Psychopathology and development: I. Childhood antecedents of adult psychiatric disorder

Mental Imagery and its Relevance for Psychopathology and Psychological Treatment in Children and Adolescents: a Systematic Review

This review provides an overview of the current state of research concerning the role of mental imagery (MI) in mental disorders and evaluates treatment methods for changing MI in childhood. A systematic literature search using PubMed/Medline, Web of Science, and PsycINFO from 1872 to September 2020 was conducted. Fourteen studies were identified investigating MI, and fourteen studies were included referring to interventions for changing MI. Data from the included studies was entered into a data extraction sheet. The methodological quality was then evaluated. MI in childhood is vivid, frequent, and has a significant influence on cognitions and behavior in posttraumatic stress disorder (PTSD), social anxiety disorder (SAD), and depression. The imagery’s perspective might mediate the effect of MI on the intensity of anxiety. Imagery rescripting, emotive imagery, imagery rehearsal therapy, and rational-emotive therapy with imagery were found to have significant effects on symptoms of anxiety disorders and nightmares. In childhood, MI seems to contribute to the maintenance of SAD, PTSD, and depression. If adapted to the developmental stages of children, interventions targeting MI are effective in the treatment of mental disorders.

Characteristics of Adolescent Psychiatric Inpatients in Relation to Their History of Preceding Child Psychiatric Inpatient Care

Among psychiatric inpatients aged 13 to 17, various familial and clinical characteristics were compared between those with and without a previous history of specialized child psychiatric care (CPSY versus non-CPSY). CPSY adolescents were younger (boys: odds ratio [OR], 0.7; girls: OR, 0.4) at admission to adolescent psychiatric inpatient care, and they more likely had mothers with psychiatric problems (boys: OR, 4.0; girls: OR, 4.8) and child welfare placement background (boys: OR, 2.8; girls: OR, 6.7) compared with non-CPSY adolescents. CPSY girls were also characterized as having unemployed mothers (OR, 3.1) and engaging in nonsuicidal self-injury (OR, 3.1), whereas CPSY boys were diagnosed with anxiety (OR, 2.7) or conduct disorder (OR, 2.8). Based on our study, family-focused care and intervention services are required to prevent continuity of psychiatric disorders from childhood into adolescence.

Children's biobehavioral reactivity to challenge predicts DNA methylation in adolescence and emerging adulthood

A growing body of research has documented associations between adverse childhood environments and DNA methylation, highlighting epigenetic processes as potential mechanisms through which early external contexts influence health across the life course. The present study tested a complementary hypothesis: indicators of children's early internal, biological, and behavioral responses to stressful challenges may also be linked to stable patterns of DNA methylation later in life. Children's autonomic nervous system reactivity, temperament, and mental health symptoms were prospectively assessed from infancy through early childhood, and principal components analysis (PCA) was applied to derive composites of biological and behavioral reactivity. Buccal epithelial cells were collected from participants at 15 and 18 years of age. Findings revealed an association between early life biobehavioral inhibition/disinhibition and DNA methylation across many genes. Notably, reactive, inhibited children were found to have decreased DNA methylation of the DLX5 and IGF2 genes at both time points, as compared to non‐reactive, disinhibited children. Results of the present study are provisional but suggest that the gene's profile of DNA methylation may constitute a biomarker of normative or potentially pathological differences in reactivity. Overall, findings provide a foundation for future research to explore relations among epigenetic processes and differences in both individual‐level biobehavioral risk and qualities of the early, external childhood environment.

Mental Imagery in Depression: Phenomenology, Potential Mechanisms, and Treatment Implications

Mental imagery is an experience like perception in the absence of a percept. It is a ubiquitous feature of human cognition, yet it has been relatively neglected in the etiology, maintenance, and treatment of depression. Imagery abnormalities in depression include an excess of intrusive negative mental imagery; impoverished positive imagery; bias for observer perspective imagery; and overgeneral memory, in which specific imagery is lacking. We consider the contribution of imagery dysfunctions to depressive psychopathology and implications for cognitive behavioral interventions. Treatment advances capitalizing on the representational format of imagery (as opposed to its content) are reviewed, including imagery rescripting, positive imagery generation, and memory specificity training. Consideration of mental imagery can contribute to clinical assessment and imagery-focused psychological therapeutic techniques and promote investigation of underlying mechanisms for treatment innovation. Research into mental imagery in depression is at an early stage. Work that bridges clinical psychology and neuroscience in the investigation of imagery-related mechanisms is recommended.

Mental imagery, emotion and psychopathology across child and adolescent development

Mental imagery-based interventions are receiving increasing interest for the treatment of psychological disorders in adults. This is based on evidence that mental imagery potently influences the experience of emotion in non-clinical samples, and that a number of psychological disorders are marked by syndrome-specific, distressing abnormalities in mental imagery. During childhood and adolescence, neurocognitive development impacting mental imagery processes may moderate its relationship with clinically-relevant emotional symptoms at a number of potential loci. Crucially, these changes could impact vulnerability to distressing mental imagery and the efficacy of mental imagery-based clinical interventions. This review synthesises evidence pertaining to developmental changes in the role and content of mental imagery, and in the cognitive sub-processes required to generate and sustain mental images. Subsequently, we discuss implications for understanding the developmental relationship between mental imagery, emotion and psychopathology. Translational cognitive neuroscience research investigating the content, emotional impact and neurocognitive substrates of mental imagery across development may reveal insights into trajectories of vulnerability to symptoms of a number of psychological disorders. If proper consideration is given to developmental factors, techniques based on mental imagery may be valuable as part of a treatment armoury for child and adolescent clinical populations and those at risk of emotional disorders.

The role of childhood parent figure loss in the etiology of adult depression: findings from a prospective longitudinal study

The underlying question of this study is whether childhood parental loss between infancy and sixth grade is a predictor of adult depression at age 26 years when a rating of loss severity is used. The loss rating considered the length of the separation/loss, the familiarity of substitute caregivers, the primary or supporting role of the lost parent figure, and traumatic features of the loss. The study also investigated the role of gender, developmental timing of the loss, life stress, SES, prior parental care and attachment history, and follow-up family relationships in the pathways between loss and depression. Results are reported from a prospective longitudinal study of children (N = 164) born into poverty. Measures were collected prenatally through age 26 years and included multiple methods and multiple reporters. Results indicated that the most robust predictor of adult depression was loss history between 5 years old and grade 2. Earlier and later measures of loss were not related to adult depression. However, intervening loss experiences predicted change in depression scores from childhood to adulthood. Loss continued to predict adult depression after controlling for SES, maternal life stress, participant life stress, gender, early caregiving, and follow up family functioning. This study found no significant gender differences. These results suggest that loss is a risk factor for adult depression for both boys and girls and that the quality of early and later caregiving do not entirely buffer children from the effects of parental loss.

Childhood predictors of future psychiatric morbidity in offspring of mothers with psychotic disorder: results from the Helsinki High-Risk Study

BACKGROUND

The Helsinki High-Risk Study monitors women treated for schizophrenia-spectrum disorders in Helsinki mental hospitals before 1975, their offspring, and controls.

AIMS

To compare the development of high-risk and control group children, and investigate which factors predicted future psychiatric disorders.

METHOD

We examined information from childhood and school health record cards of 159 high-risk and 99 control group offspring. Logistic regression was used to assess whether developmental abnormalities predicted later mental disorders.

RESULTS

Compared with controls, children in the high-risk group had more emotional symptoms before school age, attentional problems and social inhibition at school age, and neurological soft signs throughout. In this group pre-school social adjustment problems (OR=9.7, 95% CI 1.8-51.8) or severe neurological symptoms (Fisher's test, P=0.006) predicted future schizophrenia-spectrum disorder. Social adjustment problems and emotional symptoms during school age predicted future non-psychotic psychiatric disorders.

CONCLUSIONS

Our study supports the validity of neurological, emotional, social and behavioural markers as vulnerability indicators of psychotic and other mental disorders, particularly among children genetically at high risk of psychosis.

How important is permanency planning for children? Considerations for pediatricians involved in child protection

"Permanency planning" refers to maximizing stability in living situations for children in the care of child protection agencies. This issue concerns pediatricians who may be involved in assessing and providing care for these children. In North America, permanency planning is widely advocated if not always effectively implemented. The concept, however, is still controversial from the perspective of protecting parents' interests. This paper examines the principles and evidence underlying the concept of permanency planning in order to ascertain whether emphasizing it remains justified in terms of children's emotional health and development. Three related bodies of literature are reviewed: requirements for healthy child development, conditions that create risk for children, and outcomes for children in care. The findings suggest that permanency planning is vitally important for children and is not only justified, but should be given major emphasis. The implications for pediatricians are discussed.

Idiopathic Environmental Intolerance

Toxicogenic and psychogenic theories have been proposed to explain idiopathic environmental intolerance (IEI). Part 2 of this article is an evidence-based causality analysis of the psychogenic theory using an extended version of Bradford Hill's criteria. The psychogenic theory meets all of the criteria directly or indirectly and is characterised by a progressive research programme including double-blind, placebo-controlled provocation challenge studies. We conclude that IEI is a belief characterised by an overvalued idea of toxic attribution of symptoms and disability, fulfilling criteria for a somatoform disorder and a functional somatic syndrome. A neurobiological diathesis similar to anxiety, specifically panic disorder, is a neurobiologically plausible mechanism to explain triggered reactions to ambient doses of environmental agents, real or perceived. In addition, there is a cognitively mediated fear response mechanism characterised by vigilance for perceived exposures and bodily sensations that are subsequently amplified in the process of learned sensitivity. Implications for the assessment and treatment of patients are presented.

How do mothers' childrearing histories, stress and parenting affect children's behavioural outcomes?

BACKGROUND

Information is needed to understand the role of low to moderate levels of mothers' emotional stress and child characteristics (i.e. prematurity) on parenting behaviours and their impact on children's behaviour that might be deemed 'challenging' but not 'disordered'.

METHODS

The direct and indirect relations of maternal childrearing history and emotional stress, and observed parenting practices when children were 3 years of age on 4-year child behavioural outcomes was examined in a sample of low-income families with a term (n=112) or preterm (n=180) child. Parenting practices included displays of warmth and restrictiveness when interacting with their children. Child outcomes at 4 years included observation of social initiations with their mothers and maternal report of social and attentional problems.

RESULTS

A Structural Equation Model building approach guided by specific hypotheses indicated that preterm as compared to full-term children had more maternal reported social and attentional problems but did not differ in observed social initiating skills. Greater negative maternal childrearing history indirectly influenced social initiating skills through its direct influence on maternal emotional stress. Greater maternal emotional stress directly influenced mothers' parenting that, in turn, directly influenced social initiating. Prematurity and a more negative childrearing history had a direct negative influence on the maternal report of social and attentional behavioural outcomes.

CONCLUSIONS

These findings delineate the effects of prematurity and maternal parenting on the behaviour of 4-year-old-children and extend current knowledge of the influence of parental emotional stress on parenting. Even milder levels can negatively influence parenting, and in turn, contribute to children's less well developed social skills. The issues raised in this study could help with the identification and prioritization of medical and psychological services.

Predictors of later schizophrenia and affective psychosis among attendees at a child psychiatry department

BACKGROUND

Schizophrenia has been linked with psychological problems in childhood but there is little information on precursors of affective psychosis.

AIMS

To compare childhood psychological antecedents of adult schizophrenia and affective psychosis.

METHOD

Childhood item sheets, which give standardised information on signs and symptoms of mental illness in the year preceding assessment are completed for all attendees at the children's department of the Maudsley and Bethlem Royal Hospital. We examined item sheet data on individuals with an adult diagnosis of schizophrenia (n=59) or affective psychosis (n=27) and a comparison group with no adult mental illness (n=86) (all had attended the department).

RESULTS

Abnormal suspiciousness or sensitivity and relationship difficulties with peers are associated with later schizophrenia. In contrast, affective psychosis is associated with childhood hysterical symptoms and disturbances in eating.

CONCLUSIONS

Childhood psychological precursors for schizophrenia and affective psychosis differ and do not simply reflect non-specific psychiatric disturbance in adolescence.

Children of parents with mental illness. I: An overview from a nursing perspective

This paper explores the psychosocial consequences of parental mental illness for child mental health and the implications for mental health nursing. The literature on risk and vulnerability to psychosocial disorder, resilience, child protection, disorder prevention and epidemiological data are reviewed. Based upon a health promotion approach, a model for mental health nursing advocacy for families of adult consumers is proposed as an effective means of preventing disorder in subsequent generations.

Continuing the debate on a separate adolescent psychiatry

OBJECTIVE

This paper continues the debate, started by George Patton, that a separate adolescent psychiatry is required since many psychotic illnesses begin in late adolescence, and adolescent mental health needs have not been well met by child or adult psychiatry.

METHOD

Epidemiological studies are used to illustrate that there are many continuities, as well as discontinuities, in the natural history of psychiatric disorders throughout the life cycle. The paper comments on rational service planning, which requires data on the outcomes of different treatment approaches. It goes on to explore the implications of a separate adolescent psychiatry for service delivery, including how current service boundaries and the training of psychiatrists might need to change.

RESULTS AND CONCLUSIONS

An argument is mounted that psychiatrists should take a whole life perspective, rather than further fragment the specialty. In most Australian States, recent reviews of child and adolescent mental health services are likely to result in increased funding for services to adolescents. Adult psychiatry needs to attend more to the requirements of older adolescents, and greater collaboration is recommended between psychiatry services for children and adults. The authors argue for diversity of approaches, and consider that moves towards separate adolescent mental health services may not always be appropriate.

Adult outcomes of child conduct problems: a cohort study

The present study assessed the mental health and criminal records of 6,449 males and 6,268 females who presented conduct problems as children by examining an unselected birth cohort followed up to age 30. Conduct problems were defined by teacher ratings of behavior problems and/or antisocial behavior in the community. There was little overlap in the children identified by teachers and by the community. These two groups of children were at differential risk for adult mental disorder. Seventy-six percent of the males and 30% of females with childhood conduct problems had either a criminal record, a mental disorder, or both by age 30. Risk ratios for adult criminality and/or mental disorders, however, were greater for females than for males with a history of childhood conduct problems. Almost all of the mental disorders were severe substance abuse. Mental disorders and crime were strongly associated among males with a history of childhood conduct problems.

Disruptions in childhood parental care as risk factors for major depression in adult women

OBJECTIVE

The aim of this study was to examine the influence of different types of disruptions in childhood parental care before the age of 15 years as risk factors for major depression in women aged 18 to 44 years. The types of disruptions studied were parental death, parental separation or divorce, other types of loss (i.e. adoption, foster-care, etc.), and prolonged separation from both parents. Potential confounding factors were also examined.

METHOD

The data were obtained from a community probability sample. Caseness was determined by the use of the Diagnostic Interview Schedule (DIS) and both the current (one month) and lifetime prevalence periods were considered. Logistic regression was used to model the influence of each factor, singly and adjusted for the influence of other factors, on the risk for major depression.

RESULTS

It was found that in this population 17% had experienced some type of parental loss (parental death 4%, separations/divorce 10% and other types of loss 3%) and 11% had experienced prolonged separation from both parents. Parental loss was significantly associated with lifetime depression, but this effect was no longer significant when adjusted for other factors. However, prolonged separation from both parents was associated with an increased risk of current and lifetime depressive episodes of approximately three to fourfold, even when the risk was adjusted for other factors.

CONCLUSIONS

The results of this study suggest that prolonged separation from both parents has a stronger association with current or lifetime depression in women than do parental death, separation/divorce and other types of loss. Prolonged separation may be a marker for other risk factors and may not be a risk factor on its own.

Somatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways

We review the literature on the relationship between somatoform disorders and personality disorders, which reveals that approximately two in three patients with a somatoform disorder meet criteria for a personality disorder. We suggest that the most clinically salient problems presented by patients with somatoform disorders reflect dysfunctions of personality. We also examine research on the childhood antecedents of somatoform disorders and argue for reconsidering somatoform disorders, along with personality disorders, as disorders of development. Our argument involves rejecting the traditional approach to classification in favour of a prototypical polythetic view. We also suggest that the perspectives of developmental psychopathology and life-span research offer more to this field than the search for biological substrates or principles based on descriptive psychopathology, which to date have yielded meagre research findings with limited clinical utility.

Adverse parenting and other childhood experience as risk factors for depression in women aged 18-44 years

65 women who had experienced a recent major depressive disorder, and 81 women who had never been depressed, were recruited from a community probability sample. The two groups of women were compared with regard to a number of childhood experiences, including parenting style, which was assessed with the Parental Bonding Instrument (PBI). When all the childhood factors were considered simultaneously in a logistic regression analysis, only low maternal care was significantly associated with recent depressive episodes. Low maternal care increased the risk of recent major depression approximately 4-fold and the estimate of the population attributable risk was 35%. These findings give further weight to the contention that adverse parenting in childhood, particularly a maternal parenting style typified by low care, is a significant risk factor for adult depression.

Relationships between mental disorders in childhood and adulthood

Research findings on continuities and discontinuities in psychopathology between childhood and adult life are reviewed with respect to major depressive disorders, anxiety states, obsessional conditions, anorexia nervosa, conduct disorders, hyperkinetic disorders, autism, specific developmental disorders of language and schizophrenia. The findings are used to consider both the conceptual issues and possible mediating mechanisms.

Temperament and stress resilience in school-age children: a within-families study

OBJECTIVE

Stress resilience was assessed in 81 school-age children, from within 32 families acknowledging severe psychosocial stress. Resilient and nonresilient children, identified via competence and behavior disorder measures from school and home, were compared.

METHOD

Parents and teachers completed questionnaires and rating scales, and children were observed and assessed at home on attributes of temperament, self-esteem, ability, gender, and mother-child warmth.

RESULTS

Individual differences in child and family attributes that were predictive of competent child functioning varied according to the outcome measure used. Teachers' ratings of positive temperament (low emotional reactivity, high social engagement) best discriminated children showing resilience on all indicators, i.e., behavioral and social competence both at home and at school, with maternal warmth and the number of adverse life events the child had recently experienced also contributing. Level of maternal stress and individual differences in child intelligence were related to academic adjustment, but the child's age, sex, ability, and self-concept were not significant discriminators of behavioral adjustment.

CONCLUSIONS

The findings emphasize the salience of a positive temperament as a resilience factor as well as the need to consider different estimates and contexts in assessing resilience for children growing up in stressful situations.

Parental bonding in men with alcohol disorders: a relationship with conduct disorder

Men from a clinical treatment setting suffering from alcohol dependence, and randomly selected men from the community diagnosed as having alcohol abuse and/or dependence, completed the Parental Bonding Instrument. The men from the alcohol treatment setting perceived both parents as having been uncaring and overprotective. In the general population sample, an uncaring and overprotective parental style was strongly associated with childhood conduct disorder, but not with alcohol disorder symptoms. This discrepancy in perceived parenting highlights the difficulties in extrapolating findings about aetiological factors for alcohol disorders from clinical samples. It also suggests that childhood conduct disorder and adult antisocial behaviour could influence which men with alcohol disorders receive inpatient treatment.

Mental health disorders from age 15 to age 18 years

OBJECTIVE

To determine the strength of association between mental health disorders in adolescence and disorder in early adulthood.

METHOD

The study used mental health data from a longitudinal investigation of a New Zealand birth cohort. Of the 943 with prevalence data for DSM-III disorder at age 15, 890 had prevalence data for DSM-III-R disorder when aged 18 years.

RESULTS

Two-thirds of those with disorder at age 15 had disorder at age 18. The residual form of attention deficit disorder, simple phobias, and oppositional disorders (with no other accompanying disorders) were associated with the lowest risk of later disorder and conduct disorder with the highest. With the exception of the overall symptom level, a variety of characteristics examined (e.g., social competence and adversity) could not differentiate between those with transient disorder and those with disorder at both ages. Comparisons of those with recurring disorder and those with new disorder at age 18 showed that in addition to characteristics of the disorder, disadvantage was strongly associated with recurrent disorder.

CONCLUSIONS

The risk of later disorder for those with disorder in adolescence was high and differed across type of disorder. Findings suggest that to reduce the risk of disorder in early adulthood, clinicians could play a more active role in community interventions with direct social outcomes.

Symptoms of illness in late adulthood are related to childhood social deprivation and misfortune in men but not in women

Experiencing adverse life events during childhood may increase vulnerability to physical illnesses and psychological disorders during adulthood. We developed an Early Life Events Questionnaire (ELEQ) with 12 scales and administered it to 92 relatively healthy elderly individuals (29 men and 63 women). A canonical-correlation analysis of the 12 ELEQ scales and physical and psychological symptoms revealed a significant canonical correlation. The results indicate that those who grew up in a family with a harsh climate and whose affiliation needs were not met tended to have more psychological and physical symptoms in old age. Regression analysis revealed that, in men, early life events accounted for 42% of the variance in physical symptoms and 39% in psychological symptoms. No significant relationship, however, was found between ELEQ scales and health outcomes in women. These results suggest that women may be less vulnerable than men to the adverse health consequences of childhood deprivation and other misfortunes.

Association within a family of a balanced autosomal translocation with major mental illness

282 pedigrees in the MRC Cytogenetics Registry, Edinburgh, with familial autosomal anomalies were examined for the presence of associated mental illness. In one large pedigree there were 23 cases of mental and/or behavioural disorders meeting Research Diagnostic Criteria. 34 of the 77 family members available for cytogenetic analysis carried a balanced translocation t(1:11) (q43,q21). Psychiatric diagnoses had been recorded for 16 of the 34 members with the translocation compared with only 5 of the 43 without it. The lod scores (against chance linkage of the translocation with mental illness) were greatest when the mental disorders in the phenotype were restricted to schizophrenia, schizoaffective disorder, recurrent major depression, and adolescent conduct and emotional disorders. Although the mental illness in this family may not be typical of that in the general population, the findings suggest that the q21-22 region of chromosome 11 may be a promising area to examine for genes predisposing to major mental illness.

Early childhood bereavement

Acute bereavement responses in preschool children were prospectively assessed. Parentally bereaved subjects (26, 3- to 6-year-olds) were compared with matched, nonbereaved controls (N = 40). Bereaved subjects, particularly boys, were significantly more symptomatic (Child Behavior Checklist--Parent). On a newly standardized affect interview for preschoolers, bereaved children reported feeling more scared and less happy than controls. Bereaved children, especially girls, reported significantly more sadness when thinking about their parents. The ability to report these grieving emotions correlated significantly with improved functioning. Children from families experiencing a drop in income after the death were more symptomatic. Disturbance among subject parents and children was highly correlated. Issues of developmental capacity to grieve and the impact of environmental mediators are discussed.

The prognosis in early adulthood of child psychiatric patients: a case register study in Denmark

A register-based study of 485 children (0-15 years of age) admitted to a child psychiatric hospital from January 1, 1970 to December 31, 1972 who were followed up on December 31, 1986 showed higher rates of admission to psychiatric hospital in late adolescence or young adulthood (i.e. greater than or equal to 16 years of age) than found in an age-standardized general population. Patients with the childhood diagnosis neurosis (ICD-8 300 + 308.00) were found to have higher rates of admission with personality disorders (ICD-8 301.09-301.39 + 301.82-301.99) but not of other diagnoses including neurotic disorders. Patients with the childhood diagnosis of conduct disorder (ICD-8 301.09-301.99 + 308.01) had a higher risk of admission in adulthood with the diagnosis of personality disorders and drug or alcohol abuse. Girls with adjustment disorder (ICD-8 307 + 308.02-308.06) had higher risks of admission in young adulthood with diagnosis of personality disorders and psychosis. No connection was found between the age at first referral and the incidence of admission after the age of 15 years.

A call for primary prevention: reality or utopia

The efficacy of primary prevention of mental disorders has been debated over the years. The debate is complicated by ideology, semantic confusion, methodological difficulties and a paucity of good evaluative studies. This paper reviews newer concepts of primary prevention and mental health promotion, methodological issues, model programs, and inherent ethical concerns. Further evaluative studies and an increased contribution of psychiatrists to the primary prevention debate are recommended as necessary steps in further evolution of the field.

Adult personality functioning assessment (APFA). An investigator-based standardised interview

The development of an investigator-based standardised interview to assess patterns of specific and general social dysfunction is described. It covers six domains of functioning: work; love relationships; friendships; non-intimate social contacts; negotiations; and everyday coping. Inter-rater reliability was tested by three investigators rating 21 audiotaped interviews, and was shown to be high, with an intraclass correlation of 0.87 for the total score. The pattern of associations between specific and general social dysfunction was examined through determination of sensitivities and specificities and through LISREL modelling. The findings varied across social domains but it was concluded that the total APFA score provided a reasonable measure of general social dysfunction.

Pathways from childhood to adult life

Principles and concepts of development are reviewed in relation to life-span issues noting the need to consider: development in its social context; timing of experiences; intrinsic and experiential factors; continuities and discontinuities; parallels and differences between normal and abnormal development; heterotypic and homotypic continuities; key life transitions; risk and protective factors; indirect chain affects; mediating mechanisms; age as an index of maturational and experiential factors. Developmental findings from childhood to adult longitudinal studies are reviewed for possible mediating factors. These include: genetic mechanisms; the (non-genetic) biological substrate; shaping of the environment; cognitive and social skills; self-esteem and self-efficacy; habits, cognitive sets and coping styles; links between experiences.

Child psychiatry: the interface between clinical and developmental research

Developmental psychopathology constitutes a research strategy that is concerned with questions about continuities and discontinuities over time (the developmental perspective) and over the span of behavioural variation (the psychopathological perspective). The utility of this approach is discussed in relation to childhood depression, autism and schizophrenia, and the effects of adverse life experiences.

Resilience in the face of adversity. Protective factors and resistance to psychiatric disorder

Almost since the beginnings of psychiatric practice, there has been a recognition that negative life experiences and stressful happenings may serve to precipitate mental disorders (Garmezy & Rutter, 1985). Nearly 200 years ago, Pinel wrote about the psychiatric risks associated with unexpected reverses or adverse circumstances, and it is reported that his initial question to newly admitted psychiatric patients was: “Have you suffered vexation, grief or reverse of fortune?” Nevertheless, although an appreciation that a variety of stressors may play a role in the genesis of psychiatric disorder has a long history, the systematic study of such effects is much more recent.

Health consequences of youth unemployment

The impact of unemployment on the physical and mental health of adolescents is one of the critical medical and social issues of our age. This paper reviews recent studies examining the link between youth unemployment and physical and mental ill-health. The evidence suggests that youth unemployment is associated with an increased vulnerability to psychiatric disorder. It is more firmly established that unemployment influences the course and prognosis of those with preexisting psychiatric disorders. Psychiatric disorder itself can also lead to reduced employability, particularly during periods of economic adversity. Fruitful areas of further study are identified.

Psychopathology and development: II. Childhood experiences and personality development

Concepts and empirical findings are reviewed with regard to personality development and to the role of childhood experiences in that process. It is concluded that personality development cannot be reduced to the stabilisation of behavioural traits, to the production of a fixed personality structure or to the acquisition of social-cognitive skills, although there is some form of personality organisation in terms of habits, attitudes, concepts and styles of behaviour. Personality development takes place in a social context, with both continuities and discontinuities stemming from maturational and experiential factors and interactions between them. Chains of indirect linkages result from complex patterns of circular processes involving reciprocal interactions between children and their environments. No single mechanism is responsible and no one theory provides an explanation.