Sometimes a temperamental issue that seems purely psychological will turn out to have, in part, a physical cause. For example, when he was about five years old, our son became grumpy and blue, a change from his normally sunny disposition (although he continued to appear perfectly healthy). At night, when Rick put our son to bed, he often heard forrest say that his throat was "tight." Some kids in Forrest's school had gotten strep throat recently, so Jan and Rick suggested that Forrest have a throat culture done at his upcoming, annual pediatric appointment. The doctor (a wonderful, caring pediatrician) did not see any symptoms, but he was happy to order the test anyway, and indeed Forrest had strep throat. Within days after treatment began, he was back to being his old, cheerful self.

Careful Assessment

This story also points out the importance of getting good assessment. With the development of modern medicine, many fabulous tests are available that will give you detailed information about your child's health: why not use them? They will give you the facts that will reduce your uncertainty about what's going on, and enable you and your child's health care providers to make better decisions. The sooner you have that information, the sooner everyone can benefit from it. Other than the prick of a needle for a blood draw, assessment can't hurt a child - unlike the wrong treatment, or no treatment at all (if there is in fact a problem, or an opportunity to improve his or her health). The worst case result is that assessment rules out a problem, but that means you've got one less thing to worry about: not a bad result, after all!

Whenever a child has a challenging temperament, we think it's a good idea to look into nutritional deficits, allergies and food sensitivities, and gastrointestinal (GI) problems. Why? Spirited children seem especially vulnerable to allergies (perhaps because they are one more form of dysregulation), and any child is more able to control himself and learn from his experience - and the efforts of his parents! - when he's not distracted internally by an overly reactive immune system. Stress - which is generally experienced more frequently by spirited and cautious children than by easygoing ones - disturbs the gastrointestinal system, and the results can include tummy aches, constipation, and less ability to absorb nutrients. We've consistently seen sensible efforts to bring an optimal balance to a child's physiology lead to mild to moderate improvements in her mood and temperament - and once in awhile, a dramatic benefit.

As a starting point, tell your pediatrician about your child's temperamental or psychological issues, and see if the doctor thinks there might be some physical basis for them. You could also consult with a licensed professional who has specialized experience with nutritional deficits, allergies, or gastrointestinal problems in children.

Sensible Care

If assessment reveals any condition that is wearing on your child - and perhaps exacerbating temperamental issues - you'll want to care for it in sensible ways. Here are some options for using nutrition, or the skillful management of allergies or GI disturbance, to help your child's temperament.

• Nutrition - Besides leading to weight gain and tooth decay, sugar can really crank up spirited kids - so we definitely recommend limiting it to 20 grams a day. One of the easiest ways to accomplish this is to cut down on sweet drinks; for example, there are about 45 grams of sugar in a can of coke.

A different sort of problem occurs when there's too little of a nutrient. In particular:

§ Essential fatty acids have been useful in the treatment of ADHD for some children, as well as for dyslexia and dyspraxia (poor motor skills or balance), and we've seen rigidly cautious children become more flexible after giving them essential fatty acids.

Additionally, it seems like a wise, general principle to allow as few artificial or toxic chemicals to enter any child's body as possible. Some kids - particularly ones who are anxious or spirited - seem especially sensitive to their environment, such as to new carpets or a fresh coat of paint. Certain food additives may seem to have a marked effect on your child's temperament, like food dyes, artificial sweeteners, or monosodium glutamate. You can try eliminating a suspected culprit from his diet for a few weeks, and see if that makes a difference.

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§ Starve the pathogens by eating much less sugar and white flour

§ Kill them with prescription drugs or herbal products

§ Compete with them by adding beneficial microorganisms (e.g., lactobacillus or other "probiotics")

§ Repair the damage to the GI tract, typically by taking supplements such as deglycyrrhizinated licorice or L-glutamine

Since kids with demanding temperaments are bound to take more work, their parents need to make a special effort to share the load fairly, and to get support. In general, it may make sense to increase the amount of care your child receives from others, and it always makes sense for you to increase your own self-nurturance! In particular, you and your partner should have periodic summit-meetings about your plan for your child; a challenging temperament is not going to go away or be entirely "fixed" by any intervention, no matter how skillful. Perhaps read a book together - such as the excellent, Raising Your Spirited Child- and use it to come to a common view, or go together to see a parent educator, therapist, or a behavioral pediatrician.

Counseling or a social skills group could be an effective way to teach a child, even a young one, important skills - as well as offer ongoing guidance to his or her parents. This is also an effective way to identify and deal with psychological factors that may be affecting a child and intensifying her temperament, such as stress on the family or tensions in the parents' relationship. These resources are highly confidential, and young children usually like going to a therapist, since they get to play for an hour with a nice grown-up who gives them her undivided attention; before a first visit, you can describe the therapist as a kind of coach or teacher. Your pediatrician or preschool director can probably give you referrals to local therapists or social skills groups, or you can call the referral line in the local county association of different kinds of therapists that is listed in the yellow pages of the phone book. Many therapists will work on a sliding scale basis, and most counties also have non-profit agencies that offer professional services at a very low fee - such as A.P.P.L.E. FamilyWorks! Additionally, the office of education - or the school districts, in many counties - will assess, at no charge, preschool and school-aged children with perceptual, motor, or other psychological difficulties, and often provide helpful interventions as well; contact these organizations to see what services they might offer your family.

Sometimes, what looks like an ordinary matter of temperament is, in fact, a deeper psychological issue. For example, some children who are particularly rigid have a developmental disorder on the autistic spectrum, and some highly spirited kids actually have ADHD; for example, at least five percent of the first-grade boys in a typical school will have ADHD. In such cases, you definitely need professional help - and you can find it using the referral sources described in the paragraph above.

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Perhaps more than anything, try to take the long view when you're working with a challenging temperament. Most of these issues get smaller and smaller with the passage of time. Once again, Mother Nature is on your side! Qualities that are troubling in a preschooler - like risk-taking confidence or unbelievable persistence - are highly desireable in many work settings. Try not to get too invested, too aggravated, or too controlling. Your child has his or her own destiny to work out, and the poignant and wonderful truth is that you have very limited influence over its unfolding. It's more important to preserve your relationship with your child than it is to ensure nearly any particular outcome. Try to relax and keep your sense of humor. Play the long game to win: do everything you can to prevent any irrevocable disasters, but as long as your child stays on the game board and makes it to adulthood intact, he or she is almost certainly going to be just fine.

(Rick Hanson is a clinical psychologist, Jan Hanson is an acupuncturist/nutritionist, and they are raising a daughter and son, ages 12 and 14. With Ricki Pollycove, M.D., they are the authors of Mother Nurture: A Mother's Guide to Health in Body, Mind, and Intimate Relationships, published by Penguin. You can see their website at www.nurturemom.com or email them with questions or comments at info@nurturemom.com; unfortunately, a personal reply may not always be possible.)