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Exposure to early life stress (ELS) has been linked to at least double the risk of psychopathology as well as higher morbidity and earlier mortality across the lifespan. For this reason, the field of developmental psychopathology has spent decades identifying factors that explain which individuals are at risk for negative health outcomes. Preclinical experiments in this field commonly test the two-hit hypothesis, which explores how ELS potentiates vulnerability to pathogenic physiological and behavioral outcomes when an individual is exposed to a stressor later in development. Yet, translation of the two-hit hypothesis to humans is conceptually and practically challenging, thus impeding progress in the field. This review summarizes the two-hit hypothesis used in preclinical experiments as it pertains to two putative pathways linking ELS to psychopathology: the innate immune and neuroendocrine systems. This review also identifies important considerations when translating this model to humans and provides several recommendations. Specifically, attention to the biological salience of different forms of ELA and the concordance of that salience with later probes of the system are needed. Further, the consequences of ELS may be context-specific rather than ubiquitous, at least among young people. Within this conceptualization, second hits may be best operationalized using standardized acute challenges to the innate immune and neuroendocrine systems (e.g., psychosocial stress). Third, more explicit reporting of sex differences in the human literature is needed. Finally, preclinical experimental designs that more accurately reflect the natural occurrence of ELS in community samples will more effectively advance the understanding of developmental mechanisms that occur as a consequence of ELS.

Though youth living in disadvantaged neighborhoods experience greater risk for poor behavioral and mental health outcomes, many go on to show resilience in the face of adversity. A few recent studies have identified neural markers of resilience in cognitive and affective brain networks, yet the broader network organization supporting resilience in youth remains unknown, particularly in relation to neighborhood disadvantage. Moreover, most studies have defined resilience as the absence of psychopathology, which does not consider growing evidence that resilience also includes positive outcomes across multiple domains (e.g., social, academic). We examined associations between brain network organization and multiple resilience domains in a sample of 708 twins (7–19 years old) recruited from neighborhoods with above-average poverty levels. Graph analysis on functional connectivity data from resting-state and task-based functional magnetic resonance imaging was used to characterize features of intrinsic whole-brain and network-level organization, from which we explored associations with resilience in three domains: psychological, social, and academic. Fewer connections between a brain network involved in self-referential processing (i.e., default mode network) and the subcortical system were associated with greater social resilience. Further, greater whole-brain functional integration (i.e., efficiency) was associated with better psychological resilience among youth with relatively lower levels of cumulative adversity exposure. Alternatively, lower whole-brain efficiency and higher whole-brain robustness to disruption (i.e., assortativity) were associated with greater psychological and social resilience among youth with relatively higher levels of cumulative adversity. These findings advance support for multidimensional resilience models and reveal distinct neural mechanisms supporting resilience to neighborhood disadvantage across specific domains in youth. Public Significance Statement: The present study used brain imaging to examine how the organization of information flow throughout the brain relates to resilience to neighborhood disadvantage in youth. Results identified three domains of resilience (i.e., psychological, social, and academic), which showed unique associations with patterns of information flow across brain networks and the entire brain. This work bridges advancements in resilience theory with neuroscience to identify brain markers of resilience among youth marginalized by the socioeconomic status of their neighborhood. [ABSTRACT FROM AUTHOR]

Psychophysiology can help elucidate the structure and developmental mechanisms of psychopathology, consistent with the Research Domain Criteria initiative. Cross-sectional research using categorical diagnoses indicates that P300 is an electrocortical endophenotype indexing genetic vulnerability to externalizing problems. However, current diagnostic systems' limitations impede a precise understanding of risk. The Hierarchical Taxonomy of Psychopathology (HiTOP) overcomes these limitations by delineating reliable dimensions ranging in specificity from broad spectra to narrow syndromes. The current study used a HiTOP-aligned approach to clarify P300's associations with a higher-order externalizing factor versus syndrome-specific manifestations within externalizing and internalizing spectra during middle and late adolescence. Participants from the Minnesota Twin Family Study's Enrichment Sample contributed psychophysiological and clinical data at age 14 (N = 930) and follow-up clinical data at age 17 (N = 913). Blunted target P300 at age 14 was selectively associated with externalizing as manifested at age 17 at the superspectrum level (rather than specific externalizing syndromes). Unlike in prior work, target P300 amplitude was positively associated with age 17 depressive symptoms (once controlling for standard stimuli). No association was observed with lifetime symptoms of childhood externalizing or depression evident by age 14. The results indicate that blunted target P300 elucidates specific risk for the development of late-adolescent/young-adult expressions of general externalizing, over and above symptoms evident by middle adolescence. Additionally, the findings speak to the synergistic utility of studying HiTOP-aligned dimensions using multiple measurement modalities to build a more comprehensive understanding of the development of psychopathology. General Scientific Summary: This study suggests that a brain response known to be reduced among people with substance use disorders and antisocial personality disorder is associated with the serious behavioral dysregulation shared among these conditions in late adolescence and not with other forms of disruptive behavior evident by middle adolescence. These findings deepen our understanding of the neural signatures of risk for mental illness, how they transcend diagnostic boundaries, and how they change with age. [ABSTRACT FROM AUTHOR]

Childhood obesity is a prevalent health condition, the effects of which extend to mental health, social relationships, educational performance, and long-term physical health conditions. The present study focused on an optimized student support intervention that functions in predominantly high-poverty urban locations, which recognizes students as possessing unique constellations of protective and risk factors. Participants included 5,573 K-5 students that support staff identified as being overweight through a holistic, collaborative assessment process, and evaluated how these students differed from peers not perceived as overweight. Findings indicated statistically significant differences across the groups, in terms of demographic characteristics, strengths and risks recognized (in academic, social-emotional/behavioral, family, and health/medical domains), school-related academic and thriving performance scores, and the moderating effects of specific psychosocial and familial strengths and risks on those educational areas. This study underscores the importance of considering both strengths- and risks-based assessment and intervention approaches – as well as the utility of initial identification of students – particularly in low-income, underserved environments. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Characteristics of parent‐child interaction (PCI) early in life have been associated with later development in the child. Twin studies can help to disentangle child contributions to parent‐child interaction, for example, by assessing the influence of the child's genetics on his/her social environment, which includes parental behaviour.Infant twins from a community sample [354 monozygotic (MZ), 268 same‐sex dizygotic (DZ)] were assessed in terms of PCI at age 5 months. We used the classical twin design to map the aetiology of several parent and child PCI scales and their covariation. We investigated the relations between PCI and later parent‐rated child's social communication, language, and autistic traits at ages 2 and 3.Heritability was below 20% for all the included PCI traits. Unique (nonshared) environmental influences substantially overlapped across several PCI scales, suggesting that idiosyncrasies linked to each session shaped the scoring of several traits in a systematic way. Factor analysis revealed three uncorrelated latent factors, which were conceptualized as ‘child negative affect’, ‘positive affective interaction’, and ‘parent's supportive strategies’. Parents who were rated highly on ‘sensitive responsiveness’ at 5 months tended to rate their offspring higher in terms of socio‐communicative and language development and lower in terms of autistic traits in the second and third years of life.This study maps the phenotypic and aetiological structure of PCI in early infancy and supports the view that parents' sensitive responsiveness towards their infant is associated with later developmental gains in several domains. We did not find strong evidence of any so‐called evocative genetic effects on parents’ behaviour. We discuss the results considering the general challenge for lab‐based observational PCI measures to capture the richness of parent‐child interaction. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Cognitive development after schizophrenia onset can be shaped by interventions such as cognitive remediation, yet no study to date has investigated whether patterns of early behavioral development may predict later cognitive changes following intervention. We therefore investigated the extent to which premorbid adjustment trajectories predict cognitive remediation gains in schizophrenia. METHODS: In a total sample of 215 participants (170 first-episode schizophrenia participants and 45 controls), we classified premorbid functioning trajectories from childhood through late adolescence using the Cannon-Spoor Premorbid Adjustment Scale. For the 62 schizophrenia participants who underwent 6 months of computer-assisted, bottom-up cognitive remediation interventions, we identified MATRICS Consensus Cognitive Battery scores for which participants demonstrated mean changes after intervention, then evaluated whether developmental trajectories predicted these changes. RESULTS: Growth mixture models supported three premorbid functioning trajectories: stable-good, deteriorating, and stable-poor adjustment. Schizophrenia participants demonstrated significant cognitive remediation gains in processing speed, verbal learning, and overall cognition. Notably, participants with stable-poor trajectories demonstrated significantly greater improvements in processing speed compared to participants with deteriorating trajectories. CONCLUSIONS: This is the first study to our knowledge to characterize the associations between premorbid functioning trajectories and cognitive remediation gains after schizophrenia onset, indicating that 6 months of bottom-up cognitive remediation appears to be sufficient to yield a full standard deviation gain in processing speed for individuals with early, enduring functioning difficulties. Our findings highlight the connection between trajectories of premorbid and postmorbid functioning in schizophrenia and emphasize the utility of considering the lifespan developmental course in personalizing therapeutic interventions.

Empirically-based developmental psychopathology approach identified three domains involved in the emergence of borderline personality disorder (BPD): i) underlying liabilities to develop psychopathology (i.e., early patterns of internalizing and externalizing manifestations); ii) invalidating relational experiences (e.g., childhood traumatic experiences, maladaptive parenting, problematic peer relationships); iii) regulatory mechanisms of emotions and behaviors. Nevertheless, no studies have quantitatively summarized empirical findings concerning how and to what extent these domains might be temporally associated to the emergence of BPD features from adolescence to adulthood. The current multi-level meta-analysis included 106 studies (N = 86,871 participants) assessing the role of previously mentioned antecedents and risk factors for BPD. The analysis showed moderate effect sizes capturing temporal associations between early internalizing/externalizing psychopathological manifestations, different invalidating relational experiences, emotion/behavior regulation processes with later BPD features. The effect sizes of these domains were not statistically different from each other. This evidence supports a transactional developmental model of BPD. Consistently, the emergence of BPD could be viewed in the light of dynamic interplays between an underlying liability to psychopathology and invalidating relational experiences across different stages of development, which are progressively reinforced through increasing alterations of emotion and behavior regulation mechanisms. • Antecedents and risk factors for BPD were meta-analyzed (prospective/retrospective studies) • Liabilities to psychopathology showed moderate associations with later BPD features • Invalidating experiences highlighted moderate relationships with later BPD features • Emotion/behavior regulation were moderately associated with later BPD features • Findings supported a transactional etiopathogenic model of BPD [ABSTRACT FROM AUTHOR]

Despite preliminary evidence that links impulsivity to suicide risk among Native American youth, impulsivity has not been directly studied in relation to suicide ideation (SI) or behaviors in this population. We examined indexes of rapid-response impulsivity (RRI) across multiple levels of analysis (self-report, behavioral, neurobiological) and associations with SI among Native American youth ages 9–10 in the Adolescent Brain Cognitive Development Study. Data from the sample (n = 284) included self-report (UPPS-P), behavioral (Stop Signal Task), and neurobiological (right inferior frontal gyrus activation) indicators of RRI. RRI indicators were modeled using variable-centered (i.e., traditional multivariable regression) and person-centered (i.e., clustering analyses) approaches in measuring their association with SI. Logistic regression analysis demonstrated that higher negative urgency was associated with higher odds of SI (Adjusted Odds Ratio = 1.23, p = 0.015). Latent profile analysis clustered youth into five profiles based on within-individual variation in RRI indicators. Youth with an elevated self-reported negative and positive urgency profile had higher odds of reporting SI than "normative" youth (Adjusted Odds Ratio = 2.38, p = 0.019). Limitations of this study include the modest sample size particularly regarding SI (14.1 %), potential bias in estimates of lifetime SI, and generalizability to youth from specific Native American communities. Negative urgency may increase risk for SI among Native American youth in late childhood. Clinical implications, including the potential for person-centered RRI profiles to act as candidate markers of suicide risk and resilience in adolescence and inform safety assessments and planning, are discussed. • 14.1 % of Native American youth ages 9–10 reported lifetime suicide ideation. • Measures of impulsivity showed different clinical utility across levels of analysis. • Negative urgency was linked to suicide ideation in multiple statistical frameworks. • Most youth with higher negative urgency also reported higher positive urgency. [ABSTRACT FROM AUTHOR]

Abstract Background The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents’ social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. Methods During offspring’s middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. Results Parents’ social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p = .017). Parents’ social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p = .026). No effects of parents’ coping style were found. Conclusions Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents’ social support may thus have a protective function for children in these high-risk families.

Childhood conduct problems and head injuries share a bidirectional association, but how this affects the risk of adolescent delinquency is unknown. Due to their similar underlying mechanisms (i.e. increased impulsivity), this study aims to identify whether their co-occurrence increases the risk of adolescent delinquency. Data was obtained from 11,272 children at age 14 and 10,244 at age 17 years enrolled in the UK Millennium Cohort Study. Conduct problem symptoms (via the Strengths and Difficulties Questionnaire) and head injuries were parent reported from ages 3 to 14 years. Delinquency was self-reported at ages 14 and 17 including substance use, criminality, and antisocial behaviour. Incident rate ratios (IRR) were estimated for delinquency at ages 14 and 17 by childhood conduct problem and head injury status. Co-occurring head injuries and high conduct problem symptoms presented the greatest risk for overall delinquency and substance use at age 14 compared to those with the presence of one or neither (IRRs from 1.20 to 1.60). At age 17, conduct problems (with or without co-occurring head injuries) presented the greatest risk for overall delinquency, substance use, and antisocial behaviour. There was no evidence for an increased risk of delinquency at ages 14 or 17 following a head injury only. Whilst these findings suggest childhood head injuries alone do not increase the risk of adolescent delinquency, when co-occurring alongside high conduct problem symptoms there is a heightened earlier risk. These results provide further insight into adolescent delinquency and the outcomes of co-occurring childhood head injury and conduct problem symptoms. [ABSTRACT FROM AUTHOR]

Background: The offspring of parents with bipolar disorder (OBD) are at higher risk of developing psychopathology than the offspring of parents with no affective disorder (control). In addition to genetic predisposition, childhood adversity and a stressful family environment are important risk factors for the OBD. Protective factors in parents, such as social support and coping strategies, may buffer the effects of stress on at-risk children. This study tested whether parents' social support and coping style attenuated the link between risk status (OBD vs. control) and psychopathology in offspring. Methods: During offspring's middle childhood, parents underwent a diagnostic interview and completed social support and coping style questionnaires. Sixty-nine OBD (39 female) and 69 control (29 female) offspring between ages 13 and 29 completed a diagnostic interview approximately 10 years later. Results: Parents' social support satisfaction moderated the link between offspring risk status and their development of substance use disorder (SUD) symptoms (F(1,131) = 5.90, p =.017). Parents' social network size moderated the link between offspring risk status and their development of anxiety and depression symptoms in an unexpected direction (F(1,131) = 5.07, p =.026). No effects of parents' coping style were found. Conclusions: Among the OBD, having parents with greater social support satisfaction and, unexpectedly, a smaller social network buffered their development of SUD and depression and anxiety symptoms by early adulthood. Parents' social support may thus have a protective function for children in these high-risk families. [ABSTRACT FROM AUTHOR]

Boundary dissolution has broadly been defined as the breakdown of boundaries and loss of psychological distinctiveness in the parent–child subsystem. Qualitative reviews have highlighted the developmental and clinical value of examining boundary dissolution as a multidimensional construct. Though prior work suggests patterns share minimal variance, research has yet to quantitatively synthesize the weighted effect of distinct patterns. The primary aim of this meta-analysis was to aggregate empirical research on associations between boundary dissolution patterns and children's internalizing and externalizing symptoms. Four patterns of boundary dissolution were identified across developmental, clinical, and family systems literatures: (a) enmeshment—entanglement and blurring of the intergenerational parent–child boundary through psychologically controlling and intrusive behaviors, (b) disorganization—chaotic parent–child boundary (e.g., inexplicable, contradictory behaviors, and responses) reflecting no coherent pattern of relating, (c) caregiving—child functions as a caregiver providing parents with instrumental and emotional support and guidance, and (d) coerciveness—child operates as a disciplinarian or authoritarian to intimidate and control parents. The meta-analysis reviewed 478 studies. Although each boundary dissolution pattern was associated with internalizing and externalizing symptoms, weighted effects across patterns significantly varied in magnitude. Regarding externalizing symptoms, the weighted effect of enmeshment was stronger relative to the weighted effect of caregiving. Turning to internalizing symptoms, the weighted effect of enmeshment was stronger than the weighted effect of caregiving and coerciveness. Additionally, the weighted effect of disorganization was stronger than the weighted effect of caregiving. The robustness of weighted effects depended on child, contextual, and methodological characteristics as well as time lag. Public Significance Statement: The identification of (a) boundary dissolution patterns that were more strongly associated with children's adjustment than other boundary dissolution patterns and (b) children and families for whom associations between boundary dissolution and adjustment were strongest highlights the importance of developing intervention and prevention priorities to target those most at risk. Moreover, the magnitude of associations between boundary dissolution patterns and children's adjustment was stable across time, underscoring the value of testing the long-term efficacy of intervention and prevention programs. Finally, variations in the robustness of the weighted effect across methodological procedures will help advance the development and refinement of methodological instruments to assess boundary dissolution. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly impacted the mental health and developmental trajectories of children and adolescents, catalyzing a range of psychological and behavioral issues due to enforced lockdowns and other restrictions. This text explores these impacts through the lens of developmental psychopathology, which integrates clinical psychology and developmental science to examine the emergence and evolution of psychological disorders across a lifespan. This paper highlights how pandemic-related disruptions have exacerbated conditions such as anxiety and depression and, notably, increased childhood obesity due to changes in lifestyle and reductions in physical activity. The analysis includes a discussion of how isolation has not only restricted access to educational and psychological resources but also increased the risk of parental mental illness and related familial stress, thereby intensifying issues of neglect and their consequent impact on child health. By employing a developmental psychopathology framework, this paper argues for the necessity of targeted interventions that address these complex interplays of genetic, environmental, and psychological factors. Such interventions aim to support children through structured educational and health-oriented strategies, ensuring their well-being amidst the ongoing challenges posed by the pandemic. This approach underscores the importance of early, multifaceted strategies involving parents, educators, and healthcare providers to foster healthier developmental outcomes for children facing unprecedented global health crises. [ABSTRACT FROM AUTHOR]

In this study, we examined the unique associations between functional impairment and different psychopathology domains across childhood and adolescence. We examined whether functional impairment's associations with psychopathological domains can offer important insights to understanding direct and indirect pathways for the co-occurrence among mental health difficulties across childhood and adolescence. From the population-based study Spit for Science, we included 5163 participants between the ages of 6 and 18.97 years (Mean age = 9.98, SD = 2.89) with parent/self-rated quantitative measures of psychopathology. We used network estimation to examine the unique associations among ratings of functional impairment, inattention, hyperactivity, autism, obsessions and compulsions, depression, anxiety, and irritability, while accounting for age effects. Bootstrapped difference tests of edges (partial correlations between two domains in a network) and node (domains/variable within a network) influence on network connectivity were conducted. In addition to domain specific associations, functional impairment-irritability and functional impairment-depression ratings were two of the strongest connections in the network. Overall, functional impairment and depression ratings had some of the highest centrality indices, in terms of their strength and number of direct and indirect connections. Age effects varied in the network with the positive age-depressive ratings connection being the strongest. This study demonstrates the importance of examining associations among psychopathology domains together with functional impairment to delineate important direct and indirect pathways for co-occurrence. We offer data driven hypotheses for impairment-related pathways and suggest important targets for intervention that can be examined in clinical research to mitigate comorbidities. [ABSTRACT FROM AUTHOR]

Parental factors, including pathological narcissism, a maladaptive form of personality style which is characterized by pronounced interpersonal problems, may confer vulnerability to children's experiences of depression. However, the mechanisms underlying this risk remain largely unexplored. Our longitudinal study assessed whether parent pathological narcissism is associated with childhood depression 1 year later and whether this association is influenced by child attachment and perspective taking. In 59 parent-child dyads, parents reported levels of pathological narcissism, and children reported their levels of depression, attachment and social perspective taking at baseline and 1 year later. Parent pathological narcissism was positively associated with later child depression, anxious and avoidant attachment, and perspective taking. Additionally, parental pathological narcissism had a direct effect on later child depression and an indirect effect through child anxious attachment while controlling for earlier child depression. The association between parent pathological narcissism, and child depression appears to operate through children's anxious attachment, highlighting a potential mechanism of intergenerational transmission of psychological risk. [ABSTRACT FROM AUTHOR]

Despite recent applications of a developmental psychopathology perspective to the perinatal period, these conceptualizations have largely ignored the role that childbirth plays in the perinatal transition. Thus, we present a conceptual model of childbirth as a bridge between prenatal and postnatal health. We argue that biopsychosocial factors during pregnancy influence postnatal health trajectories both directly and indirectly through childbirth experiences, and we focus our review on those indirect effects. In order to frame our model within a developmental psychopathology lens, we first describe "typical" biopsychosocial aspects of pregnancy and childbirth. Then, we explore ways in which these processes may deviate from the norm to result in adverse or traumatic childbirth experiences. We briefly describe early postnatal health trajectories that may follow from these birth experiences, including those which are adaptive despite traumatic childbirth, and we conclude with implications for research and clinical practice. We intend for our model to illuminate the importance of including childbirth in multilevel perinatal research. This advancement is critical for reducing perinatal health disparities and promoting health and well-being among birthing parents and their children. [ABSTRACT FROM AUTHOR]

Guided by life history theory, the present study examined whether the degree of fluctuations in maternal depressive symptoms in early childhood was prospectively linked to children's risk for depression. This was the first study to present preliminary evidence on this topic and replicated main findings across two large, independent longitudinal samples. Study 1 included 1,364 families where maternal depressive symptoms were longitudinally assessed at child ages 1, 6, 15, 24, and 36, and 54 months, where child depressed/anxious behaviors at Grade 1 were reported. Study 2 included 1,292 families where maternal depressive symptoms were assessed at child ages 2, 6, 15, and 24 months. At 36 months, child internalizing symptoms and inhibitory control were assessed. In Study 1, findings revealed that the degree of fluctuations in maternal depressive symptoms over 54 months was associated with higher child depressed/anxious behaviors at Grade 1, only when mothers had higher but decreasing depressive symptoms. Study 2 revealed that the degree of fluctuations in maternal depressive symptoms over 24 months was related to higher child internalizing symptoms at 36 months, for mothers whose depressive symptoms were higher but decreasing, higher and increasing, and lower and decreasing. In addition, the degree of fluctuations in maternal depressive symptoms over 24 months was related to lower child inhibitory control at 36 months, for mothers who had higher but decreasing depressive symptoms. Findings highlighted the degree of fluctuations in maternal depressive symptoms during early childhood can contribute to environmental unpredictability, which can increase children's depression risks. [ABSTRACT FROM AUTHOR]

Anhedonia, or diminished pleasure and motivation, is a symptom of severe mental illness (e.g., depressive disorder, bipolar disorder, schizophrenia) that emerges during adolescence. Anhedonia is a pernicious symptom that is related to social impairments, treatment resistance, and suicide. As the mechanisms of anhedonia are postulated to include the frontostriatal circuitry and the dopamine neuromodulatory system, the development and plasticity of these systems during the vulnerable period of adolescence, as well as their sensitivity to pubertal hormones, suggest that pubertal maturation could play a role in the development of anhedonia. This review takes a developmental perspective, considering the possibility that anhedonia emerges in the context of pubertal maturation and adolescent development, with childhood adversity and chronic inflammation influencing neural reward systems to accelerate anhedonia's progression. Here, we review the relevant extant literature on the components of this model and suggest directions for future research. [ABSTRACT FROM AUTHOR]

Heart rate (HR) and vagally mediated heart rate variability (HRV) are two distinct biomarkers of cardiac autonomic activity. Decreased cardiac vagal activity (or decreased HRV) in particular has been linked with impairments in the functional flexibility of the central autonomic network (CAN), resulting in impaired stress and emotion regulatory capacities. Decreased HRV is widely used as trait marker of psychopathology. Repetitive engagement in non-suicidal self-injury (NSSI) in adolescence correlates with both deficits in stress and emotion regulation, as well as decreased HRV. Existing research has, however, focused on short-term recordings of HR and HRV under resting and phasic conditions. In this study, we examined whether diurnal variation of cardiac autonomic activity, indexed by cosinor parameters of HR and HRV derived from 48 h of ambulatory ECG recording under natural conditions over a weekend, are altered in female adolescents with NSSI disorder compared to controls (HC; N = 30 per study group). Several important confounds, including physical activity, were controlled for. Female adolescents with NSSI show higher rhythm-adjusted 24 h mean levels and greater respective amplitude of HR, as well as lower rhythm-adjusted 24 h mean levels and smaller respective amplitude of HRV. Peak levels in both HR and HRV in the NSSI group were reached approximately 1 h later compared to HC. Severity of exposure to early life maltreatment might be linked with altered amplitudes of 24 h HR and HRV. Diurnal rhythms of cardiac autonomic activity might hold promise as objective indicators of disordered stress and emotion regulation in developmental psychopathology, and as such should be investigated in future studies with rigorous assessment and control of potential confounds. [ABSTRACT FROM AUTHOR]

An important goal of clinical/developmental research is to identify factors contributing to the onset and maintenance of psychopathology – particularly factors that could be modified through intervention. Large‐scale, multi‐informant, longitudinal studies provide valuable opportunities for testing such etiological hypotheses, as illustrated by Nobakht et al.'s recent six‐wave cohort study spanning ages 4–14. At a within‐person level, emotion regulation (ER) deficits consistently predicted oppositional defiant disorder (ODD) symptoms (including both irritability and defiance), whereas victimization did not. These results comport with growing evidence highlighting ER's centrality to ODD and psychopathology more broadly. While the ER findings carry promising implications, caution is warranted in interpreting the results for victimization given that its association with psychopathology is well‐documented. More research is needed to test precise questions about within‐ and between‐person processes involving ER, victimization, and psychopathology across development. Pressing research questions include whether, how, and when youths' ER can be modified, and with what effects on clinical outcomes. [ABSTRACT FROM AUTHOR]

Affective flexibility is defined as a complex executive function which enables individuals to successfully alternate between distinct emotional and non-emotional features of a given situation in order to attain a specific goal. A large body of research has focused exclusively on flexibility in a non-emotional context, although most of our interactions with our environment are emotionally satiated. Our main aim was to propose a hierarchical framework to describe this construct from a macro-level perspective to a more nuanced and micro-level perspective, including three different levels of affective flexibility: elementary, shifting, and generative. Next, we employed this hierarchical framework to examine the role played by affective flexibility in typical development and different forms of developmental psychopathology. Lastly, we discuss how this knowledge could inform future prevention and intervention programs aimed at reducing cognitive vulnerability to developmental psychopathology.

The ability to cope with threats is crucial in today's troubling times, especially for young people who are still developing coping mechanisms. Psychopathology and the development of anxiety disorders can be viewed as a failure to adapt to changing demands. We draw on a study by Klein et al. (Journal of Child Psychology and Psychiatry, 2023), which showed that anxious youths exhibited stronger conditioned fear responses and, during delayed extinction learning, greater electrocortical differences between threat and safety stimuli. Interestingly, these signatures of learning processes were also associated with treatment outcomes. We argue for developmentally sensitive research: Individual learning and associated cognitive‐affective changes are strongly age‐dependent and represent the key mechanism for both anxiety development and treatment. They also interact with social and environmental factors. Based on the call for age‐ and context‐sensitive research, future research should focus on establishing reliable risk profiles that consider a variety of factors to enable evidence‐based, individualized treatment decisions. [ABSTRACT FROM AUTHOR]

Background: There are very few mechanistic studies of the long‐term impact of psychosocial interventions in childhood. The parent‐mediated Paediatric Autism Communication Therapy (PACT) RCT showed sustained effects on autistic child outcomes from pre‐school to mid‐childhood. We investigated the mechanism by which the PACT intervention achieved these effects. Methods: Of 152 children randomised to receive PACT or treatment as usual between 2 and 5 years of age, 121 (79.6%) were followed 5–6 years after the endpoint at a mean age of 10.5 years. Assessors, blind to the intervention group, measured Autism Diagnostic Observation Scale Calibrated Severity Score (ADOS CSS) for child autistic behaviours and Teacher Vineland (TVABS) for adaptive behaviour in school. Hypothesised mediators were child communication initiations with caregivers in a standard play observation (Dyadic Communication Measure for Autism, DCMA). Hypothesised moderators of mediation were baseline child non‐verbal age equivalent scores (AE), communication and symbolic development (CSBS) and 'insistence on sameness' (IS). Structural equation modelling was used in a repeated measures mediation design. Results: Good model fits were obtained. The treatment effect on child dyadic initiation with the caregiver was sustained through the follow‐up period. Increased child initiation at treatment midpoint mediated the majority (73%) of the treatment effect on follow‐up ADOS CSS. A combination of partial mediation from midpoint child initiations and the direct effect of treatment also contributed to a near‐significant total effect on follow‐up TVABS. No moderation of this mediation was found for AE, CSBS or IS. Conclusions: Early sustained increase in an autistic child's communication initiation with their caregiver is largely responsible for the long‐term effects from PACT therapy on autistic and adaptive behaviour outcomes. This supports the theoretical logic model of PACT therapy but also illuminates fundamental causal processes of social and adaptive development in autism over time: early social engagement in autism can be improved and this can have long‐term generalised outcome effects. [ABSTRACT FROM AUTHOR]

Childhood head injuries and conduct problems increase the risk of aggression and criminality and are well-known correlates. However, the direction and timing of their association and the role of their demographic risk factors remain unclear. This study investigates the bidirectional links between both from 3 to 17 years while revealing common and unique demographic risks. A total of 8,603 participants (50.2% female; 83% White ethnicity) from the Millennium Cohort Study were analysed at 6 timepoints from age 3 to 17. Conduct problems were parent-reported for ages 3 to 17 using the Strengths and Difficulties Questionnaire (SDQ) and head injuries at ages 3 to 14. A cross-lagged path model estimated the longitudinal bidirectional effects between the two whilst salient demographic risks were modelled cumulatively at three ecological levels (child, mother, and household). Conduct problems at age 5 promoted head injuries between 5 and 7 (Z = 0.07; SE = 0.03; 95% CI, 0.02–0.13), and head injuries at ages 7 to 11 promoted conduct problems at age 14 (ß =.0.06; SE =.0.03; 95% CI, 0.01–0.12). Head injuries were associated with direct child-level risk at age 3, whereas conduct problems were associated with direct risks from all ecological levels until 17 years. The findings suggest a sensitive period at 5–11 years for the bidirectional relationship shared between head injuries and conduct problems. They suggest that demographic risks for increased head injuries play an earlier role than they do for conduct problems. Both findings have implications for intervention timing. [ABSTRACT FROM AUTHOR]

The early stages of the COVID-19 pandemic and associated stay-at-home orders resulted in a stark reduction in daily social interactions for children and adolescents. Given that peer relationships are especially important during this developmental stage, it is crucial to understand the impact of the COVID-19 pandemic on social behavior and risk for psychopathology in children and adolescents. In a longitudinal sample (N=224) of children (7-10y) and adolescents (13-15y) assessed at three strategic time points (before the pandemic, during the initial stay-at-home order period, and six months later after the initial stay-at-home order period was lifted), we examine whether certain social factors protect against increases in stress-related psychopathology during the pandemic, controlling for pre-pandemic symptoms. Youth who reported less in-person and digital socialization, greater social isolation, and less social support had worsened psychopathology during the pandemic. Greater social isolation and decreased digital socialization during the pandemic were associated with greater risk for psychopathology after experiencing pandemic-related stressors. In addition, children, but not adolescents, who maintained some in-person socialization were less likely to develop internalizing symptoms following exposure to pandemic-related stressors. We identify social factors that promote well-being and resilience in youth during this societal event. [ABSTRACT FROM AUTHOR]

Introduction: Females are the fastest growing justice involved population in the United States, yet there is relatively little empirical research on the collateral consequences of juvenile justice involvement specifically for females. A growing body of empirical research underscores linkages between juvenile justice involvement and negative health and psychosocial outcomes, both in the short and long term. Method: The current study describes the long-term collateral consequences of juvenile justice involvement for females previously involved in the juvenile justice system, drawing from a longitudinal dataset of 166 women who were initially recruited in adolescence due to chronic and severe justice system involvement. Participants were 15 years-old on average at study enrollment and 35 years-old on average at the current assessment. This paper describes the adolescent and adult experiences of the sample, therefore depicting the developmental trajectories of risk and protective factors for females involved with juvenile justice. Results: As adults, 73% of the sample experienced arrest and 36% experienced incarceration. High rates of mental and physical health problems were reported, including that 50% of the sample met diagnostic criteria for posttraumatic stress disorder. Over 400 children were born to the sample, with high rates of documented intergenerational child welfare involvement. Discussion: Study findings are discussed in the context of best practices for supporting adolescent girls involved with the juvenile justice system. [ABSTRACT FROM AUTHOR]

Many mental disorders are accompanied by distortions in the way the own body is perceived and represented (e.g., eating disorders, body dysmorphic disorder including muscle dysmorphia, or body integrity dysphoria). We are interested in the way these distortions develop and aim at better understanding their role in mental health across the lifespan. For this purpose, we first propose a conceptual framework of body representation that defines this construct and integrates different perspectives (e.g., cognitive neuroscience, clinical psychology) on body representations. The framework consists of a structural and a process model of body representation emphasizing different goals: the structural model aims to support researchers from different disciplines to structure results from studies and help collectively accumulate knowledge about body representations and their role in mental disorders. The process model is reflecting the dynamics during the information processing of body-related stimuli. It aims to serve as a motor for (experimental) study development on how distorted body representations emerge and might be changed. Second, we use this framework to review the normative development of body representations as well as the development of mental disorders that relate to body representations with the aim to further clarify the potential transdiagnostic role of body representations. [ABSTRACT FROM AUTHOR]

Background: Impulsivity is viewed as key to attention‐deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). Yet, to date, no work has provided an item‐level analysis in longitudinal samples across the critical developmental period from childhood into adolescence, despite prior work suggesting items exhibit differential relevance with respect to various types of impairment. The current study conducted a novel longitudinal network analysis of ADHD and oppositional defiant disorder (ODD) symptoms between childhood and adolescence, with the important applied prediction of social skills in adolescence. Methods: Participants were 310 children over‐recruited for clinical ADHD issues followed longitudinally for six years in total with gold standard diagnostic procedures and parent and teacher ratings of symptoms and social outcomes. Results: Findings from baseline, Year 3, and Year 6 suggested Difficulty waiting turn, Blurts, and Interrupts/intrudes were key bridge items across cross‐sectional and longitudinal parent‐reported DBD networks. Furthermore, shortened symptom lists incorporating these symptoms were stronger predictors of teacher‐rated social skills 5 years later compared to total DBD scores. Conclusions: Such findings are consistent with the trait impulsivity theory of DBD and ADHD and may inform useful screening tools and personalized intervention targets for children at risk for DBD during adolescence. [ABSTRACT FROM AUTHOR]

Brain age, a measure of biological aging in the brain, has been linked to psychiatric illness, principally in adult populations. Components of socioeconomic status (SES) associate with differences in brain structure and psychiatric risk across the lifespan. This study aimed to investigate the influence of SES on brain aging in childhood and adolescence, a period of rapid neurodevelopment and peak onset for many psychiatric disorders. We reanalyzed data from the Healthy Brain Network to examine the influence of SES components (occupational prestige, public assistance enrollment, parent education, and household income-to-needs ratio [INR]) on relative brain age (RBA). Analyses included 470 youth (5–17 years; 61.3% men), self-identifying as White (55%), African American (15%), Hispanic (9%), or multiracial (17.2%). Household income was 3.95 ± 2.33 (mean ± SD) times the federal poverty threshold. RBA quantified differences between chronological age and brain age using covariation patterns of morphological features and total volumes. We also examined associations between RBA and psychiatric symptoms (Child Behavior Checklist [CBCL]). Models covaried for sex, scan location, and parent psychiatric diagnoses. In a linear regression, lower RBA is associated with lower parent occupational prestige (p =.01), lower public assistance enrollment (p =.03), and more parent psychiatric diagnoses (p =.01), but not parent education or INR. Lower parent occupational prestige (p =.02) and lower RBA (p =.04) are associated with higher CBCL anxious/depressed scores. Our findings underscore the importance of including SES components in developmental brain research. Delayed brain aging may represent a potential biological pathway from SES to psychiatric risk. Public Significance Statement: The present study suggests that specific components of socioeconomic status (SES), namely lower parent occupational prestige, are associated with delayed brain aging and increased anxiety/depression symptomology in youth. These findings point to age-related processes in the brain as a potential pathway from SES to anxiety/depression, informing future longitudinal research and intervention efforts. [ABSTRACT FROM AUTHOR]

Problems with sleep, emotion regulation, and externalizing psychopathology are interrelated, but little is known about their day-to-day associations in youth. We examined self-reported daily sleep quality as a bidirectional predictor of next-day positive and negative affect (PA/NA), with externalizing symptoms as a moderator. Data were drawn from an ecological momentary assessment (EMA) study involving 82 youths (ages 9–13; 50% female; 44% White, 37% Black/African American) at high (n = 41) or low (n = 41) familial risk for psychopathology. Parents rated youths' externalizing symptoms at baseline. Youths then completed a 9-day EMA protocol, reporting sleep quality 1x/day and affect 4-8x/day. Daily means, peaks, and variability in PA and NA were computed. Multilevel models examined bidirectional associations between sleep and affect (between- and within-person), testing externalizing symptoms as a moderator and controlling for age and sex. In models of sleep predicting affect: Within-person, poorer-than-usual sleep quality predicted greater variability and higher peaks in next-day NA, but only for youth with higher levels of externalizing symptoms. Between-person, poor sleep quality and higher levels of externalizing symptoms predicted lower mean and peak PA. In models of affect predicting sleep: Within-person, lower-than-usual mean PA predicted poorer subsequent sleep quality, but only for youth with higher levels of externalizing symptoms. Between-person, youths with higher mean and peak PA had better sleep quality. These findings suggest that affective functioning is bidirectionally linked to daily self-reported sleep quality among high- and low-risk youth. Specific disturbances in daily sleep-affect cycles may be distinctly associated with externalizing psychopathology. [ABSTRACT FROM AUTHOR]

The increased risk of internalizing and externalizing symptoms in children has been observed in the presence of maternal psychopathology. This study aimed to investigate a potential pathway involving the quality of early interactions between mothers and their children. A sample of 150 mother–child dyads underwent assessment when the children were 3 years old and around the age of 10. Video recordings of feeding exchanges between mothers and children were analyzed to evaluate the quality of mother–child interactions. Maternal psychopathology and child internalizing and externalizing symptoms were measured through self-report and report-form measures completed by mothers. The quality of mother–child feeding interactions at three years of age significantly differentiated (p < 0.001), eight years later, between mothers at high and low psychopathological risk and between children exhibiting clinical and subclinical internalizing symptoms. Clinically relevant child symptoms were notably more prevalent when the mother–child interaction quality at three years of age was maladaptive, particularly in the context of concurrent high maternal psychopathological risk. The study findings underscore the importance of focusing on the early quality of mother–child feeding interactions to identify potential situations of maternal and child clinical risk for the development of psychopathological symptoms and to guide preemptive measures and policies. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to assess the measurement invariance of the 9‐item self‐report Psychotic‐Like Experiences Questionnaire for Children (PLEQ‐C) across various demographic (age, gender, ethnicity) and psychopathology profiles in a community sample of children. Methods: Children aged 9–11 years (n = 613; M age = 10.4 years [SD = 0.8]; 50.9% female) completed questionnaire screening at school, with primary caregivers returning questionnaires by mail from home. Configural, metric, scalar, and residual invariance of the PLEQ‐C scores were investigated across groups differentiated by age (9; 10; 11 years), gender (female; male), ethnicity (white; black; other), and by child‐reported and caregiver‐reported psychopathology (abnormal rating; not abnormal). Results: The PLEQ‐C scores demonstrated good unidimensional model fit. Full configural, metric, scalar, and residual invariance were demonstrated across gender, ethnicity, and psychopathology (both child‐ and caregiver‐reported). Across age groups, the PLEQ‐C scores showed full configural and metric invariance, but only partial scalar and residual invariance (with a single item measuring differently among 11‐year‐olds). Conclusions: In this community sample, the PLEQ‐C was robust to age, gender, ethnicity, and psychopathology profiles, providing evidence of its capacity to identify children in the general population who might benefit from further assessment to determine the clinical significance of their psychotic experiences. [ABSTRACT FROM AUTHOR]

In the United States (U.S.), premature mortality in adulthood from suicide, alcohol-related disease, and substance overdoses has increased steadily over the past two decades. To better understand these trends, it is necessary to first examine the harmful behaviors that often precede these preventable deaths (i.e., suicidal ideation and attempts, and harmful alcohol and substance use). Representing critical developmental periods in which psychopathology is most likely to emerge, childhood and adolescence provide an informative lens through which to investigate susceptibility to harmful behaviors. This article synthesizes current evidence describing these rising U.S. mortality rates and the prevalence rates of harmful behaviors linked to these types of mortality. A brief selective review of longitudinal research on harmful behaviors in relation to the most relevant categories of child and adolescent psychopathology is then provided. Finally, recommendations for future research and implications for prevention are discussed. [ABSTRACT FROM AUTHOR]

The current study investigated the understudied relationship between pubertal timing and borderline personality disorder (BPD) symptoms in males and females. We conducted hierarchical linear regressions in a longitudinal Cohort 1 (N = 117) and a cross-sectional Cohort 2 (N = 127). Cohort 1: Pubertal timing was self-reported at age 10; BPD symptoms and covariates were assessed between ages 13 and 19. Cohort 2: All assessments were between ages 8 and 12. Covariates: race, age, internalizing and externalizing symptoms, and income-to-needs ratio. Sex differences were examined post hoc. In Cohort 1, early gonadal timing was associated with more BPD symptoms in females (beta =.46, p =.002), and late gonadal timing was associated with more BPD symptoms in males (beta = -.23, p =.035). In Cohort 2, early gonadal timing was associated with more BPD symptoms (beta =.21, p =.033) without sex moderation. Results indicate that early gonadal development could be a risk indicator for the emergence of BPD in adolescence, particularly in females, which could inform causal mechanisms and intervention targets. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly impacted the mental health and developmental trajectories of children and adolescents, catalyzing a range of psychological and behavioral issues due to enforced lockdowns and other restrictions. This text explores these impacts through the lens of developmental psychopathology, which integrates clinical psychology and developmental science to examine the emergence and evolution of psychological disorders across a lifespan. This paper highlights how pandemic-related disruptions have exacerbated conditions such as anxiety and depression and, notably, increased childhood obesity due to changes in lifestyle and reductions in physical activity. The analysis includes a discussion of how isolation has not only restricted access to educational and psychological resources but also increased the risk of parental mental illness and related familial stress, thereby intensifying issues of neglect and their consequent impact on child health. By employing a developmental psychopathology framework, this paper argues for the necessity of targeted interventions that address these complex interplays of genetic, environmental, and psychological factors. Such interventions aim to support children through structured educational and health-oriented strategies, ensuring their well-being amidst the ongoing challenges posed by the pandemic. This approach underscores the importance of early, multifaceted strategies involving parents, educators, and healthcare providers to foster healthier developmental outcomes for children facing unprecedented global health crises.

PurposeThe COVID-19 pandemic and efforts to slow the spread of disease have particularly affected the lives of adolescents. Many studies have recently identified the risks to adolescent mental health posed by the COVID-19 pandemic, yet few have identified the markers of resilience to the events and concerns associated with the pandemic's lived experience. This study examined the moderating role of psychosocial resources in the association between the tangible and emotional experiences of the COVID-19 pandemic and symptoms of common psychiatric problems during adolescence (depression, anxiety, proactive and reactive aggression, and sleep problems).MethodsParticipants were adolescents in the United States who were oversampled for early life adversity before the COVID-19 pandemic. The psychosocial resources assessed were humor styles, emotion regulation, social support, optimism, and purpose in life, which have previously been identified as protective in the acute aftermath of stressful events.ResultsGreater COVID-19 impact was associated with more anxiety, depressive symptoms, sleep disturbance, and proactive aggression. COVID-19 impact and psychiatric symptoms were unrelated among youth reporting high self-enhancing humor and cognitive reappraisal.ConclusionsAdolescents high in humor and cognitive reappraisal may be protected against the mental health correlates of the COVID-19 pandemic and other prolonged stressors. Importantly, these factors are known to be modifiable through behavioral interventions. Attention to their effectiveness in prevention and intervention studies is needed as the pandemic continues to exert its impact on individuals and society.

Depression and anxiety disorders are among the most prevalent psychiatric disorders that negatively affect individuals’ life in many ways. Understanding how these highly comorbid emotional disorders develop and persist might guide prevention, intervention, and treatment studies. Some common vulnerability factors underlie depression and anxiety disorders. Developmental psychopathology deals with these vulnerabilities and risk factors from a lifetime perspective. The aim of this review is to present the risk factors associated with depression and anxiety from the perspective of developmental psychopathology. For this purpose, we discussed genetic and biological factors, temperament, negative childhood experiences, family and peer relationships, and some cognitive and emotional factors as risk factors. Also, we discussed how these risk factors lead to depression and anxiety disorders. This review emphasizes that some common transdiagnostic risk factors underlie emotional disorders and highlights the importance of a developmental psychopathology perspective to understand the developmental pathways of depression and anxiety disorders.

Parental representations tend to be formed in the prenatal period and affect the child- parent relationship in the long term. Therefore, in the clinical environment, it is important to define parents’ representations to increase the success of therapeutic interventions and prevent childhood psychopathologies with various intervention programs. With this concern, the aim of this review was to summarize the literature about parental representations and their relationship between parenting behavior, and childhood developmental problems. Related to this purpose, this review includes the definition and categories of parental representations, the factors which contribute to parental representations, and the relations between parenting and childhood developmental problems.

BackgroundInfancy regulatory problems (RP) of sleep, feeding and eating, and excessive crying are thought to play a key role in the development of psychopathology in childhood, but knowledge of the early trajectories is limited.ObjectiveTo explore RP at ages 8–11 months and the associations with mental health problems at 1½ years, and assess the influences of maternal mental health problems and relationship problems.MethodsRP was explored in a nested in-cohort sample (N = 416) drawn from a community-based cohort (N = 2,973). Cohort children were examined by community health nurses, using a mental health screening, which included seven items of RP. Follow-up at 1½ years included diagnostic assessment according to the International Classification of Diseases, ICD-10, and the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood: Revised edition, DC:0-3R. Data analyses included logistic regression models and analyses of the mediation effect of maternal mental health and relationship problems.ResultsRP of sleep were associated with a 2-fold increased risk of child mental disorder specifically sleep disorders, adjusted odds ratio (OR) 9.3 [95% confidence interval (CI): 2.0–42.9], disorders of behavior and emotions, adjusted OR 2.9 (95% CI: 1.0–8.4), and DC:0-3R regulatory disorders, adjusted OR 2.7 (95% CI: 1.0–7.5). Children with RP of feeding and eating showed an increased risk of overall mental disorder, adjusted OR 1.4 (95% CI: 0.7–2.4), and specifically, feeding and eating disorders, adjusted OR 6.0 (95% CI: 1.6–21.7), disorders of behavior and emotions, adjusted OR 2.2 (95% CI: 0.9–5.8), as well as DC:0-3R regulatory disorders, adjusted OR 1.6 (1.0–7.5). RP of emotional regulation were associated with increased risk of any mental disorder, adjusted OR 1.5 (1.0–2.4), and specifically behavioral and emotional disorders, adjusted OR 2.2 (95% CI: 0.9–5.9) and DC:0-3R relationship disorders, adjusted OR 1.8 (95% CI: 0.9–3.8). The mediation effect of maternal mental health problems and relationship problems ranged between 0% and 48%.ConclusionRP at ages 8–11 months is associated with increased risk of ICD-10 and DC:0-3R disorders at 1½ years. Study findings highlight a group of vulnerable infants in need of preventive intervention to break the early trajectories of psychopathology.