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Social environment can interact with genetics and biological risk factors for antisocial behavior in other ways. Studies from several countries have shown that birth complications including anoxia, known to particularly damage the hippocampus interact with negative home environments e.

There is also replicated evidence that an abnormality in the MAOA gene interacts with early child abuse in predisposing to adult antisocial behavior. Social processes can also moderate the biology - antisocial relationship. Reduced prefrontal glucose metabolism particularly predisposes to violence in those from benign home backgrounds.

Low physiological arousal is particularly associated with antisocial behavior in individuals from benign home backgrounds. In these cases, where the individual lacks social risk factors that "push" them towards antisocial behavior, biological factors have a greater explanatory role. Biology is not destiny and it should ultimately be possible to remediate neurobiological risk factors. The fundamental question is: Poor nutrition in the first 3 years of life has been associated with long-term antisocial behavior throughout childhood and late adolescence.

An alternative approach is to remediate the neurotransmitter abnormalities produced by gene abnormalities. Serotonin-related genes regulating serotonin's transportation back to the cell body from the synaptic cleft have recently been linked to antisocial-aggressive behavior in children and adults. Given that antisocial-aggressive individuals have low serotonin, medications which increase the availability of serotonin such as Prozac a selective serotonin reuptake inhibitor ought to lower antisocial behavior if there is a causal connection. There is evidence to support this prediction in both aggressive adults and children.


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Despite this positive evidence, the fact remains that society is reluctant to use medication to treat aggressive and criminal behavior, while at the same time being comfortable in medicating other behavioral conditions. Paradoxically, because the environment influences gene expression, our neurobiological make-up is ever-changing, whether we like it or not.

Should society move towards grasping the biological nettle in order to snuff out crime and violence and reduce suffering? Or should it instead turn a blind eye to new clinical neuroscience knowledge and prohibit tampering with humankind's biological essence, even if this results in lives being lost which could have been saved by biological prevention efforts?

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An additional neuroethical concern is that of responsibility and punishment. Groundbreaking research is elucidating the neural mechanism that subserves moral decision-making. A psychopath may know the legal difference between right and wrong, but do they have the feeling of what is right and wrong? Emotions are believed to be central to moral judgment, and they provide the driving force to act morally. In this context, how moral is it for us to punish many criminals as harshly as we do? On the other hand, are there not significant dangers in loosening our concept of accountability?

The very concept of "from genes to brain to antisocial behavior" raises neuroethical questions that need to be aired in order for prevention science to progress. A new generation of clinical neuroscience research that encapsulates brain imaging and molecular genetics is giving rise to the concept that specific genes result in structural and functional brain impairments that predispose to antisocial, violent, and psychopathic behavior.

The next empirical step is to ascertain whether antisocial, psychopathic individuals evidence abnormal processing of moral dilemmas. How we will deal with this new knowledge at societal and legal levels is a significant neuroethical challenge concerns. The more we learn about the neurobiological causes of crime, the more difficult questions arise concerning culpability, punishment, and freedom of will. The future scientific and neuroethical challenges for the emerging field of neurocriminology can best be met by integrative cross-disciplinary research that bridges traditional macrosocial theories emphasizing broad social constructs with new perspectives from clinical and social neuroscience to better understand, and ultimately prevent, antisocial behavior children and crime in adults.

The new look of behavioral genetics in developmental psychopathology: Gene-environment interplay in antisocial behaviors. Role of genotype in the cycle of violence in maltreated children. MAOA, maltreatment, and gene-environment interaction predicting children's mental health: Neural mechanisms of genetic risk for impulsivity and violence in humans. Raine A, Yang Y. Neural foundations to moral reasoning and antisocial behavior. Soc Cogn Affect Neurosc. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder.

Brain abnormalities in murderers indicated by positron emission tomography. Genetic influences on brain structure. Screening for developmental difficulties through multiple stages of life may be appropriate among children born with obstetric complications or whose family history suggests high risk Brown and Faraone, Data from studies of high-risk groups suggest that nearly all those with affected family members who later have a diagnosis of schizophrenia had attention problems in childhood as well as diagnoses and difficulties in meeting the important task demands at successive stages of life Mirsky, Yardley, et al.

Identification of the prodromal stage of schizophrenia may present an opportunity to intervene McFarlane, Indeed, there are a number of trials currently under way that use low-dose atypical antipsychotics, often in combination with family-focused psychosocial interventions, to prevent the onset of a first episode of psychosis in adolescents and young adults with prodromal symptoms see Chapter 7.

Another promising line of research involves identification and potential intervention among youth and young adults who have underlying signs and symptoms suggesting a genetic liability for schizophrenia without full manifestation of symptoms. Such a constellation of negative symptoms and neuropsychological deficits is common among unaffected first-degree relatives of those with schizophrenia Faraone, Biederman, et al.

Particularly relevant for prevention is some evidence that schizotaxia symptoms among adults are ameliorated with low-dose resperidone Tsuang and Faraone, Despite major challenges in nosology and ethical considerations regarding labeling and intervention among young people, this line of research holds promise as a strategy for preventing schizophrenia. Substance abuse and dependence tend to emerge in mid-to-late adolescence and to be more common among boys.

Substance abuse is greater among young people who experience early puberty, particularly among girls. It is widely accepted that children of drug and alcohol abusers are more likely to develop substance abuse problems Mayes and Suchman, ; Hawkins, Catalano, and Miller, Considerable evidence supports that a genetic vulnerability to abuse may be conferred at birth, and that this vulnerability may be most significant in relation to the transition from drug use to dependence later in life Mayes and Suchman, During childhood, risk for substance abuse is higher for those who have a difficult temperament, poor self-regulatory skills, are sensation seeking, are impulsive, and do not tend to avoid harm.

Children who have early persistent behavior problems are also more likely to develop a substance use problem Hawkins, Catalano, and Miller, Furthermore, substance abuse is also often comorbid with anxiety, depression, and attention deficit hyperactivity disorder Mayes and Suchman, ; Hawkins, Catalano, and Miller, ; Sher, Grekin, and Williams, Evidence suggests that parents who form warm, nonconflictual relationships with their children, provide adequate monitoring and supervision, and do not provide models of drug use help protect their children from developing substance use disorders.

Children who associate with deviant or drug-using peers or who are rejected by peers are more likely to develop substance use problems Mayes and Suchman, ; Hawkins, Catalano, and Miller, ; Sher, Grekin, and Williams, Peers create norms and opportunities for substance use Mayes and Suchman, ; Hawkins, Catalano, and Miller, ; Sher, Grekin, and Williams, and influence attitudes toward substance use. Children and adolescents who have a low commitment to school Hawkins, Catalano, and Miller, or experience school failure are more likely to abuse substances.

And healthy peer groups and school engagement appear to be protective. Children and adolescents with more access and availability to alcohol and drugs are more likely to use them Mayes and Suchman, ; Hawkins, Catalano, and Miller, There is also evidence that child and adolescent substance use is affected by societal norms about use. Adolescent use of coping strategies involving behavioral disengagement, tendency toward negative emotionality, conduct disorder, and antisocial behavior increase the risk for substance abuse.

For both children and adolescents, early drug use predicts later drug use. In young adulthood, different risk factors appear to represent different pathways to substance abuse. There is consistent evidence of elevated substance abuse, particularly of alcohol, among those attending college, the same group that had lower use in adolescence Brown, Wang, and Sandler, For those who do not attend college, antisocial behavior and lack of commitment to conventional adult roles appear to be pathways to abuse.

Although not all those who drink in their youth develop substance abuse or substance dependence, underage drinking has received significant public health attention, given the prevalence of drinking among those under the legal drinking age, problematic drinking patterns, and their deleterious effects. A brief discussion of factors related to underage drinking provides an illustration of the developmental aspects of a problem behavior of significant public health concern and similarities with the trajectory of some MEB disorders.

The likelihood of serious alcohol dependence as an adult is greatly increased the earlier that young people start drinking Grant and Dawson, ; Gruber, DiClemente, et al. Almost one-third of young people between the ages of 12 and 20 report recent drinking, with the majority engaging in binge drinking five or more drinks , when they drink. Although at lower rates than those in older age groups, drinking is reported by youth as young as age 12, with patterns of heavy drinking increasing with age National Research Council and Institute of Medicine, b.

After age 25, rates of overall drinking, as well as rates of frequent and heavy drinking, steadily decline. Alcohol use by children and adolescents is influenced over the developmental course by genetics, family, peers, neighborhood, and broader social contexts through norm development, alcohol expectancies, and availability see the review by Zucker, Donovan, et al. Risks are apparent as early as ages 3 to 5 years, when children develop the understanding that adults drink alcoholic beverages and learn norms about its use e. This may occur because parents model drinking and help children develop positive expectancies about the effects of alcohol.

Children are also exposed to positive images of alcohol use from television and movies. Among adolescents, positive alcohol expectancies are related to initiation of alcohol use. As children grow older, peer influences become stronger. Peers provide opportunities for modeling of and encouragement for alcohol use. Media and peer culture depicts drinking as a positive part of social life.

Adolescents who associate with alcohol-using peers encourage continual use and can be resistant to change. Public policy in the form of drinking-age laws and their enforcement also influences alcohol use. Lowering the drinking age is associated with increases in teen drunk driving and teen traffic fatalities, while raising it is associated with less teen drunk driving Wagenaar and Toomey, ; National Research Council and Institute of Medicine, b. A higher drinking age and its enforcement may decrease underage drinking because it limits access to alcohol, but also by communicating social norms against drinking generally and underage drinking specifically Hawkins, Catalano, and Miller, In addition, alcohol consumption decreases with price increases from taxation, particularly among young people with less disposable income Coate and Grossman, ; National Research Council and Institute of Medicine, b.

The risk factors for underage drinking suggest that prevention efforts can be formulated to influence the availability of alcohol, norms about alcohol, and alcohol use expectancies. Limiting media exposure of even young children may decrease normative perceptions of drinking and decrease the development of positive alcohol expectancies National Research Council and Institute of Medicine, b. Within the family, interventions may be designed particularly around limiting exposure to models of excessive drinking in the home, at family events, and through media sources.

Family-based efforts may also target adolescents by monitoring exposure to alcohol-using peers and involvement in alcohol-related activities. Some risk and protective factors are associated with a broad spectrum of MEB disorders and related problem behaviors for young people, either directly or indirectly through their influence on other risk or protective factors.

As a result, preventive strategies may be aimed at these especially important risk and protective factors rather than at specific disorders. Biglan, Brennan, and colleagues spell out the implications of common and linked risk factors for prevention. First, with common risk factors for multiple problems, intervening in any single risk factor should contribute to preventing multiple outcomes, including externalizing problems, sexual activity, substance use, and academic failure. Second, with multiple risk factors across the developmental course, there should be multiple plausible routes to prevention.

Third, with developmentally early risk factors influencing later ones, preventive interventions should be timed to protect against developmentally salient risk factors. Poverty, family dysfunction and disruption, and factors associated with school and the community are particularly illustrative. Negative life events at the family, school or peer, and community levels have been associated with multiple psychopathological conditions, such as anxiety, depression, and disruptive disorders see Craske and Zucker, ; La Greca and Silverman, Similarly, social support and problem-solving coping appear to have broad protective effects e.

Studies using nationally representative samples and studies of diverse ethnic, gender, and age groups have found that behavior problems involving serious antisocial behavior, substance use cigarettes, alcohol, drugs , and risky sexual behavior have common risk and protective factors across developmental stages and across multiple levels of the social ecology, including individual genetic factors, dysfunctional parent-child interactions, and poverty. They also often occur together in adolescence Biglan, Brennan, et al. There appears to be an interrelated set of developmental factors in which earlier risk or protective factors increase the likelihood of later ones and in which earlier manifestations of problem behaviors increase the likelihood of later risk factors and problem behaviors Biglan, Brennan, et al.

Furthermore, early developmental tasks result in developmental competencies during childhood e. For example, difficult temperament, which is biologically determined, affects the parenting an infant receives, which in turn affects development of early attachment. Under one model of the development of a set of problem behaviors—antisocial behavior, high-risk sex, academic failure, and substance use—early family conflict was found to lead to poor family involvement, which later leads to poor parental monitoring and associating with deviant peers Ary, Duncan, et al.


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  7. Both poor monitoring and association with deviant peers lead to higher levels of problem behaviors. A multiyear retrospective study of the effects of adverse childhood experiences or childhood trauma psychological, physical, or sexual abuse, witnessing violence against the mother, living with household members who were substance abusers, mentally ill or suicidal, or incarcerated identified strong graded relationships between these experiences and a range of negative outcomes in adulthood.

    Adult outcomes associated with these childhood experiences included alcoholism and alcohol abuse, depression, drug abuse, and suicide attempts. The likelihood of multiple health risk factors in adulthood were greater when multiple types of negative childhood exposures were experienced Felitti, Anda, et al. An analysis specific to mental health outcomes identified a significant relationship between an emotionally abusive family environment and the level of adverse experience with negative mental health outcomes Edwards, Holden, et al.

    By whatever index used, poverty is a highly prevalent risk factor for children in the United States.

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    In , 18 percent of all U. However, this measure does not fully capture the proportion of families who do not have sufficient resources to meet their basic needs for housing, child care, food, transportation, health care, miscellaneous expenses, and taxes. The Economic Policy Institute estimated that more than 2. Families who live in poverty or near poverty continually need to make trade-offs between necessities.

    For example, 65 percent of families with household incomes between and percent of the federal poverty line experienced at least one serious hardship during the prior year, including food insecurity, lack of health insurance, or lack of adequate child care Boushey, Brocht, et al. Poverty is a risk factor for several MEB disorders and is associated with other developmental challenges. Poor children show difficulties with aspects of social competence, including self-regulation and impulsivity Takeuchi, Williams, and Adair, , and abilities associated with social-emotional competence Eisenberg, Fabes, et al.

    Prevention of mental and behavioural disorders: implications for policy and practice

    Furthermore, poverty has been found to be associated with a wide range of problems in physical health, including low birth weight, asthma, lead poisoning, and accidents, as well as cognitive development. Poor children are also more likely to experience developmental delays, lower IQ, and school failure Gershoff, ; Brooks-Gunn and Duncan, Gershoff, Aber, and Raver describe three pathways by which poverty affects child development. With the parent behavior and stress pathway, the parents are considered to be under high levels of stress because of their economic difficulties and the occurrence of stressful life events for which they have insufficient resources to cope effectively.

    Parental stress leads to increased levels of parental depression and interparental conflict, which in turn lead to problems in parenting, including withdrawal from the children, hostility, more frequent use of corporal punishment, and at extreme levels maltreatment. Each of these factors has been found to relate to higher levels of internalizing and externalizing problems in children.

    The third pathway involves the neighborhood and community in which poor families are more likely to live. Poor neighborhoods and schools are less likely to have the resources that promote healthy child development and are more likely to be settings that expose children to additional risk factors, such as violence and the availability of drugs and alcohol. Disentangling the effects of the neighborhood and the family is difficult, but there is evidence that many of the factors associated with poor neighborhoods and schools are associated with multiple mental, emotional, and behavioral problems for children Gershoff and Aber, More research is needed to tease out these effects and, most importantly, to identify factors that may protect children from the negative effects of living in high-poverty neighborhoods Roosa, Jones, et al.

    Gershoff, Aber, and Raver also describe policy- and program-level interventions that may be effective in reducing the negative effects of poverty on children. Their model illustrates interventions to change each of the pathways that lead to adverse outcomes. Income support programs, such as the Earned Income Tax Credit and the Child Support Enforcement Program, are designed to increase the economic self-sufficiency of families.

    Programs also offer in-kind support, including supplemental child nutrition e. Two-generation programs are designed with multiple components to assist both parents and children. For example, Early Head Start focuses on improving child development, family development, and staff and community development.

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    Finally, child-directed programs include providing additional funds for high-poverty schools and for after-school programs in poor neighborhoods. A natural experiment found that increases in family income and income-related resources were followed by a reduction in both psychiatric and behavioral symptoms in children Costello, Compton, et al. Family Dysfunction and Disruption. With the family as the primary setting for child development from birth through childhood and adolescence, it is not surprising that dysfunction in family relations, particularly parent—child relations, is associated with multiple mental, emotional, and behavioral problems, including those described above.

    Many risk factors e. The discussion here focuses on two broad categories of risk factors that are related to dysfunctional family relations and that provide opportunities for preventive intervention: Maltreatment of children by primary caregivers is one of the most potent risk factors for mental, emotional, and behavioral problems, and it has been found to be associated with other serious risk factors, such as poverty and parental mental illness.

    The prevalence of child maltreatment in the United States is unclear. One estimate places it at 1. Hussey, Chang, and Kotch report that In the National Longitudinal Study of Adolescent Health Add Health , which includes a nationally representative sample of adolescents, each form of maltreatment was associated with multiple health problems, including depression, substance use, violence, obesity, and poor physical health Hussey, Chang, and Kotch, The majority of these associations remained significant after controlling for such demographic variables as family income, age, gender, ethnicity, parent education, region, and immigrant generation Hussey, Chang, and Kotch, In a recent empirical examination in the National Comorbidity Study Molnar, Buka, and Kessler, , one of the largest and most methodologically sound studies, childhood sexual abuse was reported by Significant associations were found with 14 mood, anxiety, and substance abuse disorders among women and 5 disorders among men.

    The analysis controlled for other adversities, including divorced parents, parental psychopathology, parental verbal and physical abuse, parental substance use problems, and having dependents for women. The lifetime rate of depression was Rates of dysthymia, mania, and posttraumatic stress disorder were also significantly higher for sexually abused women but not for men. The impact of childhood sexual abuse was especially strong for those who had no other adversities; their odds for depression were 3.

    For those who reported 5 or more adversities, the odds of depression were 1. There was some evidence that chronic sexual abuse led to higher rates of some disorders Molnar, Buka, and Kessler, Parental psychopathology, especially among mothers, was the most significant family adversity associated with abuse Molnar, Buka, and Kessler, and warrants further investigation.

    However, finding high rates of disorder with abuse but no other risk factors emphasizes the importance of the negative effects of abuse. The persistence of negative effects of child maltreatment is seen in studies that assess functioning across periods of development. For example, the Virginia Longitudinal Study of Child Maltreatment found that of maltreated children who were followed from middle childhood through early adolescence, fewer that 5 percent were functioning well consistently over time Bolger and Patterson, Understanding the factors that influence the linkage between child maltreatment and problem outcomes starts by distinguishing different levels of abuse.

    In particular, abuse that starts early and is chronic is linked with pervasive and persistent problems across domains of functioning. Children abused in infancy show difficulties in areas that include affect regulation e. The most effective approach to reducing the effects of maltreatment is to prevent its occurrence.

    Because of the pervasive mental, emotional, and behavioral problems for which maltreated children are at risk, programs that prevent abuse have the potential to avert multiple disorders and promote healthy development across multiple domains of functioning. There is evidence, for example, that a home visiting program for economically poor, single parents has been effective in reducing the occurrence of child abuse Olds, ; see Box and that a population-level approach to strengthening parenting reduces rates of abuse in the community Prinz, Sanders, et al. Interventions are also aimed at mitigating the impact of abuse after it has occurred.

    Several randomized trials with maltreated children demonstrated that infant and preschool psychotherapy and a home visiting program were successful in markedly reducing rates of insecure attachment Ialongo, Rogosch, et al. Family disruption can occur for many reasons, including separation or divorce, the death of a parent, and incarceration of a parent. The committee focused on parental divorce and bereavement because they have been the subject both of considerable research and of preventive trials.

    The rate of divorce in the United States increased from the s through the s and then stabilized or decreased somewhat over the following decades Bramlett and Mosher, ; U. However, the official divorce rate underestimates the rate of marital disruption, which may occur as separations that do not become divorces or as disruptions of households with unmarried parents Bramlett and Mosher, It is estimated that 34 percent of children in the United States will experience parental divorce before reaching age 16 Bumpass and Lu, Children can experience a wide range of other stressors following divorce, such as loss of time with one or more parents, continuing interparental conflict, and parental depression Amato, Evidence suggests that effective child coping or interpretation of these stressors, quality of parenting received from both parents, and level of interparental conflict is related to postdivorce adjustment e.

    Death of a parent i. Social Security Administration, The effect of parental death on surviving children rises to national concern particularly when rates increase due to such national disasters as the terrorist attacks of September 11, , war, and such epidemics as HIV. Following parental divorce, children are at increased risk for multiple mental, emotional, and behavioral problems, including physical health problems, elevated levels of alcohol and drug use, premarital childbearing, receiving mental health services, and dropping out of school Troxel and Matthews, ; Furstenberg and Teitler, ; Hoffmann and Johnson, ; Goldscheider and Goldscheider, ; Hetherington, Meta-analyses of studies conducted through the s have shown that problems have not decreased Amato and Keith, a ; Amato, Adults who were exposed to parental divorce as children have been found to be more likely to divorce and to have an increased risk for mental, emotional, and behavioral problems, including clinical levels of mental health problems, substance abuse, and mental health service use Chase-Lansdale, Cherlin, and Kiernan, ; Kessler, Davis, and Kindler, ; Maekikyroe, Sauvola, et al.

    Children who experience parental bereavement appear more likely to experience mental, emotional, and behavioral problems, such as depression, posttraumatic stress disorder, and elevated mental health problems for up to two years following the death Worden and Silverman, ; Geresten, Beals, and Kallgren, These risks appear to remain after controlling for other risk factors, such as mental disorder of the deceased parent Melhem, Walker, et al.

    Research has shown mixed findings concerning the mental, emotional, and behavioral problems of bereaved children when they reach adulthood Kessler, Davis, and Kindler, However, two prospective longitudinal studies supported increased risk of depression in adult women who experienced parental bereavement as children Reinherz, Giaconia, et al.

    Although family disruption is associated with multiple MEB disorders and problems, the majority of children who experience these major stress-ors adapt well. The most consistent predictive factors are interparental conflict and the quality of parenting by both the mother and the father Kelly and Emery, ; Amato and Keith, b. Parent—child relations that are characterized by warmth, positive communication and supportiveness, and high levels of consistent and appropriate discipline have consistently been related to better outcomes following divorce Kelly and Emery, ; Amato and Keith, b.

    High-quality parenting from both the custodial parent usually the mother and the noncustodial parent usually the father is related to lower levels of child internalizing and externalizing problems King and Sobolewski, But interparental conflict is one of the most damaging stressors for children from divorced families. Conflict often precedes the divorce and is associated with lasting child problems following the divorce Block, Block, and Gjerde, In some families, conflict continues long after divorce, which is particularly destructive when children are caught in the middle Buchanan, Maccoby, and Dornbusch, Recent research has found that high-quality parenting from both parents related to lower child mental health problems even in the presence of high interparental conflict Sandler, Miles, et al.

    Several factors have been found to influence outcomes for children who experience parental bereavement. Among parentally bereaved children who had signed up for an intervention program, four factors distinguished bereaved children who had clinical levels of mental health problems from those who did not: An interesting focus of research has investigated the pathways that lead from family disruption due to divorce or bereavement, along with other commonly co-occurring biological and social risk factors, to adult depression.

    One analysis of longitudinal data on female twins, siblings, and unrelated women found support for three pathways to the development of depression Kendler, Gardner, and Prescott, In an internalizing pathway, genetic risk leads to neuroticism, which in turn leads to early-onset anxiety disorder, and these three influences each lead to episodes of major depression. In an externalizing pathway, conduct disorder and substance misuse lead to depressive disorder. In an adversity pathway, early childhood exposure to a disturbed family environment, childhood sexual abuse, and parental loss lead to low educational attainment, lifetime trauma, and low social support, which in turn lead to four adult risk factors marital problems, difficulties in the past year, dependent stressful events, and independent stressful events , which in turn lead to an episode of major depression.

    All three pathways include contributions from genetic factors and interconnections among family adversity, externalizing problems, and later adult adversities. A prospective longitudinal study, the National Collaborative Perinatal project, also considered timing in an examination of the association between family disruption divorce or separation before age 7 , low socioeconomic status, and residential instability and the onset of adult depression Gilman, Kawachi, et al.

    The effect of low socioeconomic status in childhood on depression risk persisted into adulthood, but the effects of family disruption and residential instability were specific to early-onset depression. Early-onset depression is of special concern because it carries with it a poorer prognosis of increased recurrence and, in some studies, more severe depressions.

    Most prevention research has focused on risk and protective factors at the level of the individual and the family, but there is increasing recognition that child development is powerfully affected by the broader social contexts of schools and communities Boyce, Frank, et al. Risk factors, such as victimization, bullying, academic failure, association with deviant peers, norms and laws favoring antisocial behavior, violence, and substance use, are linked primarily with neighborhoods and schools. For example, poor and ethnic minority children in particular are frequently exposed to violence in their neighborhoods and schools.

    Among low-income, primarily minority adolescents in New York City in —, rates of exposure to violence of various kinds were high: Many also reported being the victim of violent acts, such as being asked to sell or use drugs 35 percent , having their home broken into 18 percent , being beaten up 13 percent , and being threatened with death 9 percent.

    Much of the exposure to violence occurs either at school or on the way to school DeVoe, Peter, et al. A reciprocal relation exists between academic achievement and mental health outcomes, in which mental health problems adversely affect academic achievement Adelman and Taylor, , and poor academic achievement is related to the development of multiple problem behaviors e. The growing empirical research on characteristics of neighborhoods and schools that are linked with problem development as well as positive youth development has implications for the development and evaluation of prevention and promotion interventions.

    Gershoff, Aber, and Raver propose that another dimension of schools and neighborhoods that may affect the development of child mental, emotional, and behavioral problems is the degree to which they provide settings that support healthy development. They characterize neighborhood disadvantage as the absence of settings that provide opportunities for healthy child development—settings for learning e. For schools, disadvantage can be assessed as lower per student spending, a high percentage of children from families in poverty, a higher number of inexperienced and academically unprepared teachers, a high student-to-teacher ratio, and school size being either too large or too small.

    Each of these characteristics of neighborhoods and schools has been linked with mental, emotional, and behavioral problems of children. Although it is difficult to disentangle the causal effects of neighborhood and school disadvantage from the effects of factors in families and children who live in disadvantaged neighborhoods, research has found that neighborhood disadvantage was associated with higher internalizing and externalizing problems over and above the genetic contribution Caspi, Taylor, et al.

    Similarly, the strongest environmental association related to schizophrenia is urbanicity Krabbendam and van Os, , although the relation with social class is also strong. It appears that living in urban environments during childhood affects later development of schizophrenia, even if there is a move to less urban environments later in life Pederson and Mortensen, There are a few hypotheses that are being pursued to explain this relationship, including increased stress and discrimination against minorities, lack of social capital and other resources in impoverished communities, and gene—environment interactions.

    Another way in which the community influences child development is through the norms, values, and beliefs of the residents. Peer norms favoring the use of drugs, antisocial behavior, or belonging to gangs are also powerful neighborhood factors that contribute to problem behaviors. Hawkins and Catalano proposed the construct of bonding to school, community, and family as key in explaining the development of substance use and antisocial behavior. Positive bonds consist of a positive relationship, commitment, and belief about what is healthy and ethical behavior.

    Positive bonds to a group develop from having the opportunity to be an active contributor, having the skills to be successful, and receiving recognition and reinforcement for their behavior. For example, aggregate-level student-perceived norms favoring substance use, violence, or academic achievement are related to antisocial behavior. For boys with elevated levels of externalizing problems, being in a first grade classroom with high aggregate levels of behavior problems has been found to be associated with a marked increase in the odds of having serious externalizing problems when they reached the sixth grade Kellam, Ling, et al.

    But some teacher characteristics are related to lower levels of mental, emotional, and behavioral problems for students. These include using classroom management strategies with a low level of aggressive behavior, having high expectations for students, and having supportive relations with students.

    For example, use of a group contingency to promote prosocial behavior in first grade students has been found to reduce aggressive behavior in first grade Dolan, Kellam, et al. The effects persisted with a reduction 13 years later in the rate of diagnosis of alcohol and illicit drug abuse or dependence Kellam, Brown, et al.

    Also, for the subgroup of boys who started first grade with high levels of aggressive behavior, this intervention reduced the rate of antisocial personality disorder Petras, Kellam, et al. Structural and policy changes can reduce risk associated with the transition to senior high school Seidman, Aber, and French, This transition is associated with a decline in academic performance as well as an increase in delinquency, depression, suicidal thoughts, and substance use. However, policy changes, such as reduced school size, that create smaller working units with more supportive relations with teachers and peers have been shown to reduce this risk Felner, Brand, et al.

    A voluminous literature has emerged since the IOM report on the factors associated with MEB disorders in young people, with a consensus that these factors operate at multiple interrelated levels. Factors both specific to a given disorder and that provide a more generalized risk for multiple disorders provide important opportunities for the development of interventions that modify these factors and explore possible mediating mechanisms.

    Research has identified well-established risk and protective factors for MEB disorders at the individual, family, school, and community levels that are targets for preventive interventions. However, the pathways by which these factors influence each other to lead to the development of disorders are not well understood. Specific risk and protective factors have been identified for many of the major disorders, such as specific thinking and behavioral patterns for depression or cognitive deficits for schizophrenia.

    In addition, nonspecific factors, such as poverty and aversive experiences in families e. A more recent science base has solidified around the concept of developmental competencies that could inform the development of future interventions focused on the promotion of mental, emotional, and behavioral health.

    However, improved knowledge pertaining to the conceptualization and assessment of developmental competencies is needed to better inform interventions. The ways in which developmental competencies operate in a health-promoting capacity is less well understood, and additional research is needed to develop common measures that can be used in intervention research.

    Research funders led by the National Institutes of Health, should increase funding for research on the etiology and development of competencies and healthy functioning of young people, as well as how healthy functioning protects against the development of MEB disorders. The National Institutes of Health should develop measures of developmental competencies and positive mental health across developmental stages that are comparable to measures used for MEB disorders. These measures should be developed in consultation with leading research and other key stakeholders and routinely used in mental health promotion intervention studies.


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    Current knowledge on the development of MEB disorders among young people and characteristics of healthy development suggest the need for multiple lines of inquiry for future preventive intervention research. Research funders should fund preventive intervention research on 1 risk and protective factors for specific disorders; 2 risk and protective factors that lead to multiple mental, emotional, and behavioral problems and disorders; and 3 promotion of individual, family, school, and community competencies.

    Includes intermittent explosive disorder, oppositional defiant disorder, conduct disorder, and attention deficit hyperactivity disorder. This appendix is available only online. Turn recording back on. National Center for Biotechnology Information , U.

    Age-Related Patterns of Competence and Disorder Understanding the age-related patterns of disorder and competence is essential for developing interventions for prevention and promotion. Multiple Contexts Development occurs in nested contexts of family, school, neighborhood, and the larger culture Bronfenbrenner, Developmental Tasks Individuals encounter specific expectations for behavior in a given social context. Interactions Among Biological, Psychological, and Social Factors How young people develop—whether they develop mental, emotional, or behavioral problems or experience healthy development—is a function of complex interactions among genetic and other biological processes discussed in more detail in Chapter 5 , individual psychological processes, and multiple levels of social contexts.

    Characteristics of Healthy Development Although there are no universally accepted taxonomy or agreed-on measures of positive mental health, several groups have attempted to integrate research and theory on healthy development at different developmental stages. Defining Risk and Protective Factors Kraemer, Kazdin, and colleagues define a risk factor as a measurable characteristic of a subject that precedes and is associated with an outcome. Considering Risk and Protective Factors in the Design and Evaluation of Preventive Interventions Over the past several decades a voluminous literature has emerged on risk and protective factors associated with specific disorders e.

    Risk and Protective Factors Can Be Found in Multiple Contexts One of the earliest and most replicated findings from the empirical literature is that risk and protective factors are found at multiple levels of the social ecology, or the relationship between humans and their environments, from biological and psychological characteristics of the individual to the family and the community Rutter, ; Werner and Smith, , ; Luthar, ; Crews, Bender, et al.

    Risk and Protective Factors Tend to Be Correlated and to Have Cumulative Effects Risk factors tend to be positively correlated with each other and negatively correlated with protective factors. Risk and Protective Factors Influence Each Other and Mental, Emotional, and Behavioral Disorders Over Time Research in developmental psychopathology Cichetti and Toth, ; Masten, and resilience Luthar, has described multiple models—main effect, moderational, and mediational models—by which risk and protective factors influence each other and the development of emotional and behavior problems over time.

    Targeting Specific Disorders Disorder-specific risk factors are often identified on the basis of assessment of elevated but subclinical levels of the disorder or prodromal indicators of the disorder, particularly at a developmental stage at which risk for the onset of the disorder is elevated. Depression The incidence of depression is rare in children through age 6 and low prior to puberty; it increases as young people reach adolescence, with 5 percent of adolescents in a given year experiencing clinical depression and as many as 20 percent having had a clinical episode sometime during their adolescence, rates similar to those found in young adults Angold and Costello, Schizophrenia The diagnostic criteria for schizophrenia and other psychotic disorders in the schizophrenia spectrum are undergoing reexamination and revision Tsuang and Faraone, , but the current diagnostic measurements have sufficient reliability to permit a clear study of risk factors and the developmental course.

    Substance Abuse Substance abuse and dependence tend to emerge in mid-to-late adolescence and to be more common among boys.