Commentary on The Difficult Child

Dr William Carey has earned a well-deserved reputation as an important figure in the field of behavioral pediatrics. His studies and writings have enhanced our understanding of a number of behavioral issues that concern both pediatricians and mental health professionals. His major contributions have been in the field of temperament studies. Here, he has been a clinician-researcher who has made valuable theoretical, clinical, and methodologic contributions to the conceptualization of temperament, its systematic measurement, and its practical applications by the practicing clinician. His present review of "The Difficult Child" gives us an authoritative and scholarly survey of one of the complex theoretical and practical issues of temperamental individuality in children. On the one hand, the review summarizes the pertinent research literature briefly but cogently. At the same time, Dr Carey's judgments and advice are not based on any academic approach but, on the contrary, reflect his own rich clinical and research experience in the field of temperament. My own comments will focus mainly on expanding Dr Carey's discussion of the basis for the concept of the temperamentally difficult child and his comments on practical management. Our definition of difficult temperament grew out of two separate lines of investigation. First and foremost was the vivid impressions gained by Dr Alexander Thomas and myself as we interviewed the parents in our New York Longitudinal Study(NYLS), which we initiatead in 1956.