Nigg Joel T, Craver Lindsay
Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
J Child Psychol Psychiatry. 2014 May;55(5):446-7. doi: 10.1111/jcpp.12237.
In the 1950's, many experts believed hyperkinesis was a neurotic reaction to inner conflicts arising from early family experiences. In the 1990's, many experts believed ADHD to be 'genetic' (without a mechanistic explanation of what that meant). Both views appear naïve today in a scientific world grappling with the complexity of highly plastic gene expression, gene x environment interplay, and epigenetic, context-dependent emergence of psychopathology. Both views also fail to account for the uncomfortable fact that ADHD is also associated with social disadvantage - a level of analysis required in a developmental psychopathology approach. That developmental psychopathology approach, pioneered a generation ago, initially emphasized the accumulation of risk and protective factors, and emerged in a contemporary systemic approach that seeks to determine whether it is risk accumulation (e.g., allostatic load) or specific risk factors (e.g., family process) that mechanistically shape psychopathology. Despite the prominence of the developmental psychopathology perspective, the social context of ADHD is surprisingly neglected today. Both Russell et al. (this issue, 2014) and Larsson et al. (this issue, 2014) take strides toward remedying this state of affairs.
在20世纪50年代,许多专家认为多动症是对早期家庭经历所引发的内心冲突的一种神经症反应。在20世纪90年代,许多专家认为注意力缺陷多动障碍是“遗传性的”(却没有对其含义作出机制性解释)。在当今这个正在应对高度可塑性基因表达、基因与环境相互作用以及精神病理学的表观遗传、情境依赖性出现等复杂性的科学世界里,这两种观点如今看来都很幼稚。这两种观点也都没有考虑到这样一个令人不安的事实,即注意力缺陷多动障碍还与社会劣势相关——而这是发展性精神病理学方法所要求的一个分析层面。大约一代人之前开创的那种发展性精神病理学方法,最初强调风险和保护因素的积累,并在一种当代系统性方法中得以发展,这种系统性方法试图确定是风险积累(例如,应激负荷)还是特定风险因素(例如,家庭过程)在机制上塑造了精神病理学。尽管发展性精神病理学观点很突出,但如今注意力缺陷多动障碍的社会背景却出人意料地被忽视了。拉塞尔等人(本期,2014年)和拉尔森等人(本期,2014年)都在努力纠正这种状况。