by Sky Cardwell, M.S., Pennsylvania State University
As clinical science training models emphasize the importance of integrated clinical research and practice, I believe developmental psychology frameworks should be incorporated. The field of developmental psychopathology seeks to examine the development and maintenance of psychopathologies and the pathways and mechanisms involved in this development (Hinshaw, 2017). Though developmental psychopathology has grown substantially as a field in the past several decades, there still remains a gap between research on the mechanisms involved in the development and maintenance of psychopathologies and applied interventions to treat these psychopathologies (Cicchetti & Toth, 2017). Applying a developmental psychopathology framework to clinical training programs may allow for better integration between research and practice.
Specifically, considering developmental cascade models (see Cox et al., 2010) may provide training clinicians a way to better integrate developmental psychopathology research into their clinical practice. Developmental cascade models conceptualize the cumulative effects of many different factors involved in developmental processes and how these factors interact in developing systems. The models posit that occurrences at one level of developmental systems impact later occurrences and later adaptation (Cox et al., 2010). Each occurrence in a cascade influences the next and is related to individuals’ socio-emotional development throughout their lifespan. However, occurrences in a cascade are not fixed by any one influence, such as genes or environmental input. Rather, the individual and their environment are open to change and reorganization to meet adaptive demands (Cox et al., 2010).
Developmental cascade models could be helpful to training clinicians both in case conceptualization and in clinical practice. These models provide a framework through which clinicians can consider multiple causes for presenting problems developmentally. For example, over half of children referred for intervention present with externalizing behavior problems that may include inattention, hyperactivity, argumentativeness, or oppositionality that are impairing in a child’s daily functioning at home, at school, or with peers (Forgatch & Gewirtz, 2017). Clinicians working with children who display externalizing behavior problems can consider the developmental cascades that contributed to these difficulties. Doing so may facilitate better case conceptualization and thus more targeted treatment. In the case of children’s externalizing behavior problems, the developmental cascade has been theorized to begin prenatally with the transmission of genetic predispositions for affective behavior. These predispositions then influence effects of the caregiving relationship on children’s behavior which can impair independent emotion-regulation abilities in early childhood (Cox et al., 2010) and can underlie externalizing problems (Rattew et al., 2004). In other words, some children are born with higher levels of impulsivity, reactivity, and/or hyperactivity often seen in disruptive behavior problems and this leads to differences in the ways they interact with others and their environment. Using developmental cascade models provides a more developmentally sensitive case conceptualization that considers these multiple contributing factors at play, which can then guide treatment approaches.
Developmental cascade models may also lead to more effective treatment. Following our previous example, Parent Management Training (PMT) is often a first-line treatment for children’s externalizing behaviors. As the treatment’s name suggests, PMT is designed to be delivered to parents of defiant children so that they may implement strategies to change children’s behavior in the home (Kazdin, 2017). Integrating research from developmental cascades of mechanisms that underlie the externalizing behaviors to be treated with PMT may improve treatment outcomes. Once we have a case conceptualization of how a client’s problems came to be, we can use developmental cascade models to consider the factors that contribute to the maintenance of those problems. Parents of children who display externalizing behaviors may be quicker to respond to misbehaviors and exert more control by providing a greater number of reprimands (Laukkanen et al., 2014). High levels of parental psychological and behavioral control has been linked to higher levels of disruptive externalizing behaviors (Cui et al., 2014). Armed with this knowledge, a clinician can better adapt therapeutic interventions like PMT to specifically target how parents respond to their children’s misbehaviors to intervene in the developmental cascade and reduce children’s disruptive behavior problems.
Children’s externalizing problems and treatment with PMT are but one example of how integrating developmental cascade models into clinical training and practice can improve treatment and outcomes. Though much of the research using developmental cascade models focuses on outcomes in childhood, these models can be implemented throughout the lifespan for a range of psychopathology and treatments. Further, developmental cascades can differ between individuals. Applying developmental cascade models to interventions may allow for a more tailored approach with better outcomes for improving individuals’ symptoms and resulting impairment. In order to further advance developmentally informed interventions, it is imperative that researchers and clinicians integrate basic science and applied practice. Indeed, this is the stated mission of clinical science training models. Understanding the mechanisms that underlie therapeutic change allow researchers to improve existing therapies and develop new therapies to better improve client outcomes. Thus, continued integration of developmental psychopathology research into clinical science training and practice can further improve treatment effectiveness and benefit a greater number of individuals.
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References
Cicchetti, D., & Toth, S. L. (2018). Using the science of developmental psychopathology to inform child and adolescent psychotherapy. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 484–500). The Guilford Press.
Cox, M. J., Mills-Koonce, R., Propper, C., & Gariépy, J.-L. (2010). Systems theory and cascades in developmental psychopathology. Development and Psychopathology, 22(3), 497–506. https://doi.org/10.1017/S0954579410000234
Cui, L., Morris, A. S., Criss, M. M., Houltberg, B. J., & Silk, J. S. (2014). Parental psychological control and adolescent adjustment: The role of adolescent emotion regulation. Parenting, 14(1), 47-67.
Forgatch, M. S., & Gewirtz, A. H. (2017). The evolution of the Oregon model of parent management training. Evidence-Based Psychotherapies for Children and Adolescents, 3, 85–102.
Hinshaw, S. P. (2017). Developmental psychopathology as a scientific discipline. Child and Adolescent Psychopathology, 3–32.
Kazdin, A. E. (2017). Parent management training and problem-solving skills training for child and adolescent conduct problems. Evidence-Based Psychotherapies for Children and Adolescents, 142–158.
Laukkanen, J., Ojansuu, U., Tolvanen, A., Alatupa, S., & Aunola, K. (2014). Child’s difficult temperament and mothers’ parenting styles. Journal of Child and Family Studies, 23(2), 312-323.
Rettew, D. C., Copeland, W., Stanger, C., & Hudziak, J. J. (2004). Associations between temperament and DSM-IV externalizing disorders in children and adolescents. Journal of Developmental and Behavioral Pediatrics, 25(6), 383.
Disclaimer: The views and opinions expressed in this newsletter are those of the authors alone and do not necessarily reflect the official policy or position of the Psychological Clinical Science Accreditation System (PCSAS).