David C. Rettew, MD, is a child psychiatrist at the UVM Medical Center, where he is Director of the Pediatric Psychiatry Clinic.

David C. Rettew, MD, is a child psychiatrist at the UVM Medical Center, where he is Director of the Pediatric Psychiatry Clinic.

At what point does shyness become social anxiety disorder, activity become ADHD, or quirkiness become autism?

These important questions occupy not only parents trying to do right by their kids, but also mental health professionals who are asked to render opinions about the presence or absence of psychiatric disorders.  When parents bring in their child for an evaluation, they understand that 6-year-old boys may not pay attention all the time, or that 15-year-old girls can experience intense bouts of sadness or anxiety from time to time. What they want to know is not whether or not the anxiety or inattention exists, but if the level of it goes beyond what would typically be expected.

This, however, turns out to be a difficult question, because it is looking more and more as though most types of behavior exist as dimensions or spectrums with no clear boundary between what would be called a psychiatric symptoms and what would be called a personality or temperament trait.

For years, the conventional wisdom under a medical model of psychiatry was that mental health disorders were not directly related to one’s temperament or personality and instead often “come out of the blue.” Since the pioneering work of psychiatrists Stella Chess and Alexander Thomas, however, accumulating evidence has challenging this notion considerably. Consequently, diagnosing a child with ADHD is a little bit like diagnosing a child as being tall. Certainly there will be some kids who are clearly tall or not tall for their age, but that means that there will also be many kids hovering around what is somewhat of a subjective boundary.

At my workshop on April 12, we’ll dive into the world of temperament and personality and explore some of the core dimensions and types that behaviorally distinguish one child from another. Next, we’ll explore what science actually knows about how traits and linked to various types of psychiatric disorders, both in terms of behavior and in terms of underlying brain function. Finally, the workshop will conclude with a discussion about why all of these concepts are not only interesting to ponder but also have direct relevance and importance for parents and health professionals alike.  

Click here to register for Dr. Rettew’s free class “Trait or Symptom? Understanding the Boundaries of Child Temperament.”

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