Co-development of internalizing and externalizing problem behaviors: Causal direction and common vulnerability

Emotional and relational problems of adolescents with and without a migrant background in Europe: a systematic review

Mental health of migrant adolescents is a topic that has been widely studied in the past decades. Emotional and behavioural problems are amongst the most explored areas; however, little attention has been paid to the relational sphere, which represents another key aspect of mental health and is paramount during adolescence. This systematic review analysed the available evidence on emotional and relational problems comparing adolescents with and without a migrant background in Europe between 2010 and 2021. The search was conducted in four databases using a common search strategy composed of terms addressing adolescence, migrant population, and emotional and relational problems. Three rounds of screening produced 36 eligible studies. Factors affecting both types of problems were identified and categorised using thematic synthesis, dividing them into factors affecting both types of problems jointly or separately and analysing them according to three systemic levels affecting the adolescents' lives (intrapersonal, interpersonal and external). Critical analysis of the results pointed to mixed findings, with a mild tendency in migrant-background adolescents to portray more emotional problems than their native peers and a stronger tendency for relational problems in the same direction. Several limitations were identified and, along with the conclusions, point to suggestions for future research focusing on studying relational problems as a key component of mental health and its link to emotional problems. Further suggestions entail designing studies that target adolescents with different migrant-background profiles and cultural origins to establish differences between them and identify additional factors affecting emotional and relational problems during the pre-migration and transit phases of the migratory journey to help prevent the onset of these problems.

Network structure of adolescent social, emotional, and behavioral difficulties and their differential relationships with suicidality

BACKGROUND

Social, emotional, and behavioral difficulties (SEBDs) tend to develop during adolescence. Their presence and especially co-occurrence induce numerous disrupting consequences, including suicidality. A recently developed network analysis is suitable to investigate the symptom-level structure of comorbid psychopathology. Rather than pairwise comorbidity networks, the current study investigated a comprehensive network of SEBDs at the symptom level and explored the differential relationships between symptoms of SEBDs and suicidality.

METHODS

Recruited from four public schools in China, a sample of adolescents (N = 6974, mean age = 15.84, 50.1% boys) were assessed with the Strengths and Difficulties Questionnaire (SDQ) and one suicidality-related item. The cross-sectional network structure of the SEBD symptoms was investigated. The differential associations between individual symptoms of SEBDs and suicidality were also explored with a relative importance analysis.

RESULTS

The results showed that constantly fidgeting, worry a lot, unhappy, down-hearted, tearful, and easily scared emerged as the most central symptoms in the network of SEBDs. Worry a lot, constantly fidgeting, lose my temper, and being bullied served as bridge symptoms, connecting various domains of SEBDs. In addition, the centrality of symptoms was positively associated with the variance shared with suicidality, with worry a lot and unhappy, down-hearted, and tearful explaining a large portion of the variance of suicidality.

CONCLUSIONS

Taken together, the results were indicative of close connections among emotional, hyperactivity-inattention, peer, and conduct aspects of adolescent mental health difficulties, as well as the central role of emotional difficulties in the SEBDs network.

Pubertal progression and its relationship to psychological and behavioral outcomes among adolescent boys

Variations in pubertal timing and tempo have relevance to psychosocial development. Accounting for pubertal timing, tempo, and psychosocial development simultaneously in a model remains challenging. This study aimed to document the typology of pubertal development in a cohort of Taiwanese adolescent boys and then to examine how the associations between psychosocial variables across time vary by the patterns of pubertal development. A group of adolescent boys (n = 1,368) reported pubertal signs and psychosocial variables for 3 years since seventh grade. The growth mixture model revealed three major classes of pubertal transition: average pubertal growth, late-onset with rapid catch-up, and late-onset with slow catch-up. In a cross-lagged panel model, the multigroup analysis found the regression coefficients mostly invariant across all three classes, except those between deviant behavior and subsequent changes in depressive symptoms that were significantly positive only in the late-onset with slow catch-up group. Adolescent boys in this group were estimated to have the highest marginal level of depressive symptoms and deviant behavior in ninth grade among the three classes. Our study highlights the heterogeneity in boys' pubertal development and the role of the pubertal development pattern in their psychosocial development.

Gender-specific co-developmental trajectories of internalizing and externalizing problems from middle childhood to early adolescence: Environmental and individual predictors

This study aimed to identify gender-specific co-developmental trajectories of internalizing and externalizing problems from middle childhood to early adolescence, along with key environmental and individual predictors among Chinese youth. A total of 1653 Chinese elementary school students (M age = 9.40; SD = 0.51; 54.57% boys) participated in assessments at six time points, using 6-month assessment intervals. Parallel process latent class growth modeling identified four trajectories for boys: Congruent-low (65.74%), moderate-decreasing internalizing and moderate-stable externalizing problems (18.40%), high increasing-internalizing and low-stable externalizing problems (8.20%), and high decreasing-internalizing and low-stable externalizing problems (7.65%). Three trajectories were identified for girls: Congruent-low (81.09%), moderate co-occurring (7.19%), and high increasing-internalizing and low-stable externalizing problems (11.72%). Multivariate logistic regression analyses revealed that peer victimization served as an environmental risk predictor for the adverse co-developmental trajectories of internalizing and externalizing problems for boys and girls. High sensation-seeking and low self-control served as individual risk variables predicting the trajectories of high increasing-internalizing and low-stable externalizing problems, and low self-control also predicted the trajectories of high decreasing-internalizing and low-stable externalizing problems for boys. The findings highlight the importance of gender differences in understanding the progression of internalizing and externalizing problems and inform effective strategies for prevention and intervention.

Co-occurrence, stability and manifestation of child and adolescent mental health problems: a latent transition analysis

Background

Complex constellations of socio-emotional and behavioural problems (i.e., mental health problems) in childhood and adolescence are common and heighten the risk for subsequent personality, anxiety and mood disorders in adulthood. Aims of this study included the examination of patterns of mental health problems (e.g., externalizing-internalizing co-occurrence) and their transitions to reported mental disorders by using a longitudinal person-centered approach (latent class and latent transition analysis).

Methods

The sample consisted of 1255 children and adolescents (51.7% female, mean age = 12.3 years, age range 8–26 years) from three time points of the comprehensive mental health and wellbeing BELLA study. Children and their parents completed the German SDQ (Strength and Difficulties Questionnaire, Goodman, 1997) and reported on diagnoses of ADHD, depression, and anxiety.

Results

Latent class analysis identified a normative class, an emotional problem class, and a multiple problem class. According to latent transition analysis, the majority of the sample (91.6%) did not change latent class membership over time; 14.7% of individuals showed a persistent pattern of mental health problems. Diagnoses of mental disorders were more likely to be reported by individuals in the emotional problem or multiple problem class.

Conclusions

Results highlight the need for early prevention of mental health problems to avoid accumulation and manifestation in the transition to adolescence and young adulthood.

Stability and Change of Psychopathology Symptoms Throughout Childhood and Adolescence

Assessing stability and change of children's psychopathology symptoms can help elucidate whether specific behaviors are transient developmental variations or indicate persistent psychopathology. This study included 6930 children across early childhood (T1), late childhood (T2) and early adolescence (T3), from the general population. Latent profile analysis identified psychopathology subgroups and latent transition analysis quantified the probability that children remained within, or transitioned across psychopathology subgroups. We identified four psychopathology subgroups; no problems (T1: 85.9%, T2: 79.0%, T3: 78.0%), internalizing (T1: 5.1%, T2: 9.2%, T3: 9.0%), externalizing (T1: 7.3%, T2: 8.3%, T3: 10.2%) and the dysregulation profile (DP) (T1: 1.7%, T2: 3.5%, T3: 2.8%). From T1 to T2, 44.7% of the children remained in the DP. Between T2 and T3, 33.6% remained in the DP; however, 91.4% were classified in one of the psychopathology subgroups. Our findings suggest that for many children, internalizing or externalizing symptoms encompass a transient phase within development. Contrary, the DP resembles a severe at-risk state in which the predictive value for being in one of the psychopathology subgroups increases over time.

Associations of circadian factors with insomnia symptoms and emotional and behavioral problems among school-age children

STUDY OBJECTIVES

To examine the associations of circadian characteristics (ie, chronotype and social jetlag) with insomnia symptoms and emotional and behavioral problems among school-age children.

METHODS

A total of 620 primary school children (median_age = 10.06, standard deviation = 1.16, 58.7% boys) were recruited and assessed by a set of parent-report questionnaires, including Children's Sleep Habit Questionnaire for measuring sleep-wake patterns and insomnia symptoms (bedtime resistance, sleep onset delay, and night waking), Children's Chronotype Questionnaire for assessing the child's chronotype preference, and Strength and Difficulties Questionnaire for assessing emotional and behavioral problems. Linear regression models were applied to examine the associations of chronotype and social jetlag with insomnia symptoms and mental health outcomes, in which age, sex, family income, and average sleep duration were entered as covariates.

RESULTS

Evening chronotype was significantly associated with bedtime resistance and sleep onset delay, while social jetlag was not related to insomnia symptoms. Evening chronotype was also significantly associated with externalizing symptoms after controlling for potential confounders.

CONCLUSIONS

Evening chronotype, but not social jetlag, was the risk factor for insomnia symptoms, and evening chronotype was further associated with increased behavioral problems in school-age children. Our findings underscored the roles of circadian factors in relation to sleep and mental health problems in this young population.

CITATION

Sun W, Kwok NTT, Chan NY, et al. Associations of circadian factors with insomnia symptoms and emotional and behavioral problems among school-age children. J Clin Sleep Med. 2021;17(10):2107-2114.

Examining Longitudinal Associations between Externalizing and Internalizing Behavior Problems at Within- and Between-Child Levels

Externalizing and internalizing behavior problems are known to often co-occur, but mechanisms underlying this co-occurrence remain unclear: whether the associations are due to causal influences of one domain on the other or due to common risk processes influencing both domains. This study aimed to better understand the sources of co-occurring behavior problems by disentangling within- and between-child levels of associations between the two across the five years of childhood, from pre-kindergarten to Grade 3. We analyzed a longitudinal sample of 1060 children from non-urban settings in the U.S. using random-intercept cross-lagged panel models (RI-CLPMs) as an alternative to the commonly-used standard CLPMs. Results indicate that co-occurring externalizing and internalizing problems can be explained partly by a unidirectional influence from externalizing to internalizing problems operating within children and partly by stable differences between children that influence both domains of problems. Further analyses indicate that an executive function deficit in early childhood is an important shared risk factor for both problems, suggesting the utility of executive function interventions in preventing or addressing externalizing and internalizing problems in childhood.

A systematic review of transdiagnostic risk and protective factors for general and specific psychopathology in young people

A large body of research has emerged over the last decade examining empirical models of general and specific psychopathology, which take into account comorbidity among psychiatric disorders and enable investigation of risk and protective factors that are common across disorders. This systematic review presents findings from studies of empirical models of psychopathology and transdiagnostic risk and protective factors for psychopathology among young people (10-24 years). PsycInfo, Medline and EMBASE were searched from inception to November 2020, and 41 studies were identified that examined at least one risk or protective factor in relation to broad, empirically derived, psychopathology outcomes. Results revealed several biological (executive functioning deficits, earlier pubertal timing, genetic risk for ADHD and schizophrenia, reduced gray matter volume), socio-environmental (stressful life events, maternal depression) and psychological (low effortful control, high neuroticism, negative affectivity) transdiagnostic risk factors for broad psychopathology outcomes, including general psychopathology, internalising and externalising. Methodological complexities are discussed and recommendations for future studies of empirical models of psychopathology are presented. These results contribute to a growing body of support for transdiagnostic approaches to prevention and intervention for psychiatric disorders and highlight several promising avenues for future research.

Internalizing and externalizing problems across childhood and psychotic-like experiences in young-adulthood: The role of developmental period

BACKGROUND

Psychopathology in childhood and adolescence, commonly indexed by co-occurring internalizing and externalizing problem behaviors, has been found to predict psychotic-like experiences (PLEs) in adults. However, studies to date have rarely examined internalizing and externalizing problem behaviors simultaneously or identified in which developmental period do these problem behaviors predict PLEs in adults. This study tests to what extent internalizing and externalizing problem behaviors in childhood (4-9 years) or adolescence (11-16 years) predict PLEs in young-adulthood (18 years).

METHODS

Parent-rated child internalizing and externalizing problems on the Strengths and Difficulties Questionnaire at ages 4, 6, 8, 9, 11, 13, and 16 years from the Avon Longitudinal Study of Parents and Children (N = 4717) were modelled using two-piece latent growth curve modelling to predict clinician-rated PLEs at age 18 years, controlling for confounders (gender, ethnicity, socio-economic status, parental education and stressful life events) assessed prior to baseline at age 4 years.

RESULTS

Controlling for confounders, an increase in childhood internalizing problems from 4 to 9 years and externalizing problems at baseline (at 4 years) predicted PLEs at 18 years, explaining 9.5% of the variance in adult PLEs. These associations were independent to controls for any changes in adolescent internalizing and externalizing problems from 11 to 16 years.

CONCLUSIONS

High baseline levels of externalizing problems and increasing internalizing problems throughout childhood can predict PLEs at 18 years. Externalizing problems around the transition to primary school and internalizing problems throughout childhood may be particularly helpful in informing risk of PLEs in young-adulthood.

Risk and Resilience Factors for Psychobehavioral Symptom Trajectories Among Child Welfare-Involved Youth

The primary aim of the study was to investigate the development of psychobehavioral symptoms (internalizing, externalizing, and posttraumatic stress [PTS]) of child welfare-involved adolescents over a 3-year period and to identify predictors of the trajectories. Using three waves of data from the National Survey of Child and Adolescent Well-Being (NSCAW-II), latent growth curve modeling was conducted on a sample of 350 adolescents who were between 11 and 13 years of age at baseline. Findings indicated that adolescents' internalizing symptoms decreased over time, whereas externalizing symptoms remained stable over time. PTS symptoms decreased over time in girls, but not boys. Physical abuse predicted higher levels of externalizing behaviors and sexual abuse predicted a slower decrease in PTS symptoms. Greater child prosocial skills and higher quality of caregiver-child relationship were associated with lower initial levels of externalizing symptoms. In addition, a higher quality caregiver-child relationship and greater satisfaction with peer relationships were associated with lower initial levels of internalizing and PTS symptoms. Findings suggest that intervention strategies should consider gender, maltreatment type, and interpersonal and social skills to effectively prevent the development of psychobehavioral symptoms among child welfare-involved youth.

Exploring the role of emotional and behavioral problems in a personality-targeted prevention program for substance use in adolescents and young adults with intellectual disability

BACKGROUND

Adolescents and young adults with a mild intellectual disability or borderline intellectual functioning (MID-BIF) are at risk for problematic substance use and are more likely to have emotional and behavioral problems than peers without MID-BIF. A personality-targeted prevention program called Take it Personal! effectively reduces substance use in adolescents and young adults with MID-BIF.

AIMS

The program's effectiveness was examined on its secondary goal: reducing emotional and behavioral problems. The potentially moderating role of these problems on the program's effectiveness with substance use was also explored.

METHODS AND PROCEDURES

Substance use and emotional and behavioral problems were compared between participants in Take it Personal! (n = 34) and those in the control condition (n = 32) in a quasi-experimental pre-posttest study with a three-month follow-up. Effectiveness and moderation were assessed with multilevel models.

OUTCOMES AND RESULTS

Take it Personal! seems to reduce rule breaking. There were no significant effects on anxiety, withdrawal, and aggression. None of the problem domains moderated the program's effectiveness on substance use frequency.

CONCLUSIONS AND IMPLICATIONS

Take it Personal! may effectively reduce rule breaking. Moreover, adolescent and young adults with different levels of emotional and behavioral problems benefit equally in terms of reduced substance use.

Parallel Trajectories of Proactive and Reactive Aggression in Middle Childhood and Their Outcomes in Early Adolescence

This study used an accelerated longitudinal design to investigate trajectories of proactive and reactive aggression in middle childhood and their outcomes in early adolescence. Children (N = 1420; ages 5-12; 48% female) were assessed biannually over 6 school years. Classroom teachers rated students' proactive and reactive aggression throughout grades K-5; and multi-method (teacher-report, self-report, school records) measures of peer problems, depressive symptoms, academic performance, disciplinary actions, and school absenteeism were collected throughout grades 3-5. Latent class growth models were estimated to differentiate parallel-process trajectories of proactive-reactive aggression. Class membership was then examined as a predictor of outcomes at the end of 5th grade. The best-fitting solution had four trajectory classes: (1) low aggression, 76.7%; (2) high proactive-reactive aggression, 4.7%; (3) declining aggression, 4.9%; and (4) predominantly reactive aggression, 13.7%. Most classes showed seasonal upticks in aggressive behavior in the spring semester relative to fall; these were especially pronounced for proactive aggression, both as a variable and for the proactive-reactive class. Relative to their low-aggression peers, children in any elevated-aggression class had higher levels of peer problems, depressive symptoms, and disciplinary actions and lower GPAs at the end of 5th grade. The reactive class-which on no occasion had the highest total aggression-exhibited the most consistently unfavorable pattern of outcomes across methods and measures. Findings offer new insights concerning the multifinality and heterogeneity of aggressive behavior in childhood. Research, theory, and practice could benefit from adopting person-centered conceptualizations that consider the long-term trajectories, short-term variations, and proactive vs. reactive functions of youth aggression.

National Trends in Mental Health Care for US Adolescents

Importance

The prevalence of adolescent depression and other internalizing mental health problems has increased in recent years, whereas the prevalence of externalizing behaviors has decreased. The association of these changes with the use of mental health services has not been previously examined.

Objective

To examine national trends in the care of different mental health problems and in different treatment settings among adolescents.

Design, Setting, and Participants

Data for this survey study were drawn from the National Survey on Drug Use and Health, an annual cross-sectional survey of the US general population. This study focused on adolescent participants aged 12 to 17 years interviewed from January 1, 2005, to December 31, 2018. Data were reported as weighted percentages and adjusted odds ratios (aORs) and analyzed from July 20 to December 1, 2019.

Main Outcomes and Measures

Time trends in 12-month prevalence of any mental health treatment or counseling in a wide range of settings were examined overall and for different sociodemographic groups, types of mental health problems (internalizing, externalizing, relationship, and school related), and treatment settings (inpatient mental health, outpatient mental health, general medical, and school counseling). Trends in the number of visits and nights in inpatient settings were also examined.

Results

A total of 47 090 of the 230 070 adolescents across survey years (19.7%) received mental health care. Of these, 57.5% were female; 31.3%, aged 12 to 13 years; 35.8%, aged 14 to 15 years; and 32.9%, aged 16 to 17 years. The overall prevalence of mental health care did not change appreciably over time. However, mental health care increased among girls (from 22.8% in 2005-2006 to 25.4% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.19; P = .001), non-Hispanic white adolescents (from 20.4% in 2005-2006 to 22.7% in 2017-2018; aOR, 1.08; 95% CI, 1.03-1.14; P = .004), and those with private insurance (from 19.4% in 2005-2006 to 21.2% in 2017-2018; aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Internalizing problems, including suicidal ideation and depressive symptoms, accounted for an increasing proportion of care (from 48.3% in 2005-2006 to 57.8% in 2017-2018; aOR, 1.52; 95% CI, 1.39-1.66; P < .001), whereas externalizing problems (from 31.9% in 2005-2006 to 23.7% in 2017-2018; aOR, 0.67; 95% CI, 0.62-0.73; P < .001) and relationship problems (from 30.4% in 2005-2006 to 26.9% in 2017-2018; aOR, 0.75; 95% CI, 0.69-0.82; P < .001) accounted for decreasing proportions. During this period, use of outpatient mental health services increased from 58.1% in 2005-2006 to 67.3% in 2017-2018 (aOR, 1.47; 95% CI, 1.35-1.59; P < .001), although use of school counseling decreased from 49.1% in 2005-2006 to 45.4% in 2017-2018 (aOR, 0.86; 95% CI, 0.79-0.93; P < .001). Outpatient mental health visits (eg, private mental health clinicians, from 7.2 in 2005-2006 to 9.0 in 2017-2018; incidence rate ratio, 1.30; 95% CI, 1.23-1.37; P < .001) and overnight stays in inpatient mental health settings (from 4.0 nights in 2005-2006 to 5.4 nights in 2017-2018; incidence rate ratio, 1.18; 95% CI, 1.02-1.37; P = .03) increased.

Conclusions and Relevance

This study's findings suggest that the growing number of adolescents who receive care for internalizing mental health problems and the increasing share who receive care in specialty outpatient settings are placing new demands on specialty adolescent mental health treatment resources.

Frontal EEG asymmetry moderates the associations between negative temperament and behavioral problems during childhood

Fearful inhibition and impulsivity-anger significantly predict internalizing and externalizing problems, respectively. An important moderator that may affect these associations is frontal EEG asymmetry (FA). We examined how temperament and FA at 6 years interactively predicted behavioral problems at 9 years. A community sample of 186 children (93 boys, 93 girls) participated in the study. Results indicated that the effect of fearful inhibition on parent-reported internalizing problems increased as children exhibited greater right FA. The effect of impulsivity-anger on parent-reported externalizing problems increased as children showed greater left FA. Because FA was allowed to vary rather than children being dichotomized into membership in left FA and right FA groups, we observed that children's FA contributed to the resilience process only when FA reached specific asymmetry levels. These findings highlight the importance of considering the different functions of FA in combination with specific dimensions of temperament in predicting children's socioemotional outcomes. Clinical implications include providing suggestions for intervention services by demonstrating the role of FA in developing behavioral problems and inspiring research on whether it is possible to alter EEG activation and thus potentially improve developmental outcomes.

Parents' Phubbing and Problematic Mobile Phone Use: The Roles of the Parent-Child Relationship and Children's Self-Esteem

An increasing number of mobile phone users check their phones at any time and place, even during in-person interactions. Such behaviors that interrupt social interactions have been described as phubbing. The present study focused on phubbing behaviors within the context of parent-child households and aimed to examine the associations among parents' phubbing, the parent-child relationship, children's self-esteem, and problematic mobile phone use (PMPU) by adolescents. The structural equation model results based on the data collected from 1,721 secondary students revealed that parents' phubbing was not only directly associated with children's PMPU but also indirectly associated with PMPU through the mediating roles of the parent-child relationship and children's self-esteem after gender and age were controlled. These findings suggest a possible underlying mechanism for the relationship between parents' phubbing and children's PMPU, and could thus inform interventions to prevent or decrease PMPU among adolescents. Limitations and implications are discussed.

Temporal Pattern of Co-Development of Internalizing and Externalizing Problem Behaviors: An Application of Bivariate Mixed-Effects Models

BACKGROUND

Although previous research has shown that internalizing and externalizing behavior problems often co-occur, the relationship between the developmental trajectories of these two types of behavior problems is understudied. The co-occurring evolutions of developmental trajectories of two behaviors has two components: 1) the correlation between the slopes of two behavior profiles (termed the association of the evolutions); and 2) the marginal correlation of two development trajectory profiles, which is the development of correlation between internalizing and externalizing behavior over time (termed the evolution of the association). The association of the evolutions and the evolution of the association have not been fully explored in the context of the development of internalizing and externalizing behavior problems among kindergarteners in the United States.

METHODS

The random-effects approach for joint modeling of multivariate longitudinal profiles was used to evaluate the co-development and its temporal pattern of internalizing and externalizing behavior problems on a nationally representative sample of 9791 kindergarteners from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-99 (ECLS-K).

RESULTS

There was a moderate positive association between the evolutions of the two behavior problems with correlation coefficient of 0.319. The evolution of association between the two behaviors was increasing over time with the correlation coefficient from 0.195 at the Fall of kindergarten to 0.291 by the time of fifth grade in general. Race and age groups act differently on the evolution of association. The associations were getting stronger for the Asian group and older groups than their peer groups.

CONCLUSION

This investigation of the association of evolutions and the evolution of association between the internalizing and externalizing behaviors show that the two problem behaviors reciprocally reinforce each other and lead to increases in the other in a moderate strength and the strength is increasing over time.

Do executive functions explain the covariance between internalizing and externalizing behaviors?

This study examined whether executive functions (EFs) might be common features of internalizing and externalizing behavior problems across development. We examined relations between three EF latent variables (a common EF factor and factors specific to updating working memory and shifting sets), constructed from nine laboratory tasks administered at age 17, to latent growth intercept (capturing stability) and slope (capturing change) factors of teacher- and parent-reported internalizing and externalizing behaviors in 885 individual twins aged 7 to 16 years. We then estimated the proportion of intercept-intercept and slope-slope correlations predicted by EF as well as the association between EFs and a common psychopathology factor (P factor) estimated from all 9 years of internalizing and externalizing measures. Common EF was negatively associated with the intercepts of teacher-rated internalizing and externalizing behavior in males, and explained 32% of their covariance; in the P factor model, common EF was associated with the P factor in males. Shifting-specific was positively associated with the externalizing slope across sex. EFs did not explain covariation between parent-rated behaviors. These results suggest that EFs are associated with stable problem behavior variation, explain small proportions of covariance, and are a risk factor that that may depend on gender.

Etiology of Stability and Growth of Internalizing and Externalizing Behavior Problems Across Childhood and Adolescence

Internalizing and externalizing behaviors are heritable, and show genetic stability during childhood and adolescence. Less work has explored how genes influence individual differences in developmental trajectories. We estimated ACE biometrical latent growth curve models for the Teacher Report Form (TRF) and parent Child Behavior Checklist (CBCL) internalizing and externalizing scales from ages 7 to 16 years in 408 twin pairs from the Colorado Longitudinal Twin Study. We found that Intercept factors were highly heritable for both internalizing and externalizing behaviors (a2 = .61-.92), with small and nonsignificant environmental influences for teacher-rated data but significant nonshared environmental influences for parent-rated data. There was some evidence of heritability of decline in internalizing behavior (Slopes for teacher and parent ratings), but the Slope genetic variance was almost entirely shared with that for the Intercept when different than zero. These results suggest that genetic effects on these developmental trajectories operate primarily on initial levels and stability, with no significant unique genetic influences for change. Finally, cross-rater analyses of the growth factor scores revealed moderate to large genetic and environmental associations between growth factors derived from parents' and teachers' ratings, particularly the Intercepts.

Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence

Importance

Although multiple cross-sectional and longitudinal studies have established that sleep problems and behavioral difficulties are associated in children, the directionality of this association and whether sleep problems are differentially associated with different types of childhood behavioral difficulties are unclear. Understanding these associations will inform the focus and timing of interventions.

Objective

To determine whether longitudinal and reciprocal associations exist between child sleep problems and externalizing, internalizing, or both behavioral difficulties.

Design, Setting, and Participants

Prospective cohort study using nationally representative data from the first 5 waves (2004, 2006, 2008, 2010, and 2012) of the kindergarten cohort (4983 children aged 4-5 years in 2004) collected for the Longitudinal Study of Australian Children. Associations were evaluated using cross-lagged structural equation model analyses performed from May 25, 2016, to September 20, 2017.

Main Outcomes and Measures

Child sleep problems and internalizing and externalizing behavioral difficulties. Sleep problems were defined using parent-reported child sleep problem severity and specific difficulties (ie, difficulty getting to sleep at night, not happy sleeping alone, waking during the night, and restless sleep) on 4 or more nights of the week. Child behavioral difficulties were defined using the parent-reported Strengths and Difficulties Questionnaire for externalizing difficulties (conduct problems and hyperactivity/inattention subscales) and internalizing difficulties (emotional problems subscale).

Results

The 4983 children enrolled in 2004 had a mean (SD) age of 4.7 (0.2) years and comprised a similar percentage of boys (2536 [50.9%]) and girls. In 2012, 3956 children (79.4%) aged 12 to 13 years were retained. Significant bidirectional associations were detected between sleep problems and externalizing difficulties during the elementary school transition period, with greater sleep problems associated with later externalizing behavior and vice versa (cross-lagged path coefficient, 0.04 [95% CI, 0.01-0.08] to 0.09 [95% CI, 0.06-0.13]). Although sleep was a significant driver of later internalizing difficulties (coefficient, 0.10 [95% CI, 0.07-0.14] to 0.16 [95% CI, 0.12-0.19]), the reverse association was not significant. In the final model that included all 3 constructs, the associations were attenuated but remained significant over time.

Conclusions and Relevance

These results suggest that future studies should investigate whether implementing sleep problem intervention decreases the occurrence of both externalizing and internalizing difficulties. Interventions targeting externalizing, but not internalizing, difficulties may benefit childhood sleep.

Trajectories of internalizing problems during the transition to adolescence in children with and without conduct problems

Children with conduct problems are at greater risk for internalizing problems. The objectives of this study were to (1) examine trajectories of internalizing problems among children with and without clinically significant conduct problems during the transition to adolescence; and (2) identify how academic achievement, peer rejection, parent socioeconomic status, maternal distress, parental warmth, child temperament, and receptive verbal functioning explained differences between the two groups. Children with conduct problems ( N = 388, 45% girls) and a comparison sample without conduct problems ( N = 299, 52% girls) were recruited from Quebec, Canada, when they were between the ages of 7 and 10 years, and were followed across 4 years. Mothers and teachers provided information on internalizing problems each year. Having clinically significant conduct problems was associated with higher initial levels of internalizing problems according to mothers and teachers, but not with changes in internalizing problems over time. With regards to teacher ratings, academic achievement, peer rejection, and negative emotionality partially explained differences in internalizing problems for youth with and without conduct problems. For mother ratings, maternal distress, negative emotionality, and peer rejection completely explained the association for girls, and partially explained the association for boys. Findings supported a multi-rater approach for understanding risk for internalizing problems among children with and without conduct problems. In particular, they highlight the importance of differences across context for understanding factors associated with vulnerability to internalizing problems.

Childhood conduct problems and young adult outcomes among women with childhood attention-deficit/hyperactivity disorder (ADHD)

We tested whether conduct problems predicted young adult functioning and psychiatric symptoms among women diagnosed with attention-deficit/hyperactivity disorder (ADHD) during childhood, in the context of 3 potential adolescent mediators: internalizing problems, peer rejection, and school failure and disciplinary problems. We controlled for childhood ADHD severity, IQ, and demographic factors, and in the mediational tests, for adolescent conduct problems. Data came from 140 participants in the Berkeley Girls With ADHD Longitudinal Study. We used bootstrapping methods to assess indirect effects (mediators). Both childhood, F(1, 118) change = 9.00, p = .003, R2 change = .069, and adolescent, F(1, 109) change = 10.41, p = .002, R2 change = .083, conduct problems were associated with worse overall functioning during young adulthood, controlling for initial ADHD severity, child IQ, and demographics. Results were similar when predicting psychiatric symptoms. Adolescent school failure and disciplinary problems mediated the relations between childhood conduct problems and both young adult functioning and externalizing problems; adolescent internalizing problems and peer conflict mediated the relation between childhood conduct problems and young adult internalizing problems. As is true for boys, childhood and adolescent conduct problems are associated with poor adult outcomes among girls with ADHD, with school failure and disciplinary problems, internalizing problems, and peer conflict functioning as mediators of these relations.

A Mutual Hostility Explanation for the Co-Occurrence of Delinquency and Depressive Mood in Adolescence

Different interpersonal experiences are related to delinquency and depressive mood. In many studies, delinquency has been associated with exposing others to hostility, while depressive mood has been associated with being a victim of others' hostility. In this study, we proposed that adolescents with a co-occurrence of high delinquency and depressive mood may be both perpetrators and victims in their relations with parents at home, peers and teachers at school, and other people encountered in leisure time. We studied a normative sample of 1452 mid-adolescents (50.61% boys and 49.38% girls). Cluster analyses found a group with a co-occurrence of high delinquency and high depressive mood. Adolescents in this cluster group were highest on being exposed to hostility, exposing others to hostility, and being involved in mutually hostile interactions with others in different everyday contexts. The findings were especially strong when we examined being a victim and a perpetrator across contexts. The results were similar for boys and girls. We conclude that the co-occurrence of high delinquency and depressive mood among some adolescents is intimately linked to the mutually hostile interactions that these adolescents experience in their everyday interpersonal contexts.

Joint trajectories of internalizing and externalizing problems in preschool children with autism spectrum disorder

The co-occurring development of internalizing and externalizing problems were examined in an inception cohort of 392 children diagnosed with autism spectrum disorder at age 3 who were assessed on four occasions. Results indicated that internalizing and externalizing problems were stable over time and highly comorbid. Joint trajectory analysis suggested that 13% of the sample followed a dual high-risk trajectory. High risk was not found to be associated with intellectual ability or autism spectrum disorder symptom severity but was linked to lower income and gender: more girls than boys were found in the high/stable internalizing problems trajectory. The results suggest that 1 in 4 preschoolers followed a trajectory of internalizing or externalizing problems (or a combination of the two) that could be characterized as clinically elevated.

Delinquent Behavior in High School Students in Hong Kong: Sociodemographic, Personal, and Family Determinants

STUDY OBJECTIVE

On the basis of longitudinal data collected over 6 years, the changes in delinquent behavior and the related sociodemographic, personal, and family determinants were examined in this study. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A 6-year longitudinal research design was used. Students responded to a questionnaire containing sociodemographic questions and validated measures of positive youth development, family functioning, and delinquent behavior.

RESULTS

There was an increasing trend of delinquent behavior with the growth rate slowing down over the high school years. Male adolescents reported higher levels of delinquent behavior and showed a greater increase of delinquent behavior relative to female adolescents. Although positive youth development and family functioning were negatively associated with the initial level of delinquent behavior, they were positively associated with the growth rate of delinquent behavior over time.

CONCLUSION

Delinquent behavior could be described by a quadratic growth curve during high school years. Gender, positive youth development, and family functioning influence the level and developmental trajectory of delinquent behavior in adolescence.

Parental problem drinking and adolescent externalizing behaviors: The mediating role of family functioning

This study explored relationships among parental problem drinking, family functioning, and adolescent externalizing behaviors. The unique effects of maternal and paternal drinking were examined separately for girls and boys. The sample included 14-19 year old U.S. adolescents (Mage = 16.15; SD = .75; 52.5% female) and their parents. Participants completed surveys in the spring of 2007 and 2008. Structural equation modeling was used to conduct path analysis models. Results showed the distinctive and adverse effects of parental problem drinking on adolescent alcohol use, drug use, rule breaking, and aggressive behavior over time. Findings also highlighted the indirect and mediating roles of family functioning. For both girls and boys, family cohesion mediated the relationship between parental problem drinking and adolescent externalizing behaviors. For girls, adolescent-father communication predicted increased externalizing behaviors over time. These findings draw attention to the importance of exploring adolescent and parent gender when examining parental problem drinking, family functioning, and externalizing behaviors.

Change in children's externalizing and internalizing behavior problems: the role of defense mechanisms

This study investigates the relation of defense mechanism to children's externalizing and internalizing behavior problems, as assessed from mothers' report at age 9 and 12 years, based on archival data. The defense mechanisms of denial, projection, and identification were assessed from Thematic Apperception Test stories told by the children at age 9 years, using the Defense Mechanism Manual (Cramer, The development of defense mechanisms: Theory, research and assessment. New York: Springer-Verlag, 1991a; Protecting the self: Defense mechanisms in action. New York: Guilford Press, 2006). The results showed that the use of identification predicted a decrease in externalizing behaviors between age 9 and 12 years. In contrast, change in internalizing behaviors was not predicted by defense use, but the use of projection was related to fewer internalizing behaviors at both ages. These findings are consistent with the idea that behavioral intervention stressing self-regulation can be effective in reducing externalizing problems, but internalizing problems require an intervention that is sensitive to the underlying behavioral inhibition in these children.

Internalizing and externalizing problems in immigrant boys and girls

This longitudinal study explores differences between native Dutch and immigrant Moroccan adolescents in the relationship between internalizing and externalizing problems across time. By using generalized estimating equations (GEE), the strength and stability of associations between internalizing and externalizing problems in 159 Moroccan and 159 Dutch adolescents was studied over a period of 4 years. No differences in strength of co-occurring problems were found between Moroccan and Dutch adolescents. However, for Moroccan adolescents, associations between problems increased over time, whereas in Dutch adolescents, associations remained stable. The increase of co-occurring problems may be a result of undertreatment and increasing complexity of problems in Moroccans during adolescence. The results of this study imply that investigating processes leading to co-occurring problems in subgroups of adolescents, such as immigrant youths, is needed to optimize prevention and intervention efforts.

Anxiety in youth in Flemish care: a multi-informant study

Purpose

– The purpose of this paper is to investigate the prevalence of anxiety in youngsters with emotional and behavioral disorders, and its relation to other problems, using different informants.

Design/methodology/approach

– Data were collected in a Flemish treatment center. Educators completed a Child Behavior Checklist (CBCL) for each child, teachers completed a Teacher Report Form (TRF), and youth themselves completed a Youth Self Report (YSR) and a Screen for Child Anxiety Related Emotional Disorders (SCARED).

Findings

– Analyses indicated an explicit presence of anxiety. A clear relation was found between anxiety symptoms and internalizing problem behavior on the YSR, whereas only a slight relationship was found with the CBCL, and practically no relationship was found with the TRF. Only few correlations between anxiety and externalizing problems were found. Finally, youth themselves indicated strong correlations between anxiety and thought problems, whereas educators indicated strong correlations between youths’ anxiety and social problems.

Originality/value

– Several studies describe professionals’ difficulties to get a comprehensive perceptions of youths’ problems. This paper provides detailed insights in the nature of the informant discrepancies.

The trajectories of child’s internalizing and externalizing problems, social competence and adolescent self-reported problems in a Finnish normal population sample

Group-based modeling techniques are increasingly used in developmental studies to explore the patterns and co-occurrence of internalizing and externalizing problems. Social competence has been found to reciprocally influence internalizing and externalizing problems, but studies on its associations with different patterns of these problems are scarce. Using data from a Finnish longitudinal normal population sample, trajectories of internalizing and externalizing problems were formed using the Child Behavior Checklist completed by the mother at the child’s age of 4- to 5-years-old, 8- to 9-years-old, and 16- to 17-years-old ( N = 261). The results indicate that adolescent’s self-reported internalizing and externalizing problems based on the Youth Self Report were associated with the trajectories of internalizing and externalizing problems. Social competence both in early childhood and in adolescence was poorer among children with chronic internalizing problems and among those with adolescent-onset externalizing problems. One-third of the children who had a chronically high level of internalizing problems had an initially high but decreasing level of externalizing problems, while 33% of the adolescents with adolescent-onset externalizing problems had a chronically high level of internalizing problems. School psychologists are encouraged to screen for internalizing problems from children with behavioral, academic or social problems.

Peer problems mediate the relationship between developmental coordination disorder and behavioral problems in school-aged children

The aim of this study was to gain insights into the relationship between developmental coordination disorder, peer problems, and behavioral problems in school-aged children where both internalizing and externalizing behavioral problems were considered. We assumed that the relationship between developmental coordination disorder and internalizing/externalizing problems in school-aged children is mediated by peer problems and tested the hypothesis that a greater degree of motor impairment causes a greater degree of peer problems and thus a greater degree of internalizing or externalizing problems. Seventy boys and girls aged between 5 and 11 years were examined using the Movement Assessment Battery for Children 2 and the Intelligence and Developmental Scales. The results of path analysis showed that the relationship between developmental coordination disorder and internalizing/externalizing problems in school-aged children is mediated at least in part by peer problems. However, the cross-sectional design of the study does not provide conclusive evidence for a cause-effect relationship and only allows for the conservative prognosis that a greater degree of motor impairment may cause a greater degree of peer problems and thus a greater degree of internalizing/externalizing problems. Nevertheless, the results of this study emphasize the importance of being well-integrated in their peer group especially for children with developmental coordination disorder.

Codevelopment of delinquent and depressive symptoms across adolescence: time-invariant and time-varying effects of school and social failure

The codevelopment of delinquent behaviors and depressive symptoms from Grade 9 to 11 was investigated on an Italian sample of 518 adolescents (399 male) after the transition to high school, evaluating the time-invariant effects of past school failure and social failure and the time-varying effects of school achievement and social problems. Bivariate latent growth model showed a positive correlation between the two intercepts and the two slopes, suggesting that during adolescence the two trajectories are reciprocally and causally related over time. Time-invariant predictors--past school failure and social failure--explain interindividual variability only for delinquent growth. Time-varying covariates--school achievement and social problems--are significantly associated with both trajectories. These time-varying variables can act as snares, mechanisms responsible for accelerating the otherwise normative pattern of increase of delinquent behaviors and actively retarding the normative decrease of depressive symptoms over adolescence. Findings highlight how interventions aimed to promote competence during adolescence can be an effective way to prevent psychopathology or to reduce its impact.