Editorial: Developmental Psychopathology

Article excerpt

With the intensifying focus on the proposed revision of the Diagnostic and Statistical Manual (DSM-5) in 2013, the role of development in the conceptualization of psychiatric diagnosis will hopefully gain more recognition. Unfortunately, previous versions of the DSM included only brief considerations of developmental themes.

In the early parts of the last century developmental psychiatry was dominated by so-called "Grand Theories" of development which were derived mainly from philosophy and psychoanalysis. Although the insights from these theories continue to be a rich source for hypothesis building and prospective research, their early promise of explaining all of psychopathology proved disappointing. The "Grand Theories" were replaced, therefore, by painstaking evidence based research which has attacked much smaller issues. However, as this body of study increases in substance, it is becoming increasingly apparent that psychiatrists need to base their clinical work on sound developmental theory. Perhaps the most important landmark for this approach was the publication by Donald Cohen and Dante Cicchetti of their seminal work Developmental psychopathology: Theory and method (1). In the introductory presentation of this special issue, Toth and Cicchetti describe the evolution and principles of Developmental Psychopathology and how such principles are fundamental for understanding child psychiatric disorders.

It is our suggestion that one of the major frameworks for the new DSM-5 revision needs to be developmental and thus the publication of the present issue of the Israel Journal of Psychiatry and Related Sciences is extremely timely. This is perhaps even more so as the late Donald Cohen had a major role in the development of this Journal.

It is now well established that most psychiatric disorders have strong genetic predispositions with abnormal brain development trajectories. Two papers this special issue are devoted to Tourette syndrome and autism, diseases with strong genetic diatheses and a developmental emergence of both psychiatric and neurological symptoms. Despite intensive research, the genetic variants associated with the genetic risk for these neuropsychiatrie disorders are as yet uncertain. With advancements in molecular biology and cytogenetics we are now able to screen the whole genome for the presence of small microdeletions and microduplications collectively termed copy number variations (CNVs). CNVs currently account for the etiology of autism in 10%-20% (2), and there is evidence for the important role of CNVs in other psychiatric disorders, such as schizophrenia (3). Two papers in this special issue focus on microdeletion syndromes - velocardiofacial syndrome and Williams syndrome - associated with unique psychiatric, cognitive and behavioral phenotypes. Velocardiofacial is the most common known genetic risk factor for schizophrenia and Williams syndrome is associated with characteristic deficits in auditory processing and a distinct social phenotype.

Developmental psychopathology is thus an excellent framework for understanding a myriad of psychiatric disorders with distinctive abnormal neurodevelopmental trajectories, such as early onset schizophrenia (reviewed in the special issue by Kinros et al.). It is also a context for understanding extreme behaviors, such as gender identity disorder which according to the review by Schechner is a form of gender behavior which should be understood as a continuum rather than as a dichotomy of normal versus abnormal categories.

Developmental psychopathology is also important for formulations of normal development. Research by Weismann et al. in the current special issue shows how early psychological traits - temperament of children - are strongly associated with development of peer relations and problems with peers.

It is now well recognized that there are sensitive periods in core psychological functions, such as language acquisition. …