Abstract
Background: Most longitudinal or follow-up mental health studies describe developmental pathways using dimensional measures of psychopathology, but seldom using pathways described by clinical disorders.Objective: We aim to describe diagnostic pathways by homotypic (within the disorder continuity) and heterotypic development (between the disorder continuity), with maternal psychopathology as moderator for both trajectories.Methods: Clinically referred children (0–7 years; N = 83) were assessed at preschool age and at primary-school age through a clinical interview. We built a disorder cluster of emotional disorders (ED; F32, F40, F42, F43, F93.0, F93.1, F93.2, F93.8, F95), behavioral disorders (BD; F68.8, F90, F91, F91.3, F93.3, F93.9, F94), and specific early onset disorders (SEO; F50, F51, F70, F98.0, F98.1, F98.2, F98.8, F98.9). We describe the prevalence, comorbidity, and clinical trajectories of various types of homotypic and heterotypic development.Results: We observed a high rate of comorbidity throughout the study (62.6% at admission and 67.5% at follow-up) and in general, a high continuity of mental health problems from preschool to primary-school age children (69.9% of the sample showed continuity), with 50.6% of the sample showing homotypic and 44.6% showing heterotypic development. Hierarchical multiple regression analyses suggest that heterotypic development may be influenced by maternal psychopathology.Conclusion: Currently, evidence-based mental health guidelines for preschool populations are designed and evaluated assuming a homotypic development. However, our findings indicate that treatment interventions and outcome measures should also be designed and evaluated for heterotypic development especially in case of increased maternal psychopathology.
Highlights
Developmental changes in preschool-age children produce a great variation in behavior and emotional states and, for a subpopulation with an exaggerated symptom level, these problems do not seem to be transient [e.g., [1]]
The homotypic pathway describes the continuity of a particular mental health problem over time and this pathway is widely assumed to be at play in most empirical clinical studies; the heterotypic pathway describes the development of a new clinical disorder
(4) described homotypic development for anxiety, ADHD, and disruptive behavior disorder in a community sample (N > 500 from preschool to middle childhood). Such homotypic development starting in preschool age is described frequently by broader disorder categories, such as behavioral disorders and emotional disorders
Summary
Developmental changes in preschool-age children produce a great variation in behavior and emotional states and, for a subpopulation with an exaggerated symptom level, these problems do not seem to be transient [e.g., [1]]. The homotypic pathway describes the continuity of a particular mental health problem over time and this pathway is widely assumed to be at play in most empirical clinical studies; the heterotypic pathway describes the development of a new clinical disorder. Both pathways have been recently examined in several studies [2,3,4] and can shed light on disease etiology and help shape treatment planning. [4] described homotypic development for anxiety, ADHD, and disruptive behavior disorder in a community sample (N > 500 from preschool to middle childhood). Most longitudinal or follow-up mental health studies describe developmental pathways using dimensional measures of psychopathology, but seldom using pathways described by clinical disorders
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