We articulate an internalizing pathway to Negative Affect SUDs that incorporates early antecedents and developmentally-varying markers of progression toward this endpoint. We use the concept of a pathway as defined in the tree metaphor of Sroufe (1990), such that a pathway defines a course of development that is followed by a subgroup of children. Such pathways are not deterministic; we do not expect all children showing early indicators of progress on the internalizing pathway to eventually develop a Negative Affect SUD. Rather, the internalizing pathway includes the potential for moderating influences which serve to propel children along different dividing branches up the tree either toward resilience or toward sustained or increasingly maladaptive behavior. Thus, we expect that children who begin to travel along an internalizing pathway early in life will eventually evidence a wide array of outcomes ranging from normal to abnormal. However, in this paper, we begin with a simple description of one set of adjoining branches through the tree that define a pathway of increasing maladaptation, leading to the eventual development of a Negative Affect SUD.
