This article presents an overview of work conducted at the Institute of Psychiatry over the past 30 years on childhood depression. The work began with the basic question of definition and measurement. Epidemiological studies showed that depressive symptoms were quite common in children and were a good, if nonspecific, indicator of psychological disturbance. Further work in both epidemiological and clinical samples provided some evidence for the validity of a depressive syndrome. However, this work also showed that these depressive syndromes represented a heterogeneous group of phenomena. The validity of major depressive disorder in children was therefore tested further in longitudinal and family-genetic studies. These studies supported the validity of the concept but confirmed that there was heterogeneity in respect to both developmental stage at the time of onset and comorbidity with conduct disorder. We concluded that there are probably several different kinds of depressive syndromes in children. Some are strongly linked with depressive disorders in adulthood, but others are probably better conceptualized as part of another psychopathological problem altogether.

In this study, we examine issues related to the development of antisocial behavior, using data from three ongoing Swedish longitudinal projects. A correlational strategy is contrasted with a configurational approach. The correlational analyses reveal quite high temporal rank-order stabilities of behavioral problems, for both sexes, and also long-term statistical connections between childhood problems and adolescent and adult adjustment problems. However, these associations are of a modest size. This is to be expected in view of the operation of processes of a more temporary nature and of the timing of adjustment problems. It is argued here that a configurational approach, simultaneously taking into consideration relevant aspects of the individuals' risk panorama, offers a perspective on developmental pathways that is not provided by common multivariate approaches. Results from this more person-centered approach show the strong impact of adolescent multirisk patterns on future criminality and on drug and alcohol abuse. Findings also reveal that individual personal resources in adolescence may quite strongly reduce the risk of developing future criminality and drug and alcohol abuse for multiproblem individuals.

The observations of family members as well as the results of past research suggest that a variety of developmental pathways can precede the onset of schizophrenia in early adulthood. In this article, we describe recent findings from our research on the childhood precursors of schizophrenia. Taken together, the results indicate that childhood behavioral, emotional, and motoric dysfunction occur at a higher rate in preschizophrenia subjects when compared to control subjects. Further, there are developmental changes as well as significant variability among schizophrenia patients in the nature and severity of childhood impairment. Drawing on the prevailing diathesis-stress model, we explore the moderating role that stress exposure and reactivity may play in the expression of the organic diathesis for schizophrenia. Specifically, we consider the role of the biological stress response in the production of developmental changes and individual differences in the pathways to schizophrenia. Given extant models of dopamine involvement in the neuropathology of schizophrenia, stress-induced Cortisol release may alter the expression of subcortical abnormalities in dopamine neurotransmission. Thus, we present a neural mechanism for the hypothesized behavioral sensitivity to stress exposure in schizophrenia, and explore the capacity of the model to account for the changing behavioral manifestations of vulnerability.

Biometric analyses of variability in behavioral phenotypes have demonstrated that genotype plays a significant role in all behavioral development, but the developmental significance of the environment has remained obscure. Behavior genetic analyses typically show the effect of shared family environment to be very small, although considerable variability remains to be explained after genetic factors have been accounted for. Behavior geneticists have suggested, contrary to intuition, that almost all of the important effects of the environment serve to make family members more different from each other. Environmentalists of several persuasions have pointed to the crucial importance of the environment in the initiation and regulation of all developmental processes. In this article, we present a series of simulations to suggest that some of the difficulty of identifying environmental effects in biometric models is methodological. Adding simple dynamic parameters to models of development leads to systems in which environment produces substantial variability that can be detected in the context of a particular genotype, but vanishes when genotype is allowed to vary.

This study examined risk factors from infancy associated with the development of preschool disruptive behavior problems across child, parent, and sociodemographic domains. Risk factors that consistently were associated with the prediction of disruptive behavior at age 5 years included disorganized attachment classification at 12 months, and maternal personality risk and child-rearing disagreements during the second year. In addition, infants with disorganized attachment status at 12 months whose mothers perceived them as difficult in the second year showed significantly higher aggressive problems at age 5 years than those with only one of the two risk factors present. When pathways leading to clinically elevated aggression at age 5 were explored, infant disorganized attachment status, maternal personality risk, and child-rearing disagreements demonstrated equivalent predictive validity as child aggression assessed at age 3 years.

Hard-to-manage preschool boys and comparison boys were studied at age 4 years and followed at ages 6 and 9 years. Externalizing problems at ages 4 and 9 were associated with concurrent family stress, but this relationship was partially mediated by negative maternal control. Cross-lagged regressions indicated that despite the high stability in children's problem ratings, observed negative maternal control at age 4 and self-reported negative discipline at age 9 predicted externalizing problems at age 9 years, controlling for earlier levels of symptoms. Hierarchical regression analyses revealed that problems were more likely to persist in the context of chronic family stress, defined as negative life events, marital dissatisfaction, and maternal depressive symptoms. When problem boys who met diagnostic criteria for Oppositional Disorder and/or Attention Deficit Disorder were compared with boys who were improved by age 9 years, family stress and earlier symptom levels, as well as maternal control differentiated between them. Teacher ratings suggested that these boys were on a clear pathway to persistent problems by age 6 years. A small sample of comparison boys with emerging problems also were living in more dysfunctional families and their mothers reported using more negative discipline at age 9 years.

This study explores the coherence between different raters of adolescent psychopathology and examines the coherence of these ratings with earlier and later events associated with the development of psychopathology. In particular, teachers', mothers', and adolescents' ratings of the 13-year-old adolescents are examined. Additionally, the earlier factors of attachment status, environmental stress, and the friendship network are related to the different ratings. Both earlier factors and rater judgments are used to examine subsequent use of psychotherapy. The results show little coherence between raters on the presence of psychopathology in 13-year-olds and little coherence between earlier events and subsequent raters' judgments of psychopathology. However, earlier stress events and teachers' ratings of 13-year-olds' psychopathology are related to subsequent therapy use.

From teachers' rating in kindergarten through third grade, mutually exclusive groups of internalized, externalized, and mixed behavior problems were examined as pathways to three groups of psychiatric diagnosis in later adolescence: depression/anxiety, conduct/oppositional defiant, and other disorders. In looking both forward and backwards, the relation between behavior problems in the early school years, regardless of type, and psychopathology in adolescence, regardless of diagnosis, was very strong. The relations between type of early problems and specific outcomes were weak. The findings provided support for both the constructs of multifinality and equifinality; however the nature of the pathways differed somewhat by disorder. There was a substantial amount of multifinality (dispersion of outcomes) for the early internalizing pathway. There was less multifinality for the externalizing pathway, in that there was greater correspondence between early externalizing and later antisocial outcomes than for the internalizing pathway and depressed/anxious outcomes.

Although there is some evidence to suggest that depressive symptoms show age-related changes, it remains uncertain as to whether there are also developmental variations in the etiology of depression. In this article, we present findings from a population-based study of twins aged 8 to 16 years with the aim of examining the genetic etiology of depressive symptoms and the effects of age. The results suggest that environmental factors influence the transmission of depressive symptoms in childhood. However depressive symptoms in adolescence appear to be highly heritable. The etiology of depressive symptoms was further explored using factor-derived scores that again suggested the importance of genetic factors in adolescence. However there was some suggestion that genetic influences may contribute to certain types of symptoms (self-deprecation/self-esteem) even in childhood.

This study built upon earlier work documenting a theoretically derived model of four antecedents of depression, defined by a composite of global self-worth, affect (cheerful to depressed, and hope (hopefulness or hopelessness), among normative samples of adolescents. The four antecedents were: (a) perceived competence/adequacy in peer-salient domains (perceived appearance, peer likability, and athletic competence); (b) peer support; (c) perceived competence/adequacy in parent-salient domains (scholastic competence and behavioral conduct); and (d) parent support. However, not all components are observed in the profiles of individual adolescents. Thus, in this study, we examined the multiple pathways among those reporting depressive reactions (defined by the composite) as well as the different routes to positive adjustment, among those with high scores on the composite. Six profiles were identified among each group. For those reporting depressive reactions, perceived deficiencies in both peer- and parent-salient domains were particularly critical predictors. In contrast, for those reporting positive adjustment, peer and parent support were central components. The discussion emphasized the need to consider individual profile differences in planning interventions for adolescents at risk.

During the transition from early to middle adolescence there are numerous changes internal to the adolescent, such as the onset of puberty and changes in cognitive functioning, and external to the adolescent in terms of social reactions to the adolescent and changes in expectations. These changes may also be explained in terms of genetic and environmental influences on change and stability. This study employs the longitudinal sample from both waves of the Nonshared Environment in Adolescent Development (NEAD) project (395 families). The NEAD project includes adolescent siblings residing in never-divorced families (MZ and DZ twins and full siblings) and in stepfamilies (full, half, and unrelated siblings). The sample was assessed on two measurement occasions, 3 years apart. On average, the first measurement occasion assessed the families during early adolescence and the second measurement occasion occurred during middle adolescence. Composite measures of parent reports, adolescent self-reports and observer ratings of three constructs of adolescent adjustment (antisocial behavior, autonomy, and social responsibility) were examined in this analysis. Each construct showed a different pattern of genetic and environmental contributions to stability and change, suggesting different developmental pathways for each domain of adolescent adjustment. For example, genetic influences were important for both change and stability in antisocial behavior. Stability in social responsibility, on the other hand, was influenced by primarily genetic factors, while nonshared environmental factors were predominantly responsible for change. Finally, genetic and shared environmental influences contributed nearly equally to stability and change in autonomous functioning. These findings emphasize the importance of considering genetic as well as environmental factors when change in development is examined. Additionally, these data provide an armature for a comprehensive developmental theory for each of these domains of adolescent adjustment.

This study examined the extent to which the diverging pathways taken by adolescents and their parents in establishing autonomy and relatedness in their interactions at age 14 served as stage-specific markers of underlying attachment processes that could help predict states of mind regarding attachment of the adolescents 11 years later as young adults. Adolescents in two-parent families (N=73) and their parents, originally selected from either a high school sample or a psychiatrically hospitalized sample, participated in a revealed differences family interaction task when adolescents were 14 years of age. At age 25, subjects were reinterviewed using the Adult Attachment Interview, which yielded ratings of specific states of mind and overall organization of models of attachment relationships. After accounting for the prior psychiatric history of the sample (which was highly related to attachment insecurity) and global indices of functioning in both adolescence and young adulthood, coherence/ security in adults' states of mind regarding attachment was predicted from maternal behaviors promoting adolescent autonomy and relatedness 11 years earlier. One indicator of adult preoccupation with attachment relationships, passivity of thought processes, was predicted from adolescents' autonomy-inhibiting behaviors, specifically from the presence of enmeshing behaviors and the absence of distancing behaviors. Results are interpreted as suggesting that establishing autonomy and relatedness with parents may be an attachment-related, developmental task for both normal and at-risk adolescents, and that serious psychopathology and difficulties establishing autonomy and relatedness in adolescence may represent two independent pathways to insecure attachment models in young adulthood.

Follow-up studies of adolescent depression and conduct disorder have pointed to homotypic continuity, but less information exists about outcomes beyond mental disorders and about the extent to which adolescents with different disorders experience different versus similar difficulties during the transition to adulthood. We assessed the continuity of adolescent disorder by following girls in a complete birth cohort who at age 15 were depressed (n = 27), conduct disordered (n = 37), or without a mental health disorder (n = 341) into young adulthood (age 21) to identify their outcomes in three domains: mental health and illegal behavior, human capital, and relationship and family formation. We found homotypic continuity; in general, depressed girls became depressed women and conduct disordered girls developed antisocial personality disorder symptoms by age 21. Conduct disorder exclusively predicted at age 21: antisocial personality disorder, substance dependence, illegal behavior, dependence on multiple welfare sources, early home leaving, multiple cohabitation partners, and physical partner violence. Depression exclusively predicted depression at age 21. Examples of equifinality (where alternate pathways lead to the same outcome) surfaced, as both adolescent disorders predicted at age 21: anxiety disorder, multiple drug use, early school leaving, low school attainment, any cohabitation, pregnancy, and early child bearing.

Within the framework of a cumulation/nesting theory for the emergence of adult psychopathology, a typing structure for alcoholism based upon variations in life course continuity of antisocial behavior over childhood and adulthood was examined for its ability to differentiate symptomatic and life history variations among alcoholic and nonalcoholic men accessed by way of a population-based recruitment strategy. Results supported the theory and identified two alcoholic types, one high on lifetime antisociality (antisocial alcoholic = AAL), the other low (nonantisocial alcoholic = NAAL), and a third nonalcoholic type with low lifetime antisociality. Types differed in age of onset, severity, number, and life course of alcohol problems, measures of social adaptation, amount and severity of other psychopathology, and salience of family history load of alcoholism. Antisociality and alcoholism tended to be nested characteristics.

Problem alcohol use among women is increasingly recognized as an important public health and mental health issue. Younger women appear to be at increased risk for heavy drinking and alcohol-related problems compared to women from earlier cohorts. Understanding the sources for inter- and intra-individual differences in alcohol consumption is an important first step in addressing these trends. We studied the sources underlying variation in alcohol consumption in a sample of 2,163 female twins born in Virginia between 1934 and 1970. Measures of past-year alcohol consumption quantity and frequency were obtained on two occasions across a 5-year interval. Quantity and frequency of consumption declined over age, both cross-sectionally and longitudinally. Intra-individual correlations over the interval were substantial for frequency of drinking (r = .62) and quantity consumed per drinking occasion (r = .56) but lower for quantity consumed weekly (r = .22). There was significant intrapair resemblance for all measures, with the drinking behavior of identical twin pairs being more similar than that of fraternal pairs. Twin analyses of patterns of change in consumption over a 5-year interval revealed little within-pair similarity in rate of change, with correlations ranging from .06 to .18, suggesting that among young adult to middle-aged women, determinants of changing alcohol consumption are largely individual-specific. There was some evidence for significant age interactions, with the role of individual-specific sources increasing over age.

Characteristics and processes linked to self and personality functioning are considered as illustrations of resilience in old and very old age. Two self-related processes—coping styles and personal life investment—are investigated as examples of internal resources that the aging person may bring to bear when dealing with the risks of old age. Beyond chronological age as a rough approximation of such risks, this article specifically explores the relationship between physical risks, self-related processes, and level of adaptation in a representative sample of 70- to 103-year-olds. The central hypothesis is that self-related processes may buffer age-related risks, and may to a certain degree preserve or avoid large drops in levels of adaptation. Working on a correlational level of analysis, results indicated that well into old age, the self is able to maintain a relatively high level of adaptation. Also, under conditions of a high degree of physical constraints: (a) both coping styles and personal life investment were associated with resilience; (b) beyond particular coping styles, a selective flexibility in coping was associated with resilience. The degree of physical constraints moderated (c) the adaptiveness of several coping styles and of personal life investment; and (d) extreme physical constraints appeared to limit the possibilities of resilience. The effect of physical constraints on level of adaptation in turn was moderated by age. Consistent with a life-span theory of development, results are interpreted as an example of evidence for the resilience of the aging self and its limits.