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Abstract

A substantial proportion of children and adolescents come to suffer from psychological disorders. This article focuses on the temperament factors that are involved in the pathogenesis of child psychopathology. It is argued that besides the reactive temperament factor of emotionality/neuroticism, the regulative process of effortful control also plays an important role in the etiology and maintenance of internalizing and externalizing problems in youths. More specifically, vulnerability to child psychopathology is determined by a temperament that is characterized by high levels of emotionality/neuroticism and low levels of effortful control. Models are hypothesized in which reactive and regulative temperament factors either have interactive or additive effects on the development of psychological disorders in children, and conceptualized in terms of a developmental psychopathology perspective. Directions for future research and clinical implications of this temperamental view on psychopathology are discussed.
Clinical Child and Family Psychology Review, Vol. 8, No. 4, December 2005 ( C
2005)
DOI: 10.1007/s10567-005-8809-y
The Role of Temperament in the Etiology
of Child Psychopathology
Peter Muris1,3and Thomas H. Ollendick2
A substantial proportion of children and adolescents come to suffer from psychological dis-
orders. This article focuses on the temperament factors that are involved in the pathogenesis
of child psychopathology. It is argued that besides the reactive temperament factor of emo-
tionality/neuroticism, the regulative process of effortful control also plays an important role
in the etiology and maintenance of internalizing and externalizing problems in youths. More
specifically, vulnerability to child psychopathology is determined by a temperament that is
characterized by high levels of emotionality/neuroticism and low levels of effortful control.
Models are hypothesized in which reactive and regulative temperament factors either have
interactive or additive effects on the development of psychological disorders in children, and
conceptualized in terms of a developmental psychopathology perspective. Directions for fu-
ture research and clinical implications of this temperamental view on psychopathology are
discussed.
KEY WORDS: temperament; emotionality/neuroticism; effortful control; psychopathology; children
and adolescents.
Three children are referred to a clinical child
psychologist. The parents of all three have divorced
during the past year. Tim (9-years old) has become
extremely anxious since that event. He does not
dare to stay home alone anymore. When his mother
wants to go out for shopping, Tim panics and begs
her not to go. Going to bed at night is also a problem.
His mother has great difficulties getting Tim upstairs
to go to bed and when he is finally in bed, she has
to stay with him until he falls asleep. Almost every
night, Tim awakens in terror because of a nightmare,
and after being calmed down he has problems falling
asleep again. It is clear that Tim exhibits many char-
acteristics of an anxiety disorder. Tony (11-years old)
displays different symptoms. Since the divorce of his
1Institute of Psychology, Erasmus University Rotterdam, The
Netherlands.
2Virginia Polytechnic and State University, United States of
America.
3Address all correspondence to Peter Muris, Professor, Institute
of Psychology, Erasmus University Rotterdam, Burgemeester
Oudlaan 50, Suite J5-31, P.O. Box 1738, 3000 DR Rotterdam, The
Netherlands; e-mail: muris@fsw.eur.nl.
parents, he has become very quiet and increasingly
retreats in his room. He seems unhappy and sad most
of the time, and even things that used to bring him
great joy do not seem to interest him anymore. At
school, Tony shows a total lack of energy: his perfor-
mance deteriorates and because of his aloof attitude,
he becomes increasingly isolated from the other chil-
dren. Obviously, Tony appears to suffer from a de-
pressive disorder. And finally Trevor (10-years old),
since his parents have divorced, has become very
touchy and gets easily annoyed. He often argues with
his parents, does not obey his teachers any more, and
frequently fights with other students on the school-
yard. Lately, he was caught while stealing candy in
the local supermarket. Clearly, Trevor shows early
signs of a disruptive behavior disorder.
Tim, Tony, and Trevor: three children who have
been confronted with the same negative life event
and since then display different abnormal behavior.
Two important questions can be raised in the con-
text of this common clinical observation. The first
question is why do these children develop psycho-
logical problems after being exposed to a negative
271
1096-4037/05/1200-0271/0 C
2005 Springer Science+Business Media, Inc.
272 Muris and Ollendick
life event, whereas others adapt themselves without
any trouble to comparable difficult circumstances?
For example, in Western countries, up to 50% of
marriages are dissolved, and many times children in-
volved in these divorces do not develop psychopatho-
logical problems. The second question has to do with
a phenomenon that within the domain of develop-
mental psychopathology is referred to as “multifinal-
ity” (Mash & Wolfe, 2002), and can be formulated
as follows: How is it possible that three children re-
spond so differently to the same stressful event and
come to display divergent types of problem behav-
ior? Although it should be borne in mind that the eti-
ology of psychopathology is undoubtedly a complex,
multifactorial process (Ollendick & Hersen, 1999),
this article proposes that temperament plays an im-
portant role in the etiology, manifestation, and even
maintenance of the most common emotional and
behavioral disorders in children. Briefly, it can be
argued that Tim, Tony, and Trevor suffer from a
psychological disorder, precisely because their tem-
perament is characterized by high levels of emo-
tional reactivity/neuroticism and low levels of self-
regulation. This article first briefly describes the most
common types of psychopathology in children. Then,
the construct of temperament is introduced and the
role of the reactive temperament factor “emotional-
ity/neuroticism” in the origins of child psychopathol-
ogy is presented. Following this, the concept of ef-
fortful control as a regulative temperament factor
is put forward, and research is reviewed which has
demonstrated that the combination of high emotion-
ality/neuroticism and low effortful control is particu-
larly relevant for understanding the etiology of child
psychopathology. Next, it is argued that these tem-
perament factors might also be involved in the for-
mation of cognitive distortions, which are thought
to play a crucial role in the maintenance of psy-
chopathological problems. Finally, models for the
hypothesized role of reactive and regulative temper-
ament factors in the development of psychological
disorders in youths are described and directions for
future research on the link between temperament
and child psychopathology are suggested.
CHILD PSYCHOPATHOLOGY
Epidemiological studies have shown that a sub-
stantial proportion of youths suffer from a psycho-
logical disorder. For example, Costello, Mustillo,
Erkanli, Keeler, and Angold (2003) followed a
sample of 1,420 children and young adolescents over
a 4–8-year period. Every year, children and adoles-
cents were tested by means of a structured interview
to assess the most common types of psychopathol-
ogy. Results indicated that internalizing disorders
(such as anxiety disorders and depression) as well
as externalizing disorders (disruptive behavior disor-
ders, such as oppositional-defiant disorder and con-
duct disorder) were highly prevalent: every year,
prevalence rates were around 5% for both types of
disorders. In keeping with previous research, girls
more frequently exhibited internalizing disorders,
whereas boys more often suffered from externalizing
disorders (e.g., Verhulst, Van der Ende, Ferdinand,
& Kasius, 1997). However, the most remarkable find-
ing of the study was that 36.7% of the youths had
fulfilled the diagnostic criteria for at least one psy-
chological disorder before they reached the age of
16. Inasmuch as the researchers assessed clinical di-
agnoses, including the presence of significant im-
pairment in daily functioning, it is evident that the
problems were substantial and clinically meaningful
ones.
However, only a small proportion of the youths
with psychological problems are actually referred
for treatment (Champion, Goodall, & Rutter, 1995).
In addition, although in some children complaints
spontaneously diminish, in others the problems con-
tinue and subsequently manifest themselves as a
mental disorder in adulthood. Retrospective and
prospective research has indeed shown that anx-
iety disorders in youths frequently are a precur-
sor of anxiety disorders and depression in adults,
that depressive episodes during adolescence are a
good predictor of later episodes, and that behavioral
problems during childhood are solid markers for
the development of antisocial personality disorder
(Bernstein, Borchardt, & Perwien, 1996; Birmaher
et al., 1996; Loeber, Burke, Lahey, Winters, & Zera,
2000; Ollendick & King, 1994). These findings, and
others, have increasingly led researchers to study the
origins of psychological disorders in children. This
increase in research has yielded the insight that child-
hood psychopathology is not caused by a single fac-
tor operating in isolation, but rather originates from
the dynamic interplay of multiple vulnerability and
protective factors. For example, Vasey and Dadds
(2001) have formulated a model for the etiology of
childhood anxiety disorders, in which various biologi-
cal (e.g., genetics, hormones, and neurotransmitters),
psychological (e.g., coping, self-esteem, and cogni-
tive distortions), and social factors (e.g., parental
The Role of Temperament in the Etiology of Child Psychopathology 273
rearing, stress, and negative learning experiences)
are involved. Temperament also plays an important
role in their multifactorial model for the etiology
of childhood anxiety disorders, and this seems also
true for models that account for the pathogenesis of
depression and disruptive behavior disorders (Frick
& Morris, 2004; Goodyer, 2001; Nigg, Goldsmith, &
Sachek, 2004; Reid, Patterson, & Snyder, 2002).
TEMPERAMENT
Temperament can be defined as “biologically
rooted individual differences in behavior tendencies
that are present early in life and are relatively stable
across various kinds of situations and over the course
of time” (Bates, 1987, p. 1101). The difference be-
tween temperament and personality is rather vague.
Some researchers view temperament as the part of
personality that is genetically determined (see Carey
& DiLalla, 1994), others consider temperament as
the observable manifestation of the child’s emerging
personality (see for a discussion Matthews, Deary, &
Whiteman, 2003), which is a point to which we will
return later.
Many blueprints have been hypothesized for the
structure of temperament in children. A frequently
cited framework is the one formulated early on by
Chess and Thomas (1985; see also Thomas & Chess,
1977) who identified as much as nine temperamental
categories in their longitudinal study on child char-
acteristics. These categories were (1) activity level,
which refers to the motor component present in a
given child’s functioning and diurnal proportion of
active and inactive periods, (2) rhythmicity, which
has to do with the predictability and/or unpredictabil-
ity in time of any function, (3) approach or with-
drawal, which pertains to the initial response to a
new stimulus, for example a new food, a new toy, or
a new person, (4) adaptability, which is concerned
with the ease with a child modifies new or altered
situations in desired directions, (5) threshold of re-
sponsiveness, which is concerned with the intensity
level of stimulation that is necessary to evoke a dis-
cernible response, irrespective of the specific form
that the response may take, or the sensory modality
affected, (6) intensity of reaction, which refers to the
energy level of response, irrespective of its quality
or direction, (7) quality of mood, which pertains to
the amount of pleasant, joyful, and friendly behavior
as contrasted with unpleasant, crying, and unfriendly
behavior, (8) distractibility, which has to do with the
effectiveness of extraneous environmental stimuli in
interfering with or in altering the direction of the on-
going behavior, and (9) attention span and persis-
tence, which can be defined respectively as the length
of time a particular activity is pursued by the child
and the continuation of an activity in the face of
obstacles to the maintenance of the activity direc-
tion. On the basis of a quantitative analysis of their
data, Chess and Thomas (1985) noted that specific
combinations of these temperament categories yield
three fundamental temperament types. The first type
of “easy temperament” is characterized by regular-
ity, positive approach responses to new stimuli, high
adaptability to change, and mild to moderate intense
mood that is preponderantly positive. These children
are quickly at ease in a new environment or with new
people, and are welcomed by others because they are
good-natured and helpful. The second type of “diffi-
cult temperament” shows the signs of irregularity in
biological functions, negative withdrawal responses
to new stimuli, nonadaptability or slow adaptability
to change, and intense mood expressions that are fre-
quently negative. These troublesome children show
prolonged adjustment periods to new routines, peo-
ple, or situations, and relatively frequent outbursts
of crying and aggression. The third and final type is
defined as “slow-to-warm-up” and refers to children
who are characterized by a combination of negative
responses to new stimuli with slow adaptability af-
ter repeated contact. Chess and Thomas (1985) noted
that two thirds of all children fit into these three tem-
perament groups, with other children demonstrating
somewhat different constellations of the nine basic
temperament categories.
Other descriptive frameworks for children’s
temperament have been formulated, but many
of these models, including the one described by
Chess and Thomas (1985), seem to be conceptu-
ally and empirically related to three basic dimen-
sions. These basic dimensions are described by Buss
and Plomin (1984) as the Emotionality-Activity-
Sociability (EAS) model. The first dimension is
“emotionality” and refers to psychological instabil-
ity and a proneness to experience feelings of fear,
anger, and sadness. The second dimension is “ac-
tivity” and concerns characteristics such as tempo,
vigor, and endurance. The third and final dimension
is “sociability” and refers to traits such as tendencies
to affiliate and to be responsive to others. Interest-
ingly, a comparison of the EAS model with current
theories of personality such as the “Big Five” (Costa
& McCrae, 1992) and the “Giant Three” (Eysenck,
274 Muris and Ollendick
1991) makes clear that the three temperament di-
mensions for most part can be further divided into
the personality factors of “neuroticism” and “ex-
traversion.” Neuroticism can be viewed as an equiv-
alent for emotionality, whereas extraversion can be
regarded as a mixture of activity level and sociability.
Interestingly, Gray (1987, 1991) has described
three basic brain systems that are relevant for under-
standing behavior in response to salient environmen-
tal stimuli, and as such largely are associated with
temperament and personality. The first system is the
behavioral inhibition system (BIS), which consists of
subcortical structures such as the hippocampus, the
septum, and parts of the limbic system, and has pro-
jections to the frontal lobes of the cerebral cortex.
The BIS serves to alert the person to the possibility
of danger or punishment, thereby enhancing avoid-
ance behavior. Activity in the BIS is responsible for
feelings of anxiety and incites the individual to stop
whatever action is going on and to scan the environ-
ment for further cues. The second system is the be-
havioral approach system (BAS), which is sensitive
to signals of reward, and involved in approach behav-
ior. Activity in the BAS produces impulsive behav-
ior: the person will vigorously pursue any action that
might result in reward, with little attention for the
possibility of negative consequences. This system is
primarily located in brain structures that are guided
by the neurotransmitter of dopamine. Finally, the
flight/fight system is sensitive to conditioned, aver-
sive stimuli (such as pain, loud noises) and is thought
to be involved in strong emotions such as rage and
panic. This system is associated with brain structures
that are involved with the control of negative emo-
tions, such as the amygdala and the hypothalamus.
Gray (1987, 1991; see also Gray & McNaughton,
2000) has hypothesized that differences in the reac-
tivity of these three brain systems determine differ-
ences in temperament and personality. Although the
empirical evidence is not totally consistent, most re-
search has demonstrated that a stronger reactivity of
the BIS and the fight/flight system are associated with
higher levels of neuroticism, whereas stronger re-
sponsivity of the BAS is related to extraversion (e.g.,
Caseras, Avila, & Torrubia, 2003), and there are in-
dications that this is also true in child populations
(Muris, Meesters, De Kanter, & Eek Timmerman,
2005).
Gray’s brain systems model of personality bears
strong resemblance to the so-called tripartite the-
ory (see Watson, Clark, & Harkness, 1994), which
emphasizes negative affectivity, positive affectivity,
and physiological hyperarousal as the central orga-
nizing dimensions of personality that are useful when
studying psychopathology. Briefly, negative affectiv-
ity is similar to the BIS, positive affectivity is akin to
the BAS, whereas physiological hyperarousal shows
clear overlap with the fight/flight system. There is in-
creasing support for the applicability of the tripar-
tite theory to child populations (Chorpita, Daleiden,
Moffitt, Yim, & Umemoto, 2000; Laurent et al.,
1999), and this evidence converges on the notion that
negative affectivity corresponds with neuroticism,
whereas positive affectivity matches with extraver-
sion (Phillips, Lonigan, Driscoll, & Hooe, 2002).
TEMPERAMENT, PERSONALITY,
AND STABILITY
As mentioned earlier, researchers view temper-
ament as the observable manifestation of children’s
emerging personality. Empirical evidence for this no-
tion has been provided by Caspi and colleagues in the
so-called Dunedin study (Caspi, 2000; Caspi et al.,
2003; Caspi & Silva, 1995). In this study, over 1,000
3-year-old children were classified into temperament
groups on the basis of observations of their behav-
ior. There were three temperament groups that were
of particular importance: (1) the well-adjusted group,
which resembled Chess and Thomas’ (1985) “easy
type,” included children who were adequately self-
confident and who did not become upset when con-
fronted with novel stimuli and situations, (2) the
undercontrolled group, which resembled Chess and
Thomas’ “difficult type,” contained children who
were impulsive, restless, negativistic, distractible, and
labile in their emotional responses, and (3) the in-
hibited group, which resembled Chess and Thomas’
“slow-to-warm-up type,” comprising of children who
were socially uncommunicative, fearful, and easily
upset by novelty. When studying these three tem-
perament groups, more than 20 years later, results
showed that temperamental qualities predicted adult
personalities. More specifically, children who had
been classified as undercontrolled when they were
3-years old, were intolerant, easily upset, overreac-
tive to minor events, and distrustful to other peo-
ple at age 26. Children who had been identified
as inhibited, were overcontrolled and nonassertive
as adults, and seemed to express little pleasure in
their later life. Finally, those children who had been
classified as well adjusted when they were young,
still represented the normative group in adulthood.
The Role of Temperament in the Etiology of Child Psychopathology 275
Although the links between childhood temperament
and adult personality were at best modest, this study
demonstrates that there is reasonable stability in in-
dividuals’ behavioral characteristics over long time
periods.
As it is clear that temperament and personal-
ity change over time as a result of a person’s in-
teraction with the environment and as such have
modest stability over longer time periods (Caspi &
Roberts, 2001), it could be concluded that temper-
ament has little value for predicting psychopathol-
ogy. However, two remarks can be made that
qualify this negatively tinted conclusion. First of all,
it should be borne in mind that methods for assessing
temperament in young people may be subject to er-
ror, thereby decreasing the power for predicting the
development of personality features over longer time
periods. Second, the stability of temperament and
personality factors over shorter time periods seems
to be remarkably better, and therefore such features
may still be important as precursors of child psy-
chopathology.
EMOTIONALITY/NEUROTICISM
AND PSYCHOPATHOLOGY
Research has demonstrated that the tempera-
ment dimension of emotionality or its equivalent
neuroticism is involved in the etiology of child psy-
chopathology (Calkins & Fox, 2002; Lonigan &
Phillips, 2001). For example, John, Caspi, Robins,
Moffitt, and Stouthamer-Loeber (1994) demon-
strated early on that this temperament/personality
dimension was associated with high levels of emo-
tional and behavioral symptoms in youths. In their
study, mothers’ Q-sorts of 350 12–13-year-old boys
were subjected to a factor analysis. Neuroticism
clearly emerged as one of five personality factors
(which showed remarkable resemblance to the “Big
Five”), but most importantly in the context of this
review, high levels of this reactive personality fac-
tor were accompanied by high levels of psychopatho-
logical symptoms, and this appeared especially true
for internalizing symptoms. Similar findings were
obtained by Huey and Weisz (1997) who assessed
personality factors in 116 clinic-referred youths by
means of the Q-sort technique administered to a
teacher who was familiar with the child. Results
demonstrated that neuroticism was positively related
to internalizing but not to externalizing symptoms. A
further study by Ehrler, Evans, and McGhee (1999),
which employed a teacher-rated questionnaire for as-
sessing personality variables including neuroticism in
a small sample of 86 school children, yielded a highly
similar finding. That is, neuroticism was accompanied
by higher levels of anxiety and depression but not
with conduct problems.
The above-described research demonstrates
that there seem to be concurrent relationships
between emotionality/neuroticism and behav-
ior problems in youths. A number of studies
have demonstrated that this reactive tempera-
ment/personality dimension is also associated with
psychological disorder. For example, Prior, Sanson,
Smart, and Oberklaid (1999) studied temperament
factors in 11–12-year-old “at risk” children (N=186)
of whom almost half met the diagnostic criteria for
aDSM-defined disorder. Results demonstrated that
these children displayed higher levels of negative re-
activity and withdrawal (which are both indicators of
an emotional/neurotic temperament) as compared to
children in the control group. Another investigation
by Rettew, Copeland, Sytanger, and Hudziak (2004)
examined temperament characteristics in children
with attention-deficit and hyperactivity disorder
(ADHD), disruptive behavior disorder, disruptive
behavior disorder plus an affective and/or anxiety
disorder, and control children who did not suffer
from a psychiatric disorder. Results revealed many
temperament differences across the four groups,
but most interesting for the present discussion was
the finding that children in the disruptive behavior
disorder plus affective and/or anxiety disorder
clearly displayed higher levels of harm avoidance
(which parallels emotionality/neuroticism) than
children in the other three groups.
Besides cross-sectional data on the link be-
tween emotionality/neuroticism and psychopathol-
ogy, there is also evidence coming from prospec-
tive studies that support this relationship. A first
study that is mentioned in this respect was car-
ried out by Caspi, Henry, McGee, Moffitt, and Silva
(1995). These researchers assessed various tempera-
ment dimensions when children were 3 and 5 years
of age. Results demonstrated that the temperament
dimension of withdrawal, which can be regarded
as a derivate of emotionality/neuroticism, predicted
parent- and teacher-rated internalizing symptoms
when children reached middle childhood and early
adolescence. A longitudinal twin study of Gjone and
Stevenson (1997) examined the significance of ge-
netic and common environmental influences on tem-
perament (the above-described EAS dimensions)
276 Muris and Ollendick
and behavioral and emotional problems in a sample
of 758 twin pairs aged 7 through 17 years who were
followed for a 2-year period. Results supported the
idea that the temperament factor of emotionality is
(at least in part) genetically determined. Further, the
data indicated that emotionality was the strongest
predictor of emotional and behavioral problems. In
an investigation by Asendorpf and Van Aken (2003),
the personality development of 151 children was fol-
lowed from the first or second year in preschool until
age 12, using Q-sorts and rating scale data of teach-
ers, parents, and friends. In addition to personal-
ity characteristics, judgments and behavioral obser-
vations of inhibition, aggressiveness, and self-esteem
were also obtained. Results demonstrated that the
personality factor of neuroticism was fairly stable and
even showed continuity over longer time periods, in
spite of the fact that different judges and instruments
were used for assessing the personality factors of chil-
dren at various ages. Further, neuroticism was signif-
icantly linked to higher levels of inhibition (but not
to aggression) and lower levels of self-esteem. In a
prospective study by Ruschena, Prior, Sanson, and
Smart (2005), the impact of a negative family tran-
sition, that is, parental separation, divorce, or death,
upon the lives of children and adolescents was exam-
ined. Results again indicated that the temperamen-
tal characteristic of withdrawal was a significant pre-
dictor of internalizing symptoms, and this appeared
not only the case in youths who had been confronted
with a negative family transition but also in youths
of whom the families remained intact. Finally, Mun,
Fitzgerald, Van Eye, Puttler, and Zucker (2001) in-
vestigated temperamental characteristics as predic-
tors of externalizing and internalizing behavior prob-
lems in boys who were 3–5-years old and again
when they were 6–8-years old. Results clearly in-
dicated that reactivity and withdrawal, which both
represent aspects of emotionality/neuroticism, were
significant predictors of behavior problems. Inter-
estingly, reactivity was clearly linked to external-
izing behavior problems, whereas withdrawal was
convincingly associated with internalizing behavior
problems.
Longitudinal research demonstrating a link be-
tween emotionality/neuroticism and psychological
disorders is scarce. One exception is a study by
Craske, Poulton, Tsao, and Plotkin (2001) who evalu-
ated the temperamental factor of emotionality at age
3 as a predictor of panic disorder and agoraphobia at
ages 18 or 21 in an unselected sample (N=992). Re-
sults indicated that emotionality at age 3 predicted
later panic disorder and agoraphobia, but this ap-
peared only the case in males.
Recently, a number of studies have included
self-report questionnaires when investigating tem-
perament and personality correlates of child psy-
chopathology. This seems to be an important
development as it is generally assumed that self-
description is an important source of information in
the field of personality research (Carver & Scheier,
1996). Muris, Winands, and Horselenberg (2003)
showed that neuroticism as measured by the Ju-
nior version of the Eysenck Personality Question-
naire (Eysenck & Eysenck, 1975) was significantly
associated with symptoms of anxiety disorders, de-
pression, and somatization. Two studies that em-
ployed the recently developed Big Five Question-
naire for Children (Barbaranelli, Caprara, Rabasca,
& Pastorelli, 2003; Muris, Meesters, & Diederen,
2005) found that neuroticism as indexed by this self-
report inventory was not only associated with inter-
nalizing but also with externalizing symptoms, and
this appeared true for various age groups of non-
clinical children and adolescents. Finally, a longitu-
dinal study by Lonigan, Phillips, and Hooe (2003)
examined the tripartite theory in relation to chil-
dren’s symptoms of anxiety and depression. Results
showed that self-reported negative affectivity (which
as mentioned earlier can be viewed as an equiva-
lent of emotionality/neuroticism) was relatively sta-
ble over a 7-month period. Most importantly, nega-
tive affectivity appeared to be a significant correlate
of anxiety and depression symptoms on both occa-
sions, and was found to predict changes in anxiety
and depression symptoms over time.
This review of the link between emotional-
ity/neuroticism and child psychopathology suggests
that this reactive personality factor is particularly as-
sociated with high levels of internalizing symptoms in
youths. This does not mean, however, that tempera-
ment factors are less relevant for the etiology of ex-
ternalizing psychopathology in youths. Several lon-
gitudinal studies have demonstrated that a “difficult”
temperament as assessed in early childhood is predic-
tive of externalizing symptoms in middle childhood
or adolescence (e.g., Bates, Pettit, Dodge, & Ridge,
1998; Guerin, Gottfried, & Thomas, 1997; Maziade
et al., 1985, 1990; Shaw et al., 1998). The problem is
that difficult temperament in this research is opera-
tionalized in terms of a construct that reflects several
more basic temperament dimensions (e.g., resistance
to control; see Bates et al., 1998). Thus, although such
difficult temperament certainly contains features of
The Role of Temperament in the Etiology of Child Psychopathology 277
emotionality/neuroticism, it also refers to lack of reg-
ulative temperament factors, which makes it diffi-
cult to include these studies in the context of the
present review. Further, it should be noted that
emotionality/neuroticism consists of various lower-
order traits, of which fear, anger/frustration, and
sadness are most important. Most instruments that
have been used to assess emotionality/neuroticism
are mainly tapping the lower-order traits of fear
and sadness, and as such it is not overly surprising
that these measures are more convincingly related to
internalizing symptoms than to externalizing symp-
toms. In fact, a recent study by Muris, Meesters, and
Blijlevens (submitted) demonstrated that when emo-
tionality/neuroticism is measured by an instrument
covering the full range of lower-order traits (i.e.,
the Early Adolescent Temperament Questionnaire;
Ellis & Rothbart, 2001), this reactive personality trait
is predictive of both internalizing and externalizing
symptoms in youths. Also noteworthy in this regard
is a longitudinal study by Rydell, Berlin, and Bohlin
(2003) who collected data on emotionality when chil-
dren were 5-years old and internalizing and external-
izing behavior problems some 1.5 years later. Results
indicated that emotionality was positive linked to
behavior problems. Interestingly, evidence was ob-
tained for the notion that lower-order traits of the
emotional temperament determined the type of be-
havior problems. That is, the lower-order trait of
fear predicted internalizing problems, whereas the
lower-order trait of anger/frustration was predic-
tive of externalizing problems. Similar findings were
obtained by Blair (2002) who followed low birth
weight, premature infants for a 2-year period. Neg-
ative temperament assessed when infants were 12-
months old appeared to predictive for the occurrence
of behavior problems in children at age 3. Again,
temperamental fear specifically predicted internaliz-
ing symptoms, whereas anger/frustration augured ex-
ternalizing symptoms.
Thus, it seems plausible that emotional-
ity/neuroticism predisposes children to internalizing
as well as externalizing disorders. Further, it can be
assumed that the lower-order traits of this reactive
personality factor play an important role in the type
of psychopathology from which children eventually
come to suffer. A child with a fearful temperament
is more prone to develop an anxiety disorder, a
child with a temperament characterized by high
anger/frustration runs greater risk to develop a
disruptive behavior disorder, whereas a child with
sad temperament is more susceptible to develop a
depression. However, empirical evidence for this
idea is still meager, and so the issue certainly needs
further validation.
Although this review article focuses primarily on
basic temperament factors in relation to child psy-
chopathology, it is also worthy of note that some re-
searchers have devoted their research attention to
certain temperament types in their study of children’s
vulnerability to psychological disorders. A good ex-
ample of such a temperament type is “behavioral
inhibition to the unfamiliar,” which can be defined
as the tendency of children to be unusually shy and
to react with fear and withdrawal in stimuli and
situations that are novel and/or unfamiliar (Kagan,
1994). There is abundant evidence showing that be-
havioral inhibition is associated with the develop-
ment of high levels of anxiety symptoms and anx-
iety disorders. For example, in a longitudinal study
by Biederman et al. (1993), preschool children were
followed for a 3-year period. Results showed that
children initially identified as behaviorally inhibited
were subsequently more likely to develop anxiety
disorders compared to control children (i.e., chil-
dren who at study onset were not classified as behav-
iorally inhibited; see for a review, Hirshfeld-Becker,
Biederman, & Rosenbaum, 2004). Several authors
have argued that behavioral inhibition is the percep-
tible manifestation of one or more underlying tem-
perament or personality dimensions (Craske, 1997;
Turner, Beidel, & Wolff, 1996). The most obvious
candidate in this respect is of course emotional-
ity/neuroticism, which also refers to psychological in-
stability and proneness to experience negative emo-
tions and as such bears strong similarity to behavioral
inhibition (see Muris & Dietvorst, in press).
TEMPERAMENT AND PSYCHOPATH-
OLOGY: TAUTOLOGICAL?
The position that temperament plays a critical
role in the etiology of child psychopathology can be
criticized by pointing to the presumed tautological
nature of the link between these temperament fac-
tors and psychopathology (Frick, 2004; Lahey, 2004).
That is to say, it can be argued that children who are
frequently fearful suffer from an anxiety disorder,
children who become easily angry and frustrated dis-
play the symptoms of a disruptive behavior disorders,
and those who are regularly sad show the signs of a
depression. Nevertheless, research has demonstrated
that the temperamental characteristics of emotional-
ity are different from the symptoms of psychological
278 Muris and Ollendick
disorders. For example, Lemery, Essex, and Smider
(2002) asked a group of experts (consisting of child
psychologists with a clinical and/or a research back-
ground) to sort out items taken from behavioral
rating scales for assessing temperament and psy-
chopathology. Results showed that items for most
part were correctly assigned to either the tempera-
ment or the psychopathology construct. This finding
was confirmed in an empirical study in which tem-
perament and psychopathology data of a large sam-
ple of children were subjected to a factor analysis.
This procedure nicely produced the expected two-
factor solution with most temperament items loading
on one factor and most psychopathology items load-
ing on the other factor. Most importantly, the elim-
ination of confounded items did not affect the rela-
tion between temperament and psychopathological
symptoms: emotionality/neuroticism remained a sig-
nificant predictor of psychological problems, suggest-
ing that this link was not due to measurement con-
founding. Lengua, West, and Sandler (1998) came to
a similar conclusion in their study of temperament
as a predictor of psychopathological symptoms in
children. With regard to the contamination of mea-
sures of temperament and psychopathology, these
researchers note: “Results show that even after re-
moval of the threat of validity presented by overlap
in measures, there continue to be significant, inter-
pretable relations between temperament and symp-
toms” (p. 164).
A clinical observation that supports the role
of the temperament dimension of emotional-
ity/neuroticism and its lower-order traits in the
manifestation of child psychopathology pertains to
the fact that a substantial proportion of the children
show adjustment problems or even develop an
adjustment disorder (see Diagnostic and Statistical
Manual of Mental Disorders; American Psychiatric
Association, 2000) after being confronted with major
life events (Newcorn & Strain, 1992). Actually, these
children seem to be seriously upset by such events
and display various psychopathological symptoms.
There is indeed support for the notion that children
with an emotional temperament, or if one likes
a “neurotic personality,” are more susceptible
to develop such adjustment disorders (Heringa,
2003). Interestingly, an adjustment disorder appears
in many guises: some children predominantly
display anxiety symptoms, others suddenly show
oppositional-defiant behavior and conduct problems,
whereas again others exhibit depressive symptoms
(think back of Tim, Tony, and Trevor). The reason
for this diversity in symptoms appears to be obvious:
it is likely the case that the underlying lower-order
temperamental structure determines the type of a
child’s psychopathology.
EFFORTFUL CONTROL
Taken together, the temperamental dimension
of emotionality/neuroticism and its underlying lower-
order traits of fear, anger/frustration, and sadness
appear to be involved in the origins and the mani-
festation of psychological disorders in children. But
does this mean that the contribution of tempera-
ment to the etiology of child psychopathology should
merely be viewed as a reactive process that occurs
whenever a vulnerable child is exposed to poten-
tially threatening stimuli or stressful life events? Ac-
cording to the recently formulated temperament the-
ory of Rothbart (Putnam, Ellis, & Rothbart, 2002;
Rothbart & Bates, 1998), the answer to this ques-
tion would be negative. This theory proposes that
temperament not only consists of reactive tempera-
ment dimensions such as emotionality/neuroticism,
but also contains a regulative temperament factor,
namely “effortful control.” Several authors have put
forward the notion that a combination of high emo-
tionality/neuroticism and low effortful control makes
children more prone to develop psychological disor-
ders (Calkins & Fox, 2002; Lonigan & Phillips, 2001).
Effortful control refers to self-regulative pro-
cesses and can best be defined as “the ability to in-
hibit a dominant response to perform a subdominant
response” (Rothbart & Bates, 1998). Clearly, this
definition is quite abstract and suggests that effort-
ful control pertains to “controlling” or “regulating”
one’s behavior under certain circumstances. Yet, it
should be kept in mind that effortful control not
only pertains to behavioral control but also atten-
tional control processes. More specifically, effortful
control is generally thought to consist of two main
components: inhibitory control, which pertains to the
ability to inhibit one’s behavior if necessary, and at-
tentional control, which can be defined as the ability
to focus and shift attention as needed. Effortful con-
trol shows strong similarities to what neuropsychol-
ogists refer to as “executive functions,” and as such
this temperament factor is usually assessed by means
of cognitive performance tests, which tap children’s
capacity of governing their attention and controlling
their behavior (Murray & Konchanska, 2002). Vari-
ous tests have been employed that map on to diverse
The Role of Temperament in the Etiology of Child Psychopathology 279
aspects of effortful control. For example, various re-
searchers have adapted go/no-go tasks for use with
children (e.g., Schachar & Logan, 1990). These tasks
tap children’s level of impulsivity or lack of inhibitory
control. In addition, the Test of Everyday Attention
for Children (TEA-Ch; Manly et al., 2001; Manly,
Robertson, Anderson, & Nimmo-Smith, 2004) in-
cludes various tasks that call on focusing, sustaining,
and switching attention, thereby indexing important
aspects of attentional control.
There are also behavior rating scales on which
parents and teachers are asked to indicate to what
extent children possess effortful control-related abil-
ities. Noteworthy in this regard is the series of
questionnaires that have been developed by Mary
Rothbart and colleages, which intend to measure a
wide range of reactive and regulative temperament
factors in children of various ages: (1) the Infant
Behavior Questionnaire (see Rothbart, 1981) can be
used with very young children, aged between 3 and
12 months, (2) the Early Childhood Behavior Ques-
tionnaire basically is an extension of Goldsmith’s
(1996) Toddler Behavior Assessment Questionnaire,
and can be employed in somewhat older children
aged between 18 and 36 months, (3) the Children’s
Behavior Questionnaire (Rothbart, Ahadi, Hershey,
& Fisher, 2001), which is suitable for children aged
between 3 and 7 years, and finally (4) the Early
Adolescent Temperament Questionnaire (Capaldi &
Rothbart, 1992), which is appropriate for older chil-
dren aged 8–15 years. All these questionnaires are
parent-report behavior rating scales that not only in-
clude the main elements of emotionality/neuroticism,
but also incorporate various aspects of effortful con-
trol (i.e., inhibitory control and attentional control;
see Table I).
Table I. Examples of Effortful Control-Related Items Taken From Various Rothbart Questionnaires
Questionnaire Scale Definition of scale Item example
Infant Temperament Questionnaire Duration of orienting The baby’s attention to and/or
interaction with a single
object for extended periods
of time
How often did the baby stare at
a mobile, crib bumper or
picture for 5 min or longer?
Early Childhood Behavior
Questionnaire
Attentional focusing Sustained duration of orienting
on an object of attention;
resisting distraction
When looking at picture books
on his/her own, how often did
your child stay interested in
the book for more than
10 min at a time?
Attentional shifting The ability to transfer
attentional focus from one
activity/task to another
During everyday activities, how
often did your child pay
attention to you right away
when you called to him/her?
Inhibitory control The capacity to stop, moderate,
or refrain from a behavior
under instruction
When asked to wait for a
desirable item (such as ice
cream), how often did your
child wait patiently?
Children’s Behavior Questionnaire Attentional focusing Tendency to maintain
attentional focus upon
task-related channels
When drawing or coloring in a
book, shows strong
concentration
Inhibitory control The capacity to plan and to
suppress inappropriate
approach responses under
instructions or in novel or
uncertain situations
Can easily stop an activity when
he/she is told “No”
Early Adolescent Temperament
Questionnaire
Attention control The capacity to focus attention
as well as to shift attention
when desired
Is good at keeping track of
several different things that
are happening around
him/her
Activation control The capacity to perform an
action when there is a strong
tendency to avoid it
Usually finishes her/his
homework before it’s due
Inhibitory control The capacity to plan, and to
suppress inappropriate
responses
Is able to stop him/herself from
laughing at inappropriate
times
280 Muris and Ollendick
Recently, a self-report version of the Early Ado-
lescent Temperament Questionnaire has become
available that assesses temperament from the child’s
point-of view; this scale can be completed by children
as young as 8 years (Ellis & Rothbart, 2001). Fur-
ther, it is worthy of note that several researchers have
developed self-report questionnaires that specifically
intend to tap (elements of) the regulative tempera-
ment factor of effortful control. Examples are the At-
tentional Control Scale (Derryberry & Reed, 2002;
Vasey et al., 2002) and the Effortful Control Scale
(Philipps & Lonigan, 2004).
It is generally assumed that the capacity for
effortful control processes is innate (Poggi Davis,
Bruce, & Gunnar, 2002). Relatively few data exist on
the temporal stability of this regulative temperament
factor, but available evidence has revealed fairly
robust stability from toddlerhood through preschool
and into early school years (Kochanska & Knaack,
2003; Kochanska, Murray, & Coy, 1997), and so it can
be concluded that effortful control has trait-like qual-
ities (see also Rothbart & Bates, 1998). Meanwhile,
it is also clear that this regulative temperament fac-
tor further develops as a result of brain maturation
and interaction with the environment (Kochanska,
Murray, & Harlan, 2000; Posner & Rothbart, 2000).
The gradual improvement of effortful control in-
creasingly enables children to regulate emotions and
to control their behavior, which may have positive
effects on their social interactions with other chil-
dren (Eisenberg, Liew, & Pidada, 2004; Fabes et al.,
1999). In children who have little effortful control by
nature or who fail to adequately develop this regu-
lative trait, such normal processes can be disturbed.
Precisely these children run greater risk for develop-
ing psychological disorders, in particular when their
temperament is also characterized by high levels of
emotionality.
VULNERABILITY AND TEMPERAMENT
Current temperament researchers assume that
vulnerability to psychopathology is characterized
by a combination of high levels of emotional-
ity/neuroticism and low levels of effortful con-
trol (Calkins & Fox, 2002; Lonigan & Phillips,
2001). More specifically, high levels of emotional-
ity/neuroticism make children prone to develop psy-
chological disorders, but it may well be the case
that the negative impact of this reactive tempera-
ment factor can be buffered by effortful control. That
is, a stressful life event will elicit negative emotions
in children and particularly in those who are char-
acterized by high levels of emotionality. However,
only children with low levels of effortful control will
experience difficulties to deal adequately with these
negative feelings and hence will react with avoid-
ance behavior, aggression, and depression. In con-
trast, children with high levels of effortful control are
capable of regulating these negative emotions by em-
ploying more strategic, flexible and effective coping
strategies (Lengua & Long, 2002; Salmon & Pereira,
2002). This view on the role of temperament in the
pathogenesis of child psychopathology is attractive,
as it enables us to more precisely predict which chil-
dren run greater risks to develop a psychological
disorder. This representation also offers a plausible
explanation for the high prevalence of comorbid dis-
orders in children who suffer from ADHD (Jensen,
Martin, & Cantwell, 1997). These children are typi-
cally characterized by low levels of effortful control
and as such left to the mercy of their reactive tem-
perament (Barkley, 2004), and hence run greater risk
for developing internalizing and other externalizing
disorders (Mangione Walcott & Landau, 2004; Nigg
et al., 2004).
So far, only a handful of studies have actually
examined the role of emotionality and effortful con-
trol in the etiology of child psychopathology. In an
investigation by Eisenberg et al. (2001), parents and
teachers completed rating scales for measuring reac-
tive and regulative temperament factors in a sam-
ple of 4–8-year-old children. Some of these chil-
dren clearly displayed internalizing problems, other
children exhibited externalizing problems, whereas
again other children did not manifest any psycho-
logical problems. Results showed that children with
internalizing problems and children with externaliz-
ing problems scored relatively high on the reactive
temperament factor of emotionality, and in partic-
ular on the lower-order traits that are relevant for
their specific complaints (respectively fear and sad-
ness versus anger/frustration). Further, children with
internalizing problems and children with externaliz-
ing problems both evidenced lower levels of effortful
control as compared to children without psychologi-
cal problems. Comparable results were obtained in a
subsequent investigation by Eisenberg et al. (2005).
In this study, not only concurrent but also prospec-
tive relations between reactive and regulative tem-
perament and behavior problems were investigated.
Again, high emotionality and low effortful control
were predictive of behavioral problems, although
The Role of Temperament in the Etiology of Child Psychopathology 281
the role of effortful control appeared more promi-
nent in the case of externalizing symptoms. Further
studies of this research group have predominantly fo-
cused on the relation between reactive and regula-
tive temperament and externalizing problem behav-
ior (Eisenberg et al., 1996, 2000; Valiente et al., 2003).
The findings of this research consistently demon-
strate that both internalizing and externalizing prob-
lems in children of various ages are associated with
high levels of emotionality and low levels of effortful
control.
Further support for a link between effortful con-
trol and externalizing problems in young (i.e., 3-
years-old) children comes from a recent study of Ol-
son, Sameroff, Kerr, Lopez, and Wellman (2005).
The results of this study indicated that individual
differences in effortful control abilities, as assessed
using behavioral and parent rating measures, were
negatively associated with children’s externalizing
problems as reported by mothers, fathers, and teach-
ers. Thus, again lower levels of effortful control were
accompanied by higher levels of externalizing prob-
lems (see for similar results Rubin, Burgess, Dwyer,
& Hastings, 2003). Interestingly, this association re-
mained significant after controlling for other cogni-
tive factors (i.e., IQ) and reactive temperament fac-
tors (e.g., emotionality).
An interesting study was carried out by Lengua
and Long (2002) who assessed emotionality and ef-
fortful control as predictors of children’s appraisal
and coping styles and adjustment problems in a com-
munity sample of 8–12-year-old children. Mothers
rated children’s temperament factors and adjustment
problems, whereas children reported on threat ap-
praisal and active and avoidant coping styles. Results
demonstrated that emotionality was positively asso-
ciated with threat appraisal, avoidant coping, and
subsequent adjustment problems. In contrast, effort-
ful control predicted more active coping and lower
adjustment problems.
Recently, Oldehinkel, Hartman, De Winter,
Veenstra, and Ormel (2004) studied a large sample
of nonclinical youths aged between 10 and 12 years.
Children’s internalizing and externalizing problems
were assessed by means of the Child Behavior
Checklist (Achenbach, 1991), whereas temperament
was evaluated with the parent version of the Early
Adolescent Temperament Questionnaire (Capaldi &
Rothbart, 1992). Temperament patterns were stud-
ied in (a) control children with neither internalizing
nor externalizing problems, (b) children with only
internalizing problems, (c) children with only exter-
nalizing problems, and (d) children with both inter-
nalizing and externalizing problems (i.e., comorbid
problems). The expected patterns of temperament
factors were found for the various groups. Com-
pared to control children, children with internaliz-
ing problems and children with externalizing prob-
lems scored high on emotionality/neuroticism, with
the former displaying particularly high levels of the
lower-order trait of fear and the latter exhibiting
high levels of frustration. Further, both groups of
children also displayed low levels of effortful con-
trol. Finally, as expected, the children with comorbid
problems were characterized by strong emotional re-
activity as evidenced by high levels of both fear and
frustration, in combination with low levels of effort-
ful control. On the basis of these findings, Oldehinkel
et al. (2004) conclude that both reactive (i.e., emo-
tionality/neuroticism) and regulative (i.e., effortful
control) temperament factors are involved in inter-
nalizing as well as externalizing psychopathology in
children.
Recent self-report surveys in nonclinical chil-
dren and adolescents (Meesters, Muris, & Van
Rooijen, submitted; Muris, De Jong, & Engelen,
2004; Muris, Meesters, & Blijlevens, submitted)
have also demonstrated that reactive and regula-
tive temperament factors each make a unique con-
tribution to the occurrence of psychopathological
problems. Again it was found that high levels of
emotionality/neuroticism and low levels of effort-
ful control were accompanied by higher levels of
anxious-depressive (internalizing) and aggressive-
delinquent (externalizing) symptoms. Further, two
of the three studies revealed a significant interac-
tion effect of emotionality/neuroticism and effortful
control on psychological problems, which indicated
that the combination of high levels of emotional-
ity/neuroticism and low levels of effortful control was
associated with the highest levels of psychopathol-
ogy. Finally, it should be mentioned that different
aspects of effortful control were allied to specific
psychopathological symptoms. More precisely, a lack
of attentional control was more strongly linked to
internalizing symptoms, whereas a deficiency of in-
hibitory control was more clearly related to exter-
nalizing symptoms. Note that these differential rela-
tions are in keeping with the clinical observation that
internalizing disorders are typically characterized by
uncontrollable negative thoughts while externaliz-
ing disorders are frequently marked by impulsive
and disinhibited behavior (see American Psychiatric
Association, 2000).
282 Muris and Ollendick
COGNITIVE DISTORTIONS
According to Beck’s (1976) cognitive model,
psychopathology is maintained by distortions that oc-
cur during various stages of information processing,
and there is increasing evidence that this is also true
for psychological disorders in children (e.g., Leung
& Wong, 1998). For example, upon entering a so-
cial situation, children with behavioral disorders pay
more attention to aggression-relevant information,
more frequently make hostile attributions about oth-
ers, and more often think up and enact aggressive be-
havioral responses (Crick & Dodge, 1994). Children
with internalizing disorders display similar cognitive
distortions: for example, anxious children show bi-
ased attention for threat-related stimuli (e.g., Vasey,
El-Hag, & Daleiden, 1996), whereas anxious and de-
pressed young people display a greater tendency to
interpret ambiguous stimuli and situations in a more
negative way (e.g., Muris, Luermans, Merckelbach,
& Mayer, 2000). Interestingly, children with anxi-
ety disorders predominantly interpret the external
world as threatening, whereas depressed children
more often make negative evaluations about them-
selves (Dineen & Hadwin, 2004).
Few studies have actually examined whether
such cognitive distortions indeed contribute to the
maintenance of psychological problems in children.
One exception is a prospective study by Dodge et al.
(2003) on the development of externalizing problems
in primary school children. These authors found sup-
port for a model in which cognitive distortions pre-
dicted aggressive behavior in children who were re-
jected by their peers. Although empirical evidence is
currently scant, it seems plausible that cognitive dis-
tortions play a similar role in the persistence of in-
ternalizing problems such as anxiety and depression
(Muris, Jacques, & Mayer, 2004).
As noted, temperament factors may play a
role in the formation of psychopathology-related
cognitive distortions in children. Various studies
have demonstrated that high levels of emotional-
ity/neuroticism are associated with a higher fre-
quency of cognitive distortions in youths (see for
a review, Vasey & MacLeod, 2001). However, few
studies can be found that have examined the in-
fluence of effortful control on cognitive distortions,
in spite of the fact that most of such distortions
refer to conscious, controlled processes, which pos-
sibly are susceptible to the regulative impact of this
temperament factor. One exception is an experi-
ment described by Lonigan, Vasey, Phillips, and
Hazen (2004), investigating the effects of temper-
ament factors of emotionality/neuroticism and ef-
fortful control on children’s attentional bias regard-
ing threat-related stimuli. In that study, a large
sample of children was screened to identify four
temperament groups: (1) children with high emotion-
ality/neuroticism and high effortful control, (2) chil-
dren with high emotionality/neuroticism and low
effortful control, (3) children with low emotion-
ality/neuroticism and high effortful control, and
(4) children with low emotionality/neuroticism and
low effortful control. All children were tested with
a dot probe detection task that measures attentional
bias for threat. It is important to note that the pre-
sentation interval used in this task was relatively
long (i.e., 1250 s) in order to make it possible for the
children to exert willful control over their attention.
Results demonstrated that children high on emotion-
ality/neuroticism generally displayed a larger atten-
tional bias toward threat-related words than children
low on emotionality/neuroticism. Most interestingly,
however, was a significant interaction involving emo-
tionality/neuroticism and effortful control. That is,
children with high emotionality/neuroticism and low
effortful control demonstrated a significant bias to-
ward threat, whereas children with high emotion-
ality/neuroticism and high effortful control did not
exhibit a significant bias toward threat. There was
no such differential effect of effortful control for
children with low emotionality/neuroticism: children
with low emotionality/neuroticism did not demon-
strate a significant attentional bias. The results pre-
sented by Lonigan et al. (2004) are in keeping with
our previous conclusion that in particular a combina-
tion of high emotionality/neuroticism and low effort-
ful control is relevant for understanding vulnerability
to child pychopathology.
A recent study by Muris, Meesters, and Rompe-
lenberg (submitted) investigated the relation be-
tween attention control, which is a key component of
effortful control, and cognitive distortions in a sam-
ple of nonclinical children between 9 and 13 years of
age. Children first completed the Attentional Con-
trol Scale (Derryberry & Reed, 2002; Vasey et al.,
2002) and were then tested with a vignette paradigm
to assess threat perception bias. Results showed that
attention control was negatively related to threat per-
ception distortions, which means that children with
low levels of this regulative temperament factor were
more prone to show this cognitive bias. When con-
trolling for neuroticism, correlations between atten-
tion control and threat perception distortions largely
The Role of Temperament in the Etiology of Child Psychopathology 283
disappeared. However, the link between attention
control and threatening interpretations of ambigu-
ous vignettes survived this correction. In other words,
this study also found some support for the notion
that effortful control is involved in psychopathology-
related cognitive distortions.
Altogether, then, there is emerging evidence
showing that high levels of emotionality/neuroticism
and low levels of effortful control may make children
prone to cognitive distortions, which in turn may play
a role in the persistence of psychological problems.
Obviously, these ideas warrant further empirical
attention.
DISCUSSION
Taken together, it is increasingly acknowledged
by developmental and clinical psychologists that tem-
perament plays a role in the etiology and main-
tenance of psychological disorders in children, and
there is growing awareness that not only reactive
but also regulative temperament factors are involved
(see also Frick, 2004). More specifically, vulnera-
bility to child psychopathology is largely associated
with a temperament that is characterized by high
levels of emotionality/neuroticism and low levels of
effortful control (Calkins & Fox, 2002; Lonigan &
Phillips, 2001). Figures 1 and 2 show two possible
models depicting the role of reactive and regulative
temperament factors in the etiology of child psy-
chopathology. In the first model, effortful control
Emotionality/
neuroticism
Fear
Sadness
Anger/
frustration
Attention
control
Inhibitory
control
Effortful
control
Anxiety
disorder
Depressive
disorder
Disruptive
behavior
disorder
Fig. 1. Model in which effortful control moderates the effect
of emotionality/neuroticism on the development of child psy-
chopathology (black arrows indicate increased vulnerability, gray
arrows indicate protective influence).
Emotionality/
neuroticism
Fear
Sadness
Anger/
frustration
Attention
control
Inhibitory
control
Effortful
control
Anxiety
disorder
Depressive
disorder
Disruptive
behavior
disorder
Fig. 2. Model in which emotionality/neuroticism and effortful
control have additive effects on the development of child psy-
chopathology (black arrows indicate increased vulnerability, gray
arrows indicate protective influence).
acts as a moderator on the link between emotion-
ality/neuroticism and psychopathology. This model
assumes that the negative impact of emotional-
ity/neuroticism may be either enhanced when a child
possesses low levels of effortful control, or reduced
in case the child has high levels of effortful control
at its disposal. The second model assumes that emo-
tionality/neuroticism and effortful control each play
a unique role and hence have additive effects in the
development of psychopathology. Although the first
“interactive” model is intuitively more plausible, it
should be acknowledged that, at present, there is
more evidence for the second “additive” model. A
final remark pertains to the specific links that are de-
picted in the models. It is clear that more research is
needed to definitely establish the specificity of these
relationships. Further, it should be borne in mind
that only the most plausible relationships are shown.
This does not mean, however, that attention control
is merely involved in anxiety and depressive disor-
ders, or that fear and sadness do not play a role
in disruptive behavior disorders. As mentioned by
Shiner and Caspi (2005) the role of temperament in
child psychopathology should not merely be viewed
in terms of vulnerability and resilience. Tempera-
ment may also play a “psychoplastic” role, which
means that personality characteristics affect the pre-
sentation of psychopathology. This psychoplastic as-
pect is important for understanding the comorbidity
among various disorders and may be helpful for iden-
tifying subtypes of childhood disorders.
284 Muris and Ollendick
The present article reviews the evidence on
the links between the reactive and regulative
temperaments factors of respectively emotional-
ity/neuroticism and effortful control and child psy-
chopathology. A critical evaluation of this evidence
raises the following issues. First of all, many stud-
ies merely rely on one assessor (in most cases:
the parent) who rates both temperament and psy-
chopathological problems, thereby introducing the
problem of informant bias. Second, most studies
(even the longitudinal investigations) only rely on
a single-time-point measurement of child tempera-
ment. Third, research has generally focused on the
relation between emotionality/neuroticism and ef-
fortful control and psychopathological symptoms;
few studies have examined the links between these
temperament factors and psychological disorders.
Fourth, the evidence for the link between effort-
ful control and psychopathological symptoms is pre-
dominantly coming from cross-sectional studies. This
makes clear that more research is required that
rely on a multimethod approach using prospective,
multiple-time-point assessments of reactive and reg-
ulative temperament factors and clinical manifesta-
tions of child psychopathology.
A somewhat different point of critique that can
be raised with regard to the link between tempera-
ment and psychopathology pertains to the fact that
associations between these two constructs in general
are rather modest, and this is particularly true over
longer time periods (e.g., Aguilar, Sroufe, Egeland,
& Carlson, 2000). This point has been adequately
tackled by Shiner and Caspi (2003) who noted that
(1) even associations with small effect sizes can be
of theoretical and practical significance, (2) it is im-
plausible that complex behavior such as child psy-
chopathology is the product of one or two temper-
ament factors, (3) temperament factors may interact
with each other and with other variables, and so the
“true” impact of temperament is bigger than the ef-
fect of the single temperament factors, and (4) the ef-
fects of temperament factors accumulate over a life-
time, and so the focus on a single outcome measure
may underestimate the contribution of temperament
to the course of developmental trajectories.
The latter points also make clear that the role
of temperament in the etiology of psychological
problems in youths can best be conceptualized in
terms of a developmental psychopathology perspec-
tive (Seifer, 2000). One important implication of
adopting this perspective is that temperament factors
and psychological disorders are developmental phe-
nomena, which may manifest themselves differently
at various ages. Thus, reactive and regulative temper-
ament factors may look quite different in toddlers as
compared to older children and adolescents, which
stresses the need for age-appropriate assessment
tools and underlines the necessity of multiple time-
point assessments in long-term prospective research
(Rothbart & Bates, 1998). The same is true for psy-
chopathology as it is clear that externalizing and in-
ternalizing disorders each have their typical manifes-
tations during various developmental stages (Loeber,
Green, Lahey, Frick, & McBurnett, 2000; Muris, in
press). Another implication pertains to the fact that
most forms of psychopathology are the result of mul-
tiple, interacting causal influences. Previous research
on the role of temperament in the pathogenesis of
child psychopathology has predominantly looked for
direct linear effects. However, it is far more likely
that reactive and regulative temperament factors in-
teract with other etiological factors. One obvious
candidate is the occurrence of negative life events, as
it is likely that both reactive and regulative tempera-
ment factors really come into play when the child is
exposed to adverse or stressful circumstances. Fur-
ther, it has been demonstrated that high levels of
emotionality in children are associated with lower
levels of responsiveness in their mothers (Owens,
Shaw, & Vondra, 1998), which in turn may hinder
the formation of a secure attachment relationship,
thereby further enhancing the risk for developing
internalizing and/or externalizing psychopathology
(see Seifer, 2000). Finally, negative temperament fac-
tors such as high emotionality/neuroticism and low
effortful control may not only influence parental re-
sponsiveness but may also elicit negative parental
rearing behaviors, such as inconsistency and restric-
tiveness, which may accrue children’s behavioral and
emotional problems (Bates et al., 1998; Lengua &
Kovacs, 2005; Rubin et al., 2003).
Obviously, more studies are required to fur-
ther investigate the proposed temperamental in-
fluences on the etiology of child psychopathology.
As mentioned earlier, research on the relation be-
tween reactive and regulative temperament factors
and cognitive distortions, and longitudinal investiga-
tions, which examine the predictive value of temper-
ament on the development of psychological prob-
lems, are urgently needed. In the latter research,
other vulnerability and protective factors should also
be included so that it becomes possible to inves-
tigate the relative contribution of temperament to
the etiology of psychological disorders in children.
The Role of Temperament in the Etiology of Child Psychopathology 285
Attention should also be devoted to the develop-
ment of reliable and valid instruments for assess-
ing effortful control. So far, researchers have relied
on neuropsychological performance tests and behav-
ior rating scales for measuring this regulative tem-
perament factor. With regard to the neuropsycho-
logical instruments, it should be noted that a great
variety of tests have been used although they all
seem to tap relevant aspects of effortful control (e.g.,
Manly et al., 2001, 2004; Murray & Konchanska,
2002; Rothbart, Ellis, Rueda, & Posner, 2003). Still,
the lack of uniformity hinders the comparability of
the studies, and hence it would be preferable to use
a standardized battery of tests that is suitable for as-
sessing effortful control processes in children of var-
ious ages. With respect to the behavior rating scales,
one has to conclude that solid psychometric data
are currently missing. Preliminary evaluations of the
Rothbart questionnaires indicate that the reliability
of some scales is not satisfactory (Muris, Meesters,
& Blijlevens, submitted). In addition, it is also un-
known to what extent scores on these measures are
associated with performance on various neuropsy-
chological tests. Finally, studies in clinical settings are
also important. In this article, clear hypotheses have
been formulated regarding the temperament profiles
of children with anxiety disorders, depression, dis-
ruptive behavior disorders, ADHD, and adjustment
disorders, and thus comparisons among these clin-
ical groups and comparisons with nonclinical con-
trol children would make it possible to test these
predictions.
Admittedly, the present review focused on the
temperament traits of emotionality/neuroticism and
effortful control. Although a temperament model of
two components provides a thrifty theory for the
pathogenesis of child psychopathology, the possibil-
ity cannot be rules out that other temperament di-
mensions are also relevant for understanding the
etiology of child psychopathology. The most likely
candidate in this respect is extraversion, although it
should be borne in mind that this personality fac-
tor may act differently in various types of disorders.
That is, there is some evidence that low levels of
extraversion are associated with internalizing prob-
lems, whereas high levels of extraversion are linked
to externalizing problems (e.g., Muris et al., 2003;
Oldehinkel et al., 2004). Thus, it may be worthwhile
to not only assess emotionality/neuroticism and ef-
fortful control, but also to include a measure of ex-
traversion in future research on the link between
temperament and child psychopathology.
It remains to be seen whether the proposed
temperament model has implications for the treat-
ment of child psychopathology. Most child-directed
treatment programs for children with anxiety dis-
orders, depression, or disruptive behavior disorders
contain elements of emotion regulation (Southam-
Gerow & Kendall, 2002), which seem to target at
soothing the reactive temperament factor of emo-
tionality. However, it is equally plausible to assume
that these programs promote children’s ability of
effortful control. Note that this aspect is clearly
present in cognitive-behavioral therapy. For exam-
ple, for children with behavioral problems, the Stop-
Think-Do method has been developed (see Petersen,
1995), which urges children not to respond immedi-
ately in provocative social situations, but rather to
think about the feelings of oneself and others, before
switching over to behavioral action. This method has
clearly yielded positive effects (Orobio De Castro,
Bosch, Veerman, & Koops, 2003), and as such it is ap-
propriate that this approach is included in most of the
treatment programs that target children with these
types of problems (e.g., Lochman & Wells, 1996;
Van Manen, Prins, & Emmelkamp, 2004). Although
less obvious on first sight, cognitive-behavioral pro-
grams for anxiety disorders and depression also con-
tain Stop-Think-Do elements (cf., Barrett, Lowry-
Webster, & Turner, 2000; Barrett, Dadds, & Rapee,
1991; Shochet, Holland, & Whitefield, 1997): chil-
dren are prompted to carefully analyze the stim-
uli and situations that cause their anxious and de-
pressed feelings, to think about what is going on in
their head, and to eventually choose a more adaptive
behavioral response in stead of avoidance (anxiety)
or passivity (depression). In other words, cognitive-
behavioral therapy teaches techniques that help chil-
dren to inhibit their maladaptive behaviors and to
regulate their attention, thereby improving their ef-
fortful control.
Given the importance of effortful control in
the etiology of child psychopathology, some au-
thors (e.g., Rothbart, 2004) have even suggested that
a specific attention-based intervention may prove
helpful to prevent or to treat childhood disorders.
In a pilot study, Rothbart and Rueda (2003) em-
ployed a computerized joystick-controlled program
(see Washburn & Rumbaugh, 1992) to train chil-
dren’s attentional skills. It was found that children
who received the attention training exhibited more
increase in their IQ than control children who were
not treated with the program. Further research is
necessary to study whether such training is useful in
286 Muris and Ollendick
children who are characterized by low levels of ef-
fortful control, and can be employed as an interven-
tion to reduce children’s vulnerability to develop psy-
chological problems.
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Although the field of child psychopathology is of relatively recent origin, it is a healthy, burgeoning one. Within the past 10 to 20 years, numerous articles and books have been published, and the field can now be described as emerging with an identity of its own. No longer can child psychopathology be viewed simply as a downward extension of adult psy­ chopathology. Rather, children must be viewed as children, not as miniature adults. Such a situation requires that issues of child psychology and developmental psychology be inti­ mately considered when delineating the problems of children. Such a focus has guided our efforts in soliciting contributors and topics for this volume. All contributors are active researchers and clinicians in the area of child psychopathology, and all are acutely aware of the special considerations of child and developmental psychol­ ogy as they relate to child behavior problems. Further, all contributors are empirically minded; consequently, the various chapters are data-based and represent the most up-to­ date knowledge available. However, since research-based knowledge is more abundant in some topic areas than in others, the chapters vary in length and scope.
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STOP THINK DO was developed in a clinic as a group social skills training program for children and adolescents, referred with social-behavioural problems. It also involves the child’s critical social supports including parents, teachers and peers to ensure transfer and maintenance of skills in the real world. The program is a cognitive-behavioural-motivational approach to social skills training which is both didactic and experiential. The STOP THINK DO method of social problem solving is the core of the program, following the traffic light symbol, a simple cue for learning the process for children and adults alike. Through liaison with educationalists, the clinical treatment program has been adapted with a preventive focus for use in school classrooms, incorporating a social skills training curriculum and a teacher training program. Research described in the paper indicates the utility of the program to enhance social competence in children in clinic and school settings. The STOP THINK DO method is also useful as a framework for motivating learning in any child, including those with attention deficits, learning disabilities or gifted under-achievement. In essence, the application of the STOP THINK DO model in either a social or learning context attempts to de-emotionalise these areas, and empower the child with cognitive and behavioural skills with motivation to change through peer and adult support.