Assessing Sensitivity in Youth as a Moderator of Psychopathological Outcomes Across Contexts

Youth differ in how strongly they respond to environmental influences, with some individuals demonstrating greater sensitivity to both adverse and supportive contexts. Environmental sensitivity (ES) has emerged as a unifying framework encompassing theories such as differential susceptibility, biological sensitivity to context, and vantage sensitivity. This scoping review examined sensitivity as a moderator of the relationship between environmental exposures and mental health outcomes in children and adolescents. The review aimed to (1) identify key markers used to approximate individual differences in sensitivity and (2) examine the methods used to measure these markers across studies. A total of 34 articles representing 37 studies were included. Markers of ES fell into five categories: phenotypic (e.g., temperament, sensitivity), genetic (e.g., 5HTTLPR, DRD4), physiological (e.g., cortisol, vagal tone), biological (e.g., prematurity), and neurobiological (e.g., amygdala activation). Phenotypic markers were most commonly studied, primarily assessed through parent- or youth-report questionnaires. Sensitivity was found to moderate the effects of various environments on mental health, with differential susceptibility emerging as the most consistently supported theoretical model. Assessment approaches varied widely in measurement tools, informants, and analytic methods depending on the marker used. Few studies used multi-informant or longitudinal methods. This review highlights the value of identifying sensitive youth who may be more responsive to both risk and protective factors and highlights the need for more methodologically rigorous research to guide personalized prevention and intervention efforts within an ES framework.