When should a child who is considered “shy” be diagnosed with social anxiety disorder? What is the line between feeling sad and clinical depression? A new book from David Rettew, M.D., titled Child Temperament: New Thinking About the Boundary Between Traits and Illness, explores the continuum from personality traits to diagnosable psychiatric disorders in children. Published by W.W. Norton and Company, it is intended for a broad audience, says Rettew.
“An interested parent could pick this up,” he says. “This was purposefully written to be free of as much scientific jargon as possible.”
Rettew, who is an associate professor of psychiatry and pediatrics at the University of Vermont College of Medicine, draws on his own research and his clinical work as director of the pediatric psychiatry clinic at Fletcher Allen Health Care in writing the book. He revisits and explains the five temperament types and major dimensions of temperament. Although they have long been considered fixed traits that carry into adulthood, new research shows how family, environment, and genetics all shape and interact with each other to modify or solidify a child’s temperament over time.
What emerges is a “more layered and complex” view, Rettew says, one that asks practitioners to consider temperament when treating psychiatric disorders in children. Instead of a stark line separating children with disorders from “healthy” children, it may be that all children exist on continuum of behavior, with certain temperament types putting some children more at risk for particular disorders. The complexity of an individual’s neurobiology, family, and environment makes it hard to generalize, Rettew says, and although that doesn’t lend itself to easy answers, it does offer some hope.
“Temperament is not destiny,” he says, “and the implications for clinicians like me, as well as parents, and teachers are pretty profound.”
Publication of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) in May 2013 has generated a lot of discussion about the diagnosing of psychiatric disorders in children, Rettew says. Considered the “standard classification of mental disorders,” the new version has stirred controversy about how low a bar should be set for a diagnosis, in addition to new diagnoses that in the past didn’t rise to the level of disorder.
“This book puts these changes in an understandable light,” Rettew says, “and adds some context to the conversation.”
Rettew’s book provides practical ways practitioners may consider temperament when treating psychiatric disorders. For parents, there are suggestions on how to consider the “fit” between family members’ temperaments and the child’s in considering treatment options. It also offers school-based approaches, and weighs in on the question of medication, including whether performance-enhancing psychiatric medication may be on the horizon.
“The ‘so what’ is pretty important,” Rettew says. “I want readers to walk away with practical applications.”
Visit http://childtemperament.net to read more or to purchase the book.