Transcript survival from criminal offences for major depressive disorder

DEVELOPMENTAL PATHWAYS AND
CONTINUITIES BETWEEN CHILD AND
ADULT PSYCHOPATHOLOGY
By Michael Rutter
REVOLUTION IN THINKING ABOUT
CONTINUITIES AND DISCONTINUITIES
BETWEEN CHILDHOOD AND ADULTHOOD I
1.
2.
3.
4.
Persistence of early neurodevelopmental disorders
Childhood origins of schizophrenia
Recurrence of childhood depression in adult life
Heterotypic continuity
REVOLUTION IN THINKING ABOUT
CONTINUITIES AND DISCONTINUITIES
BETWEEN CHILDHOOD AND ADULTHOOD II
5.
6.
7.
8.
Persistence of effects of early life experiences
Differences in disorder by age of onset
Range of mediating mechanisms for persistence
Important effects of experiences in adolescence
and adult life
SOCIAL FUNCTIONING IN ADULT LIFE OF
INDIVIDUALS WITH AUTISM AND AN
INITIAL IQ OF 70+ (Howlin et al., 2004)
50
Very good: living
independently, holding a job &
some friendships
40
30
Good: living with parents or in
sheltered provision, holding a
job, some friendships
20
Fair: not living independently,
sheltered employment or some
friendships, some freedom to
travel
10
Poor/Very poor: substantially
impaired in all respects
0
ADULT SPELLING AT AGE 44/45 YEARS
(NORMATIVE SD UNITS) OF CHILDHOOD POOR
AND COMPETENT READERS
(data from Maughan et al., 2005)
80
70
60
50
% 40
30
20
10
0
<=-2 sds
<2/<1 sds
Poor readers
-1 sd/mean mean/+1 sd >+1/+2 sds
Competent readers
LANGUAGE LEVELS IN THE MID-30s 0F MALES
WITH SLI COMPARED WITH THEIR SIBLINGS
AND IQ-MATCHED CONTROLS (Clegg et al., 2005)
Britis h Pictur e Vocabulary Sc ores
150
140
130
120
110
100
90
N=
Group
17
17
13
DLD
IQ M AT CH
SIBLI NGS
6
MARITAL RELATIONSHIPS OF SLI
MEN UP TO MID-30s (Clegg et al., 2005)
100%
90%
80%
70%
SLI
60%
%
50%
Siblings
40%
30%
20%
10%
0%
Married &
Cohabiting
Divorced
No cohabitation
Category of relationship
ADOLESCENT AND ADULT STATUS OF
BOYS WITH ‘PURE’ ADHD (data from
Mannuzza et al., 1998)
Cohort 1, aged 18 years
40
35
30
25
20
15
10
5
0
Cohort 2, aged 24 years
ADHD
Individuals
Comparison
group
Ongoing
ADHD
Antisocial
personality
disorder
Substance
abuse
40
35
30
25
20
15
10
5
0
ADHD
Individuals
Comparison
group
Ongoing
ADHD
Antisocial
personality
disorder
Non-alcohol
substance
abuse
PREDICTORS OF POOR OUTCOME IN
INDIVIDUALS WITH ADHD (data from
Mannuzza et al., 1998)
Key predictors (controlling for other variables)
1.
2.
Conduct disorder symptoms
ADHD (even in the absence of conduct problems
in childhood)
RECEPTIVE LANGUAGE DEVELOPMENT AT AGE
3, 5, 7 & 9 FOR INDIVIDUALS WITH DIFFERENT
ADULT DIAGNOSES (From Cannon et al., 2002)
0.4
0.3
0.2
0.1
0
-0.1
-0.2
-0.3
-0.4
-0.5
-0.6
Control
Anxiety/
Depression
Mania
Schizophreniform
3
5
7
Age in years
9
INTELLIGENCE SCORES AT AGE 3, 5, 7, 9 & 11
FOR INDIVIDUALS WITH DIFFERENT ADULT
DIAGNOSES
(From Cannon et al., 2002)
0.3
0.2
0.1
0
-0.1
-0.2
-0.3
-0.4
-0.5
-0.6
Control
Anxiety/
Depression
Mania
Schizophreniform
3
5
7
Age in years
9
11
PSYCHOTIC-LIKE SYMPTOMS AT AGE 11
YEARS AND ADULT DIAGNOSIS AT AGE 26
(data from Poulton et al., 2000)
20
18
16
% with
specified 14
disorder 12
10
at 26
8
years
6
4
2
0
Psychotic-like
symptoms present
Psychotic-like
symptoms absent
Depression
Schizophrenia
Adult diagnosis
TEN YEAR FOLLOW-UP OF FAMILIAL
HIGH RISK INDIVIDUALS AGED 16 TO 24
YEARS (data from Johnstone et al., 2005)
50
No symptoms
40
% with
specified
outcome 30
20
Possibly
psychotic
symptoms
Schizophrenia
10
0
N.B. Best predictors of psychotic features were schizotypal
cognitions and psychotic-like symptoms
CUMULATIVE RISK OF DEPRESSIVE
DISORDER IN ADULT LIFE IN CHILDHOOD
DEPRESSED CASES (Harrington et al., 1990)
0.7
0.6
0.5
Childhood
depressed
Controls
0.4
0.3
0.2
0.1
0
16 17 18 19 20 21 22 23 24 25 26 27
Age in years
Probability of survival
SURVIVAL FROM MAJOR DEPRESSIVE
DISORDER WITH OR WITHOUT CONDUCT
DISORDER (from Fombonne et al., 2001)
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
With
conduct
disorder
Without
conduct
disorder
17 19 21 23 25 27 29 31 33 35 37 39 41 43
Age in years
SURVIVAL FROM CRIMINAL OFFENCES FOR
MAJOR DEPRESSIVE DISORDER SUBJECTS
WITH OR WITHOUT CONDUCT DISORDER
1
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
With
conduct
disorder
Without
conduct
disorder
17
19
21
23
25
27
29
31
33
35
37
39
41
43
45
Probability of survival
(from Fombonne et al., 2001)
Age in years
CHILDHOOD CONDUCT DISTURBANCE AND
ADOLESCENT-ONSET VS. ADULT-ONSET
DEPRESSION
% with conduct disturbance in
childhood
Isle of Wight Follow-Up (Maughan et al., 2004)
12
10
8
6
4
2
0
No
depression
Adol-Onset
Adult-Onset
Single Episode
Adol-Onset
Adult-Onset
Recurrent Episodes
CUMULATIVE INCIDENCE OF FIRST
DEPRESSIVE EPISODE BY AGE AT SEXUAL
MOLESTATION (From McCutcheon et al., 2007)
ASSOCIATION BETWEEN EMOTIONAL
REACTIVITY AT 4 MONTHS AND ANXIETY
SYMPTOMS AT 7 YEARS
(data from Kagan & Snidman, 1999)
50
45
40
35
% Anxious 30
symptoms 25
20
15
10
5
0
High reactivity
Low reactivity
Neither high nor
low reactivity
SCORES ON ALCOHOL ABUSE SYMPTOM SCALE
AT 21 YEARS AS A FUNCTION OF BEHAVIOUR
STYLES AT 3 YEARS AND SEX
(from Caspi et al., 1996)
14
12
10
Well adjusted at
age 3 yrs
8
Uncontrolled at
age 3 yrs
6
4
Inhibited at age 3
yrs
2
0
Male subjects
Female subjects
Sample
mean at age
21 yrs
PROBABILITY OF MAJOR DEPRESSIVE DISORDER (MDD)
DURING FOLLOW-UP STRATIFIED ON SUBSTANCE USE
DISORDER (SUD) AT STUDY ENTRY, AFTER
CONTROLLING FOR THE EFFECTS OF SOCIOECONOMIC
STATUS AND PRIOR MDD (from Rao et al., 2000).
those with prior
SUD
participants
with no prior
SUD.
EARLY DELINQUENCY ONSET
PREDICTS GREATER FAMILIALITY
from Taylor et al. (2000)
70%
60%
50%
1st degree
relatives
2nd degree
relatives
Antisocial 40%
relatives
30%
20%
10%
0%
LateNon
delinquent starters
Earlystarters
DUNEDIN LONGITUDINAL STUDY: TRAJECTORY
ANALYSIS (N =526 males) (From Odgers et al., 2007)
(10.5%) LCP
4
(19.6%)
Adolescent-onset
3
(24.3%)
Childhoodlimited
(45.6%) Low
2
1
0
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Conduct Problems Scale
5
Age
ODDS RATIOS FROM COTWIN-CONTROL
ANALYSES OF CHILDHOOD SEXUAL ABUSE AND
RISK FOR PSYCHIATRIC AND SUBSTANCE USE
DISORDER IN FEMALE TWIN PAIRS (From Kendler et
al., 2000)
12
10
Odds
Ratio
8
All subjects
6
Discordant
pairs
4
2
0
Alcohol
dependency
Drug
dependency
2+ disorders
AGE AT FIRST DIAGNOSIS FOR PARTICIPANTS
WITH AN ADULT PSYCHIATRY DIAGNOSIS
INVOLVING TREATMENT
(From Kim-Cohen et al., 2003)
11-15 years
18 years
21 years
26 years
KEY FINDINGS ON CHILD AND ADULT
CONTINUITY IN PSYCHOPATHOLOGY
(From Kim-Cohen et al., 2003)
1.
2.
3.
4.
The disorders in the two age periods tended to be
of the same type
BUT
Most adult disorders preceded by a variety of
disorders in childhood
The proportion of adult psychiatric disorders with
childhood psychopathology before 15 years is
greatest for eating disorders and antisocial
personality disorders
Conduct/oppositional defiant disorder is the
childhood disorder most likely to precede adult
psychopathology
ANTISOCIAL BEHAVIOR AS A FUNCTION OF
MAOA ACTIVITY AND A CHILDHOOD HISTORY OF
MALTREATMENT (from Caspi et al., 2002)
1.25
1
Composite
index of
0.75
antisocial
behavior
0.5
(z scores)
Low MAOA
activity, n =
163
0.25
High MAOA
activity, n =
279
0
-0.25
-0.5
None
Probable
Childhood
maltreatment
Severe
EFFECT OF MALTREATMENT IN
CHILDHOOD ON LIABILITY TO
DEPRESSION MODERATED BY 5-HTT GENE
Probability of major depression episode
(from Caspi et al., 2003)
.70
s/s
.60
.50
s/l
.40
l/l
.30
.20
0
No maltreatment
Probable maltreatment
Severe maltreatment
s/s = short allele
homozygous
l/l = long allele
homozygous
s/l =
heterozygous
SCHIZOPHRENIA SPECTRUM DISORDER:
CANNABIS USE INTERACTS WITH
GENOTYPE (Caspi et al., 2005)
%schizophreniform disorder
20
COMT genotype
Met/Met
Met/Val
15
Val/Val
10
5
0
No adolescent use
Adolescent use
MEAN + SE (ERROR BARS) IQ SCORES OF CONTROL
CHILDREN AND CHILDREN WHO MET DIAGNOSTIC
CRITERIA FOR ADHD ACCORDING TO GENOTYPE STATUS
ON 2 DOPAMINE GENES (from Mill et al., 2006)
MEAN NUMBER OF DSM-IV CONDUCT
SYMPTOMS BY GENOTYPE AND BIRTH WEIGHT:
ASSOCIATION WITH C0MT GENOTYPE (From
Thapar et al., 2005)
Mean conduct symptom score
3
2.5
2
Normal
birth weight
1.5
Low birth
weight
1
0.5
0
val/met and met/met
val/val
C0MT genotype
MEAN OF CHILDREN’S SYMPTOMS AS A
FUNCTION OF A CLOSE RELATIONSHIP WITH AN
ADULT IN GOOD AND POOR PARENTAL
MARRIAGES (from Jenkins & Smith, 1990)
25
None N=8
20
15
10
Moderately close N=22
None N=10
Very close N=39
Very close N=27
5 Moderately close N=13
0
Good marriage
Poor marriage
CHILDHOOD BEHAVIOR AND ADULT
PSYCHOSOCIAL
STRESSORS/ADVERSITIES
(data from Robins, 1966)
60
50
%
40
30
Antisocial
boys
20
Control
boys
10
0
Divorced
Unemployed
10+ job changes Unskilled/semiPractically
in 10 years
skilled job
without friends
SEVERE EVENTS AND DIFFICULTIES IN
EARLY ADULT LIFE AND TYPES OF
DISTURBANCE AT 10 YEARS IN
FEMALES (Champion et al., 1995)
6
5
Mean
number of
events/
difficulties
4
Conduct/Mixed
3
Emotional
Disturbance
No Disturbance
2
1
0
Severe Events
Severe
Difficulties
RANGE OF MEDIATING EXPERIENCES
1.
2.
3.
4.
5.
6.
Effects of experience on gene expression
Biological programming
Effects of neuroendocrine system
Effects on shaping/selecting of later environments
Effects on patterns of interpersonal interaction
Effects on cognitive/affective models
TURNING POINT EFFECT OF PARTNER IN
FEMALES WITH ANTISOCIAL BEHAVIOR
IN CHILDHOOD (Pickles, 1996)
20
2
1.5
15
10
1
5
0.5
0
0
Mean Teacher
Questionnaire
score in
childhood
Lack of
support
Support
from
nondeviant
partner
Mean score in Adult
Problems in Social
Functioning
MILITARY SERVICE AND LATER
SOCIOECONOMIC ACHIEVEMENT (data
from Sampson & Laub, 1996)
Key predictors of success: Overseas duty
Training under the GI Bill
Lack of a military arrest
but interactions with
Early entry to military service
N.B. effects of military service comparable to those of
measured ability and much greater than SES or
educational achievement
OVERALL MESSAGES
1.
2.
3.
4.
5.
6.
Continuities across the lifespan much stronger than
used to be appreciated
Heterogeneity much stronger than previously
realised
Gene-environment interplay crucial and pervasive
Experiences post-childhood can be very influential
Range of mediating mechanisms wide
A developmental perspective essential for both
childhood and adult disorders
DEVELOPMENTAL PATHWAYS AND
CONTINUITIES BETWEEN CHILD AND
ADULT PSYCHOPATHOLOGY
By Michael Rutter