Childhood Onset of “Adult” Psychopathology: Clinical and Research Advances

This volume consists of the presentations from the 1998 meeting of the American Psychopathological Association that focused on the theme, Child Onset of Adult Psychiatric Disorders. Emphasis is accorded schizophrenia, depression, alcoholism, anxiety, and criminality. The 16 chapters are organized into five sections: Mechanisms and Methods, Neurodevelopmental Pathways and Triggers of Disease Onset, Schizophrenia, Depression and Anxiety, and Early Prevention of Adult Disorders. The topics within these sections encompass a rich array of findings related to genetic influences on age at onset of disorders, markers as precursors to schizophrenia, and variations in early versus late onset of disorders (e.g., major depression, anxiety, and bipolar disorder). Two general areas of focus are especially noteworthy, namely, etiology of disorders and mechanisms of onset.

Several key points are made and illustrated throughout. For example, age at onset is pertinent to diagnosing disease, early- and late-onset disorders may vary in their precursors and correlates, and prenatal influences and exposure to biological insult (famine, influenza) can increase the risk for adult onset of psychiatric disorders. Many of the precursors seem to be general insofar as they reflect greater vulnerability to many different disorders; others seem to be more specific to particular disorders such as schizophrenia or depression. The contributions underscore the continuity between psychiatric and biological (medical) conditions and some of the discontinuities of disorders over the course of development. Focus on these areas can promote sophisticated and more interdisciplinary research about mechanisms of action and intervention.

The contributions vary considerably in their format and technical level. A few are rather technical (e.g., those which discuss gene sites, repeat sequences, and nucleotides), and others are broader sweeps and perspectives (e.g., genetics and evolution). Some of the contributions review an area of research; others provide updates on a single program of research. For the most part, the chapters are presentations of research and could readily appear in a technical journal. That may limit the audience a bit; the best way to stay abreast of timely technical material is through the journals. Nevertheless, the book provides a critical focus and formalizes a topic that warrants special attention. Firmer conceptual and empirical connections ought to be made between physical and mental health and between early and later stages of development. This book conveys the importance of these connections, hints at the likely yield such work will provide, and illustrates the special challenges of the protracted longitudinal studies required to answer key questions.