Editorial: From infancy to adulthood: identifying risk factors for deviant developmental trajectories

This issue of the Journal contains a couple of illustrative examples of the rapid advances in our understanding of how genetic mechanisms and environmentally and psychosocially mediated risk processes operate on the developing brain and influence specific developmental trajectories and outcomes, often across the life course. The question of whether and how risk factors contribute to the emergence of separable neural systems abnormalities is a particularly challenging one but equally important for the understanding of psychopathological development. Examining rare, but well-defined, genetic disorders may allow us to clarify the developmental pathways of expression of the genome as reflected in cognition, social behaviour, and brain structure. However, as pointed out by various papers in this issue, it will make no sense to consider genetic influences in isolation from environmental factors when trying to understand most developmental patterns and outcomes (such as personality traits, communication and language skills, social and suicide-related behaviour) in the general population. The papers in this issue highlight the importance of various risk, resilience and moderating factors (such as very low birth weight, traumatic events, adverse home, school, cultural or societal environments) influencing specific developmental trajectories and outcomes. Clinicians should know about these risk factors and understanding them may pave the way for preventive and treatment interventions. The issue starts with a comprehensive Research Review from Martens, Wilson, and Reutens on the ‘Williams syndrome: a critical review of the cognitive, behavioral, and neuroanatomical phenotype’, summarising three decades of research on the cognitive and behavioural phenotype and the neural substrates of this genetic condition, which is characterised by a unique combination of striking behavioural abnormalities, such as hypersociability and relative language strengths – compared with heavily impaired visuospatial construction abilities. As pointed out recently by Meyer-Lindenberg and colleagues, research on Williams syndrome provides us with the opportunity to understand dissociable genetic influences on complex brain functions in a ‘bottom-up’ way that may allow us to elucidate genetic mechanisms of behaviour in the general population, in which contributions of individual genes are small, gene–gene and gene–environment interactions are the rule, and unambiguously functional variations are uncommon and difficult to characterise (Meyer-Lindenberg et al., 2006). Furthermore, this disorder raises fundamental questions about the modularity of mind and brain development – because of the coexistence of localised structural–functional abnormalities with non-localised functionally altered neural circuitries – that need to be viewed as results of compensatory, and possibly adaptive, processes and studied from a developmental perspective (Meyer-Lindenberg et al., 2006). The second paper, by Pesonen and colleagues, explores the ‘personality of young adults born prematurely: the Helsinki study of very low birth weight adults’. Intriguingly, young adults born with very low birth weight showed markedly different personality traits compared with their controls. They displayed less negative emotions, were more dutiful and cautious, and displayed more warmth in their social relationships than their term-born peers. The present findings challenge straightforward connections between severe prematurity and later presence of psychopathology. In contrast, higher conscientiousness, which was found to characterise the very low birth weight adults, is clearly a protective trait against various clinical disorders. The authors discuss two potential mechanisms underlying these findings, parental influences and biological mechanisms associated with prematurity, such as an altered hypothalamic-pituitary-adrenal (HPA) axis activity. Parental influences on neuronal system regulations are also the topic of the next paper by Scher who reports on the impact of maternal separation anxiety on her infant's sleep quality. The contribution of the mother's own separation anxiety to her child's night-waking at 10 months of age remained significant even after controlling for the child's fussiness. Thus, maternal separation anxiety, rather than the child's distress perceived by the mother, was associated with the child's sleep quality as objectively recorded. These interesting findings are in accord with a multi-factorial transactional model of sleep regulation. The following two papers report on later language and communication outcomes. Beitchman and colleagues report on one of the longest community-based follow-up studies investigating the effect of speech and language impairment on receptive vocabulary growth. Using data from the Ottawa Language Study, a 20-year prospective follow-up study, the authors studied determinants of the child's receptive vocabulary growth from age 5 to age 25. The results show that childhood language impairment tends to persist into early adulthood and seems to be associated with negative life outcomes. Socioeconomic factors, including family income, family separation, maternal education, and mother's age at first birth also predicted receptive vocabulary scores at age 5 and beyond. Because the poorer vocabulary of the language-impaired children compared to controls continued throughout the 20-year follow-up period, interventions in early childhood to improve the trajectory of vocabulary growth are very much needed. Clinically, early identification and intervention offered to children with language impairment is an important issue. Thus, the identification of early predictors of language impairment and associated outcomes is required for the development of clinically useful screening procedures. Chiat and Roy investigate the use of ‘very early phonological and sociocognitive skills as predictors of later language and social communication outcomes’. In a first large-scale study of very young clinically referred children, the authors found that these measures are differentially informative about outcomes and can make a distinct contribution to the prediction of specific language and social communication difficulties, and, thus, are better predictors for the development of specific skills than general language. In the next paper, Oliver, Pike, and Plomin examine the issue of ‘non-shared environmental influences on teacher-reported behaviour problems: monozygotic twin differences in perceptions of the classroom’. Interestingly, siblings with less favourable perceptions of their classroom environment were reported by their teachers as less prosocial, more hyperactive, and to have more conduct and peer problems. The results indicate that classroom environment is related to behaviour problems even when genetic factors are held constant. Intriguingly, classroom environment was more strongly associated with behaviour problems when the home environment is more chaotic, indicating a cumulative risk phenomenon: children most at risk for being rated as behaviourally disorganised by their teachers were those with a disorganised home environment, and a classroom environment that the children deemed less satisfactory than their twin. The following two papers address the issue of deliberate self-harm and suicide-related outcomes in adolescents constituting a major public health problem in various societies. Borges and colleagues investigated suicide-related outcomes in Mexican adolescents who have suffered a traumatic event during childhood, taking into account the onset of psychiatric disorders. Adolescent victims of traumatic events, particularly victims of sexual assault or other violence-related events, are at increased risk for suicidal ideation, making suicide plans and conducting suicide attempts. Conversely, the report of suicide-related outcomes in the complete absence of any lifetime traumatic event was rare. While there are several different pathways from the experience of early adverse events to the engagement in self-injurious and suicidal behaviours, the relationship between early adverse experiences and the experience of suicidal thoughts and behaviours during adolescence seems to be strongly mediated by adolescent self-criticism. Another key message from this study is that suicide prevention interventions for adolescent victims of traumatic events, especially those with a history of cumulative events, should include but not be restricted to psychiatric treatment, since not all of the risk was fully accounted for by the occurrence of a prior psychiatric disorder. Although the prevention of suicidal behaviour and self-injury is a priority internationally, it is not always easy to identify adolescents who deliberately self-harm. Identifying those at risk is made harder as many young people show little premeditation before deciding to harm themselves. In their first international report from the CASE study, a seven-country multi-centre investigation of deliberate self-harm among adolescents in the community, Madge and colleagues demonstrate that self-harm among young people is much more prevalent than is indicated within clinical populations, and highlight how it is often a ‘hidden’ problem. Overall, study countries were remarkably similar in rates of deliberate self-harm and self-harm thoughts, the preponderance of females engaging in self-harm behaviours, the methods used and the reasons given. The majority of young people who harm themselves do not attend a hospital as a result and many remain hidden in the community. However, about half of all adolescents who harm themselves do so repeatedly. The main clinical implication from these findings is that much more attention should be paid to identifying young people who are suffering from emotional and mental health difficulties, in order to prevent self-harm through school-based and other initiatives, and to provide young self-harmers with appropriate care and support. Clinicians need to be aware that self-harm may be present in patients presenting to clinical settings for other reasons. Furthermore, some young people may have experienced repetitive thoughts about harming themselves without actually doing so. These patients require special support both because their thoughts may reflect distress and because current thoughts may be linked with subsequent self-harming behaviour. In the last paper of this issue, Heiervang, Goodman, and Goodman disentangle the ‘Nordic advantage in child mental health: separating health differences from reporting style in a cross-cultural comparison of psychopathology’. The authors’ cross-cultural comparison illustrates an inconsistent relationship between questionnaire and interview data, indicating why cross-cultural differences on questionnaires should not automatically be interpreted as reflecting true differences in psychopathology. While lower questionnaire scores for externalising disorders in Norway compared to Britain appear to reflect real and substantial differences between the countries, by contrast, lower questionnaire scores for emotional problems seem to reflect under-reporting or under-recognition by Norwegian adults, and not a genuine lower prevalence of emotional disorders. The results clearly indicate that cross-cultural comparisons in psychopathology based on questionnaire data may be misleading, if cultural differences in reporting style are not taken into account. Clinical evaluation of children should therefore routinely include multiple informants, as well as other assessment approaches such as a structured interview.

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