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Cicchetti and Toth (1995) have described two major goals of a developmental approach
to psychopathology. The first is to study the development of individual capacities across the life
span. The second is to examine the relation between outcomes and earlier adaptations in
functioning, considering distal as well as proximal influences on development. A temperament
approach to development and psychopathology is concerned with the constitutionally based
dispositions that underlie the individuals social and emotional development. Temperament also
provides a view of distal influence that is evolutionary in scope, identifying variations in
affective-motivational and attentional adaptations to human life that are both inherited and
shaped by experience. Along with attention, these include affect related to threatening input that
organizes motor and autonomic circuits to support avoidant behavior, and perceptual pathways to
enhance information relevant to threat and safety (Derryberry& Rothbart, 1984; Derryberry &
Tucker, 1992; Gray, 1982; Ohman, 2000). They also include affect and emotion related to
incentives that support approach, and perceptual pathways that enhance information relevant to
reward, as well as affect related to goal blockage and loss that support attack and withdrawal.
Except in rare cases, we all exhibit these adaptations, and share a number of them with
non-human animals (Panksepp, 1998). Individuals vary in the reactivity of their affective
motivational systems and in the self-regulatory capacities, such as attention, that modulate them
(Rothbart & Derryberry, 1981). As the child develops, initially more reactive forms of
regulation such as approach and fearful inhibition are increasingly supplemented by capacities of
voluntary or effortful control (Posner and Rothbart, 1998; Rothbart & Bates, 1998). These
patterns of regulation may, promote a progressive stabilization of synapses within the brain,
contributing to the structural organizations central to personality (Derryberry & Reed, 1994, p.
633). The self-organization of social and emotional development based on temperament and
experience provides a further proximal basis for thinking about psychopathology and its
development (Cicchetti & Tucker, 1994).
In the previous edition of this chapter (Rothbart, Posner, & Hershey, 1995), we identified
a number of ways in which temperament might shape individual adaptation and vice versa.
These include (1) individual differences that in the extreme may constitute the psychopathology
or dispose the person toward it; (2) characteristics evoking reactions in others that can promote
the risk of psychopathology or buffer it; (3) characteristics influencing the persons niche
picking, putting him/her at greater or lesser risk for psychopathology; (4) temperamental
influences on the form of a disorder, its course, and the likelihood of its recurrence, (5)
Temp., Atten., & Dev. Psychopathology 3
temperamental biases in information processing about the self and the world, increasing or
decreasing the likelihood of psychopathology; (6) temperamental regulation or buffering against
the effects of risk factors or stress; (7) temperamental heightened responsiveness to
environmental events; (8) interaction among temperament systems, some of them later
developing. Two major temperamental control systems are fear, developing late in the first year,
inhibiting approach and expressive tendencies, and effortful control, developing during the
preschool years and beyond. In addition, (9) temperamental dispositions may shape different
developmental pathways to a given outcome, and individual dispositions may allow for multiple
outcomes (Cicchetti & Cohen, 1995). Finally, (10) temperament characteristics and caregiving
environment may make independent contributions to outcomes, or may interact in increasing or
decreasing risk of disorder; and (11) disorders themselves may change aspects of temperament.
We have been impressed at the number of studies during the past decade that speak to these
issues, and we revisit them in the course of our discussion.
This chapter has two major sections. In the first, we describe findings on individual
differences in temperament and attention and consider their links to neural networks. We then
discuss theories and research relating temperament to the development of risk conditions for
psychopathology. Individual differences in attentional capacities, a major aspect of
temperament, are critical to our understanding of these issues.
HISTORICAL APPROACHES
The ancient Western typology of temperament was developed by Greek and Greco-
Roman physicians, including Theophrastus, Vindician, and Galen (Diamond, 1974). Like later
approaches to temperament, the fourfold typology related individual differences in behavior and
emotionality to variability in the human constitution as it was understood at the time. The
temperamental syndrome of melancholia (a tendency to negative and depressed mood) and its
relation to a predominance of black bile was developed in the 4th century B.C. writings of
Theophrastus, and the complete fourfold typology of temperament as linked to the Hippocratic
bodily humors was present by the time of Vindician in the 4th century A.D. (Diamond, 1974).
In addition to the melancholic type, the fourfold typology included descriptions of the
choleric person (quick-tempered and touchy, easily aroused to anger, with a predominance of
Temp., Atten., & Dev. Psychopathology 4
yellow bile), the phlegmatic (apathetic and sluggish, not easily stirred to emotion, with a
predominance of phlegm), and the sanguine person (characterized by warmth, optimism, and
lively expressiveness, with a predominance of blood). The fourfold temperament typology was
endorsed throughout the Middle Ages and Renaissance (cf. Burton, 1621/1921; Culpeper, 1657)
and discussed by Kant (1798/1978). More recently, Eysenck's (1970) work made use of the
typology, and Merenda (1987) has argued that it constitutes a four-factor model for our current
understanding of temperament and personality. Recently, Watson and Clark (1995) discussed
the melancholic temperament in connection with links between negative emotionality and
psychopathology.
If we look at woodcuts from the Middle Ages, representing the four temperament types,
the behaviors depicted often do appear pathological. The choleric man is depicted beating a
woman, the phlegmatic person is asleep in bed while others are working, and the melancholic
person is seen in depressed attitude or portrayed as a distraught lover (e.g., Carlson, 1984, p.
613). The sanguine type is more often depicted as adjusted than the other three, but even the
sanguine individual may be shown overeating or overdrinking. These images suggest that, at the
extreme, individual differences in temperament may in themselves constitute maladaptations.
One of the issues immediately raised by these historical treatments of temperament and
psychopathology is thus the relation between a temperamental extreme and a psychopathological
condition.
In this century, the type construct has been modified conceptually, resulting in
dimensional and factor-analytically derived approaches to an understanding of individual
differences. Even the psychological types put forward by Jung (1923) differ in important ways
from the fourfold typology. To Jung, introverted and extraverted qualities were predominant
human attitudes, related to thinking, feeling, sensation, and intuition. Unlike the ancients, or
Kagan's (1989) view of inhibited and uninhibited types as qualitatively different classes of
individuals, Jung (1923) did not view psychological types as representing qualitative differences.
Instead, he described them as Galtonesque family-portraits, which sum up in a cumulative
image the common and therefore typical characters, stressing these disproportionately, while the
individual features are just as disproportionately effaced (Jung, 1923, p. 513).
Jung's approach to the type is similar to the idea of the prototype in cognition (Posner &
Keele, 1968; Rosch, 1973); it is also related to principles of measuring the individual trait. In
deriving a score for an individual on a temperament or personality trait, the individual's item
scores on a scale are aggregated to describe a single score that represents similarity of response
across time and situations. This trait score can be seen as the individuals "common and
therefore typical" characteristics, "stressing these disproportionately"; the influence of particular
situations or other important factors is also "just as disproportionately effaced." The type can
then be seen to refer to a set of traits that tend to occur together in groups of individuals. Factor-
analytic approaches to temperament and personality identify clusters of characteristics that tend
to covary; results of this work are described in more detail below.
Temp., Atten., & Dev. Psychopathology 5
Jung also suggested that introverted and extraverted tendencies are present in all persons,
but, for a given person, one attitude tends to become more elaborated and conscious, while the
other is less elaborated, more primitive, and, for the most part, unconscious. Differentiation
between extraversion and introversion, he wrote, can be seen early in life:
By objects, Jung included both physical and social entities, so that the more introverted
child would show a tendency to dislike new social situations, approaching strangers with caution
or fear, and the introverted adult to dislike new situations or social gatherings, and demonstrating
hesitation and reserve. Jung suggests that the introvert would also be inclined toward pessimism
about the outcome of future events. The extraverted person would show more ready approach
and action toward social and physical objects (impulsivity), and greater sociability and optimism
about the future (Jung, 1923).
Factor-Analytic Studies
descriptive words and personality items, constitute what have been called the Big Five
personality factors.
In Eysenck's (1944, 1947) early factor-analytic work on male neurotic subjects, factors of
extraversion-introversion and neuroticism were extracted. He also reported support for Jung's
distinction between more extraverted (hysteric) symptoms and more introverted (dysthymic or
psychasthenic) symptoms in neurosis. Eysenck (1947) also reviewed results of a factor analysis
of Ackerson's (1942) data describing a large sample of children studied by the Illinois Institute
for Juvenile Research. These data yielded a general neuroticism factor, along with a factor that
distinguished between more introverted behavior problems (sensitive, absent-minded, seclusive,
depressed, daydreams, inefficient, queer, inferiority feelings, and nervous), and extraverted
behavior problems (such as stealing, truancy from home and school, destructive, lying, swearing,
disobedient, disturbing influence, violent, rude and egocentric) (Eysenck & Eysenck, 1985, p.
53).
There has since been extensive replication of this factor structure of psychopathology in
childhood, distinguishing between internalizing problems, including inhibition, shyness, and
anxiety related to introversion, and externalizing problems, including aggressive and acting-out
problems related to extraversion (Achenbach & Edelbrock, 1978; Cicchetti & Toth, 1991).
Results of these analyses, combined with evidence for stability of extraversion-introversion
across long periods (see reviews by Bronson, 1972; Kagan, 1998; and Rothbart, 1989a), suggest
that individual differences on extraversion-introversion may be basic to both a description of
temperament and, in their extremes, to an individual's likelihood of demonstrating particular
kinds of behavior problems or psychopathology. Below, we describe some direct and indirect
links between temperament, caregiving, and risk for psychopathology. First, however, we
discuss the structure of temperament.
Much of the early research and thinking in the field of temperament in childhood has
relied on Thomas and Chess's pioneering work in the New York Longitudinal Study (NYLS;
Thomas & Chess, 1977; Thomas, Chess, Birch, Hertzig, & Korn, 1963). Dimensions of
temperament identified by the NYLS included activity level, threshold, mood, rhythmicity,
approach/withdrawal, intensity, adaptability, distractibility, and attention span/persistence.
Chess and Thomas (1986; Thomas, Chess, & Birch, 1968) also developed the important idea of
"goodness-of-fit" to describe situations in which there is a "match" between the temperamental
characteristics of the child and the expectations of others and/or demands of the situation. In
their model, a good fit would predict a more favorable mental health outcome; a poor fit or
incompatibility would predict impaired function and risk of development of behavior disorders.
himself or herself. The child quality is then a source of positive self-regard for the child, as well
as need-satisfying to the parent (p. 112).
Child qualities providing a match or mismatch with parental need could be gender,
appearance, intellectual or physical aptitude, or temperament. Within American society
generally, a positive and outgoing temperament may represent a particularly auspicious "match"
between the child and many situational requirements; in school, effortful and/or fear control may
provide a better match (Lerner, Nitz, Talwar, & Lerner, 1989). In other cultures, reserve rather
than extraversion may be more generally valued (Chen, Rubin, & Li, 1995: Chen, Rubin, & Sun,
1992).
Thomas, Chess, and associates (Thomas et al., 1963, 1968) also identified groups of
children they designated as easy, difficult, and slow to warm up, and their construct of
difficultness, has been frequently used in studies of the development of behavior problems.
This construct stemmed from results of a factor analysis of data from the original NYLS, which
identified a cluster of five temperament dimensions: approach/withdrawal, mood, intensity,
adaptability, and rhythmicity, labeled as difficult (Thomas et al., 1963). In algorithms for
assessing difficulty, developed by Carey and McDevitt (1978), Fullard, McDevitt, and Carey
(1984), and others, difficulty is derived from extreme scores on all five dimensions.
There are several problems with the use of the difficulty construct in temperament
research (For a discussion of this issue, see Plomin, 1982; Rothbart, 1982.). One is the wide
variability of operationalizations of the construct. Because factor analyses of data collected on
the NYLS dimensions have frequently failed to yield loadings for rhythmicity in the "difficulty"
factor (Bates, 1989), these studies often delete rhythmicity measurements or use varying
composites, depending on the outcome of the factor analysis or the particular measures used in
the study. Those based on the Carey and McDevitt (1978) or Fullard et al. (1984) algorithms
always include it. Inconsistency in the use of difficulty as a construct then creates serious
problems for knowing what is meant by difficulty in any given study, and greater precision will
result only when assessments of the construct are psychometrically sound and comparable across
studies.
Bates (1980, 1989) argued that the core variable of measures of difficulty is negative
emotionality, and his work used measures assessing this variable. Factor-analytic work by Bates
and others also identified two kinds of negative emotionality in infancy: the first is related to
children's responses to novelty and the second, more general distress proneness (Bates et al.,
1979). Bates's research indicated that the two varieties of negative emotionality may be
differentially related to specific behavior problems that develop later, and differentiated
temperamental contributions to behavioral problems and psychopathology have consistently
been found in recent research, as indicated below and in Rothbart and Bates (in press). This
differentiation is lost in the more general NYLS-based difficulty construct.
Another way of looking at difficulty is to say that some children are labeled by their
caregivers as problem children at an early age, and this labeling is likely influenced by the
Temp., Atten., & Dev. Psychopathology 8
childs temperament. Use of the terms easy and difficult may be further extended as a
parent has more than one child (the first was easy, but the second was difficult). The terms
may be applied in an endearing way, or used to indicate the source of problems in family
relationships. Attributions about the child may in turn contribute to developmental outcomes in
the childs adaptation. Nevertheless, social attributions and values take us to a different level of
analysis than measurement of temperamental dispositions in the child.
In the original clinical application of the NYLS work (Thomas et al., 1968), no attempts
were made to avoid conceptual overlap across the nine dimensions, so that individual
questionnaire scales based on the NYLS have sometimes been highly overlapping in meaning.
Findings of relatively high intercorrelations among scale scores designed to assess the NYLS
dimensions have not been too surprising, given that a behavioral item might, in some cases,
belong as easily to any one of three different scales (Rothbart & Mauro, 1990). Lack of internal
homogeneity within individual scales based on some of the NYLS dimensions has also been
found, which, when combined with lack of independence among scales, has led researchers in
Sweden and Australia to attempt item-level factor analysis of NYLS-based parent report scales
(Hagekull & Bohlin, 1981; Sanson et al., 1987).
Gartstein and Rothbart (2003) recently studied the factor structure of expanded scales
measuring parent-reported infant temperament, adapted from dimensions identified in research
on temperament in childhood. Factor analysis of a large data set describing 3- to 12-month-old
children yielded three broad dimensions: Surgency/Extraversion, defined primarily from scales
of approach, vocal reactivity, high intensity pleasure (stimulation seeking), smiling and laughter,
activity level and perceptual sensitivity; Negative Affectivity, with loadings from sadness,
frustration, fear, and loading negatively, falling reactivity; and Orienting/Regulation, with
loadings from low intensity pleasure, cuddliness, duration of orienting and soothability, and a
secondary loading for smiling and laughter. As early as infancy, there is thus evidence for three
broad temperament dimensions.
assessing positive emotionality and approach, including positive anticipation, high intensity
pleasure (sensation-seeking), activity level, impulsivity, smiling and laughter, and a negative
loading from shyness. The Negative Affectivity factor involves positive loadings for shyness,
discomfort, fear, anger/frustration, and sadness, and a negative loading from soothability-falling
reactivity. The Effortful Control Factor is defined by positive loadings from inhibitory control,
attentional focusing, low intensity pleasure (non-risk taking pleasure), and perceptual sensitivity.
These broader factors suggest a hierarchical structure to temperament, with more narrow
constructs related to each other at a higher level in the hierarchy. Questions regarding breadth of
temperamental predictors of psychopathology will be addressed later in the chapter.
These childhood temperament factors conceptually and empirically map fairly well upon
the Extraversion/Positive Emotionality, Neuroticism/Negative Emotionality, and
Conscientiousness/Constraint dimensions found in Big Five studies of the adult personality
(Ahadi & Rothbart, 1994; Rothbart, Ahadi, & Evans, 2000). These broad temperament constructs
further suggest that temperament dimensions go beyond lists of unrelated traits and generalized
characteristics of positive and negative emotionality. Particularly important are temperament-
based interactions between the childs motivational impulses and his or her efforts to constrain
them.
We (Ahadi & Rothbart, 1994; Rothbart, 1989d; Rothbart & Ahadi, 1994) and Martin and
Presley (1991) have indicated possible relationships between temperament factors identified for
childhood and personality factors identified for adults, and in our adult research program, we
have found empirical links between Negative Affectivity and big five Neuroticism,
Surgency/Extraversion, and Extraversion, and Effortful Control and Conscientiousness (Evans &
Rothbart, 2004; Rothbart et al., 2000).
In the next section, we describe conceptual and neural models developed to enhance our
understanding of these dimensions. The first two dimensions are positive affectivity and
approach (Surgency/Extraversion) and fear (distress and latency to approach novel or
challenging stimuli). The third dimension, anger/irritability, is seen, along with fear, discomfort,
and sadness to represent part of a general susceptibility to negative affect. These dimensions are
particularly interesting because they are related to differences observed in non-human animals
(Gosling & John, 1999; Panksepp, 1998), and to factor structures extracted from studies of
personality in adults. The fourth dimension, effortful control, will be further discussed in
connection with a neural model for individual differences in alerting, orienting, and executive
attention (Posner & Fan, in press). We begin our more specific discussion with a consideration
of positive affectivity/approach and fear.
NEURAL MODELS
Cloninger (1986, 1987), Gray (1979, 1982), LeDoux (1987, 1989), Panksepp (1982,
1986, 1998), and Zuckerman (1984) have all made contributions to the development of neural
models for temperament (Rothbart, Derryberry, & Posner, 1994). LeDoux identifies emotions as
broadly integrative systems ordering feeling, thought, and action. In his analysis, emotions are
Temp., Atten., & Dev. Psychopathology 10
seen to be the output of information processing networks assessing the meaning or affective
significance of events for the individual (LeDoux, 1989). Whereas object recognition systems
and spatial processing systems address the questions, What is it? and Where is it?,
respectively, neural emotion processing networks give answers to the questions, Is it good for
me? and Is it bad for me?, in turn influencing the organism's behavioral answers to the
questions, What shall I do about it? or simply, What shall I do?
In the neural processing of emotion, thalamic connections route information about object
qualities of a stimulus through sensory pathways, while simultaneously routing information for
evaluative analysis to the limbic system and the amygdala, where memories of the affective
meaning of the stimulus further influence the process (LeDoux, 1989). Later stages of object
processing update the emotional analysis based on early sensory information, but, in the
meantime, back projections from the amygdala influence the subsequent sensory processing of
the stimulus. Output of the amygdala to organized autonomic reactions via the hypothalamus
and to motor activation via the corpus striatum constitutes the motivational aspect of the
emotions.
In this view, emotional processing can be seen as information processing of a special sort.
Attentional neural networks can then act on emotional information similarly to their action on
output of other data processing systems, including those for object recognition, language, and
motor control, each of which in turn has its own underlying neural networks (Posner & Fan, in
press; Posner & Petersen, 1990). Neuroimaging studies demonstrate connections between
emotional processing networks and the anterior attention system, including the anterior
cingulate, that allow attentional influence on the selection of emotional information for
conscious processing, a consequence of which is that we may or may not be aware of our
emotional evaluations (Bush, Luu, & Posner, 2000; Posner & Rothbart, 1992). However, the
attentional controls on emotion may be somewhat limited and difficult to establish. Panksepp
(1998) lays out anatomical reasons why the regulation of emotion may pose a difficult problem
for the child as follows:
One can ask whether the downward cognitive controls or the upward emotional controls
are stronger. If one looks at the question anatomically and neurochemically, the evidence
seems overwhelming. The upward controls are more abundant and
electrophysiologically more insistent: hence one might expect they would prevail if push
came to shove. Of course, with the increasing influence of cortical functions as humans
develop, along with the pressures for social conformity, the influences of the cognitive
forces increase steadily during maturation. We can eventually experience emotions
without sharing them with others. We can easily put on false faces, which can make the
facial analysis of emotions in real-life situations a remarkably troublesome business.
(Panksepp, 1998, p. 319)
Attentional systems can act on and influence conscious aspects of emotional analyses,
and emotion also influences the focusing and shifting of attention (Derryberry & Reed, 1994,
1996; Gray, 1982). An important aspect of social adaptation involves the appropriateness of the
persons social interaction and related acceptance by others (Parker & Asher, 1987). Information
about the state of others is an important contributor to appropriate social action, and failure of
Temp., Atten., & Dev. Psychopathology 11
access of this information to action and consciousness can be a critical element in the
development of disordered functioning (Blair, Jones, Clark, & Smith, 1997). Focusing attention
on threatening stimuli or on the self also may make access to information about others less
accessible. These are important examples of information processing aspects of temperament,
with implications for social development and psychopathology.
We now briefly consider neural models developed to describe a physical substrate for
approach and inhibition. Based on animal research, Gray (1979, 1982) described the Behavioral
Activation System (BAS), involving sensitivity to rewards, and the Behavioral Inhibition System
(BIS), involving sensitivity to punishment, nonreward, novelty, and innate fear stimuli. These
two systems are seen as mutually inhibitory, with their balance determining degrees of
extraversion-introversion. Gray also posited a fight-flight system moderating unconditioned
punishment (Gray, 1971, 1975). According to Grays model of the BAS, reward-related
projections from the amygdala to the nucleus accumbens activate the next step in a motor
program that maximally increases proximity to the desired stimulus. Converging dopaminergic
projections to the accumbens enable the switch to this neuronal set, facilitating goal-oriented
behavior (Gray, 1994; Gray & McNaughton, 1996).
In a broader Behavioral Facilitation System (BFS), Depue and Collins (1999) propose
a circuit involving the nucleus accumbens, ventral pallidum, and dopaminergic neurons that
codes the intensity of the rewarding stimuli, while related circuits involving the medial orbital
cortex, amygdala, and hippocampus integrate the salient incentive context. Individual
differences in the functioning of this network are thought to arise from functional variation in
dopaminergic projections that encode the intensity of the incentive motivation and facilitate
contextual processing across multiple limbic and frontal sites. As development proceeds,
dopaminergic facilitation helps to stabilize synaptic contacts within the medial orbital and limbic
circuits, and thus to enhance responsivity to positive incentive stimuli (Depue & Collins, 1999).
Depue and Iacono (1989) originally posited the BFS to help account for bipolar affective
disorders. The BFS involves the individual's initiation of locomotor activity, incentive-reward
motivation, exploration of environmental novelty (if the stimulus and its context do not induce
opposing fear reactions), and irritable aggression. In Depue and Iaconos model, nucleus
accumbens DA activity appears to modulate the flow of motivational information from the
limbic system to the motor system, and thereby contributes to the process of initiating locomotor
activity, incentive, and goal-directed behavior (1989, p. 470). Panksepp (1982, 1986a, 1998)
also reviewed the literature on DA effects, concluding that the general function of DA activity
in appetitive behavior is to promote the expression of motivational excitement and anticipatory
eagernessthe heightened energization of animals searching for and expecting rewards (1986,
p. 91). Cloninger (1986, 1987) specified a novelty-seeking dimension related to DA functioning,
as did Zuckerman (1984) in his dimension of sensation seeking (see review by Rothbart, 1989b).
In research on infants (Rothbart, 1988; Rothbart, Derryberry, & Hershey, 2000), we have found
expressions of positive affect (smiling and laughter) to be positively related to infants' rapid
latency to approach objects, and to predict anticipatory eagerness about upcoming positive
events when the same children were 7 years old.
In recent fMRI research, Canli et al. (2001) found that the brains activation to positive
and negative pictures varied depending on the subjects temperament or personality. Persons
higher in extraversion showed greater brain response to positive than to negative stimuli in
widespread frontal, temporal, and limbic activation of both hemispheres. Subjects higher in
neuroticism reacted more to the negative than to the positive stimuli, and showed more
circumscribed activation (fronto-temporal on the left side) and deactivation in a right frontal
area. These findings also demonstrated a positive emotional bias for extraverts and a negative
bias for those high in neuroticism.
Factor analyses of infant temperament questionnaires have reliably yielded two distress
factors: one involving distress to novelty, and the other, irritability, including distress to
limitations or frustration (Rothbart & Mauro, 1990). In our recent revision of the Infant
Behavior Questionnaire, we have also found a higher order negative emotionality factor that
includes fear and frustration (Gartstein & Rothbart, 2003). The distress to novelty factor is
linked to an extended latency to approach new objects (Rothbart, 1988), and a combination of
behavioral inhibition and distress proneness to novelty appears to correspond to the introverted
pole of a broader extraversion-introversion dimension.
Emotional networks involving the amygdala also appear to respond more strongly to
novel than to familiar stimuli (Nishijo, Ono, & Nishino, 1988). Lesions of the amygdala in
rodents disrupt autonomic and cortisol reactions, behavioral freezing and fear vocalizations, and
similar findings have been reported in primates (Lawrence & Calder, in press). In humans,
Temp., Atten., & Dev. Psychopathology 13
functional neuroimaging studies by Calder, Lawrence, & Young (2001) and others support
involvement of the amygdala in both acquiring and expressing fear, although not in the voluntary
production of facial expressions of fear (Anderson & Phelps, 2002). The amygdala also is
involved in the recognition of fear in the human face (Calder et al., 2001), and there is evidence
in humans with amygdalar damage of reduced fear experience (Adolphs et al., 1999;
Sprengelmeyer et al., 1999).
Projections from the amygdala implement autonomic and behavioral components of fear,
including startle, motor inhibition, facial expression, and cardiovascular and respiratory change
(Davis, Hitchcock, & Rosen, 1987). Individual variability in the structure and functioning of any
of these subsystems may be related to variations in behavioral expressions of fear, and multiple
components of other affective motivational systems such as approach/positive affect and
anger/irritable distress would also be expected.
The amygdala also appears to affect information processing within the cortex. For
example, the basolateral nucleus of the amygdala projects to frontal and cingulate regions
involved in the executive attention system (Posner & Petersen, 1990), as well as to ventral
occipital and temporal pathways involved in processing object information. These connections
are consistent with findings that anxious individuals show enhanced attention to threatening
sources of information (e.g., Derryberry & Reed, 1994).
relations between extreme right EEG asymmetry and basal and reactive cortisol, replicating
primate findings from Kalin and his colleagues (Kalin, Larson, Shelton, & Davidson, 1998).
Fox, Calkins, and Bell (1994) found that infants with stable right frontal EEG asymmetry
between 9 and 24 months of age displayed more fearfulness and inhibition in the laboratory than
other children. At four years, children who showed more reticence and social withdrawal were
also more likely to show right frontal asymmetry. Calkins, Fox, and Marshall (1996) also
reported that children selected for high motor activity and negative affect to laboratory
stimulation at 4 months showed greater right frontal asymmetry at 9 months, greater mother
reports of fear at 9 months, and more inhibited behavior at 14 months. However, no concurrent
relation was found between behavior and frontal asymmetry at 9 and 14 months, and greater
activation of both right and left frontal areas was related to higher inhibition scores at 14 months.
Calkins et al. (1996) suggest a need to differentiate between fearful and angry distress, as
discussed above in the Structure of Temperament section. They also hypothesize that infant high
motor/high negative affect and high motor/high positive affect may be associated with different
kinds of problems developing later. For high motor/high positive affect, the problems would be
associated with difficulties in control.
Important distinctions have more recently been made among different varieties of
aggression and anger, in relation to their underlying neural systems. Aggression as a self-
defense reaction seems to be based upon the functioning of the same amygdala circuits as
involved in the production of fear (Blanchard & Takahashi, 1988). Aggression linked to
protection of resources, competition, and offensive aggression, on the other hand, involves a
different neural system based on the monoamine Dopamine (DA; Lawrence & Calder, in press).
The DA system has been linked to both the production of offensive aggression (Smeets &
Gonzlez, 2000), and to the recognition of anger in the human face (Lawrence, Calder,
McGowan, & Grasby, 2002). In Lawrence et al.s study, DA blockade impaired the recognition
of anger, while recognition of other emotions and of facial identity was spared.
Depue and Iacono (1989) suggest the dopaminergic system may facilitate irritable
aggression aimed at removing a frustrating obstacle, consistent with findings that DA agonists
(e.g., amphetamine) can enhance aggressive behaviors. Their view suggests links between
approach and frustration/anger, and, in fact, infants and childrens activity level and anger have
been consistently positively related in parent-reported temperament (Rothbart & Derryberry,
2002). Moreover, infant activity level predicts not only positive emotionality at age seven, but
also anger/frustration and low soothability-falling reactivity (Rothbart, Derryberry, et al., 2000).
Temp., Atten., & Dev. Psychopathology 15
Together with findings relating seven-year Surgency to aggression (Rothbart, Derryberry, et al.,
2000), this suggests that strong approach tendencies may be linked to negative as well as positive
emotions (Derryberry & Reed, 1994; Rothbart, Derryberry, et al., 2000). Children who quickly
grasped objects during infancy showed seven-year high levels of positive anticipation and
impulsivity, as well as high anger-frustration and aggression, again suggesting that strong
approach tendencies can contribute to later specific negative emotions as well as to positive
emotionality.
There are several possibilities for neural systems supporting higher order negative
emotion reactions. One is the link between systems supporting fear and self-defensive
aggression (Blanchard & Takahashi, 1988). Defensive aggression in animal models seems to be
based on the same amygdalar circuits as fear, and in humans, anger in response to threat may
also be linked to fear. Negative affect systems are also regulated by more general neurochemical
systems including dopaminergic and serotonergic projections arising from the midbrain, and by
circulating gonadal and corticosteroid hormones (Rothbart, Derryberry, et al., 1994; Zuckerman,
1995). Neurochemical influences may thus also provide coherence of emotional states within an
individual, and support more general factors of temperament such as negative emotionality.
For example, serotonergic projections from the midbrain raphe nuclei appear to moderate
limbic circuits related to anxiety and aggression (Spoont, 1992). Low serotonergic activity may
thus increase an individual's vulnerability to both fear and frustration, contributing to a general
factor of negative affectivity, including depression, and molecular genetics studies related to
serotonin function are therefore of interest in identifying negative affect as a general diathesis.
Lesch et al. (1996), for example, have reported relations between a polymorphism of the
serotonin transporter gene and measures of anxiety, depression, and neuroticism.
Affiliativeness/Agreeableness
We share with other animals, including mammals, birds, and fish, systems of affiliation
that support pair bonds and care of the young (Insel, 2003). Panksepp (1986b) indicates that
affiliative and prosocial behaviors may depend in part on opiate projections from higher limbic
regions (e.g., amygdala, cingulate cortex) to the ventromedial hypothalamus, with brain opiates
promoting social comfort and bonding, and opiate withdrawal promoting irritability and
aggressiveness. Because ventromedial hypothalamic lesions dramatically increase aggression,
Panksepp (1986b) also suggests that this brain region normally inhibits aggressive behaviors
Temp., Atten., & Dev. Psychopathology 16
controlled by the midbrain's central gray area. Hypothalamic projections can allow for friendly,
trusting, and helpful behaviors between members of a species by suppressing aggressive
tendencies. Mechanisms underlying prosocial and aggressive behaviors would in this way be
reciprocally related, in keeping with the bipolar Agreeableness-Hostility dimension found in Five
Factor Models of personality.
Panksepp (1993) has also reviewed research suggesting links between social bonding and
the hypothalamic neuropeptide oxytocin (OXY), involved in maternal behavior, feelings of
social acceptance and social bonding, and reduction of separation distress. OXY is also released
during sexual activity by both females and males. In Cloninger's (1987) theory, Reward
Dependence is a dimension ranging from being emotionally dependent, warmly sympathetic,
sentimental, persistent, and sensitive to social cues to being socially detached, cool, tough-
minded and independently self-willed. He sees Reward Dependence as related to social
motivation; it is thus similar to dimensions of affiliativeness or agreeableness.
Agreeableness, including at the high end, the prosocial emotions and behaviors and
affiliative tendencies, and at the low end, aggression and manipulativeness has been increasingly
studied in childhood (Graziano, 1994; Graziano & Eisenberg, 1997; Graziano & Tobin, 2002).
Like other originally bipolar dimensions, prosocial and antagonistic dispositions have also been
studied separately (Bohart & Stipek, 2001), and Graziano and Eisenberg (1997) suggest that the
two dispositions may be separable, even though they are negatively related. In a related
argument, Shiner and Caspi (2003) point out that antisocial and prosocial behaviors have
different etiologies (Krueger, Hicks, & McGue, 2001). Any temperamental predisposition to
pro-social behavior needs to be seen as an open system, interacting with social experience for its
outcomes. In research linking parent-reported temperament to personality in early and middle
childhood, two forms of extraversion/surgency have been identified; one is linked to prosocial
behavior and the other to antisocial behavior and aggression (Rothbart & Victor, 2004), again
suggesting the importance of socialization to the development of pro- or anti-social behavior.
Attentional Networks
Functional neuroimaging has allowed many cognitive tasks to be analyzed in terms of the
brain areas they activate, and studies of attention have been among the most often examined
(Corbetta & Shulman, 2002; Driver, Eimer, & Macaluso, in press; Posner & Fan, in press).
Imaging data support the presence of three networks related to different aspects of attention.
These networks carry out the functions of alerting, orienting, and executive control (Posner &
Fan, in press). A summary of the anatomy and transmitters involved in the three networks is
shown in Table 1.
Table 1
Brain Areas and Neuromodulators Involved in Attention Networks
The alerting system has been associated with frontal and parietal regions of the right hemisphere.
A particularly effective way to vary alertness has been to use warning signals prior to targets.
The influence of warning signals on alertness is thought to be due to modulation of neural
activity by the neurotransmitter norepinepherine (Marrocco & Davidson, 1998).
Orienting involves aligning attention with a source of sensory signals. This may be overt,
as in eye movements, or may occur covertly, without any movement. Orienting to visual events
has been associated with posterior brain areas, including the superior parietal lobe and temporal
parietal junction and the frontal eye fields (Corbetta & Shulman, 2002). Orienting can be
manipulated by presenting a directional or symbolic cue indicating where in space a person
should attend, thereby directing attention to the cued location (Posner, 1980). Event related
functional magnetic resonance imaging (fMRI) studies have suggested that the superior parietal
lobe is associated with orienting following the presentation of a symbolic cue (Corbetta &
Shulman, 2002). The superior parietal lobe in humans is closely related to the lateral
intraparietal area (LIP) in monkeys, which is known to produce eye movements (Anderson,
1989). When a target occurs at an uncued location and attention has to be disengaged and moved
to a new location, there is activity in the temporal parietal junction (Corbetta & Shulman, 2002).
Lesions of the parietal lobe and superior temporal lobe have been consistently related to
difficulties in orienting (Karnath, Ferber, & Himmelbach, 2001).
The second major temperamental control system over reactive approach and action (the
first is reactive fear) is effortful control, supported by development of the executive attention
network. Executive control of attention is often studied by tasks that involve conflict, such as
various versions of the Stroop task. In the Stroop task, subjects must respond to the color of ink
(e.g., red) while ignoring the color word name (e.g., blue) (Bush et al., 2000). Resolving conflict
in the Stroop task activates midline frontal areas (anterior cingulate) and lateral prefrontal cortex
Temp., Atten., & Dev. Psychopathology 18
(Botwinick, Braver, Barch, Carter, & Cohen, 2001; Fan, Flombaum, McCandliss, Thomas, &
Posner, 2003). There is also evidence for the activation of this network in tasks involving
conflict between a central target and surrounding flankers that may be congruent or incongruent
with the target (Botwinick et al., 2001; Fan, McCandliss, Sommer, Raz, & Posner, 2002).
Experimental tasks may provide a means of fractionating the functional contributions of different
areas within the executive attention network (MacDonald, Cohen, Stenger, & Carter, 2000).
Regulatory functions of attention. The anterior cingulate gyrus, one of the main nodes of
the executive attention network, has been linked to a variety of specific functions in attention
(Posner & Fan, in press), working memory (Duncan et al., 2000), emotion (Bush et al., 2000),
pain (Rainville, Duncan, Price, Carrier, & Bushnell, 1997) and monitoring for conflict
(Botwinick et al., 2001) and for error (Holroyd & Coles, 2002). These functions have been well
documented, but no single rubric seems to explain all of them. In emotion studies, the cingulate
is often seen as part of a network involving orbital frontal and limbic (amygdala) structures. The
frontal areas seem to have an ability to interact with the limbic system (Davidson, Putnam, &
Larson, 2000) that could fit well with the idea that attention subserves self-regulation.
A specific test of a self-regulatory role for the cingulate involves exposure to erotic films,
with the requirement to regulate any resulting arousal. The cingulate activity shown by fMRI
was found to increase in relation to the regulatory instruction (Beauregard, Levesque, &
Bourgoulin, 2001). In a different study, cognitive reappraisal of photographs producing negative
affect showed a positive correlation between the extent of cingulate activity and the amount of
affect to be controlled (Ochsner, Bunge, Gross, & Gabrieli, 2002). Similarly, in a study in which
hypnotism was used to control the perception of pain, cingulate activity reflected the degree of
pain as rated by the subject under hypnotism rather than the physical intensity of the heat
stimulus (Rainville et al., 1997). These results show a role for the anterior cingulate in
regulating limbic activity related to emotion, and provide evidence for its role as a part of a
network involved in regulation, cognition, and affect (Bush et al., 2000).
In experimental paradigms like the Stroop and flanker tasks, conflict is introduced by the
need to respond to one aspect of the stimulus while ignoring another (Bush et al., 2000; Fan et
al., 2003). Cognitive activity that involves this kind of conflict activates the dorsal anterior
cingulate and lateral prefrontal cortex. Large lesions of the anterior cingulate either in adults
(Damasio, 1994) or children (Anderson, Damasio, Tranel, & Damasio, 2000) result in great
difficulty in regulating behavior, particularly in social situations. Smaller lesions may produce
only a temporary inability to deal with conflict in cognitive tasks (Turken & Swick, 1999;
Ochsner et al., 2002).
Early Development
Developmental studies of non-disordered children are also consistent with models such as
Gray and McNaughtons (1996), where an anxiety-related behavioral inhibition system inhibits
an approach-related behavioral activation system. An early appearing inhibitory influence on
temperamental approach is behavioral inhibition or fear control. Fearful inhibition is well
developed by the end of the first year of life, and if a disposition to behavioral inhibition is
strong, positive and negative expressive and approach/avoidance behavior will be moderated
under novel or challenging situations. In non-disordered children, measures of infants'
fearfulness in the laboratory negatively predict mothers' reports of children's impulsivity,
activity, and aggression at age 7. Fearfulness in infancy also positively predicted susceptibility
to guilt and shame, two powerful socializing emotions (Rothbart, Derryberry, et al., 2000;
Rothbart, Ahadi, et al., 1994).
Together with the earlier finding relating seven-year Surgency to aggression (Rothbart,
Derryberry, et al., 1994), this suggests that strong approach tendencies may contribute to
negative as well as positive emotionality (Derryberry & Reed, 1994; Rothbart, Derryberry, et al.,
1994). A more complex pattern emerges with the infants approach behavior. Children who
showed short-latency grasps of objects at 6.5, 10, and 13.5 months showed high levels of
positive anticipation and impulsivity, along with high anger-frustration and aggression at seven
years. This again suggests that strong approach tendencies contribute to later negative as well as
positive emotionality.
From an evolutionary point of view, fearful inhibition can serve to protect the individual
from approaching potentially harmful objects or situations. Nevertheless, the fearful form of
inhibitory control remains a relatively reactive process that can be easily elicited by situational
cues. In the course of development, this system can lead to rigid and over-controlled patterns of
behavior that can limit the individual's positive experiences with the world (Block & Block,
1980; Kremen & Block, 1998).
Later Development
Shiner and her colleagues have recently been studying the continuity of personality from
the period 8-12 years to 20 years (Shiner, Masten, & Tellegen, 2002) and 30 years (Shiner,
Masten, & Roberts, 2003). The middle childhood variables, based on parent and child interviews
and teacher questionnaires, included mastery motivation, academic conscientiousness, surgent
engagement, agreeableness, and self-assurance versus anxious insecurity. Adult measures
employed self- and parent-report questionnaires, including the Multidimensional Personality
Questionnaire (MPQ; Tellegen, 1985), as well as data on academic achievement, rule
compliance, social competence, job competence, and romantic competence.
Shiner, Masten, and Tellegen (2002) suggest on the basis of longitudinal findings that
positive emotionality might be more closely linked to current adaptation, whereas negative
emotionality shows more continuity with earlier adaptation. Below, we note strong links
between negative emotionality and psychopathology, both in childhood and adulthood. Negative
emotionality is also particularly linked to behavior problems when effortful control is low
Temp., Atten., & Dev. Psychopathology 21
(Eisenberg, Fabes, Guthrie, & Reiser, 2000). How might this occur? First, mental processing
related to distress may have involved attempts to decrease distress, possibly including calling up
repeated memories of the negative event. Positive experiences would in most instances be less
problematic and less intense, and unlikely to involve negative affect unless shame or guilt is also
present, and they are likely to have been less rehearsed. Thus, when mental processing has been
tied to difficult and painful situations in the past, one may face not only current problems, but
also representations in memory that bring forward the linked mental habits experienced in
similar situations in the past. Well-practiced associations make negative affect, cognition, and
action links stronger. Thus early failure, e.g., poor achievement in school, may create the
possibility of long term negative affect that extends to a range of achievement situations later in
life. Shiner et al. (2002) also found that adults high on negative emotionality were particularly
upset by daily problems (Suls, Martin, & David, 1998).
Caspi, Harrington, et al. (2003) linked observations of 1000 children at age 3 to their self-
reported personality at age 26 (96% of the original sample). Undercontrolled children (10% of
the sample) had been temperamentally impulsive, restless, distractible, and negativistic at age 3;
Confident children (28%) were friendly, eager, and somewhat impulsive; Inhibited children (8%)
were fearful, reticent, and easily upset; Reserved children (15%) were timid but not extreme in
shyness; Well-adjusted children (40%) appeared to be capable of self control, adequately self-
confident, and did not become upset during testing. At age 26, previously Undercontrolled
children were higher in negative emotionality, more alienated, and subject to stress reactions.
They also tended to follow a traditional morality. Formerly Inhibited and Reserved children
were high in harm avoidance, low in social potency (less vigorous, dynamic, forceful), and low
in achievement. Both previously Undercontrolled and Confident children were low in harm
avoidance. Confident children were high on social potency; whereas Inhibited children were
high in Constraint and low in Positive Emotionality.
Caspi, Harrington, et al.s (2003) findings provide evidence that the temperament of the
child truly provides a core for the developing aspects of personality. Undercontrolled children,
who combined extraversion/surgency, negative affect, and low attentional control at age 3,
showed neurotic and alienated tendencies as adults. Confident extraverted children were
confident and unfearful as adults. The more shy and fearful Inhibited and Reserved children
maintained their caution and harm avoidance and were low in social potency, whereas the more
extreme Inhibited children were also high in Constraint (a mixture of fearfulness and self-
control) and low in Positive Emotionality and social support. The most interesting aspect of the
results, however, go beyond temperament to touch upon alienation, traditional values, and social
support. Additional research on these topics is needed.
In this section, we discuss studies that have linked temperament and attention to the
development of behavior problems and other forms of psychopathology. Two concerns must be
taken into account, however, in reviewing this literature. First, although studies have identified
links between temperament and behavior problems or psychopathology, a clear drawback lies in
Temp., Atten., & Dev. Psychopathology 22
determining the direction of influence. Although temperament extremes may predispose one to
behavior problems, an alternative interpretation is that the child's problems associated with the
disorder lead to extremes in the behavior measured as temperament. For example, punishment
from peers and teachers may lead to increased negative affect in the child. Asendorpfs (1989,
1990) model for the development of shyness follows two developmental routes: one is early
appearing and related directly to temperament (social fearfulness); the other is indirect and
operates through peer rejection and punishment. In the latter case, the childs shyness may have
been not present initially but shaped through social experience. In Asendorpf and van Akens
(1994) longitudinal research, only the latter form of shyness was related to later problems in self-
evaluation.
Another important issue raised by a number of investigators (e.g., Barron & Earls, 1984;
Prior, Sanson, Oberklaid, & Northam, 1987; Sanson, Prior, & Kyrios, 1990; Wertlieb, Wiegel,
Springer, & Feldstein, 1987), is the possible confounding of concepts of temperament and
behavior problems, especially when they are assessed by the same rater (usually the mother).
For example, items assessing temperamental dimensions such as activity, approach/withdrawal,
and adaptability may bear considerable similarity to items assessing behavior problems such as
hyperactivity, anxiety, and oppositional behavior. Bates (1990), on the other hand, argued that if
temperament is seen as contributing to the development of behavior problems, then conceptual
overlap across constructs might be theoretically expected.
Lengua, West, and Sandler (1998) addressed possible contamination of measures by
eliminating overlapping items between temperament and symptom measures; associations were
nevertheless found between negative emotionality and depression, and between impulsivity and
conduct problems in a large sample of children of divorce. In further support of Lengua et al.s
(1998) findings, Lemery, Essex, and Smider (2002) asked experts to categorize both Childrens
Behavior Questionnaire items (CBQ; Rothbart et al., 2001) and behavior problem symptoms
(Preschool Behavior Questionnaire; Behar & Stringfield, 1974) as temperament and/or behavior
problem constructs. Factor analysis of longitudinal multi-informant combined data was also
used. With the latter method, 9% of temperament and 23% of symptom items were confounded.
Removing all confounded items did not affect the extensive relation between the two
measures, including mothers reports of temperament predicting fathers and caregivers reports
of behavior problems, and temperament at 3-4 years predicted later DSM-IV symptoms at age 5
(Lemery et al., 2002). Activity level, attentional focusing, and inhibitory control predicted
ADHD better than internalizing or externalizing, but the general finding was that high negative
emotionality and low effortful control predicted childrens problems. Because the CBQ allowed
further differentiation of the negative affectivity construct, anger was found to predict
externalizing, whereas fear and shyness predicted internalizing problems.
Finally, Sheeber (1995; Sheeber & Johnson, 1994) used a treatment outcome study to
address the overlap issue. In her research, parents were trained in a temperament-focused
approach to parenting. In post-treatment assessment, differences were found for the trained
parents in behavior problem ratings, but not temperament ratings. Childrens behavior was
reported as improved on both internalizing and externalizing measures. Although the
temperament-focused content may have influenced this finding, Sheeber (1995) reviews another
Temp., Atten., & Dev. Psychopathology 23
study with similar findings that used a behavior management program (Webster-Stratton &
Eyberg, 1982).
Clark, Watson, and Mineka (1994), follow Tellegen (1985) in describing Negative
Affectivity (NA) or Neuroticism as a temperamental sensitivity to negative stimuli. Those high
in NA:
. . . experience a broad range of negative moods, including not only fear/anxiety and
sadness/depression but also such emotions as guilt, hostility, and self-dissatisfaction
(Watson & Clark, 1984). A wide range of non-mood variables are related to this
affective core, including negative cognitions (Clark, Beck, & Stewart, 1990), somatic
complaints (Watson & Pennebaker, 1989), negativistic appraisals of self and others (Gara
et al., 1993), diverse personality characteristics such as hardiness, pessimism, and low
self-esteem, and various indices of job, marital and life dissatisfaction (Clark et al., 1994,
p. 104).
Watson, Clark, and Harkness (1994) also identify an affective core to Positive Affectivity
or Extraversion, ranging from joyful, enthusiastic, energetic, friendly, bold, assertive, proud,
and confident to dull, flat, disinterested, and unenthusiastic (p. 106). In their review of the
adult literature, including measures of negativity predating the onset of depression, Watson et al.
(1994) concluded that temperamental negative affect is generally related to the mood disorders
of both depression and anxiety, whereas low positive affect appears to be more specifically
related to depression. In this case, two general temperamental dispositions would be seen as
predispositions to depression; one to anxiety.
mother-child relationship, from the preschool to the middle-childhood periods (Bates & Bayles,
1988; Bates, Bayles, Bennett, Ridge, & Brown, 1991; Bates, Maslin, & Frankel, 1985; Lee &
Bates, 1985). Early negative reactivity to novel situations (unadaptability) predicted less
consistently, but when it did, it predicted internalizing problems more than externalizing
problems. Early resistance to control (perhaps akin to the manageability dimension of Hagekull
(1989), and perhaps at least partly related to the construct of effortful control) predicted
externalizing problems more than internalizing problems. This was also found in predicting
externalizing problems at school in both the BLS and in a separate longitudinal study, the Child
Development Project (CDP; Bates, Pettit, Dodge, & Ridge, 1998).
In a structural modeling analysis of CDP data, dealing with the overlap in externalizing
and internalizing symptoms, Keiley, Lofthouse, Bates, Dodge, and Pettit (2003) separated
mother and teacher reports of behavior problems across ages 5 to 14 years into pure
externalizing, pure internalizing, and covarying factors, and then considered early childhood
predictors of each of these factors. Resistant temperament (unmanageability) predicted the pure
factors of mother- and teacher-rated externalizing problems, but not the pure internalizing
factors. Unadaptable temperament (novelty distress) predicted, in a positively direction, both
mother and teacher pure internalizing factors, and to a lesser degree, and negatively, the pure
mother and teacher externalizing factors. That is, fearful temperament predicted higher levels of
internalizing problems and, less strongly, lower levels of externalizing problems. Although a
disposition to fearfulness would not necessarily constrain the possibilities of aggressive and
uncooperative behaviors, it is intuitively reasonable that children who are fearful and sensitive to
potential punishment would be likely to inhibit externalizing behavior (Bates, Pettit, & Dodge,
1995). And finally, difficult temperament (negative emotionality and demandingness) predicted,
in this multivariate context, none of the pure factors, but only the covarying externalizing plus
internalizing factor for mothers.
These predictions are all consistent with models where temperament extremes either
constitute pathology dimensions or predispose to risk for these conditions. The linkages are of
modest size, but they obtain from early in life, and are not eliminated by the inclusion of family
and parenting characteristics in prediction, so they are not simply artifacts of family functioning.
Also supporting the general pattern, Gilliom and Shaw (2004) found, in a sample of preschool-
age boys from low-income families, that high levels of negative emotionality were associated
with initial levels of both externalizing and internalizing problems, whereas high levels of
fearfulness were associated with high initial levels of internalizing problems and with increases
in internalizing problems over time, and with decreases in externalizing problems over time.
In the Dunedin longitudinal study (Caspi & Silva, 1995), ratings based on the child's
behavior during testing sessions, aggregated from ages 3 and 5 years, predicted ratings of parents
and teachers over ages 9 to 11 and in early adolescence (over ages 13 and 15). A temperament
dimension combining lack of control, irritability, and distractibility, predicted for both genders
externalizing problems more strongly than internalizing problems or positive competencies.
Early approach (positive responses to strangers and new test materials) predicted, inversely,
internalizing problems better than externalizing problems for boys. It did not predict either kind
of problem for girls. Early sluggishness (a factor combining a lack of positive affect, passivity,
and wariness/withdrawal from novelty) predicted later internalizing and externalizing problems
Temp., Atten., & Dev. Psychopathology 25
for girls, but not boys, as well as the relative absence of positive competencies for both girls and
boys. The discovery of differentiated patterns in these studies has been found despite the
tendency for externalizing and internalizing adjustment scores to be correlated with each other.
Caspi and Silva (1995) report somewhat similar patterns of linkage between early temperament
and self-reported personality patterns on Tellegen's Multidimensional Personality Questionnaire,
with undercontrolled children tending as adults to be low on harm/avoidance and high on social
alienation, and inhibited children high on harm/avoidance, low on aggression, and low on social
potency.
Another group of studies considered relations between parent ratings on the Middle
Childhood Temperament Inventory (MCTI; Hegvik, McDevitt, & Carey, 1982) and adjustment.
Wertlieb et al. (1987) found parent ratings of high negative mood were correlated with both
externalizing and internalizing disorders. Scales having to do with manageability (activity, non-
adaptability, and intensity) and self-regulation (non-persistence and non-predictability), on the
other hand, tended to have higher correlations with externalizing than with internalizing. Guerin,
Gottfried, Oliver, and Thomas (1994) found a similar pattern of correlations between parent
temperament reports and teacher adjustment reports at age 10 years, except that negative mood
correlated more strongly with teacher reports of externalizing than internalizing behavior
problems; similar relations were found between age 10 parent temperament ratings and age 11
teacher ratings. Teglasi and MacMahon (1990) also found a similar pattern, with manageability
and self-regulation temperament scales correlating more strongly with externalizing adjustment
scales than with internalizing scales. In addition, their negative reaction to novelty scale was
more closely associated with internalizing than externalizing scales, and mood was moderately to
highly correlated with both kinds of adjustment.
McClowry et al. (1994) found parent rated negative emotional reactivity to be related to
both internalizing and externalizing problems, with low task persistence (self-regulation)
correlated only with externalizing. Their approach scale did not correlate with either
internalizing or externalizing. However, in research by Rothbart, Derryberry, et al. (2000),
infant activity and smiling, related to extraversion, predicted 7-year aggressiveness and
negativism; infant fear predicted lower levels of aggressiveness, and higher levels of fear,
sadness, empathy, guilt, and shame.
Examining the link between temperament and behavior problems in older children (6-
and 9-year-olds), Wertlieb et al. (1987) found high activity, withdrawal, distractibility, and
intensity, and low adaptability, persistence, negative mood, and unpredictability to be
significantly related to higher behavior problem scores. Internalizing behavior scores (reflecting
anxiety, phobias, social withdrawal, etc.) and externalizing behavior scores (reflecting
Temp., Atten., & Dev. Psychopathology 26
Rothbart, Ahadi, et al. (1994) considered relations between parent reports of temperament
on the Children's Behavior Questionnaire (CBQ) and adjustment on a newly developed
questionnaire on social behavior patterns in a group of 6- and 7-year-olds. A second-order factor
composite index of temperamental negative affectivity predicted the full range of social traits,
including aggressiveness, guilt, help-seeking, and negativity. However, components of the
general negative affect factor were associated with the social traits in a more differentiated way:
fear and sadness were more related to traits such as empathy; anger and discomfort were more
related to aggression and help-seeking.
In summary, these findings indicate that fear-related negative affect is particularly related
to internalizing disorders; anger and irritability to externalizing disorders. In addition, although
self regulation is related to both internalizing and externalizing problems, it appears to be more
strongly related to externalizing disorders. Fearful negative affect also appears to predict later
lower externalizing problems, in keeping with its aspects as a control system. Thus, when
negative affect is decomposed, there appear to be greater possibilities for differentiating the
disposition to mood and behavior problems. Effortful control is also an important negative
predictor of later problems. This control may serve both emotional and behavioral regulation. In
the future, the uses of more highly differentiated measures of temperament are likely to lead to a
better understanding of the development of adjustment and psychopathology.
Behavior genetics studies have also examined the generality of negative affect links to
mood disorders, suggesting a general negative affect predisposition to anxiety and depression.
The genetic correlation between anxiety and depression symptoms in adult twins is in the
vicinity of 1.00, indicating shared genetic influence on these two disorders (Kendler, Heath,
Martin, & Eaves, 1987). Pennington (2002) suggests, given this overlap, that more specific
syndromes may be related to environmental events, with threat related to anxiety and loss to
depression (Eley & Stevenson, 2000).
and Rose (1987) found that preschool children with anxiety disorders were reported by their
mothers to be less adaptable, more negative in mood, and more difficult than a nonanxious
control group, and internalizing problems were related to high temperamental withdrawal.
Rosenbaum et al. (1988) studied 2- to 7-year-old children of parents with agoraphobia or panic
disorder. Compared with children of psychiatric controls, the rates of behavioral inhibition were
close to 80% for the children of the agoraphobic or panic disorder parents, and approximately
15% for non-major-depression controls. In a study of adult subjects with major depression, the
co-diagnosis of agoraphobia or panic disorder has been found to be positively related to risk for
psychiatric disorders in their children, especially risk for major depression and separation anxiety
(Weissman, 1989). Weissman concluded that there may be a common underlying process
constituting a vulnerability (diathesis) for both panic disorder and major depression. High
comorbidity of anxiety and depression further suggest that differentiating the two is difficult,
even at the level of clinical diagnosis (Kovacs & Devlin, 1998).
Imaging studies may cast further light on this question. Thomas et al. (2001) carried out
an fMRI study on amygdala functions, comparing a small sample of children with anxiety and
major depression diagnoses in comparison with controls. Differential findings were reported for
anxious and depressed children, with anxious children showing a stronger right amygdala
response to fear faces, and depressed children showed a decreased left amygdala response to all
faces.
Kagan, Snidman, Zentner, and Peterson (1999) have reported that highly reactive infants
at 4 months were likely to be behaviorally inhibited at 4 years, and to exhibit more anxious
symptoms at age 7. Behavioral inhibition in toddlers also predicted general social anxiety at age
13, particularly for girls (Schwartz, Snidman, & Kagan, 1999). Recent genetics contributions to
the fear/phobia literature suggest a continuum of diathesis, from fearfulness to phobias. In a twin
study by Kendler, Myers, Prescott, and Neale (2001), the lifetime history of multiple phobias as
well as irrational fears was assessed. For a sample of males, a common genetic factor was found
for 5 phobia subtypes, as well as genetic factors specific to each subtype, and a common familial
environmental factor. Kendler et al. (2001) also analyzed irrational fears, with findings
consistent with the idea that the irrational fears were a mild manifestation of the same genetic
risk factor that produced clinical phobias. A previous study of women subjects was in agreement
with these findings for men (Kendler, Neal, Kessler, Heath, & Eaves, 1992).
Rubin and Burgess (2001) have reviewed research on links between temperamental
behavioral inhibition, social withdrawal, and maladaption. They distinguish, as did Rubin and
Asendorpf (1993), between children who isolate themselves from the peer group (social
withdrawal) and children who have been rejected by the peer group (social isolation). Their
model posits that inhibited children withdraw from the peer group, thereby failing to develop
social interaction skills, becoming increasingly uncomfortable amongst peers, and finally facing
social isolation from the peer group. This experience in turn, is expected to encourage negative
self-perceptions with respect to social relationships and social competence. Rubin (1993)
identified a group of 11-year-old children above the clinical cutoff on depression inventory
scores. Compared with non-depressed 11-year-olds, the depressed children at age 7 had been
Temp., Atten., & Dev. Psychopathology 28
high on social withdrawal and negative self-perception of social competence. The groups did not
differ on 7-year-old aggression or popularity, suggesting that, contrary to expectation, the
negative self-perception appeared to precede social isolation.
Rubin and Burgess (2001) also suggest that relative right frontal EEG activation in
inhibited children may be related to low left hemisphere-related affective regulation. They note
Eisenberg, Shepard, Fabes, Murphy, and Guthries (1998) findings that early school age
childrens shyness was related to distress, upset and nervousness, and negatively related to
excitement and enthusiasm. Higher levels of negative emotions were also related to avoidant
coping in social problem situations.
Finally, Rubin and Burgess (2001) review research indicating that mothers of anxious
and avoidant children tend to direct, control, and protect their children. They note, however, that
the influence could well be bidirectional, with childrens apparent vulnerability leading to
parental overprotection. It is worthy of note that several studies have now reported that children
whose mothers are more demanding and less protective. For a more complete report of this
work, see Rothbart and Bates (in press).
Lee and Bates (1985), observing mothers' interaction with 2-year-olds at home, in
situations where the mothers were attempting to control their toddlers' "trouble" behavior, found
that more distress-prone ("difficult") children approached trouble more often, tended to resist the
mothers' attempts to control them, and had mothers who were more likely both to use more
aversive discipline and to give in to their children. Lee and Bates indicated that the pattern of
Temp., Atten., & Dev. Psychopathology 29
these early interactions resembles the coercive cycle of behavior described in socially aggressive
boys and their mothers (Patterson, 1977, 1980). Even at early ages, children who present their
mothers with more troublesome, resistant behavior may encourage mothers to use aversive
discipline tactics more frequently or to give in, and these in turn may be the antecedents of a
coercive cycle of parent-child interactions related to problems with aggression (Patterson, 1980).
The energizing effect of punishment on extraverts response in the Nichols and Newman
(1986) study is interesting in this respect. Nichols and Newman asked subjects to view a visual
pattern and match a subsequent pattern against it. Rewards and punishments were
preprogrammed and noncontingent on subject response. On trials following punishment,
introverts responded more slowly, but extraverts responded more quickly. Subjects who were
more slowed by punishment performed better on the go-no go task (Patterson, Kosson, &
Newman, 1987). In a study with young children, Saltz, Campbell, and Skotko (1983) found that,
in support of Luria's (1961) observations, increasing the loudness of a no go command
increased 3- to 4-year-old children's likelihood of performing a prohibited act. They also found
that increasing loudness decreased the likelihood of responding for children 5 to 6 years of age,
indicating developmental change in the development of excitatory and inhibitory control and
their balance during the preschool years. Development of the executive attention system
underlying effortful control may be related to these findings.
function, while lateral prefrontal areas may be more related to executing the inhibitory operation.
In our 7-year-old sample, inhibitory control was predicted by infants' longer latency to approach
toys at 11 and 13 months and by their lower activity level in the laboratory at 13 months
(Rothbart, Derryberry, et al., 2000). At 7 years, inhibitory control was concurrently related to
attentional control and empathy, and negatively to aggression. Inhibitory control was also
moderately positively related to guilt/shame, although uncorrelated with behavioral inhibition as
assessed in shyness.
Eisenberg et al. (2001) compared the temperament of school age children with
externalizing problems to those with internalizing problems and non-disordered children.
Children with externalizing problems showed higher anger, impulsivity, and lower regulation.
Eisenberg et al. (1998) also found, in non-disordered children, that high internalizing negative
emotion at age 4-6 years predicted shyness at ages 6-8 and 8-10, but chiefly for children low in
the ability to control attention shifting. Lack of emotional, behavioral, and attitudinal control in
the preschool period, assessed via negativism, emotional lability, restlessness, and short attention
span, has predicted externalizing behaviors in adolescents (Caspi, Henry, McGee, Moffitt, &
Silva, 1995). In a multiple regression analysis, lack of control and low approach independently
predicted boys anxiety; lack of control and sluggishness were independent predictors for girls.
Here, both lack of control and response to novelty (behavioral inhibition) predicted childrens
later problems with anxiety. Preschool lack of control has also been used to distinguish between
life-course persistent antisocial behavior and antisocial behavior limited primarily to the period
of adolescence (Moffitt, Caspi, Dickson, Silva, & Stanton, 1996). There is also strong evidence
of links between high levels of control and positive or adaptive outcomes (see review by
Eisenberg, Fabes, Guthrie, & Reiser, 2002).
Merikangas, Swendsen, Preisig, and Chazan (1998) studied adults with psychiatric
disorders and their 7- to 17-year-old offspring. Externalizing or substance use disorders were
associated with low attentional control and high activity across the lifespan. Anxiety and
depression were associated with low adaptability and approach/withdrawal, and comorbidity of
externalizing and externalizing disorders was associated with both clusters of temperament
characteristics and with high clinical severity and impairment.
Temp., Atten., & Dev. Psychopathology 31
Interactive effects. Interactive effects of temperament and parenting are also found.
These are reviewed in Rothbart and Bates (in press), where recent contributions to the literature
make this a particularly exciting area of research. For example, in the 1500-subject Australian
Temperament Study, infant difficult temperament had little direct relation with 7-8 year-old
hostile-aggressive problems, but when this temperament occurred in a setting reflecting poor
mother-child relationships, the level of risk for behavior problems substantially increased
(Swanson et al., 2000). Belsky, Hsieh, and Crnic (1998) also found that parenting of male
Temp., Atten., & Dev. Psychopathology 32
infants was more predictive of externalizing behavior problems at 3 years for infants high in
negativity versus those low in negativity.
Stice and Gonzales (1998) found a moderating effect for temperament; maternal control
and support were more strongly related to antisocial behavior among adolescents who were high
on negative affectivity and behavioral undercontrol. Maziade et al. (1990) reported that 7-year
child difficulty in dysfunctional families with lack of parental rule clarity, consistency, and
consensus, predicted later oppositional and attention deficit disorders at 12 and 16 years. Few
children with difficult temperament and a well-functioning family developed behavior disorders,
and few of the very easy children at 7 showed problems at 12, regardless of family functioning.
Lengua, Wolchik, Sandler, and West (2000) found that both temperament (high positive
emotionality, low negative emotionality, and impulsivity) and parenting (low rejection and
inconsistent parenting) independently predicted successful adjustment after parental divorce.
Interactive effects were found for dysfunction. Rejection was most strongly associated with
behavior problems in children low in positive affect and inconsistency with problems for highly
impulsive children. Belsky et al. (1998) found that parenting of male infants was more
predictive of externalizing behavior problems at age 3 years for infants high in negativity. Shaw
et al. (1998) regressed out main effects in predicting 24-month externalizing and found a
remaining Sex x Temperament x Parenting interaction. For boys, noncompliant temperament
and mother rejection exerted independent effects on externalizing. For girls, noncompliant
temperament predicted later behavior problems only when combined with mother rejection.
In a setting where negativity was not measured, Bates et al. (1998) found that 13 and 24
month resistance to control interacted with mothers restrictive control at 6, 13 and 24 months, to
predict externalizing in middle childhood. For mothers who were low in control, correlations
were found between earlier temperament and externalizing; when mothers were high in
restrictive control, there was a low correlation between these measures. Bates et al. (1998)
carried out a conceptual replication of this finding in a second study and suggested that
resistance to control may reflect strong approach, weak fear, and/or low effortful control.
Parental control may be more likely to lead to coercive cycles of interaction when the child is
also highly negative, but when control is the main issue, children may benefit from mothers
intervention.
Overall, these findings suggest that there are particular temperamental vulnerabilities that
may make some children more susceptible to negative environments than others. In a recent
study, Caspi et al. (2002) have added an exciting molecular genetics contribution to this
literature, looking specifically at the relation between child maltreatment and the childs
possession of the MAOA gene, which has been related to the development of aggressivity in
monkeys. Maltreatment was assessed between the ages of 3 and 11 years and antisocial
outcomes were predicted for male teenagers and adults. A significant gene by environment
interaction was found, indicating that the effect of maltreatment was stronger in males with low
MAOA activity.
This finding will require replication, but a link has also been reported between the same
gene (MAOA) and the ability of normal subjects to regulate conflict in the Attention Network
Temp., Atten., & Dev. Psychopathology 33
Test (Fossella, Posner, Fan, & Swanson, 2002). When people with two different alleles of the
MAOA gene were studied in fMRI (Fan, Fossella, Sommer, Wu, & Posner, 2003), a difference
was observed in the amount of activity in the anterior cingulate, which is an important node in
the executive attention network (Fan et al., 2002). MAOA is also linked to the regulation of NE,
DA and 5-HT and thus appears to provide protection for antisocial outcomes given stressful early
experience. The authors argue that studying other genotypes associated with stress responses
may promote an understanding of, how stressful experiences are converted into antisocial
behavior toward others in some, but not all, victims of maltreatment (p. 853).
In summary, evidence has increasingly been found for interactions between child
temperament and caregiver treatment in psychopathology outcomes. In addition, studies
continue to find additive contributions to temperament and caregiver treatment in child
outcomes. The coercion model suggests that child characteristics can influence parental
reactions, leading to increased risk of externalizing psychopathology.
Gender Influences
With the exception of activity level (Eaton, 1994), sex differences are rarely found in
early assessments of temperament (Rothbart, 1986), but behavior problems develop
disproportionately in boys. Girls are also at greater risk than boys for depression (Zahn-Waxler,
Cole, & Barrett, 1991), and antisocial behavior is generally found at higher rates for males than
for females (Eagly & Steffen, 1986). Research results currently describe interplay among
temperament, social experience, and gender in the development of depressive mood; two recent
studies suggest that antecedents for depressive mood may be somewhat gender-specific (Block,
Gjerde, & Block, 1991; Patterson & Capaldi, 1990).
Measuring depressive mood at age 18, with self-reported anxiety partialed out, Block et
al. (1991) found that girls' depressive mood was predicted from intropunitive, oversocialized,
and overcontrolling behavior at age 7 and from higher preschool IQ. Boys' depressive mood, on
the other hand, was predicted from higher aggressive, self-aggrandizing, and undercontrolled
behavior at age 7, and from lower preschool IQ. Variables assessing undercontrol for males and
overcontrol for females were also found to be concurrently related to depressive mood at age 18
for this sample (Gjerde, Block, & Block, 1988). Block et al. (1991) noted that their findings
were congruent with findings of a positive relationship between conduct disorder and depression
for male but not for female clinically depressed preadolescents (Edelbrock & Achenbach, 1980;
Puig-Antich, 1982).
Patterson and Capaldi (1990) provided further information on this point, in research with
two samples of 4th-grade boys. Their research results supported a model in which peer rejection
is a central mediating influence on depressed mood. In this model, for at least some boys,
undercontrolled behavior is seen to lead to peer rejection, which in turn is related to development
of depressive mood. For girls, on the other hand, Zahn-Waxler et al. (1991) offered a
developmental model for depression, highlighting vulnerability to depression in highly socialized
girls. Once again, gender may be a moderating variable in the relation between temperament and
the development of depressive mood.
Temp., Atten., & Dev. Psychopathology 34
In a further analysis of gender and psychopathology, Maziade, Cote, Bernier, Boutin, and
Thivierge (1989) suggested that boys difficult temperament is more stable than girls', and that
girls are prone to become less difficult over time even when there is stress in the family. In
addition, Earls and Jung (1987) reported that marital discord and maternal depression are related
to behavior problems in boys but not in girls. They speculated that boys may be under different
socialization pressures than girls, especially when the mother is under stress, although the
direction of effects might also be reversed, with boys' greater externalizing problems creating
higher levels of stress for the mother and for her relationship with the father.
The reader will now have noted the important links between failures of self-regulation
and developmental disorders. In the final section of our review, we consider what we have
learned about attention systems in relation to the development of psychopathology.
The ability of attention to regulate distress can be traced to early infancy (Harman,
Rothbart, & Posner, 1997). In infants as young as three months, we have found that orienting to
a visual stimulus provided by the experimenter produces powerful if only temporary soothing of
distress. One of the major accomplishments of the first few years is for infants to develop the
means to achieve this regulation on their own. These events have been reviewed in Rothbart and
Rueda (in press) and Rothbart, Posner, and Kieras (in press).
A sign of the control of cognitive conflict is found late in the first year of life (Diamond,
1991). For example, in A-not-B tasks, children are trained to reach for a hidden object at
location A, and then tested on their ability to search for the hidden object at a new location B.
Children younger than 12 months of age tend to look in the previous location A, even though
they see the object disappear behind location B. After the first year, children develop the ability
to inhibit the prepotent response toward the trained location A, and successfully reach for the
new location B. During this period, infants develop the ability to resolve conflict between line of
sight and line of reach when retrieving an object. At nine months of age, line of sight dominates
completely. If the open side of a box is not in line with the side in view, infants will withdraw
their hand and reach directly along the line of sight, striking the closed side (Diamond, 1991). In
contrast, 12-month-old infants can simultaneously look at a closed side while reaching through
the open end to retrieve a toy.
The ability to use context to reduce conflict can be traced developmentally using the
learning of sequences of locations. Infants as young as 4 months can learn to anticipate the
location of a stimulus, provided the association in the sequence are unambiguous (Haith, Hazan,
& Goodman, 1988). In unambiguous sequences, each location is invariably associated with
another location (e.g., 123) (Clohessy, Posner, & Rothbart, 2001). Because the location of the
current target is fully determined by the preceding item, one type of information needs to be
attended, and there is therefore no conflict (e.g., location 3 always follows location 2). Adults
can learn unambiguous sequences of spatial locations implicitly even when attention is distracted
by a secondary task (Curran & Keele, 1993).
Temp., Atten., & Dev. Psychopathology 35
Ambiguous sequences (e.g., 1213) require attention to the current association in addition
to the context in which the association occurs (e.g., location 1 may be followed by location 2, or
by location 3). Ambiguous sequences pose conflict because for any association, there exists two
strong candidates that can only be disambiguated by context. When distracted, adults are unable
to learn ambiguous sequences of length six (e.g., 123213) (Curran & Keele, 1993), a finding that
demonstrates the need for higher-level attentional resources to resolve this conflict. In young
children, even simple ambiguous associations (e.g., 1213) were not performed at above chance
level until about two years of age (Clohessy et al., 2001).
Developmental changes in executive attention were found during the third year of life
using a conflict key-pressing task (Gerardi-Caulton, 2000). Because children of this age do not
read, location and identity, rather than meaning and ink color, served as the dimensions of
conflict (spatial conflict). Children sat in front of two response keys, one located to the childs
left and one to the right. Each key displayed a picture, and on every trial a picture identical to
one member of the pair appeared on either the left or right side of the screen. Children were
rewarded for responding to the identity of the stimulus regardless of its spatial compatibility with
the matching response key (Gerardi-Caulton, 2000). Reduced accuracy and slowed reaction
times for spatially incompatible relative to spatially compatible trials reflect the effort required to
resist the prepotent response and resolve conflict between these two competing dimensions.
Performance on this task produces a clear interference effect in adults and activates the anterior
cingulate (Fan, Flombaum, et al., 2003). Children 24 months of age tended to perseverate on a
single response, while 36-month-old children performed at high accuracy levels, but like adults
responded more slowly and with reduced accuracy to incompatible trials.
At 30 months, when toddlers were first able to successfully perform the spatial conflict
task, we found that performance on this task was significantly correlated with their ability to
learn the ambiguous associations in the sequence learning task described above (Rothbart, Ellis,
Rueda, & Posner, in press). This finding, together with the failure of 4-month-olds to learn
ambiguous sequences, holds out the promise of being able to trace the emergence of executive
attention during the first months and years of life.
The importance of being able to study the emergence of executive attention is enhanced
because cognitive measures of conflict resolution in these laboratory tasks have been linked to
aspects of children's temperament. Signs of the development of executive attention by cognitive
tasks relate to a temperament individual differences measure obtained from caregiver reports
called effortful control. Children relatively less affected by spatial conflict received higher
parental ratings of temperamental effortful control and higher scores on laboratory measures of
inhibitory control (Gerardi-Caulton, 2000). We regard effortful control as reflecting the
efficiency with which the executive attention network operates in naturalistic settings.
The Attention Network Test (ANT) examines the efficiency of the three brain networks
we have discussed above (Fan et al., 2002). The ANT procedure uses differences in reaction
times (RT) between conditions to measure the efficiency of each network. The procedure for the
ANT is illustrated in Figure 1. Subtracting RTs obtained in the double-cue condition from RT in
Temp., Atten., & Dev. Psychopathology 36
Figure 1. The figure illustrates the Attention Network Test (ANT). Each trial begins with one of
the four cues shown in a. The three targets are shown in b. The time course of each trial is
shown in c. At the bottom, are the subtractions that provide the measurement of the efficiency
of each network (After Fan et al., 2002).
the no-cue condition gives a measure of alerting due to a warning signal. Subtracting RTs to
targets at the cued location (spatial cue) from trials using a central cue gives a measure of
orienting. Subtracting RTs for congruent from incongruent target trials provides a measure of
conflict and marks the executive attention network.
The ANT has some useful properties as a measure of attentional efficiency. It does not
use language stimuli, so it can be used with children, speakers of any language, and patients
unable to read or special populations. In about 20 minutes, the test provides a measure of the
efficiency of the alerting, orienting, and conflict networks with reasonable reliability, in addition
to overall RT and error rates. Measuring the three networks scores in the same test also allows
assessment of possible patterns of interactions between them. We do not exclude the possibility
that certain psychopathologies or brain-injured patients would have a dysfunction in the way the
attentional networks interact.
Temp., Atten., & Dev. Psychopathology 37
In a sample of 40 normal persons, network scores were reliable over two successive
presentations. In addition, no correlation was found among the three network scores. An
analysis of RTs in this task showed large main effects for cueing and for the type of target, but
only two small but significant interactions (Fan et al., 2002). They both involved very small
reductions in conflict when either no warning cue is provided or when the cue is at the location
of the target. The latter interaction is to be expected because the effective eccentricity of
flankers is increased when attention is on the central arrow. The first finding appears to arise
because with no warning the subject is generally slow and some conflict resolution may occur
during the longer overall RT. This effect also appears to be responsible for a small but
significant negative correlation between alerting and conflict (r = -.18), found in a larger sample
of more than 200 people who had taken the ANT (Fossella et al., 2002).
Recently, ANT scores have been used as a phenotype to assay the heritability of each of the
attentional functions with a sample of 26 pairs of MZ and DZ twins (Fan, Wu, Fossella, &
Posner, 2001). In accordance with their neuroanatomical and behavioral independence, the three
attentional networks showed different heritability indexes. Despite the small scale of the study,
the executive network scores showed a significant correlation (r = .73) between MZ twins. This
correlation was also significant, although weaker, for the alerting scores (r = .46), while the
orienting network showed no evidence of heritability.
A child version of the ANT task has also been developed that is appropriate for children
from about four years of age. In previous work we found that children work best when there is a
story and when there is clear feedback on their performance (Berger, Jones, Rothbart, & Posner,
2000). In the child version of the ANT, five colorful fish replaced the arrows that typically
appear in the flanker task. Children are invited to help the experimenter feed the middle fish by
pressing a button corresponding to the direction in which it is swimming. Visual feedback (the
middle fish smiles and bubbles come out of its mouth) and auditory feedback (a woohoo
sound) is provided when the response has been successful. In each trial, the flanker fish are
swimming in the same (congruent) or opposite (incongruent) direction as the center fish.
Using the child ANT, the developmental course of the attentional networks has been
studied (Fan, Rueda, et al., 2003; Rueda, Posner, & Rothbart, 2004). As in the adult data, the
child study also revealed independence among the three networks scores. Despite a common
decline in RT, each network also showed a different developmental course. Significant
improvement in conflict resolution was found up until age seven as compared to younger
children, but a remarkable stability in both RT and accuracy conflict scores from the age seven to
adulthood. Alerting scores showed some improvement in late childhood and continued
development between ten year olds and adults. Finally, the orienting score was similar to adult
levels at the age of six. The normal development of these networks may be important in
understanding issues related to developmental pathologies such as those in autism, ADHD and
anxiety and depression.
empty classification. This situation has been changed with the systematic application of our
understanding of attentional networks to pathological issues. Viewing attention in terms of
underlying neural networks provides a means of classifying disorders that differs from the usual
internalizing versus externalizing classification that we have applied earlier in the paper. A
number of abnormalities involving attention, including Alzheimers dementia, anxiety, attention
deficit hyperactivity disorder (ADHD), autism, borderline personality disorder, depression and
schizophrenia have been studied either with the Attention Network Task (ANT; Fan et al., 2002),
that measures the efficiency of all three networks (See Figure 1), or parts of the task that measure
one or two of the networks.
Alerting
The alerting network is obtained in the ANT by subtracting the RT following a warning
of when a target will occur, from RTs when participants do not receive any warning signal.
Alerting shows the longest period of development of any of the networks, not reaching adult
levels even by age 10 (Rueda, Fan, et al., 2004). Young participants have larger alerting scores
than adults because they have abnormally long RTs without a warning signal. These effects are
reduced with age. One effect of a warning signal is to improve the alert state, but there may be
other influences as well. For example, children may rehearse the task after the warning signal,
and this may allow them to respond more quickly, and they may be caught somewhat unaware
when a target occurs without warning. Since the ANT task is so simple, adults dont seem to
need to rehearse it once it has been practiced.
It is also known that patients with anterior and posterior right hemisphere damage have
problems when tasks are given without warning (Posner, Inhoff, Friedrich, & Cohen 1987;
Robertson, Mattingley, Rorden, & Driver, 1998). This arises because patients, like young
children, have very long RTs in the absence of warning. Robertson has argued that the inability
to maintain the alert state without a warning signal is a major contributor to the reduced attention
to the side of space opposite the lesion found more strongly in patients with right than with left
posterior lesions.
A study using the ANT has shown that normal elderly persons also show dramatically
larger alerting effects than young adults, resembling what is found with children (Fernandez-
Duque & Black, 2004). The study also found that normally developing older adults and
Alzheimers patients showed the same elevated alerting scores, but only the Alzheimers patients
showed increased difficulty in resolving conflict (see also the discussion of executive attention
below).
ADHD. Studies of ADHD have linked the disorder to aspects of both attention and
sensation seeking, a component of extraversion/surgency (Swanson et al., 2001). Many theories
of ADHD have also suggested a deficit in executive functions (Barkley, 1997). However, in
early work using a spatial orienting task, the most compelling deficit appeared to be a difficulty
in maintaining the alert state in the absence of a warning signal (Swanson et al., 1991). This
difficulty might arise from right hemisphere damage, which has also been reported to be a
feature in many studies of ADHD.
Temp., Atten., & Dev. Psychopathology 39
More recent studies using the ANT have replicated problems with alerting in ADHD,
again mostly due to the inability to maintain the alert state when no warning signal was used
(Beane & Marrocco, 2004; Booth, Carlson, & Tucker, 2001). In one of these studies (Booth et
al., 2001), the ANT was used to discriminate the inattentive subtype from normal children and
the combined subtype. The alerting network best distinguished the different forms of ADHD,
with inattentive children showing less ability to maintain the alert state in the absence of warning
signals. Neuroimaging studies of ADHD children have generally shown right frontal, cingulate,
and basal ganglia deficits (Casey et al., 1997). Since right frontal areas have been related both to
problems with the alert state and with inhibitory control, there could be links between the ANT
results and these imaging studies, but this research has not yet been done.
Casey and colleagues (2001) used three different tasks that rely upon different processes
(stimulus selection, response selection, and response execution) to analyze executive functions in
different types of developmental disorders (Schizophrenia, Sydenham's Chorea, Tourettes
Syndrome, and ADHD). They suggest that each of the cognitive operations is implemented in a
particular basal ganglia-thalamo-cortical circuit. Stimulus processing seems to be related to
connections between basal ganglia, thalamus and the dorso-lateral prefrontal cortex, whereas
response processing is associated with connections of subcortical structures to the lateral orbital
frontal cortex. Schizophrenic patients exhibited deficits in stimulus election, Sydenham's chorea
in response selection, Tourette's syndrome children in response execution, and ADHD children
in both stimulus selection and response execution, suggesting that specific cognitive operations
related to executive attention can be independently damaged.
For a number of years it has been thought that ADHD related to problems with dopamine
and other catecholamine function (Wender, 1971). In molecular genetics research, the dopamine
theory found support in replicated findings that one allele (the 7-repeat) of the dopamine 4
receptor gene is over-represented in children with ADHD and also is associated with a
temperament featuring high sensation seeking (see Swanson et al., 2001, for a recent summary).
Sensation seeking is a lower order construct of extraversion. This finding has been well
replicated for the syndrome of ADHD, but the allele has not been associated with a cognitive
deficit in executive function in a study of children with and without the 7-repeat allele (Swanson
et al., 2000). The 7-repeat was associated with ADHD, but showed it was not with the cognitive
deficit that usually accompanies ADHD (Swanson et al., 2000). This finding led to the
suggestion that there may be two routes to ADHD. One would involve a temperamental extreme
of sensation seeking (or extraversion), the frequency of which might be increased by the
presence of the repeat version of the Dopamine 4 receptor gene. This route need not involve a
cognitive deficit. A second route to ADHD would involve cognitive deficits that might be either
genetic, or due to early brain injury or other experiential factors.
Orienting
Anxiety and depression. There is much new information on the role of attention in
anxiety, depression, and mood disorders. In a series of studies, sub-clinical college students with
high scores on trait anxiety were cued to attend to a location by a positive, negative, or neutral
face. Trials on which the cue to the location was negative and invalid produced longer reaction
times for the trait anxiety subjects (Fox, Ricardo, & Dutton, 2002; Fox, Russo, Bowles, &
Temp., Atten., & Dev. Psychopathology 40
Dutton, 2001). These results replicate and extend previous studies by Derryberry and Reed
(1994), and together suggest that trait anxiety influences the ability to disengage, particularly
from threat stimuli. Derryberry & Reed (1994) suggest that this finding may be dependent upon
relatively low levels of effortful control. Subjects high in effortful control but suffering from
depression did not have difficulty disengaging from negative affect.
Children who have had a history of abuse have also been found to be hypersensitive to
the recognition of angry faces, misclassifying objectively neutral faces as angry (Pollak &
Kistler, 2002). Together these findings suggest that both temperament and experience can
influence aspects of attention toward threat stimuli, perhaps by both enlarging the boundary of
the classification and increasing the time to dwell on these stimuli. Because orienting to cues
and targets can be studied in children from birth onward (Pollak & Kistler, 2002) it would be
possible to use these findings to obtain more information on the effect of anxiety on normal
development, and to determine the degree to which it predicts later problems, given stressful
experience.
Brain systems related to unipolar depression have been explored in a number of imaging
studies (Drevets & Raichle, 1998; Liotti, Maybert, McGinnis, Brannan, & Jerabeck, 2003).
These studies have generally shown the importance of midline frontal areas, including the
anterior cingulate and orbital prefrontal cortex. In normal persons these areas are related to the
experience and control of emotion (Bush et al., 2000), behavior and cognition (Drevets, 2000),
and self image (Gusnard et al., 2003). The areas appear to function abnormally in depressed
persons exposed to material producing a sad mood, whether or not they were currently
depressed. The overlap between brain activities in currently depressed people with those who
have suffered from depression in the past may explain the frequent occurrence of multiple
depressive bouts.
Autism. Autism is a disorder that has been linked to the orienting system (Akshoomoff,
Pierce, & Courchesne, 2002; Landry & Bryson, in press; Rodier, 2002). It is well known that
autistic persons do not normally orient to faces. However, Landry & Bryson report artistic
difficulty in orienting in tasks that involve non-social stimuli similar to those used in the ANT.
Similar deficits in the ability to disengage and move attention have been reported in autism in
relation to abnormal development of the cerebellum (Akshoomoff et al., 2002). We do not know
if this abnormality is due only to cerebellar deficits, since many of the patients also show parietal
Temp., Atten., & Dev. Psychopathology 41
abnormalities as well. Rodier (2002) has some evidence that the orienting abnormalities found
in autism might relate to a gene associated with migration of cells in early development.
Executive Function
The deficit in orienting rightward has been replicated in first break schizophrenics, but it
does not seem to be true later in the disorder (Maruff, Currie, Hay, McArthur-Jackson, &
Malone, 1995), nor does the pattern appear to be part of the genetic predisposition for
schizophrenia (Pardo et al., 2000). First break schizophrenic subjects often have been shown to
have left hemisphere deficits, and there have been many reports of anterior cingulate and basal
ganglia deficits in patients with schizophrenia (Benes, 1999). The anterior cingulate may be part
of a much larger network of frontal and temporal structures that operate abnormally in
schizophrenia (Benes, 1999).
A recent study using the ANT casts some light on these results (Wang et al., 2004). In
this case, the schizophrenic patients were chronic and they were compared with a similarly aged
control group. The schizophrenic patients had a much greater difficulty resolving conflict than
Temp., Atten., & Dev. Psychopathology 42
did the normal controls. The deficit in patients was also much larger than that found for
borderline personality patients. There was still a great deal of overlap between the patients and
normal subjects, however, indicating that the deficit is not suitable for making a differential
diagnosis. The data showed a much smaller orienting deficit of the type that had been reported
previously. These findings suggest there is a strong executive deficit in chronic schizophrenia,
as would be anticipated by the Benes (1999) theory. It remains to be determined whether this
deficit exists prior to the initial symptoms, or whether it develops with the disorder.
Chromosome 22q11.2 deletion syndrome. This syndrome is a complex one that involves
a number of abnormalities, including facial and heart structure, but also a mental retardation to
deletion of a number of genes. Children with the deletion are at a high risk for developing of
schizophrenia. Among the genes deleted in this syndrome is the COMT gene, which has been
associated with a performance in a conflict task (Diamond, Briand, Fosella & Gehlbach, 2004)
and with schizophrenia (Egan et al., 2003). In light of these findings, it was to be expected that
the disorder would produce a large executive deficit (Simon et al., in press; Sobin, et al., in
press). Sobin has found in a further paper that the deficit in resolving conflict is associated the
ability to inhibit a blink following a cue that a loud noise would be presented shortly (pre-pulse
inhibition). The authors suggest that the association of the high level attention and pre-pulse
inhibition deficit suggests a pathway that includes both the basal ganglia and the anterior
cingulate.
Summary
In this chapter, we have described recent findings on the structure and development of
temperament, and related temperament and attention to the development of psychopathology.
We have noted that temperament involves a number of interacting systems, each of which
follows its own course of development. We have identified two major control systems of
temperament, reactive fearfulness, and self-regulatory effortful control, with the latter based on
the development of executive of executive attention that serves to moderate or break the
approach and incentive-related systems, and allow activation of lower probability responses.
attentional shirting, and attentional focusing. These three higher order general dimensions of
temperament are related to 3 of the "Big 5" factors, as well as the Big 3 factors in adult
personality.
The ability of temperamental differences to predict disorders has been impressive, but it
is not yet possible to determine the direction of these effects. Increased understanding of the
brain networks and genetic mechanisms related to temperamental dimensions could improve this
picture, and allow us to understand which aspects of temperament predictions of disorders are
causative. A large number of disorders have now been shown to produce different specific
effects on attention networks. Although these effects might not be reliable enough to be used as
differential diagnosis, they do provide clues as to the anatomy impaired by the disorder, and in
the future may guide more specific therapeutic strategies.
When we wrote this chapter for the first edition of the Handbook, we speculated on
possible relations between temperament and psychopathology, and on brain systems related to
reactivity and self-regulation. Evidence for these connections has vastly improved in the eight
intervening years. We expect by the time the handbook is modified again, these trends will be
even more developed, and hope that they will lead to both better understanding and more certain
improvements in treatment.
Temp., Atten., & Dev. Psychopathology 44
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