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    Nygaard - 2002 - Temperament in Children With DS

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    ‘Scandinavian Journal of Psychology, 2002, 43, 61-71 Temperament in children with Down syndrome and in Prematurely born children EGIL NYGAARD, LARS SMITH? and ANNE MARI TORGERSEN’ ‘Educuional Psychological Advisory Service, Barum Kommune, Norway institu of Psychology, University of Oslo, Norway "institute of Psyehiatry, Uniersity of Oslo, Norway. Nypaard, E, et al, (2002). Temperament in children wit Psychology, 43, 61-71 Down syndrome and in prematurely bor children. Scandinavian Jounal of Parents of three groups of children completed the Children's Behavior Questionnaire (CBQ), Participants were children with Down syndrome ‘ged 4-11 years (n = 55), prematurely born children aged 5 years (n = 97), and a group of normally developing kindergarten ehildren $-7 years of age (n= 91). Mean levels and factor structures on the CBQ were compared between the three groups. The children with Down Syndrome had less avtentional focusing and expressed les inhibitory contro! and less sadness than the normally developing children, There were aso group differences in temperament structures, especially a clearer emotional factor of “surgency” among the children with Down syndrome. The only significant difference in mean temperament scores between the premature children and the control group was that the former evinced less attervional focussing. The temperament structures in the Norwegian samples were very similar to those reported in earlier studies, conducted in China and the US. Key words: Children's Behavior Questionnaire, cultural differences, Down syndrome, premature birth, temperament. Egil Nygoard, Harreschousre 7, 1338 Sandvik, Norway. E-mail: egilnygaard@baerum.kommune.20 INTRODUCTION During the past 30 years there has been considerable progress in identifying the broad outlines of temperament in child- hhood. Temperament is looked upon as a subset of the more general area of personality. It includes basic psychological processes constituting the affective, activational, and atten- tional core of personality and its development. Temperament is offen defined as constitutionally based, influenced by gen- cic inheritance, maturation, and experience. Temperament influences a person's behavior and development in several ways. Although there has been considerable progress in iden- tifying the broad outlines of temperament in childhood, there is still need for continuing work on its subdimensions (Rothbart & Bates, 1998), ‘Most work on temperament has been done with normally developing children. However, during the past 20. years researchers have also studied temperament in children with ‘Down syndrome (see Beeghly, 1998; Goldberg & Marcoviteh, 1989, for reviews). Most of these studies have reported dif- {erences in mean values on various temperamental dimensions between young children with Down syndrome, and cither ‘age-matched controls of age norms published by scale de- velopers. Such studies have led to few conclusive answers (Beeghly, 1998). The most reliable group difference is the following: Adults tend to perceive children with Down syn drome as less persistent than normally developing children (Bridges & Cicchetti, 1982; Green, Dennis & Bennets, 1989; Gunn & Berry, 1985a; Gunn & Berry, 1985b; Gunn & Cuskelly, 1991; Marcovitch, Goldberg, MacGregor & Lojkasck, 1986; Pueschel & Myers, 1994; Ratekin, 1996) Furthermore, children with Down syndrome have been per- ceived as being cither more or less sociable than norm depending on their age. In infancy they tend to be rated as more difficult than age-matched, normally developing infants, but with increasing age this trend seems to be reversed (Ratekin, 1996), Temperamental differences have also been reported When children with low birth weight and normally developing children have been compared (Field, Hallock, Dempsey & Shuman, 1978; Garcia Coll, Halpern, Vohr, Seifer & Oh, 1992; Gennaro, Medoff-Cooper & Lotas, 1992; Malatesta, Grigoryev, Lamb, Albin & Culver, 1986; Plunkett, Cross & Meisels, 1989; Van Beck, Hopkins & Hocksma, 1994). Since temperament is related to maturation and general health in infancy (Torgersen, 1985) this is only what one would expect. There are fewer studies of toddlers and preschool children related to this question Only a few studies have investigated temperament in children with low birth weight above 3 years of age. Some hhave reported that premature children have a more difficult {temperament than full-term children (Howard & Worrell, 1952; Malatesta-Magai, 1991; Minde, Goldberg, Perrotta, Washington, Lojkasek, Corter & Parker, 1989), whereas others have found no difference in global temperamental traits (Pfeiffer & Aylward, 1990), Some (Minde et al,, 1989) {© 2002 The Scandinavian Psychological Associations. Published by Blackwell Publishers, 108 Cowley Road, Oxford OX4 JF, UK and 330 Main Street, Malden, MA 02148, USA. ISSN 0036-556, 62_E Nygaurdeet al ‘Scand J Psychol 43 (2002) have reported that premature children tend to be more ‘active, whereas others have found the opposite tendency, or 1no difference at all (Prior, Sanson & Oberklaid, 1989; Wiener, Rider, Oppel, Fischer & Harper, 1965). Children of low birth weight have been reported to be more inhibited and less attentive (Malatesta-Magai, 1991; Minde er al, 1989), but others report no difference in shyness (Grunau, Whitfield & Petrie, 1994), or approach (Prior etal, 1989). These children may have poorer concentration (Minde er a., 1989), and be ‘more impulsive (Wiener et al., 1965), although studies have also reported no differences in distractibility (Wiener et al., 1965) or rhythmicity (Prior et al., 1989). Whereas some te- searchers are of the opinion that premature children express ‘more negative and less positive emotions (Minde er al. 1989; Prior eral, 1989), others (Grunau, Whitfield, Petrie & Fryer, 1994) have been unable to find any difference in emotionality, ‘The problem with this literature is that for each paper reporting a difference, there exists another study reporting failure to replicate, Differential studies are also hard 10 compare because different instruments are used to measure temperament. To our knowledge the only study of temp- ferament among premature children above 3 years, using ‘observational data, is Malatesta-Magai’s (1991). Most other investigators have used questionnaires filed out by the parents. There are large differences between the question- naires in terms of which dimensions are examined, how they are defined, and how many dimensions are examined. Other differences that make it hard to do a comparison include age of the participants, birth weight, whether or not small-for-gestational-age children were included or not, sample size, which instruments were used to measure tem- perament, and cultural differences. The lack of conclusive findings could also be due to the fact that the existing dif- ferences in temperament between premature and full-term children often are quite small, with few measurable behavioral ‘consequences. In most studies of temperament in atypical children the instruments that have been used were developed and stand- ardized on normally developing children. When interpret- ing the results itis therefore important to be familiar with the underlying structure of the instruments. The Children’s Behavior Questionnaire (CBQ) measures three factors, called “surgeney/positive affect”, “negative emotionality”, Table L, Descriptive savstis of the samples and “effortful control”. The 16 subdimensions are assumed to contribute to these three factors in the same way as in the normative sample (Ahadi er al, 1993). For example, if ‘one finds a group difference on the dimension called smiling ‘and laughter itis important to know whether this difference is related to affect and emotion, or whether it should be associated with attention and control Correlations between different dimensions may vary across ccultures (Ahadi er al, 1993) as well as between different groups of participants. Thus itis important to evaluate the instrument's validity and reliability on other samples, and in different cultures. To our knowledge no previous studies hhave explored the factor structure of temperament in children with Down syndrome or among premature children ‘The aim of the present study was threefold. The first goal was to examine differences seen in children with Down syndrome and premature children, compared with normally developing children, on a large number of temperamental dimensions. By using a broad-scaled instrument the study ‘may contribute to the knowledge of temperamental differ- tences between children with known etiologies compared with normally developing children. Second, the study was designed to compare the factor structure of the CBQ in different groups of participants. Thus light may be thrown on the construct validity and reliability of temperamental factors. A third aim was to explore cultural differences by comparing the factor structure obtained on a Norwegian sample with those found in the US and China. METHOD, Participants Invitations were sent o all parents of ehikren with Down syndrome ataged 4-11 years, who were living in five counties around the city ‘of Oslo, Norway. OF 110 families asked to participate, 85 consented, For ehical reasons, information about the families who didnot wish to panicipate is not available. One participant, who scored more than thre standard deviations below the mean on the intelligence test, was excluded (see Table | for descriptive statistics). Mean age according to motor ability was 43.8 months (SD 11.3). Sex ratio (26 girs, 29 boys) was as expected (Stele, 1996), In contrast to an expected rate of 20% (National Bureau of Statistics, 1996), 69.8% fof the parents held # university degre. This could imply a higher willingness to participate among parents of higher socioesonomic lasses, othe rate might be due o general diference in etoational (Children with Down Premature chikiten Normally developing syndrome children Namber of subjects 5s 97 ot Mean age in months (SD) 85.1 03.4) 02 (0.6) Approximately 74(6) Number of gilvboys 2609 449 sito Proportion of parents with university-level education 70. % Not available ‘Mean birth weight (SD) [Not available 1124 g 219) Not available {© 2002 The Scandinavian Psychological Associations Seand J Psychol 43 (2002) Temperament. Down syndrome and prematurity 63 level between urban neighborhoods and rural areas, since most of the participants came from urban aress. A total of 25 children had severe medical complication, including cardia illness (n =9), espit- tory illness (5, a history of severe infections (2, elise disease (2), substantial hearing impairment 2), hypothyroidism (2), cataract (1), absent colon (I), and allergies (1) AAs part of a longitudinal study, children with birth weight below 1501 g were also reruited for the eurent investigation. OF children (mean birth weight 1128 g, SD 219) who were sen at 3 years (Smith, Ulvund & Lindemann, 1994), one died before the age (of 5, and six were lost to follow-up at age 5, OF these 107 parents, ‘97 returned the temperament questionnaire when the children (48 sels) were S years. The parenis, who belonged to all socioeconomic levels (Hollingshead, 1957), came from mixed urban, suburban and rural areas, and only 9% held university degree A\ group of normally developing children, who participated in a kindergarten study (Alsaker, unpublished), was als rated on the ‘CBQ by their parents, These children were recruited from 14 day cere groups all located in a stable and socially mined suburban area near the ety of Bergen. Out of 150 invited families, 91 patents ‘completed the CBQ. The children’s ages range from 37 107 years {formation about the exact ages of thee children and the socio- «economic status (SES) of their parents was not available. Instruments “The temperament measure usd i this stady was the CRQ (Ahad fal, 1993). This isa 1954tem questionnaire that provides scores fn 16 temperament dimensions. I is 2 parental report measure on which the parents decide whether a statement about thet child is {rue or untrue on 7-point scale, Factor analytic studies inthe US and China have shown that the CBO consists of three factors: “surgencyiposiive affect”, “negative emotionality", and “efforful control ‘The frst factor, “surgeney/positive affect” includes postive loud ings on the dimensions of acuvey level, approach, high tensity pleasure, impulsivity, smiling and laugher, and x negative loading for shyness. Positive loadings for anger, discomfort, fear, sadnes, and shynes, and a negative loading for fllng reactivity fsoodhabiliy define the second factor, “negative emotionality”, The third factor, “efortul control", includes the dimensions of uitention. inhibitory ‘contro, low inensiey pleasure apd. percepual sensitivity. tn the US sample smiling and layghier loaded. mainly on the third Factor, and approach and attention loaded almost idetieally on all three factors In the version of CBQ used in the present study, atention was split into uentonal focusing and atentonal shifting, In the studi in the US and China refered to below, the dimension of attention is identical with atenonal focusing as used hee. ‘The questionnaire was translated by one of the authors (AMT), and ambiguous items were discussed with colleagues and resolved before use ‘SPSS for MS Windows Release 61.3 was used forall statistics, RESULTS, Background variables Among the children with Down syndrome, there were significant negative correlations between age and the follow- ing three temperamental dimensions: activity (r = ~0.42 0,002), falling reactivtytsoothability (r = ~0.36, p = 0.007) and high intensity pleasure (r= ~0.36, p = 0,008). This means {© 2002 The Seandinavian Psychological Associations that the younger children were more active, calmed down quicker, and enjoyed more often high intensity pleasures than the older ones. Within the other two groups age did not vary significantly. The ag diferences between the three groups (Table 1) must be taken into account when discuss ing group differences in temperament ‘There were no gender differences in temperament among the children with Down syndrome or in the control group. In the group of premature children the following sex differ ences were found: anger (boys higher. = 2.16, p = 0.03), attentional shifting (gil higher, = 2.27, p= 0.03) and high intensity pleasure (boys 2.16, p = 0.03) Inthe group of children with Down syndrome, SES as measured by parental education (National Bureau of Statistic, 1989) didnot correlate significantly with any ofthe tempera- ment dimensions, SES as measured by the parents’ profession (National Bureau of Statistics, 1984) correlated significantly only with activity (r = -0.30, p = 003) and Zow intensity pleasure (r = 0.3, p = 0.01). In the group of premature children parents with high SES had children with signifie- antly more fow intensity pleasure (r= ~0.24, p = 0.02). Table 2 presents the internal consistency coefficient for the 16 CBQ scales for each of the three groups. The internal consistency varied between 43 und 0.87. Mean internal consistency in the Norwegian samples was 0.67, which i very similar to the Chinese sample (065), but lower than the value reported for the US sample (0:77). Among the children with Down syndrome 17 questions were negatively related to the dimension they belonged to. Inthe group of premature children this was true for five of the questions, and in the control group for seven of the questions. For comparative reasons each question was analyzed as if it belonged to the same dimension in each ofthe three groups. Wis thereby possible to compare the data of the three ceurrent groups as well to compare the present data with data obtained from the Chinese and US samples Mean differences ‘Table 3 presents the means and standard deviations of the three groups of participants. There were no differences in the total average between the groups. Children with Down syndrome scored significantly lower on the dimensions of attentional focusing, inhibitory control, and sadness than did the control group, This means that they were perceived to have less ability to sustain attention, to inhibit their impulses, and express sadness. Children with Down syndrome were also rated lower than the premature children on activity level and inhibitory control; that is, they were seen to have lower activity level and less ability to inhibit their impulses. Pre- mature children were rated lower than the control group on _avtentional focusing, which implies that they appeared to have less ability to sustain attention, There were no significant differences between the groups on any of the following factors: “surgency”, “negative emotionality”, and “effortful 64 _E. Nygard et al. ‘Scand J Psychol 43 (2002) Table 2. CBQ scale of internal consistency (a) in the present groups and in US and Chinese samples (Ahad! etal, 1993) Children Premature Normally US (Abadi, China with Down, chileon eveloping ta, 1993) (hadi er al, 1993) syndrome (=97) chuldzen (n= 6) (n= 468) (n=55) 29) Activiy 0.74.49) 0.66 80) 0.792) ost O78 ‘Angee 072.48) 077 0) 0.78 68) 076 07 ‘Approach 0.47 83) 0.71 (86) 0.63 70) 076 0.65 ‘Attentional focusing 0.40 (48) 07788) 0.10 69) 07 04s ‘Attentional shifting 057451) 05103) 048 (80) om 043 Discomfort 0.61 40) 065.07) 0.54 (58) om 62 Falling reactvity/soothability 036187) 057 (89) 059 (7) 080. 043 Feat 079.06) 067 1) 07331) 069 om High intensity pleasure ost as) 083.0) 0.77 66) on 076 Impulstvty 049.62) 0728) 079 @2) 078 063 Inhibitory controt 076.33) 0765) 078 68) on on Low intensity pleasure 043 43) 0.66 00) 0.68 67) 070 oe Perceptual sensitivity 061.84) 0.68 (39) 0.56 (3) on oor Sadness 61 G3) 03508) 0.50 7, 067 0s Shyness 0.77 (46) 087 86) 087 73) oot 03s: Smiling and laughter 036.89) 0.64 683) 0.79 (68) on 0.65 ‘Mean internal consistency 0.63 009 0.68, om 06s Notes: Cronbach's alpha is used as measure of internal consistency. ‘Attention is split nto two dimensions in the Norwegian sample, Table 3. CBQ means and standard deviations Children Premature children Normally ratio with Down syndrome (n= 97) developing children (n= 55) (=) Activity 42087) 4.67 (0.60) 456(087) aster Anger 429074) 438 (0.79) 455 (080) 2.10 ‘Approach 4.98 (0.56) 491 (061) 499 0.64) 039 “Attentional focusing 4.26 (042) 442093) 4330.77) git DP EN ‘Awcentonal shifting 387 (087) 401 (081) 378 (0.80) 174 Discomfort 4.33 (0.76) 4.26 0.76) 4100.30) 183 Falling reactivity/soothabiity 4.81 (0.60) 478 0.53) 472039) 038 Fear 3934088) 3.88 (0.83) 390 (0.82) os High intensity pleasure 4.46091) 4.55 (085), 4790.82) 270 Impulstvity 477015, 4.40 (067) 4380.70), 03s Inhibitory contral 423 (086) 4590.5) 467 080) 562" D< PN Low intensity pleasure 553 (0.50) 531 (033) 5207), 275 Perceptual sensitivity 465 (0.75) 479079) 489072) 183 Sadness 4.11 069) 4290.63) 4.38 (0.52) BIT D

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