Continuity of Psychopathology Throughout Adolescence and Young Adulthood

Abstract

Objective This study tested two opposing hypotheses on the continuity of psychopathology throughout adolescence and young adulthood; differentiation versus dynamic mutualism. Differentiation predicts that co-occurrence decreases, while dynamic mutualism predicts that co-occurrence increases due to causal interactions amongst mental health problems. Method Using data from the Dutch TRacking Adolescents’ Individual Lives Survey (n = 2228, 51% female), we studied the development of self-reported internalizing, externalizing, and attention problems at ages 11 to 26 across six waves. Random-intercept cross-lagged panel modeling was employed to distinguish within-person development from stable between-person processes. Results Large stable between-person associations indicated that adolescents with internalizing problems tended to have both externalizing and attention problems as well. On a within-person level, mental health problems showed partial stability and strong cross-sectional co-occurrence. Within-wave associations of internalizing with externalizing or attention problems decreased between age 11 and 16 years, after which they increased again. Little heterotypic continuity was found: age 11 externalizing predicted age 13 attention, which in turn predicted age 16 externalizing problems, and internalizing predicted externalizing problems across ages 22 to 26. Findings were similar for males and females. Conclusions Our findings suggest co-occurrence decreases during early and middle adolescence, supporting differentiation. While co-occurrence increased again into young adulthood, this could not be labeled as dynamic mutualism because little evidence for heterotypic continuity was found in this phase of life. The strong stable links between internalizing, externalizing, and attention problems stress the importance of targeting these mental health problems and their shared risk factors together.

Developmental co‐occurrence of psychopathology dimensions in childhood

“…Finally, within-person associations of externalizing on attention problems from age 7 to age 9-10 were evident in both cohorts, providing converging evidence with previous work employing a genetically sensitive design (Kuja-Halkola et al, 2015). This relationship was also evident in later adolescence in TEDS, consistent with work jointly analysing internalizing, externalizing and attention problems (Richards et al, 2022), from adolescence through early adulthood. It is of note, however, that this relationship disappeared in early adulthood in this previous recount.…”

“…These conflicting results might, partly, be a result of the developmental timeframe considered in the different studies. However, as noted earlier in the introduction and pointed out elsewhere (Richards et al, 2022), methodological differences between these studies make it challenging to draw conclusions in this regard. For example, previous studies mostly looked at bivariate relationships between psychopathologies, or concurrently estimated effects of different developmental traits, while here we jointly estimate effects between four different psychopathologies.…”

“…Previous work attempting to separate within-and between-level processes of psychopathology has focused on the bidirectional relationship between externalizing and internalizing behavior, (Oh et al, 2020, Murray et al, 2020, externalizing and internalizing together with IQ (Flouri et al, 2019), anxiety and ADHD (Murray et al, 2022), and more recently between internalizing, externalizing, and attention problems (Richards et al, 2022).…”

Reexamining Developmental Continuity and Discontinuity in the 21st Century: Better Aligning Behaviors, Functions, and Mechanisms

“…Most studies asserting heterotypic continuity find a predictive association of one behavior or syndrome at T1 in predicting another behavior or syndrome at T2 (e.g., Ferdinand et al, 2007;Lahey et al, 2014;Lavigne et al, 2014;Miller et al, 2009;Nagin & Tremblay, 2001;Putnam et al, 2008;Richards et al, 2022;Shevlin et al, 2017;Snyder et al, 2017;Wichstrøm et al, 2017).…”

Annual Research Review: Stability of psychopathology: lessons learned from longitudinal population surveys

“…Several studies suggest that rank‐order homotypic and heterotypic stability increases with age. For instance, reported homotypic stability estimates rose from .19 (internalizing problems) and .53 (externalizing problems) between ages 5 and 6 years to, respectively, .32 and .61 between ages 8 and 9 (Oh, Greenberg, & Willoughby, 2020); from .14 (anxiety symptoms) and .19 (ODD/CD symptoms) between ages 4 and 6 years to, respectively, .40 and .48 between ages 8 and 10 (Wichstrøm, Belsky, & Steinsbekk, 2017); and from .50 (internalizing problems) and .44 (externalizing problems) between ages 11 and 14 years to, respectively, .65 and .60 between ages 22 and 26 (Richards et al., 2022). Heterotypic stability estimates followed the same pattern and rose from .08/.05 between ages 5 and 6 years to .15/.19 between ages 8 and 9 (Oh et al., 2020); from .10/.19 between ages 4 and 6 years to .25/.25 between ages 8 and 10 (Wichstrøm et al., 2017); and from .30/.21 between ages 11 and 14 years to .38/.36 between ages 22 and 26 (Richards et al., 2022).…”