Temperament Development Research Articles

Prenatal influences on temperament development: The role of environmental epigenetics.

This review summarizes current knowledge and outlines future directions relevant to questions concerning environmental epigenetics and the processes that contribute to temperament development. Links between prenatal adversity, epigenetic programming, and early manifestations of temperament are important in their own right, also informing our understanding of biological foundations for social-emotional development. In addition, infant temperament attributes represent key etiological factors in the onset of developmental psychopathology, and studies elucidating their prenatal foundations expand our understanding of developmental origins of health and disease. Prenatal adversity can take many forms, and this overview is focused on the environmental effects of stress, toxicants, substance use/psychotropic medication, and nutrition. Dysregulation associated with attention-deficit/hyperactivity-disruptive disorders was noted in the context of maternal substance use and toxicant exposures during gestation, as well as stress. Although these links can be made based on the existing literature, currently few studies directly connect environmental influences, epigenetic programming, and changes in brain development/behavior. The chain of events starting with environmental inputs and resulting in alterations to gene expression, physiology, and behavior of the organism is driven by epigenetics. Epigenetics provides the molecular mechanism of how environmental factors impact development and subsequent health and disease, including early brain and temperament development.

Cross-cultural differences in temperament: Comparing paternal ratings of US and Dutch infants

This study conducted longitudinal comparisons of US and Dutch paternal ratings of temperament, measured via the Infant Behaviour Questionnaire-Revised, at 4 months (US n = 99; Dutch n = 127) and 12 months (US n = 66; Dutch n = 112) of age. US fathers rated their infant higher in the broad temperament trait Surgency, and its subscales vocal reactivity, high-intensity pleasure, and activity level. US fathers also rated their infants higher in negative emotionality, and its subscales of sadness, distress to limitations, and fear. Dutch infants received higher ratings in falling reactivity. Though the cultures did not differ in ratings of Orienting/regulatory capacity, US infants were higher on the subscale duration of orienting, and lower in soothability. Significant culture-by-age and culture-by-gender interactions were also noted. Overall, results are largely consistent with those reported for Dutch mothers and speak to considerable differences in early temperament development between cultures viewed as largely similar because of their Western/individualistic orientations.

Positive Affectivity and Fear Trajectories in Infancy: Contributions of Mother-Child Interaction Factors.

Fear and positive emotionality were considered in a growth modeling context. Mothers, primarily Caucasian (91.9%) and of middle socioeconomic status, participated in play interactions with infants at 4months (N=148). Infant fear and positive affectivity were evaluated at 6, 8, 10, and 12months of age. A linear trajectory was superior in explaining growth for parent report and observation-based indicators of positive affectivity and parent report of fearfulness; a piecewise model explained the nonlinear growth of observation-based fear. Responsiveness in mother-infant interactions emerged as a significant predictor of the fear trajectory, with higher sensitivity predicting lower levels of observed fear. Reciprocity, tempo, emotional tone, and intensity of mother-infant interactions also made significant contributions to temperament development; however, analyses addressing these were exploratory.

Prenatal maternal distress seems to be associated with the infant's temperament and motor development: an explorative study.

According to the concept of fetal programming, prenatal distress has long-lasting consequences on the offspring's health later in life. The hypothalamic-pituitary-adrenal axis is considered a mediating system by which maternal distress is transferred to the fetus in intrauterine environment. In this longitudinal explorative study on 30 mother-child-dyads, reported maternal distress and salivary cortisol were collected during pregnancy. Infant temperament, motor and cognitive development were assessed at 16months. Additionally, infant cortisol levels throughout the day and in reaction to a psycho-social stressor where measured. As expected, infants whose mothers had experienced higher prenatal distress expressed a more difficult temperament and lower fine motor development at 16months. No association could be shown between prenatal maternal distress and infant salivary cortisol.

Child regulative temperament as a mediator of parenting in the development of depressive symptoms: a longitudinal study from early childhood to preadolescence

Child temperament as well as parenting behaviors have been linked to adolescent depression. Beyond their main effects, the interplay between these factors is of interest. For example, in an interactive model, a differential susceptibility of temperamental variants to parenting has been suggested. However, so far, the differential susceptibility hypothesis has mostly been studied with a focus on externalizing disorders. On the other hand, parenting may shape the child's temperament and vice versa in a transactional process. In a prospective, longitudinal at-risk sample (163 boys, 176 girls), we assessed emotional (easy-difficult) and regulative (self-control) temperament at ages 4.5, and 8years, respectively, as well as parenting quality at age 4.5years using the HOME inventory. Hierarchical linear regression analysis was used to investigate the prediction of depressive symptoms at age 11, measured by the Child Depression Inventory, including interaction terms between the temperament variable and parenting. We additionally tested whether parenting was mediated by child temperament. As previously reported, both self-control and parenting were longitudinally associated with preadolescent depressive symptoms. There were no interactive effects between temperament and parenting. However, the effects of parenting were partly mediated by self-control. Our data do not support a differential susceptibility of temperamental variants in the development of preadolescent depression. However, our results are in line with the assumption that parenting may shape young children's temperament, with positive parenting in the early childhood fostering the development of regulative temperament.

Preliminary Investigation of the Relationship between the Temperament of Young Children Who Stutter and the Temperament of Their Parents

Previous studies suggest temperamental differences between young preschool-age children who stutter and those who do not. It is also known that parental socialization plays a major role in the temperamental development of children. However, to-date, whether temperamental differences exist between parents of children who stutter and parents of those who do not is unknown. The nature of relational differences between parent-child temperament across talker groups is also unclear. The present preliminary study examined the relationship between the temperament of parents and the temperament of children who stutter (CWS) and children who do not stutter (CWNS). It was hypothesized that the temperament of CWS would differ significantly from CWNS and that the temperament of parents of CWS would differ significantly from parents of CWNS. Participants included 16 CWS and 16 CWNS (ages of 36 to 64 months) matched for age and gender. The primary parent for each child completed the Children's Behavior Questionnaire (CBQ) and the Adult Temperament Questionnaire (ATQ) that assessed factors of the temperament of the child and parent, respectively. Data was subjected to a series of t-tests and correlational analyses. Preliminary findings indicated no significant difference in the temperament of CWS and CWNS and no significant difference in the temperament of parents of CWS and parents of CWNS according to the ATQ. Relational differences were noted between some aspects of the CBQ and the ATQ scores for both talker groups. Preliminary findings suggest no temperamental differences between CWS and CWNS or their parents. However, findings do suggest relational differences in parental socialization of emotional development between CWS and CWNS. Results also suggest a need to make parents of children who stutter aware of the importance of modeling appropriate use of emotions in order to influence emotional development of their child.

East–west, collectivist-individualist: A cross-cultural examination of temperament in toddlers from Chile, Poland, South Korea, and the U.S.

The present study examined toddler temperament across Chilean, South Korean, Polish, and U.S. samples, providing an opportunity to examine both collectivist-individualist and East–West contrasts. The effect of culture on the three factor and 18 dimension scores provided by the Early Childhood Behavior Questionnaire were investigated. Results provide evidence of cross-cultural differences between the four samples. Chilean toddlers scored significantly higher than U.S., Polish, and South Korean children on the overall factor of Negative Affectivity, as well as higher than the Polish and South Korean samples on the Surgency factor. South Korean toddlers scored significantly higher on the factor of Effortful Control, and two related dimensions, than U.S., Polish, or Chilean samples. Results are discussed in terms of the apparent roles of individualism/collectivism and East–West distinctions in shaping temperament development.

Adaptation of the Infant Behavior Questionnaire-Revised for use in Ethiopia: Expanding cross-cultural investigation of temperament development

Cross-cultural differences in temperament were evaluated for Ethiopian (N=109) and U.S. (N=109) samples of infants. We anticipated that the Sidama version of the Infant Behavior Questionnaire-Revised (IBQ-R; Gartstein & Rothbart, 2003) developed for use in Ethiopia would demonstrate satisfactory psychometric properties, and hypothesized significant cross-cultural differences in levels of fine-grained temperament characteristics. Interactions between culture, infant age, and sex were also considered. Internal consistency was satisfactory for 13 of the 14 IBQ-R scales (with a somewhat low estimate observed for Duration of Orienting), and an examination of the structure indicated patterns similar to those observed in the US, and elsewhere. Differences between Ethiopia and the US were noted for Activity Level, Distress to Limitations, Fear, Smiling/Laughter, Falling Reactivity, Cuddliness/Affiliation, Sadness, Approach, and Vocal Reactivity. Parents of infants in the US reported higher levels of attributes associated with Surgency/Positive Affectivity (Activity, Smiling/Laughter, Approach Vocal Reactivity), whereas Ethiopian infants’ scores were higher for Distress to Limitations and Fear, linked with the over-arching temperament factor of Negative Emotionality; however, US infants received higher ratings on Sadness, also associated with this factor. Higher Falling Reactivity, a regulation-related attribute, was reported for Ethiopian infants, with US babies receiving higher Cuddliness/Affiliation scores. Significant culture*age interactions were observed for Activity and Fear, along with a significant culture*age*sex interaction for Distress to Limitations.

Effects of prenatal and postnatal maternal emotional stress on toddlers’ cognitive and temperamental development

BackgroundMaternal stress is associated with impairments in the neurodevelopment of offspring; however, the effects of the timing of exposure to maternal stress on a child's neurodevelopment are unclear. MethodsIn 2010, we studied 225 mother-child pairs in Shanghai, recruiting mothers in mid-to-late pregnancy and monitoring offspring from birth until 30 months of age. Maternal stress was assessed prenatally (at 28–36 weeks of gestation) and postnatally (at 24–30 months postpartum) using the Symptom-Checklist-90-Revised Scale (SCL-90-R) and Life-Event-Stress Scale to evaluate mothers’ emotional stress and life event stress levels, respectively. Children's cognition and temperament were assessed at 24–30 months of age using the Gesell Development Scale and Toddler Temperament Scale, respectively. Multi-variable linear regression models were used to associate prenatal and postnatal stress with child cognitive and temperamental development. ResultsMaternal prenatal and postnatal Global Severity Index (GSI) of SCL-90-R were moderately correlated (ICC r=0.30, P<0.001). After adjusting for relevant covariates, the increase in prenatal GSI was associated with decreases in toddlers’ gross motor, fine motor, adaptive and social behavior development independently of postnatal GSI, while the increase in postnatal GSI was associated with changes in multiple temperament dimensions independently of prenatal GSI. The effects of prenatal and postnatal depression scores of SCL-90-R were similar to those of GSI. LimitationRelatively small sample size. ConclusionsCompared with postnatal exposure, children's cognitive development may be more susceptible to prenatal exposure to maternal emotional stress, whereas temperamental development may be more affected by postnatal exposure to maternal emotional stress compared with prenatal exposure.

Cross-Cultural Comparisons of Infant Fear

Cross-cultural investigations addressing the development of individual differences are important because these speak to the generalizability of results and the extent to which the development of temperament and personality differs by culture. The present study was aimed at comparing manifestations of fear, defined in infancy as startle or distress to sudden changes in stimulation (e.g., facial/bodily expressions of fear), and inhibited approach to novelty (e.g., escape/avoidance), for samples from Spain ( n = 51) and the United States ( n = 102). We obtained data from mothers of U.S. and Spanish infants at 12 months of age, also observing these babies in the context of a structured laboratory procedure designed to elicit fearful reactivity. Data reduction efforts produced coherent observation-based fearfulness constructs for both groups, and individual indicators were also examined. Significant differences between U.S. and Spanish infants for the observation-based fear composite and component indices of distress vocalizations, bodily fear, and escape intensity, but not for the parent-report of this attribute, were demonstrated. A significant culture-by-gender interaction emerged for the laboratory-based fear composite and the intensity of facial fear indicator, wherein Spanish female infants exhibited higher intensity of expression, relative to the U.S. counterparts.

Toddler temperament and prenatal exposure to lead and maternal depression.

BackgroundTemperament is a psychological construct that reflects both personality and an infant’s reaction to social stimuli. It can be assessed early in life and is stable over time Temperament predicts many later life behaviors and illnesses, including impulsivity, emotional regulation and obesity. Early life exposure to neurotoxicants often results in developmental deficits in attention, social function, and IQ, but environmental predictors of infant temperament are largely unknown. We propose that prenatal exposure to both chemical and non-chemical environmental toxicants impacts the development of temperament, which can itself be used as a marker of risk for maladaptive neurobehavior in later life.In this study, we assessed associations among prenatal and early life exposure to lead, mercury, poverty, maternal depression and toddler temperament.MethodsA prospective cohort of women living in the Mexico City area were followed longitudinally beginning in the second trimester of pregnancy. Prenatal exposure to lead (blood, bone), mercury, and maternal depression were assessed repeatedly and the Toddler Temperament Scale (TTS) was completed when the child was 24 months old. The association between each measure of prenatal exposure and performance on individual TTS subscales was evaluated by multivariable linear regression. Latent profile analysis was used to classify subjects by TTS performance. Multinomial regression models were used to estimate the prospective association between prenatal exposures and TTS performance.Results500 mother-child pairs completed the TTS and had complete data on exposures and covariates. Three latent profiles were identified and categorized as predominantly difficult, intermediate, or easy temperament. Prenatal exposure to maternal depression predicted increasing probability of difficult toddler temperament. Maternal bone lead, a marker of cumulative exposure, also predicted difficult temperament. Prenatal lead exposure modified this association, suggesting that joint exposure in pregnancy to both was most toxic.ConclusionsMaternal depression predicts difficult temperament and concurrent prenatal exposure to maternal depression and lead predicts a more difficult temperament phenotype in 2 year olds. The role of temperament as an intermediate variable in the path from prenatal exposures to neurobehavioral deficits and other health effects deserves further study.

Bidirectional pathways between relational aggression and temperament from late childhood to adolescence

Relational aggression is linked to numerous adverse consequences. However, we know little about how temperament leads individuals to become perpetrators/victims of relational aggression, or how being a perpetrator/victim influences the development of temperament. We used longitudinal data from 674 Mexican-origin youth to examine relations between relational aggression and mother- and child-reported temperament from 5th grade (Mage=10.8; SD=0.60) through 11th grade (Mage=16.8; SD=0.50). Results show that: (a) high Negative Emotionality and low Effortful Control predicted increases in victimization; (b) low Effortful Control predicted increases in perpetration; (c) victims increased in Negative Emotionality and decreased in Effortful Control; and (d) perpetrators increased in Negative Emotionality and Surgency. Thus, temperament serves as both an antecedent to and a consequence of relational aggression.

DEVELOPMENT OF SOCIAL SKILLS IN LEARNING SOCIAL STUDIES IN PRIMARY SCHOOL

Referring to the standard social studies curriculum content subjects, 2006, one of the competencies that would be developed is to give students with a useful social knowledge, social skills, and intellectual, in fostering social attention as well as human resources who care as good Indonesian citizen and responsible realize national goals. To be able to successfully learn social studies, students should be equipped not only knowledge, but also the need to be explored and developed dimension of the skills and attitude value. Therefore, the focus of discussion in this paper is the urgency to develop social skills that are integrated into social studies teaching in elementary school. Processes and learning outcomes with social skills and building value is needed to equip learners to anticipate the future challenges that certainly will be more severe and complex. Teachers as curriculum developers are demanded to be skillful to bring atmosphere and learning activities which has purpose on developing basic skills and the cultivation and development of personality, temperament and character.. Implementation of educational based on social skills and coaching will is believed have valuable graduates outcome that have personality, temperament and good character. Therefore, the main task of basic education is to build students' character and have purpose build students from an early age in order to not fail be a perfect human.

Early childhood cortisol reactivity moderates the effects of parent-child relationship quality on the development of children's temperament in early childhood.

Positive parenting has been related both to lower cortisol reactivity and more adaptive temperament traits in children, whereas elevated cortisol reactivity may be related to maladaptive temperament traits, such as higher negative emotionality (NE) and lower positive emotionality (PE). However, no studies have examined whether hypothalamic-pituitary-adrenal axis activity, as measured by cortisol reactivity, moderates the effect of the quality of the parent-child relationship on changes in temperament in early childhood. In this study, 126 3-year-olds were administered the Laboratory Temperament Assessment Battery (Lab-TAB; Goldsmith etal., 1995) as a measure of temperamental NE and PE. Salivary cortisol was collected from the child at 4 time points during this task. The primary parent and the child completed the Teaching Tasks battery (Egeland etal., 1995), from which the quality of the relationship was coded. At age 6, children completed the Lab-TAB again. From age 3 to 6, adjusting for age 3 PE or NE, a better quality relationship with their primary parent predicted decreases in NE for children with elevated cortisol reactivity and predicted increases in PE for children with low cortisol reactivity. Results have implications for our understanding of the interaction of biological stress systems and the parent-child relationship in the development of temperament in childhood.

Measuring Preschool Children Temperament: Implications for Preschool Care and Education Practice

With the aim of measuring preschool children temperament, EASI temperament Survey has been applied. Preschool teachers (N=192), all female, rated a total of N=3275 children (1612 girls and 1639 boys) with mean age M 4.368 (SD=1.482) within age range between 7 months and 7.7 years. Validation for the instrument was run. Factor analysis on principal components with Oblimin rotation and reliability analysis were performed on data based on preschool teachers’ ratings. Three-factor solution has been determined: Emotionality, Activity and Sociability, which have explained 57.427% variance. As it was expected, impulsivity component was not replicated. Subscales inter-correlations and gender and age differences confirmed results from prior research. Overall, the findings were discussed within the frame of preschool children temperament development and variables related to the characteristics of observers. Several significant implications for preschool teachers practice and the quality of educational process have been emphasized

Mitochondrial Gene Expression Profiles Are Associated with Maternal Psychosocial Stress in Pregnancy and Infant Temperament.

BackgroundGene-environment interactions mediate through the placenta and shape the fetal brain development. Between the environmental determinants of the fetal brain, maternal psychosocial stress in pregnancy has been shown to negatively influence the infant temperament development. This in turn may have adverse consequences on the infant neurodevelopment extending throughout the entire life-span. However little is known about the underlying biological mechanisms of the effects of maternal psychosocial stress in pregnancy on infant temperament. Environmental stressors such as maternal psychosocial stress in pregnancy activate the stress response cascade that in turn drives the increase in the cellular energy demand of vital organs with high metabolic rates such as, in pregnancy, the placenta. Key players of the stress response cascade are the mitochondria.ResultsHere, we tested the expression of all 13 protein-coding genes encoded by the mitochondria in 108 placenta samples from the Stress in Pregnancy birth cohort, a study that aims at determining the influence of in utero exposure to maternal psychosocial stress in pregnancy on infant temperament. We showed that the expression of the protein-coding mitochondrial-encoded gene MT-ND2 was positively associated with indices of maternal psychosocial stress in pregnancy including Prenatal Perceived Stress (β = 0.259; p-regression = 0.004; r2-regression = 0.120), State Anxiety (β = 0.218; p-regression = 0.003; r2-regression = 0.153), Trait Anxiety (β = 0.262; p-regression = 0.003; r2-regression = 0.129) and Pregnancy Anxiety Total (β = 0.208; p-regression = 0.010; r2-regression = 0.103). In the meantime MT-ND2 was negatively associated with the infant temperament indices of Activity Level (β = -0.257; p-regression = 0.008; r2-regression = 0.165) and Smile and Laughter (β = -0.286; p-regression = 0.036; r2-regression = 0.082). Additionally, MT-ND6 was associated with the maternal psychosocial stress in pregnancy index of Prenatal Perceived Stress (β = -0.231; p-regression = 0.004; r2-regression = 0.120), while MT-CO2 was associated with the maternal psychosocial stress in pregnancy indices of State Anxiety (β = 0.206; p-regression = 0.003; r2-regression = 0.153) and Trait Anxiety (β = 0.205; p-regression = 0.003; r2-regression = 0.129).ConclusionsOur data support the role of mitochondria in responding to maternal psychosocial stress in pregnancy, as assessed in placenta, while also suggesting an important role for the mitochondria in the infant temperament development.

The Development of Early Profiles of Temperament: Characterization, Continuity, and Etiology.

This study used a data-driven, person-centered approach to examine the characterization, continuity, and etiology of child temperament from infancy to toddlerhood. Data from 561 families who participated in an ongoing prospective adoption study, the Early Growth and Development Study, were used to estimate latent profiles of temperament at 9, 18, and 27 months. Results indicated that four profiles of temperament best fit the data at all three points of assessment. The characterization of profiles was stable over time, while membership in profiles changed across age. Facets of adoptive parent and birth mother personality were predictive of children's profile membership at each age, providing preliminary evidence for specific environmental and genetic influences on patterns of temperament development from infancy to toddlerhood.

Relative Age Effects in Dutch Adolescents: Concurrent and Prospective Analyses.

The literature on relative age position effects is rather inconsistent. In this study we examined intra-classroom age position (or relative age) effects on Dutch adolescents’ school progress and performance (as rated by teachers), physical development, temperamental development (fear and frustration), and depressive symptoms, all adjusted for age at the time of measurement. Data were derived from three waves of Tracking Adolescents' Individuals Lives Survey (TRAILS) of 2230 Dutch adolescents (baseline mean age 11.1, SD = 0.6, 51% girls). Albeit relative age predicted school progress (grade retention ORs = 0.83 for each month, skipped grade OR = 1.47, both p<.001), our key observation is the absence of substantial developmental differences as a result of relative age position in Dutch adolescents with a normative school trajectory, in contrast to most literature. For adolescents who had repeated a grade inverse relative age effects were observed, in terms of physical development and school performance, as well as on depressive symptoms, favoring the relatively young. Cross-cultural differences in relative age effect may be partly explained by the decision threshold for grade retention.

Effect of the 5-HTTLPR polymorphism on affective temperament, depression and body mass index in obesity

Background and aimMany studies show high prevalence of affective disorders in obese patients. Affective temperament is a subclinical manifestation of such conditions. The 5-HTT gene encoding the serotonin transporter may be involved in both mood and eating dysregulation. The aim of this study was to investigate the influence of a polymorphism in the 5-HTT gene on affective temperament types, depressive symptoms and Body Mass Index (BMI) in obese patients. MethodsThis study involved 390 patients (237 females, and 153 males) with obesity. The TEMPS-A questionnaire, Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were used to evaluate affective temperaments and prevalence of depression. DNA was obtained for serotonin transporter gene-linked polymorphism (5-HTTLPR) genotyping. ResultsIn obese patients S/S genotype was associated with depressive and L/L with cyclothymic temperament. Subjects with L/L genotype presented significantly higher BMI and greater intensity of depressive symptoms in BDI and HDRS. Females scored higher in anxious and depressive, while males in hyperthymic, cyclothymic and irritable temperaments. Females scored higher in BDI (subjective depression) while males in HDRS (objective depression). LimitationsTEMPS-A, BDI and HDRS are frequently used in studies on affective disorders. However, these methods do not examine all dimensions of mood and personality. ConclusionsIn obese patients S allele of 5-HTTLPR was associated with development of depressive temperament while L allele corresponded with greater obesity and prevalence of depression. Different mechanisms may be involved in manifestation of depression in males and females with obesity.

Difficult Psychiatric Consultations: An Integrated Approach

Back to table of contents Previous article Next article Book ReviewsFull AccessDifficult Psychiatric Consultations: An Integrated ApproachJohn Boronow, M.D.John BoronowSearch for more papers by this author, M.D.Published Online:1 May 2015https://doi.org/10.1176/appi.ps.660506AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Sergio V. Delgado and Jeffrey R. Strawn; Heidelberg, Germany, Springer, 2014, 151 pagesWhat an odd book this is! Under the deceptively simple label of “consultation,” the authors manage to present a succinct synopsis of numerous psychotherapeutic and psychological theories. Their scope includes brief reviews of psychodynamics (including attachment, intersubjectivity, and mentalization), cognitive and temperament development, family and medical team dynamics, and the role of cultural factors, with additional chapters on ethics and how to do clinical presentations. The stated purpose of this very broad and inclusive overview is to provide consultation liaison psychiatrists and the medical teams with whom they work the missing psychological perspectives that have been lost in the simplistic world of the DSM. In turn, such perspectives can then be usefully applied to resolving challenging impasses that routinely occur in behaviorally complicated medical cases in hospitals, when the psychiatric consultant is called on to help deal with the “difficult” patient.A consultation liaison psychiatrist has a very brief time to evaluate a patient, the patient’s family and culture, and the issues with the treatment team and then to offer a helpful intervention enabling all parties to move forward in the service of the patient’s medical treatment—no small task! The authors’ major contribution with Difficult Psychiatric Consultations is their presentation of a systematic and comprehensive approach to considering all these factors, organizing them in a way that may shed light on what still needs to be clarified, and then prioritizing a few discrete but potentially powerful interventions that may unblock the impasse and facilitate resumption of treatment. A tabular analysis, used repeatedly with the nine full case vignettes that are presented, helps the user to quickly but systematically conceptualize cases based on the observed strengths and weaknesses in the multiple aforementioned psychological domains and to prioritize interventions accordingly.As a grateful student in the 1970s of a superb psychodynamic consultation liaison psychiatrist, Milton Viederman at New York Hospital, I immediately recognized the authors’ description of the “life narrative” method and found their description of its utility to have compelling face validity. The examples in this book ring true, and the breadth of skills and perspectives mastered by the authors must surely enhance the care of the fortunate patients they treat. Unfortunately, I fear this rather brief and ambitious book may not succeed in providing the novice with sufficient specifics and details to effectively “fill in” the novel treatment table that is proposed by the authors. It is one thing to succinctly review a wide variety of perspectives but quite another to actually use them effectively, especially in such a compact time frame as a few consultation liaison encounters. The reader will need to look elsewhere for more depth.Dr. Boronow is medical director for adult services at Sheppard Pratt Hospital and associate clinical professor of psychiatry at the University of Maryland School of Medicine, Baltimore.The reviewer reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited ByNone Volume 66Issue 5 May 01, 2015Pages e2-e2 Metrics PDF download History Published online 1 May 2015 Published in print 1 May 2015