Contextual risk and child psychopathology

In developmental psychopathology it almost goes without saying that contextual risk factors do not occur in isolation and that it is the combination of various risk factors that portends numerous negative child outcomes. Despite this, the body of literature that examines the relation between multiple risk exposure and child psychopathology using a cumulative risk approach is still relatively small. Even when studies use a cumulative risk approach they rarely test properly whether the relation between cumulative risk and child psychopathology is linear or nonlinear, with consequences for both theory development and intervention design: if cumulative risk impacts problem behavior in a positively accelerated exponential manner, for instance, it means that exposure to multiple risk is especially difficult to manage as problem behavior accelerates at a critical level of risk. Furthermore, few studies have actually examined factors that protect from negative outcomes in those exposed to cumulative risk and even fewer have explored cumulative protection in relation to cumulative risk. On the other hand, there is the view that a cumulative risk approach at least implicitly assumes that risk factors are, in essence, interchangeable. According to this view, the importance of testing for specificity should not be underestimated. Finally, the renewed interest in the role of neighborhood risk in child development has initiated a lively debate as to whether contextual risk should be operationalized at the family or the area level. In this letter I discuss these issues, and offer some suggestions as to how future research can address them.