One of the strengths of the Journal is that different kinds of review articles are published, which are very positively perceived by the readers. Hence, I am pleased that this issue includes an annotation on ‘Understanding the development of psychopathy’ by E. Viding and a practitioner review on ‘Stress intervention’ by R.P. Hastings and A. Beck. A third key article looks like a review but is an original contribution covering a long time span.
The paper by S. Collishaw and colleagues on ‘Time trends in adolescent mental health’ not only gives an informative overview of the issue but presents cross-sectional data of 15–16-year-olds from 1974, 1986 and 1999, gathered from three general population samples in the UK. It helps us to answer the question frequently asked by parents, physicians and policy-makers: to what extent have conduct, hyperactive and emotional problems become more common over the past 25 years? While the data showed an increase in adolescent conduct and emotional problems, mixed evidence was found in relation to rates of hyperactive behaviour. Future data points and the consideration of comorbidity patterns could give more insight into the topic and especially its practical implications. Nevertheless, the results as they stand already have an important practical and theoretical meaning and the other articles in the issue seem to contribute to one or the other topic raised by Collishaw et al.’s paper.
First, methodological limitations have made it difficult to provide conclusive answers concerning the time trends of psychosocial disorders. This is also reported in the paper by C.E. Cunningham and colleagues on children with selective mutism (SM); they confirmed the association between internalizing disorders and SM, while there were no major difficulties in parenting, academic skills and victimisation. Whereas early epidemiological studies reported prevalence rates of SM of .038–.069%, recent studies suggest about 2%. The problem of historical changes is also discussed in the paper by Chen and colleagues on ‘Loneliness and social adaptation’. The authors suggest that it appears as if the adaptive value of shy-sensitive behaviour in China might have changed in the past decade, probably because of the fact that Chinese society has undergone dramatic transitions towards a ‘capitalistic’ economy and lifestyle. It remains to be determined whether, as social assertiveness and competitiveness are increasingly required in the society, the positive value of shy-restrained behaviour in social and psychological adjustment may decline, being replaced by positive feedback related to aggressive behaviour. Further, the controversies about the time trend of ADHD and its role in the scientific and political context (Buitelaar & Rothenberger, 2004) reflect the many open questions concerning the ongoing debate of ‘time trends vs. mind trends’.
Second, several articles raise the point of transcultural similarities and differences of psychosocial problems and adaptation. Findings from different countries have produced somewhat different results, indicating the likelihood of culture-specific trends. Unfortunately, Collishaw et al. were unable to determine whether the trends in White adolescents have also been monitored among teenagers of specific minority groups. Conduct problems were largely independent of ethnic group status. On the other hand, Chen et al. focus on the socio-cultural context for children's social functioning in Brazil, Canada, China and Italy. Loneliness may be a common experience of children and adolescents across cultures. However, factors that predict loneliness may differ across cultures. For example, aggression is associated with loneliness in Chinese children, but not in the other samples. Shyness-sensitivity is associated with loneliness directly in Brazilian and Italian children and indirectly through peer relationships in Canadian children, but not associated with loneliness in Chinese children. The results suggest that specific social and cultural contexts need to be taken into account in the development of effective prevention and intervention programmes for children with different backgrounds who experience feelings of loneliness. Similarly, Hastings and Beck suggest further research to clarify how to incorporate culturally appropriate elements into parental stress intervention. How important cultural aspects in child psychology and psychiatry are can also be seen in the light of demographic trends in western societies (e.g., the proportion of children from ethnic minority backgrounds included in the UK samples of Collishaw et al. increased over time from 1.7% to 9.3%).
A third important point in this issue is related to different aspects of parenting. Supporting, training and/or relearning of adequate parenting in modern society, is increasingly a political problem mainly related to mothers’ professional development and children's well-being. Family influences affect children's adjustment through more proximal processes such as parenting practices or the quality of parental relationships (Hill, 2002, see in Collishaw et al.). But the influence of sibling relationships on parenting and child adjustment seems to need more attention. As Branje et al. suggest, siblings can be an important source for each other during adolescence, and thereby affect each other's externalizing behaviour as well as each other's internalizing behaviour. During the developmental processes of adolescence, teenagers may seek help from their siblings, and thereby become an important role model for each other. Tamrouti-Makkink et al.’s data indicate that clinicians should not just focus on the direct parent–child relationship alone but, in addition, need to take into account how parents relate to other children in the family in comparison to the child referred to treatment. Children from families of mixed gender sibling pairs (at least among Dutch children – this might be different in other cultural settings) seem particularly sensitive to differences, as reflected in the finding that increased levels of differential warmth and control relate to higher levels of problem behaviour.
Another aspect of parenting, controversially discussed and probably reflecting a time trend of changes in family structure and function in western societies, is the issue of ‘Children raised in fatherless families from infancy’. F. MacCallum and S. Golombok report an increasing number of lesbian and single heterosexual women bringing up children with no male parenting involvement. Hence, they investigated these two groups of ‘fatherless families’ to assess the quality of parenting by the mother, and the social and emotional development of the child at early adolescence. They conclude that being without a resident father from infancy does not seem to have serious negative consequences for children and that there seems to be no evidence that the sexual orientation of the mother influences parent–child interaction or the socio-emotional development of the child. However, further studies are needed to clarify the issue of gender development of children in lesbian families as well as the role of a father as a model for boys and as the disciplinarian partner.
Fourth, health economic aspects are mentioned in different articles of the issue, either in relation to long-term costs both for individuals and society or to the effectiveness and efficiency of interventions. As Collishaw et al. point out, adolescent conduct problems (as well as ADHD) and depression are associated with high costs, not only for the healthcare system. There is an urgent need to identify reasons for these trends, and to explore how early detection and intervention could help to reduce the family burden and costs. As Viding et al. suggest in this context, it cannot be stressed enough how important it will be to gather information about possible psychopathic traits in children with conduct disorder. While some cognitive-behavioural and family-oriented approaches have been successful in the treatment of conduct disordered children who are primarily impulsive, there has been less success in treating those with psychopathic tendencies. Early treatment that promotes the development of empathy and internalization of values, while using motivational strategies that capitalize on the reward-oriented response style and general self-interest shown by children with psychopathic tendencies, may prove a useful strategy. The neurocognitive research in the area supports this type of treatment strategy and emerging behaviour genetic research puts the impetus on very early intervention.
One should remember that even if behaviour has genetic origins and a sub-optimally functioning feedback loop of amygdala, posterior cingulate and orbitofrontal cortex at the neural level seems to play an important role, it is amenable to social and environmental treatments, especially if they take place early in development when the brain is still very responsive to environmental input. Hence, genetics and neuroscience are vital to develop targeted, effective and efficient interventions to allow public policy-makers to develop health plans with an optimal cost–benefit ratio.
Very practical approaches to the direction of better targeted diagnostics and interventions for autism and risk behaviour in adolescents are empirically followed by the publications of Aldred et al. (one of the first rigorous randomised controlled trials of a successful psychosocial treatment for autism), Bishop et al. (the Autism Spectrum Quotient appears to be sensitive to a broad phenotype), Geurts et al. (usefulness of the Children's Communication Checklist in differentiating clinically diagnosed ADHD from high-functioning autism children) and Wild et al. (suggesting that interventions helping adolescents to increase their self-esteem in the family and school domains are likely to reduce their engagement in risk behaviours).
To conclude, the Journal has again collected a number of high quality papers dealing with timely issues of general importance. As one of the new Joint Editors, I am happy to be part of ‘The World's No. 1 Child Psychology and Psychiatry Journal’ and hope that readers may share my enthusiasm.