Grand Challenges in Child and Neurodevelopmental Psychiatry

Humans have known for at least 3500 years that the functioning of the brain affects behavior, and that damage to the brain causes behavioral malfunctions (Breasted, 1930). Around 2400 years ago, Hippocrates taught that “from the brain, and from the brain only, arise our pleasures, joy, laughter and jests, as well as our sorrows, pains, griefs, and tears.” He was also aware that “...all the most acute, most powerful, and most deadly diseases, and those which are most difficult to be understood by the inexperienced, fall upon the brain” (Adams, 1939, p.360). Those who contribute to modern understanding of neurodevelopmental psychiatry are not “the inexperienced”, but experts in a wide range of disciplines and areas of knowledge – as, indeed, they need to be. As Steven Rose put it, “Perhaps in a sense it (the brain) is the greatest challenge for science as a whole, beyond moon landings, the ultimate particles of the physicist and the depths of astronomical space” (Rose, 1973). Or as James Watson joked: “The brain boggles the mind” (Watson, 1992). In confronting this challenge, we have several resources. First, more than a 100 years of painstaking study of “normal” development, set on a firm scientific footing by William Preyer (1841–1897) and others, has led to the current explosion of work exploiting methods such as neuroimaging to map changes in mental, behavioral, and emotional capacities onto changes in the brain. This work has given us not only invaluable knowledge about psychological development, but also a sense of what is “normal” at different developmental stages in different areas of functioning, such as intelligence, self-regulation, and social functioning. This body of knowledge can help us to evaluate the functioning of children who come to the clinic in need of help. Second, psychiatry is beginning, at last, to take seriously the developmental nature of psychopathology. A recent national epidemiological study of adults In the United States reported that “Half of all lifetime cases start by age 14 years and three fourths by age 24 years”. (Kessler et al., 2005) This is a misestimate, caused by relying on retrospective recall by adults of their lifetime history of mental illness. Prospective studies beginning in childhood set the onset of most psychiatric disorders (apart from the dementias) in the first two decades of life (Jaffee et al., 2005). The first grand challenge is thus to link what we learn about the developing brain to the earliest appearance of symptoms psychiatric disorder. In his book “The Development of Psychopathology: Nature and Nurture” (Pennington, 2002), Bruce Pennington posed the question “Why do we need a developmental understanding of psychopathology?”, and gave four answers that provide a template for our program of work for this journal.