Therapist's Guide to Pediatric Affect and Behavior Regulation

Table of Contents

Cover image

Title page

Copyright

Introduction

Chapter 1. The Regulatory Disordered Infant and Child

Normal Development of Regulatory Processes in Infancy

Defining Regulatory Disorder

Defining Emotion

Bibliography

Further Reading

Chapter 2. Assessment and Diagnosis

Assessment Strategies for the Regulatory Disordered Infant/Child

Diagnosis

Conducting an Educational Assessment – Behavioral Dysregulation

Bibliography

Further Reading

Chapter 3. Treatment Planning

Preparing for Treatment Planning

Treatment Planning Format

Treatment Planning

Resources

Further Reading

Chapter 4. Resources

Business Forms and Interview Format

Bibliography

Index

Copyright

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Introduction

In an effort to improve the health and mental health of young children, physicians, mental health professionals, occupational therapists, educators, speech pathologists and others have diligently worked to understand the maladies and associated solutions to the constellation of difficulties which impact their optimal development. In much the same manner in which a pebble tossed into a body of water results in a ripple effect, each difficulty experienced by a young child has the potential of resulting in complicating consequences to their emotional and intellectual development. The realm of treatment is often multidisciplinary in scope, individualized and creative, recognizing there are many ways to treat and manage these issues. Thus, parents and professionals work together to develop a comprehensive plan for optimizing each child’s learning potential and increased coping ability.

Central to the functioning of a young child is the concept of regulation. The development of regulation of mood, impulse, and an internal state of regulation is fundamental to the developmental process. The concept of regulation was fortunately recognized by a number of professionals who have dedicated their professional efforts to the understanding and treatment of the manifested difficulties experienced by young children. While the contribution of these practitioners and researchers is significant regarding regulation, their insight comprehensively encompassed the interrelationship of attachment, emotional regulation and internal regulation. Thus clarifying the complex relationship and interaction of numerous facets of development. As a result, those who specialize in working with young children acknowledge that, in addition to the diagnoses outlined in the Diagnostic and Statistical Manual and ICD-9, Regulatory Disorders of Sensory Processing (RDSP) characterize distinct responses and behavioral patterns, though dynamic and evolving over time, underlying many of the obstacles which interfere with the normal trajectory of development. Diagnostic acknowledgement of developmental process, such as RDSP, as it is intertwined with adjustment and pathology, is conceptualized in the DC:0–3R. The overlap of these three diagnostic frames can be found in the diagnostic crosswalk in Chapter 2 serving as a tool for the behavioral health provider in identifying the correct diagnosis describing the range of symptoms and developmental difficulties interfering with maximal developmental ability. Due to the inherent association between diagnosis and treatment planning, effective treatment requires an accurate diagnosis enhanced by a conceptual foundation of development and factors influencing enrichment versus pathology.

The far-reaching social consequences of the negative impact of developmental problems of young children reinforced the importance of early detection and intervention. The goal of early detection is to prevent more serious, long-term perceptual, language and sensory integrative and behavioral difficulties. The parameters or conceptualization of intervention may be impacted by the differing perspectives of health set forth by the variety of professionals on the treatment team. This may best be demonstrated in the regulations and requirements set forth by the structure of improving academic performance as outlined by the goals of the individualized family service plan (IFSP) and the individualized education plan (IEP). This text fully acknowledges the important focus of the IFSP and IEP, but is not limited to their scope or objective of outcome associated with academic performance of preschoolers and kindergarteners. Instead, the scope of intervention is comprehensive, including aspects of psychological and emotional functioning which may not be targeted for intervention with regards to improving academic performance but, indeed, are related to quality of life experience and relationship functioning in general as it pertains to the developmental and familial demands of the 0–5 year old.

Chapters 1 and 2 lay the foundation for conceptualizing the range of difficulties experienced by a young child (and, therefore, their family), how to identify and clarify symptom presentation, and accurate diagnosing with the aforementioned diagnostic nomenclature systems. The emphasis in Chapter 2 not only discusses thorough assessment procedures but also includes the type of processes used to conduct them without being a cookbook approach. Such flexibility in the assessment process is demanded by the stages of child development, individual needs, setting and circumstances. Thus, encompassing a multimethod and multi-informant approach with common assessment procedures. Chapter 3 provides a range of treatment possibilities for individualized treatment planning. Perhaps the most important aspect of the treatment-planning chapter is its representation as a balance between science and practice. Clinicians are always interested in the latest research. Unfortunately, the gap between research and practice, often due to financial limitations in the private sector, can be frustrating. Therefore, as much as possible, empirically-based procedures, evidence based, and the vast clinical experience from the clinical practice of numerous practitioners with a history of providing services in a range of environments were gleaned with an emphasis on increased effectiveness and outcome oriented focus. Furthermore, the treatment section recognizes there may be an overlap between treatment planning from several different environments (i.e., individual/family treatment may share goals and interventions similar to those in the preschool/kindergarten environment), but that specific environmental demands also play a role in the unique selection of treatment goals and interventions and how they are operationalized.

The final chapter offers an array of beneficial forms from initial client information or patient information, additional business-related forms and interview question outline/format. The goal of interviews and other forms of documentation is to serve as a baseline, a clarification of the presenting problems, a thorough source of information to review and substantiate treatment progress, for work associated with collateral contacts and overall case management. The selection of forms is not an exhaustive collection but all were chosen for their potential utility and to meet a variety of needs in working with young children and their families.

Chapter 1

The Regulatory Disordered Infant and Child

There is no such thing as a baby – only a baby and someone.

Donald Winnicott (Finichel & Eggbeer, 1990)

To comprehend fully the implications of pediatric disorders of regulation in affect and behavior requires a fundamental background in child development, family systems theory and psychopathology. Such a clinical perspective provides the framework to utilize the following information as a basic review on normal or typical child development versus the development of psychopathology which is the foundation necessary for assessment, accurate diagnosis and effective treatment.

The regulation of affect and behavior are developmental processes extended through infancy and childhood, thus establishing the foundation of lifelong abilities and individual differences associated with self-control. The individual differences in emotional regulation underlie important differences in psychological well-being, social competency and, in some cases, evolving psychopathology. Therefore, this section will focus on the processes of development associated with emotion regulation, temperament, attachment, the role of emotion regulation being influenced by the child’s conceptual growth and understanding, and social/environmental influences, thereby demonstrating a complex factorial interplay in normal and abnormal development.

It is nothing short of amazing that a human conception survives the journey to birth. Congenital abnormalities and the loss of embryos and fetuses prior to birth are caused both intrinsically and extrinsically. For those who survive, both parents and professionals are challenged by the presentation of early regulatory problems commonly exhibited by babies. Regulation is basically the sensory processing method used to recognize, organize, and make sense of incoming sensory information (hearing/auditory, vision/ocular, smell/olfactory, touch/tactile, taste/gustatory) and internal sensations (vestibular system which detects movement/tells us when we are surrounded by something that is moving or on something moving/tells us up from down/influences concept of outside space and proprioceptive system which is body awareness/tells us where the body parts are). An adaptive response is created by the external information being reviewed along with input from the body. When irregularities in regulation are present they are demonstrated by problems associated with sleep cycles, feeding, digestion, attention, arousal, mood regulation, and self-soothing. According to DeGangi (2000), these infants are often hyper- or hypo-sensitive to sensory stimulation. Most of these issues have been resolved by the time the infant is 6 months of age. However, some infants continue to demonstrate problems of regulation in these areas including mood regulation. For these infants, their development into toddlerhood is marked by problems in regulation (Kostuik & Fouts, 2002; Fox & Calkins, 2003; Schore, 2005; Bell & Deater-Deckard, 2007):

 Difficulties with attention

 Sensory processing

 Intolerance for change

 Socially inappropriate behavior

 A hyper-alert state of arousal

 Severe separation anxiety.

As a result of the observation of infant to child difficulties with regulation in affect and behavior as well as increased emotional distress of the parents, these infants and children find their way into pediatric medical and psychological practices. The clinical presentations offer a unique opportunity to understand and to intervene early and proactively with young children and their families. Therefore, the understanding of emotion possesses important implications for revealing normal as well as abnormal development. This significant focal point is directed to the role and development of links between emotion, behavior and psychopathology. The clinical perspective seeks to clarify which category or parameters the infant/child demonstrates difficulty with, how much it interferes with their or others’ lives and what the impact is to their level of functioning. There may be identified symptoms in one category and none in another or some symptoms in more than one category. The different types of regulatory disorders described by Diagnostic Classification: 0-3 (DC:0-3R) are utilized for the presentation of symptomology, disorders and subtypes.

Normal Development of Regulatory Processes in Infancy

Emotion regulation is a component of emotional activation in a network of multilevel processes consisting of internal and external processes responsible for monitoring, evaluating and modifying emotional reactions – specifically their timing and intensity in meeting one’s goals. These processes are exemplified by the interaction and feedback between higher and lower systems, such as the mutual influence of multiple emotional related systems which sometimes contribute to maladaptive outcomes, especially in circumstances of environmental hardship (Thompson et al, 2008). This complex construct is an integration of behavior (including motor skills), genetic mechanisms, attention, cognition, environmental influences and emotional control (especially negative emotions). All of these factors contribute to the unique differences in self-regulation. Self-regulation is the ability to control inner states (responses) with regard to emotions, thoughts, attention, and function (performance) (Bell & Deater-Deckard, 2007). It is the development of competence in responding to life demands. The brain is continually sensing and responding to the needs of the body and the environment. An infant/toddler is able to maintain internal equilibrium by modulating sensory stimulation from their environment by altering or adjusting the intensity of arousal experienced while remaining engaged in an interaction or being able to disengage easily from an activity. Much of this regulation takes place automatically outside of conscious awareness. Therefore, an adaptive response is an appropriate action resulting from the synthesis of incoming sensory information received through the central nervous system. It can be conscious or unconscious (predominantly) and is the consequence of adequate sensory integration which, in turn, reinforces the improvement or continuing refinement of sensory integration. Therefore, normal regulation or modulation is not a straight trajectory, but rather a developmental process which takes place within a range of limits. Normal, healthy self-regulation is related to the capacity to tolerate the sensations of distress that accompany an unmet need through the repetition of the experience of a chain of associated stimulus response cues (Schore, 2001, 2005; Bell & Deater-Deckard, 2007; Thompson et al, 2008; Benson & Haith, 2009). For example:

(this is a simple example of early learning that the feeling of distress will pass as a result of the intervention of an attuned adult. This leads to learning skills of self-management which includes increased tolerance and eliciting appropriate resources).

As the child learns to tolerate distress they become much less reactive and impulsive. This is a demonstration of the evolution of self-regulation. The responsiveness of the attuned adult facilitates the learning that allows the child to build the capacity to place a moment between the impulse and an action. Such a delay results in reinforcing success and increasing self-regulation. When the child is able to insert a moment between a feeling and an action they then have achieved the ability to take the time to think, plan, and develop a response to the challenge and demonstrate goal directedness. This scenario is a simplistic example of the multifaceted process of developing self-regulation. However, it does provide a useful display of the power of interplay between an infant/child and a positive effective caregiver. Additionally, it serves to demonstrate the emergent knowledge and skill development associated with self-regulation. The infant’s success at regulation significantly depends on the caregiver’s awareness, flexibility, and responsivity to the child’s emotional expression and need for caregiver intervention. The toddler advances this theme with the ability to initiate a greater repertoire of self-regulating behaviors critical to developmental progression of independence, control and an identity separate from the caregiver. As the toddler makes the transition to preschool and subsequently to school there is a marked acquisition of an integrated set of domain-specific mechanisms or self-regulation.

Over the course of development, initiated prenatally and evolving into sophisticated and self-initiated processes from toddler > preschool > school years, regulatory processes progress in association with the child’s increasing capacity to regulate their motoric and effective behavior. This takes place first in the dyadic relationship (infant), progresses to guiding caregiver in toddlerhood, and later as a function of voluntary and effortful control. The transition from toddler to preschooler (age 2 to 3 years) is particularly interesting in normal or typical regulatory development. The child begins to gain control over impulses and actions that are primarily activated situationally, whereby they demonstrate increased capability regarding behavior compliance and delay of gratification. During their preschool experience they begin to engage in more executive or cognitive control of thoughts and actions. It is the emergence of these skills that supports the successful transition to the school and peer environment which demands independent and adaptive behavioral functioning (Rothbart et al, 2000, 2003; Fox & Calkins, 2003; Calkins 2004; Rothbart & Rueda, 2005). Increases in language development, cognitive abilities, and specific self-regulation skills acquired during toddlerhood allow for most children to learn to control early (normal) non-compliant, aggressive, and impulsive tendencies resulting in a decrease in problem behavior (Campbell, 2002).

In conclusion, a child’s emotional health is molded by a complex interaction between genetic, constitutional and environmental factors. The environmental factors are double edged offering a compelling influence of risk and protection. These factors are dependent on quality and availability in their command by either protective aspects via buffering and encouraging resilience and typical development or by exacerbating the likelihood of emotional, social and cognitive problems.

Caregiver Characteristics

 Mental health (emotional/psychological functioning)

 Educational level

 Self-efficacy/self-sufficiency

 Resourcefulness and coping

 Health and general well-being

Family Factors

 Caregiver–child relationship

 Emotional atmosphere

 Marital quality/task collaboration

 Degree of stress

 Stability

 Sibling issues

Community Connectedness Factors

 Caregiver social support

 Quality of child care

 Child’s peer relationships

 Extended family influence

 Cultural/ethnic norms and expectations

Environmental/neighborhood Factors

 Availability and diversity of resources

 Adequacy of housing

 Violence/safety

Attachment

At birth, the brain is the most undifferentiated organ. It has a plasticity that enables the creation of neural circuitry throughout life. This means the brain is capable of renewing its structure and function as a result of experiences, in particular, social experiences. Attachment, the emotional bond that is formed between an infant and their primary caregiver, profoundly influences both the structure and the function of the developing infant brain. When that attachment bond is not adequately formed, whether as a result of abuse, neglect, or emotional unavailability on behalf of the caregiver, brain structure and function can be negatively impacted, causing relational or developmental trauma (Diener et al., 2002; Schore, 2001, 2005; van der Kolk, 2005).

The role of attachment in association with emotion regulation during early childhood emphasizes the importance of the context of the parent–child relationship. As the infant develops and directs interest outwards, it is the caregiver who is responsible for helping the infant to regulate the level of arousal. The caregiver accomplishes this by responding to infant cues of distress and providing comfort as well as intense positive arousal experiences. The infant learns from these interactions to trust the caregiver and their help to resolve distressing arousal. This relationship development lays the foundation for establishing an effective attachment relationship, or the dyadic regulation of infant emotion and arousal. As a result, the quality of care provided during this developmental period (dyadic regulation) significantly contributes to the infant’s regulatory ability. This relationship has a bidirectional quality for the infant. Not only do they receive from the attuned caregiver, but they directly elicit through their willingness to utilize the caregiver as a secure base, thus allowing them to expand the exploration of their world. As the infant progresses to toddler and then preschooler the role of dyadic regulation and then caregiver-guided self-regulation is replaced with a desire for increased autonomy. The transitional states from dyadic regulation to caregiver-guided regulation to self-regulation are significantly influenced by the quality and consistency of the attachment relationship. Attachment security is associated with effective self-regulation and fewer behavioral problems in preschool. In other words, secure infant–caregiver attachment is related to lower risk for later peer and behavioral problems. Of course, other features unique to the infant (genetic, temperament, as well as other characteristics) are also a part of this evolving matrix of skill development, or deficiencies in development. Bottom line, competence is associated to healthy developmental trajectories as a protective factor which also increases opportunities for positive interactions and feedback (Mahler et al, 1975; Weinfield et al, 1999; Zeanah, 2000; Schore, 2001) (Figure 1.1).

Figure 1.1 Family members toast with water glasses.

Schore (2001, 2005; Benson & Haith, 2009) clearly speaks of the relationship between emotion and biology. Multiple regions of the brain and neurohormonal processes are intertwined with emotion and its management. In the nature–nurture scheme, the capacities of emotion regulation unfold along with developmental advances of maturity and the neurobiological influence of attachment. At birth, these systems are active but lack maturity. The HPA (hypothalamic–pituitary–adrenocortical) axis and the subcortical structures such as the amygdala and hypothalamus work together in the activation of the sympathetic nervous system thus arousing the newborn infant. In a manner similar to the activation of sympathetic arousal, the other branch of the autonomic nervous system, the parasympathetic branch, has an inhibitory affect. These immature nervous system responses are the underlying reason for the all or nothing quality of infant response (such as crying). Thus demonstrating that the infant cannot yet regulate manifestations of arousal. An additional feature on the nature side of the equation is the constitution that the infant brings with them, particularly temperament.

Neurological functioning stems from both genetics and environmental influence. Genetics provides innate capacities shaped by experience toward optimal functioning or by limiting capacity. Neurobiology is an integrated network of crucial developmental elements and is the cornerstone of attachment relationships as well as executive functions development. In turn, secure attachments provide the foundation of optimal brain development which facilitates and reinforces skill of executive function such as judgment, planning and management ability of emotional trauma, loss and neglect. Likewise, in the fashion of a negative feedback loop trauma, loss and neglect have the ability to impact negatively neurobiological developmental capacities for attachment, self-regulation and executive function. The demonstration of the neurobiological factors works much like a bidirectional arrow: external (information taken in) ↔ internal (integrated) ↔ external (reflected in skill development and risk). A central characteristic of neurobiology is plasticity. Plasticity is a lifelong ability of the brain to reorganize neural pathways based on new experiences (or the ability of the brain to change with learning). Children imitate and internalize influences of their caregiving experiences. Therefore, sensitive responsive care, as well as the opposite, shape brain development (Shore 2001, 2005; Teicher, 2002; Charney, 2004; Lieberman, 2004).

The model of the caregiver–infant attachment relationship (Schore, 2001,2005) facilitates increasing the dimensions of the child’s coping capacities. Thus suggesting, adaptive infant mental health can be fundamentally defined as the earliest expression of flexible strategies for coping with the novelty and stress that is inherent in human interaction. The caregiver role of providing sensory stimulation through physical contact such as bathing, dressing and soothing, and play activity facilitates sensorimotor modulation. The quality of the attachment relationship between an infant and a caregiver is determined by the quality of the caregiver’s response to the infant at times when the infant’s attachment system is activated (i.e., emotionally distressed, physically hurt, ill, etc.). The integration of the caregiver–infant experiences of touch, movement, auditory stimulation and visual stimulation, which takes place during the first 18 months of life, makes possible the development of self-soothing behaviors (Schore, 2001). Self-soothing behaviors use internal and external resources: visual in the form of looking at sights of interest in their environment; auditory via listening to pleasant or calming sounds; self-touch such as holding on to their own hands or feet, sucking, and holding on to a familiar object such as a blanket or soft toy. Mahler et al (1975) describe face-to-face affective synchrony, symbiotic phase, as beginning at 2–3 months, generating high levels of positive arousal and shared or mutual regulation (attuned) called instances of optimal mutual cueing. In this pleasurable state of symbiosis (a state in which the infant behaves and functions as if it were one with the caregiver), the infant (Mahler et al, 1975; Polan & Hofer, 1999)

 is in a state of undifferentiation

 is in a state of fusion with the caregiver

 experiences interaction regulation synchronicity

 experiences dual unity within one common boundary

 is within a self-organizing system composed of caregiver and infant as one unit.

This concept of attachment, as a deep and enduring connection established between a child and caregiver, as an interactive regulation of biological synchronicity is possibly best demonstrated by the sharing of facial expressions between caregiver and infant becoming one, or shared-mutual reflection. Attachment refers to the child’s thoughts, feelings and behaviors in reflection to significant others, most often the primary caregiver. Early experiences with caregivers shape a child’s core beliefs about self, others, and life in general. Experiences of the infant and young child are encoded in the brain. Emotional experiences of nurturance and protection are encoded in the limbic system. Over time, repeated encoded experiences become internal working models or the lens through which the child views themselves, others and, overall, their world (Schore, 2001). Healthy social-emotional development for infants and toddlers unfolds in an interpersonal context, namely that of the positive ongoing relationships with familiar, nurturing adults. These expanding capacities help young children to become competent in negotiating increasingly complex interactions. Between the ages of 8 and 18 months, the infant develops the ability to modify responses in relation to events and object characteristics in accordance with intentionality, reciprocal interactions and organized affects. Thus, there is meaning in verbal and contextual cues. This stage is marked by the blossoming of skill development (DeGangi, 2000):

 initiate, maintain, and inhibit physical actions

 the emergence of problem solving

 intentionality

 awareness that actions lead to a goal

 increasing awareness of self as a separate identity (allowing for the differentiation of their own responses from the actions of others).

At about 18 months of age, self-control emerges with the creation of mental images. Mental images have immense utility for homeostasis of the self. They allow the internalization of routines and responding to requests or commands, pretend play and functional language, delaying actions to comply with social expectations (without external cues), and being able to differentiate self from others. Representational thought and recall memory are hallmark features of development at this stage. The role of the caregiver is one of reflective interpretation in pairing affective meaning to situations as well as providing social expectations and values related to particular and specific emotional responses. This caregiver attachment of affective meaning facilitates the infant to label and understand emotion and its context. The instrumental features in achieving emotional regulation are identified as (DeGangi, 2000; Schore, 2002; Thompson et al, 2008):

 Action schemes

 Vocalizations, self-distraction, motoric responses

 Cognitive organization

 Representational thinking and self-monitoring

 Motivation

 Caregiver support.

Another accepted construct of attachment was set forth by Bowlby (1969). His theory of attachment views the infant’s emotional tie to the caregiver as an evolved response that promotes survival. Bowlby’s stages of attachment begin as a set of innate signals used by the baby to summon the parent and gradually develops through four stages into an affectionate bond:

1. Pre-attachment (birth to 6 weeks): inborn signaling bringing newborn into close contact with other humans who comfort them

2. Attachment-in-the-making (6 weeks to 6 to 8 months): the baby responds differently to a familiar caregiver than to a stranger and begins to develop a sense of trust

3. Clear-cut attachment (6 to 8 months to 18 to 24 months): the baby displays separation anxiety, becoming upset when the trusted caretaker leaves

4. Formation of reciprocal relationship (18 to 24 months and on): separation protest declines.

Therefore, emotional security is attachment’s role in the regulation of emotion. It is a central concept as a regulatory process in normal or typical development and the development of psychopathology. Moreover, failure to acquire mental-age appropriate social-emotional skills may be associated with greater risk for concurrent and later emotional/behavioral problems. For example, secure infant attachment is related to lower risk for later peer and behavior problems. Emotional security serves as a model emphasizing the interplay between social-emotional and biological processes whereby the regulation of emotional well-being and security develop. The experience of this concept is defined from an organizational perspective of the entire person and their unique responses (reactions to events) illustrating a central focus on the impact of marital and parent–child relations on the child’s emotional security. There are additional implications for social-emotional development associated with the interaction between attachment and temperament (Cummings & Davies, 1996).

Effortful Control

The study of temperament and the associations to neural circuitry and attentional tasks furthers the examination of development of executive attention and self-regulation. The construct of effortful control tends to increase with age and is associated with several characteristics of children and parents. This construct includes the ability to inhibit dominant responses to act upon subdominant responses, to detect errors, and to engage in planning. Effortful control includes focused attention, perceptual sensitivity, inhibitory control, and low intensity pleasure (Figure 1.2). Given the range of abilities in which effortful control plays an important role, it is not unexpected that it is associated to the development of conscience and aggression. It is also a protective factor which promotes following instructions and obedience to caregiver rules.

Figure 1.2 Young boy creates bubbles.

An infant’s ability for focused attention combined with maternal responsiveness and caregiver personality characteristics (such as dependability, effective management and self-control) are also associated with the demonstrated range of effortful control. For example, the influence of affective synchrony in caregiver–infant interaction in the development of effortful control is significant for children demonstrating high negative emotionality in childhood versus the effect of affective synchrony for infants not demonstrating negative emotionality being much smaller. Features defining effortful control include (Rothbart et al, 2000; Carlson & Moses, 2001; Casey et al, 2001; Blair, 2002; Calkins et al, 2002; Fan et al, 2003; Jones et al, 2003; Rueda et al, 2004; Rothbart & Rueda, 2005):

 Temperament, or individuality, in constitutional reactivity and self-regulation. Temperament refers to the relatively enduring framework influenced over time by heredity, maturation, and experience. Temperament evolves from genetic provision, however, it influences and is influenced by the individual’s experience.

 Reactivity refers to the excitability, responsivity, or arousability of the behavioral or physiological systems.

 Self-regulation refers to neural and behavioral processes functioning to modulate the underlying reactivity, or the ability to control inner states.

*Competence functions as a protective factor or buffer which supports the understanding of varying developmental trajectories. Competencies also increase opportunities for positive interactions and feedback which serves to diminish problem behavior.

Temperament

Temperament is defined as a constitutionally or biologically based characteristic associated with differences in emotional, motor and attentional reactivity and self-regulation. It is the relatively enduring biological framework influenced over time by heredity, maturation and experience. Infants respond to their environment with reactivity, emotion, and attention with their own unique responsivity from infant to infant. These reactions to the environment, along with the mechanisms that regulate them, make up the child’s temperament (Rothbart & Rueda, 2005). Temperament is seen to be relatively consistent across situation and stable over time. It is seen as a key factor in early child characteristics being predictors of later personality development, behavioral patterns, emotional response patterns, adjustment, and the presence as well as severity of clinical symptoms. It is with temperament that the concept of goodness of fit plays a significant role. Goodness of fit refers to the degree of correspondence between child characteristics and parental expectations and demands. Thus, a good fit results in a positive adjustment and outcome, whereas, a poor fit results in a negative outcome or less than satisfactory adjustment (Wolraich et al, 2008; Benson & Haith, 2009).

With regards to temperament, infants who are easily frustrated use more physical regulation, scanning and caregiver orienting and less distraction. Additionally, they have higher activity levels and demonstrate decreased attention during task exercises. Aside from anger and frustration, other characteristics of temperament include vocal expression/excessive crying, impact of caregiver availability, caregiver attachment quality, and physical stimulation. Constructs of ineffective self-regulation and difficult temperament overlap. Therefore, a child may have a regulatory disorder but not present with a difficult temperament or the opposite can be evident as well (DeGangi, 2000). *Terrikangas et al (1998), in the conclusion of a 15-year longitudinal study, identified infants with difficult temperaments demonstrating an increased risk of developing psychiatric symptoms in adolescence. This risk was diminished for these children when families received mental health interventions.

There exists a direct contribution to social-emotional and personality development by means of temperament and its interactions with caregivers, family, and other environmental factors. For instance, gender differences in temperament of infants/toddlers reveal males to demonstrate higher levels of activity and tendency to approach, while females demonstrate greater hesitation/withdrawal behavior. Furthermore, females show greater fearfulness as well as higher levels of regulation-related skills in early childhood. Individual differences in temperament play a role in children’s selection of environment and associated adaptation.

Johnson & Johnson (2011) state that, over the course of the toddler–preschool years, the development of successful regulation of reactive responses is associated with four cognitive skills as the ability to:

 inhibit a preponent motor response

 switch attention

 focus attention

 plan and execute strategies.

The developmental progression of change associated with the growth of these skills is related to parental influence, contextual environmental factors, and underlying neural changes (predominantly maturation of prefrontal cortex areas). Parents offer important input by providing physical comfort, secure attachment, and moderating negative affect or distress. Since the neural structures necessary for successful regulation have not yet developed, parenting behavior allows and supports the child to learn to contain response to arousal, such as distraction and inhibition and is beneficial for regulating negative affect.

Differences in Self-Regulation

Distinguishing, or demonstrating the differences between reactivity and self-regulation is useful for the general conceptualization of development in that early behavior can be seen as reactive to immediate stimulus events and endogenous changes, whereas complex self-regulatory systems develop to modulate reactivity (executive attention system). The development and refining of self-regulatory mechanisms, which transpire