Mental Health: Temperament - Understanding the Child’s Wiring

While some babies arrive in the world seemingly content with almost anything, others protest diaper changes, cling tightly to caregivers or react intensely to minor frustrations. These differences often emerge within the first months of life and reflect one of the most important, yet underappreciated, concepts in child development – temperament.

Temperament refers to the biologically based differences in emotional reactivity, activity level, attention and self-regulation that emerge early in life and remain moderately stable over time.^1-3 When discussing temperament with families, I often describe it as the genetic component of our personality. These early traits serve as the foundation for adult personality and influence mental health throughout the lifespan.^4,5

Two major models of temperament dominate the field:

Model 1: Chess and Thomas classified children as “easy,” “difficult,” or “slow to warm up” based on nine temperamental dimensions.⁶

Model 2: Rothbart’s psychobiological model focuses on three broad factors^1,2:

• Negative Affectivity: tendency toward fear, anxiety, frustration, sadness and emotional distress.
• Surgency: tendency toward high activity, sociability, positive emotions and reward-seeking behaviors.
• Effortful Control: ability to regulate emotions, inhibit impulses and maintain attention.

These dimensions closely resemble adult personality traits and help explain why some children are naturally more cautious, intense, outgoing or impulsive than others.^5,7

Most importantly, temperament is not destiny. It simply represents a child’s starting point.^8,9 

Shy or Anxious Temperaments:

One of the best-studied temperamental styles is behavioral inhibition, which affects approximately 15% of children.^10,11 These children tend to be cautious around new people, unfamiliar environments and novel experiences. Parents often describe them as having been “shy from birth” or “worriers since toddlerhood.”

Behavioral inhibition is one of the strongest known early risk factors for anxiety disorders. Children with this temperament have a four- to seven-fold increased risk of developing social anxiety later in life.^10,11 However, approximately 60% never develop a psychiatric disorder.^10,12,13 This discrepancy is related to temperament’s interactions with parenting, life experiences, coping skills and cognitive development. A cautious child is not doomed to become an anxious adult. In fact, many grow into thoughtful, conscientious and highly successful individuals. The goal is not to eliminate their caution, but to help them build confidence while working with the nervous system they were given.

The Hyper and Intense Child:

Other children seem to be in constant motion from infancy. They are highly active, impulsive, emotionally intense and difficult to redirect.

It is important to remember that these traits are common in toddlerhood and are not inherently pathological. However, studies have found that elevated activity levels, high negative affectivity, and difficulty sustaining attention in infancy and toddlerhood are associated with an increased risk of attention-deficit/hyperactivity disorder and disruptive behavior disorder later in life.^8,14

The same traits that create challenges early in life may also come with strengths. These children are often enthusiastic, energetic, creative, socially engaging and resilient. As with anxious children, the objective is not to change who they are, but to help them develop the skills needed to channel those traits effectively.

Temperament Across the Lifespan:

One of the most fascinating findings from developmental psychology is how strongly temperament predicts adult personality.

Longitudinal studies have shown that early negative affect is associated with later neuroticism, while effortful control predicts conscientiousness and broader personality maturity.⁵ A 30-year prospective study found that infant behavioral inhibition predicted adult personality characteristics, social functioning and internalizing symptoms decades later.¹⁵

More recent research has identified distinct temperament trajectories that persist into adulthood. Individuals with chronically elevated negative emotionality show higher rates of depression and other internalizing disorders, while those with poor self-regulation are more likely to develop externalizing problems.¹⁶ Difficult temperament in toddlerhood has also been associated with increased depressive symptoms and lower well-being in early adulthood.¹⁷

Clinical Pearls for Pediatricians:

• Normalize temperament differences: Children are born with different emotional operating systems.^1-3
• Reduce blame: Temperament reflects biologically based individual differences and is not simply the result of parenting practices.^1-3
• Look for strengths: The cautious child may become thoughtful and prepared. The highly active child may become energetic and innovative.^5,15
• Focus on skill-building: Effortful control and proactive cognitive control are modifiable factors that may reduce later psychiatric risk.^8,13
• Promote a thriving environment: The goal is not to change a child’s temperament, but to help families create environments in which that temperament can flourish.^18,19

The most important message to emphasize to parents is:  

Your child isn’t choosing to be anxious, irritable or intense. Their nervous system is simply built differently. We must adapt our approach to their temperament style to help them thrive.

Temperament influences risk, but it does not determine destiny. With supportive caregivers, realistic expectations and opportunities to develop coping skills, children of every temperament style can thrive. 

References:

1. Clark DA, Durbin CE, Donnellan MB, Neppl TK. Internalizing symptoms and personality traits color parental reports of child temperament. J Pers. 2017;85(6):852-866. doi:10.1111/jopy.12293
2. Underwood JJ, Gonzalez MAR, Distler KL, Muhlestein CS, Gartstein MA. Examining a common method of measuring infant fear: considering temperament, neurophysiology, age, and sex differences. Dev Psychobiol. 2025;67(6):e70094. doi:10.1002/dev.70094
3. Leri J, Liu J, Kelly M, Kertes DA. A preliminary investigation of epigenome‐wide DNA methylation and temperament during infancy. Dev Psychobiol. 2024;66(3):e22475. doi:10.1002/dev.22475
4. Katz BA, Shields AN, Watts AL, Wu C, Tackett JL. Temperament, personality, and psychopathology in youth: a preregistered multilevel meta-analytic review and preregistered large-scale replication and extension. Psychol Bull. 2026;152(2):127-156. doi:10.1037/bul0000515
5. Ringwald WR, Lawson KM, Kaurin A, Robins RW. Linking temperament and personality traits from late childhood to adulthood by examining continuity, stability, and change. J Pers Soc Psychol. 2026;130(5):1047-1061. doi:10.1037/pspp0000576
6. McCorkle G, Andres A, Sims CR, et al. Exploring the relationship between child temperament, maternal psychiatric symptoms, family environment and infant feeding. Matern Child Nutr. 2025;21(1):e13728. doi:10.1111/mcn.13728
7. Strickhouser JE, Sutin AR. Family and neighborhood socioeconomic status and temperament development from childhood to adolescence. J Pers. 2020;88(3):515-529. doi:10.1111/jopy.12507
8. Wichstrøm L, Penelo E, Rensvik Viddal K, de la Osa N, Ezpeleta L. Explaining the relationship between temperament and symptoms of psychiatric disorders from preschool to middle childhood: hybrid fixed and random effects models of Norwegian and Spanish children. J Child Psychol Psychiatry. 2018;59(3):285-295. doi:10.1111/jcpp.12772
9. Laceulle OM, Ormel J, Vollebergh WA, van Aken MA, Nederhof E. A test of the vulnerability model: temperament and temperament change as predictors of future mental disorders - the TRAILS study. J Child Psychol Psychiatry. 2014;55(3):227-36. doi:10.1111/jcpp.12141
10. Fox NA, Zeytinoglu S, Valadez EA, et al. Annual research review: developmental pathways linking early behavioral inhibition to later anxiety. J Child Psychol Psychiatry. 2023;64(4):537-561. doi:10.1111/jcpp.13702
11. Ramos ML, Zhou AM, Lytle MN, et al. Interactions among stress, behavioral inhibition, and delta–beta coupling predict adolescent anxiety during the COVID‐19 pandemic. Dev Psychobiol. 2024;66(3):e22485. doi:10.1002/dev.22485
12. Fox NA, Buzzell GA, Morales S, et al. Understanding the emergence of social anxiety in children with behavioral inhibition. Biol Psychiatry. 2021;89(7):681-689. doi:10.1016/j.biopsych.2020.10.004
13. Valadez EA, Morales S, Buzzell GA, et al. Development of proactive control and anxiety among behaviorally inhibited adolescents. J Am Acad Child Adolesc Psychiatry. 2022;61(12):1466-1475. doi:10.1016/j.jaac.2022.04.012
14. Joseph HM, Lorenzo NE, Fisher N, et al. Research review: a systematic review and meta-analysis of infant and toddler temperament as predictors of childhood attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry. 2023;64(5):715-735. doi:10.1111/jcpp.13753
15. Tang A, Crawford H, Morales S, et al. Infant behavioral inhibition predicts personality and social outcomes three decades later. Proc Natl Acad Sci U S A. 2020;117(18):9800-9807. doi:10.1073/pnas.1917376117
16. Wang FL, Duong S, Joseph HM, Kennedy TM, Hartman C. Temperament multi-trajectory groups across adolescence: associations with adulthood psychopathology and polygenic scores in TRAILS. Dev Psychopathol. Published online September 17, 2025. doi:10.1017/S0954579425100680
17. Wu TC, Meehan AJ, Rijlaarsdam J, et al. Developmental pathways from toddler difficult temperament to child generalized psychopathology and adult functioning. J Affect Disord. 2022;301:14-22. doi:10.1016/j.jad.2022.01.012
18. Wilson S, Olino TM. A developmental perspective on personality and psychopathology across the life span. J Pers. 2021;89(5):915-932. doi:10.1111/jopy.12623
19. Nigg JT. Temperament and developmental psychopathology. J Child Psychol Psychiatry. 2006;47(3-4):395-422. doi:10.1111/j.1469-7610.2006.01612.x
20. Groenman AP, Janssen TWP, Oosterlaan J. Childhood psychiatric disorders as risk factor for subsequent substance abuse: a meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(7):556-569. doi:10.1016/j.jaac.2017.05.004