Development and Psychopathology, 12 (2000), 265–296 Copyright  2000 Cambridge University Press Printed in the United States of America

Developmental psychopathology: Concepts and challenges

a b MICHAEL RUTTER AND L. ALAN SROUFE aUniversity of London; and bUniversity of Minnesota

Abstract The defining features of developmental psychopathology concepts include attention to the understanding of causal processes, appreciation of the role of developmental mechanisms, and consideration of continuities and discontinuities between normality and psychopathology. Accomplishments with respect to these issues are reviewed in relation to attachment disorders, antisocial behavior, autism, depressive disorder, schizophrenia, and intellectual development. Major research challenges remain in relation to measurement issues, comorbidity, gender differences, cognitive processing, nature–nurture interplay, heterotypic continuity, continuities between normal variations and disorders, developmental programming, and therapeutic mechanisms in effective treatments.

Origins of a Developmental of the processes underlying both continuity Psychopathology Perspective and change in patterns. The focus was on the how of developmental processes, rather than Karl Popper (1972), the distinguished philos- on the charting of age-related progressions. opher of science, made the astute point that Many, perhaps most, causal processes were definitions need to be read from right to left, viewed in terms of chain reactions operating and not left to right. In other words, it makes over time. Development was seen as an ac- no sense to ask what a word means. Rather, tive, dynamic process that involved individu- we have to ask what is the concept or idea to als processing (cognitively and affectively) which we wish to attach the descriptive term. and adding meaning to their experiences, the Sixteen years ago we succinctly referred to biology of the individual influencing how in- developmental psychopathology as the study dividuals respond to their experiences but, in of the origins and course of individual pat- turn, the biology being shaped by those expe- terns of behavioral maladaption (Sroufe & riences. Because development was likely to Rutter, 1984). We went on to emphasize that be affected by experiences that often occurred the main aim was to provide an understanding for the first time only in adult life (such as marriage, rearing children, and establishing a We are greatly indebted to Dante Cicchetti for his invalu- work career), development was viewed as ex- able suggestions on an earlier draft of this paper, as well tending into adult life—a life-span approach. as for his leadership of the field over many years. In addi- The end product of development was, there- tion, however, this account of developmental psychopath- fore, conceptualized, not as the attainment of ology has been possible only as the result of the creative research of many pioneers from both developmental and biological maturity or the highest level of clinical fields; we wish to express our deep appreciation competence or the stabilization of personality for their contributions, which have done so much to set traits but rather as the establishment of a co- an exciting and fruitful research agenda. herence of functioning as a thinking, feeling Address correspondence and reprint requests to: Prof. Sir Michael Rutter, Social, Genetic & Developmental human being. In this essay, we look back on Psychiatry Research Centre, Institute of Psychiatry, De the origins of the domain of developmental Crespigny Park, Denmark Hill, London SE5 8AF, UK. psychopathology, consider its current stand-

265 266 M. Rutter and L. A. Sroufe ing, review some of its accomplishments, and developmental operation of the complex mix look forward to the very considerable chal- of influences that give rise to resilience in the lenges that remain. face of adversity (Masten & Curtis, 2000; Rutter, in press-a; Sroufe, 1997), and to real- ize that individuals cannot be subdivided cate- Positive influences on origins gorically into the vulnerable and invulnerable. Many ideas, and many people, played critical There were many individuals who suffer in roles in the emergence of developmental psy- some ways but not in others (Luthar, Cic- chopathology as a key perspective on both de- chetti, & Becker, in press). Furthermore, velopmental processes and the causes and some of the adverse outcomes take the form course of psychopathology. We make no at- of serious patterns of social malfunction that tempt to cover these in exhaustive fashion but, do not fit readily into any of the existing rather, provide a few disparate examples to psychiatric diagnostic categories (Richters & indicate the diversity of the roots of the per- Cicchetti, 1993; Rutter, in press-c). If risk spective. In so doing, we have sought to pro- processes are to be understood adequately, in- vide a balanced overview of perspectives, vestigations need to include detailed longitu- rather than expound our own positions, al- dinal studies of risk populations, as well as though doubtless our own views will have large-scale epidemiological studies. Hether- colored our scientific vision to some extent. ington’s (1989; Hetherington & Clingempeel, We begin with risk research because it is 1992; Hetherington & Stanley–Hagan, 1997) paradigmatic of developmental psychopathol- studies of divorce and stepparenthood well il- ogy (Sroufe & Rutter, 1984). At first, particu- lustrate this trend. larly in the United States, both the origins and Of all the specific features of development, the outcomes of risk were viewed in diagno- the study of emergence of selective attach- sis-specific terms (Garmezy, 1974). Thus, ments, our second example, was possibly the longitudinal studies were set up to examine most crucial in moving thinking in a develop- the emergence of schizophrenia in the off- mental psychopathology direction. Early stud- spring of mothers with a schizophrenic disor- ies had made clear both the importance of se- der. It soon became clear, however, that many lective attachments and the phases of early of the children who did not develop schizo- development that were involved in their estab- phrenia did show other forms of psychopath- lishment (Bowlby, 1969). Ainsworth, Blehar, ology, and that the risks for such psychopath- Waters, and Wall’s (1978) recognition that ology also derived from other forms of mental not only were universals of development in- illness in parents (Rutter, 1989a). Epidemio- volved but also patterns of attachment rela- logical studies provided a further extension in tionships differed in the degree of security their demonstration that many of the risks provided and that these individual differences were found in families exhibiting discord, dis- mattered for later development moved devel- ruption and disharmony but where the parents opmental thinking into an individual differ- had no diagnosable mental illness (Rutter & ences perspective. It was, however, an indi- Quinton, 1984). Studies of all manner of vidual differences perspective that involved a risks, both mild and severe, were consistent in key shift from trait views. The individual dif- their demonstration of the extreme heteroge- ference initially lay in a dyadic relationship, neity of outcome and in their indication that and only later did this become transformed it was the number of serious risks, rather than into something more akin to an individual the nature of any one, that was critical (Sam- characteristic (Sroufe, 1989). Also, the indi- eroff, 2000). Given the same risk experience, viduality, as carried forward in time, was some children succumb with disorder whereas thought to derive from a particular way of others seem to escape largely undamaged. At- thinking about relationships, or cognitive set, tention, increasingly, came to be drawn to the termed an internal working model (Brether- need to consider both risk and protective ton, 1995; Bretherton & Waters, 1985). The mechanisms (Rutter, 1990), to understand the functions of behavior were crucial. Thus, the Developmental psychopathology: Concepts and challenges 267 approach behavior of attachment in the tod- no sense to assume one or the other. Instead, dler age period was viewed as (and empiri- the research advantage lay in examining what cally found to be) a precursor of later inde- was involved in the continuities and disconti- pendence (rather than dependence), if the nuities between normal and abnormal behav- attachment relationships were secure (Sroufe, ior (Rutter, 1986a). 1983; Sroufe, Fox, & Pancake, 1983). A prob- A further stimulus came from the growth abilistic “pathways” model of development of findings and theories in the domain of life- was a key feature (Rutter, 1989b; Sroufe, span development (Baltes, Staudinger, & Lin- Egeland, & Carlson, 1999). denberger, 1999; Hetherington, Lerner, & A third area of research that was influential Perlmutter, 1988; Rutter & Rutter, 1993). The concerned the study of cognitive processing importance of this field of inquiry derived of experiences. Findings in the fields of both from the important changes in functioning antisocial behavior (Dodge, Bates, & Pettit, that take place in adult life; the powerful im- 1990; Dodge, Pettit, Bates, & Valente, 1995) pact of key experiences in adult life; the find- and depression (Garber, Quiggle, Panak, & ing that people varied in the life trajectories Dodge, 1991; Teasdale & Barnard, 1993) they took, and that it was misleading to see showed the importance of individual differ- development as a single universal progression ences in the attributions that people make to that varied only in its timing (see Emde & the experiences and personal interactions that Spicer, 2000); the importance of social con- they encounter. The importance of this body text; and the extent to which what had seemed of research lay in its emphasis on the active to be universals were much influenced by life thinking and feeling processes that were in- experiences. For example, it had been thought volved in the interplay between persons and that a thinning of the bone structure was an their environments. The findings pointed to inevitable part of aging but it became appar- the need to move away from a sharp dichot- ent that this was very considerably attenuated omy between risk factors based on environ- if the individuals continued to engage in mental hazards and risk factors involved with strenuous physical exercise as they grew older personal attributes. A more dynamic apprecia- (Lane, Bloch, Jones, Marshall, Wood, & tion of how the two worked together was re- Fries, 1986; Lane, Bloch, Wood, & Fries, quired. 1987). The fourth positive stimulus derived from The principles that unite these disparate studies of children with handicapping disor- examples include the concept of development ders. The findings showed both the common- as an active dynamic process in which the alities in the course of development shown by meanings attributed to experiences alter their normal and handicapped children (Cicchetti & consequences, and the notion of individual Sroufe, 1978) and also the marked differences pathways that diverge in both their origins associated with certain disorders, such as au- and endings (Cicchetti & Rogosch, 1996). tism (Hermelin & O’Connor, 1970). Studies of individuals with gross sensory handicaps Limitations in traditional theories provided an interesting mixture of the two and concepts (O’Connor & Hermelin, 1978). What the re- search demonstrated was the very consider- In part, too, developmental psychopathology able extent to which comparisons across perspectives arose because of limitations in groups could be informative about the mecha- the traditional developmental and psychiatric nisms involved in both normal and abnormal concepts as they applied during the 1970s. development. There was a need to avoid false Progress in psychiatry had been greatly decisions about whether there were continui- helped by the appreciation of the importance ties between normal and abnormal or whether of diagnosis and classification and by the de- the presence of disorder marked a qualitative velopment of standardized approaches to discontinuity. The research was clear in its in- both. On the other hand, there was concern dication that both could be found, and it made about the unhelpful reification of diagnostic 268 M. Rutter and L. A. Sroufe categories (Rutter & Shaffer, 1980). Instead of experiences as well as the years of biologi- of being treated as useful working hypotheses, cal growth. diagnostic systems were becoming increas- Second, very little attention was being paid ingly constraining, with their implication that to the transition into adult life. This is a curi- categories represented some form of real ous lack because, if development is seen as truth. It was not so much that the categories that which leads up to adulthood, its under- lacked diagnostic validity (there was good ev- standing necessarily required a study of adult idence for at least partial validity of some of outcomes (see Cicchetti & Toth, 1995). One the main diagnoses; Cantwell & Rutter, 1994) might suppose that what would characterize but rather that there was too little appreciation developmental psychology most of all would of the limitations in what was known. All be a focus on longitudinal studies that sorts of rules had been devised to differentiate spanned the period from infancy to adult life. between disorder and normality without an In fact, the opposite was more the case (De adequate understanding of the extent to which Ribaupierre, 1989). Most developmentalists so many psychopathological concepts were specialized in a very narrow age period, and dimensional (Achenbach, in press), with the most research was cross-sectional rather than need to account for variations along the di- longitudinal. mensions and not just for the causes of ex- Third, little attention was paid to the causal treme disorders. This was evident, for exam- processes involved in individual differences ple, in the fields of disruptive behavior, in development. There were many exceptions anxiety, and depression. Much causal research to these limitations, and there was much that seemed to be based on the expectation that was good in developmental research. Never- one single main cause for any disorder would theless, the perspectives needed to be broad- be found and that the cause would be diagno- ened. Achenbach’s (1974) textbook, the first sis specific. Too little attention was paid to labeled “developmental psychopathology,” was pioneering in that concern. the possibility that the mechanisms involved Fourth, it had become increasingly obvious in causation might entail dynamic processes that the prevailing developmental theories operating over time, that indirect chain effects were inadequate in a whole variety of ways. might often be present, and that there might To begin with, most focused on the universals be several different routes to the same out- of a progression through predetermined come. Of course, there was a great deal of stages, whether defined in terms of psycho- value in the psychiatric research perspectives sexual stages (Freud, 1953), cognitive phases that were being taken, and, in addition, there (Gelman & Baillargeon, 1983; Piaget, 1970), were many exceptions to these apparent rigid- or social tasks and crises (Erikson, 1950), ities. Nevertheless, a broadening of perspec- with individual differences seen in terms of a tives was needed. stage fixation or regression or a phase adapta- Parallel, but different, concerns applied to tion. developmental psychology. To a considerable There were three main types of problem. extent, research seemed to be preoccupied First, most of the theories seemed to portray with an undue concern to chart the universals an all-encompassing view of life, rather than of developmental progression. Three main an attempt to provide an explanation for par- limitations stood out. First, there was a ten- ticular empirical phenomena. On the face of dency to regard age as a sufficient explanation it, there seemed to be an untenable assump- for this progression (Wohlwill, 1970, 1973). tion that a single theory could account for all It came to be appreciated that age constituted the complexities that were involved in devel- an ambiguous measure (Rutter, 1989c). Bio- opment. Second, theories failed to address a logical maturity was not a single thing; hor- host of crucial developmental issues. Little at- monal maturity and brain maturity, for exam- tention was paid to biological processes or ge- ple, did not proceed directly in parallel. Also, netic influences, and gender differences were necessarily, age indexed the nature and extent inadequately conceptualized. Third, all the Developmental psychopathology: Concepts and challenges 269 theories had a poor empirical basis, and re- levels, operate on a dimensional basis with search findings showed the many ways in variations within the normal range being asso- which the theories were seriously wrong on ciated with differences in risk. The causal pro- numerous essentials (Bowlby, 1988; Bryant, cesses operate over a long period of time, be- 1974; Piaget, 1970; Rutter, 1971a). ginning early in life. Thus, for example, it has Of course, these big theories had been im- been found that infants of low birth weight portant historically in ways that have stood have a substantially increased risk of cardio- the test of time. Thus, psychoanalytic theory vascular disease in later life (Barker, 1998; was very important in drawing attention to the Nathanielsz, 1999). The finding is of interest role of mental mechanisms and of emotional because that is the opposite of the way in influences, Piagetian theory to the role of ac- which weight operates in middle age (when tive cognitive processes, and Eriksonian the- the risks are associated with being overweight ory to the importance of social context and and not underweight). The notion of develop- social challenges. Nevertheless, they were mental programming (Bock & Whelan, 1991) ceasing to serve a useful role, and it was nec- has come to the fore, whereby it is thought essary to move on. Although it was clear that that the body-regulating systems are adapted good developmental research required a hy- in early life to low levels of nutrition and that pothesis-testing approach, it was equally ap- the risk comes from being, therefore, mal- parent that it was completely implausible that adapted to high levels of nutrition in later life. any one theory could account for all develop- The importance of social factors in the gene- mental phenomena. Bowlby’s (1969) judi- sis of somatic disease (including cardiovascu- cious integration of perspectives in his formu- lar conditions) has been well established for a lation of attachment theory provided a useful long time. McKeown (1976), in the 1950s and alternative model. 1960s, pointed out that the huge improve- ments in infantile mortality and the increase in life expectancy in the first half of this cen- The Current Standing of Developmental tury were largely attributable to improved liv- Psychopathology ing conditions and improved nutrition, with Developmental psychopathology perspectives medical advances being of limited impor- have become mainstream now, in both devel- tance. The huge social disparities in levels of opmental psychology and psychiatry, al- illness are well documented (Acheson, 1998; though, quite properly, they do not constitute Townsend & Davidson, 1992; Wilkinson, the whole of either. Thus, with respect to psy- 1996), and psychological factors too have a chiatry, a major body of research is concerned well-demonstrated role (Marmot & Wilkin- with the evaluation of methods of treatment son, 1999). Medicine has also long appreci- and of the delivery of services. Similarly, and ated that a single-risk factor can lead to quite equally appropriately, developmental psychol- diverse disorders (smoking is an obvious ex- ogy is concerned with studying what is in- ample of this kind) and that the same disease volved in developmental processes as they end point may come from rather varied causal apply universally. Both of these are of interest pathways, as the study of comorbidity well il- to developmental psychopathology, but they lustrates (Rutter, 1997a). All of this closely do not constitute a key feature. parallels the perspective of developmental It is also relevant that the perspective rep- psychopathology. The perspective is a biolog- resents an equally mainstream, modern, medi- ical one that encompasses medicine and be- cal model. Thus, for example, with respect to havior equally. The importance of emphasiz- cardiovascular disease, it has long been recog- ing this is that, in the past, there has been a nized that there is multifactorial causation, in- tendency for behavioral scientists to wish to volving influences as diverse as cholesterol develop a special set of mechanisms and of levels, clotting factors in the blood, smoking, concepts that apply specifically to psychologi- lack of exercise, obesity, and sex hormones. cal development, as if this were somehow Many of the risk factors, such as cholesterol separate or different from the rest of bodily 270 M. Rutter and L. A. Sroufe functioning. It is not. It is true, of course, that mental psychopathology perspective. First, an the study of cognitive and affective processes understanding of causal processes requires is distinctive of psychology and psychiatry knowledge about how risk and protective (and vital in developmental psychopathology mechanisms operate. With rare exceptions, all perspectives), but this is part of biology and behavior is influenced by both genetic and en- medicine and not separate from it. vironmental factors, and knowing the propor- tion of the population variance accounted for by each is, on its own, uninformative about Central Concepts of Developmental how the causal process operates. The need to Psychopathology find out how causal processes operate has im- Although there are many features of develop- portant design implications for research. Re- mental psychopathology that could be consid- views have considered those relevant to the ered important, we suggest that the defining study of environmental risks (Rutter, Pickles, features can be reduced to the approach taken Murray, & Eaves, 2000), and those that apply to three key issues: (a) the understanding of to genetic research (Rutter et al., 1999a, causal processes, (b) the concept of develop- 1999b; Rutter, in press-a). As already noted, ment, and (c) continuities and discontinuities it will usually be necessary to study the opera- between normality and pathology. tion of causal processes as they operate over time through direct and indirect chain effects, and a developmental perspective also requires Causal processes questioning how effects are carried forward The rising influence of behavior genetics in and how they influence the way the individual recent years, supported by empirical research deals with later situations and circumstances. findings (Rutter, Silberg, O’Connor, & Simo- Second, behavior–genetic partitioning of noff, 1999a, 1999b), has led many psycholo- population variance is entirely concerned with gists and psychiatrists to think increasingly the study of individual differences. That is that the study of causal processes can be re- only one of several types of causal questions. duced to the partitioning of population vari- For example, both theoretical and public ance into additive and nonadditive genetic, health considerations require attention to the and shared and nonshared environmental, ef- causes of differences in level of a trait or a fects. The findings have, undoubtedly, been disorder. Thus, for example, why has there important in showing that genetic factors play been such a massive rise in the rate of so a major role in individual differences in all many psychosocial disorders in young people kinds of behavior. Among other things, the over the last 50 years (Rutter & Smith, 1995)? genetic findings have been crucially important Or, why has there been a rise in the overall in showing that genetic influences operate IQ level over this century (Anderson, 1982; with respect to normal variations in behavior Flynn, 1987)? Or, why are most forms of anti- as well as to diseases and disorders. social behavior so much more prevalent in Some developmentalists (Baumrind, 1993) males than females (Moffitt, Caspi, Rutter, & and some neuroscientists (Rose, 1995) have Sylva, 2000), and why are depressive disor- worried that this implies a genetic determin- ders (Bebbington, 1996) and eating disorders ism. We do not share that concern. One of the (Lucas, Beard, O’Fallon, & Kurland, 1991; most important messages of genetic research Nielsen, 1990) more characteristic of women has been that genetic influences are probabi- than men? listic and not deterministic, and that environ- It is important to appreciate that the causal mental factors and genetic factors are broadly processes involved in differences in level may speaking of roughly equal importance not be the same as those involved in relation (Plomin & Rutter, 1998; Rutter & Plomin, to individual differences (see Tizard, 1975, 1997). with respect to the same point in relation to We do, however, have three rather differ- the huge secular increase in average height ent concerns that are central to a develop- during the first half of this century). A differ- Developmental psychopathology: Concepts and challenges 271 ent type of causal question concerns course. ate the importance of personal effects on the Many disorders involve several distinct environment that are not genetically medi- phases. Thus, for example, in order for per- ated. Bell (1968) first pointed out, in a semi- sons to develop drug dependency, they must nal paper, the importance of recognizing the first take the drug, they must progress to tak- need to determine the direction of socializa- ing it regularly, and they must then develop a tion effects. That there are important effects psychological or pharmacological dependency of children on their environments has been on the substance. Factors that influence each shown through a variety of research designs of these phases may be rather different (Rob- (Bell & Chapman, 1986); O’Connor, Deater– ins, Davis, & Wish, 1977), as well illustrated Deckard, Fulker, Rutter, and Plomin (1998) by Robins’s (1993) study of heroin depen- showed that, with respect to antisocial behav- dency in Vietnam veterans. Also, the factors ior, most of the children’s effect on their associated with the onset of the first episode parents was not a function of genetic risk. of a depressive disorder may not be the same Longitudinal research designs are ordinarily as those associated with its repeated recur- necessary for differentiating between personal rence (Post, 1992). effects on the environment and environmental A further type of causal question concerns effects on the person; as already noted, they the factors involved in the translation of an constitute a key feature of a developmental individual liability into the commission of a psychopathology research perspective (Sroufe, particular behavioral act such as attempting in press). suicide or undertaking a burglary. The predis- Person–environment interplay is character- posing influences are often rather different ized by complex chains, sometimes involving from those concerned with individual differ- heterotypic continuity. For example, avoidant ences in liability, and they involve factors attachment in infancy is associated with later within the individual, such as alcohol intoxi- conduct problems, but avoidant attachment is cation, or situational factors, such as the avail- also associated with low self-esteem (Sroufe, ability of the means of the suicide or opportu- 1983), negative attributional biases (Suess, nities for crime (see Rutter, Maughan, Meyer, Grossman, & Sroufe, 1992), and rejection by Pickles, Silberg, Simonoff, & Taylor, 1997, peers and teachers (Sroufe & Fleeson, 1988), for a discussion of these issues with respect all of which may predispose to conduct prob- to antisocial behavior). lems. We are only beginning to understand The third concern about the need to move how these chain effects operate in predisposi- beyond partitioning the population variance in tion to psychopathology. Their understanding the study of causal processes is that nature provides an unavoidable tension between the and nurture are not neatly separable in the need to seek simplification (the hallmark of way that was once envisaged (Bronfenbren- all good science) and the need to note com- ner & Ceci, 1994; Rutter, Dunn, Plomin, Si- plexity. Research has often suffered from un- monoff, Pickles, Maughan, Ormel, Meyer, & warranted simplifying assumptions, but a true Eaves, 1997; Rutter 1997b). Behavior geneti- understanding of biological processes usually cists have produced an increasing body of evi- shows that the complexity is explicable in dence on the importance of different types of terms of a limited set of unifying mechanisms gene–environment correlations and also and principles. gene–environment interactions. In the tradi- tional way of tackling partitioning the vari- The role of development ance, these will all be included under genet- ics, although, by definition, they have their In 1984 (Sroufe & Rutter, 1984), we argued effects through interplay with the environ- that it was possible to understand the complex ment. links between early adaptation and later disor- In recent years, most of the discussion in der only through detailed appreciation of the the literature has concerned gene–environ- nature of the developmental process itself. ment correlations, but it is crucial to appreci- This entails a progressive transformation and 272 M. Rutter and L. A. Sroufe reorganization of behavior as the developing the influences as restricted to the genetic and organism continually transacts with the envi- the environmental. The genetic programming ronment. We stressed that development neces- of development is probabilistic rather than de- sarily involved a change (because that is what terminative (Michel & Moore, 1995). Thus, development is all about) but, also, that it in- neuronal migration is a key feature of early volved a degree of continuity and the estab- brain development, but the genetic program- lishment of some coherence. It could be ar- ming provides a general instruction as to gued that the introduction of the notion of where neurons are meant to go, rather than a development does not add anything to the control of what happens with each and every study of behavior because development, like nerve cell (Goodman, 1994). It is because of behavior, is subject to the same mix of genetic this probabilistic feature that one important el- and environmental influences that have to be ement in brain development concerns the se- investigated and delineated. However, al- lective pruning of neurons that have not ended though that is the case, and although it is diffi- up in the right place. That means that there is cult to define the differences between devel- stochastic, or random, variation in develop- opment and other forms of behavioral change ment—what Molenaar, Boomsma, and Dolan (Harris, 1957; Rutter, 1984), it misses the (1993) have called “the third force,” meaning point for three main reasons (Gottlieb, Wahl- beyond genetic and environmental influences. sten, & Lickliter, 1998; Wahlsten & Gottlieb, For example, each girl inherits two X chromo- 1997). somes, one from each parent, but only one of First, the overall, universally applicable these remains functionally active. One is inac- pattern of biological development is deter- tivated, or “switched off,” and it seems that mined by nonsegregating genes possessed by which one it is is randomly determined, as is all humans. For example, over the course of the case with various other biological pro- evolution, all humans have come to have cesses (see Goodman, 1991). genes that provide the possibility of language The third consideration is that the study of (these genes not being possessed, e.g., by causal processes has to be concerned with the mice). Many of the universals of development carryforward of effects, whether they be ge- are of this kind (see, e.g., Kagan, 1981). netic or environmental. In each case, it is im- These universals (the occurrence of which is portant to ask about the nature of internal not influenced by either genes or experiences changes within the individual that are taking that differ among children) are important be- place (Rutter, 2000). Thus, with respect to cause they may have important implications psychosocial experiences, these may involve for adaptation and maladaptation. Thus, there variations in brain structure (Cicchetti & are well-documented age-dependent differ- Tucker, 1994; Liu, Diorio, Tannenbaum, ences in vulnerability to particular kinds of Caldji, Francis, Freedman, Sharma, Pearson, experiences, and there are age-dependent vari- Plotsky, & Meaney, 1997; O’Brien, 1997), or ations in the incidence of disorders (Petersen, alterations in neuroendocrine functioning 1993; Rutter, 1986a; Sroufe, in press). Of (Hennessey & Levine, 1979), or modifica- course, it cannot be assumed that these varia- tions of affect regulation (Sroufe, 1996), or tions are a consequence of biological matura- changes in cognitive set or cognitive process- tion, but that does constitute one possibility ing (Dodge et al., 1990, 1995), or altered pat- requiring investigation. Moreover, with re- terns of interpersonal interaction (Pawlby, spect to certain well-established variations— Mills, & Quinton, 1997; Pawlby, Mills, Tay- for example, the response to brain injury (see lor, & Quinton, 1997; Quinton & Rutter, Vharga–Khadem, Isaacs, van der Werf, 1988). Robb, & Wilson, 1992)—biological matura- tion almost certainly is responsible. The continuities and discontinuities between The second consideration with respect to normality and psychopathology development is that, even when considering The central concern for developmental psy- individual differences, it is misleading to see chopathology is delineation of what is in- Developmental psychopathology: Concepts and challenges 273 volved in the continuities and discontinuities from research by scientists who would not between normality and pathology. Two points identify themselves as using developmental are crucial in this connection. First, the key psychopathology (that would perhaps particu- issue concerns continuities and discontinuities larly apply to research in the field of adult in mechanisms, and not just in measures. Sec- psychiatry). As noted in the introduction to ond, even with the same feature, it is often the this paper, one of the marks of the achieve- case that both continuities and discontinuities ment of a developmental psychopathology are present. For example, IQ functions dimen- perspective is that it has become mainstream sionally as a predictor of educational attain- and is no longer easily separated off as a dif- ment or social competence right across the ferent approach. Our aim, however, is to show range, extending from profound retardation to something of the value of a developmental above-normal levels of functioning. On the psychopathology perspective, rather than the other hand, for the most part the causes of achievements of individuals who would iden- severe and profound retardation are quite dif- tify with this approach. We have chosen to ferent from the causes of the variations in IQ structure this section of the paper according within the normal range or, even, of mild to different types of psychopathology and, in mental retardation (Cantwell & Rutter, 1994; looking forward into the next millennium, we Rutter, Simonoff, & Plomin, 1996). Similar structure the challenges in terms of issues and issues apply to many other forms of behavior. mechanisms, rather than disorders. Neverthe- For example, the phenomenon of depression less, in looking back into the past, we do draw clearly spans normality and disorder in a di- attention to some of the outstanding research mensional way, but it may also be the case needs with respect to the disorders that we that bipolar affective psychoses are discontin- consider. uous with normal variations in mood (Perris, 1992). Attachment disorders A further point is that, regardless of whether or not the underlying liability to psy- Attachment concepts have come to have an chopathology is dimensional, with a contin- increasing prominence in developmental re- uum spanning normality and disorder, cate- search in recent years. Six main trends may gorical decisions will often be required for be identified. First, many studies have shown practical purposes. Thus, clinicians need to that early insecure attachment relationships decide whether or not to use antidepressant are associated with a higher risk of later psy- medication or to admit somebody to hospital. chopathology (Belsky & Nezworski, 1988; It is important to distinguish between these Cassidy & Shaver, 1999; Sroufe, Egeland, & practical requirements for having diagnostic, Carlson, 1999). Increasingly, clinical re- or severity, categories and an understanding searchers have sought to apply attachment of the underlying patterning of behavior. concepts to an understanding of the genesis of different forms of psychopathology in child- hood and adolescence and to the development Past Value of Developmental of methods of treating them. The findings em- Psychopathology phasize the importance of social relationships Because developmental psychopathology, as in human functioning and the extent to which conceptualized by us, has been such a bur- they are affected in a wide range of disorders geoning field in the last 2 decades, it would (Hinde, 1997). Nevertheless, there is a danger require a textbook to discuss the many ad- that attachment concepts become too all ex- vances that have derived from adopting a de- planatory. Attachment features do not consti- velopmental psychopathology perspective. In tute the whole of relationships (indeed, one this section of the paper, we therefore provide of Bowlby’s, 1969, key contributions, was the only a limited set of examples to illustrate differentiation of attachment features from something of the range of accomplishments. other aspects of relationships), and insecure Some of the examples that we give derive attachments are not themselves indicative of 274 M. Rutter and L. A. Sroufe psychopathology (Sroufe, 1988; Rutter, 1995). and other forms of observational methods Research must meet the challenge of deter- were needed. mining just how insecure attachment relation- Earlier research had shown that the old- ships play a role in psychopathology, putting style notion of fixed critical periods for devel- competing explanations under research scru- opment were misleading, but new findings of tiny and not just assuming the primacy of an various kinds have highlighted the importance attachment paradigm (see Rutter, 2000b, and of age-defined periods of especial vulnerabil- Rutter, Pickles, et al., 2000, for a discussion ity (“sensitive periods”) to particular kinds of of the broader issue of testing causal hypoth- stress or adversity. Thus, the follow-up study eses). of children placed in residential nurseries in Second, there has been a growing attention infancy, undertaken by Hodges and Tizard to the social development of children reared (1989a, 1989b), showed that antisocial behav- in grossly abnormal environments. This ne- ior was more a function of current social cir- cessitated several developments. To begin cumstances and adolescence than the situation with, it soon became apparent that the tradi- in very early childhood. By contrast, both the tional ways of classifying security and insecu- children who had been restored to the biologi- rity were not always picking up the features cal parents (and often were living in discor- that seemed most distinctive of these children dant, disadvantageous circumstances) and reared in highly atypical circumstances (Von- those who had been adopted (and who were dra & Barnett, 1999). Much earlier, Main and mainly in above-average quality homes) dif- Solomon (1986) had recognized the need for fered from controls in showing a pattern of a category of “disorganized attachment” (see peer relationships that lacked intensity and se- review by van IJzendoorn, Schuengel, & lectivity. The features were not normal, but Bakermans–Kranenburg, 1999, on its quali- they did not constitute a disorder in the usual ties), and this seemed to apply particularly to psychiatric sense. Like the findings of indis- children from grossly abnormal backgrounds. criminate friendliness, the links with earlier In addition, because many of the children be- attachment relationships remain uncertain, but ing studied were substantially older than the it seems very likely that, in some way, the age period below 2 years for which the lack of opportunity to form selective attach- “Strange Situation” had been developed, some ments in early childhood predisposed to these modifications of procedure were required later features in peer relationships and adult (Waters, Vaughan, Posada, & Kondo–Ike- relationships. Findings of this kind highlight mura, 1995). They were also necessary be- the need to understand how early selective at- cause the scattered nature of unusual samples tachments are related to other social relation- often meant that the children needed to be as- ships in later life. sessed in their own homes rather than in the A fourth important trend in the field of at- research laboratory. In addition, studies of tachment concerns the extrapolation of attach- children reared in severely depriving Roma- ment concepts into adult life (Hazan & nian orphanages, and later adopted into North Shaver, 1994). Various measures of different American (Chisholm, 1998) or UK families aspects of adult relationships have been devel- (O’Connor, Bredenkamp, Rutter, & the En- oped. The adult attachment interview has fo- glish and Romanian Adoptees [ERA] Study cused especially on the cognitive set of rela- Team, 1999; O’Connor, Rutter, & the ERA tionships that is thought to have been derived Study Team, in press), showed a pattern of from the individual’s relationships in early somewhat indiscriminate friendliness to life (Main, Kaplan, & Cassidy, 1985; van IJ- adults that was not well picked up by the zendoorn, 1995). From all points of view, it presses of the “Strange Situation” procedure makes sense to extend attachment concepts when it was used with postinfancy age groups into adult life. After all, the loss of a love rela- (Goldberg, 1997; Marvin & O’Connor, 1999), tionship constitutes a major risk factor at all although noted by Bowlby (1973) as indica- age periods after infancy, and there is a uni- tive of attachment problems. Both interview versal wish to seek security in close intimate Developmental psychopathology: Concepts and challenges 275 human relationships. On the other hand, much dertaken. Traditionally, the measurements of work has still to be done sorting out the conti- security of attachment have been categorical, nuities and discontinuities across the life span. although it would seem conceptually that The early childhood measures are dyadic, there are underlying dimensions. Well-vali- whereas the measures in adult life reflect indi- dated dimensional measures are needed, and vidual characteristics. Also, in order to extend are being developed, in order to examine con- into older age, it will be necessary to alter tinuities and discontinuities across the span of concepts in fairly substantial ways. In the behavioral variation (Waters et al., 1995). years ahead, it will be important to put to rig- orous test the various assumptions that under- Antisocial behavior lie the extrapolations across ages and across different types of relationships. It has been appreciated for a long time that A fifth trend has been the study of inter- antisocial behavior is heterogeneous, but until generational continuities and discontinuities recently the ways of subdividing it had proved (see Fonagy, Steele, Steele, Higgitt, and Tar- rather unsatisfactory. A way forward was pro- get, 1994). Strikingly, several studies have vided by the recognition by Patterson (1995; found that the security of the mother’s adult Patterson & Yoerger, 1997), Moffitt (1993), attachments, as assessed by the Adult Attach- and others that the age of onset, together with ment Interview during her pregnancy, pre- course, might prove to be a key differentiating dicted the security of the infant’s attachment feature. A distinction was drawn between life- to its mother. Similar, the mothers’ prenatal course-persistent antisocial behavior and ado- representation of their infant has also pre- lescence-limited antisocial behavior. Empiri- dicted the infants’ attachment security (Be- cal research has broadly confirmed the valid- noit, Parker & Zeanah, 1997). Questions re- ity of this distinction (Lahey, Waldman, & main on the mediation mechanisms involved McBurnett, 1999; Rutter, Giller, & Hagell, and on the factors leading to differences in 1998). The life-course-persistent variety, attachment security among children being which is much more common in males (Mof- reared in the same family. fitt et al., 2000), is characterized by the first Over recent years, too, there has been the manifestations of markedly disruptive behav- application of attachment concepts to all sorts ior in the preschool years, by an association of abnormal groups, but all too often the mea- with hyperactivity–inattention, by poor peer sures used both depart considerably from relations, by difficult behavioral features (of- standard attachment measures and also lack ten involving aggressivity, impulsiveness, and proven validity (Rutter & O’Connor, 1999). sensation seeking), and by mild cognitive im- The potential is rich, but there is a great need pairment. Family discord and disruption stand to bring together the kind of approaches used out as part of the mix of risk features, and to study normal development and those de- insecure attachment relationships are often vised to study disorder. In that connection, present (Aguilar, Sroufe, Egeland, & Carlson, uncertainty continues over the precise mean- 2000). By contrast, the adolescence-onset va- ing and boundaries of so-called attachment riety is much less characterized by these risk disorders (Zeanah, 1996). The pattern of in- features (although they may be present in discriminate friendliness provides a close ap- mild degree), but poor parental supervision proximation to the prevailing concepts of one and being part of an antisocial peer group sort of reactive attachment disorder (disinhib- stand out as the main risk features. Although ited type), and it seems probable that that will males predominate to a slight extent, the sex stand the test of time, although questions are ratio is much near parity than is the case with still being posed as to how this relates to early the life-course-persistent variety. Research selective attachments (Zeanah, in press). evidence, so far, is inconclusive on whether Much less work has been done with the other or not the two groups differ qualitatively or, form of attachment disorder (inhibited type), rather, quantitatively; and it is likely that there and that remains an important task to be un- are more than just two types (Nagin, Farring- 276 M. Rutter and L. A. Sroufe ton, & Moffitt, 1995). Nevertheless, the dis- as there is good evidence of a much stronger tinction according to age of onset and devel- genetic component in the liability for hyperac- opmental course has proved useful and is tive behavior than is the case for other forms likely to hold up as a key differentiator. of antisocial behavior (Rutter et al., 1998; Because delinquency reaches its peak in Thapar, Harold, & McGuffin, 1998), and in adolescence, there has often been an assump- showing the importance of cognitive deficits, tion that aggression and disruptive behavior and of a pattern of correlates that differ from start at a low level and then increase over time that evident for other forms of disruptive be- in vulnerable groups. The implication has havior (Taylor, Sandberg, Thorley, & Giles, been that the search needs to be for factors 1991; Taylor, 1994). Longitudinal studies, that foster antisocial behaviors. Longitudinal particularly those using latent variable analy- studies undertaken by Tremblay and his col- ses, have also shown that the developmental leagues (Nagin & Tremblay, 1999; Tremblay, paths of hyperactivity and of antisocial behav- Japel, Pe´russe, Boivin, Zoccolillo, Mont- ior are somewhat different (Ferguson & Hor- plaisir, & McDuff, in press; see also wood, 1993). It seems that hyperactivity is a Loeber & Hay, 1997) have called that as- marker for early disruptive behavior but that sumption into question. Their evidence sug- the continuation of antisocial behavior is de- gests that the peak occurs during the pre- pendent on these early associations, rather school years and falls off thereafter. If than on any risk for later onset antisocial be- confirmed by other studies, the implication is havior. Findings are much in line with those that the search needs to be for factors that fail already considered with respect to life-course- to inhibit aggressive–disruptive behavior, as persistent and adolescence-limited antisocial well as for factors that foster it. behavior. On the other hand, concerns have Traditionally, psychiatric classifications been expressed that the mere presence of hy- have differentiated between oppositional–de- peractivity–inattention is too readily used as fiant disorders and conduct disorders, the for- an indicator of constitutional origin, and that mer being characterized by disruptive inter- the likelihood is that the phenomenon is more personal interactions and the latter by more heterogeneous than the diagnostic category severe predatory or illegal acquisitive behav- suggests (Carlson, Jacobvitz, & Sroufe, 1995; ior. A range of longitudinal studies have Sroufe, 1997). Recent research on children suggested that this categorical distinction is reared in institutions supports this concern. probably misleading. Oppositional–defiant Studies of both children in well-run residen- behavior is more characteristic of the earlier tial nurseries in the United Kingdom (Roy, years of childhood, but if it continues it tends Rutter, & Pickles, 2000a, 2000b), and of chil- to lead into conduct disorder (Lahey et al., dren from very poor quality Romanian or- 1999). In other words, the slightly different phanages (Kreppner, O’Connor, Rutter, & the manifestations probably reflect what is char- ERA Study Team, 2000), have both shown acteristic of different age periods rather than strong associations with hyperactivity–inat- of different disorders. tention. Of all the forms of unusual behavior, Longitudinal studies have shown that hy- this stands out as the one that is the more dis- peractive–inattentive behavior is a risk factor tinctive. Whether or not the particular charac- for later antisocial behavior, particularly for teristics of the hyperactivity–inattention are that which persists into adult life (Farrington, the same as those found with the diagnostic Loeber, & van Kammen, 1990). On the other category in children reared in more ordinary hand, psychiatric diagnostic conventions have circumstances remains quite uncertain. The tended to place attention-deficit disorder with genetic evidence is also important in indicat- hyperactivity as a strongly constitutional, and ing that the genetic liability applies to a much in some respects “organic,” condition that is broader range of hyperactivity–inattention rather different from the broad run of antiso- than that which is included in the extreme di- cial behavior. Findings have to some extent agnostic category (Rutter, Maughan, et al., confirmed this concept (Taylor, 1999), insofar 1997; Thapar et al., 1998). Developmental psychopathology: Concepts and challenges 277

Research in the field of antisocial behavior an increase in disruptive behavior and heavy has also been important in throwing new light drinking. The Dunedin longitudinal study in on the role of early experiences. When re- New Zealand showed much the same but viewed some years ago (Rutter, 1981), it was added to the finding in an important way concluded that it was unusual for even mark- through its demonstration that, although the edly adverse early experiences to have endur- stimulus was clearly biological, the mediating ing effects that were independent of later cir- mechanism was almost certainly social. The cumstances. That finding still holds true effect of early puberty in girls was found to (although there are some important excep- be dependent on the girls’ entering an older tions, as research into the adoptees from Ro- peer group (as also found by Stattin & Mag- mania has shown, for at least some outcomes; nusson, 1990) and that the effect was confined O’Connor et al., in press; Rutter, O’Connor, to coeducational schools, where, presumably, Beckett, Castle, Croft, Groothues, Krepp- the presence of males increased the likelihood ner, & the ERA Study Team, in press). How- of an antisocial ethos (Caspi, Lyman, Mof- ever, the question had been posed the wrong fitt, & Silva, 1993; Caspi & Moffitt, 1991). way. What has been found to be important is The importance of interplay between na- the considerable extent to which early experi- ture and nurture has also been brought out in ences shape and influence later experiences genetic studies of antisocial behavior (Rutter, (Rutter, Champion, Quinton, Maughan, & 1997b). Gene–environment correlations are Pickles, 1995). Indeed, it is rather unusual for frequent and gene-environment interactions later experiences to be independent of earlier are also evident (Bohman, 1996; Cadoret, ones. Although the direct effects of early ex- Yates, Troughton, Woodworth, & Stewart, periences on functioning many years later are 1995; Cadoret, 1985; Rutter et al., 1998). In- quite small, the indirect effects are very much dividuals showing antisocial behavior interact greater (Sroufe et al., 1999). These continui- with other people in ways that frequently ties and experiences play a substantial role in bring about further stressful or risky circum- enhancing behavioral characteristics, either in stances. This is strikingly evident, for exam- an adaptive or maladaptive direction (Caspi & ple, in the strong tendency for antisocial Moffitt, 1991, 1993, 1995). individuals to marry or cohabit with other an- On the other hand, research has also shown tisocial individuals (Krueger, Moffitt, the major importance of experiences in ado- Caspi, & Bleske, 1998). Indeed, this assorta- lescence and adult life, provided that they tive mating tendency is actually quite a lot bring about either a radical alteration in life stronger than the tendency for antisocial par- opportunities or a substantial alteration in a ents to have antisocial children (Farrington, person’s self-concept or cognitive set. This Barnes, & Lambert, 1996). has been shown, for example, with respect to army experiences when they bring about dis- Autism continuities from the past for disadvantaged youths (Elder, 1986; Sampson & Laub, 1996) At first sight, it might seem that autism is the and for a cohesive, harmonious marriage diagnostic category least likely to require a (Zoccolillo, Pickles, Quinton, & Rutter, 1992; developmental psychopathology perspective. Quinton, Pickles, Maughan, & Rutter, 1993; As traditionally diagnosed, it stands out as a Laub, Nagin, & Sampson, 1998). Depending severely handicapping disorder that appears on whether or not the experiences in later life qualitatively quite distinct from normality. show continuities or discontinuities with early Nevertheless, there are two ways in which this experiences, the consequence may be either view has proved, at least partially, mistaken. an accentuation (Caspi & Moffitt, 1993) or a Psychiatric writings in the 1960s tended to turning-point effect (Rutter, 1996). consider autism as a variety of infantile psy- Magnusson’s Swedish longitudinal study chosis, with parallels being drawn with schiz- (Stattin & Magnusson, 1990) showed that an ophrenia. Much research indicated that the unusually early menarche was associated with differences between autism and schizophrenia 278 M. Rutter and L. A. Sroufe far outweighed the similarities and that also it noff, 1996) might also provide part of the was probably highly misleading to consider cognitive basis for autism. Doubts have been autism as a psychosis that involved some raised about both (Griffith, Pennington, break with a previous normality (Rutter, Wehner, & Rogers, 1999; Plaisted, Swetten- 1972). Research by Hermelin and O’Connor ham, & Rees, 1999) but they warrant further (1970) and their colleagues was the first to study. show the value of an experimental psycholog- A second area of autism research where a de- ical approach that sought to examine the cog- velopmental psychopathology perspective has nitive features in greater detail and to link been useful concerns the delineation of the di- them with the social deficits. Nevertheless, agnostic boundaries. Genetic research has been there were considerable difficulties in know- important in indicating that the phenotype, as ing just how the cognitive deficits might lead defined by genetic liability evident from twin to the particular social features that are diag- and family studies, extends far beyond the tra- nostic of autism (Rutter, 1983). ditional boundaries of the diagnosis of autism A major step forward was provided by the as a major handicapping condition (Bailey, application of “theory of mind” concepts, Palferman, Heavey, & Le Couteur, 1998; Rut- originally derived from studies of normal chil- ter, 2000a; Rutter, Maughan, et al., 1997). dren (Baron–Cohen, Leslie, & Frith, 1985). This broader phenotype, or lesser variant, of Subsequent research has confirmed that most autism may occur in as many as one in five of autistic individuals lack the mentalizing skills the first-degree relatives of individuals with to know what another person is likely to be autism, and the possibility that autistic fea- thinking, given knowledge of the social con- tures might extend even further into the gen- text or past happenings (Frith, 1989; Baron– eral population, although not considered plau- Cohen, 1995; Happe´, 1994). The detailed sible a few years ago, cannot now be ruled findings provide good grounds for the infer- out entirely. ence that this cognitive deficit plays a major One further feature to mention, with re- role in autistic individuals’ severe limitations spect to recent autism research, concerns the in the development of reciprocal relation- finding that atypical varieties of autism may ships. One difficulty, however, has been the derive from congenital blindness (Brown, fact that autism is manifest before age 2 years Hobson, & Lee, 1997) and profound early so- in most instances, well before normal children cial and nutritional deprivation (Rutter, An- show theory of mind skills when tested in the dersen–Wood, Beckett, Bredenkamp, Castle, usual way. In part, this is probably a conse- Groothues, Kreppner, Keaveney, Lord, quence of the fact that the particular experi- O’Connor, & the ERA Study Team, 1999). mental situation used does not pick up theory The clinical pictures associated with these un- of mind skills that are demonstrable in more usual risk factors seem somewhat different naturalistic circumstances (Dunn, 1988, 1996). from “ordinary” autism, and it is doubtful In addition, the focus shifted to earlier emerg- whether they have much direct relevance for ing cognitive skills, such as joint attention, the causation of autism arising in more ordi- that might constitute precursors of theory of nary circumstances. Nevertheless, the findings mind or an alternative cognitive route to the do raise important questions about the hetero- social dysfunction (Sigman & Ruskin, 1999). geneity of autism and the possibly different Although theory of mind deficits constitute a routes by which it may arise. plausible explanation for social dysfunction, it is not so obvious that they could account for Depressive disorders the repetitive stereotyped behaviors that are also characteristic of autism. For that and Up until about a generation ago, depressive other reasons, research has sought to deter- disorders were rarely diagnosed in childhood mine whether a lack of central coherence because psychoanalytic theory claimed that (Happe´, 1996) or deficits in particular aspects they could not occur in the young (see Rutter, of executive planning (Pennington & Ozo- 1986b). The situation changed as people be- Developmental psychopathology: Concepts and challenges 279 came more sceptical about the unvalidated tween depressive disorders arising for the first claims of psychoanalytical theory, and as em- time in childhood and those arising in adoles- pirical observations, and especially the use of cence or later (Duggal, Carlson, Sroufe, & standardized interview methods, made it clear Egeland, in press). that depressive phenomena could and did oc- One of the striking features of depressive cur in children. The pendulum has now rather disorders is that they become much more fre- swung to the opposite extreme, depressive quent at some point during the adolescent age disorders being diagnosed with a high fre- period and that this increase in frequency is quency (Lewinsohn, Rohde, & Seeley, 1998). much stronger in females than males (Silberg, Indeed, there have even been claims that bipo- Pickles, Rutter, Hewitt, Simonoff, Maes, Car- lar disorders are extremely common in high- bonneau, Murrelle, Foley, & Eaves, 1999). risk groups (see Biederman, Faraone, Mil- Clearly, a developmental perspective is likely berger, Guite, Meck, Chen, Mennin, Marrs, to be useful in investigating why depression Ouellette, Moore, Spencer, Norman, Wilens, becomes so much more common during the Kraus, & Perrin, 1996). A key problem is teenage years and why the sex ratio alters that, at one extreme, feelings of depression from, roughly, parity in childhood to a are simply a normal part of the human condi- marked female preponderance in adulthood tion but that, at the other extreme, they consti- (Peterson, 1993). Again, the evidence is thin tute a serious psychosis. A key issue, from a on the ground, but findings from the Virginia developmental perspective, is whether or not twin study suggest that genetic influences re- the depressive disorders arising in early life lated to both life events and depression play a are the same as those occurring in adulthood. significant role (Silberg et al., 1999). Several findings are crucial in drawing Research from many research groups but conclusions. First, longitudinal studies have especially that from Brown and Harris (1978) made it clear that children who suffer from a has shown the high frequency with which the depressive disorder have a greatly increased onset of depressive disorder in adult life has risk of a recurrence of depressive disorders in been preceded by a stressful life event that adult life (Harrington, Fudge, Rutter, Pick- carries long-term threat. On the other hand, it les, & Hill, 1990; Weissman, Wolk, Gold- is obvious that many people have life events stein, Moreau, Adams, Greenwald, Klier, without developing depression, and it has Ryan, Dahl, & Wickramaratne, 1999). How- been necessary to consider why there are such ever, it is also relevant that very few of the marked individual differences in response to recurrences in adult life take the form of a apparently similar circumstances. Three fea- bipolar disorder. That has been true even tures have seemed influential. First, many when samples have consisted of severe de- studies have shown that adverse experiences pressive disorders in childhood that have led in childhood are associated with an increased to hospital admission (Weissman et al., 1999). liability to depressive disorder in adult life Second, there is some evidence from ques- (Harris, Brown, & Bifulco, 1990). Second, the tionnaire studies that depressive phenomena personal meaning of the event seems to influ- (not necessarily disorders) show a lower ge- ence its impact (Brown & Harris, 1978, netic component in childhood than they do in 1989). Third, there is evidence that genetic adolescence or adult life (Thapar & McGuf- factors may play a role in susceptibility to life fin, 1994). Early-onset depressive disorders stressors (Kendler, Kessler, Walters, Mac- may also be more likely to be associated with Lean, Neale, Heath, Corey, & Eaves, 1995; antisocial problems in the individual and in Silberg et al., 2000). the family (Harrington, Rutter, Weissman, For a long time, it has been implicitly as- Fudge, Groothues, Bredenkamp, Pickles, sumed that all depressive disorders can be Rende, & Wickramaratne, 1997), although treated as equivalent (apart from, perhaps, bi- this finding requires replication. The data are polar and severe melancholic varieties). How- too sparse for firm conclusions, but it seems ever, recent findings have raised queries as to that there may be important differences be- whether the factors involved in the onset of 280 M. Rutter and L. A. Sroufe the first episode of the disorder may not be investigated features of gender differences the same as those involved in later recur- and of age changes in frequency of depressive rences (Brown, Harris, & Hepworth, 1994). disorder, including features that maintain on The issue is an important one, if only because or deflect individuals from a depression most depressive disorders are recurrent (Judd, pathway. 1997). The evidence suggests that genetic fac- tors may be more important in the lifetime lia- Schizophrenia bility to depression than in the onset of the first episode (Kendler et al., 1995), and that Like autism, schizophrenia was long consid- depressive-style attributions may also play a ered as a severe disorder that provided a role in the persistence or recurrence of depres- sharp, qualitative departure from normality. It sion (Teasdale & Barnard, 1993). Psychiatric was not obvious that a developmental per- classifications have tended to draw sharp dis- spective would be useful because it was so tinctions between depressive disorders on the uncommon for schizophrenic psychoses to be- one hand and anxiety disorders on the other, gin in childhood. despite the fact that, at an individual level, Nevertheless, it has become increasingly there is very considerable overlap. Twin-study appreciated that a developmental perspective findings indicate that both anxiety and depres- is needed. (See Cicchetti & Cannon, 1999, for sive disorders probably reflect the same ge- an overview of the issues involved in relating netic liability and that this may well reside, neurodevelopment to psychopathology.) Of- to a considerable extent, in the temperamental ford and Cross (1969) pointed to the evidence feature of neuroticism (Eley & Stevenson, that about half of schizophrenic psychoses 1999; Kendler, 1996). with an onset in adult life had been preceded Although there is good reason for conclud- by substantial nonpsychotic abnormalities in ing that adverse life experiences play a sub- childhood. In the 40-odd years since then, the stantial role in the genesis of depressive disor- evidence that it is so has steadily mounted, ders (see Rutter, in press-c), a caveat is with the impact from prospective longitudinal necessary. Very little of the research is longi- studies of the general population being crucial tudinal, and because, in adults, the life experi- (Done, Johnstone, Frith, Golding, Shep- ences and the depressive symptomatology are herd, & Crow, 1991; Jones, Rodgers, Mur- reported by the same informant, some of the ray, & Marmot, 1994). It is not just that social association may reflect reporting bias. Also, and behavioral abnormalities may be evident few of the studies have used genetically sensi- in childhood (although that is the case) but tive designs, and it is relevant that genetic fac- also that there are developmental delays in a tors play a role in the individual differences in substantial proportion of individuals who later the likelihood of experiencing and of reacting develop schizophrenia. A neurodevelopmental adversely to stress events, and that the genetic concept of schizophrenia has come to the fore factors may also overlap with those that un- (Cannon & Murray, 1998; Harrison, 1997; derlie depressive disorders (Kendler & Kar- Murray & Woodruff, 1995). At first, it was kowski–Shuman, 1997; Thapar et al., 1998). thought that the neurodevelopmental risks An immense amount has been learned were specific to schizophrenia. Recent find- from the study of depressive disorders in ings have begun to cast doubt on whether that adults. There is a growing body of research is, strictly speaking, so. It seems that rather findings on comparable disorders occurring in similar risks may apply in the case of affec- young people. Nevertheless, the adoption of a tive psychoses, although the findings are developmental perspective has raised a num- stronger in the case of schizophrenia (Jones, ber of important queries that have yet to be 1997). Genetic findings, like those in autism, fully resolved. There is a need for more longi- have shown that the genetic liability extends tudinal research that is explicitly focused on beyond schizophrenic psychoses to include understanding the details of risk and protec- schizotypal and paranoid disorders (Kendler tive mechanisms and that focuses on the less et al., 1995). The evidence is still in favor of Developmental psychopathology: Concepts and challenges 281 a substantial degree of diagnostic specificity, ment at that early age. On the other hand, but it is necessary to extend the concept of early brain injuries are perhaps more likely schizophrenia beyond psychoses, to include than later ones to result in global intellectual some forms of personality disorder. Precisely impairment (Vharga–Khadem et al., 1992). how and where to draw the boundaries is, Also, adverse intellectual sequelae are more however, still unclear. likely if the injury is associated with epi- There is good evidence that genetic factors lepsy—suggesting that active brain dysfunc- play a substantial role in schizophrenia (Mol- tion, rather than loss of function, may be criti- din & Gottesman, 1997), and the notion that cal. The results of research are clear cut in it is a psychogenic disorder has largely been indicating marked age-dependent variations in abandoned (with good reason). Nevertheless, response to brain injury, but the differences one of the most striking findings in recent lie more in the pattern of sequelae than in years has been the evidence that schizophre- whether or not cognitive impairment occurs. nia has a much increased rate among people Until recently, the available evidence has of West Indian origin living in the United given no clear indication of gene–environ- Kingdom. The rate is higher than that in the ment interactions in relation to intellectual de- West Indies and is higher than in other ethnic velopment, but new findings have suggested groups within the United Kingdom (McKen- that genetic influences are less when children zie & Murray, 1999). Careful analysis of pu- are reared in less advantageous environments tative causal influences indicates that some (Rowe, Jacobson, & van den Oord, 1999). form of psychosocial stress or adversity that The possible importance of nature–nurture in- impinges differentially on people of West In- terplay needs to be reconsidered. dian background in the United Kingdom is In most psychological theorizing about in- likely to be responsible. Whether or not this tellectual development, dietary factors have form of schizophreniform disorder, in which played a negligible role. It has, therefore, been psychosocial factors appear relatively strong, quite surprising that well-conducted research, is different from other forms of schizophrenia both naturalistic and experimental, comparing remains to be established. the effects of natural breast milk and formula milk on the later intellectual development of prematurely born children has shown substan- Intellectual development tial benefits of breast milk (Lucas, Morley, & It used to be said that if you were going to Cole, 1998). It has been argued that some have a head injury it would be better to have form of developmental programming may un- it early because the effects were so much derlie the finding. The research is sound and less—the so-called Kennard principle (1942). well designed, but, as with all forms of re- Research evidence has shown that this is a search, independent replication with other re- somewhat misleading oversimplification search groups is required before too much is (Rutter, 1982, 1993). The age of the individ- built into this finding, however compelling ual at the time of brain injury clearly is a most the evidence from one set of investigations. important factor, but its effects are somewhat Moreover, the effect may not apply to full- more complicated than the original principle term babies (Richards, Wadsworth, Rahimi– suggested. Contrasted with the situation in Foroushani, Hardy, Kuh, & Paul, 1998). adults, lateralization effects following brain Numerous studies over the years have injuries in infancy are negligible. That is to shown that IQ scores in the first few years say, unlike the situation in adults, left-brain of life are of negligible value for intellectual injuries do not result in specific verbal defi- functioning in adolescence and adulthood. cits, and right-brain injuries do not lead to cir- The findings had seemed to suggest a sharp cumscribed visuospatial deficits. It seems that discontinuity between earlier and later intel- either there is a transfer of functions across lectual functioning. There were many reasons the hemisphere when one side is damaged, or why there should be a degree of discontinuity, there is greater plasticity in brain develop- particularly because language skills become 282 M. Rutter and L. A. Sroufe increasingly important in cognitive perfor- that are available for the assessment of psy- mance during childhood. Also, animal studies chopathology in childhood and adolescence, had shown that with maturation, different as well as in adult life (Shaffer, Lucas, & parts of the brain may come to be responsible Richters, 1999). A rich assortment of ques- for the same cognitive functions (Goldman– tionnaire, interview, observational, and psy- Rakic, Issernoff, Schwartz, & Bugbee, 1983). chometric measures have been developed and Nevertheless, it had seemed surprising that al- for many of them there is good evidence of most no continuity was evident. About 20 their reliability and validity. It might well be years ago, researchers began to adopt differ- thought that we have got as far as we can in ent strategies for studying cognitive function- the field of measurement, but there are sub- ing in infancy, recognizing that different skills stantial unresolved problems. In many re- might be needed at this early age. The result spects, the most pervasive, and perhaps the was the development of methods for attention most surprising, finding has been the poor and habituation. These showed substantial in- agreement between parents, teachers, and dividual differences that, contrary to findings children on almost all aspects of psychopath- with developmental milestones of a traditional ology, and also of family experiences (Achen- kind, did show modest continuities with intel- bach, McConaughy, & Howell, 1987; lectual performance as assessed in the usual Elander & Rutter, 1996; Simonoff, Pickles, ways in middle childhood (Bornstein & Sig- Meyer, Silberg, Maes, Loeber, Rutter, Hew- man, 1986; Colombo, 1993; McCall & Car- itt, & Eaves, 1997). riger, 1993). Many questions remain, and it There are many reasons why this might be has not proved easy to define tests that are so. Thus, for example, children in rating their applicable across more than quite narrow age own behavior may focus particularly on the periods. Even so, the findings have been im- contrast between how they are feeling now (or portant in showing that there are continuities what they are doing now) as compared with as well as discontinuities in intellectual how things were some time ago. Parents, on achievement and that the continuities are het- the other hand, are more likely to compare erotypic. That is to say, although it seems children with their siblings or with other chil- likely that the underlying function remains dren whom they know. Teachers, too, will broadly the same over development, its sur- make comparisons with other children but face manifestations differ markedly. will have a much larger sample of comparison available to them. Inevitably, too, parents will focus more on what they have perceived in Looking Forward Into the 21st Century the context of the home, whereas teachers will As illustrated by this selective review of some do so in the context of the school, the situa- key findings, considerable progress has been tional demands of the two settings being made in understanding many of the features rather different. presented by the domain of development psy- Evidence has accumulated that, with some chopathology. Even so, it is equally apparent behaviors such as hyperactivity, parents may that major research challenges remain. In this exaggerate the contrasts between siblings, final section of the paper, we outline a few of leading to an artifactually low correlation be- these key challenges. We make no attempt at tween ratings of the behavior of the twins or being exhaustive in our coverage, but we do siblings (Simonoff, Pickles, Hervas, Silberg, seek to highlight issues that have broad impli- Rutter, & Eaves, 1998). But the problem goes cations beyond the specifics of a particular more broadly than that. It is not just that the trait or disorder. agreement between informants is modest but also that the correlates tend to be rather differ- ent. Thus, for example, genetic influences on Measurement issues behavior as rated by children tend to be lower The last few decades have seen major im- than as rated by parents (Hewitt, Silberg, Rut- provements in the methods of measurement ter, Simonoff, Meyer, Maes, Pickles, Neale, Developmental psychopathology: Concepts and challenges 283

Loeber, Erickson, Kendler, Heath, Truett, are being found as risk correlates of one disor- Reynolds, & Eaves, 1997; Eaves, Silberg, der may, in fact, be the risk factors for some Meyer, Maes, Simonoff, Pickles, Rutter, other form of psychopathology with which it Neale, Reynolds, Erickson, Heath, Loeber, happens to be associated), and because, if Truett, & Hewitt, 1997; Eley & Stephenson, properly handled, the investigation of the 1999). Interest has also grown with respect to mechanisms underlying comorbidity may be the ways in which ratings may be biased by highly informative on risk and protective fac- the current mental state of the person making tors more generally. the rating (such as the effects of parental de- pression on the parental ratings Boyle & Pick- Gender differences les, 1997; Brewin, Andrews, & Gotlib, 1993). The findings of such comparisons have been The existence of major gender differences in informative, but it has to be said that the rates of particular forms of psychopathology mechanisms involved in the similarities and has been well recognized for many years differences among informants remain very (Earls, 1987; Eme, 1979, 1992), although poorly understood. Their elucidation requires their meaning has been ill understood (Rutter, systematic epidemiological–longitudinal stud- 1970; Gualteri & Hicks, 1985; Taylor & Rut- ies focused on testing specific hypotheses ter, 1986). Thus, autism, attention-deficit hy- about possible explanations. perkinetic disorder, developmental language disorders, and delinquency all show a marked male preponderance, whereas adolescence-on- Comorbidity set eating disorders (such as anorexia and bu- After years of neglect, the issue of comorbid- limia nervosa) and depressive disorders in the ity has become the “flavor of the moment,” years after childhood are both substantially with the literature full of papers on its occur- more frequent in females. In all cases, it is rence and patterning. Unfortunately, many of necessary to check that the gender differences the studies are not as informative as they are not artifactual. For example, Zoccolillo might be because the research has not been (1993) has suggested that conduct disorders planned in a way that provides an adequate in girls are much more frequent than usually test of competing mechanisms. The fact that appreciated but that the diagnostic threshold supposedly separate forms of psychopathol- for a number of symptoms needs to be differ- ogy frequently co-occur in the same individ- ent for girls than for boys. Likewise, Crick ual has been well demonstrated in numerous (1996) has argued that much aggression in epidemiological studies (Angold, Costello, & girls has been overlooked because it is of a Erkanli, 1999; Caron & Rutter, 1991). The different form from that in boys. As both No- key question is what the co-occurrence len–Hoeksema (1987) and Moffitt et al. means; it is likely that some, perhaps much, (2000) have sought to demonstrate, it is possi- is artifactual, deriving from mistaken assump- ble to postulate a range of different explana- tions in diagnostic concepts and boundaries. tions and to undertake appropriate research Alternatively, both may derive from the same tests to choose between competing hypothe- set of intercorrelated risk factors. Or, yet ses. Clearly, there is a need to understand the again, the presence of one form of psycho- processes underlying these quite marked gen- pathology may, through its effects, constitute der differences. We do not even know a risk mechanism for another form of psycho- whether the causes of gender differences are pathology. There are numerous examples in the same across different disorders or whether internal medicine of all of these (Rutter, quite different risk processes are operating. 1997a), and they provide useful models for On the face of it, it is not obvious that the research strategies. It is crucially important to explanation for the male excess in delin- determine the meanings of comorbidity, both quency and in autism would be the same. because its presence is likely to confuse and However, it would be premature to entirely distort the meaning of findings (because what reject the possibility of a unifying explana- 284 M. Rutter and L. A. Sroufe tion. The point is that this major phenomenon, to obtain a better understanding of how they gender differences in rates of specific psycho- are involved in the risk processes. For exam- pathology, requires systematic study, and this ple, the evidence suggests that a depresso- is likely to involve somewhat different re- genic attributional style may be more impor- search strategies to those ordinarily employed. tant in the persistence or recurrence of That is because the topic being investigated depression than in its original onset (Teas- concerns differences between groups in level, dale & Barnard, 1993). In addition, there is an rather than individual differences within a sin- equally pressing need to understand the con- gle population. nections between brain and mind. The devel- opment of functional brain-imaging tech- niques, as represented at first by positron Cognitive processing emission tomography (PET scans) (Bremner, The study of cognitive processing has consti- Innis, Ng, Staib, Salomon, Bronen, Duncan, tuted one of the major growth areas in psy- Southwick, Krystal, Rich, Zubal, Dey, chology over the last few decades. Two some- Soufer, & Charney, 1997), and more recently what different phenomena seem to be by magnetic resonance imagery (MRI scans) important in relation to psychopathology provide one possible way forward (Rugg, (Rutter, 1987). On the one hand, there are dis- 1997; Fletcher, Happe´, Frith, Baker, Dolan, orders, such as autism, where the underlying Frackowiak, & Frith, 1995; Schultz, Gauthier, problem seems to lie in the presence of cogni- Klin, Fulbright, Anderson, Volkmar, Skudlar- tive deficits for particular kinds of mental pro- ski, Lacadie, Cohen, & Gore, 2000). In addi- cesses. Similar arguments have been put in re- tion, however, studies of experiential effects lation to schizophrenia (Frith, 1992) and on cognitive styles, and on their changing antisocial behavior (Moffitt, 1993). On the manifestations with age, are needed. other hand, some disorders seem to be charac- Sometimes functional imaging is “sold” as terized by unusual styles of cognitive process- a means of seeing the brain in action, and of ing, rather than deficits as such. That seems identifying the parts of the brain that are mal- to apply, for example, to affective disorders functioning in the case of particular forms of and their associated depressogenic attributions psychopathology. That is, however, a some- (Teasdale & Barnard, 1993) and antisocial be- what misleading way of putting things. What havior with its associated tendency to make the scans show is the part of the brain where hostile attributions with respect to other peo- the main metabolic activity, as reflected in ple’s actions (Dodge & Schwartz, 1997; blood flow, is taking part during particular Coie & Dodge, 1997). In some cases, too, it cognitive tasks. That provides a most valuable remains uncertain which type of cognitive means of differentiating among supposedly feature applies. For example, attention deficits separate cognitive functions, and it should have long been considered as fundamental in also be possible to determine whether the hyperactivity disorders. However, despite ear- same brain areas are used to solve specific lier views to the contrary, the evidence now cognitive tasks by normal individuals and by suggests that the basis does not lie in any de- individuals with psychopathological disor- fect in selective attention (Schachar, 1991). ders. There is no doubt that this linking of There are associated cognitive impairments, brain function with the workings of the mind although it is uncertain how far they show is going to increase our understanding of cog- specificity, but also there seem to be more nitive and affective processing, but on its own stylistic problems in terms of impulsivity and it will not identify brain pathology. It is im- a difficulty in delaying gratification (Sonuga– portant to appreciate that changes in behavior Barke, Taylor, Sembi, & Smith, 1992; Scha- brought about by psychological treatments char, Tannock, Marriott, & Logan, 1995). In may also alter brain functioning as shown on each of these cases, there is still a need to scans, as illustrated by the case of obsessive– determine the degree of diagnostic specificity compulsive disorder (Baxter, Schwartz, Berg- of the cognitive features, and there is a need man, Szuba, Guze, Mazziotla, Alazraki, Selin, Developmental psychopathology: Concepts and challenges 285

Ferug, Munford, & Phelps, 1992). Neverthe- ations in affect regulation, and changes in less, this is going to constitute one of the cognitive set or styles of cognitive processing. highly important technologies that will help As discussed more fully elsewhere (Rutter us understand brain–mind interrelationships. et al., 2000), there is also a major need to pro- At present, there are few such studies in de- vide a much better understanding of environ- velopmental journals, but we predict that the mental risk mechanisms. We know a good situation is likely to change radically during deal about what are key risk indicators, but the next decade. we know much less about the environmental risk processes that they reflect. Research in the past has made clear that it is easy to mis- Nature–nurture interplay take risk indicators and risk mechanisms, and As already noted, with respect to the past, the that the theoretical policy implications are study of the details of nature–nature interplay quite different according to which is which. are likely to constitute another major growth For example, in relation to both childhood area during the years ahead. The importance (Rutter, 1971b; Ferguson, Horwood, & Lyn- of personal effects on the environment, and of skey, 1992) and adult life (Harris, Brown, & gene–environment correlations and interac- Bifulco, 1986), it has become evident that pa- tions, has been well demonstrated, but we still rental loss is not usually a major risk mecha- lack adequate understanding of the role of nism. It is, however, a risk indicator because these mechanisms in the emergence of psy- it tends to be associated with deficits in par- chopathology. Thus, almost all of the research enting that do constitute something closer to into person effects on the environment have a risk mechanism. Research in the field of di- concerned very short-term effects (the study vorce and remarriage has also brought out the by Maccoby & Jacklin, 1983, constituting one important point that it should not be consid- of the few exceptions). Findings in the field ered as a time-limited event but rather as a of antisocial behavior suggest that these may process in which the family interactions be- be particularly important during the preschool fore and after the marriage breakup are as im- years, and that the effects may be quite long portant as the breakup itself (Block, Block, & lasting (O’Connor et al., 1998), but very few Gjerde, 1986; Cherlin, Furstenberg, Chase– relevant data are available. The topic is a most Lansdale, Kiernan, Robins, Morrison, & important one because it necessarily changes Teitler, 1991). Studies have begun to address the way in which both genetic and environ- the possible mediating factors that are in- mental risk mechanisms have to be thought volved in these risk processes operating over about. If genetically influenced susceptibili- time (O’Connor, Thorpe, Dunn, Golding, & ties operate indirectly, rather than directly, it the ALSPAC Study Team, 1999b), and more may be that the search needs to be not for the research of this kind is clearly indicated susceptibility genes for depressive disorder (Gottlieb, 1997). but rather the susceptibility genes for reactiv- ity to environmental stressors. Similarly, if Heterotypic continuity environmental effects are mainly evident in genetically vulnerable individuals, we need to Several examples of heterotypic continuity understand how individual characteristics have already been given. The social deficits play a role in people’s responses to the envi- in adult life associated with severe develop- ronment. mental disorders of receptive language consti- It is also important that we determine what tute another (Howlin, Mawhood, & Rutter, in it is that environmental effects do to the or- press). It is important to appreciate, however, ganism that enables the sequelae to be carried that to establish heterotypic continuity, it is forward to a later age. As already noted, not enough to show that one behavior follows mechanisms to be considered are heteroge- another during development. Such consecu- neous, spanning changes in brain structure, tive occurrence could occur for a whole vari- changes in neuroendocrine function, alter- ety of reasons. Rather, it is crucial to show 286 M. Rutter and L. A. Sroufe that the different behaviors thought to repre- Bishop, Eley, Oliver, Price, Purcell, Steven- sent heterotypic continuity have comparable son, & Plomin, 1998). So far, the findings, correlates. Very little research of that kind has from a twin study, apply only to 2 years of been undertaken. Genetic research strategies age (which is rather too early to determine would be informative. Thus, for example, is language disorders), and the sample was bi- there the same genetic liability for the mea- ased in certain key respects. Nevertheless, the sures of attention and habituation in infancy findings are provocative in showing that ge- and for the measures of general intelligence netic influences for the extremes were much in later childhood and adolescence? Similar stronger than for variations within the normal questions arise with respect to the neurodevel- range. The comparison of so-called individual opmental precursors of schizophrenia. Do heritability and group heritability (the latter they constitute a diagnostically nonspecific referring to the difference between the ex- risk factor or are they indexing a specific ge- tremes and the normal variation) provides a netic liability to schizophrenia? Again, geneti- means of determining whether the differences cally sensitive designs would provide an an- are statistically significant (DeFries & Fulker, swer. Of course, the correlates to be examined 1985). So far, there has been very little sys- should include psychosocial risk factors as tematic research testing for continuities and well as genetic ones. Thus, with respect to the discontinuities across the range of behavioral links between a lack of early selective attach- variation, and there are substantial practical ments and a pattern of indiscriminate friendli- problems in view of the very large numbers ness later, as shown by adoptees from Roma- that are required to do this. Nevertheless, it nia, it is necessary to ask whether the does remain an important research priority for correlates are similar. That is, is there evi- the future. dence not only of within-individual continuity between the two, but are the correlates simi- Developmental programming lar? The fact that both show the same associa- tion with duration of privation begins to pro- Animal studies have provided strong evidence vide evidence of heterotypic continuity, but for the existence of certain forms of develop- much more needs to be done. The negative mental programming by which environmental findings with respect to disruptive behavior input influences brain structure and develop- show that disproof is possible. Thus, although ment. This is best established with respect to hyperactivity–inattention in Romanian adopt- the role of visual input in the development of ees was associated with the duration of priva- the occipital brain area underlying later visual tion, disruptive behavior was not (Kreppner function (Blakemore, 1991). The practical im- et al., 2000) indicating that it probably had portance of the phenomenon is shown in hu- somewhat different origins. man studies by the evidence that an uncor- rected squint in early childhood leads to a later loss of binocular vision. Hormonal influ- Continuities and discontinuities between ences in animals have also been shown to af- normal variations and disorder fect the sexual differentiation of the brain Similar issues apply to the study of continui- (Gorski, 1996). In the fields of biology and ties and discontinuities between normal varia- internal medicine, there are also parallels with tions in behavior and disorder that might re- respect to the development of immunity and flect an extreme on the same dimension. The responses to diet (Bock & Whelan, 1991). In need, again, is to determine whether the corre- the field of psychopathology, there is a possi- lates are the same or different. The example ble parallel in the case of the effects of pro- of severe mental retardation has already been found early social privation on the later devel- given with respect to discontinuity. Recent opment of close confiding friendships and findings suggest that the same might apply love relationships. We have already noted the with respect to normal variations in language extent to which such social deficits seem to and severe language delay (Dale, Simonoff, persist in spite of a radical change for the bet- Developmental psychopathology: Concepts and challenges 287 ter in the environment. The concept of devel- lessons for the understanding of both normal opmental programming, at least as extended development and disorder. For example, they more broadly, remains a controversial one, have shown the importance of a pathways ap- and much has still to be learned about the bio- proach to causal processes that recognizes logical processes that it reflects. The issues, both direct and indirect effects, and which ac- however, are of obvious importance, and fur- cepts that a single risk factor may have di- ther research into the phenomenon is much verse consequences and that a single disorder needed. outcome may arise by a variety of routes. It is likely that, with full understanding of the mechanisms involved, these complexities will Therapeutic mechanisms in treatment reduce to a limited set of unifying processes, but the striving for parsimony needs to be Studies of treatment, as such, are not a central tempered by a frank appreciation of the com- feature of developmental psychopathology, plexities that have to be explained. Similarly, but an understanding of the mechanisms in- developmental psychopathology approaches volved in psychotherapeutic efficacy are, be- have underlined the importance of consider- cause of the light they may throw on develop- ing both continuities and discontinuities in de- mental processing generally (Rutter et al., velopment and of examining age-indexed submitted). The work of Clark and his col- variations in vulnerability to specific influ- leagues in the field of panic disorders pro- ences and of variations in onset and life vides a good example of what can be done in course as indices of psychopathological heter- this connection (Clark, 1996; Clark & Fair- ogeneity. Concepts of risk and protective burn, 1997), and the studies of Patterson and mechanisms, of resilience, of nature–nurture his colleagues have begun to do the same in and person–environment interplay, of the the field of antisocial disorders (Forgatch & cognitive and affective processing of experi- DeGarmo, 1999). The effects of attachment- ences, of dimensional risk and protective pro- based interventions are similarly informative cesses and psychopathological outcomes, and (van IJzendoorn, 1995). The field is, however, of the interplay between different domains of very underexplored up to now. The compari- development have all proved informative. But son of experimental and control groups will much work lies ahead. Developmental psy- not, on its own, give this information. What chopathology arose out of a recognition of the is needed is the demonstration that, within the value of combining developmental and clini- treated group, there is a systematic dose–res- cal perspectives but also out of an apprecia- ponse relationship between changes in the tion of the limitations of the grand theories of postulated mediated mechanism and changes the day. There is a continuing need to remain in the target feature of psychopathology. sceptical about the new evangelisms that have Much greater use of this research stratagem come to take their place, but equally the im- should be made. perative must be to replace doubt with pro- grammatic research that truly tests competing Conclusions hypotheses and which has the potential of providing a real understanding of the range of Developmental psychopathology perspectives causal processes as they apply across the span have already provided many useful leads and of behavioral and developmental variation.

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