In Modern Psychiatry, the issue of continuity and discontinuity of the various psychopathological disorders between childhood and adulthood, i.e. the longitudinal evolution of psychopathology during the life cycle, constitutes an extremely interesting research area. In our effort to understand and deal with the various mental disorders of adulthood, it is considered appropriate to view them as a dynamic continuum of homologue or non-homologue disorders of childhood (homotypic or heterotypic continuity) or to search for their correlations with subclinical characteristics of childhood or even with very early constitutive traits, i.e. temperament. Although Kraepelin noted in 1919 that the information on the overall course of a disorder is at least as important for diagnostic decision-making as the presence of specific behavioural indicators, it took a lot of robust longitudinal studies to highlight the developmental perspective as appropriate, useful and necessary in our concept of a mental disorder.

In that context, we can understand the evolution of a disorder with childhood onset and the way it can
project in adult life, like Autism Spectrum Disorders or Attention Deficit Hyperactivity Disorder. We are identifying the observed differentiations of psychopathology in relation to the life cycle, like in the manifestation of depression in childhood (e.g. somatization) which differs from that of adolescence (e.g. delinquent behavior) or from that in old age (e.g. hypochondrial symptoms). We can also tackle the mechanisms leading in the long term developmental correlation between disorders and symptoms or characteristics of childhood and the mental disorders of adulthood or to the possible discontinuity between them, like in schizophrenia, or in disruptive behaviours and antisocial behaviour. As pointed out by Maughan & Kim-Cohen, we can explore how “the genetic vulnerabilities interact with prenatal or postnatal environmental insults resulting in biological or psychological processes whose effects cumulate across development, or are activated by later developmental challenges”. Thus, the exposure at stress of a brain in the train of shaping and differentiating has mid- and longterm impact upon the mental health of the person. The early psychic trauma that react on the brain during the critical developmental period, with a still immature neocortex and limbic system, renders children more vulnerable than adults to the impact of stress.

The way a certain type of behaviour at an early age switches in a different one in a later age is not clear. In certain cases we can assume a common underline deficit that is simply expressed differently depending on the age. For instance, the switch from early reading difficulties to later spelling ones could reflect the same deficit in written language. The same, but in a lesser extent, applies for the switch from the pre-pubertal anxiety to post-pubertal depression, or from conduct disorder to substance misuse. On the other hand, it is harder to conceptualize the correlation between certain non-specific childhood difficulties, like the impairments in receptive language and motor development, or even the prodromata of adolescence, and the onset of schizophrenia in a later age.

The current issue of "Psychiatriki" comprises the content of the presentations given in the context of a conference under the title: "Psychiatric disorders of childhood and adolescence: Continuities and discontinuities in adulthood" that was organised on the 26/2/2011 from the 2nd Psychiatric Department of Athens University in collaboration with the 1st Psychiatric Department and the Child Psychiatric Department of Athens University. The authors explore the above mentioned concepts in the way these are differentiated in specific disorders, focusing at the relevant findings and studies. This issue aspires to enhance the understanding of psychiatrists for the mental disorders suggesting a dimensional and longitudinal approach. 

Lefteris Lykouras
Professor of Psychiatry,
2nd Department of Psychiatry,
National and Kapodistrian University of Athens,
"Attikon" General Hospital, Athens, Greece
Guest Editor

References

• Hofstra MB, Van der Ende J, Verhulst FC. Continuity and change of psychopathology from childhood into adulthood: a 14-year follow-up study. J Am Acad Child Adolesc Psychiatry 2000, 39:850–858
• Maughan B, Kim-Cohen J. Continuities between childhood and adult life. Br J Psychiatry 2005,187:301–303
• Reef J, van Meurs I, Verhulst FC, van der Ende J. Children’s problems predict adults’ DSM-IV disorders across 24 years. J Am Acad Child Adolesc Psychiatry 2010, 49:1117–1124
• Rutter M, Kim-Cohen J, Maughan B. Continuities and discontinuities in psychopathology between childhood and adult life. J Child Psychol Psychiatry 2006, 47:276–295