Citation

McCrory EJ, Viding E. Dev. Psychopathol. 2015; 27(2): 493-505.

Affiliation

University College London.

Copyright

(Copyright © 2015, Cambridge University Press)

DOI

10.1017/S0954579415000115

PMID

25997767

Abstract

Maltreatment in childhood is associated with a significantly increased likelihood of psychiatric disorder that endures across the life span. If disorders emerge they tend to be more severe and less responsive to treatment. We introduce the concept of latent vulnerability as a way of conceptualizing the nature of this psychiatric risk. We argue that vulnerability to mental health problems can be understood as changes in a suite of neurocognitive systems that reflect adaptation or altered calibration to early neglectful or maltreating environments. Altered threat processing is presented as one exemplar candidate system. Heightened neurocognitive vigilance to threat is argued to reflect a calibration to an early at-risk environment that becomes maladaptive (and instantiates vulnerability) in the longer term. Other neurocognitive domains, including reward and memory processing, represent equally promising candidates for indexing latent vulnerability and warrant future enquiry. We suggest that the operationalization of latent vulnerability has the potential to guide a preventative psychiatry approach. Intervention currently occurs at two stages when maltreatment is confirmed: first, by addressing issues of risk; and second, by providing clinical intervention if a child meets criteria for psychiatric disorder. We argue that indexing latent vulnerability represents a third intervention opportunity, with the potential to target an indicated prevention approach for the most vulnerable children, offsetting risk trajectories before psychiatric disorders emerge.

Language: en