A dimensional approach to developmental psychopathology

Abstract

The expression psychopathology in general and child psychopathology in particular, is affected by multiple sources of variance. Some of these sources include gender differences, informant differences, and age-related differences. In this paper, we discuss how these sources of variance complicate both research and clinical management. We argue that the current diagnostic system would be aided by the inclusion of a quantitative axis that can take these sources of variance into account. We reason that the fields of genomics and neuroscience are prepared to move the field of developmental psychopathology forward, but need a diagnostic system that allows for these sources of variance to be controlled. We demonstrate how in Conduct Disorder, inclusion of dimensional information would allow the clinician or researcher to demonstrate not only the presence or absence of pathology, but also the degree to which the disorder is manifested in a particular individual. Because dimensional approaches are already used widely as an alternative measure of psychopathology, we argue that there is reason to consider dimensionalizing some aspects of the DSM.

Em busca das origens desenvolvimentais dos transtornos mentais

“…Como desfechos possíveis do processo de desenvolvimento 12 , os transtornos mentais não seriam necessariamente categorias distintas, mas sim trajetórias desenvolvimentais dimensionais 10 . Como uma complexa malha rodoviária, em que diferentes rodovias podem levar ao mesmo local, diferentes trajetórias desenvolvimentais podem levar ao mesmo processo psicopatológico.…”

“…Neste artigo, são discutidos conceitos e abordagens utilizados por esse modelo para compreender como e por que determinados in di víduos desenvolvem transtornos mentais. Inúmeros artigos de revisão sobre diferentes aspectos dessa disciplina [2][3][4][10][11][12][13] foram publicados, assim como um livro texto com mais de 3.000 páginas 14 . Portanto, o objetivo deste artigo é esti mu lar que o leitor considere esta abordagem na sua busca indi vidual por ferramentas para entender o processo de desen volvimento dos transtornos mentais.…”

Heterogeneity in Clinical Symptoms and Cognitive Functioning of Children with Hyperactivity-Impulsivity and Inattention: Dimensional and Person-Centered Perspectives

“…The co-occurrence of comorbid disorders -both internalizing (e.g., anxiety and depression) and externalizing (e.g., aggressive and delinquent behaviors) -with ADHD is a consistently replicated finding (Baeyens, Roeyers & Walle, 2006;Milich, Balentine & Lynam, 2001). Previous studies shown that it is important to look for higher-order patterns among symptoms of different disorders (Hudziak, Althoff, Derks, Faraone, & Boomsma, 2005;Hudziak, Achenbach, Althoff & Spine, 2007;Stevenson et al, 2005). Mechanisms underlying various constellations of psychopathological symptoms may differ (Hudziak et al, 2005(Hudziak et al, , 2007Stevenson et al, 2005).…”

“…Previous studies shown that it is important to look for higher-order patterns among symptoms of different disorders (Hudziak, Althoff, Derks, Faraone, & Boomsma, 2005;Hudziak, Achenbach, Althoff & Spine, 2007;Stevenson et al, 2005). Mechanisms underlying various constellations of psychopathological symptoms may differ (Hudziak et al, 2005(Hudziak et al, , 2007Stevenson et al, 2005). For example, a study performed by Hudziak and colleges (2005) shows that children with comorbid ADHD, ODD and MDD are characterized by distinct genetic factors compared to children with different configurations of these psychopathological symptoms.…”

“…The important problem is low agreement between different informants (various teachers and parents) in the assessment of the intensity of hyperactivity-impulsivity and inattention symptoms (Amador-Campos, Forns-Santacana, Guardia-Olmos, & Pero-Cebollero, 2006;Stevenson et al, 2005;Schultz & Evans, 2012;Thapar, Langley, O'Donovan, & Owen, 2006). Although guidelines how to integrate parent and teacher DSM symptom ratings of ADHD (i.e., And/Or Rule) exist (Evans, Owens & Bunford, 2014), a dimensional approach makes it easier to use data from multiple sources of information, such as parents, teachers, and the children themselves and assess their intensity on the rating scales (Hudziak et al, 2007). Based on this approach, we can perceive symptoms observed by parents and teachers as related, but distinct dimensions.…”