Dr Marcel Zentner developed the Integrative Child Temperament Inventory (ICTI) at a time in which the focus on children's mental health in the UK was just on the rise. Now, thanks to several important global and UK-wide campaigns, the lens is truly focused on mental health, including important areas such as child behaviour and temperament. We spoke with Dr Zentner about the ICTI and the growing need for assessment and intervention.
Q: The ICTI was initially published in a time where the need for testing children’s behaviour/temperament was just on the rise. Would you say this need has continued to grow? What are the factors that have led to this demand?
The demand is linked to a growing body of research showing that certain temperament traits place young children at risk for the development of behaviour disorders later in life. For example, children high on behavioural inhibition have up to seven times the risk of developing social anxiety disorder (SAD) as that of controls, making behavioural inhibition a principal predictor of SAD (Clauss & Blackford, 2012). Poor impulse in preschool, in turn, has been found to predict adult antisocial disorders just as strongly as low intelligence and low social class origins, which are known to be extremely difficult to improve through intervention (Moffitt et al., 2011). This pattern of results calls for temperament measures that can be used easily. The ICTI is relatively brief (30 items) and can be used from age 2. As such it fills important gap in current assessment tools for identifying behavioural and emotional risk factors in childhood.
The ICTI also has applications in both research and applied contexts. It allows researchers to collect basic information on temperament where this would have been difficult until now, notably in situations when time with participants is very limited, when numerous other constructs must be assessed, or when temperament needs to be included as a secondary or control variable. In applied settings, the measure lends itself to a quick assessment of a child’s temperament in the context of screening for behavioural or emotional risk, such as in primary paediatric care, thus providing a diagnostic tool to match recent developments in temperament-focused interventions.
Q: In the UK, access to mental health has been under scrutiny and well-known individuals like the Duke and Duchess of Cambridge have come forward to shine a light on the need for early intervention in schools. Do you think this is starting to take root?
Early intervention is increasingly necessary and it is widely recommended, but studies report slow uptake and low rates of follow-through after referral to specialised services. While there are many reasons for this slow development, one has to do with the lack of commonly adopted standards for behavioural screening. Temperament offers a promising possibility to provide such a standard, because it relates to a broad spectrum of behaviours. Also, even if some temperament characteristics have been found to predict behaviour disorders up to adulthood, variations in child temperament are considered to be variations within a normal range. This allows parents, teachers, and primary care providers to use a vocabulary that is relatively benign and accessible, and follow-ups to a positive screen may be more easily framed in terms of enhancing “character literacy” rather than preventing psychopathology or violence. These features have been shown to positively affect parents’, teachers’, and primary care providers’ motivation to engage with relevant forms counseling or intervention.
Q: The ICTI is relatively unique in that it’s used for children 2-8 years. Why did you decide on this particular age range?
This age range was chosen because (a) it covers a key period for the assessment of early temperament risk factors, and (b) it spans a relatively wide range, extending from toddlerhood to early school age, all while (c) allowing for using the same items for behaviours at the early and the late end of the range. While the applicability in toddlers as young as 24 months of age responds to the importance of early behavioural risk detection, the broad age range covered by the ICTI allows researchers and clinicians to track changes in temperament over time using the same rather than different instruments.
Q: What is a typical next step for a child who is screened with the ICTI and shows need for intervention?
You are putting your finger on a crucial point, because even the most sensitive diagnostic tools are of limited value if they cannot be matched with effective interventions that can be put in place in case of a risk diagnosis. Fortunately, the last decade has seen the advent of several temperament-based interventions that can be used in case of a positive screen. For example, the Cool Little Kids Program is designed for temperamentally inhibited preschool children (Lau, Rapee, & Coplan, 2017). INSIGHTS into Children’s Temperament is a more comprehensive intervention program using parent and teacher guidance that is tailored to the child’s entire temperamental profile. A growing recent trend consists of computer exercises aimed at promoting self-regulation or reducing behavioural inhibition (e.g., P. Liu, Taber-Thomas, Fu, & Pérez-Edgar, 2018). All these forms of intervention have been shown to be effective, including in two randomised controlled trials (McClowry & Collins, 2015).
An important point to keep in mind is that temperament-based assessments and interventions can be integrated into already existing forms of intervention that target behaviours with temperamental components, such as poor self-regulation or aggression. One major advantage of temperament assessments is that traits such as behavioural inhibition and deficits in attentional control are risk factors that can be discerned and measured as early as in toddlerhood, and the ICTI is an inventory that was purposefully devised to allow for such very early assessments. It is my hope that it can facilitate the deployment of interventions at an age when the relatively high degree of brain and behavioural plasticity makes successful outcomes more likely.
Clauss, J. A., & Blackford, J. U. (2012). Behavioral inhibition and risk for developing social anxiety disorder: A meta-analytic study. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 1066–1075. doi:10.1016/j.jaac.2012.08.002
Lau, E. X., Rapee, R. M., & Coplan, R. J. (2017). Combining child social skills training with a parent early intervention program for inhibited preschool children. Journal of Anxiety Disorders, 51, 32–38. doi:10.1016/j.janxdis.2017.08.007
Liu, P., Taber-Thomas, B. C., Fu, X., & Pérez-Edgar, K. E. (2018). Biobehavioral markers of attention bias modification in temperamental risk for anxiety: A randomized control trial. Journal of the American Academy of Child & Adolescent Psychiatry, 57, 103–110. doi:10.1016/j.jaac.2017.11.016
McClowry, S. G., & Collins, A. (2015). Temperament-based intervention: Reconceptualized from a response to intervention framework. In R. Shiner & M. Zentner (Eds.), Handbook of temperament (pp. 607–627). New York, NY: Guilford Press.
Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., . . . Caspi, A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. PNAS, 108, 2693–2698. doi:10.1073/pnas.1010076108