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破坏性行为问题的发展起源:“原罪”假说、表观遗传学及其对预防的影响。

Developmental origins of disruptive behaviour problems: the 'original sin' hypothesis, epigenetics and their consequences for prevention.

机构信息

International Network for Early Childhood Health Development, University College Dublin, Ireland.

出版信息

J Child Psychol Psychiatry. 2010 Apr;51(4):341-67. doi: 10.1111/j.1469-7610.2010.02211.x. Epub 2010 Feb 8.

Abstract

This paper reviews publications on developmental trajectories of disruptive behaviour (DB) problems (aggression, opposition-defiance, rule breaking, and stealing-vandalism) over the past decade. Prior to these studies two theoretical models had strongly influenced research on DB: social learning and disease onset. According to these developmental perspectives, children learn DB from their environment and onset of the disease is triggered by accumulated exposition to disruptive models in the environment, including the media. Most of the evidence came from studies of school age children and adolescents. Longitudinal studies tracing developmental trajectories of DB from early childhood onwards suggest an inversed developmental process. DB are universal during early childhood. With age, children learn socially acceptable behaviours from interactions with their environment. A 'disease' status is given to children who fail to learn the socially acceptable behaviours. The mechanisms that lead to deficits in using socially accepted behaviours are strongly intergenerational, based on complex genetic and environmental contributions, including epigenetic mechanisms. Prevention of these deficits requires early, intensive and long-term support to parents and child. Newly discovered epigenetic mechanisms suggest that intensive perinatal interventions will have impacts on numerous aspects of physical and mental health, including DB. This review also concludes that: a) subtypes of disruptive behaviours should not be aggregated because they have different developmental trajectories and require specific corrective interventions; b) the overt-covert and destructive-nondestructive dimensions appear the most useful to create DB subtypes; c) overt DB onset before covert DB because the latter require more brain maturation; d) DB subtype taxonomies are more useful for clinicians than developmental taxonomies because the latter are post mortem diagnoses and clinicians' retrospective information is unreliable; e) we need large-scale collaborative preventive experimental interventions starting during early pregnancy to advance knowledge on causes and prevention of DB problems.

摘要

本文回顾了过去十年中关于破坏性行为(DB)问题(攻击、反抗、违反规则和偷窃破坏)发展轨迹的出版物。在这些研究之前,有两个理论模型对 DB 研究产生了强烈影响:社会学习和疾病发作。根据这些发展观点,儿童从环境中学习 DB,疾病的发作是由环境中破坏性模型(包括媒体)的累积暴露引发的。大多数证据来自对学龄儿童和青少年的研究。追踪从幼儿期开始的 DB 发展轨迹的纵向研究表明存在相反的发展过程。DB 在幼儿期普遍存在。随着年龄的增长,儿童通过与环境的互动学习社会可接受的行为。那些未能学习社会可接受行为的儿童被赋予“疾病”状态。导致社会可接受行为使用缺陷的机制具有强烈的代际性,基于复杂的遗传和环境贡献,包括表观遗传机制。预防这些缺陷需要早期、密集和长期的父母和儿童支持。新发现的表观遗传机制表明,密集的围产期干预将对身心健康的许多方面产生影响,包括 DB。本综述还得出结论:a)破坏性行为的亚型不应聚合,因为它们具有不同的发展轨迹,需要特定的纠正干预;b)外显-内隐和破坏-非破坏维度似乎是创建 DB 亚型最有用的;c)外显 DB 先于内隐 DB 发作,因为后者需要更多的大脑成熟;d)DB 亚型分类对于临床医生比发展分类更有用,因为后者是死后诊断,而临床医生的回顾性信息不可靠;e)我们需要在怀孕早期开始大规模的合作预防实验干预,以推进对 DB 问题的原因和预防的认识。

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