The confluence of mental, physical, social, and academic difficulties in middle childhood. I: exploring the "head waters" of early life morbidities.

OBJECTIVE To present the conceptual and methodological backgrounds for development of the MacArthur Assessment Battery for Middle Childhood and one of its constituent instruments, the MacArthur Health and Behavior Questionnaire (HBQ). METHOD As a component of HBQ development, research addressing "developmental psychopathology" as a nosological category of human disorder was reviewed. Such research bears, as its conceptual legacy, the strengths and frailties of the nosology from which the category was derived. RESULTS Defining developmental psychopathology has done much to foster psychiatric and medical awareness of the particular dilemmas and problems intrinsic to childhood psychopathology. On the other hand, its delineation has obscured the tendency for psychiatric morbidities to emerge gradually along trajectories of development, to involve interactions among organismic and contextual factors, and to represent "confluences" of childhood difficulties suggesting common, less distinctive origins among psychiatric and biomedical disorders. The recognizable psychopathology of adolescence is most often preceded by protean manifestations of early difficulties resulting from the conjoint operation of child-specific vulnerabilities and context-derived risk factors. Co-occurrences of mental, physical, social, and academic difficulties in children's lives are more frequently the rule than the exception, and isolated, singular psychopathology is less common in childhood than the prevailing diagnostic nosology may imply. CONCLUSIONS The MacArthur Assessment Battery represents an effort to assemble, in a single set of instruments, measures of child, context, and health risk factors for the prevalent morbidities of middle childhood. The HBQ, a component of the Battery, is a parent- and teacher-report instrument that assesses mental health, physical health, social, and school adaptation in 4- to 8-year-old children.