A developmental psychopathology perspective on child and adolescent treatment policy

This article considers the implications of theory and research in developmental psychopathology for existing and emerging social policy concerning treatment of child and adolescent psychopathology. Based on the concept that all psychopathology is a process, four core principles of a developmental psychopathology perspective are discussed. In turn, each is applied to an evaluation of policy issues with implications for intervention, including mental health parity, treatment guidelines, mental health reimbursement, and level of intervention. It is concluded that social policy on treatment must be based on an empirically supported theory of developmental psychopathology and on evidence-based interventions that link treatments to pathogenic processes.     

The transmission of risk to children from mothers with schizophrenia: a developmental psychopathology model

Research in children of mothers with schizophrenia (HRsz children) has focused on identifying the early antecedents of adult illness to understand its intergenerational (primarily genetic) transmission. From a developmental psychopathology perspective, the vulnerability of HRsz children may result from multiple environmental factors interacting with ongoing developmental processes. The objectives were: (1) to understand the extent to which having a mother with schizophrenia impacts on developmental and clinical trajectories; (2) to review whether research supports a proposed model for the non-genetic transmission of risk in HRsz offspring; (3) to discuss the implications of the model for early intervention. HRsz children show vulnerability in a range of areas throughout childhood, but the findings are not unanimous in any single domain, and poor developmental functioning in any given domain does not necessarily predict morbidity. Broad support for a developmental psychopathology model is provided by studies suggesting a generalised vulnerability and studies on the impact of psychosocial factors. However, little empirical research has elucidated specific proximal social environmental influences through development. Gaps in the literature are identified where studies in depressed mothers and other groups are potentially informative, and which suggest that conventional psychological therapies may not be sufficient to enhance offspring outcomes. Future research could inform our understanding of developmental psychopathology and the development of preventative interventions.     

International adoption of institutionally reared children: research and policy

This article summarizes the research on the developmental outcomes of postinstitutionalized children and discusses the implications for social policy. Postinstitutionalized children often reach their adoptive families with varying degrees of physical growth retardation, cognitive delays, and socioemotional problems. Many children demonstrate remarkable recovery following adoption. Unfortunately, some of the children continue to display significant problems that require professional intervention. It appears that the children's recovery may be influenced by their early experiences with their birth family and in institutional care, and there is suggestive evidence that postadoption experiences also play a role. These findings indicate that preadoption and postadoption services may support the outcome of postinstitutionalized children.     

Striving to do well what comes naturally: social support, developmental psychopathology, and social policy

Social support can have significant stress-preventive and stress-buffering benefits for troubled individuals in everyday circumstances. Consequently, it is not surprising that many therapeutic and preventive programs enlist social support to address problems of child and family psychopathology, especially in the context of "two-generation interventions" that seek to improve child well-being by strengthening parental functioning and parent-child relationships. Home visitation programs are the best known of these two-generation strategies and have become the focus of state-level and national efforts to support families and prevent harm to children. The conclusions of basic research studies on social support converge significantly with the findings of evaluation studies of the impact of home visitation programs to yield important new insights into the conditions in which formal social support is likely to be beneficial. or ineffective, in improving child and family well-being. Both basic and applied research literatures emphasize the importance of linking formal social support to informal social networks in extended families, neighborhoods, and communities, and attending to the complex reactions of the recipients of support and the needs of support providers. These studies are reviewed and evaluated to highlight the connections between social support, developmental psychopathology. and social policy.     

Changes in womens' roles: impact on and social policy implications for the mental health of women and children

In recent years. womens' roles have changed dramatically, prompting researchers to examine the impact of these changes on the development of women and children. In this article, we examine three major changes that women have experienced over the past several decades: increased participation in the paid labor force, changes in domestic labor and child-care patterns, and increased numbers of female-headed single-parent families. For each, we first describe the nature of the changes that have occurred over the last 50 years. We then review research concerning the effects of these changes on the development of women and children. Finally, we discuss the implications for social policy that stem from this research. It is broadly concluded that research informed by a developmental-contextual perspective may contribute importantly to the development of social policies focused on promoting the well-being of women and children.     

Saving lives for a lifetime: supporting orphans and vulnerable children impacted by HIV/AIDS

President's Emergency Plan for AIDS Relief (PEPFAR's) response to the millions of children impacted by HIV/AIDS was to designate 10% of its budget to securing their futures, making it the leading supporter of programs reaching orphan and vulnerable children (OVC) programs globally. This article describes the evolution of PEPFAR's OVC response based on programmatic lessons learned and an evergrowing understanding of the impacts of HIV/AIDS. In launching this international emergency effort and transitioning it toward sustainable local systems, PEPFAR helped establish both the technical content and the central importance of care and support for OVC as a necessary complement to biomedical efforts to end the HIV/AIDS epidemic. Critical services are reaching millions of HIV-affected children and families through vast networks of community-based responders and strengthened national systems of care. But rapid program scale-up has at times resulted in inconsistent responses, failure to match resources to properly assessed needs, and a dearth of rigorous program evaluations. Key investments should continue to be directed toward more sustainable and effective responses. These include greater attention to children's most significant developmental stages, a focus on building the resilience of families and communities, a proper balance of government and civil society investments, and more rigorous evaluation and research to ensure evidence-based programming. Even as HIV prevalence declines and medical treatment improves and expands, the impacts of HIV/AIDS on children, families, communities, economies, and societies will continue to accumulate for generations. Protecting the full potential of children-and thus of societies-requires sustained and strategic global investments aligned with experience and science.     

Addressing the Needs: Guidelines for Training Psychologists to Work with Children,Youth, and Families

A need exists for criteria for training psychologists who work with children, youth, and families. Recognizing that the provision of competent services is directly related to training for those services, a set of recommendations was adopted by the Executive Committee of the Division on Child, Youth, and Family Services. This paper outlines these recommended experiences and coursework with their rationale for child development and lifespan developmental psychology, child and adult psychopathology, mental retardation and developmental disabilities; specialized child assessment techniques; child psychotherapy and behavior change; parent, family, and school intervention techniques; specialized clinical practice in child, parent, and family therapy; research methods in child psychology; ethics and legal issues related to children, youth, and families; and subspecialties within psychology for children, youth, and families. Examples of training programs meeting these recommended training criteria are discussed.     

A developmental perspective on functional somatic symptoms

OBJECTIVE: To provide a new approach for conceptualizing and studying functional somatic symptoms (FSS) in children and adolescence. METHODS: A developmental model is proposed based on the synthesis of the extant literature and previous theoretical perspectives of FSS in children and adolescents. RESULTS: Multiple risk and protective factors from child, familial, social, and environmental domains, the interactions across risk domains, and potential developmental pathways of FSS are identified. CONCLUSIONS: This article underscores the necessity of taking a broader, developmental view of FSS. The tenets of developmental psychopathology emphasize the utility of viewing FSS on a continuum of severity rather than as a discrete entity or diagnosis. This article concludes with directions for future research and treatment implications.     

Child, parent, and parent-child emotion narratives: implications for developmental psychopathology

Studies using narratives with children and parents offer ways to study affective meaning-making processes that are central in many theories of developmental psychopathology. This paper reviews theory regarding affective meaning making, and argues that narratives are particularly suited to examine such processes. The review of narrative studies and methods is organized into three sections according to the focus on child, parent, and parent-child narratives. Within each focus three levels of analysis are considered: (a) narrative organization and coherence, (b) narrative content, and (c) the behavior/interactions of the narrator(s). The implications of this research for developmental psychopathology and clinical work are discussed with an emphasis on parent-child jointly constructed narratives as the meeting point of individual child and parent narratives.     

Pubertal neuromaturation, stress sensitivity, and psychopathology

Normal adolescent development is often accompanied by transient emotional and behavioral problems. For most individuals with postpubertal-onset adjustment problems, there is a resolution by early adulthood and relative stability through the adult life span. But for a minority, adjustment problems escalate during adolescence and portend the development of serious mental illness in adulthood. In this article, we explore adolescent behavioral changes and neurodevelopmental processes that might contribute to stress sensitivity and vulnerability for the emergence of the mental disorders. Of particular interest is the role that hormonal changes might play in the expression of genetic vulnerabilities for psychopathology. Drawing on recent findings from clinical research and behavioral neuroscience, we describe the ways in which postpubertal hormones might alter brain function and, thereby, behavior. It is concluded that there are both activational and organization effects of hormones on the adolescent brain, and these contribute to developmental discontinuities in behavioral adjustment. Implications for adult psychopathology and preventive intervention are discussed.     

Emotion Dysregulation as a Risk Factor for Child Psychopathology

This article reviews research on the construct of emotion regulation in young children. The lack of consensus with regard to a definition of emotion regulation notwithstanding, it appears that biological and behavioral processes involved in emotion regulation can be reliably measured early in life. Such indices of reactivity may be useful in identifying children at risk for developmental psychopathology, but the predictive utility of these indices has yet to be established. Measurement issues and factors hypothesized to affect an infant's risk for dysregulation, such as care-giving factors, are presented. The implications of continued programmatic research on emotion dysregulation early in life are discussed.     

Closing the Gaps: Developmental Psychopathology as aTraining Model for Clinical Child Psychology

Espouses developmental psychopathology as a framework for training our future leaders due to its emphasis on an ecological, transactional lifespan perspective, as well as interdisciplinary bridging and policy focus. This perspective, used as a framework for questioning and thinking about the complex interplay of psychological and social phenomena, provides a method for closing the gaps in training future psychologists as it allows for the development of niche expertise under an umbrella of the broader, ecological perspective. In an increasingly complex world of shrinking mental health dollars and growing severity of mental health problems for families and youth, clinical psychologists are needed more than ever to solve social problems. The current training paradigms in clinical child psychology programs need redirection and clarification for future psychologists to contribute meaningfully to science, practice, and policy. This article provides background in the history and influence of the developmental psychopathology perspective, as well as future implications for doctoral training programs in clinical psychology.     

Bringing basic research on early experience and stress neurobiology to bear on preventive interventions for neglected and maltreated children

A major focus in developmental psychopathology is on understanding developmental mechanisms and, armed with this information, intervening to improve children's outcomes. Translational research attempts to bridge the distance between understanding and intervention. In the collaborations that have formed the core of our research network on early experience, stress, and prevention science, we have focused on translating basic research on early experiences and stress neurobiology into preventive interventions for neglected and abused children. Our experiences in attempting to move from bench to bedside have led us to recognize the many challenges that face translational researchers. This review provides a brief synopsis of the animal model literature on early experience and stress neurobiology from which we glean several key bridging issues. We then review what is currently known about the impact of childhood neglect and abuse on stress neurobiology in human adults and children. Next, we describe how this work has informed the evaluation of our preventive interventions with maltreated children. Finally, we discuss several considerations that should facilitate a more complete integration of basic research on early experience and stress neurobiology into preventive intervention strategies.     

Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression

The focus of this article is on internalizing problems that are experienced by children and adolescents. We provide an historical perspective, selectively examine the current state of knowledge, consider advances and gaps in what is known, and identify new research directions. Diagnosis, epidemiology, theory, and research first are considered separately for anxiety and depressive disorders. These internalizing problems, however, whether clinical or subclinical, share many common features and show high comorbidity rates. We emphasize the importance of systematic analysis of comorbid anxiety and depression, including their comorbidity with externalizing problems. This could lead to more valid classification of subtypes of internalizing problems and further an understanding of the diverse conditions that constitute internalized distress. We highlight the need to study anxiety and depression within a developmental psychopathology framework, as well as to include both categorical and dimensional assessments of these problems in the same research designs. This will be essential for understanding the complex interplay of biological and environmental processes that contribute to the emergence, progression, and amelioration of internalizing problems over time.     

Effect of incest on self and social functioning: a developmental psychopathology perspective.

The effects of child sexual abuse have become a leading concern of mental health service providers. Despite an explosion of studies, one major difficulty in this research is the lack of a developmentally sensitive model for conceptualizing short- and long-term effects and continuity and discontinuity of effects over time. This article proposes a model based in the perspective of developmental psychopathology. It is argued that incest has its unique negative effects in the domains of self and social functioning, specifically in jeopardizing self-definition and integration, self-regulatory processes, and a sense of security and trust in relationships. Studies with clinical samples indicate that diagnostic conditions associated uniquely with a history of incest reflect serious self- and social impairments. A review of the developmental literature on self and social development summarizes each major developmental transition from infancy to middle adulthood, and the implications for the negative effects of incest on development are discussed. Finally, implications for developmentally sensitive research are discussed.     

Advocacy for children's mental health: a personal journey.

This article describes the ways in which I have tried, primarily as a policy researcher, to bring an advocacy perspective to my own work and, in collaboration with others, engage in efforts to improve the lives of children experiencing emotional and behavioral challenges as well as the lives of their families. It is organized in 3 sections. The 1st section highlights my early career path and its relation to advocacy. The 2nd section summarizes the policy research I have conducted that has given me a broad understanding of children's mental health. The 3rd highlights lessons for advocates and my view of critical recommendations for the future.     

The beliefs, motivations, and expectations of parents who have enrolled their children in a genetic biorepository

PurposeLittle is known about parental attitudes toward return of individual research results (IRRs) in pediatric genomic research. The aim of this study was to understand the views of the parents who enrolled their children in a genomic repository in which IRRs will be returned.MethodsWe conducted focus groups with parents of children with developmental disorders enrolled in the Gene Partnership (GP), a genomic research repository that offers to return IRRs, to learn about their understanding of the GP, motivations for enrolling their children, and expectations regarding the return of IRRs.ResultsParents hoped to receive IRRs that would help them better understand their children’s condition(s). They understood that this outcome was unlikely, but hoped that their children’s participation in the GP would contribute to scientific knowledge. Most parents wanted to receive all IRRs about their child, even for diseases that were severe and untreatable, citing reasons of personal utility. Parents preferred electronic delivery of the results and wanted to designate their preferences regarding what information they would receive.ConclusionIt is important for researchers to understand participant expectations in enrolling in a research repository that offers to disclose children’s IRRs in order to effectively communicate the implications to parents during the consenting process.Genet Med 2012:14(3):330–337     

Future Directions in Childhood Adversity and Youth Psychopathology

Despite long-standing interest in the influence of adverse early experiences on mental health, systematic scientific inquiry into childhood adversity and developmental outcomes has emerged only recently. Existing research has amply demonstrated that exposure to childhood adversity is associated with elevated risk for multiple forms of youth psychopathology. In contrast, knowledge of developmental mechanisms linking childhood adversity to the onset of psychopathology—and whether those mechanisms are general or specific to particular kinds of adversity—remains cursory. Greater understanding of these pathways and identification of protective factors that buffer children from developmental disruptions following exposure to adversity is essential to guide the development of interventions to prevent the onset of psychopathology following adverse childhood experiences. This article provides recommendations for future research in this area. In particular, use of a consistent definition of childhood adversity, integration of studies of typical development with those focused on childhood adversity, and identification of distinct dimensions of environmental experience that differentially influence development are required to uncover mechanisms that explain how childhood adversity is associated with numerous psychopathology outcomes (i.e., multifinality) and identify moderators that shape divergent trajectories following adverse childhood experiences. A transdiagnostic model that highlights disruptions in emotional processing and poor executive functioning as key mechanisms linking childhood adversity with multiple forms of psychopathology is presented as a starting point in this endeavour. Distinguishing between general and specific mechanisms linking childhood adversity with psychopathology is needed to generate empirically informed interventions to prevent the long-term consequences of adverse early environments on children’s development.     

Advocacy for Children's Mental Health: A Personal Journey

This article describes the ways in which I have tried, primarily as a policy researcher, to bring an advocacy perspective to my own work and, in collaboration with others, engage in efforts to improve the lives of children experiencing emotional and behavioral challenges as well as the lives of their families. It is organized in 3 sections. The 1st section highlights my early career path and its relation to advocacy. The 2nd section summarizes the policy research I have conducted that has given me a broad understanding of children's mental health. The 3rd highlights lessons for advocates and my view of critical recommendations for the future.     

Benefits and pitfalls in the merging of disciplines: the example of developmental psychopathology and the study of persons with autism

Recent advances in the discipline of developmental psychopathology highlight the contributions of developmental thought to the study of persons with autism. This article briefly outlines primary developmental innovations in theory, methodology, and the interpretation of findings. Specifically. we discuss two sets of issues that arise from the general notion of developmental level. One set is relevant to the choice of persons that comprise the comparison group and the other to the various implications of the subjects' levels of functioning. In sum, we contend that researchers need to frame their empirical work within the context of developmental theory and methodology and interpret their findings accordingly. This will lead to scientifically compelling work and an increasingly heuristic approach to the study of persons with autism.