Editorial: Developmental risks and prevention

Authors

  • Aribert Rothenberger


There is a growing body of research on developmental risks and their influence on later child psychiatric problems (e.g., nicotine use during pregnancy and later ADHD). This knowledge is needed in more detail to better understand the pathophysiological pathways of disorders and the psychosocial impact of different risks at different time-points of child development. Both issues are a prerequisite for composing useful prevention and treatment programmes.

This issue of JCPP contributes in several ways very positively to the field, having a multilevel approach (motor, cognitive, emotional, social) in mind. Fortunately, the changing brain–behaviour relationship during development was raised, too (e.g., Drechsler et al. on age-related neuropsychological functions in ADHD), since treatment and training programmes need a sound developmental neuroscientific basis.

In the Practitioner Review on developmental coordination disorder, Wilson gives a critical evaluative commentary on its assessment and treatment, which shows us that the neglected field of motor clumsiness in children needs more attention in research and clinical practice. This is strengthened by the debate in public health on the issue of ‘non-moving children’ and the consequences for society, which is scarcely reflected in the media.

Between 5% and 15% of children experience difficulties in learning movement skills. This can impact greatly on their ability to engage in many activities of daily living and educational experience. Many of these children suffer from low self-esteem, emotional and social problems (e.g., bullying). The long-term outcomes of poor motor coordination are not particularly encouraging either, with about 50% of children showing persistent motor and associated difficulties, even into early adulthood (Rasmussen & Gillberg, 2000). Thus, valid and reliable assessment of movement skills is crucial to identify children who may then benefit from early intervention. The type of prevention/treatment itself should also be based on principled models of development, where the neuroscientific approach of motor control and learning seems to be most promising. The social–emotional benefits of sensorymotor training per se cannot be underestimated as an impetus for continued skills development, but they have to be further evaluated (Banaschewski, Besmens, Zieger, & Rothenberger, 2001).

Another area of developmental risks for psychosocial functioning in adulthood concerns the consequences of early conduct problems and/or low intelligence. The two contributions of Fergusson et al. in ‘Show me the child at seven’ use data from the Christchurch Health and Development Study to examine the linkages between conduct problems, intelligence assessed in middle childhood and later outcomes in adolescence and young adulthood. Although there are linkages between conduct problems and IQ (but indirectly via social background and attention deficits!), the authors suggest that their data fit a dual pathway model in which early conduct problems are a precursor of later interpersonal adjustment (e.g., crime, mental health, substance abuse, sexual behaviours) but not educational or occupational achievement, whilst early IQ is a precursor of longer-term educational outcomes (e.g., school grades resolved, income, unemployment) but not later interpersonal adjustment. These results suggest that the longer-term consequences of these problems are far reaching and can be seen at least two decades later in a broad spectrum of psychosocial impairment.

About 10 years ago it would have proved difficult to develop a clear listing of policy approaches to address the issue of conduct problems. However, meanwhile scientific and practical evidence exists for methods that have the potential to reduce levels of childhood conduct problems (e.g., programmes for at-risk families, at-risk preschoolers, school-based programmes, home management). But one must caution against approaches that simply address conduct problems without addressing the social, family and individual factors that are associated with these problems. This is underlined by the articles of Harrington et al. (referring to the high rate of mental health problems in offenders) and de Wied et al. (suggesting training of empathy in disruptive behaviour disorders).

In sum, child psychiatrists and child psychologists should have a lifespan perspective, with many changes over time in mind, when they are assessing and treating children to support them in developing a successful psychosocial future.

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