relationship between family history of mental health challenges and specifically parental mental health problems, although this was not a focus of this study (47). Interestingly, the current study found that maternal antenatal depression was not related to difficult temperament. Familial psychopathology may be an important risk factor for difficult temperament that could be identified during the prenatal and postpartum stages. Early interventions that target maternal prenatal and postpartum depression and anxiety may be beneficial to promote positive parent child interactions and also maternal perceptions of child’s temperament (48, 49). However, if other members of the family have this history, it may be more difficult to identify and intervene. Future research is needed to examine the relationship between toddler temperament, familial psychopathology and parental mental health problems.
In the current study, stressful life events (e.g., parental divorce) were related to difficult temperament, a finding that aligns with other research showing a link between stressful life events and emotional and behavioural difficulties in young children (50). Positive temperament characteristics have been shown to act as a protective factor for the child to cope with “stressful” parent relationships (51). This study may indicate that the converse is also true, whereby children with a difficult temperament may be more likely to act out during a stressful event. It is recommended that clinicians be aware of stressful life events that may be impacting the families they support, and appropriate support and intervention be made available, such as parenting resources (50, 52). Culturally diverse families may be at higher risk for stressful life events and should be given particular attention (53).
Understanding and responding to a toddler’s needs may be more difficult for parents who have a negative perception of their child’s temperament (39). In this regard, research has shown that parental perceptions of difficult temperament are related to greater parenting stress, lower mindful parenting, lower parenting sense of competence, and lower parenting efficacy (39, 54). Providing parents with education and support for difficult temperament may help to increase parenting efficacy (55, 56). Mindfulness based interventions for parents are recommended to improve the parent-child bond and perceptions of child temperament (57–59). Parent-child interaction interventions which focus on emotion regulation may also be important in reducing future psychopathology in children with difficult temperaments (10, 60). Fearful temperament in toddlerhood is related to conflictual co-parenting; therefore, early interventions that address co-parenting conflict may be helpful (61). Increasing availability of interventions and improving pathways of care may be particularly important for culturally diverse and socioeconomically disadvantaged families who are less likely and less able to access services (62, 63).
Limitations
This study has several limitations. A potential limitation is the validity of the two statements “My child is often fearful or anxious” and “My child is often angry or defiant” as a substitute for formal measurement of temperament type. However, parental temperament rating can be a good proxy despite being subjective due to their own understanding and perceptions of “normal” child behaviour (9). Additionally, whilst having a sample size of 500 participants, another limitation is the small proportion of children with a difficult temperament (7.3%) which severely limits the power to detect smaller effects. Future research using more robust parental ratings and objective measures is needed to replicate current findings.