Journal of Consulting and Clinical Psychology
2002, Vol. 70, No. 1, 124 –128
Copyright 2002 by the American Psychological Association, Inc.
0022-006X/02/$5.00 DOI: 10.1037//0022-006X.70.1.124
Clinical Adolescent Psychology: What It Is, and What It Needs to Be
Laurence Steinberg
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Temple University
This commentary on the special section on clinical adolescent psychology (G. Holmbeck & P. Kendall,
2002) reviews and critiques the conceptual and empirical articles that this compilation comprises. As
articulated in the conceptual contributions to this collection, two fundamental principles should guide
research on the etiology, prevention, and treatment of psychological disorder and dysfunction during
adolescence: First, drawing on the field of developmental psychopathology, the study of clinical
adolescent psychology should focus on the trajectories of disorder that precede, characterize, and follow
adolescence. Second, drawing on the literature on normative adolescent development, the study of
clinical adolescent psychology must proceed with an explicit recognition of the unique biological,
cognitive, psychosocial, and contextual features that define adolescence as a developmental period. The
empirical contributions to this compilation are evaluated with respect to the extent to which they reflect
these tenets. Although the study of clinical adolescent psychology, as evidenced by this collection of
articles, is appropriately grounded in the broader enterprise of developmental psychopathology, less
progress has been made with respect to the integration of the study of clinical phenomena in adolescence
with the study of normative adolescent development.
clinical phenomena in the context of adolescence as a developmental period, rather than the study of clinical phenomena among
individuals who merely happen to be older than children and
younger than adults. The latter is what the field has been doing.
The former is what the field should be doing. The distinction
between the two is both subtle and profound, and it has important
implications for the ways in which we conceive, study, diagnose,
and treat emotional and behavioral problems among young people.
The current set of articles helps to focus attention on both what
is, and what is not, the sort of research that is appropriately
classified as clinical adolescent psychology as I have defined it in
the preceding paragraph. The first four articles in the collection
provide the theoretical and conceptual underpinnings of this
emerging field, whereas the five empirical reports that follow
provide examples of what research that adheres to at least some of
these principles might look like. I say “some,” and not “all,” of
these principles because, as I shall make clear, the five studies are
truer to some of these principles than they are to others. Thus,
although the empirical reports nicely illustrate the best of what the
current study of clinical adolescent psychology has to offer, their
limitations also reveal how much further our research needs to go
to fulfill the expectations set forth in the four foundational articles
by Holmbeck and Kendall (2002), Cicchetti and Rogosh (2002),
Weisz and Hawley (2002), and Cauce et al. (2002).
Let me begin by elucidating what I think are the main points
raised by the first four articles. Holmbeck and Kendall (2002), in
their introduction to the issue, “focused on the interface between
the fields of developmental and clinical psychology” (p. 3) and use
this as a jumping-off point to raise seven specific questions that are
at the heart of the study of clinical adolescent psychology: (1) Why
does age of onset vary across disorders?, (2) Do the precursors of
child-onset versus adolescent-onset disorders differ?, (3) Does
symptom presentation change between childhood and adolescence
(and I would add, between adolescence and adulthood)?, (4) How
is adaptation affected by mastery of the developmental tasks of
For centuries, the study of psychological maladjustment and the
study of adolescent development have been inextricably linked,
both conceptually and empirically. Philosophers, clinicians, scientists, and virtually all observers of human behavior have long noted
that adolescence is a period of special significance for the emergence or intensification of various forms of emotional and behavioral disorder, including many internalizing problems (e.g., depression, eating disorders), externalizing problems (e.g., delinquency,
violence), and addictive disorders (e.g., alcohol abuse and dependency, drug abuse and dependency). Although scholars may disagree about why adolescence is so important to the study of clinical
phenomena, there is little dispute over whether it is important.
Indeed, the list of clinical phenomena that are not primarily associated with adolescence (e.g., bipolar illness, autism, dementia) is
probably shorter than the list of clinical phenomena that are.
To the extent that the designation “clinical adolescent psychology” merely describes the study of psychological disorder among
individuals between the ages of 10 years and 20 years, it is little
more than a label for a field that has existed for some time but that
was unaware of its own existence. My suspicion is that the editors
of this special issue had something else in mind when they decided
to invite the series of articles contained herewith, however. Rather
than use the label “clinical adolescent psychology” to describe an
already extant enterprise, they have coined the term to draw
attention to a way of thinking about clinical phenomena that
reflects a paradigmatic shift—a shift away from seeing psychological disturbance during adolescence as either the grown-up
version of childhood disorder or the immature or prodromal counterpart of adult pathology. As reflected in this compilation of
articles, “clinical adolescent psychology” refers to the study of
Correspondence concerning this article should be addressed to Laurence
Steinberg, Department of Psychology, Temple University, Philadelphia,
Pennsylvania 19122. E-mail: lds@temple.edu
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SPECIAL SECTION: CLINICAL ADOLESCENT PSYCHOLOGY
adolescence?, (5) What developmental pathways in childhood
affect the likelihood of psychopathology in adolescence?, (6) What
developmental and contextual processes mediate or moderate the
links between socialization and adolescent adjustment?, and (7)
Does treatment effectiveness vary as a function of the client’s
developmental level?
This introductory essay leads nicely into the overview of the
field of developmental psychopathology provided by Cicchetti and
Rogosh (2002), who note that “a developmental [psychopathology] approach requires that an issue of interest be conceptualized in
terms of how it would be manifested in view of the particular
developmental capacities and attainments of the adolescent period
of development” (p. 7). Their argument is that clinical phenomena
during adolescence must be understood against a backdrop of
normative adolescent development and studied with specific reference to the developmental challenges of the period. Doing so
requires that investigators and practitioners focus on the developmental trajectories of disorder to understand how the nature, antecedents, correlates, and consequences of various types of dysfunction are transformed as individuals move into, through, and
out of the adolescent period. Cicchetti and Rogosh’s overview
reminds us that it is important to stress the “developmental” in
developmental psychopathology, for it helps push us to see adolescence as a period of development, and not simply as an age
range.
This theme—attempting to understand what it is about adolescence as a developmental period that affects the expression,
course, and treatment of psychological disorder—is front and
center in the article by Weisz and Hawley (2002). Their systematic
and trenchant examination of the treatment-outcome literature asks
whether and to what extent treatments for various psychological
disorders among adolescents actually take into account the fundamental features of adolescent development. Thus, they ask whether
cognitive-based treatments factor in the development of abstract
reasoning, a hallmark of adolescent intellectual development, or
whether our understanding of puberty and its impact on psychological functioning finds its way into therapeutic approaches for
the treatment of internalizing or externalizing problems. Their
conclusion is worrisome, for it reveals just how little of the kind of
integration of developmental and clinical psychology called for by
Holmbeck and Kendall (2002) has found its way into the treatment
community or, for that matter, into the community of researchers
who study treatment effectiveness. For the most part, the therapies
directed at adolescents with psychological problems look no different than those directed at children or at adults who suffer from
the same maladies.
One issue not discussed by Weisz and Hawley (2002), but which
strikes me as a crucial consideration, is the extent to which the
absence of developmentally sensitive treatments for adolescents is
as much a reflection of the absence of a developmentallyappropriate taxonomy of disorder as it is a reflection of a lack of
developmental thinking within the treatment community. Perhaps
part of the reason practitioners and developers of clinical interventions for adolescents do not think developmentally is that the
categorization and definition of disorder they are responding to is
itself so adevelopmental. After all, the criticism that Weisz and
Hawley quite rightly aimed at the developers of interventions
applies in spades to those who have developed the Diagnostic and
Statistical Manual of Mendal Disorders (e.g., 4th ed., American
125
Psychiatric Association, 1994) and other diagnostic systems,
which, as Jensen and others have pointed out (Jensen & Hoagwood, 1997), force practitioners to apply a taxonomy of disorder
developed from clinical observation of adults to children and
youth. One wonders whether the sort of changes that Weisz and
Hawley call for in the way we think about treatments are likely to
occur without a concomitant transformation in the way we think
about disorder.
The Cauce et al. (2002) contribution broadens the discussion of
clinical adolescent psychology as an enterprise. In addition to
developmentally sensitive research on the diagnosis and treatment
of mental disorder during adolescence, these authors call for systematic services research, a woefully understudied area among
psychological researchers, particularly among those who study
children and youth. It goes without saying that the sorts of improvements in the design of treatment protocols for adolescents
with psychological problems called for by Weisz and Hawley
(2002) will do little to improve the mental health of adolescents if
young people who need treatment do not receive it. Yet, as Cauce
et al. (2002) point out, the field of services research has not looked
systematically at adolescents as consumers of psychological services, and they persuasively argue that the study of clinical adolescent psychology should include studies of which adolescents
actually receive mental health services, of the processes through
which adolescents actually obtain mental health services, of the
impediments to mental health service delivery to adolescents, and
of the range of services, including services from nontraditional
providers, that adolescents actually receive. As a developmental
period, adolescence is a fascinating one within which to study
service utilization, because adolescents are autonomous enough to
seek out mental health services on their own but often dependent
on adults to actually gain access to the services they seek.
Implicit in Cauce et al.’s (2002) argument is the notion that
mental health services research, like research on etiology and
treatment, must be designed with adolescence as a developmental
period in mind; it will be of little value to simply replicate extant
services research on adults with samples of younger individuals
without taking into account developmental differences between
adolescents and adults and attempting to understand how these
differences affect help-seeking behavior. But research on help
seeking among adolescents must attend to the importance of ethnicity as well as to the importance of development. Given that a
sizable proportion of the adolescent population in the United States
is from ethnic minority backgrounds, and in light of the fact that
ethnic minority youth are disproportionately likely to need mental
health services but disproportionately unlikely to receive them, any
research on services provision and utilization must seek to understand the causes of, and remedies for, problems of differential
access.
Two overarching principles emerge from these four stagesetting articles that, in my view, are fundamental to the study of
clinical adolescent psychology. First, the study of clinical adolescent psychology requires some understanding of the trajectories of
disorder that precede, characterize, and follow adolescence. Second, the study of clinical adolescent psychology must proceed with
an explicit recognition of the unique biological, cognitive, psychosocial, and contextual features that define adolescence as a developmental period. The first principle is central to the study of
developmental psychopathology; the second is central to the study
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126
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of normative adolescent development. Implicit in Holmbeck and
Kendall’s (2002) seven questions is a call for research that incorporates both points of view.
The five empirical reports that complete this compilation represent research from some of the top groups in the country currently studying clinical adolescent psychology, and in this sense,
they provide the perfect opportunity to ask how well the best of
what is being done in this area meets the implicit standards set out
in the first four articles of this issue. I think it is fair to say that the
reports deliver more on the developmental psychopathology front
than they do on the adolescent development front. Indeed, the
contrast between the clear and incontrovertible influence on contemporary adolescent clinical psychology of the developmental
psychopathology perspective, as articulated by Cicchetti and Rogosh (2002), and the surprising absence of attention to the fundamentals of normative adolescent development is readily apparent
in the present set of empirical articles. Thus, the good news is that
researchers studying clinical phenomena in adolescence are taking
seriously the need to understand developmental trajectories of both
individuals (e.g., Chassin, Pitts, & Prost, 2002) and groups (Garber, Keiley, & Martin, 2002), to examine the interplay of risk and
protective factors (Stouthamer-Loeber, Loeber, Wei, Farrington, &
Wikström, 2002), to examine typical development in atypical
populations (Holmbeck et al., 2002), and to place psychopathology
in a relational context (Allen et al., 2002). In these respects, the
studies contained in this issue make it quite apparent that contemporary research on clinical adolescent psychology, at least as it is
conducted by the very best people in the field, is adhering to many
of the fundamental principles that are foundational to the field of
developmental psychopathology.
It is beyond the scope of this brief commentary to discuss in any
detail the specific findings of the five articles, and the articles are
so well written that readers will not need any assistance in making
sense of what they say. What is most impressive about them, as a
group, is that they illustrate how the application of the developmental psychopathology perspective broadens our understanding
of clinical phenomena in adolescence in ways that would not be
possible within a conventional clinical psychology perspective. In
this sense, the articles are more important in their illustrative
capacity than in their specific findings. For example, we see in
Chassin et al.’s (2002) report on binge drinking an exemplary
demonstration of how one combines techniques to model developmental trajectories with a cluster analytic approach, in order to
characterize a population in terms of groups of individuals following different developmental pathways—a blending of nomothetic
and idiographic approaches that would apply equally well to the
longitudinal data presented by Garber et al. (2002), on developmental trajectories of depressive symptomatology. Chassin et al.’s
analyses reveal that examining differences among individuals in
their trajectories of binge drinking may be more informative, and
more predictive of subsequent illness, than focusing on differences
among individuals at any one point in time. During the early years
of high school (e.g., ages 14 –15 years), for example, the frequency
of problem drinking observed among adolescents who would later
become heavy binge drinkers was no different from that observed
among those whose binge drinking would remain infrequent. Only
by studying trajectories of binge drinking over time were these
researchers able to identify those adolescents who were at greatest
risk for developing alcoholism in adulthood.
Where Chassin et al.’s (2002) approach could benefit from the
tack taken by Garber et al. (2002) is in the latter’s innovative
strategy of modeling developmental trajectories of symptoms in
relation to developmental trajectories of the factors presumed to
drive the clinical phenomenon under investigation, in this case, the
impact of changes in depressogenic cognitions on changes in
depressive symptomatology. Whereas Chassin and her colleagues
use static variables measured at single points in time to predict
trajectories of binge drinking, Garber and her collaborators examine changes in their outcome of interest as a function of changes in
one or more predictors. Accordingly, not only are Garber et al. able
to say something about static predictors of patterns of change in
depression over time (to be sure, a contribution in and of itself),
they are also able to show that changes in cognitions precede
changes in symptoms. This is terribly important, not only for
understanding the etiology of depression, but for the design of
treatment programs and preventive interventions.
Both Chassin et al. (2002) and Garber et al. (2002) have adopted
a risk factor approach to the study of the development of psychopathology, attempting to isolate those particular risk factors that
have the most predictive power. Stouthamer-Loeber et al. (2002)
extended this approach by looking simultaneously at risk and
protective (or in their terminology, “promotive”) factors related to
engagement in antisocial behavior, a strategy that derives from
studies of risk and resilience. Their approach is grounded in the
belief that it is just as important to understand the factors that
protect against delinquency as it is to understand the factors that
increase the risk of antisocial behavior. As they point out, the
distinction is not merely conceptual—it is practical as well. Risk
factor research is important in identifying those factors that make
adolescents vulnerable to various types of psychopathology, but as
Stouthamer-Loeber et al. point out, in many instances there is little
that psychologists can do about the prevention or diminution of the
most powerful components of risk, such as neighborhood poverty
or household composition. For this reason, it may be more useful
to understand the factors that promote mental health among adolescents exposed to risk than it is to understand risk itself, because
these promotive factors may well be things that psychologists can
realistically hope to affect. Unfortunately, few investigators have
adopted this approach, and most researchers who study psychological disturbance in adolescence continue to study risk without
studying protection.
As Stouthamer-Lober et al. (2002) noted, their analysis does not
differentiate among types of risk or types of protection—instead,
these researchers proceed from the assumption that more risk is
bad and more protection is good. Although other researchers may
take issue with this conceptualization, my reading of the literature
on the role of context in the development of psychopathology
supports the logic of these authors’ approach. The search for the
specific risk and protective factors that predict particular forms of
adolescent psychopathology has proven futile (Steinberg & Avenevoli, 2000). Instead, it appears that stress is a nonspecific trigger
of psychological disorder, with the form of the disorder determined
largely by factors internal to the adolescent, such as temperament
or, as Garber et al. (2002) demonstrate, a particular cognitive style.
Although the Chassin et al. (2002), Garber et al. (2002), and
Stouthamer-Loeber et al. (2002) articles make important contributions to the study of clinical adolescent psychology by injecting a
developmental psychopathology perspective into the picture, the
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SPECIAL SECTION: CLINICAL ADOLESCENT PSYCHOLOGY
articles fall short when it comes to incorporating an adolescent
development framework into their study of clinical phenomena.
Indeed, although the three studies are studies of adolescents, the
research is not really about adolescence in the sense that Cicchetti
and Rogosh (2002) or Weisz and Hawley (2002) suggest it should
be. Apart from the fact that binge drinking, depression, and delinquency are not generally phenomena that one sees much before
adolescence, the participants in the three studies could have been
virtually any age, and the research designs used and the constructs
measured would have been for the most part perfectly appropriate.
One potential remedy for this is the addition of measures of
developmental status to the design of longitudinal studies of clinical phenomena to supplement chronological age as the metric
against which changes in the dependent variables of interest are
tracked. For example, studies of drinking, depression, or delinquency in adolescence might track changes in these phenomena as
a function of pubertal maturation, the development of hypothetical
thinking, growth in autonomy or identity, changes in family or
peer relationships, or school transitions. The incorporation of these
markers of adolescent development— biological, cognitive, emotional, and social—would help elucidate the underlying processes
by which clinical phenomena change as individuals mature into
and through adolescence, not just over time.
One may fairly ask whether the same sort of criticism that Weisz
and Hawley (2002) leveled at those who have designed and studied
treatments for adolescent mental health problems—that the treatments or their evaluation rarely pay attention to the unique biological, psychological, and social aspects of adolescent development— could be directed at these otherwise exemplary studies.
The hallmarks of adolescent development—pubertal maturation;
the emergence of abstract thinking; shifts in social status; and the
psychosocial challenges of identity, autonomy, intimacy, and sexuality, for example—play virtually no role in these research designs. Thus, although each of these research programs attempts to
track change in a clinical phenomenon as a function of time (i.e.,
alcohol abuse, depression, and delinquency), none attempts to
track change in these phenomena as a function of development.
The articles by Holmbeck et al. (2002) and by Allen et al. (2002)
are interesting to consider in tandem, both because they do focus
on adolescent development and because each concerns the links
between family functioning and adolescent adjustment. The Holmbeck et al. article makes an important contribution to the study of
parental control and its impact on psychological functioning, in
particular, a topic that has seen revived interest in recent years
(e.g., Barber, 2001). Holmbeck and his colleagues draw a distinction between psychological control, which is often hostile, and
overprotectiveness, which is not. Most researchers have treated
these phenomena as interchangeable variants of enmeshment or
intrusiveness, but as Holmbeck et al. pointed out, the psychological experience of being on the receiving end of overprotectiveness
(e.g., feeling babied) may be very different from that of psychological control (e.g., feeling manipulated). Even though overprotectiveness may derive from parental concern, however, as it most
likely does among parents whose adolescent suffers from a chronic
illness, there is still the possibility of too much of a good thing. As
Holmbeck and his colleagues discover, closeness can become
problematic when it crosses the line from concern to overprotection because it may interfere with the adolescent’s developing
127
sense of autonomy, and threats to autonomy may result in emotional and behavioral problems.
The link between adjustment and autonomy is also a focus in the
Allen et al. (2002) article. Like Holmbeck and his colleagues,
Allen and his collaborators examined adolescent maladjustment
within the context of a family system engaged in the renegotiation
of the emotional contours of the parent–adolescent relationship.
Not surprisingly, adolescents who report greater security in their
attachment to parents show healthier patterns of social development, reaffirming the well-established finding that an emotionally
healthy parent–adolescent relationship, as reflected in the adolescent’s security of attachment, is predictive of positive psychological functioning. The importance of having a healthy attachment to
parents is indirect as well as direct, however, in that the quality of
attachment appears to moderate the links between autonomy and
adolescent functioning. Among adolescents with secure attachments to parents, displays of autonomy during family interaction
were associated with positive development. Among adolescents
whose attachments were less healthy, autonomy in the family
context had negative effects. The Allen et al. article serves as a
reminder that studies of the development of autonomy in the
family and its relation to psychopathology must take into account
the level of closeness between adolescents and parents at the same
time. Autonomy in the context of a problematic parent–adolescent
relationship has different effects than autonomy in the context of a
healthy attachment (Lamborn & Steinberg, 1993).
The Holmbeck et al. (2002) and Allen et al. (2002) articles
provide further evidence that the optimal family environment for
adolescent development is one that balances independence and
interdependence, a finding that has now been reported frequently
in the literature on adolescent development. As I have written
elsewhere, “we know some things” about familial influences on
adolescent development (Steinberg, 2001), and one of them is that
adolescents need to establish a sense of autonomy from parents
within a relational context that is warm and connected. Disruptions
in the balance between autonomy and connectedness may result
from, accompany, and lead to psychological and emotional
difficulties.
With their emphasis on attachment and autonomy, the articles
by Allen et al. (2002) and Holmbeck et al. (2002) locate themselves more centrally within the broader literature on normative
adolescent development than do the other empirical reports in this
special issue. But whereas both of these studies examined psychosocial phenomena that are central to the study of adolescent
development, neither focused on the sort of serious pathology
studied by Chassin et al. (2002), Garber et al. (2002), and
Stouthamer-Loeber et al. (2002). The Allen and Holmbeck articles
are important contributions to our understanding of the ways in
which the family contributes to the development of psychological
adaptation and maladaptation in adolescence, but I think it is fair
to say that these studies are more about adjustment difficulties than
they are about serious psychopathology. At least with respect to
the current set of research reports, then, it appears that the more the
research is about psychopathology, the less it is it about development, and the more it is about development, the less it is about
psychopathology. And this is precisely the problem that needs
fixing.
The challenge, it seems to me, is to find ways of taking the sorts
of developmental concerns that are central to the Holmbeck et al.
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128
(2002) and Allen et al. (2002) research programs— concerns like
the study of autonomy and attachment in the adolescent’s family
context—and injecting them into the research of investigators like
Chassin et al. (2002), Garber et al. (2002), Stouthamer-Loeber et
al. (2002), and others who are studying the sort of serious psychopathology of interest to clinicians who work with adolescent
populations. If the field of adolescent clinical psychology is to
fulfill its promise, we need to move from research that is simply at
the “interface between the fields of clinical and developmental
psychology” (Holmbeck & Kendall, 2002, p. 3) to research that
reflects the genuine integration of these disciplines. Fostering the
interface of these disciplines, as this special section does, is the
necessary first step, but it is only a beginning. Not until we see the
seamless integration of clinical and developmental psychology in
research on adolescent psychopathology will we begin to bear the
intellectual fruit of the sort of interdisciplinary collaboration to
which the emerging field of clinical adolescent psychology aspires.
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Received May 17, 2001
Revision received July 26, 2001
Accepted August 1, 2001 䡲