Developmental Psychopathology and the Research Domain Criteria: Friend or Foe?

Clinical Psychology in the Era of Research Diagnostic Criteria (RDoC): Reconciling Individually-Focused Practice with a Broader Biopsychosocial Context

There is growing consensus that diagnostic labels are insufficient to describe the individual child's psychiatric profile, much less inform the precise combination of interventions that will minimize the impact of risk and/or bolster protective factors over the course of a particular child's development. Moreover, investigations of neurobiological and genetic mechanisms associated with psychopathology have revealed considerable cross-diagnostic overlap, undermining the validity of models that propose a 1:1 relationship between risk and psychiatric disorder. Accordingly, recent publications have advocated for neurodevelopmental models that utilize trait-based measurement, as well as increased emphasis on integration of biological and experiential mechanisms. Despite an expanding body of literature supporting this conceptual shift, the practical implications remain unclear. In this special issue, we compile a collection of novel empirical research papers and reviews that build on the trans-diagnostic principles of the RDoC framework.

The long and winding road: Pathways from basic research to implementation and evaluation

In this article, we celebrate Dante Cicchetti's extensive contributions to the discipline of developmental psychopathology. In his seminal article, he articulated why developmental psychopathology was imperative to create research portfolios that could inform the causes, consequences, and trajectories for adults often initiated by early lived experiences (Cicchetti, 1984). In this three-part article, we share our transdisciplinary efforts to use developmental psychopathology as a foundational theory from which to develop, implement, and evaluate interventions for populations who experienced early adversity or who were at risk for child abuse and neglect. After describing interventions conducted at Mt. Hope Family Center that spanned over three decades, we highlight the criticality of disseminating results and address policy implications of this work. We conclude by discussing future directions to facilitate work in developmental psychopathology. Currently, one of three national National Institute of Child Health and Human Development-funded child abuse and neglect centers, we look forward to continuing to build upon Dante's efforts to disseminate this important work to improve society for our children, our nation's often most vulnerable and forgotten citizens.

A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents

Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.

Using the Infant Sibling-Design to Explore Associations Between Autism and ADHD Traits in Probands and Temperament in the Younger Siblings

The purpose of the current study was to use the infant sibling design to explore whether proband traits of autism and ADHD could provide information about their infant sibling's temperament. This could help us to gain information about the extent to which infant temperament traits are differentially associated with autism and ADHD traits. We used parent-ratings of autistic traits and ADHD traits (CRS-3) in older siblings diagnosed with autism (age range 4 to 19 years), and their infant siblings' temperament traits (IBQ) at 9 months of age in 216 sibling pairs from two sites (BASIS, UK, and EASE, Sweden) to examine associations across siblings. We found specific, but modest, associations across siblings after controlling for sex, age, developmental level and site. Proband autistic traits were specifically related to low levels of approach in the infant siblings, with infant developmental level explaining part of the variance in infant approach. Proband ADHD traits were specifically related to high levels of infant activity even after controlling for covariates. Our findings suggest that proband traits of autism and ADHD carry information for infant sibling's temperament, indicating that inherited liability may influence early emerging behaviours in infant siblings. The impact of sex, age, developmental level and site are discussed.

Restoring the missing person to personalized medicine and precision psychiatry

Precision psychiatry has emerged as part of the shift to personalized medicine and builds on frameworks such as the U.S. National Institute of Mental Health Research Domain Criteria (RDoC), multilevel biological "omics" data and, most recently, computational psychiatry. The shift is prompted by the realization that a one-size-fits all approach is inadequate to guide clinical care because people differ in ways that are not captured by broad diagnostic categories. One of the first steps in developing this personalized approach to treatment was the use of genetic markers to guide pharmacotherapeutics based on predictions of pharmacological response or non-response, and the potential risk of adverse drug reactions. Advances in technology have made a greater degree of specificity or precision potentially more attainable. To date, however, the search for precision has largely focused on biological parameters. Psychiatric disorders involve multi-level dynamics that require measures of phenomenological, psychological, behavioral, social structural, and cultural dimensions. This points to the need to develop more fine-grained analyses of experience, self-construal, illness narratives, interpersonal interactional dynamics, and social contexts and determinants of health. In this paper, we review the limitations of precision psychiatry arguing that it cannot reach its goal if it does not include core elements of the processes that give rise to psychopathological states, which include the agency and experience of the person. Drawing from contemporary systems biology, social epidemiology, developmental psychology, and cognitive science, we propose a cultural-ecosocial approach to integrating precision psychiatry with person-centered care.

ADHD Symptoms, Peer Problems, and Emotion Dysregulation as Longitudinal and Concurrent Predictors of Adolescent Borderline Personality Features

OBJECTIVE

ADHD and borderline personality (BP) disorder are highly comorbid and characterized by emotion dysregulation and peer problems. However, limited research has examined social and emotional predictors of BP features in samples that include youth with ADHD.

METHOD

Using a sample of 124 youth with and without ADHD (52% female), ADHD symptoms, peer problems, and emotion dysregulation were assessed in childhood (8-13 years) and in adolescence, along with BP features (13-18 years).

RESULTS

In addition to the significant effect of ADHD symptoms, teacher-rated child peer victimization and adolescent-reported peer victimization, poorer close friendships, and emotion dysregulation domains significantly predicted adolescent BP features. Greater parent-rated child and adolescent emotion dysregulation domains also significantly predicted adolescent BP features, with ADHD symptoms no longer significant.

CONCLUSION

Even for youth with ADHD, peer and emotional vulnerabilities in childhood and adolescence may serve as important markers of risk for adolescent BP features.

The role of internet gaming in the association between anxiety and depression: A preliminary cross-sectional study

BACKGROUND

Disordered Internet gaming is thought to be perpetuated by one's need to escape their real-life distress or mental health symptoms, which may in turn generate depressive feelings. Nevertheless, moderate engagement with Internet games has also been suggested to provide relief, thus improving one's mood. This study aspires to clarify the contribution of Internet gaming and gender in the association between anxiety and depression.

METHODS

A large sample of Internet gamers (N = 964) were recruited online. Disordered Internet gaming was assessed with the Internet Gaming Disorder Scale, 9 Items Short Form (IGD9S-SF). Anxiety and depression symptoms were assessed using the Depression, Anxiety and Stress Scale, 21 items (DASS-21).

RESULTS

Regression, moderation and moderated moderation analyses accounting for the effects of gender on the relationship between disordered gaming, anxiety, and depression found a significant effect for anxiety symptoms on depression symptoms and a significant interaction between anxiety and Internet gaming disorder on depression symptoms. Findings support the theory that although anxious gamers bear a higher depression risk, this is buffered with lower and exacerbated with higher disordered gaming symptoms.

CONCLUSION

Findings suggest a dual role of Internet gaming in the association between anxiety and depression, depending on the intensity of one's disordered gaming symptoms. Depression prevention and intervention protocols should be optimized by considering the effects of Internet gaming among anxious gamers by focusing on the intensity of a gamer's involvement and any gaming disorder symptoms. Further research should include clinical samples to better understand this interaction.

Adverse childhood experiences predict neurite density differences in young children with and without attention deficit hyperactivity disorder

Adverse childhood experiences (ACEs) put millions of children at risk for later health problems. As childhood represents a critical developmental period, it is important to understand how ACEs impact brain development in young children. In addition, children with attention-deficit/hyperactivity disorder (ADHD) are more likely than typically developing (TD) peers to experience ACEs. Therefore, the current study examined the impact of ACEs on early brain development, using a cumulative risk approach, in a large sample of children with and without ADHD. We examined 198 young children (M_age  = 5.45, 82.3% Hispanic/Latino; 52.5% ADHD) across measures of brain volume, cortical thickness, neurite density index (NDI), and orientation dispersion index (ODI). For the NDI measure, there was a significant interaction between group and cumulative risk (ß = .18, p = .048), such that for children with ADHD, but not TD children, greater cumulate risk was associated with increased NDI in corpus callosum. No other interactions were detected. Additionally, when examining across groups, greater cumulative risk was associated with reduced ODI and volume in the cerebellum, although these findings did not survive a correction for multiple comparisons. Our results highlight the role early cumulative ACEs play in brain development across TD and children with ADHD.

Applying new RDoC dimensions to the development of emotion regulation: Examining the influence of maternal emotion regulation on within-individual change in child emotion regulation

While the Research Domain Criteria (RDoC) acknowledges that environmental and developmental influences represent important elements of the RDoC framework, there is little specificity regarding how and when to systematically examine the impact of these dimensions on domains of function. The primary aims of this paper are to demonstrate the ways in which the RDoC can be expanded to include an explicit emphasis on (a) assessing within-individual change in developmental processes over time and (b) evaluating the extent to which selective and measurable environmental influences drive meaningful change during key developmental periods. We provide data from an ongoing randomized control trial as a proof of concept to highlight how repeated assessments within an experimental intervention design affords the unique opportunity to test the impact of environmental influences on within-individual change. Using preliminary data from 77 mother–child dyads repeatedly assessed across 12 months during the sensitive preschool period, we demonstrate the impact of change in maternal emotion regulation (ER) on within-individual growth in child ER and link that growth to fewer teacher-reported externalizing problems. In line with this Special Issue, findings are discussed within the context of expanding and clarifying the existing RDoC framework to explicitly incorporate environmental and developmental dimensions.

Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care

Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.

Advancing the RDoC initiative through the assessment of caregiver social processes

The relationships infants and young children have with their caregivers are fundamental to their survival and well-being. Theorists and researchers across disciplines have attempted to describe and assess the variation in these relationships, leading to a general acceptance that caregiving is critical to understanding child functioning, including developmental psychopathology. At the same time, we lack consensus on how to assess these fundamental relationships. In the present paper, we first review research documenting the importance of the caregiver-child relationship in understanding environmental risk for psychopathology. Second, we propose that the National Institute of Mental Health's Research Domain Criteria (RDoC) initiative provides a useful framework for extending the study of children's risk for psychopathology by assessing their caregivers' social processes. Third, we describe the units of analysis for caregiver social processes, documenting how the specific subconstructs in the domain of social processes are relevant to the goal of enhancing knowledge of developmental psychopathology. Lastly, we highlight how past research can inform new directions in the study of caregiving and the parent-child relationship through this innovative extension of the RDoC initiative.

Childhood ADHD Symptoms, Parent Emotion Socialization, and Adolescent Peer Problems: Indirect Effects Through Emotion Dysregulation

Although parent reactions to children's negative emotions are important to the development of adolescent social and emotional functioning, there is a lack of research examining this aspect of parenting in samples that include youth with attention-deficit/hyperactivity disorder (ADHD). This study addresses this gap in the research by examining the independent effects of childhood ADHD symptoms and parent reactions to negative emotions in the longitudinal prediction of adolescent emotion dysregulation and peer problems. A sample of 124 youth (52% female) with and without clinical elevations in ADHD symptoms were assessed in childhood (8-12 years; M = 10.50) and followed up 5-6 years later in adolescence (13-18 years; M = 16.15). Path models tested the direct effects of childhood ADHD symptoms, supportive parent reactions, and non-supportive parent reactions on adolescent peer problems (friendship quality, deviant peer affiliation, peer aggression) and the indirect effects via adolescent emotion dysregulation. Emotion dysregulation mediated the effects of greater ADHD symptoms and of less parent supportive reactions on adolescent peer problems; parent reactions also independently predicted specific adolescent peer problems. Even for youth with clinical elevations in ADHD symptoms, parent reactions to children's negative emotions may be important in understanding adolescent emotion dysregulation and peer problems.

Using Development and Psychopathology Principles to Inform the Research Domain Criteria (RDoC) Framework

In 2010, the Research Domain Criteria (RDoC) were developed to advance our understanding of the pathophysiology of mental illness across multiple levels of analysis, ranging from cells to circuits to self-report instruments. Several conceptual RDoC-informed manuscripts have highlighted the importance of studying how developmental processes give rise to psychopathology. However, there are few empirical studies that integrate the RDoC framework with development and psychopathology principles. This special issue was developed to fill this empirical gap. In this introduction to the special issue, we describe how the developmental psychopathology field predates and informs the RDoC framework. We highlight three important ways in which developmental psychopathology and the RDoC framework can mutually inform one another, leading to novel discoveries to identify, prevent, and treat mental health problems across the life span.

The centrality of temperament to the research domain criteria (RDoC): The earliest building blocks of psychopathology

The research domain criteria (RDoC) is an innovative approach designed to explore dimensions of human behavior. The aim of this approach is to move beyond the limits of psychiatric categories in the hope of aligning the identification of psychological health and dysfunction with clinical neuroscience. Despite its contributions to adult psychopathology research, RDoC undervalues ontogenetic development, which circumscribes our understanding of the etiologies, trajectories, and maintaining mechanisms of psychopathology risk. In this paper, we argue that integrating temperament research into the RDoC framework will advance our understanding of the mechanistic origins of psychopathology beginning in infancy. In illustrating this approach, we propose the incorporation of core principles of temperament theories into a new "life span considerations" subsection as one option for infusing development into the RDoC matrix. In doing so, researchers and clinicians may ultimately have the tools necessary to support emotional development and reduce a young child's likelihood of psychological dysfunction beginning in the first years of life.

Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective

By the time they are typically detected, neurodevelopmental disorders like autism spectrum disorder (ASD) are already challenging to treat. Preventive and early intervention strategies in infancy are critical for improving outcomes over the lifespan with significant cost savings. However, the impact of prevention and early intervention efforts is dependent upon our ability to identify infants most appropriate for such interventions. Because there may be significant overlap between prodromal symptoms across neurodevelopmental disorders and child psychopathology more broadly which may wax and wane across development, we contend that the impact of prevention and early intervention efforts will be heightened by identifying early indicators that may overlap across ASD and other commonly co-occurring disorders. This paper summarizes the existing literature on infant symptoms and identification of ASD to demonstrate the ways in which a transdiagnostic perspective could expand the impact of early identification and intervention research and clinical efforts, and to outline suggestions for future empirical research programs addressing current gaps in the identification-to-treatment pipeline. We propose four recommendations for future research that are both grounded in developmental and clinical science and that are scalable for early intervention systems: (1) development of fine-grained, norm-referenced measures of ASD-relevant transdiagnostic behavioral domains; (2) identification of shared and distinct mechanisms influencing the transition from risk to disorder; (3) determination of key cross-cutting treatment strategies (both novel and extracted from existing approaches) effective in targeting specific domains across disorders; and (4) integration of identified measures and treatments into existing service systems.