For the week’s topic of an introduction to the study of abnormal child psychology, analyze the primary arguments presented in either one of additiona

The past achievements and future promises of developmental psychopathology: the coming of

age of a discipline

Dante Cicchetti1 and Sheree L. Toth2

1Institute of Child Development and Department of Psychiatry, University of Minnesota, USA; 2Mt. Hope Family Center, University of Rochester, USA

Over the past decades, developmental psychopathology has coalesced into a discipline that has made significant contributions toward the understanding of risk, psychopathology, and resilience in individuals across the life course. The overarching goal of the discipline has been to elucidate the interplay among biological, psychological, and social-contextual aspects of normal and abnormal development. In addition to directing efforts toward bridging fields of study and aiding in elucidating important truths about the processes underlying adaptation and maladaptation, investigators in developmental psychopathology have been equally devoted to developing and evaluating methods for preventing and ameliorating maladaptive and psychopathological outcomes. Increasingly, efforts are being made to conduct investigations at multiple levels of analysis and to translate basic research knowledge into real-world contexts. In this article, the contributions, challenges, and future directions of the field are highlighted. Keywords: Developmental psychopathology, interdisciplinary, multiple levels of analysis, translational research.

Special Issues of scientific journals often signify noteworthy junctures in the development and mat- uration of a discipline. The publication of this Spe- cial Issue commemorating the 50th anniversary volume of the Journal of Child Psychology and Psy-

chiatry provides us with an occasion to reflect upon the scientific discoveries, advances, and challenges that have occurred and that have brought us to our current state of knowledge in the field of develop- mental psychopathology. As we contemplate these historical events in the context of the future that awaits us, we are provided with a unique and envi- able opportunity for reflection, creativity, and pro- gnostication regarding the issues that are likely to exert a major impact upon determining the future foci of the field of developmental psychopathology.

Although precise definitional divergence exists, developmental psychopathology can be conceptual- ized as an evolving interdisciplinary scientific field that seeks to elucidate the interplay among the bio- logical, psychological, and social-contextual aspects of normal and abnormal development across the life course. Because psychopathology unfolds over time in a developing organism, it is critical to adopt a developmental perspective in order to understand the processes underlying individual pathways to adaptive and maladaptive outcomes (Sroufe, 1989, 2007). A ‘developmental analysis’ presupposes change and novelty, highlights the critical role of timing in the organization of behavior, underscores multiple determinants, and cautions against expecting invariant relations between causes and

outcomes. Moreover, a developmental analysis is as applicable to the study of the gene or cell as it is to the investigation of the individual, family, or society (Cicchetti & Pogge-Hesse, 1982).

Despite its relatively recent crystallization as a coherent framework for examining and conceptual- izing the links between the study of psychopathology and development, developmental psychopathology owes its ascendance and coalescence as a scientific discipline to many historically based endeavors within a variety of areas, including embryology, epi- demiology, genetics, neuroscience, philosophy, psy- chiatry, psychoanalysis, clinical, developmental, experimental, and physiological psychology, and sociology (Cicchetti, 1990). Before developmental psychopathology could emerge as an integrative discipline with its own integrity, the efforts of those working in the aforementioned related fields had been separate and distinct (Cicchetti, 1984). In part, the lack of integration across disciplines stemmed from long-standing tensions between the philo- sophical traditions underlying academic training and clinical practice and between basic and applied research.

Principles inherent to a developmental psychopathology perspective

An ongoing goal of developmental psychopathology has been to become a science that not only bridges fields of study and aids in the discovery of important new truths about the processes underlying adapta- tion and maladaptation across the life course, but also to provide the best means of preventing andConflict of interest statement: No conflicts declared.

Journal of Child Psychology and Psychiatry 50:1-2 (2009), pp 16–25 doi:10.1111/j.1469-7610.2008.01979.x

� 2008 The Authors Journal compilation � 2008 Association for Child and Adolescent Mental Health. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA

ameliorating maladaptive and pathological outcomes (Cicchetti, 1990; Sroufe & Rutter, 1984). Moreover, the field of developmental psychopathology has continuously sought to reduce the dualisms that exist between empirical research and the clinical study and treatment of childhood and adult high- risk conditions and mental disorders, between the behavioral and biological sciences, and between basic and applied research (Cicchetti, 1990; Masten, 2006; Toth & Cicchetti, 1999).

The essence and uniqueness of a developmental psychopathology perspective lies in its focus on both normal and abnormal, adaptive and maladaptive, developmental processes. A basic theme in the writings of the early systematizers in the field is that because all psychopathology can be conceived as a distortion, disturbance, or degeneration of normal functioning, it follows that, if one wishes to com- prehend psychopathology more fully, then one must understand the normal functioning with which psy- chopathology is compared (Cicchetti, 1984, 1990, 1993; Rutter, 1986; Sroufe, 1990). Not only is knowledge of normal biological, psychological, and social processes exceedingly useful for assessing, diagnosing, understanding, preventing, and treating psychopathology, but also the deviations from and distortions of normal development that characterize pathological processes indicate in exciting ways how normal development may be better investigated and understood.

These naturally occurring conditions, including populations of children reared in institutions, children who have experienced abuse and neglect, persons with brain damage, and individuals with mental disorders, have provided an entrée into the study of system organization, disorganization, and reorganization that is otherwise not possible due to the ethical constraints associated with conducting experimental research with human participants (Cicchetti, 2003; Rutter, 2007). Because there are limits to experimental manipulations that can be invoked with humans, and because the investigation of a system in its smoothly operating normal or healthy state does not afford the opportunity to comprehend the interrelations among its component subsystems, utilization of samples of individuals who are experiencing difficulties frequently is the only way to examine developmental processes in their full complexity.

If we decide to bypass or ignore the study of these atypical phenomena, then the eventual result is likely to be the construction of theories that are contradicted by the revelation of critical facts dis- covered through research on maladaptation and psychopathology (cf. Lenneberg, 1967). However, when extrapolating from atypical populations with the goal of informing developmental theory, it is essential that a range of high-risk conditions and mental disorders be investigated. The examination of a single pathological or risk process may eventuate

in spurious conclusions if generalizations are made solely on that condition or disorder. However, if a specific biological or behavioral pattern is viewed in the light of an entire spectrum of disordered modi- fications, then it may be possible to attain significant insight into the processes of development not gen- erally achieved through sole reliance on studies of relatively nondisordered populations.

Investigators in the field of developmental psycho- pathology also are invested in comprehending indi- vidual pathways to competent adaptation despite exposure to significant adversity or prolonged trauma (i.e., resilience – see Luthar, Cicchetti, & Becker, 2000; Masten, 2001). Moreover, developmental psychopathologists emphasize the importance of understanding the functioning of individuals who, after having diverged onto deviant developmental pathways, resume positive functioning and achieve adequate adaptation (Cicchetti & Rogosch, 1997; Masten, 2006; Zigler & Glick, 1986).

The field of developmental psychopathology tran- scends traditional disciplinary boundaries and pro- vides fertile ground for moving beyond descriptive facts to a process-level understanding of adaptive and maladaptive, normal and abnormal, trajectories of individual development. Research conducted within a developmental psychopathology framework may challenge assumptions about what constitutes health or pathology and may redefine the manner in which the mental health community operationalizes, assesses, classifies, communicates about, and treats the adjustment problems and functional impair- ments of infants, children, adolescents, and adults (Cicchetti & Toth, 1998). Thus, one of developmental psychopathology’s potential contributions lies in the heuristic power it holds for translating facts into knowledge, understanding, and practical application (Cicchetti & Toth, 2000, 2006). Accordingly, such a developmental perspective may aid in the prevention and reduction of the individual and societal burden of mental disorder, alleviate the onus of suffering that mental illness engenders in individuals, their families, and the communities in which they reside, and contribute toward eliminating the stigma com- monly associated with the presence of mental dis- order (Hinshaw, 2007; Hinshaw & Cicchetti, 2000).

What have we learned thus far? Some illustrations

During the four-plus decades since the emergence of the field, substantial progress has taken place. Indeed, remarkable advances have occurred in understanding the complexity of causality, the interaction of risk and protective factors, the prob- abilistic rather than the causal status of risk and protective factors, the heterogeneity of mental disorder, and the importance of developmental processes and mechanisms in elucidating pathways

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to adaptation and maladaptation (Kraemer et al., 1997; Rutter & Sroufe, 2000; Sroufe, 1997). Although they had been in use in biology for nearly three decades before they emerged in the vocabulary of psychopathologists, concepts of developmental pathways, multifinality and equifinality, now are prominent in the field (Cicchetti, 1990; Cicchetti & Rogosch, 1996; Sroufe, 1989).

It is known that a variety of developmental pro- gressions may eventuate in a given disorder (i.e., equifinality), rather than expecting a singular prim- ary pathway to the disorder. For example, Sroufe (1989) discovered that there were multiple, alternat- ive causal pathways to attention deficit hyperactiv- ity disorder (ADHD), one predominantly biological, the other largely attributable to insensitive caregiv- ing. Likewise, Cicchetti and Rogosch (1997) demon- strated that there were different developmental pathways for resilient maltreated and resilient nonmaltreated children. Ego overcontrol, or a more reserved, guarded approach, appeared to be better suited for maltreated children in adapting to their particular environments. Restraining from emotional reactivity in volatile family circumstances was thought to serve a protective function for maltreated children, but may be problematic for nonmaltreated children.

Additionally, the same risk and protective factors may lead to, or be associated with, different out- comes (i.e., multifinality). For example, the develop- ment of an insecure attachment relationship with one’s primary caregiver in childhood may eventuate in any number of outcomes for children, depending on the context of their environments and their indi- vidual competencies and coping strategies (Green- berg, Speltz, & DeKlyen, 1993). One such outcome may be conduct disorder, in a child who has the genetic and neurobiological diathesis, who has an insecure representational model of the self, and who faces extremes of additional stress in the form of a violent home and/or community environment in conjunction with minimal support or nurturance from caregivers (Richters & Cicchetti, 1993). Like- wise, not all sexually abused children develop psy- chopathology, let alone the same type of mental disorder (Kendall-Tackett, Williams, & Finkelhor, 1993).

The knowledge that there are multiple pathways to similar manifest outcomes and that there are differ- ent outcomes of the same pathway ultimately may contribute to the implementation of important refinements in the extant diagnostic classification of mental disorders (Richters & Cicchetti, 1993; Sroufe, 1997). Moreover, the incorporation of pathways concepts also strongly calls attention to the impor- tance of conducting process-oriented studies and of reframing the questions asked in research on the antecedents and consequences of mental disorder. Specifically, rather than searching for the indicators or predictors of later maladaptation or disorder, the

central focus of developmental psychopathology has shifted to investigating and describing the interactive processes that lead to the emergence and course of disturbed behavior. Question such as ‘what are the various factors that initiate and maintain individuals on pathways probabilistically associated with a particular disorder and a family of related out- comes?’ and ‘what differentiates those individuals progressing to disorder ‘‘X’’ from those progressing to disorder ‘‘Y’’ and those who do not develop mal- adaptively or do not develop a mental disorder?’ have increasingly come to the fore. Although some researchers emphasize one set of initiating and maintaining conditions, whereas other researchers accentuate divergent factors, the answer to ques- tions such as those posed above require the utiliza- tion of developmental studies. As scientists increasingly conceptualize and design their invest- igations with the pathways concepts of equifinality and multifinality as a foundation, we will move pro- gressively closer to attaining the unique goals of developmental psychopathology, first explicated by Sroufe and Rutter (1984): to explain the development of individual patterns of adaptation and maladap- tation.

Our knowledge of developmental biology, the area of neuroscience that focuses on factors regulating the development of neurons, neuronal circuitry, and complex neuronal systems, including the brain, also has burgeoned. A rapid growth in sophisticated techniques that allow for anatomical and physiolo- gical imaging of the brain to occur has taken place (Thomas & Cicchetti, 2008). These new neuro- imaging methods have been used to enhance our understanding of normal and abnormal neurobio- logical development and of the processes linking neurodevelopmental factors and later disordered outcomes (Cicchetti & Cannon, 1999).

There also has been increasing recognition of the dynamic interplay of influences over developmental time. One of the most dramatic examples of this has been the research on experience-dependent brain development (Greenough, Black, & Wallace, 1987). It is now widely recognized that neurobiological devel- opment and experience are mutually influencing (Cicchetti & Tucker, 1994; Eisenberg, 1995). Rather than adhering to a unidimensional belief in the deterministic role that unfolding biology exerts on behavior, it is now widely believed that brain func- tion and its subsequent influence on behavior pos- sesses self-organizing functions that can, in fact, be altered by experiences incurred during sensitive periods of development that occur across the life course (Cicchetti & Tucker, 1994; Nelson & Bloom, 1997).

Experience-dependent synapse formation involves the brain’s adaptation to information that is unique to the individual (Black, Jones, Nelson, & Green- ough, 1998) Experience-dependent synaptogen- esis is localized to the brain regions involved in

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processing information arising from the event experienced by the individual. For example, children endowed with normal brains may encounter a number of experiences (e.g., extreme poverty, early and chronic child abuse and neglect, etc.) that can exert deleterious impacts upon neurobiological development. Pathological experience may become part of a vicious cycle, as the pathology induced in brain structure may distort the child’s experience, with subsequent alterations in cognition or social interactions causing additional pathological experi- ence and added brain pathology (Black et al., 1998; Cicchetti & Tucker, 1994).

We increasingly recognize that the mechanisms of neural plasticity are integral to the very anatomical structure of cortical tissue, and that they cause the formation of the brain to involve an extended mal- leable process that presents developmental psy- chopathologists with new avenues for understanding the vulnerability of the brain as a basis for the emergence of mental disorder. Perturbations that take place in the developing brain can trigger a cas- cade of growth and function changes that lead the neural system down a path that deviates from that usually taken in normal neurobiological develop- ment, leading to the development of aberrant neural circuitry that contributes to these early develop- mental abnormalities eventuating in relatively enduring forms of psychopathology (Cicchetti, 2002).

Furthermore, advances in molecular biology and molecular genetics, including the completion of the DNA sequencing of the human genome and the publication of the map of human haplotypes that provides valuable information about individual genetic variation, have helped to engender renewed interest in the contribution that investigations on gene–environment (G · E) interaction can make to unraveling the complex pathways to normality, psychopathology, and resilience (Cicchetti & Curtis, 2006; Moffitt, Caspi, & Rutter, 2006). The empirical contributions of a molecular genetic approach make the search for the intermediate developmental mechanisms in the (Gene fi Brain) · E intercon- nection more accessible than ever before (Gottesman & Hanson, 2005). Moreover, progress in molecular genetics and on G · E research on psychopathology raises hopes of developing interventions to prevent and remediate mental disorder and to promote resilience (Cicchetti & Curtis, 2006; Moffitt et al., 2006).

Finally, developmental psychopathology has played a significant role in contributing to the devel- opment of clinical initiatives directed toward the prevention and treatment of mental disorders. By elucidating developmental mechanisms that are linked with the initiation or avoidance of maladapta- tion and psychopathology, theoretically-informed interventions have been developed and evaluated (Izard et al., 2002; Toth, Rogosch, Manly, & Cicchetti,

2006). For example, Fisher, Gunnar, Dozier, Bruce, and Pears (2006) report the results of two randomized controlled preventive trials involving infants, toddlers, and preschoolers in foster care. These interventions were able to exert positive effects on many areas of functioning that have been shown to be negatively affected by early stress – including hypo- thalamic-pituitary-adrenal (HPA) axis activity, behavior, and attachment to caregivers (see also Cicchetti & Gunnar, 2008). Importantly, develop- mentally-informed prevention and intervention strategies also have contributed to refinements in developmental theory (Cicchetti & Hinshaw, 2002).

Future perspectives

In a relatively brief period of time, the field of devel- opmental psychopathology has demonstrated that it can play a significant role in increasing our under- standing of risk and psychopathology and in bridg- ing the schism that has for too long separated the worlds of basic research and clinical practice. In order to sustain this momentum and to foster new advances, a number of challenges that lie ahead must be addressed. Perhaps most significantly, there must be continued striving toward and pro- gress made to attain enhanced fidelity among the elegance and complexity of the theoretical models extant in the field, the definitional parameters inherent to a developmental psychopathology per- spective, and the design, measurement, and data analytic strategies employed in our investigations of risk, disorder, and adaptation across the life course.

Multiple levels of analysis

In order to continue to foster the advances that have occurred in understanding developmental processes in both normal development and psychopathology, it is essential that a multiple-levels-of-analysis approach and an interdisciplinary perspective be increasingly incorporated into the field. Because one of the major goals of developmental psychopathology is to comprehend individual patterns of adaptation and to understand the ‘whole organism’ (Sroufe & Rutter, 1984; Zigler & Glick, 1986), calls for inter- disciplinary research and a multiple-levels-of anal- ysis approach have been gaining momentum in scientific laboratories across the country (Cicchetti & Dawson, 2002; Cicchetti & Posner, 2005; Pellmar & Eisenberg, 2000).

Although some problems are best addressed with the methods and concepts of a single discipline, other issues require interdisciplinary integration in order to fully comprehend the complexities that are present. This is particularly true when grappling with psychopathology. Thus, investigators and investigative teams must direct their collective energies toward an examination of multiple levels of

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analysis within the same individual. The sophis- ticated and comprehensive portrayals of adaptation and maladaptation that ensue will serve not only to advance scientific understanding, but also to inform efforts to prevent and ameliorate psychopathology.

Most of what is known about the correlates, causes, pathways, and sequelae of mental disorders has been gleaned from investigations that focused on relatively narrow domains of variables. Although growing attention has been directed toward discov- ering the processes through which individuals at high risk for psychopathology do not develop mal- adaptively, until quite recently the empirical study of resilience has focused exclusively on detecting the psychosocial determinants of the phenomenon (Charney, 2004; Curtis & Cicchetti, 2003; but see Cicchetti & Curtis, 2007). To understand psycho- pathology and resilience in their full complexity, all levels of analysis must be examined and integrated. Each level both informs and constrains all other levels of analysis. Moreover, the influence of levels on one another is almost always bidirectional. There- fore, no component, subsystem or level of organiza- tion possesses causal privilege in the developmental system (Thelen & Smith, 1998). Because levels of organization and processes are reciprocally interact- ive, it is difficult, if not impossible, to impute ultim- ate causation to one level over another. It is the mutual relationship between at least two compon- ents of the developmental system that influences developmental organization or disorganization (Gottlieb, 1992).

Since different levels of analysis constrain other levels, as developmental psychopatholgists learn more about multiple levels of analysis, researchers conducting their work at each level will need to de- velop theories that are consistent across all levels of inquiry. When disciplines function in isolation, they run the risk of creating theories that ultimately will be incorrect because vital information from other disciplines has either been ignored or is unknown. As is true in systems neuroscience, it is essential that an integrative framework that incorporates all levels of analysis about complex systems in the development of psychopathology or in the promotion of resilience be utilized. Rather than adhering to a single domain or unitary disciplinary focus, striving for a multi-domain, multi-level synthesis may impel researchers to broaden their visions and thereby lead to the formulation of integrative developmental theories that can elucidate both normal and abnor- mal forms of ontogenesis across developing systems.

One of the major challenges confronting scientific progress involves establishing communication sys- tems among disciplines. For example, despite tre- mendous technological advances in neuroimaging and molecular genetics, great knowledge gaps remain between scientists who possess competence with the technologies and methods of brain imaging and genetics and those who are focused on

addressing the complex issues inherent in the investigation of development and psychopathology. Consequently, the field has not yet made optimal use of the advances in technology that have taken place.

In contrast with the viewpoint that mental illnesses should be conceived as ‘brain disorders’ or ‘brain diseases,’ a multiple-levels-of analysis approach suggests that mental disorders can better be conceptualized in a more dynamic fashion that reflects the probabilistic, bidirectional, and trans- actional nature of genetic, neurobiological, social, psychological, and pre- and postnatal environmental influences over the life course. Whereas the brain is clearly involved in all forms of mental disorder, many other levels contribute and transact with the brain in dynamic fashion to bring about experience-depen- dent brain development. Although many types of mental disorder may be characterized by strong psychobiological predispositions, the ‘brain disorder’ concept may connote primacy or exclusivity for the biology and fail to adequately capture the transac- tional processes that are operative between biology and the broader psychological and social environ- ments. An alternative to the ‘brain disorder’ view- point would be to conceptualize mental illnesses as involving dysfunction among multiple and transact- ing developmental processes.

Beyond the calls for research programs incorpo- rating multiple levels of analysis seen in recent overviews of the field, such research must actually be supported by funding agencies, some of whom continue to view multiple-levels-of-analysis approaches to research questions as too broad and risky to merit financial support. In addition, journal editors need to encourage such research by increasing their willingness to publish papers that investigate a phenomenon across multiple levels of analysis, some of which might fall somewhat outside the purview of the particular journal. Furthermore, research in developmental psychopathology that is driven by broadly based theory incorporating mul- tiple levels of analysis must increasingly be encour- aged by faculty in the context of graduate training.

In order to ensure that future generations of scholars in developmental psychopathology are exposed to a broad, dynamic, systems-based, multiple-levels-of-analysis perspective, undergradu- ate and graduate programs in clinical and develop- mental psychology need to encourage students to take courses in a broad spectrum of areas. These might include courses on basic molecular biology, neuroendocrinology, neuroscience, and develop- mental processes, as well as courses that incor- porate information on brain-imaging technology, molecular genetic methods, neuroendocrine and immunological assay techniques, and other tools involved in assessing neurobiological and genetic processes. Likewise, students in basic science areas, such as neuroscience or genetics, should be encouraged to gain exposure to the fundamentals of

20 Dante Cicchetti an

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