Abstract
There is growing appreciation that a developmental perspective is helpful in Psychiatry. However, clinical practice and research, especially in an era of very large sample sizes, often ignore the developmental context. In this perspective piece, we discuss why a developmental view is important in Psychiatry and how recent genetic-epidemiological findings further highlight this. DSM-5 childhood neurodevelopmental disorders such as ADHD, typically onset in early childhood but can persist into adult life; the same ADHD genetic loading appears to contribute across the life course. However, recent longitudinal studies have observed that ADHD symptoms may emerge later during adolescence and adult life in some individuals although the etiology of this late-onset group is unclear. The epidemiology and genetics of depression do not appear to be the same in childhood, adolescence, and adult life. Recent genetic findings further highlight this. Autistic type problems and irritability also appear to show developmental variation in their genetic etiology. These findings raise the question of whether social communication and irritability have the same meaning at different ages. Schizophrenia typically onsets after adolescence. However, it is commonly preceded by childhood antecedents that do not resemble schizophrenia itself but do appear to index schizophrenia genetic liability. We conclude that there is a need for clinicians and scientists to adopt a developmental perspective in clinical practice and research by considering age-at-onset and changes over time as well as different developmental periods when interpreting clinical symptoms.
Highlights
It is well recognized that physical, behavioral, brain, and biological phenotypes are subject to changes across the life span and that such transformation is especially marked during fetal life, childhood, and adolescence
There is growing appreciation from biological, imaging, genetic, and clinical studies that a developmental perspective is important for investigating psychiatric disorders
We revisit why a developmental view is important in Psychiatry using recent findings from genetic-epidemiology studies— those using polygenic risk scores (PRS)
Summary
It is well recognized that physical, behavioral, brain, and biological phenotypes are subject to changes across the life span and that such transformation is especially marked during fetal life, childhood, and adolescence. Several recent longitudinal studies adopted a developmental life-course perspective to assessing ADHD and identified an apparent “late-onset” form of ADHD where ADHD symptoms were not reported in childhood but emerged newly in adolescence or adult life [46] These individuals would not meet current diagnostic criteria for ADHD if their age-at-onset was known and the discovery of this group challenges the conceptualization of ADHD as a neurodevelopmental disorder. Given growing evidence of the importance of early brain development in relation to psychiatric disorder, prospective pregnancy-birth cohorts are especially attractive Such studies have shown enormous value because they start before the onset of disorder, focus across different diagnoses, typically take a dimensional as well as a categorical approach to measurement [65] and include multiple risk factors measured across the life course. Prospective high-risk studies (e.g., offspring of parents with mental illness; enriched for a known risk factor such as rare mutation or preterm birth) as well as nationwide prospective clinical registry data can be useful additions here
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