Allostatic Load in Childhood, Adolescence, and Young Adulthood: Are Assumptions of Measurement Invariance Warranted?

OVERVIEW: Allostatic load represents the cumulative toll of chronic mobilization of the body's stress response systems, as indexed by biomarkers. Higher levels of stress and disadvantage predict higher levels of allostatic load, which, in turn, predict poorer physical and mental health outcomes. To maximize the efficacy of prevention efforts, screening for stress- and disadvantage-associated health conditions must occur before middle age-that is, during childhood, adolescence, and young adulthood. However, this requires that models of allostatic load display properties of measurement invariance across age groups. Because most research on allostatic load has featured older adults, it is unclear if these requirements can be met. METHODS: To address this question, we fit a series of exploratory and confirmatory analytic models to data on eight biomarkers using a nationally representative sample of N = 4260 children, adolescents, and young adults drawn from the National Health and Nutrition Examination Survey dataset. RESULTS: Exploratory and confirmatory models indicated that, consistent with allostatic load theory, a unidimensional model was a good fit to the data. However, this model did not display properties of measurement invariance; post-hoc analyses suggested that the biomarkers included in the final confirmatory model were most strongly intercorrelated among young adults and most weakly intercorrelated among adolescents. CONCLUSIONS: These results underscore the importance of testing assumptions about measurement invariance in allostatic load before drawing substantive conclusions about stress, disadvantage, and health by directly comparing levels of allostatic load across different stages of development, while underscoring the need to expand investigations of measurement invariance to samples of longitudinal data.

Commentary on the power of predictability: patterns of signals in early life shape neurodevelopment and mental health trajectories.

As Davis and Glynn observe in the introduction to their review, early life adversity is a significant impediment to healthy child development. Whereas some theoretical accounts emphasize the sheer number of physical and psychosocial risk factors children experience (Evans, Li, & Whipple, Psychological Bulletin, 2013, 139, 1342), Davis and Glynn review a program of research that is aligned with models highlighting the types of adversity children encounter. They expand on accounts that differentiate threat from deprivation (McLaughlin & Sheridan, Current Directions in Psychological Science, 2016, 25, 239) to draw attention to the role of unpredictability in children's development.

Resilience to Maltreatment in Early Adulthood Does Not Predict Low Allostatic Load at Midlife.

BACKGROUND: Although childhood maltreatment is associated with a host of poor health and social outcomes in adulthood, many individuals manifest resilience. PURPOSE: We tested competing predictions about whether achieving positive psychosocial outcomes in young adulthood would be differentially predictive of allostatic load at midlife for those with and without a childhood history of maltreatment. METHODS: The sample included 808 individuals, 57% of whom had court-documented records of childhood abuse or neglect between 1967 and 1971, and demographically matched controls without those histories. Participants provided information on socioeconomic, mental health, and behavioral outcomes in interviews conducted between 1989 and 1995 (mean age = 29.2 years). Indicators of allostatic load were measured between 2003 and 2005 (mean age = 41.2 years). RESULTS: The relationship between positive life outcomes in young adulthood and allostatic load in middle adulthood varied depending on childhood maltreatment status (b = .16, 95% CI: .03; .28); for adults who did not experience childhood maltreatment, more positive life outcomes predicted lower allostatic load (b = -.12, 95% CI: -.23; -.01), whereas the relationship was not significant for adults with a childhood history of maltreatment (b = .04, 95% CI: -.06; .13). There were no differences in the results predicting allostatic load for African-American and White respondents. CONCLUSIONS: Childhood maltreatment may have enduring effects on physiological functioning that are manifest in elevated allostatic load scores in middle age. Alternatively, resilience to maltreatment-as manifest in positive functioning in socioeconomic and behavioral domains-may not be sufficiently stable over adulthood to buffer individuals from the physiological consequences of stressful environments.

We tested whether young adults who were succeeding in life according to conventional standards would have lower allostatic load at midlife, which reflects wear and tear on organs and tissues, resulting from chronic stress. We also tested whether any association between positive outcomes in young adulthood and allostatic load at midlife would differ depending on whether someone had a childhood history of maltreatment. That is, does being resilient to maltreatment in young adulthood predict good health in middle age? In a sample of 808 individuals, 57% of whom had court-documented records of childhood maltreatment, we found that success in young adulthood was associated with lower allostatic load at mid-life only for those without a history of maltreatment. Individuals with a childhood history of maltreatment had elevated allostatic load at midlife regardless of their success in young adulthood. Thus, although some individuals were resilient to maltreatment in young adulthood, this did not predict low allostatic load, at mid-life. The findings suggest that (1) childhood maltreatment may have enduring physiological effects or (2) individuals with childhood histories of maltreatment may have difficulty maintaining or building on the successes they establish early in life, such that their buffering effects on health are limited.

Differential exposure to gun or knife violence over two decades is associated with sibling differences in depression.

We tested whether exposure to gun or knife violence over two decades is a cause of depression in young adulthood using data from a nationally representative sample in the United States. The National Longitudinal Study of Adolescent to Adult Health is a sample of 20,745 adolescents, assessed in 1994-95 with follow-ups in 1995-1996 (n = 14,738), 2001-2002 (n = 15,197) and 2007-2008 (n = 15,701; 24 to 32 years old). At each wave, respondents reported exposure to gun or knife violence and symptoms of depression. Regression and sibling fixed effects analyses were conducted to test whether cumulative exposure to gun or knife violence was associated with depression. In fully adjusted models, greater cumulative exposure to gun or knife violence was associated with more symptoms of depression (b = 0.12, 95% C. I. = 0.05; 0.19, p < 0.01) and higher risk for clinically significant depression in young adulthood (OR = 1.07, 95% C. I. = 1.02; 1.13, p < 0.01). Results replicated in sibling fixed effects models (b = 0.21, 95% C. I. = 0.01; 0.42, p < 0.05). These quasi-experimental data suggest that exposure to gun or knife violence is a cause of depression in young adulthood.

'Excessive and Unreasonable': The Relation Between Clinical Insight and Clinical Correlates and Treatment Outcomes in Obsessive-Compulsive Disorder Across the Life Course.

Individuals with mental disorders possess varying levels of clinical insight-the degree to which one understands that they are afflicted with a mental disorder and that their symptoms are manifestations of this psychopathology. Although clinical insight in OCD is thought to play an especially important role in determining various clinical characteristics and treatment outcomes, insight has not been sufficiently addressed developmentally, the importance of which this review will elucidate. Findings from this review suggest that clinical insight is typically associated with more complex cases and worse treatment outcomes across the life course, and also reveal nuances between pediatric and adult OCD cases with low insight. Implications of these findings, future research directions, and recommendations for the field are discussed.

Editorial: The times they are a-changin': paradigm shifts in child and adolescent psychology and psychiatry.

The world is a different place than it was more than 2 years ago, at the start of the COVID-19 pandemic. The times are always changing, but events of the recent past have radically shifted how we work, when and how we interact with each other, and how we understand our history. The papers in the current issue echo this spirit of change, challenging us to fundamentally re-think how we conceptualize psychopathology, where we define boundaries between 'normal' and 'abnormal' (and, who gets to define those boundaries), and whether our current conceptual models are generalizable to ever more diverse groups. These challenges represent healthy and timely critiques of dominant paradigms. Collectively, the authors who contributed to the current Annual Research Review make the case that these new frameworks will have big pay-offs in terms of improving clinical practice and policy.

Alexithymia in individuals maltreated as children and adolescents: a meta-analysis.

BACKGROUND: Children who are maltreated show deficits in emotion recognition, expression, and understanding. The goal of the current meta-analysis was to determine the degree to which maltreatment is associated with deficits in the ability to recognize one's own emotions - a phenomenon known as alexithymia. Alexithymia may be a mechanism explaining the association between childhood maltreatment and various psychological disorders. METHODS: This meta-analytic review (88 studies, n = 43,076) examined the association between the experience of childhood maltreatment and alexithymia, mainly in adulthood. Additional meta-analyses were run to examine if the strength of the association between maltreatment as a child and alexithymia varied as a function of the type of maltreatment individuals reported and other moderators. RESULTS: We found significant small effect sizes for all models, indicating higher levels of maltreatment in childhood or adolescence were associated with higher levels of alexithymia. Alexithymia was more strongly associated with forms of neglect than with physical or sexual abuse. The effect sizes also increased as the percentages of females in the sample increased. CONCLUSIONS: Results suggest that researchers should examine whether alexithymia is a transdiagnostic mechanism in the association between childhood maltreatment and psychopathology and whether targeting alexithymia in treatment could reduce a wide range of symptoms.

Editorial: 'In our time': Has the pandemic changed the way we write and read mental health and neurodevelopmental disorder research reviews?

The past year was marked by upheaval, as countries across the globe shut down in the face of the COVID-19 pandemic. Although the topics for this year's Annual Research Review were decided long before most of had heard of the coronavirus, many readers may find themselves reading the papers in this issue through a pandemic lens. For some authors, the COVID-19 pandemic and the social unrest that characterized parts of the world where these authors live are likely to have shaped the way they ultimately framed the topics of their reviews. This issue serves as a reminder that it is critical to read science in social and historical context. Our preoccupations as psychologists and psychiatrists reflect our cultural values and societal experiences at a particular time and place.

Early-onset and recurrent depression in parents increases risk of intergenerational transmission to adolescent offspring.

BACKGROUND: To assess whether the age-of-onset or the recurrence of parents' major depressive disorder (MDD), measured prospectively in a longitudinal birth cohort study, predicted offspring depression at age 15. METHODS: A two-generation study of New Zealanders, with prospective, longitudinal data in the parents' generation (n = 375) and cross-sectional data from their adolescent offspring (n = 612). Parent and offspring depression was measured with structured clinical interviews. Parent depression was measured at six time points from age 11 to 38 years. Adolescent offspring depression was measured at age 15. RESULTS: Compared to adolescents whose parents were never depressed, those whose parents met criteria for MDD more than once and those whose parents first met criteria before adulthood had more symptoms of depression. The combination of early-onset and recurrent depression in parents made adolescents particularly vulnerable; their odds of meeting criteria for MDD were 4.21 times greater (95% CI = 1.57-11.26) than adolescents whose parents were never depressed. The strength of the intergenerational effect did not vary as a function of parent or offspring sex. The prevalence of adolescent depression was 2.5 times higher in the offspring than at age 15 in the parents' generation. CONCLUSIONS: Recurrent depression in both fathers and mothers increases offspring risk for depression, particularly when it starts in childhood or adolescence, but a single lifetime episode does not. Health practitioners should be aware of age-of-onset and course of depression in both parents when assessing their children's risk for depression.

The neurophysiological embedding of child maltreatment.

Maltreatment adversely impacts the development of children across a host of domains. One way in which maltreatment may exert its deleterious effects is by becoming embedded in the activity of neurophysiological systems that regulate metabolic function. This paper reviews the literature regarding the association between childhood maltreatment and the activity of three systems: the parasympathetic nervous system, the sympathetic nervous system, and the hypothalamic-pituitary-adrenal axis. A particular emphasis is placed on the extent to which the literature supports a common account of activity across these systems under conditions of homeostasis and stress. The paper concludes with an outline of directions for future research and the implications of the literature for policy and practice.

Bullying behaviours and other conduct problems: longitudinal investigation of their independent associations with risk factors and later outcomes.

PURPOSE: Bullying behaviours and other conduct problems often co-occur. However, we do not yet know whether bullying behaviours are associated with early factors and later poor outcomes independently of conduct problems. While there are differing, specific interventions for bullying behaviours and for conduct problems, it is unclear if such specificity is justified given parallels between both behaviours. METHODS: We used prospective data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative sample of 2232 children. Mothers and teachers reported on children's bullying behaviours and conduct problems at ages 7 and 10. We collected measures of risk factors, including temperament and family factors, when children were age 5. We assessed behavioural, emotional, educational and social problems when participants reached the ages of 12 and 18. RESULTS: Bullying behaviours and conduct problems co-occurred in childhood. Our findings indicated that bullying behaviours and other conduct problems were independently associated with the same risk factors. Furthermore, they were associated with the same poor outcomes at both ages 12 and 18. Despite this, bullying behaviours were uniquely associated with behavioural, emotional, educational and social problems at age 18. CONCLUSIONS: Our findings suggest that anti-bullying programmes and interventions aimed at reducing conduct problems could benefit from greater integration. Furthermore, our study highlights the mental health problems children who bully may face in later years and the need to consider those in intervention plans.

Psychosocial Correlates and Consequences of Adolescents' Self-Generated Academic Goals and Appraisals.

The current study examined whether characteristics of adolescents (i.e., externalizing problems) and their environments (i.e., social support, adverse childhood experiences) relate to academic goal setting, appraisals, and outcomes. Adolescents (n = 99; 87% Black/African American) 13-16 years old completed baseline interviews, and 80% also completed follow-up interviews. Adolescents with more externalizing problems set fewer academic goals, and youth with social networks characterized by greater support (and less strain) appraised their academic goals as more supported and achievable. Adolescents' appraisals of their academic goals, but not how many academic goals they had, predicted grades at follow-up. Increasing social support (and reducing social strain) may foster adolescents' positive appraisals of their academic goals, which may promote academic achievement.

Using discordant twin methods to investigate an environmentally mediated pathway between social support and the reduced likelihood of adolescent psychotic experiences.

BACKGROUND: Social support has been shown to be associated with a reduced likelihood of developing psychotic experiences in the general population and even amongst those at high risk due to exposure to multiple forms of victimisation (poly-victimised). However, it is unclear whether this association is merely due to the confounding effects of shared environmental and genetic influences, or reverse causality. Therefore, we investigated whether social support has a unique environmentally mediated effect on adolescent psychotic experiences after accounting for familial factors, including genetic factors, and also prior psychopathology. METHODS: Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 UK-born twins. Adolescents were interviewed at age 18 about psychotic experiences and victimisation exposure since age 12, and their perceptions of social support. Prior childhood mental health problems and psychotic symptoms were assessed at age 12. The discordant twin method was used to disentangle the relative family-wide and unique-environmental effects of social support on psychotic experiences in the general population and among poly-victimised adolescents. RESULTS: Perceived social support, particularly from friends, was found to have a unique environmentally mediated buffering effect on adolescent psychotic experiences in the whole sample and in the high-risk poly-victimised group. CONCLUSIONS: The protective effects of social support on adolescent psychotic experiences cannot be accounted for by shared environmental or genetic factors, nor by earlier psychopathology. Our findings suggest that early intervention programmes focused on increasing perceptions of social support have the potential to prevent the emergence of psychotic experiences amongst adolescents.

Editorial: Something new - what's next for child and adolescent psychiatry?

The start of a new decade is often the moment when people pause to reflect on what they have accomplished in the past 10-20 years and where they would like to be at the start of the next decade. Although not designed as such, the 2020 Annual Review issue engages in exactly this sort of a backwards and forwards look at the field of child and adolescent psychiatry and psychology. In doing so, it covers topics that are at the core of the field and have preoccupied researchers and clinicians for decades. It also covers research endeavors that have only more recently captured the attention of the field and that build bridges to disciplines that have not historically been involved in the study of neurodevelopment. In every case, the authors who have contributed to the 2020 Annual Research Review highlight exciting new directions for research and make novel recommendations for how to advance the state of our science.

College Expectations Promote College Attendance: Evidence From a Quasiexperimental Sibling Study.

When adolescents are asked how likely they think it is that they will go to college, does their answer influence what they will actually do? Typically, it is difficult to determine whether college expectations promote academic achievement or just reflect a reasonable forecast of what is likely to happen to them. We used a sample of siblings from the National Longitudinal Study of Adolescent to Adult Health (N = 1,766) to test whether associations between college expectations and educational attainment remained after accounting for unobserved family factors that may shape both educational expectations and attainment. Compared with their siblings, adolescents with higher college expectations were also 43% more likely to attend college, even when analyses controlled for grades and IQ. The effect of college expectations on college attendance was strongest among youths living in higher-socioeconomic-status families.

Childhood socioeconomic status and inflammation: A systematic review and meta-analysis.

Recent research suggests that risk for chronic diseases of aging including cardiovascular disease, diabetes, and even cancer can be programmed early in the lifespan as a result of exposure to chronic stressors like low socioeconomic status (SES) that are hypothesized to promote a pro-inflammatory response in immune cells that results in chronic, systemic inflammation. The present paper conducted a meta-analysis to establish whether exposure to low (versus higher) SES in childhood and adolescence is associated with higher levels of inflammation (as measured by C-reactive protein, IL-6, and fibrinogen) concurrently and in adulthood. We conducted meta-analyses with both unadjusted bivariate associations between SES and inflammation and with adjusted associations that controlled for a range of covariates including demographic factors, body mass index, smoking, physical activity and current SES. A systematic review of Pubmed and PsycINFO identified a total 35 studies (26 with unadjusted and 31 adjusted effect sizes) to be included in the meta-analysis. Random-effects meta-analysis showed that individuals who were exposed to low SES in childhood and adolescence had significantly higher levels of inflammatory markers (r = -0.07, p < .001, 95% CI = -0.09, -0.05). This association remained significant in adjusted analyses (r = -0.06, p < .001, 95% CI = -0.09, -0.03). However, the relationship between childhood SES and inflammation was non-significant in a meta-analysis with longitudinal studies that all controlled for adulthood SES (r = -0.03, p = .356, 95% CI = -0.08, 0.03). Future longitudinal research should utilize measurement of inflammatory markers at multiple time points to further examine the complex relationships between SES and health both in childhood and adulthood.

Editorial: The rise and rise of developmental perspectives in child psychology and psychiatry.

When developmental psychopathology emerged as a discipline in the late 1970s and early 1980s, its proponents were as careful to explain what it was not, as they were to define what it was (e.g. Sroufe & Rutter, 1984). In particular, they differentiated developmental psychopathology from child psychiatry, which is primarily concerned with the differential diagnosis, prognosis, and treatment of childhood disorders. In contrast, developmental psychopathology was defined as 'the study of the origins and course of individual patterns of behavioral maladaptation, whatever the age of onset, whatever the causes, whatever the transformations in behavioral manifestation, and however complex the course of the developmental pattern may be' (Sroufe & Rutter, 1984, p. 18).

Commentary: ADHD lifetime trajectories and the relevance of the developmental perspective to Psychiatry: reflections on Asherson and Agnew-Blais, (2019).

Asherson and Agnew-Blais review evidence from prospective, longitudinal studies in Brazil, New Zealand, Sweden, the United Kingdom and the United States showing that ADHD can emerge for the first time in adolescence or young adulthood. These findings defy conventional wisdom specifying that ADHD is, by definition, a disorder that emerges in childhood. We discuss possible explanations for the late-onset of ADHD, including the removal in adolescence or young adulthood of features of a young person's environment that played a buffering role against the emergence of symptoms and heterotypic continuity in a general liability to psychopathology that is present from childhood.