title: [The challenge of staging developmental disorders].
abstract: BACKGROUND
  On the basis of our current knowledge, developmental disorders can be divided into the following stages: stage 0: normal variation, stage 1: simple disorder of moderate severity, stage 2: complicating co-morbidity and/or harmful background circumstances, and stage 3: serious disorder with harmful background circumstances.
  
  
  OBJECTIVE
  To describe the current views on prognostic aspects of staging from a developmental perspective.
  
  
  METHODS
  The study is based on a critical review of the relevant literature.
  
  
  RESULTS
  The current division into stages is still insufficiently predictive, partly because development is a flexible process with risks, chances and second chances. All psychiatric disorders are in essence developmental disorders that arise in the course of development as a result of the interaction between predisposition and background circumstances. As from the very first meiosis the hereditary predisposition is subject to influences in the womb environment. The forming of networks in the brain, the distribution of neurotransmitters and the neurological profile are influenced by the genetic potential for chances and risks and are all a result of interactions. This complicated developmental history raises questions about the specificity of current clinical syndromes.
  
  
  CONCLUSIONS
  In time there is likely to be a much more accurate staging system. This will come about if, as a result of the analysis of large pooled databases, it becomes possible to make a better assessment of the relative risks of genetic configurations, brain connections, stress regulation in the brain, neuropsychological profiles and behavioural and emotional forms of expression in the light of the interactions that occur with the aforementioned background circumstances.
authors.forename: R J
authors.initials: RJ
authors.lastname: van der Gaag
authors.forename: P J M
authors.initials: PJ
authors.lastname: van Wijngaarden-Cremers
authors.forename: W G
authors.initials: WG
authors.lastname: Staal
mesh_terms: D000223:Adaptation, Psychological; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000145:classification* / Q000175:diagnosis*; D002658:Developmental Disabilities / Q000145:classification* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D020022:Genetic Predisposition to Disease; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D012931:Social Environment; D016896:Treatment Outcome