Preventing Mental Health Symptoms and Disorders

Temperament-based parent guidance.

Posted Feb 23, 2021

After recently contributing to the Netflix documentary Babies, specifically the episode entitled: “Nature and Nurture," I have been thinking a lot about how to understand what aspects of individual differences in temperament and personality are strongly biologically driven and which are more readily shaped by contextual factors. These are not easy questions to answer.

Just because a trait is genetically based, like reactivity that results from approach/avoidance neurobehavioral systems being engaged, that does not mean that there is zero malleability. It certainly does not mean that the manner in which these systems manifest themselves behaviorally or in terms of emotional expression is not flexible.

In fact, many psychological treatment approaches are aimed at altering their manifestations. For example, when we provide treatments for anxiety disorders (largely products of excessive avoidance emotions and motivation), shown to be very effective in reducing the severity of symptoms, as well as distress and impairment that stem from these (e.g., the Coping Cat intervention), we are not getting rid of fear, anxiety and behavioral inhibition per se. Rather, we are teaching the child how to recognize signs of anxiety and interpret these correctly (e.g., “just butterflies in my stomach… this doesn’t mean something dangerous is going to happen”, etc.), coping in a more adaptive fashion.

Thus, thinking about our physiological reactions, as well as automatic thoughts that may not be helpful and in need of modification (“She didn’t say hi… I always knew she didn’t like me”), can alter the way these underlying neurobehavioral systems, themselves products of genetic programming setting the stage for the structure and function of the Central Nervous System, operate.

Of course, there are other important elements to a successful anxiety treatment program, with exposure key among these. That is, safely encountering the feared object or situation on multiple occasions (usually with these encounters increasing in intensity) teaches the brain in essence that anticipated danger does not materialize. Importantly, participating in exposure exercises also teaches the child that they can successfully negotiate feared encounters. These anxiety programs are lengthy and expensive and not readily available, but what if there was a way to provide preventative low-cost services earlier? What would these services look like? 

Although identifying those at risk early in childhood may not be feasible because of the costs involved in population-based assessment, one readily available approach is to provide parents temperament-based guidance. That is, we can tell parents about temperament and related neurobehavioral systems, how these “come online,” and what the caregivers’ role is in terms of providing the context that either enhances the risk for later symptoms/disorders (e.g., anxiety), or diminishes it and serves a protective function.

We recently tested this approach with several graduate students in my laboratory at Washington State University contributing to the effort (Iverson, Desmarais, Neumann, & Gartstein, 2020). Specifically, we were able to show that providing parents of infants with written information about temperament, similar to brochures in the doctors’ offices about Attention Deficit Hyperactivity Disorder or benefits of breastfeeding, produced positive outcomes. That is, mothers demonstrated increased temperament knowledge and reported satisfaction with the program and information received. Importantly, behavioral changes in mother-child interactions were observed. Sensitivity/responsiveness increased, and interactions shifted from more parent-directed to more balanced following the intervention.

Sensitive and responsive caregiving has been linked with a variety of positive outcomes in infancy, chief among these secure attachment (van der Voort, Juffer, & Bakermans-Kranenburg, 2014). Although we know less about directedness in play, it is clear that children learn more when they drive the exchanges and become more competent interaction partners as a result (Whipple, Bernier, & Mageau, 2011).

Of course, a lot more research needs to be done to demonstrate that providing such information can actually prevent the onset of symptoms and disorders, or disrupt their maintenance, and we are hoping to do so after enlisting the help of pediatric clinics and family practitioners to deliver this information on a larger scale. It should be noted, however, that this initial study provided promising results, and given the cost of attempting to alter trajectories of full-blown disorders later in childhood, this pathway should definitely be explored further. Please let me know if you are interested in helping with this effort!

References

Iverson, S.L., Desmarais, E.E., Neumann, A.A., & Gartstein, M.A. (2020). Brief temperament guidance program for parents of infants: A pilot evaluation. Journal of Child and Adolescent Psychiatric Nursing, 33, 38-48.

van der Voort, A., Juffer, F., & J. Bakermans-Kranenburg, M. (2014). Sensitive parenting is the foundation for secure attachment relationships and positive social-emotional development of children. Journal of Children's Services, 9(2), 165-176. 

doi: 10.1108/JCS-12-2013-0038

Whipple, N., Bernier, A., & Mageau, G. A. (2011). Broadening the study of infant security of attachment: Maternal autonomy‐support in the context of infant exploration. Social Development, 20(1), 17-32. doi:10.1111/j.1467-9507.2010.00574.x