Psychosocial Interventions for Genetically Influenced Problems in Childhood and Adolescence

How to weigh genetic factors while choosing the best psychosocial interventions

Psychosocial Interventions for Genetically Influenced Problems in Childhood and Adolescence explores empirically supported psychosocial interventions in light of our current understanding of the genome. It considers how interventions may be modified and enhanced as the products of genomic research continue to expand – and why they offer the most promise for making substantial gains in treatment and prevention.

Providing a clear, accessible assessment of our current knowledge, both of the genome and evidence based treatments, Psychosocial Interventions for Genetically Influenced Problems in Childhood and Adolescence provides practical advice to clinicians,policy makers, and others invested in treating young people who present with a variety of conditions including anxiety, depression, ADHD, autism, substance abuse, and dyslexia. Rende discusses the current understanding of genetic etiology of psychopathology, and explores the support, or lack thereof, for various modes of treatment in light of new genomic knowledge. The overall premise is that our advances in genetics will be put to best therapeutic use by fueling translational psychosocial interventions.

Key points raised include:

• The need for treating children suffering today, rather than waiting for a biological "magic bullet"
• Discussion of how empirically-supported interventions mesh with genetic vulnerabilities
• Ways in which interventions may change as genetic research continues

Preface ix

Acknowledgments xiii

1 Prelude: Great Expectations 1

Aren’t Magic Bullets Possible? 10

So Aren’t Similar Successes Imminent? 11

What Will be the Yield of Genetic Research in Terms of Intervention? 14

Where Will All of This Lead? 17

2 Autism Spectrum Disorder: Can We Use Environmental Intervention to Reprogram Genetic Effects? 21

Genomic Approaches to ASD 24

Is There a New Fundamental Etiological Model of ASD? 27

Genomics, Complex Disorders, Hype, and Hope 30

Using the Environment to Reprogram the Effects of Genes 34

What’s Next? 41

References 44

3 Attention-Deficit/Hyperactivity Disorder and Reading Disorder: Illuminating How the Environment Shapes Highly Heritable Disorders 45

Genetic Models of ADHD and RD: Why Has Gene Discovery Been So Elusive? 47

Why Would the Environment be Important for Highly Heritable Disorders? 51

More Nuanced Models of Gene–Environment Interplay for ADHD and RD 54

The Promise of Psychosocial Interventions 59

Concluding Remarks 66

References 67

4 Conduct Problems and Substance Use: The Underappreciated Role of Shared Environmental Influences 69

Genetic Models of CP and SU 73

The Impact of Shared Environmental Influences 75

Getting Molecular About the Environment 81

A Developmental Gene–Environment Model 86

Family-Based Interventions and Genetic Epidemiology 90

Summary and Looking Ahead 95

References 96

5 Depression: The Importance of the Family as a Context for Gene Expression 99

High-Risk Studies of Offspring of Depressed Parents 101

Genetic Models of MDD 104

GxE Interaction and Depression 108

Depression in Adolescents and Children 112

Who Should be Treated in Families at Risk? 116

Implications of the Parental Treatment Studies 120

References 124

6 Pediatric Bipolar Disorder: Complex Phenotypes, Genotypes, and Environments 127

Current Thinking on the Genetics of BP 128

Is PBD an Early Manifestation of Genetic Risk to BP? 130

The Clinical Complexity of PBD 138

Emphasizing Psychosocial Interventions for PBD 143

Conclusions 148

References 150

7 Pediatric Anxiety Disorders: The Intersection of Genes and Environments 153

The Heterogeneity of Anxiety Disorders: Focusing on Anxiety-Related Behaviors in Childhood and Adolescence 154

Anxiety in the Family: The Intersection of Genes and Parenting 164

Genes, Environment, and Anxiety: Newer Methdologies 168

Concluding Remarks 174

References 177

8 The Future: Why Psychosocial Intervention Will Matter Even More 179

Future Genetic Research and the Conceptualization of Disorders 183

Genomics May Refine Diagnosis and Point to Tailored Interventions 188

Genomics Will Lead to Earlier Intervention 191

Genomics Will Accelerate the Development of Psychosocial Interventions 193

Will We Discover Magic Bullets? 194

Author Index 197

Subject Index 203

Richard Rende, Ph.D., is a nationally and internationally recognized researcher who combines expertise at the intersection of developmental psychopathology and developmental behavioral genetics. As Associate Professor of Psychiatry and Human Behavior at Alpert Medical School of Brown University, he has been awarded multiple grants from 4 branches of the National Institutes of Health. He is the founder of Social Behavioral Research Applications (SBRA), a unique consultation service for industry, government, and academics. Rende developed the Red-Hot Parenting blog for Parents.com and a monthly column for the New Bedford Standard Times. His work has been featured on NPR, ABC News, The Huffington Post, Yahoo!, Time.com, CNN.com, and MSNBC.

A guide to weighing the genetic factors when selecting effective psychosocial interventions

Psychosocial Interventions for Genetically Influenced Problems in Childhood and Adolescence offers an accessible guide and well-researched assessment of the most current knowledge, both of the genome and evidence-based treatments, for treating young people who present with a variety of conditions such as anxiety, depression, ADHD, autism, substance abuse, and dyslexia. The text also contains information on how interventions may be adapted as the products of genomic research continue to develop. Written for clinicians, policymakers, and others invested in working with youth, this important book is filled with up-to-date research findings, practical advice, effective interventions, and illustrative examples.

Designed as a useful resource, the book puts the focus on what professionals can do right now to improve the lives of children and adolescents, using environmental designs combined with the growing sophistication about how genes have their influence. The book includes a valuable and illuminating discussion of how empirically-supported interventions mesh with genetic vulnerabilities.

The author also reveals when “reprogramming” genetically influenced pathways via the environment are most appropriate and explores how the effects of genes may be circumvented or shaped. The author includes compelling examples in which genes and environment seem to be inextricably linked, but in surprising ways that can direct new ways of thinking about changing the result of that mix by manipulating the environment.

While the burgeoning field of genomic research holds great promise for the future, this important text shows how today’s clinicians can use the emerging knowledge about genetics and integrate it with non-biological approaches to effective treatment.