ABSTRACT
Despite the rapidly growing body of research literature on temperament, only a few articles and two books (Carey & McDevitt, 1989; Chess & Thomas, 1986) have been published suggesting practical ways that clinicians might use the concept in behavioral interventions. I have previously proposed that there are three principal uses of temperament concepts and data in pediatric practice (Carey, 1981, 1982): (1) general educational discussions with parents to increase their awareness and understanding, (2) identification of the particular child's temperament profile to provide a more organized and objective picture, and (3) interventions that influence the temperament-environment interaction when its dissonance is leading to reactive symptoms. These possibilities were illustrated with readily available examples but without a systematic review of all possible records to develop a more complete view of all the variations on these main themes. This report presents a more detailed analysis of these specific opportunities for pediatric intervention. During a period of 2 years, I have had the burdensome but interesting task of reviewing practically all the active charts (perhaps 1,200) in my general pediatrics practice as I have prepared individual transcripts to send to other physicians after the termination of that practice in September of 1989. Such an analysis cannot be regarded as truly quantitative in that processes of selection have operated at several points: the parents' decision to participate in the practice, their presentation of their problems to the physician, the variable recording of these discussions by the physician, and the fact that even after 2 years not all records have been requested. However, the several reaction patterns reported here turned up with such frequency that they would surely stand out in a more rigorous cross-sectional study. We should stress that these are concerns encountered in pediatric care, not just psychiatric diagnoses.
