Developmental Psychopathology - Where we come from & where we may be headed
If you are parent wondering how your child came to be the way they are - or perhaps where they might be headed - you may seek out what the science has to say about that. And to get to grips with the science you probably need an understanding of developmental psychopathology.
Developmental psychopathology is definitely not a theory of the form if X happens then Y will follow. It is more a stance towards different kinds of knowledge and how to integrate diverse research areas. It talks about pathways into and out of pathology and wellness over the course of development.
An over-simplified take home message might be: life is complex and people are different. Which is hopefully obvious, but is too often forgotten when it comes to thinking about children and young people with early adverse experiences. Being integrative, the developmental psychopathology framework encourages us to avoid focussing on one bit of evidence in isolation. Keeping an open mind to all possibilities is critical for effective assessment and intervention.
The development of developmental psychopathology
Developmental Psychopathology is definitely not a brand-new approach. It has a long history and one can start looking at its origins in various places, but for mental health the 1984 collection in the journal Child Development, edited by Dante Cicchetti, is a good place to start [https://www.jstor.org/stable/1129830].
Interestingly, it was perhaps such a new approach that not every paper in that collection used the term developmental psychopathology in their title.
For myself, as an attachment researcher once trained by L. Alan Sroufe and who has worked as a clinical psychologist at the Michael Rutter Centre [https://www.nationaladoptionandfosteringclinic.com/] since the beginning of my clinical career, I have always been particularly fond of the article by Sroufe & Rutter about the domain itself [https://www.jstor.org/stable/1129832].
Looking forward and looking back
One of the things these two great clinical academics discussed in this paper was the extra challenge of looking forward compared to looking back; something that was highlighted over a century ago by Freud – who was not an influence on modern developmental psychopathology, but who nonetheless did make some clever observations about what we can and cannot know about ourselves. Freud said, more or less, that when we look back over a life we may think we discern a clear and simple story of where problems have come from and why we have ended up the way we have; but when we try to look forward to predict where things are headed it, then it feels impossible [quoted in Sroufe & Rutter, 1984 p17]. In fact, any certainty we may think we see with retrospective knowledge is likely a fiction because “the links between earlier adaptation and later pathology generally will not be simple or direct” [ibid, p17]. We need to resist the allure of simplistic accounts of why ‘this child is like that’. We need to be careful of accounts based solely upon one idea, say: attachment; trauma; foetal toxins; abuse; neglect; or even genetics, culture or whatever else that seems to explain it all.
Simple is seductive but probably not that helpful – especially in the context of early adversity. All too often children and young people with these experiences come to our clinic described under rather simplistic headings of their issues being caused by attachment or trauma or X or Y or Z or whatever; or that their issues simply are attachment, trauma, X, Y, Z or whatever.
Sroufe & Rutter described how “Developmental psychopathology may be defined as the study of the origins and course of individual patterns of behavioural maladaptation, whatever the age of onset, whatever the causes, whatever the transformations in behavioural manifestations, and however complex the course of the developmental pattern may be.” [p18, italics in original]. There is a lot of openness in that definition. But it reflects how across development issues can come and go. How the unfolding of lived experiences operates. It is why it can seem easy to look back and see a convincing (if largely fictional) trail of where we have come from, but so much harder to work out where we are going. And, importantly, they talk about ‘individual patterns’ rather than lumping people together.
Putting the pieces together
There are various ways of breaking down the elements of a developmental psychopathology approach, depending on where you look, but these are at least part of them…
Consider normal & abnormal processes together
Consider what we typically call ‘abnormality’ as being some degree of variation from degrees of normative development. Then from that we get normality and abnormality - or wellness and pathology - as existing on a sliding scale or continuum. Variations of normal and variations of abnormal are ‘mutually informative’. So we can learn about degrees of pathology from looking at varieties of wellness. We should not just study categories of illness (e.g., diagnoses), as if they are static and fixed things and think that is sufficient [even though such approaches are helpful in some contexts].
Developmental is central
Developmental tasks [e.g., learning to walk, talk, go to school, or self-regulate emotions, behave appropriately, manage peer relations or whatever] are different at different points of development. And a child’s ability to cope with these tasks may vary at different times, so their adaptation to the tasks at different points may vary. Indeed, what is considered normal (adaptive) at one time may be seen as abnormal (maladaptive) at another.
The child and their context together
The child is undergoing their own individual development, but they are also moving through different contexts [e.g. home to school on the same day] and so the external demands placed on the child are also changing. What is adaptive in one context may be maladaptive in another. And of course, develop also applies to contexts which change over time, e.g. nursery to primary school to secondary school.
Processes unfold over time in ways that are reciprocal & ‘transactional’
The changes occurring inside the child and what is happening outside the child in different external contexts interact with each other and can cascade over time. The quality of adaptations at one point set up the possibilities for adaptation at a later one as the external world responds to the child. For example, the peers (the external environment) of a child who has poor social skills, may start to increasingly avoid them; this leaves the child more isolated and more reliant on their already poor social skills to try to relate to these peers; but the child’s social skills are not getting the same normative developmental opportunities to be fine-tuned through use so their skills do not progress as well as they could; and a process gets set up that could leave the child further isolated and behind in their social skills; not least because their peers are advancing their own sets of skills and their expectations of what is appropriate, amongst themselves through their typical development experiences. So, the task demands on the child who wants to relate to these peers are getting greater and greater.
We can think of developmental pathways or trajectories to capture this dynamic journey involving the interplay between the child’s on-going development and what is developing in the context around them now, and what is likely to come next. It informs developmental research and also how we might intervene. This process is dynamic and reciprocal - or ‘transactional’ - and very similar to how Bowlby described attachment processes developing over time. Indeed, there is clear conceptual overlap between attachment research and developmental psychopathology.
Multidisciplinary
There is all that is going on within the child - their neurodevelopment, genetic expressions, hormones, physical maturity, intelligence, personality… etc - but also outside them - their immediate family, their peer groups and the larger systems around them, school, culture, environments. So the study of developmental psychopathology needs to draw from multiple disciplines – from genes/neurobiology to psychology/behaviour to social contexts & cultures – and tries to weave them together to make a bio-psycho-social account. Prior to the developmental psychopathology framework these studies were most often conducted in isolation but now there is more integration of different kinds of science. However, we are unlikely to ever have a study that encompasses all possible levels at once, so we need to patch our understanding together between different kinds of studies; and, just as importantly, also recognise where the gaps in our knowledge are.
Developmental pathways
From these points so many other ideas emerge, but key are developmental pathways. Developmental pathways allow us to think flexibly about a child’s development; of journeys into and out of psychopathology and wellness. Along that journey there may exist potential risks and vulnerabilities, as well as resiliences and opportunities, at different points in time and in different contexts, which can nudge the child one way or another, towards well-being or illness.
It allows us to see problems as degrees of adaptations rather than just as intrinsically wrong or bad or ill… what is maladaptive now was perhaps quite adaptive then; what is more or less adaptive here becomes problematically maladaptive there… These degrees of wellness and pathology, that can exist at different times or in different contexts means that adaption is not set in stone early on and for all time thereafter - which is hopeful. Although it doesn’t mean that absolutely anything is possible, which tempers that optimism. These ideas also relate to the key issues of multifinality & equifinality [discussed elsewhere].
The story we get from the framework of developmental psychopathology is that the science tells us that working out how we got somewhere or where we are heading to is necessarily full of uncertainty. And especially when we remember that people live their lives as individuals and not averages. But with uncertainty there is possibility, and perhaps we can more easily allow a bit of hope even for children and young people who have experienced early adversity.
