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Why Are Children Who Exhibit Psychopathology at High Risk for Psychopathology and Dysfunction in Adulthood?

There is now strong and often replicated evidence from prospective longitudinal studies that psychopathology in childhood and adolescence robustly predicts psychopathology in adulthood.1-4 This evidence suggests a degree of specificity over time, such as childhood conduct disorder predicting adult antisocial personality, but also a considerable degree of heterotypic continuity. That is, one disorder in childhood often predicts other disorders in adulthood. In particular, childhood conduct disorder5 and oppositional defiant disorder nonspecifically predict a broad range of mental disorders in adulthood.6 The study by Copeland et al7 in this issue of JAMA Psychiatry adds to this literature by suggesting that exhibiting a subthreshold or threshold mental disorder at some time from late childhood through adolescence predicts lower levels of adaptive functioning in early adulthood, even when adult mental disorders are controlled. This suggests that even subthreshold child and adolescent disorders predict dysfunction in early adulthood, and do so even beyond the dysfunction associated with mental disorders in adulthood. When considered together, these longitudinal studies1-7 provide cogent information for those who design studies of the causes of psychopathology, make decisions regarding the allocation of limited resources to fund such studies, and make policy decisions regarding funding for the prevention and treatment of psychopathology. After reading these studies, it is very tempting to conclude that the mental health problems that affect adults often arise in childhood and should be treated early to prevent a lifetime of mental health problems and dysfunction. Helping children with impairing and distressing mental health problems is an unquestionable good, but to make the best data-based decisions about the amelioration of mental health problems across the life span, it is important to consider what the findings of these longitudinal studies actually do and do not mean. The theoretical and clinical implications of the strong predictive correlation between child and adult psychopathology are actually not at all clear.4 These findings could mean 1 or more things about the causal links between psychopathology in childhood and psychopathology in adulthood: