Research in the field of genomics has answered many questions — but as far as the psychological conditions children and adolescents face, it has left many more unanswered. In his new book, Psychosocial Interventions for Genetically Influenced Problems in Childhood and Adolescence, Richard Rende explores the most recent developments.
Rende, a professor at Brown University’s medical school, looks at which genes may play a role in psychological disorders common in youth, as well as which interventions seem promising. What stands out, however, is that Rende emphasizes, too, the limitations of using genomics. The field in itself is not, he warns, a panacea.
Focusing on a range of issues including ADHD, pediatric bipolar disorder, autism, and substance abuse, Rende begins by exploring the seductive nature of genomics. We may search for “magic bullet solutions,” he writes, but these simply do not exist. For one thing, Rende reminds us, “even if the genetic locus for a single-gene disorder has been identified, the translation to intervention is clearly not an easy step.” Genomics is, right now, too complicated for even experts to know what solutions it might bring to genetically influenced behaviors.
But we can, Rende writes, make considerable improvements in the way we treat these conditions if we use findings from genomics to supplement psychosocial treatment methods. For children diagnosed with autism spectrum disorder, for instance, practitioners can use the Early Start Denver Model, which involves focusing on positive affect, shared engagement, and affect-based relationship dynamics to improve the expression of genes linked to things like social and relational functioning. By focusing on environmental factors, we can perhaps see improvements in the phenotypic expression of what Rende calls the “presumed underlying genetic liability.”
Environmental factors, Rende emphasizes, are key. When it comes to ADHD, he writes, “heritability is defined in part by context and technically may embed gene-environment interplay.” Rather than pin everything on a genetic blueprint, we must focus on changing the psychosocial environment for a child suspected of having ADHD.
When it comes to drugs and alcohol, and how likely it is for a young person to progress from initiation to substance abuse, Rende provides more examples. “What is noteworthy here,” he writes, “is the idea that genetically informative studies have yielded a consensus that implicates environmental risk processes anchored at a specific developmental stage.” That in turn lets us know that “psychosocial intervention may be particularly effective in reducing substance use in early adolescence.” Of these psychosocial interventions is the Family Check-Up, which highlights important parenting skills like effective monitoring and limit setting — skills that have been empirically shown to be factors in a person’s early substance use.
In the case of major depressive disorder manifesting in adolescents, a condition that is “moderately heritable,” Rende warns us to be cautious with pharmacological interventions, writing that they can “in some cases can make things worse.” Here again, we should look to psychosocial interventions — but in this case, aimed at the parents. Rende references one study where when parents responded well to treatment — when their symptoms lifted and their depression remitted — their children showed marked improvements as well.
As for the highly misunderstood and often complex pediatric bipolar disorder, and even more controversial new disruptive mood dysregulation disorder, Rende again offers sound advice: that “psychosocial interventions provide feasible treatment options that are safe for youth.” Among these is Family-Focused Therapy for Adolescents, which in a recent study resulted in youth who “recovered faster from their baseline levels of depression.” This study, Rende writes, “illustrates what we typically see when we evaluate psychosocial interventions. They are not easy to administer, but they have positive effects — and no side effects.”
Meanwhile, Rende points out, abusive or neglectful parenting can influence gene expression. He refers to “the increasing evidence that maltreatment may interact with genes and alter the expression of genes.” Luckily, psychosocial interventions to prevent the recurrence of abusive and neglectful parenting have shown promise.
More than a decade since the Human Genome Project, Rende reminds us that “genetic findings are not fundamentally rewriting our diagnostic manuals by focusing on core causes rather than descriptive pictures of symptoms.” Genomics is not the one and only answer. Still, clinicians who seek to think beyond the “categorical structure” that underscores the DSM will be drawn to Rende’s nuanced and well-researched exploration.
Psychosocial Interventions for Genetically Influenced Problems in Childhood and Adolescence
Wiley, September 2014
Paperback, 240 pages