DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN CHILD AND ADULT PSYCHOPATHOLOGY

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DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN
CHILD AND ADULT PSYCHOPATHOLOGY

• By Michael Rutter

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REVOLUTION IN THINKING ABOUT CONTINUITIES AND
DISCONTINUITIES BETWEEN CHILDHOOD AND ADULTHOOD I

1. Persistence of early neurodevelopmental disorders
2. Childhood origins of schizophrenia
3. Recurrence of childhood depression in adult life
4. Heterotypic continuity

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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

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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
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ADULT SPELLING AT AGE 44/45 YEARS (NORMATIVE SD
UNITS) OF CHILDHOOD POOR AND COMPETENT READERS
(data from Maughan et al., 2005)
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LANGUAGE LEVELS IN THE MID-30s 0F MALES WITH SLI
COMPARED WITH THEIR SIBLINGS AND IQ-MATCHED
CONTROLS (Clegg et al., 2005)
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MARITAL RELATIONSHIPS OF SLI MEN UP TO MID-30s
(Clegg et al., 2005)

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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
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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)

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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
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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
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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
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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
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CUMULATIVE RISK OF DEPRESSIVE DISORDER IN ADULT
LIFE IN CHILDHOOD DEPRESSED CASES (Harrington et
al., 1990)
Cumulative risk
Age in years
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SURVIVAL FROM MAJOR DEPRESSIVE DISORDER WITH OR
WITHOUT CONDUCT DISORDER (from Fombonne et al.,
2001)
Probability of survival
Age in years
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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
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CHILDHOOD CONDUCT DISTURBANCE AND
ADOLESCENT-ONSET VS. ADULT-ONSET DEPRESSION Isle
of Wight Follow-Up (Maughan et al., 2004)
Single Episode
Recurrent Episodes
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CUMULATIVE INCIDENCE OF FIRST DEPRESSIVE EPISODE
BY AGE AT SEXUAL MOLESTATION (From McCutcheon et
al., 2007)
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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
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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
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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.
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EARLY DELINQUENCY ONSET PREDICTS GREATER
FAMILIALITY from Taylor et al. (2000)
Antisocial relatives
Late-starters
Non delinquent
Early-starters
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DUNEDIN LONGITUDINAL STUDY TRAJECTORY ANALYSIS
(N 526 males) (From Odgers et al., 2007)
Conduct Problems Scale
Age
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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
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AGE AT FIRST DIAGNOSIS FOR PARTICIPANTS WITH AN
ADULT PSYCHIATRY DIAGNOSIS INVOLVING TREATMENT
(From Kim-Cohen et al., 2003)
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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

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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
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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
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SCHIZOPHRENIA SPECTRUM DISORDERCANNABIS USE
INTERACTS WITH GENOTYPE (Caspi et al., 2005)
COMT genotype
Met/Met Met/Val Val/Val
schizophreniform disorder
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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)
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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
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MEAN OF CHILDRENS SYMPTOMS AS A FUNCTION OF A
CLOSE RELATIONSHIP WITH AN ADULT IN GOOD AND POOR
PARENTAL MARRIAGES (from Jenkins Smith, 1990)
None N8
Childrens symptoms
Moderately close N22
None N10
Very close N27
Very close N39
Moderately close N13
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CHILDHOOD BEHAVIOR AND ADULT PSYCHOSOCIAL
STRESSORS/ADVERSITIES (data from Robins, 1966)

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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
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RANGE OF MEDIATING EXPERIENCES

1. Effects of experience on gene expression
2. Biological programming
3. Effects of neuroendocrine system
4. Effects on shaping/selecting of later
   environments
5. Effects on patterns of interpersonal interaction
6. Effects on cognitive/affective models

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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
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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

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OVERALL MESSAGES

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

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DEVELOPMENTAL PATHWAYS AND CONTINUITIES BETWEEN
CHILD AND ADULT PSYCHOPATHOLOGY

• By Michael Rutter