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http://dx.doi.org/10.1037/0000065-002 APA Handbook of Psychopathology: Vol. 2. Child and Adolescent Psychopathology, J. N. Butcher (Editor-in-Chief) Copyright © 2018 by the American Psychological Association. All rights reserved.

Over the past five decades, theory and practice concerned with psychopathology in children and youth has shifted profoundly to integrate develop mental theory and knowledge. This transformation was heralded by the emergence of developmental psychopathology (DP) as an integrative and multi disciplinary perspective for research and inter vention on adaptive and maladaptive behavior in human development (Achenbach, 1974; Cicchetti, 1984, 1990, 2006; Cummings, Davies, & Campbell, 2000; Cummings & Valentino, 2015; Masten, 1989, 2006; Sameroff, 2000; Sroufe & Rutter, 1984). Central to this integrative movement was the simple but important idea that understanding psychopa thology in a developing organism would neces sitate a developmental perspective. This idea had profound implications for theory, diagnosis, assess ment, research, and practice which gradually perme ated multiple disciplines concerned with the mental health and wellbeing of young people and, subse quently, individuals of all ages across the develop mental lifespan.

In this chapter, we describe the emergence of DP and the implications of this perspective for theory, research, and practice. Core principles of a develop mental approach to psychopathology are delineated, with an emphasis on developmental systems theory. Key models and concepts stemming from a devel opmental approach are described, including models of multilevel dynamics, behavioral pathways, risk, resilience, developmental cascades, and related implications for prevention and intervention.

Past contributions and future directions of a devel opmental perspective on psychopathology are high lighted in the conclusion.

EmErgEncE of DEvElopmEntal psychopathology

Although the roots of DP have been traced back to early Western philosophy (Cicchetti, 1990), modern DP emerged in the 1970s as pioneering scientists began a concerted effort to study the origins of mental health problems among children believed to be at risk for psychopathology (E. J. Anthony & Koupernik, 1974; Cicchetti, 2013b; Masten, 2006). An international cadre of risk researchers undertook multiple projects aimed at delineating the etiology of psychological problems and mental illnesses, including specialists in child psychiatry, epide miology, clinical psychology, behavior genetics, education, and child development (Garmezy, 1974; Garmezy & Rutter, 1983; Gottesman, 1974; Gottes man & Shields, 1972, 1982; Sameroff & Chandler, 1975; Sroufe, 1979; Watt, Anthony, Wynne, & Rolf, 1984; Werner & Smith, 1982).

By some criteria, the early studies on risk and psychopathology were disappointing, because they did not prove to be as informative as investigators anticipated. High hopes floundered as investigators began to struggle with variability in development among children in highrisk categories and more generally with the complexities of understanding human development in relation to psychopathology

C h a P t e r 2

Developmental perspectives on psychopathology in chilDren

anD aDolescents Ann S. Masten and Amanda W. Kalstabakken

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or mental health (Sameroff, 2000). However, from the perspective of contemporary science on DP and its cousin, resilience science, the early risk studies were a spectacular success.

Early research on risk for psychopathology initiated a crucial process of communication and integration across fields and scientists, leading to a merger of developmental and clinical sciences that opened new horizons for research and spurred a developmental revolution in mental health research and practice that is still unfolding today (Cicchetti, 2006, 2013b; Cummings & Valentino, 2015; Masten, 2006). Variability in the development of children classified as “at risk” because of family background, biological risks, adversity exposure, or early behavior problems pointed to the complexity of developmental processes and highlighted the fact that many children designated to be at risk grew up to be healthy. These observations gave impe tus to the integrated and interrelated sciences now described as DP and resilience (Cicchetti, 2016a; Masten & Cicchetti, 2016).

Personal relationships played a key role in the development of DP (Masten, 2006). Influential early proponents of DP, including Norman Garmezy, Irving Gottesman, Michael Rutter, Arnold Samer off, Alan Sroufe, and Edward Zigler not only knew each other, but often collaborated together and with graduate students who spread their ideas. Their stu dents included Thomas Achenbach and Dante Cic chetti, among many others. Achenbach published the first book entitled Developmental Psychopathol- ogy in 1974. Cicchetti published the first special journal issue on DP in 1984 in the flagship journal of the Society for Research in Child Development, Child Development, and later founded the journal, Development and Psychopathology, among his many other contributions.

Defining Developmental psychopathology DP has been variously defined by leading propo nents as an interdisciplinary science or integrative framework for understanding psychopathology in the full context of development over the lifespan (Cicchetti, 1984, 1989, 1990, 2006; Cummings & Valentino, 2015; Masten, 2006; Sroufe, 1990; Sroufe & Rutter, 1984; Zigler, 1989). Cicchetti

(2006), for example, described DP as “an evolving scientific discipline whose predominant focus is elu cidating the interplay among the biological, psycho logical, and socialcontextual aspects of normal and abnormal development across the lifespan” (p. 1). Although definitions of DP continue to vary, there are striking consistencies in the fundamental prin ciples described by key proponents of this approach to psychopathology.

corE principlEs of DEvElopmEntal psychopathology

As DP evolved, central tenets emerged and were gradually reshaped by advances in the sciences concerned with developmental change and mental health. Fundamentally, however, the core principles described by multiple proponents share the imprint of developmental systems theory, as this synthesis of developmental ideas became the prevailing concep tual framework for research in human development (Cummings & Valentino, 2015; Masten & Cicchetti, 2016; Zelazo, 2013).

Key concepts from Developmental systems theory Developmental systems theory brings together eco logical models of individual development with gen eral systems theory, emphasizing that the course of individual development emerges from many interac tions among changing systems within and outside the organism, coacting to shape the structure and function of the developing individual (Bronfen brenner & Morris, 2006; Gottlieb, 2007; Lerner, 2006; Lickliter, 2013; Overton, 2013). Dynamic and everchanging, individuals grow and change because of many interactions across levels of func tioning, from the epigenetic and neurobiological levels to cultural and societal levels. Natural eco system factors (e.g., air and water quality, exposure to microbiotic organisms) also play a critical role in development.

The individual is embedded in socioecologi cal systems, proximal and distal, that directly or indirectly influence the life course. Bronfen brenner described the proximal ecological sys tems that the individual directly interacts with

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(e.g., family, school, peer group) as microsystems (Bronfenbrenner, 1979; Bronfenbrenner & Mor ris, 2006). More distal, indirect, but nevertheless influential systems include exosystems (e.g., a parent’s workplace) and macrosystems (e.g., mass media, culture, governmental policies, health care systems). Bronfenbrenner also noted the influence on development of interactions among microsystems (mesosystem) and historical time (chronosystem).

Over the course of development, the relevant importance and exposure to these influential sys tems change. For example, in the developing fetus, all the external influences are mediated by processes within the biological mother. For example, diet, trauma, or illness experienced by a pregnant mother can alter the biology of the developing child prior to birth (Boyce & Kobor, 2015; Meaney, 2010; Monk et al., 2016). In early childhood, experiences with most systems are also regulated or mediated by caregiving adults. As children grow up, they interact with more systems directly through play, school, work, and social relationships, and they also take on greater agency in choosing interactions with specific individuals or systems.

In a developmental systems framework, indi vidual development is shaped by many interac tions and the directions of influence are reciprocal and probabilistic, rather than unidirectional and deterministic (Gottlieb, 2007; Sameroff, 2000). Experiences can influence the development of psychopathology but the behavior of the indi vidual also influences the nature of experiences and the quality of the ecological system. Young people influence their own experiences with parents, teachers, classmates, friends, romantic partners, and other social actors who in turn play major roles in their lives. This interplay over time between children and other people, reciprocally influencing the life course of the dyad or members of larger groups, was described in developmental theory as a transactional model (Sameroff, 1975). More broadly, transactional models refer to the reciprocal influences of individuals and their con texts on each other (Sameroff, 2009).

The idea that children influence the interactions that subsequently shape their own development

encompasses the role of human agency in develop ment (Bandura, 1997; Sroufe, 1979). As children grow older, they typically exert more choice about their interactions with the environment, playing an increasingly active role in their own development. At the same time, however, transactional models recognize the profound influences of external socio cultural conditions in constraining or altering devel opment (Sameroff, 2009). These influences include poverty, discrimination, war, education, and posi tive opportunities in many forms.

The developmental systems perspective empha sizes that human individuals show enormous plas ticity, adapting to their experiences in multiple ways, ranging from brain development to social behavior and cultural beliefs (Boyce & Kobor, 2015; Del Giudice, Ellis, & Shirtcliff, 2011; Hochberg et al., 2011; Overton, 2013). Many human adaptive systems that evolved biologically and socioculturally over time show this kind of plasticity or openness, requiring calibration through experience to become fully effective. Examples range from language acqui sition to immune function.

The human immune system, for example, requires exposure to challenges to become effec tive at fighting off disease or infections. Children raised on farms with extensive exposure to diverse microorganisms have a lower risk for asthma than children raised with little exposure to these microorganisms (Figueiredo et al., 2013; Guerra & Martinez, 2008; von Mutius & Radon, 2008). Find ings about the protective effect of early exposure to microorganisms generated the hygiene hypothesis. In terms of calibrating the human immune system, modern lives can be too clean, increasing the risk for various allergies or a less optimal immune response. Vaccination is another protective strategy for boost ing the effectiveness of human immune systems through deliberate exposure to manageable forms of infectious agents to build up antibodies that fight off infectious diseases.

Developmental systems theory gradually became the dominant theoretical model in developmental science (Lerner, 2016). Core principles comprising a developmental approach to psychopathology, delin eated next, reflect central ideas from developmental systems theory.

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Developmental principle As noted previously, the defining tenet of DP is that understanding psychopathology in a develop ing organism requires a developmental perspective. DP can be viewed as a developmental science that focuses on understanding variations and change in behavioral adaptation over the life course. Develop mental science is the study of such changes in living organisms as they form, mature, and decline.

Multiple influences on the course of develop ment result in a multiplicity of possible pathways for human development, whereas individual devel opment also exhibits continuity and orderly pro gression (Cicchetti, 2006; Cummings & Valentino, 2015; Sroufe, 1979, 1997, 2007).

systems principle A second core principle common to developmental frameworks for psychopathology is the recognition that normative as well as pathological development emerge from interactions of many systems at mul tiple levels. Human individuals are living systems that encompass many neurobiological subsystems, and they are also embedded in many other sys tems, living and nonliving. A systems perspective underscores the idea that all human development is influenced by these interactions, leading to devel opmental change emerging over time. Genes, as well as environments, shape development through interactions, from the epigenetic to the social level. Consequently, development is dynamic, and the natureversusnurture debate is moot.

Living systems are assumed to have self organizing, selfregulatory, and selfrighting prop erties that maintain vital functions while adapting to the environment (Masten, 2006). As a social species, human individuals also are regulated by relationships and cultural beliefs, influences that change over the course of development. Caregivers play crucial regulatory roles early in development and, later in life, others will gain influence through friendships, mentorships, and romantic relation ships. Cultural norms, passed on through socializa tion, influence these social relationships and the goals of selfregulated behavior.

This principle has numerous implications for conceptualizing and treating psychopathology, at

the individual, dyadic, or system levels, and in the context of other groups engaged for treatment. For individuals, problems—as well as healthy development—arise from complex interactions among systems within an individual and also between the individual and all the multiple systems in which a human life is embedded over time. Prob lems can arise from deficits in adaptive skills (e.g., poor selfregulation, poor problemsolving skills), application of normative skills to antisocial or other goals disapproved by society, deviant environments or discrimination, a poor fit between the person and the context, and other kinds of adaptive challenges.

multiple-levels principle Developmental systems theory presupposes that processes occurring at multiple systems levels influ ence the development, course, and treatment of psy chopathology. Multiple levels of influence can occur simultaneously or sequentially in a cascading man ner. Such cascades, discussed following, can result in the biological embedding of experience or genetic influences on neural development, and many other forms of influence across levels and time. Commu nity or familylevel violence can influence stress regulation systems within individuals, good parent ing can alter gene expression in children, medica tion can alter neurotransmitters that in turn can alter mood or behavior; there are many different examples of multilevel effects that result in cascad ing changes (see Masten & Cicchetti, 2010). Such multilevel dynamics and cascades have many impli cations for intervention and the timing of interven tion strategies.

normative principle In DP frameworks, psychopathology is defined or delineated in relation to what is generally expected for individuals of a given age, situation, socioecolog ical context, period in history, and culture. Norma tive expectations for human behavior are sometimes described as developmental tasks or milestones, or simply as “normal behavior.” This principle explicitly acknowledges that judgments about the quality of adaptation, whether they are concerned with good or poor functioning, always are based on expectations about what is typical or expected

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Developmental Perspectives on Psychopathology in Children and Adolescents

for people of a particular age, gender, situation, and culture (Masten, Burt, & Coatsworth, 2006; McCormick, Kuo, & Masten, 2011).

Some expectations for human development are universal, reflecting the nature of our species and its typical development across most environments, whereas others are distinctive to a specific era, place, or culture. Developmental milestones, such as walk ing and talking, are universal developmental tasks. When these do not occur, adults (especially parents) grow concerned that something is radically amiss. Additional tasks are shared by many cultures at a given period in history, reflecting widelyshared similarities in human capabilities, cultures, and opportunities. These include the developmental task expectations of learning to obey rules at home or in public, going to school, learning to read, and getting along with other people. The exact forms of these expected achievements vary across cultures, but the fundamental expectations are similar (Masten & Coatsworth, 1998; McCormick et al., 2011). Other expectations about what is important for individu als to learn or do over the course of development vary dramatically across cultures and historical time. These include rites of passage and other cultural practices and the skills needed for adult life in a specific community.

Expectations for behavior change as children grow up. The norms for behavior are highly tuned to agenormative development. The same behaviors that are viewed as normative in a 2 or 3yearold (e.g., tantrums, distractibility, imaginary friends) are viewed as problematic in older children and adults because behavior is judged against developmental norms. These norms may be explicit, as in norm referenced scoring on intellectual or achievement tests, or implicit, as in community disapproval of nonnormative behavior. Salient developmental tasks wax and wane in importance over the life course. School success, for example, is important for schoolage children and then wanes in importance in adolescence or adulthood as new developmental tasks begin to rise in salience (e.g., work or family formation).

It is important to keep in mind that not all devia tions from the norm are pathological. Societies usu ally value exceptionally good intellectual, language,

artistic, or other desirable skills. International com petitions like the Olympics are held to honor “devi ance” in the form of exceptional athletic prowess.

Nonetheless, developmental task expectations influence definitions of adaptive and maladap tive behavior. Classification systems for mental disorders implicitly or explicitly acknowledge these expectations in multiple ways. One key way is through agerelated criteria for disorders or by designating whether behavior problems are age inappropriate or interfere with adaptive function in these kinds of developmental task domains (e.g., interfere with school competence or peer rela tions). Diagnosing psychopathology requires judg ments about normality and deviance that are highly related to expectations about normative behavior in developmental perspective (Drabick & Kendall, 2010; Masten, 2006).

There are allowances for exceptional circum stances. In traumatic situations, for example, behav ior that would ordinarily be viewed as abnormal may be widely recognized as typical and acceptable. The diagnosis of posttraumatic stress disorder in most contemporary classification systems recognizes this allowance by specifying that the symptoms are lingering past an expected window of normative recovery time (e.g., one month).

This principle implies that evaluations of psy chopathology must account for the developmental and contextual expectations for behavior. It also raises the interesting issue of who decides what is “normal” or not. Societies, professionals, cultural leaders, families, and individuals themselves all have a stake in defining psychopathology in contrast to normal development. Cultural subgroups within a community or society may also differ in their views about what is “good” or normal behavior.

mutually informative principle Another widely held idea in DP is that the study of normative development and psychopathology are mutually informative. This principle recognizes that understanding variations in adaptation from a devel opmental perspective is important for understand ing undesirable deviant behavior as well as desirable typical behavior. From this perspective, research on positive development in the context of risk for

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psychopathology adds important information to the knowledge base on the etiology of mental illness. Moreover, it is important to understand promo tive and protective influences on pathways toward or away from problems as well as the influences of risks, vulnerabilities, and adversities. Promotive factors are positively associated with good adapta tion regardless of risk, whereas protective factors are more important or only important when risk or adversity is high (Masten & Cicchetti, 2016).

Research on competence and resilience in devel opment contributes important knowledge to the etiology, prevention, and treatment of psychopa thology (Cicchetti, 2006; Masten, 2006). Similarly, knowledge on the full range of human development, including pathological patterns, informs develop mental science and theories of how development proceeds.

Developmentally sensitive assessment and intervention Although the final principle noted here is not always explicitly articulated, developmental approaches to psychopathology assume that assess ment, diagnosis, prevention, and intervention must be grounded in developmental context. There are many reasons for this view. First, the meaning of the same behavior (e.g., tantrums, distractibility, talking to an imaginary friend) changes over the course of development, as noted previously, and different behaviors (e.g., crying, texting to some one) may have the same meaning (e.g., seeking contact with an attachment figure) at different periods of development. Second, judgments about the course of individual development often depend on comparisons with normativeexpected patterns of behavior or progress that change with develop ment. Third, tailoring interventions to optimize developmental timing is likely to be more effective (Toth & Cicchetti, 1999).

In prevention, knowing what to do and when to do it in order to have the greatest impact (on future competence or symptoms) depends on theory and knowledge about the course of development lead ing up to competence or problems, the best devel opmental timing of a particular intervention, and the best type of intervention for different periods

of development. Similarly, in intervention planning and implementation more generally defined, strate gies always need to be informed by developmental knowledge about what has been shown or is most likely to work for whom and when. These points are often discussed in terms of developmental tim ing and targeting.

All these principles continue to evolve and change as knowledge increases. Meanwhile, the core ideas have numerous implications for sciences and practices concerned with psychopathology.

DEvElopmEntal pattErns anD pathways

One of the important implications of a developmen tal systems perspective on psychopathology as well as normative development is the focus on pathways (Cicchetti, 2006; Cummings & Valentino, 2015; Masten & Cicchetti, 2016; Sroufe, 1990). Individual development arises from complex interactions across many systems and levels, creating potentiali ties for many possible pathways that development may take, although some are much more likely than others. This idea was championed decades ago by Waddington (1957; see also Mitchell, 2007) in the concept of an epigenetic landscape and beautifully articulated in modern form as probabilistic epigen esis by Gottlieb (2007).

In behavior genetics, Gottesman (1974; Gottes man & Shields, 1972, 1982) depicted contrasting pathways toward and away from mental illness among individuals with varying levels of initial genetic risk in his diathesisstressor models of schizophrenia. Net liability for mental disorder (e.g., schizophrenia) fluctuated as a function of experiences over time. These compelling models illustrated the possibility of diverging pathways of mental health functioning, even for identical twins (discordant for mental illness), as well as converging pathways to disorder from different initial starting points of liability.

In child psychopathology, Bowlby (1988) described multiple pathways of development, not ing how experiences can lead a child’s development in deviant directions. Sroufe (1997) elaborated on the idea of multiple pathways using an organic tree

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metaphor adapted from Waddington’s (1957) earlier branching pathway models.

The course of individual development can change directions many times as a function of expe rience or epigenetic processes. There can be “turn ing points” or “branching” in new directions. In resilience science, investigators were particularly interested in positive turnarounds in the lives of young people (Masten, 2012, 2014c; Rutter, 1987; Werner & Smith, 1992, 2001).

The concept of pathways also underscored two key concepts originating from systems theory but also widely observed in individual cases: equifinal ity and multifinality (Cicchetti, 2006; Cicchetti & Rogosch, 1996). There were different pathways to the same or similar outcomes (i.e., equifinality), as well as different outcomes among individuals with the same or similar starting points (i.e., multifinal ity). Just as identical twins could become discordant for a mental disorder, individuals from very differ ent genetic and experiential backgrounds could end up in the same kind of trouble or identified with the same diagnostic category through the influ ence of many interactions over time. The focus on epigenetic pathways and branching patterns in DP highlighted the complexity of human behavior and development and counteracted deterministic views of development.

Multiple pathway perspectives have been validated repeatedly in research on twins (Grigorenko & Cicchetti, 2012; Jaffee, Price, & Reyes, 2013; van Dongen, Slagboom, Draisma, Martin, & Boomsma, 2012), by epidemiological data documenting changes in prevalence of specific disorders over the life course (Costello & Angold, 2016), in longitudinal studies of individual adjust ment (e.g., Hauser, Allen, & Golden, 2006; Masten & Tellegen, 2012; Werner & Smith, 1982, 1992, 2001), and in research on patterns of adjustment following masstrauma experiences (see Masten, Narayan, Silverman, & Osofsky, 2015).

With advances in statistical methodology, investigators have begun to identify or corroborate trajectories of behavior (positive and negative) through techniques such as latent growth modeling, to capture empirically the diversity and regularity of pathways hypothesized in the literature or reported

in case studies (see KimSpoon & Grimm, 2016). Trajectory analyses have delineated several distinctly different patterns of response to trauma and differ ent patterns of development among young people with significant problems or disorders. For example, Betancourt, McBain, Newnham, and Brennan (2013) documented different recovery patterns among for mer child soldiers. Osofsky, Osofsky, Weems, King, and Hansel (2015) studied patterns of adaptive function among double victims of Katrina and the Deepwater Horizon oil spill. Numerous investigators have attempted to portray different pathways of sub stance abuse problems and desistance (see Chassin, Colder, Hussong, & Sher, 2016; Zucker, Hicks, & Heitzeg, 2016).

Often, investigators seek to identify patterns within patterns, in the sense of finding distinct sub groups that account for general symptom or preva lence patterns observed in epidemiological data. Perhaps the most famous example of this effort to find subgroups with a larger pattern is provided by research on serious offending or antisocial behavior. Crime data dating back to the 1800s long have doc umented an agecrime curve phenomenon, where criminal behavior rises in prevalence sharply during adolescence and then falls again in early adulthood (Loeber & Farrington, 2014). Moffitt (1993) pro posed a developmental explanation of this crescendo pattern of misbehavior in a highly cited theoretical article, suggesting two key subgroups that generated this apparent pattern: an adolescencelimited form of antisocial behavior and a lifecoursepersistent pattern. She and her colleagues subsequently tested this theory through empirical analysis of data from the Dunedin cohort (e.g., Moffitt, Caspi, Har rington, & Milne, 2002). Similar efforts have been made to disaggregate data on substance abuse (see Masten, Faden, Zucker, & Spear, 2008). Again, distinct subgroups of individuals who share similar patterns of onset and/or offset of substance abuse problems have been identified that together com prise a general developmental crescendo pattern of prevalence. Some of the subgroups observed in these studies are characterized by high, chronic substance abuse; low use over time; and onset in adolescence followed by desistance. Such patterns are impor tant because they have very different implications

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for prognosis, prevention, and treatment, as well as theories of etiology.

DEvElopmEntal rEsiliEncE sciEncE anD psychopathology

The history of resilience science and DP are closely intertwined (Masten & Cicchetti, 2016). Research on resilience often is viewed as a component of DP and certainly it is not a coincidence that resilience science and DP blossomed at the same time (Mas ten, 2014c). The search for understanding and pre venting the development of mental health problems, and particularly the study of young people at risk for psychopathology, played a central role in the emer gence of both lines of work. Pioneers in resilience science, including Norman Garmezy and Michael Rutter, were psychopathologists by training, in clini cal psychology and child psychiatry, respectively. They interacted and collaborated not only with each other (Garmezy & Rutter, 1983; see Masten, 2012), but also with leading developmental scientists, such as Alan Sroufe (Sroufe & Rutter, 1984).

One of the crucial insights of the investigators who led the first wave of research on resilience was recognizing the importance of variation they observed in their research on children at risk for psychopathology (Masten, 2014c). Many of these children manifested normal development despite their risk status and often in the context of highly adverse conditions. Others recovered to good func tion when supportive caregiving or rearing environ ments were established or restored. The pioneers recognized that knowledge about pathways away from disorder were just as illuminating as pathways to problems, providing important clues about etiol ogy, particularly with respect to the practical goal of preventing psychopathology.

Resilience in contemporary developmental sci ence refers to the capacity of a system to adapt suc cessfully to challenges that threaten the function, survival, or positive development of that system (Masten, 2011, 2014c). This capacity can be inferred from manifest evidence of coping effectively with significant challenges or recovering from traumatic experiences. The potential for resilience may also be assumed from the presence of wellestablished

promotive or protective factors associated with good adaptation.

This definition of resilience is grounded in developmental systems theory, and has the benefit of scalability across levels of analysis, from subsys tems within the individual to largescale social and ecological systems (Masten, 2011, 2014a; Masten & Obradović, 2008). The concept of resilience can be applied to any dynamic adaptive system, such as a person’s immune system, a family system, or a large ecosystem. There are growing efforts to integrate resilience theory and research across multiple sys tem levels, perhaps because of the surge of concerns about global challenges that scale multiple levels, including climate change, natural disasters, war, and pandemics (Masten, 2014a, 2014c, 2015; Masten & Monn, 2015).

Waves of resilience science have made numer ous contributions to theory, methods, knowledge, and interventions in DP documented over the years (Luthar, 2006; Masten, 1989; Masten & Cicchetti, 2016; Wright, Masten, & Narayan, 2013). Most fun damentally, the focus on positive adaptation in the context of risk or adversity shifted models of mental health and practice from a narrow and inherently limited deficitcentered perspective to a broader and more hopeful emphasis on strengths and promotive or protective influences, dynamic adaptive systems, and the potential for positive change. Influences on human development and function long overlooked and neglected in clinical sciences and practice became the focus of greater attention, complement ing the longstanding emphasis on risk, vulnerability, and problems in development.

The overall effects of this shift transformed the frameworks for practice in multiple fields, includ ing family therapy (Walsh, 2016), school counsel ing (e.g., Akos & Galassi, 2008; Masten, Herbers, Cutuli, & Lafavor, 2008), social work (e.g., E. K. Anthony, Alter, & Jenson, 2009), military training and family services (Cozza & Lerner, 2013; Masten, 2013), positive youth development (Lerner et al., 2013; Masten, 2014b), disaster response (Masten et al., 2015), and humanitarian outreach (Ager, 2013; Lundberg & Wuermli, 2012). Models and practices of prevention and intervention for psy chopathology in children and youth also reflect this

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shift (Cicchetti, 2013a; Gest & Davidson, 2011; Luthar, Cicchetti, & Becker, 2000; Masten, 2014c; Masten et al., 2006; Winslow, Sandler, Wolchik, & Carr, 2013).

Resilience science focused on variations and change in the quality of adaptive function over the life course in relation to changing experiences and development, particularly when individuals were faced with very challenging situations. Two key judgments (and corresponding measures) were critical to research on resilience, concerning the nature of challenges faced and the quality of adap tive functioning (Masten, 2014c). Resilience often was inferred from evidence of good adaptation in the context of significance challenge. Accounting for good outcomes when one might expect otherwise because of high risk or adversity exposure led these investigators in search of factors that functioned to prevent, counteract, or mitigate risk or spur positive function even in the presence of adversity. Investiga tors expected that better knowledge of preventive, promotive, and protective processes would yield better policy and practices to promote mental health and prevent problems in development.

Applied models of risk and resilience encouraged better assessment of positive outcomes as well as symptoms and disorders; assets and resources that could function as potential promotive factors; and potential moderators of risk that might be malleable, and therefore a target for intervention, to protect the health or wellbeing of a person encountering challenges. As a result, models and measures of competence, assets, and protective factors expanded (Masten, 2014c; Masten & Tellegen, 2012).

Tracking the quality of adaptation over time also required a developmental knowledge base to inform assessments as children grew up. Collaborations of clinical and developmental scientists ensued as clini cal scientists began to follow the development of highrisk children in longitudinal studies.

From the very beginnings of resilience research, scientists were interested in pathway models because compelling data in individual or aggregated case studies of resilience indicated that some indi viduals showed compelling turnaround patterns in their adaptive success (judged by developmental tasks or other criteria). These turns sometimes

occurred naturally (Masten, 2014c; Rutter, 1987; Werner & Smith, 1992), but sometimes turn arounds were deliberately induced by intervention (e.g., Masten & O’Connor, 1989; Nelson, Fox, & Zeanah, 2014; Rutter, SonugaBarke, & Castle, 2010).

Research on children in war, terror, and disas ter has been influential in resilience science (Gar mezy & Rutter, 1983; Masten, 2014a, 2014c; Masten et al., 2015). Differential pathways of response and recovery to masstrauma experiences have been observed and studied since World War II. This large and expanding body of case accounts and research highlights the key roles of developmental timing, nature of exposure, previous trauma exposure, vul nerabilities and protective factors, and the nature of the recovery environment in the patterns of response to these extremely threatening situations.

Resilience science motivated an expansion of research on competence and positive development and how individual difference in normal develop mental domains of adaptive function were related to psychopathology. This work would lead to new measures, research on developmental cascades, and a growing body of research linking child develop ment research on normative psychosocial develop ment to psychopathology (see Burt, Coatsworth, & Masten, 2016; Masten et al., 2006; Masten & Cic chetti, 2016).

Initial waves of resilience studies were focused on psychosocial adaptation in children and youth, often in developed countries. Processes at other levels of analysis were relatively neglected, includ ing neurobiological processes and sociocultural processes that might differ in diverse cultural settings (Luthar, 2006; Masten, 2014a, 2014b; PanterBrick & Leckman, 2013). Over the past two decades, as research on neurobiological develop ment and genetic processes expanded, there has been a surge of research on resilience at the biologi cal level and in relation to processes of gene by envi ronment interaction (G×E) processes (Cicchetti, 2013a; Masten & Cicchetti, 2016). Concomitantly, research on cultural influences in resilience has burgeoned (Lundberg & Wuermli, 2012; Motti Stefanidi, 2015; Ungar, 2012; Ungar, Ghazinour, & Richter, 2013).

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Increasingly, there are calls for greater integra tion across levels and disciplines focused on resil ience (Cicchetti, 2013a; Masten, 2007, 2015, 2016; Masten & Monn, 2015; Southwick, Bonanno, Mas ten, PanterBrick, & Yehuda, 2014). As noted previ ously, global challenges may account for some of the impetus behind these calls for more integrated the ory, knowledge, and action. In addition, however, a key motivation may stem from growing acceptance of a developmental systems perspective on adapta tion, for investigators focused on competence and resilience and those focused on preventing or ame liorating psychopathology in development.

aDaptivE anD malaDaptivE pErspEctivEs: compEtEncE anD psychopathology

Developmental approaches to psychopathology highlight the importance of considering how nor mal and abnormal behavior are related in develop ment (Burt et al., 2016; Masten et al., 2006). Earlier theory and research in child psychopathology was in some respects “truncated” to focus on under standing patterns linking risk, vulnerabilities, and maladaptive behavior while neglecting contributors to positive adjustment and development. Earlier models also often ignored intriguing combinations of adaptive behavior, when individuals with simi lar symptom profiles showed markedly different success in their environments or individuals who appeared to function well in one domain struggled in another domain.

It has been clear for many decades that patterns of competence in developmental tasks (e.g., school or work success) are often linked to psychopathol ogy, concurrently and sequentially. Numerous explanations are possible, ranging from common causal antecedents, like shared risk factors (e.g., poverty, poor parenting) to confounded measure ment (e.g., similar items on measures purported to assess competence and symptoms or biased reporting); symptoms may also directly affect suc cess in life or vice versa (Masten et al., 2006). The dualfailure model posited by Patterson, Capaldi, and colleagues suggested that antisocial behavior arising initially in the family led to failures in the

developmental tasks of academic achievement and getting along with peers, which in turn led to inter nalizing symptoms (Capaldi, 1992; Patterson & Stoolmiller, 1991).

In classification, assessment, and diagnosis of mental disorders, considerations of competence and adaptive behavior often have entered research and clinical practice through the concept of impairment or in scales of adaptive function (Burt et al., 2016). For individuals with developmental disabilities, there are welldeveloped assessment tools designed to assess adaptive skills in specific domains of adap tive function (Ditterline & Oakland, 2009). The Vineland Adaptive Behavior Scale is widely used for assessing functional impairment in agenormative developmental tasks and expected skills in daily tasks of living (Sparrow, Cicchetti, & Balla, 2005). For adults with wideranging mental disorders, one of the most important broadspectrum efforts to improve the assessment of adaptive “disability” level is the World Health Organization’s Disability Assess ment Schedule (Üstün et al., 2010), which has been translated into numerous languages. This tool, how ever, is not optimal for a developmentally sensitive assessment (Burt et al., 2016). Efforts are currently underway to create a comparable tool suited to ear lier periods of life, when developmental consider ations are paramount.

Struggles to sort out the nature of linkages between indices of adaptive success (including impairment measures) and indices of psychopathol ogy (at the level of symptom and disorder) raised a host of issues, and sparked reconsiderations about how to organize research on psychopathology (Burt et al., 2016). One promising product of this struggle is the shift by the National Institute of Mental Health to research domain criteria, which focuses on constructs better suited to a dynamic systems model of human function and psychopathology. However, this approach has not been well grounded in devel opmental theory or evidence (Burt et al., 2016).

Another promising area of advancement that arose from struggles to understand linkages among levels and domains of adaptive behavior is work on developmental cascades. Cascade models attempt to test hypotheses about progressive changes across levels, domains, and even generations that may

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result from the dynamic interactions of systems (Masten & Cicchetti, 2010). Some cascade analyses focus exclusively on domains within positive or negative adjustment frameworks and pathways (e.g., “competence begets competence,” studying how abuse of one substance precipitates abuse of another substance). Many cascade studies, however, attempt to encompass multiple domains of adaptive behav ior (positive and negative) and interactions that span levels of analysis, systems, or developmental transitions.

DEvElopmEntal cascaDEs

Developmental cascades refer to the cumulative con sequences on development of the many interactions among systems at different levels over time whereby effects of changes in one or more levels of function, domains of adaptive function, or generation spread to change other levels, domains, and generations (Masten & Cicchetti, 2010). These types of effects were observed decades ago and sometimes described by researchers and clinicians as snowballing or pro gressive effects (Masten et al., 2006). It has been noted, for example, that antisocial behaviors in childhood forecast a greater risk for a multiplicity of later problems in development, including school problems, peer rejection, substance abuse, work problems, relationships problems, and criminal offending (Dodge et al., 2009; Dodge & Pettit, 2003; Hinshaw & Anderson, 1996; Kohlberg, LaCrosse, & Ricks, 1972; Maguin & Loeber, 1996; Patterson, Reid, & Dishion, 1992). Patterson’s dualfailure model described previously represents a develop mental cascade model (Patterson & Stoolmiller, 1991).

On the favorable side of the story, childhood intellectual skills forecast later successes in life (Kohlberg et al., 1972; Masten et al., 2006). More over, the evidence on the predictive significance of selfcontrol, although often studied from a negative perspective (low selfcontrol predicting an array of poor outcomes; e.g., Moffitt et al., 2011), could also be interpreted to implicate good selfcontrol as a key advantage for future development. Findings on the predictive significance of executive function skills and other indicators of inhibitory selfcontrol or the

capacity to delay gratification, align well with these observations (Zelazo & Carlson, 2012).

The changes studied in research on developmen tal cascades alter the course of development; they are not fleeting in nature. Cascades have implica tions for understanding etiology and cooccurrence of disorders and problems and for intervention, par ticularly with respect to targeting and timing. Two special issues of the journal Development and Psy- chopathology, edited by Masten & Cicchetti (2010), provided wideranging examples of research on developmental cascades. Numerous other empirical examples have been published on this theme in this and other journals since those special issues.

Considerable diversity of focus is evident in this emerging body of literature. Some studies attempt to demonstrate how community violence cascades into family and peer environments, resulting in increased aggression of individual youth (e.g., Boxer et al., 2013). Others focus on pathways by which family stress can alter allostatic load in children (Repetti, Robles, & Reynolds, 2011) or family interventions that may alter biological function (e.g., inflamma tion; Miller, Brody, Yu, & Chen, 2014). Interven tions have targeted improved parenting or foster care as a strategy for lowering risks related to child maltreatment or stress (e.g., Dozier, Peloso, Lewis, Laurenceau, & Levine, 2008; Fisher, Stoolmiller, Gunnar, & Burraston, 2007).

To date, the evidence base on developmental cascades remains limited (Burt et al., 2016; Cum mings & Valentino, 2015). Moreover, the pro cesses by which cascade effects occur are rarely wellarticulated. Nonetheless, a new era of research has arrived, focused on multisystem processes and their consequences for development (positive or negative).

The most persuasive evidence on cascade effects is provided by intervention experiments with randomized assignment to treatment or control/ comparison groups. Prevention science provides strong examples of efforts to alter development by changing a process hypothesized to play a role in the adaptation of individual children or youth. In this case, the anticipated cascade sequence is that the intervention alters the targeted moderator/ mediator of change (e.g., parenting or school

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engagement) which in turn precipitates changes in individual children (e.g., reduced symptoms, improved achievement). Patterson and colleagues at the Oregon Social Learning Center devoted decades to basic research and intervention development aimed at reducing the risk for antisocial behav ior and related problems (Patterson, Forgatch, & Degarmo, 2010; Patterson et al., 1992). Patterson et al. (2010) described some of their important pre ventive intervention efforts designed to interrupt cascades they had observed in basic studies, using the Parent Management Training—Oregon Model. Mothers in the experimental group were trained with the goal of altering their parenting interactions with their children, for example to become more consistent in reinforcing positive child behaviors. Results indicated that the intervention had altered their parenting and that child behavior improved. Moreover, these effects expanded over time after the intervention stopped.

Cascades theoretically also would be expected to produce unexpected changes among intercon nected systems. Results from the Patterson et al. (2010) studies illustrate unanticipated cascades as well. Longitudinal followups revealed that mothers became less depressed and more economically suc cessful over the long term.

implications of a DEvElopmEntal pErspEctivE for intErvEntion: timing anD targEting

Developmental approaches to psychopathology have yielded important models and evidence for practice while underscoring the challenges of promoting change in complex adaptive systems. Data from DP and resilience science alike point to the crucial importance of timing and targeting for intervention and the potential benefits of multiple level, multi disciplinary integration.

Theory and basic research on development and psychopathology suggests that timing matters for intervention. There appear to be windows of vul nerability and opportunity in development when plasticity or malleability from experiences, including interventions, are greater (Dahl, 2004; Karatoreos & McEwen, 2013; Lupien, McEwen, Gunnar, & Heim,

2009; Masten, 2014c; Masten, Faden, et al., 2008; Nelson, 1999; Steinberg et al., 2006). These win dows are associated with developmental transitions, like the complex processes attending puberty and periods of rapid brain development, prenatal and postnatal. They also are associated with contextual changes, like the transition into formal schooling, going to college or otherwise leaving home, and ill ness, trauma, or other challenging experiences that disrupt function in multiple systems. These periods may reflect the dynamic nature of complex adap tive systems which are more open to change during times of disruption or transition.

Developmental models, including cascade mod els, suggest that early timing could be important for initializing positive cascades or interrupting nega tive cascades (Masten et al., 2006; Masten & Cic chetti, 2010). Economist Heckman (2006), among others (see Masten, 2014c), has argued that there is a higher return on early investment in children because competence builds on competence. Analy ses of benefits to costs of early intervention by Heck man and others support this perspective (Temple & Reynolds, 2007). This high return on early invest ments (e.g., high quality early childcare programs) could be the result of positive cascade processes.

Numerous investigators have argued that early intervention is important to interrupt pathways to antisocial behavior and related problems in chil dren, because of the risks to development posed by persisting aggressive and dysregulated behavior (Dishion & Patterson, 2016; Dodge et al. 2009; Shaw, Hyde, & Brennan, 2012). Very early starters may require early childhood intervention to prevent progressions along these pathways. Early interven tions for conduct problems often focus on parenting skills. However, as Dishion and Patterson (2016) observed, there is good evidence of successful inter ventions later in childhood and adolescence.

Evidence on the rapid development of neural systems associated with selfregulation during the preschool years and associated control of attention and action provides another example of a widely acknowledged window of plasticity for interven tions to support or promote the development of skills considered essential for successful transi tions to school (Blair & Raver, 2015; Blair & Razza,

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2007; Zelazo, Blair, & Willoughby, 2016; Zelazo & Carlson, 2012). Evidence indicates that the skills involved in goaldirected problemsolving and delib erate selfregulation show malleability as well as rapid development in the preschool years, consistent with a sensitive period or window of opportunity (Blair & Raver, 2015; Diamond & Ling, 2016).

Over the decades, prevention models have expanded to include competence promotion as well as psychopathology prevention (Burt et al., 2016). For example, in the consensus study by the Insti tute of Medicine on Preventing Mental, Emotional, and Behavioral Disorders Among Young People, the first recommendation of the report underscores the importance of promoting healthy development as well as preventing specific disorders:

The federal government should make the healthy mental, emotional, and behav ioral development of young people a national priority, establish public goals for the prevention of specific [mental, emotional, and behavioral] disorders and for the promotion of healthy development among young people, and provide needed research and service resources to achieve these aims. (National Research Council & Institute of Medicine, 2009, p. 378)

The committee that conducted this consensus study adopted a developmental framework for their review and they included many examples of programs that promote positive behaviors as a prevention strategy for lowering the risk of psy chopathology later in development. These include wellvalidated programs to promote parenting skills, school engagement, or prosocial behavior. Effective programs often combine strategies to reduce prob lems and to boost competence.

Efforts to promote better selfregulation skills to boost learning and socioemotional skills for school success represent a more focused strategy of preven tion directed at competence promotion, targeting a set of skills considered foundational for learning and social relationships. However, there are several mul tifaceted efforts to improve school success through high quality early childcare and education. These include the Head Start program (Zigler & Styfco,

2010) and the Chicago Parent–Child Center (Reyn olds & Ou, 2011; Reynolds, Temple, White, Ou, & Robertson, 2011).

Head Start and the Chicago Parent–Child Cen ters are examples of multicomponent programs that take a broadbased approach to intervention in early childhood, with the expectation that more compre hensive programs are needed for the multiplicity of risks experienced by children and their families growing up in poverty. These programs often com bine quality childcare and early education with parent education and outreach to support positive child development. Some programs include exten sive resources, all aiming to bolster the chances for successful development in children. The Harlem Achievement Zone, created by Geoffrey Canada, and related programs funded by Promise Neighborhood grants take a very comprehensive approach. Writing about the Harlem Achievement Zone, Tough (2009) described Canada’s comprehensive approach to aca demic success for the highrisk children of Harlem in the title of his book Whatever It Takes.

Comprehensive interventions reflect an implicit, and sometimes explicit, recognition that the com plicated pathways of risk and adaptation in human development require a multifaceted effort to redirect the course of development. The aim of such pro grams is synergy, to generate a positive cascade of interactions across domains and systems of a child’s life (Masten, 2011). A recent issue of the Future of Children edited by Haskins, Garfinkel, & McLana han (2014) focused on twogeneration mechanisms of intervention and policy that target parents and children.

International efforts to promote healthy devel opment through humanitarian aid and economic investment also increasingly focus on multiple sys tems, attempting to align vertical or horizontal sys tems for greater impact (Leckman, PanterBrick, & Salah, 2014; Lundberg & Wuermli, 2012; Masten, 2014a). Vertical alignment strategies can span many levels of embedded systems, from a child to public policies. At a more basic level, interventions can focus on twogeneration approaches that encom pass parent and child in an effort to generate more synergy. Horizontal alignment includes attempts to encompass multiple systems of child or family

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life, such as housing, schooling, and health care. Humanitarian interventions are increasingly aligned to provide a combination of education, housing, health and nutrition, and other essentials to parents and children in the same families.

Human individuals are complex adaptive sys tems connected to many other complex adaptive systems. The goals of facilitating specific changes in complex adaptive systems is remarkably chal lenging, although this complexity offers many avenues for intervention. Complex adaptive sys tems have many interacting components, includ ing many independent individuals who may act independently in ways that collectively impact systems at higher levels of organization. Efforts to change systems in a specific direction, whether one is aiming to promote mental health in chil dren, alter a nation’s health care system, promote economic growth, or reform education, face great opportunities and challenges related to the nature of multilevel dynamics across levels in complex adaptive systems. Wellintended programs can have unanticipated consequences because of resistance, cascades, or counterregulatory processes, among many other influences (National Research Coun cil & Institute of Medicine, 2015; Reiman, Rollen hagen, Pietikainen, & Heikkila, 2015). Prevention and intervention sciences show progress in imple menting a developmental perspective, but much work remains to be done.

conclusions anD futurE DirEctions

Over the past five decades, theory, research, and practice in mental health have been transformed by the infusion of a developmental systems perspective. Developmental systems theory has permeated devel opmental science and its applications in multiple fields. This framework has many implications for conceptualizing and addressing psychopathology, with respect to its origins, assessment, classification, prevention, treatment, and policy.

Results of this transformation, often described as the emergence of DP, were evident first in work focused on children and youth. This early focus on young people probably occurred because so many early proponents of this perspective were

investigating adaptation and the etiology of disor ders in childhood and adolescence, although there were certainly champions of a lifespan perspective early on (Sroufe & Rutter, 1984; Zigler & Glick, 1986). The core principles of DP apply as well to later life as they do to early development. DP is an integrative developmental framework for the entire lifespan (Cicchetti, 2016b; Masten, 2006; Rutter, 2013; Rutter, KimCohen, & Maughan, 2006). A rich developmental perspective on psychopathology during the adult years, particularly in middle and later life, remains a work in progress.

Nonetheless, lifespan applications of develop mental perspective on psychopathology and men tal health are growing (Achenbach & Rescorla, 2016; Cicchetti, 2016b; Cummings & Valentino, 2015). One of the most important areas of expand ing research in DP is motivated by identifying the linkages between early experience and later health, including mental health. There is growing attention to childhood roots of health disparities in adulthood and the lifelong consequences of early toxic stress (Hochberg et al., 2011; Shonkoff, Boyce, & McEwen, 2009; Shonkoff & Garner, 2012). Concomitantly, a compelling case is emerg ing for investments in childhood with the explicit goal of promoting health and preventing health disparities in adulthood (e.g., Campbell et al., 2014; Shonkoff, 2011).

Research also is rapidly expanding to encom pass multiplelevel processes that shape pathways toward and away from mental health (Cicchetti, 2013b, 2016b; Cicchetti & Toth, 2009; Masten & Cicchetti, 2016). This expansion includes research on epigenetic processes, spurred by technological advances in assessing the human genome and gene expression (Addington & Rapoport, 2012; Boyce & Kobor, 2015; Brookes & Shi, 2014; Jaffee et al., 2013; Meaney, 2010; Roth, 2013). Further, there is growing attention to interactions of individuals with families, schools, and cultural systems as they shape development and prevent or foster competence, resilience, and psychopathology (Chen & Liu, 2016; DeaterDeckard, 2013; Durlak, Domitrovich, Weiss berg, & Gullotta, 2015; Kerig, 2016; Masten, 2014c; Masten & Monn, 2015; Mayes & Lewis, 2012; MottiStefanidi, 2015).

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In other words, ideas about the importance of multilevel interactions for development, norma tive and deviant, are plentiful. Less common are detailed delineation of processes that account for developmental cascades or diverse pathways. Similarly, although it is commonly recognized that experiments to prevent or mitigate psychopa thology offer powerful strategies for testing causal hypotheses about processes in the development of competence, resilience, and psychopathology, many processes remain untested to date. There fore, there is ample uncharted territory for devel opmental investigators to study. It is a time of challenges and opportunities in the development of DP.

Future advances in developmental theory and evidence pertinent to psychopathology will depend on a new generation of scholars and practitioners who do not shy away from the com plexity of human development and its variations, who are comfortable with collaboration across disciplines, and who move well across the bidirec tional bridges spanning real world contexts and university laboratories. It is impossible for a single individual to master all the skills needed to gain traction along the pathways of DP. Therefore, it is crucial that training for research and practice provide experience with multidisciplinary col laboration as well as multiple perspectives on development.

There is a parallel need for developmental and interdisciplinary training of clinicians on the front lines of evaluation and intervention. These clini cians are expected to address the needs of individu als with issues related to psychopathology at many points along the pathways of adaptive or maladap tive behavior. Developmental knowledge and per spectives could enhance the work of professionals across the lifespan: before birth, early in develop ment, in adulthood, and in later periods of life. Cur rently, the knowledge base on DP during the early decades of life is more advanced, but that is likely to change rapidly as a lifespan developmental perspec tive gains traction. The future looks bright for devel opmentally informed theory, research, and practice that aims to understand, identify, prevent, and treat psychopathology.

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