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DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN CHILD AND ADULT PSYCHOPATHOLOGY

DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN CHILD AND ADULT PSYCHOPATHOLOGY. By Michael Rutter. REVOLUTION IN THINKING ABOUT CONTINUITIES AND DISCONTINUITIES BETWEEN CHILDHOOD AND ADULTHOOD I. Persistence of early neurodevelopmental disorders Childhood origins of schizophrenia

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DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN CHILD AND ADULT PSYCHOPATHOLOGY

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  1. DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN CHILD AND ADULT PSYCHOPATHOLOGY By Michael Rutter

  2. REVOLUTION IN THINKING ABOUT CONTINUITIES AND DISCONTINUITIES BETWEEN CHILDHOOD AND ADULTHOOD I • Persistence of early neurodevelopmental disorders • Childhood origins of schizophrenia • Recurrence of childhood depression in adult life • Heterotypic continuity

  3. REVOLUTION IN THINKING ABOUT CONTINUITIES AND DISCONTINUITIES BETWEEN CHILDHOOD AND ADULTHOOD II • Persistence of effects of early life experiences 6. Differences in disorder by age of onset 7. Range of mediating mechanisms for persistence 8. Important effects of experiences in adolescence and adult life

  4. SOCIAL FUNCTIONING IN ADULT LIFE OF INDIVIDUALS WITH AUTISM AND AN INITIAL IQ OF 70+(Howlin et al., 2004) % at different levels of social functioning

  5. ADULT SPELLING AT AGE 44/45 YEARS (NORMATIVE SD UNITS) OF CHILDHOOD POOR AND COMPETENT READERS (data from Maughan et al., 2005)

  6. LANGUAGE LEVELS IN THE MID-30s 0F MALES WITH SLI COMPARED WITH THEIR SIBLINGS AND IQ-MATCHED CONTROLS (Clegg et al., 2005) 6

  7. MARITAL RELATIONSHIPS OF SLI MEN UP TO MID-30s (Clegg et al., 2005) %

  8. ADOLESCENT AND ADULT STATUS OF BOYS WITH ‘PURE’ ADHD(data from Mannuzza et al., 1998) Cohort 1, aged 18 years Cohort 2, aged 24 years

  9. PREDICTORS OF POOR OUTCOME IN INDIVIDUALS WITH ADHD(data from Mannuzza et al., 1998) Key predictors (controlling for other variables) 1. Conduct disorder symptoms 2. ADHD (even in the absence of conduct problems in childhood)

  10. RECEPTIVE LANGUAGE DEVELOPMENT AT AGE 3, 5, 7 & 9 FOR INDIVIDUALS WITH DIFFERENT ADULT DIAGNOSES (From Cannon et al., 2002) Language test performance, z scores Age in years

  11. INTELLIGENCE SCORES AT AGE 3, 5, 7, 9 & 11 FOR INDIVIDUALS WITH DIFFERENT ADULT DIAGNOSES (From Cannon et al., 2002) IQ test performance, z scores Age in years

  12. PSYCHOTIC-LIKE SYMPTOMS AT AGE 11 YEARS AND ADULT DIAGNOSIS AT AGE 26 (data from Poulton et al., 2000) % with specified disorder at 26 years Adult diagnosis

  13. TEN YEAR FOLLOW-UP OF FAMILIAL HIGH RISK INDIVIDUALS AGED 16 TO 24 YEARS (data from Johnstone et al., 2005) % with specified outcome N.B. Best predictors of psychotic features were schizotypal cognitions and psychotic-like symptoms

  14. CUMULATIVE RISK OF DEPRESSIVE DISORDER IN ADULT LIFE IN CHILDHOOD DEPRESSED CASES(Harrington et al., 1990) Cumulative risk Age in years

  15. SURVIVAL FROM MAJOR DEPRESSIVE DISORDER WITH OR WITHOUT CONDUCT DISORDER (from Fombonne et al., 2001) Probability of survival Age in years

  16. SURVIVAL FROM CRIMINAL OFFENCES FOR MAJOR DEPRESSIVE DISORDER SUBJECTS WITH OR WITHOUT CONDUCT DISORDER (from Fombonne et al., 2001) Probability of survival Age in years

  17. CHILDHOOD CONDUCT DISTURBANCE AND ADOLESCENT-ONSET VS. ADULT-ONSET DEPRESSIONIsle of Wight Follow-Up (Maughan et al., 2004) Single Episode Recurrent Episodes

  18. CUMULATIVE INCIDENCE OF FIRST DEPRESSIVE EPISODE BY AGE AT SEXUAL MOLESTATION (From McCutcheon et al., 2007)

  19. ASSOCIATION BETWEEN EMOTIONAL REACTIVITY AT 4 MONTHS AND ANXIETY SYMPTOMS AT 7 YEARS(data from Kagan & Snidman, 1999) % Anxious symptoms • High reactivity Low reactivity Neither high nor low reactivity

  20. SCORES ON ALCOHOL ABUSE SYMPTOM SCALE AT 21 YEARS AS A FUNCTION OF BEHAVIOUR STYLES AT 3 YEARS AND SEX(from Caspi et al., 1996) Symptom scale for alcohol dependence Sample mean at age 21 yrs

  21. PROBABILITY OF MAJOR DEPRESSIVE DISORDER (MDD) DURING FOLLOW-UP STRATIFIED ON SUBSTANCE USE DISORDER (SUD) AT STUDY ENTRY, AFTER CONTROLLING FOR THE EFFECTS OF SOCIOECONOMIC STATUS AND PRIOR MDD (from Rao et al., 2000). those with prior SUD participants with no prior SUD.

  22. EARLY DELINQUENCY ONSET PREDICTS GREATER FAMILIALITY from Taylor et al. (2000) Antisocial relatives Late-starters Non delinquent Early-starters

  23. DUNEDIN LONGITUDINAL STUDY: TRAJECTORY ANALYSIS(N =526 males) (From Odgers et al., 2007) Conduct Problems Scale Age

  24. ODDS RATIOS FROM COTWIN-CONTROL ANALYSES OF CHILDHOOD SEXUAL ABUSE AND RISK FOR PSYCHIATRIC AND SUBSTANCE USE DISORDER IN FEMALE TWIN PAIRS (From Kendler et al., 2000) Odds Ratio

  25. AGE AT FIRST DIAGNOSIS FOR PARTICIPANTS WITH AN ADULT PSYCHIATRY DIAGNOSIS INVOLVING TREATMENT(From Kim-Cohen et al., 2003)

  26. KEY FINDINGS ON CHILD AND ADULT CONTINUITY IN PSYCHOPATHOLOGY(From Kim-Cohen et al., 2003) • The disorders in the two age periods tended to be of the same type BUT 2. Most adult disorders preceded by a variety of disorders in childhood 3. The proportion of adult psychiatric disorders with childhood psychopathology before 15 years is greatest for eating disorders and antisocial personality disorders 4. Conduct/oppositional defiant disorder is the childhood disorder most likely to precede adult psychopathology

  27. ANTISOCIAL BEHAVIOR AS A FUNCTION OF MAOA ACTIVITY AND A CHILDHOOD HISTORY OF MALTREATMENT (from Caspi et al., 2002) Composite index of antisocial behavior (z scores) Childhood maltreatment

  28. EFFECT OF MALTREATMENT IN CHILDHOOD ON LIABILITY TO DEPRESSION MODERATED BY 5-HTT GENE (from Caspi et al., 2003) .70 s/s s/l .60 s/s = short allele homozygous l/l = long allele homozygous s/l = heterozygous .50 Probability of major depression episode .40 l/l .30 .20 0

  29. SCHIZOPHRENIA SPECTRUM DISORDER:CANNABIS USE INTERACTS WITH GENOTYPE(Caspi et al., 2005) COMT genotype Met/Met Met/Val Val/Val %schizophreniform disorder

  30. MEAN + SE (ERROR BARS) IQ SCORES OF CONTROL CHILDREN AND CHILDREN WHO MET DIAGNOSTIC CRITERIA FOR ADHD ACCORDING TO GENOTYPE STATUS ON 2 DOPAMINE GENES (from Mill et al., 2006)

  31. MEAN NUMBER OF DSM-IV CONDUCT SYMPTOMS BY GENOTYPE AND BIRTH WEIGHT: ASSOCIATION WITH C0MT GENOTYPE(From Thapar et al., 2005) Mean conduct symptom score C0MT genotype

  32. MEAN OF CHILDREN’S SYMPTOMS AS A FUNCTION OF A CLOSE RELATIONSHIP WITH AN ADULT IN GOOD AND POOR PARENTAL MARRIAGES(from Jenkins & Smith, 1990) None N=8 Children’s symptoms Moderately close N=22 None N=10 Very close N=39 Very close N=27 Moderately close N=13

  33. CHILDHOOD BEHAVIOR AND ADULT PSYCHOSOCIAL STRESSORS/ADVERSITIES (data from Robins, 1966) %

  34. SEVERE EVENTS AND DIFFICULTIES IN EARLY ADULT LIFE AND TYPES OF DISTURBANCE AT 10 YEARS IN FEMALES(Champion et al., 1995) Mean number of events/ difficulties

  35. RANGE OF MEDIATING EXPERIENCES • Effects of experience on gene expression • Biological programming • Effects of neuroendocrine system • Effects on shaping/selecting of later environments • Effects on patterns of interpersonal interaction • Effects on cognitive/affective models

  36. TURNING POINT EFFECT OF PARTNER IN FEMALES WITH ANTISOCIAL BEHAVIOR IN CHILDHOOD (Pickles, 1996) 2 Lack of support 1.5 Support from non-deviant partner 1 0.5 0 Mean Teacher Questionnaire score in childhood Mean score in Adult Problems in Social Functioning

  37. MILITARY SERVICE AND LATER SOCIOECONOMIC ACHIEVEMENT (data from Sampson & Laub, 1996) Key predictors of success: Overseas duty Training under the GI Bill Lack of a military arrest but interactions with Early entry to military service N.B. effects of military service comparable to those of measured ability and much greater than SES or educational achievement

  38. OVERALL MESSAGES • Continuities across the lifespan much stronger than used to be appreciated • Heterogeneity much stronger than previously realised • Gene-environment interplay crucial and pervasive • Experiences post-childhood can be very influential • Range of mediating mechanisms wide • A developmental perspective essential for both childhood and adult disorders

  39. DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN CHILD AND ADULT PSYCHOPATHOLOGY By Michael Rutter

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