[Continuities and discontinuities of psychopathology from childhood to adulthood]

Abstract

Important data about possible continuities and discontinuities of psychopathology from childhood to adulthood have been provided by findings from well scheduled prospective longitudinal studies of community-based samples. Findings from clinical populations have contributed as well. This presentation relies on data from selected studies of reference. An effort is made to combine results demonstrating the extent of continuity at a more general level with those indicating continuities or discontinuities concerning disorders commonly presented in clinical practice. These disorders are those included in the internalizing (anxiety and mood disorders) and externalizing (ADHD, oppositional, conduct disorder-antisocial personality disorder) domains of psychopathology. Discontinuities do exist, however findings also suggest considerable longitudinal links between childhood-adolescence and adulthood. Reports from the Dunedin longitudinal study showed that half of those with psychiatric diagnoses at the age of 26 had met criteria for psychiatric disorder by the age of 15, and that figure approached 75% by the age of 18. Homotypic continuity is the most prominent. There are also heterotypic continuities, while homotypic and heterotypic continuities may co-occur. Among common disorders, findings suggest continuity tendencies even for anxiety disorders and for subclinical cases with obsessive and compulsive symptoms as well. Comorbidity between different anxiety disorders (strict homotypic continuity) as well as between them and depression (broad homotypic continuity) is very common. In the externalizing domain, longitudinal links between conduct disorder and antisocial personality disorder, including adverse consequences in psychosocial functioning, have been repeatedly found. Childhood onset subtype of conduct disorder is more prone to this adverse outcome, however all cases with conduct disorder need early recognition and intervention. During the course of conduct disorder, substance use is now recognized as a kind of homotypic continuity. About half of attention deficit-hyperactivity disorder (ADHD) cases continue into adulthood. These individuals usually face problems in several aspects of their adult life, such as interpersonal relationships, educational and occupational functioning. In ADHD cases, the emergence of conduct disorder worsens the adverse outcome; therefore prevention of this complication is of significant importance for intervention. There are indications that oppositional disorder cases may be heterogeneous and that this may explain the heterotypic continuities that have been found so far. Many aspects are open to further study, particularly those concerning the possible mechanisms involved in continuities or discontinuities in various disorders. Data suggesting the extent of continuities are important for both child psychiatry and psychiatry. Attention should be focused on early intervention, services provision and cooperation. The latter is of vital importance during the transition from child to adult services.