Autism's existential crisis: a reflection on Livingston et al. (2018)

Livingston and colleagues present an empirical investigation of the compensatory framework describing the autism clinical phenotype as the sum of intrinsic neurocognitive deficits and compensatory mechanisms. This commentary highlights several methodologic features of the study that are pertinent to interpretation and reflects on the reduction of social behavior to cognitive processes. Taken together, the notion of compensation calls into question the validity and utility of the current behavioral diagnosis of autism.     

Commentary: Response to commentary by Rutter on Munafo et al. (2014)

Rutter's commentary (Rutter, 2014) on our article (Munafò et al., 2014) provides us the opportunity to clarify some issues that he (and therefore, we suspect, others) may have misunderstood.     

A commentary on Ehrlich et al. (2023): a resilience paradox for child development

Paradoxically, resilience carries with it the risk of disorder. When understood systemically, this should come as no surprise. All complex systems demonstrate this same propensity for both positive and negative feedback loops. A thriving ecosystem eventually succumbs to its own dominance over its environment, using up available resources until its survival is threatened and its population declines (e.g. predators like coyotes in a national park where hunting is prohibited) (Ward et al., 2018). For this reason, systems that demonstrate powerful resistance to threat are, paradoxically, often made vulnerable by their success.     

Commentary: Attachment is a biological concept – a reflection on Fearon et al. (2014)

This article is a commentary on Fearon et al. (2014, Genetic and environmental influences on adolescent attachment) published in this issue.     

Commentary: Mapping the young,resilient brain – reflections on Burt et al. (2016)

The resilience of many children in the face of adversity has long been a research focus. The study by Burt et al. delineates the neuroanatomy of resilience, using in vivo magnetic resonance images acquired on 1,800 youth. They find that resilient youth had a larger right lateral prefrontal cortex compared to youth who either lacked resilience or did not experience adversity. The size of the right lateral prefrontal cortex was further associated with a likelihood of a maladaptive problem of alcohol use. These findings implicate high‐order regulatory processes supported by the right lateral prefrontal cortex as pivotal in resilience. The study also sets the stage for exploring how neuroimaging data, combined with behavioral and genomic information might be used to assess treatment efficacy and identify children who need therapeutic interventions to boost their resilience.     

Commentary: Supporting preterm children's parents matters – a reflection on Treyvaud et al. (2016)

Children born preterm or with low birth weight (LBW) grow up with an increased risk for a range of neurodevelopmental, cognitive, socioemotional, and academic problems. While long‐term effects of preterm and LBW birth have traditionally been studied from a deficit perspective, Treyvaud et al. correctly state that the increased risk for impairments in this population urgently requires identification of protective factors. Their new findings add to empirical evidence from observational studies showing that sensitive parenting can protect preterm children from negative developmental outcomes. In order to identify strategies that support preterm children's life chances, well‐designed longitudinal studies, such as the one by Treyvaud et al., are indispensable. Next, we will need large randomized trials to test the causality between intervention‐induced parenting changes and preterm children's long‐term outcomes. We need interdisciplinary and international collaboration to study preterm parent–child dyads within multimethod frameworks and uncover the highly complex mechanisms that shape individual developmental trajectories.     

Mediation of meaningful outcomes in early intervention: a commentary on Carruthers et al. (2023)

Across the spectrum of behavioral, naturalistic developmental behavioral, and developmental/relational interventions for young children with autism, there has been limited empirical testing of the mechanism of these early intervention approaches. Testing mediation provides insights to the how or why the intervention condition may be preferred in comparison to a control in the population sample (Kraemer, American Journal of Psychiatry, 2016, 173, 672). Combined with an understanding of moderation (for whom or under what conditions), we move toward a better understanding of how to personalize interventions to build on strengths and maximize skill gains for autistic children. Yet, to date there are very few published texts of mechanism in early intervention for young children with autism. This commentary explores a recently published article by Carruthers et al (2023) and examines themes and considerations for measurement of intervention outcomes and mediators.     

Commentary: Cognitive and emotional empathy in transdiagnostic research – reflections on Klapwijk et al. (2016)

Evidence across multiple disorders indicates that empathy is a transdiagnostic dimension of psychopathology. Klapwijk et al.'s (2016) functional MRI study examines whether autism spectrum disorder (ASD) and conduct disorder (CD) can be distinguished by the constructs of ‘cognitive’ and ‘emotional’ empathy – with the former focusing on accurate emotion perception and the latter on shared affective experience. This commentary examines the implications of the cognitive/emotional empathy distinction, and how it fits with existing accounts of perceptual differences in ASD. Cognitive empathy overlaps substantially with the constructs of emotion perception and Theory of Mind – both well studied among individuals with ASD, but generally viewed as fairly distinct from empathy. CD, on the other hand, is typically not associated with frank perceptual deficits. Although the brain imaging data from this study do not provide strong support for the constructs of cognitive and emotional empathy, the general approach used in this study is precisely the kind needed to test the validity and utility of transdiagnostic mechanisms of psychopathology.     

Commentary: Getting fathers into parenting programmes – a reflection on Panter‐Brick et al. (2014)

Research, policy and clinical practice focussed on engaging and working with fathers and their children often seems to oscillate between extremes. Where policy documents relating to children's health and wellbeing do include fathers it is often in a restricted way, and similarly discussions about the role of fathers in the media are often one‐dimensional. It is sometimes hard to escape a feeling of despondency at the continuing exchanges, too often made ignoring or misinterpreting years of research regarding the importance of co‐parenting and the involvement of fathers and other carers. One of the great contributions of child and adolescent mental health professionals has been the drawing of attention to the importance of family processes and systemic thinking, yet in relation to parenting, this seems to have been increasingly overlooked in recent years with an increased focus on attachment or social learning inspired approaches for a single parent–child dyad. In this issue of the JCPP, in a thorough and timely review, Catherine Panter‐Brick and colleagues call for a clear change to the way parenting programmes are considered, studied and implemented. In this commentary, we reflect on this call and look at three challenges for CAMHS professionals.