Trajectories of dynamic predictors of disorder: Their meanings and implications

Abstract

Developmental psychopathologists are increasingly focused on characterizing heterogeneity of trajectories of psychological disorders across the life course~e.g., developmentally limited vs. chronic forms of disorder!. Although the developmental significance of trajectories has been highlighted, there has been little attention to relations between trajectories and their etiologically and clinically relevant time-varying covariates~dynamic predictors!. Depending upon the functional relation between a disorder and a dynamic predictor, we expect to see different trajectories of dynamic predictors. Thus, we propose a taxonomy of trajectories of dynamic predictors of course of disorder and provide an initial investigation into its validity. Using a mixed-gender, high-risk sample of young adults followed over 7 years, we identified dynamic predictors that covary with the course of alcohol use disorder~AUD!. Based on a logically derived classification to facilitate interpretation of findings, three comparison groups were examined: persons whose AUD "remitted"~n ϭ 33!, those with a chronic AUD~n ϭ 29!, and nondiagnosers~n ϭ 274!. We hypothesized seven patterns of dynamic prediction~stable vulnerability indicators, course trackers, deterioration markers, developmentally specific variables, developmental lag markers, course-referenced variables, and recovery behaviors! and found evidence for five of them. The interpretation of markers of risk for development and course of AUDs and their implications for prevention, early intervention and formal0self-change treatments are discussed.

Similarities and Differences of Longitudinal Phenotypes Across Alternate Indices of Alcohol Involvement: A Methodologic Comparison of Trajectory Approaches.

“…Some of the more temperamental measures (e.g., conduct disorder, novelty seeking, reasons for drinking) predicted membership in the chronic group, relative to the developmentally limited group, for the problematic alcohol indices. Following the framework suggested by Sher, Gotham, and Watson (2004), these constructs (particularly conduct disorder and novelty seeking) could be considered "stable vulnerability indicators" that distinguish course and may be indexing a severity-graded vulnerability process such that the developmentally limited course is a less severe form of the chronic course. Conversely, those in the chronic group may be vulnerable to the influence of more time-varying, situational risk factors, which were not assessed (e.g., peer influence, life stressors), that could increase their risk of problematic alcohol involvement.…”

Patterns and Correlates of Substance Use Among Affluent, Suburban High School Students

“…However, in the context of ongoing interest in the nature of substance use trajectories that emerge during adolescence (e.g., see Chassin, Presson, Pitts, & Sherman, 2000;Windle & Wiesner, 2004), very little is known about patterns of substance use occurring during middle adolescence in the context of socioeconomic advantage. Moreover, researchers have repeatedly examined the demographic correlates, developmental antecedents, and longer term consequences of different substance use trajectories, but there has been little consideration of change in other aspects of psychosocial adjustment as they occur simultaneously with change in substance use (Sher, Gotham, & Watson, 2004). As Sher et al noted, exploration of concurrent change in other aspects of psychosocial adjustment may better clarify potential causes and consequences of specific patterns of substance use as they unfold over time in a specific context.…”

“…There is, however, evidence from research done with other populations of teens that suggests the persistence of certain types of anxiety within this population may contribute to the escalation of substance use (e.g., see Kaplow, Curran, Angold, & Costello, 2001), and there is evidence that persistent or escalating patterns of substance use may contribute to an exacerbation of certain types of anxiety (e.g., see Fergusson, Lynskey, & Horwood, 1996;Hansell & White, 1991;Johnson & Kaplan, 1990). As Sher et al (2004) noted, it is also possible that substance use and specific forms of anxiety may change concurrently, and it is possible that specific anxiety symptoms may promote substance use in vulnerable teens that persists even though the anxiety symptoms do not.…”

“…Positive, concurrent relations between depression and substance use evident within this population suggest that persistent depressive symptoms may contribute to an escalation of substance use or depressive symptoms and substance use may escalate concurrently. The results of research done with other populations suggest that persistent and escalating patterns of substance use may contribute to an exacerbation of depressive symptoms (e.g., see Fergusson et al, 1996;Hansell & White, 1991;Johnson & Kaplan, 1990), and, although less likely, it is again possible that the onset of depressive symptoms ensnares vulnerable teens by promoting substance use that persists even though the depressive symptoms resolve (Sher et al, 2004).…”

“…Second, once common substance use trajectories were defined, there was interest, as suggested by Sher et al (2004), in using growth curve analyses to identify change in other aspects of psychosocial adjustment associated with specific patterns of substance use as they unfold over time. Specifically, there was interest in examining relations involving different patterns of substance use and nine constructs representing six aspects of psychosocial adjustment: (a) severity of depression, (b) different dimensions of anxiety, (c) involvement in delinquent activity, (d) degree of peer acceptance, (e) different dimensions of adaptive school behavior, and (f) academic performance.…”