Developmental psychopathology: concepts and challenges

The relations among depression in fathers, children's psychopathology, and father–child conflict: A meta-analysis

Research on parental depression is beginning to recognize the importance of studying fathers in relation to maladaptive outcomes in their offspring. Paternal depression is hypothesized to correlate with internalizing and externalizing psychopathology in children and adolescents and to compromise adaptive parent-child relationships (e.g., increased conflict). In the present paper, meta-analytic procedures were applied to this literature to address the magnitude and direction of covariation between paternal depression and children's functioning. In addition, we tested whether variation in findings could be accounted for by study characteristics. Results indicated that paternal depression was significantly related to offspring internalizing and externalizing psychopathology and father-child conflict. Larger effects for internalizing symptoms were associated with the use of community samples and symptom rating scales of internalizing problems.

Theories of conduct disorder: a causal modelling analysis

BACKGROUND

If a clinician has to make decisions on diagnosis and treatment, he or she is confronted with a variety of causal theories. In order to compare these theories a neutral terminology and notational system is needed. The Causal Modelling framework involving three levels of description - biological, cognitive and behavioural - has previously been used to compare causal accounts for dyslexia and autism.

METHOD

In this article we present this framework and explore its application to four causal theories of conduct disorder. We discuss the problems we encountered in this application and evaluate both the framework and the theories of conduct disorder.

CONCLUSIONS

It was possible to capture parts of the theories of conduct disorder in the Causal Modelling framework but a multi-model approach may be necessary for the alternative theories of conduct disorder we evaluate. The application of the framework helps to see the relationships among the various theories of aspects of conduct disorder and demonstrates the need for more explicitness in the causal theories.

Integrating Research on Temperament and Childhood Psychopathology: Its Pitfalls and Promise

This article discusses the promise and problems associated with integrating research on child temperament and research on childhood psychopathology. Unfortunately, these 2 extensive and influential areas of psychological research with children have largely been conducted independently of each other. This article provides a summary of the disciplinary, conceptual, and methodological issues that have hampered an integration of these 2 important bodies of research. It also highlights the great promise that such an integration could have for advancing causal theories of childhood disorders and for eventually improving the treatment provided to children with serious emotional and behavioral disturbances.

The Intergenerational Transfer of Psychosocial Risk: Mediators of Vulnerability and Resilience

The recurrence of social, behavioral, and health problems in successive generations of families is a prevalent theme in both the scientific and popular literatures. This review discusses recent conceptual models and findings from longitudinal studies concerning the intergenerational transfer of psychosocial risk, including intergenerational continuity, and the processes whereby a generation of parents may place their offspring at elevated risk for social, behavioral, and health problems. Key findings include the mediational effects of parenting and environmental factors in the transfer of risk. In both girls and boys, childhood aggression and antisocial behavior appear to predict long-term trajectories that place offspring at risk. Sequelae of childhood aggression that may threaten the well-being of offspring include school failure, adolescent risk-taking behavior, early and single parenthood, and family poverty. These childhood and adolescent behavioral styles also predict harsh, aggressive, neglectful, and unstimulating parenting behavior toward offspring. Buffering factors within at-risk families include maternal educational attainment and constructive parenting practices (e.g., emotional warmth, consistent disciplinary practices, and cognitive scaffolding). These findings highlight the potential application and relevance of intergenerational studies for social, educational, and health policy.

Impulsivity, Emotion Regulation, and Developmental Psychopathology: Specificity Versus Generality of Linkages

Impulsivity, closely related to the construct of response (dis)inhibition, is central to conceptions of both attention-deficit/hyperactivity (ADHD) and aggressive-spectrum or disruptive behavior disorders. The multifaceted nature of inhibitory deficits requires careful specification in any explanatory accounts of psychopathology. A host of brain regions and neural interconnections are involved in response inhibition; neural models are likely to be complex at the levels of neurotransmitter systems and white-matter tracts. Despite the substantial heritability of ADHD and the substantial continuity of early-onset forms of aggression, developmental processes (including gene-environment correlations and interactions) and transactional models are crucial to the unfolding of regulated versus dysregulated behavioral outcomes. Thus, stressful prenatal and childhood environments must be investigated with as much precision as genetic loci and neural pathways. Differentiating executive inhibition (believed to be largely dopaminergic and frontal/frontal-striatal in nature) from motivational inhibition (believed to be largely noradrenergic/serotonergic and limbic in nature) is necessary to distinguish subtypes of youth with attentional and aggressive problems, and to differentiate key etiologic processes. Indeed, the executive function deficits in children with ADHD appear to independent of their emotion dysregulation, which is specific to an aggressive subgroup. Sex differences in response inhibition and sex differences in its linkages to psychopathology are relatively unexplored. For progress in subsequent research to occur, the following are required: precision in measurement at both biological and behavioral levels; contrasts with clinical comparison samples and comorbid groups (as well as normal control samples); prospective longitudinal investigations; and attention to both developmental processes and contextual variables, including stressful life events, socialization practices, and cultural parameters.

The effects of children's exposure to domestic violence: a meta-analysis and critique

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Zr = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.

Childhood and adolescent psychologic development

Child and adolescent psychologic development is a complex process that is governed by the interactions of multiple biologic, genetic, sociocultural, and environmental variables. Viewed from an ecological context, the individual influences, and is influenced by, a multilayered set of systems, including the family, school, neighborhood, and peer group, as well as the more indirect effects of the workplace, health care and social services systems, and the larger cultural belief and value systems of the society in which the individual lives. This article reviews the major developmental themes and transitions through which children and adolescents must move on the path to adulthood. Primary developmental tasks are reviewed within each age period from birth to adulthood, along with a discussion of several risk factors that present challenges to normal development at the individual, family, community, and societal levels. The important roles of pediatricians and other health care professionals in helping children and families negotiate these developmental challenges is also reviewed.

Differential risks of covarying and pure components in mother and teacher reports of externalizing and internalizing behavior across ages 5 to 14

In a sample of 585 children assessed in kindergarten through 8th grade, we fit a confirmatory factor model to both mother- and teacher-reported symptoms on the Achenbach checklists (CBCL, TRF) and determined that a covariation factor of externalizing and internalizing behaviors existed, in addition to the pure-form factors of externalizing and internalizing for each reporter. In 3 structural equation models, between 8 and 67% of the variance in these 6 latent factors was accounted for by a set of antecedent child, sociocultural, parenting, and peer risk variables. Each of the 6 latent factors, taken 2 at a time, was predicted by a unique set of risk variables; however, there were some patterns that held for both mother- and teacher-report symptom factors: Child temperamental unadaptability and female gender were predictors of higher internalizing symptoms; child temperamental resistance to control, parental harsh punishment, male gender, low SES, and peer rejection were related to higher externalizing symptoms whereas child temperamental unadaptability was related to lower externalizing symptoms; and peer rejection and family stress were also related to the covarying, externalizing-plus-internalizing component of both mother and teacher reports.

Maltreatment and trauma: tracking the connections in adolescence

Posttraumatic stress disorder is one of the most common and often prolonged consequences of childhood maltreatment. In this article the authors consider theories of trauma continuity, with emphasis on a relational path to maladjustment that links childhood maltreatment to elevated trauma symptomatology and intimate victimization in adolescent dating relationships.

Childhood developmental abnormalities in schizophrenia: evidence from high-risk studies

According to cohort studies, individuals who develop schizophrenia in adulthood show developmental abnormalities in childhood. These include delays in attainment of speech and motor milestones, problems in social adjustment, and poorer academic and cognitive performance. Another method of investigating developmental abnormalities associated with schizophrenia is the high-risk (HR) method, which follows up longitudinally the development of children at high risk for schizophrenia. Most HR studies have investigated children who have a parent with schizophrenia. This review summarizes findings concerning childhood and adolescent development from 16 HR studies and compares them with findings from cohort, conscript, and family studies. We specifically addressed two questions: (1) Does the development of HR children differ from that of control children? (2) Which developmental factors, if any, predict the development of schizophrenia-spectrum disorders in adulthood? While the answer to the first question is affirmative, there may be other mechanisms involved in addition to having a parent with schizophrenia. Factors which appear to predict schizophrenia include problems in motor and neurological development, deficits in attention and verbal short-term memory, poor social competence, positive formal thought disorder-like symptoms, higher scores on psychosis-related scales in the MMPI, and severe instability of early rearing environment.

O senso de auto-eficácia e o comportamento orientado para aprendizagem em crianças com queixa de dificuldade de aprendizagem

Objetiva-se avaliar aspectos do desempenho acadêmico de crianças, relacionando indicadores da produção e do comportamento orientado para aprendizagem com indicadores de percepção do senso de auto-eficácia. Procedeu-se a avaliação por meio do Roteiro de Observação Clínica Comportamental da Criança e do Roteiro de Avaliação do Senso de Auto-Eficácia de 52 crianças, de ambos os sexos, na faixa etária de oito a 12 anos, alunos de 1ª a 4ª série, divididas em: 26 crianças com queixa de dificuldade de aprendizagem, encaminhadas para atendimento psicológico e 26 crianças com bom desempenho acadêmico avaliado por Teste de Desempenho Escolar. Observou-se que as crianças com queixa de dificuldade de aprendizagem, quando comparadas às crianças com bom desempenho, apresentaram diferença estatisticamente significativa; a) quanto à produção: atividades de qualidade média; b) quanto ao comportamento: baixa capacidade de organização, atenção, iniciativa, decisão, comunicação e interação espontânea; c) quanto à percepção: baixo senso de auto-eficácia.

A self-report typology of behavioral adjustment for young children

A large, national U.S. sample of children rated their own behavior and emotions using the Self-Report of Personality-Child version (SRP-C) of the Behavior Assessment System for Children (C. R. Reynolds & R. W. Kamphaus, 1992). Cluster analysis was used to group 4,981 self-reports (SRP-C) of children between the ages of 8 and 11 years. Theoretical and empirical considerations were used to identify a 10-cluster solution. Internal validation procedures revealed that the 10-cluster solution was well replicated by independently classifying 2 large subsamples of participants. External validation evidence revealed that only 2 of the 10 clusters could be differentiated by parent and teacher ratings of behavior problems. Peer ratings of social status and behavior, however, proved far better than adult ratings at differentiating the clusters. These findings suggest that the realm of intraindividual adjustment is not well understood by parents and teachers of these same children.

Experience effects on brain development: possible contributions to psychopathology

Researchers and clinicians are increasingly recognizing that psychological and psychiatric disorders are often developmentally progressive, and that diagnosis often represents a point along that progression that is defined largely by our abilities to detect symptoms. As a result, strategies that guide our searches for the root causes and etiologies of these disorders are beginning to change. This review describes interactions between genetics and experience that influence the development of psychopathologies. Following a discussion of normal brain development that highlights how specific cellular processes may be targeted by genetic or environmental factors, we focus on four disorders whose origins range from genetic (fragile X syndrome) to environmental (fetal alcohol syndrome) or a mixture of both factors (depression and schizophrenia). C.H. Waddington's canalization model (slightly modified) is used as a tool to conceptualize the interactive influences of genetics and experience in the development of these psychopathologies. Although this model was originally proposed to describe the 'canalizing' role of genetics in promoting normative development, it serves here to help visualize, for example, the effects of adverse (stressful) experience in the kindling model of depression, and the multiple etiologies that may underlie the development of schizophrenia. Waddington's model is also useful in understanding the canalizing influence of experience-based therapeutic approaches, which also likely bring about 'organic' changes in the brain. Finally, in light of increased evidence for the role of experience in the development and treatment of psychopathologies, we suggest that future strategies for identifying the underlying causes of these disorders be based less on the mechanisms of action of effective pharmacological treatments, and more on increased knowledge of the brain's cellular mechanisms of plastic change.

Project for a scientific psychiatry in the 21st century

OBJECTIVE

To discuss potential advances in neuroscientific knowledge in the 21st century, enabling the realization of Freud's original vision of a basic biological science and an associated metapsychology.

RESULTS

The Australian Twin Study of Attention Deficit Hyperactivity Disorder (ADHD) has demonstrated the high heritability of the core symptoms of ADHD, as well as showing important genetic and environmental influences on comorbid conditions. Brain mapping techniques suggest that working memory, as measured by an A-X Continuous Performance Task, is important in ADHD.

METHODS

To outline the development of our own clinical research into ADHD, and the potential for future behaviour and molecular genetic approaches.

CONCLUSIONS

The 21st century promises new and exciting developments in phenomenology, genetics, and neuroscientific understandings in Child Psychiatry.

Process, mechanism, and explanation related to externalizing behavior in developmental psychopathology

Advances in conceptualization and statistical modeling, on the one hand, and enhanced appreciation of transactional pathways, gene-environment correlations and interactions, and moderator and mediator variables, on the other, have heightened awareness of the need to consider factors and processes that explain the development and maintenance of psychopathology. With a focus on attentional problems, impulsivity, and disruptive behavior patterns, I address the kinds of conceptual approaches most likely to lead to advances regarding explanatory models in the field. Findings from my own research program on processes and mechanisms reveal both promise and limitations. Progress will emanate from use of genetically informative designs, blends of variable and person-centered research, explicit testing of developmental processes, systematic approaches to moderation and mediation, exploitation of "natural experiments," and the conduct of prevention and intervention trials designed to accentuate explanation as well as outcome. In all, breakthroughs will occur only with advances in translational research-linking basic and applied science-and with the further development of transactional, systemic approaches to explanation.

Annotation: randomised trials

BACKGROUND

This annotation describes the uses of randomised controlled trials (RCTs) in clinical child psychology and psychiatry.

METHOD

It explores the scientific basis for randomised designs, the conceptual and methodological issues that can arise when using them, alternative methods, and future directions.

RESULTS

There are many issues that have to be tackled when using randomised trials to answer questions about the effectiveness of interventions used by child mental health professionals. The most important are conceptual issues concerning the design of these studies, practical issues, and issues about the interpretation of the results. There are some situations in which randomised trials are not possible or ideal and alternative strategies may therefore be needed. Future RCTs should be more explicit about whether their primary purpose is to further scientific knowledge or to evaluate the benefit of a treatment in routine clinical practice. Future trials should also have outcomes of unequivocal significance and be reported in accordance with standardised guidelines.

CONCLUSIONS

Well-designed and unambiguously reported RCTs usually provide the best possible evidence about the effectiveness of an intervention. RCTs are not, however, the only way of establishing cause and effect and their results should always be interpreted in the light of other evidence.

Child neglect: developmental issues and outcomes

OBJECTIVE

This article highlights the manner in which child neglect, the most common form of maltreatment, affects children's development.

METHOD

The review is organized according to three developmental periods (i.e., infancy/preschool, school-aged and younger adolescents, and older adolescents and adults) and major developmental processes (cognitive, social-emotional, and behavioral). Although the focus is on specific and unique effects of various forms of child neglect, particular attention is paid to studies that allow comparisons of neglect and abuse that clarify their similarities and differences.

RESULTS

Past as well as very recent findings converge on the conclusion that child neglect can have severe, deleterious short- and long-term effects on children's cognitive, socio-emotional, and behavioral development. Consistent with attachment and related theories, neglect occurring early in life is particularly detrimental to subsequent development. Moreover, neglect is associated with effects that are, in many areas, unique from physical abuse, especially throughout childhood and early adolescence. Relative to physically abused children, neglected children have more severe cognitive and academic deficits, social withdrawal and limited peer interactions, and internalizing (as opposed to externalizing) problems.

CONCLUSIONS

The current review offers further support for the long-standing conclusion that child neglect poses a significant challenge to children's development and well-being. Limitations with regard to the state of the knowledge are discussed and directions for future research are outlined.

A developmental psychopathology perspective on adolescence

Developmental psychopathology offers an integrative framework for conceptualizing the course of development during adolescence, with particular relevance for understanding continuity and the emergence of psychopathology during this and subsequent developmental periods. In this article, the utility of a developmental psychopathology perspective for informing the design of research, prevention, and intervention is highlighted. Interdisciplinary, organizational models of development, emphasizing the dynamic relations between the developing individual and internal and external contexts, are discussed. Examination of boundaries between abnormal and normal development during adolescence offers important vantage points for articulating diversity in the developmental course during this period. Conceptualizing divergence and convergence in developmental pathways, continuity and discontinuity in development, and the transactions of risk and protective processes leading to maladaptation, psychopathology, and resilience are highlighted.

The impact of prenatal stress, fetal alcohol exposure, or both on development: perspectives from a primate model

The question of whether psychosocial stress during pregnancy (alone or in combination with fetal alcohol exposure) has negative consequences for offspring has not been clearly established in human studies. In this article, we present an overview of three prospective longitudinal studies. Using rhesus monkeys as subjects, a noise or hormone stressor, alone or in combination with moderate level alcohol solution, was presented daily during different stages of pregnancy. Prenatal stress resulted in lighter birth weights in two of three studies, and males from the alcohol plus noise stress condition had reduced birth weights. There were no significant effects of any of the prenatal treatments on gestation duration. Both prenatal stress and moderate fetal alcohol exposure reduced attention span and neuromotor capabilities of offspring during the first month of life, while early gestation prenatal stress, during the period of neuronal migration, emerged as a period of enhanced vulnerability for these effects. Under conditions of challenge, prenatally stressed monkeys showed more disturbance behaviors and reduced locomotion and exploration as well as altered hypothalamic-pituitary-adrenal (HPA) axis reactivity to stress. Fetal alcohol exposed monkeys also showed increased HPA axis activity in response to stressful conditions. Finally, altered patterns of alcohol consumption during adolescence were associated with prenatal stress.

Attachment and family therapy: clinical utility of adolescent-family attachment research

The divide separating research and clinical work is narrowing. New therapies have been informed by research from specialties such as developmental psychology and developmental psychopathology. In this article, we attempt to illustrate the usefulness of research on attachment relations for family-based therapy with adolescents. We examine the clinical utility of adolescent attachment research within the context of multidimensional family therapy, an empirically supported treatment model that has incorporated developmental research, including basic research on attachment, in its assessment and intervention framework.

Prenatal stress alters early neurobehavior, stress reactivity and learning in non-human primates: a brief review

In this paper we review three prospective longitudinal studies from our laboratory examining the effects of prenatal stress on early neuro behavior, stress reactivity and learning performance in rhesus monkeys. Either a noise stressor or ACTH treatment was administered to pregnant monkeys during specific periods of pregnancy and offspring were examined repeatedly across development. In all three studies, the prenatally stressed monkeys showed reduced attention and impaired neuromotor functioning during the first month of life compared to controls from undisturbed pregnancies. When the monkeys were separated from their mothers or peers at 6-8 months of age, prenatally stressed monkeys exhibited more disturbance behavior and showed hypothalamic-pituitary-adrenal axis dysregulation. During adolescence, they exhibited impairments in learning, compared to controls.

Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent-child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.

Testing hypotheses on specific environmental causal effects on behavior

There have been strong critiques of the notion that environmental influences can have an important effect on psychological functioning. The substance of these criticisms is considered in order to infer the methodological challenges that have to be met. Concepts of cause and of the testing of causal effects are discussed with a particular focus on the need to consider sample selection and the value (and limitations) of longitudinal data. The designs that may be used to test hypotheses on specific environmental risk mechanisms for psychopathology are discussed in relation to a range of adoption strategies, twin designs, various types of "natural experiments," migration designs, the study of secular change, and intervention designs. In each case, consideration is given to the need for samples that "pull-apart" variables that ordinarily go together, specific hypotheses on possible causal processes, and the specification and testing of key assumptions. It is concluded that environmental risk hypotheses can be (and have been) put to the test but that it is usually necessary to use a combination of research strategies.