Early childhood temperament and the covariation between internalizing and externalizing behavior in school-aged children

Systematic Review and Meta-Analysis: Early Irritability as a Transdiagnostic Neurodevelopmental Vulnerability to Later Mental Health Problems

OBJECTIVE

Irritability is a transdiagnostic indicator of child and adolescent internalizing and externalizing problems that is measurable from early life. The objective of this systematic review was to determine the strength of the association between irritability measured from 0 to 5 years and later internalizing and externalizing problems, to identify mediators and moderators of these relationships, and to explore whether the strength of the association varied according to irritability operationalization.

METHOD

Relevant studies published in peer-reviewed, English-language journals between the years 2000 and 2021 were sought from EMBASE, PsycINFO, MEDLINE, CINAHL, and ERIC. We synthesized studies that included a measure of irritability within the first 5 years of life and reported associations with later internalizing and/or externalizing problems. Methodological quality was assessed using the JBI-SUMARI Critical Appraisal Checklist.

RESULTS

Of 29,818 identified studies, 98 met inclusion criteria, with a total number of 932,229 participants. Meta-analysis was conducted on 70 studies (n = 831,913). Small, pooled associations were observed between infant irritability (0-12 months) and later internalizing (r = 0.14, 95% CI = 0.09, 0.20) and externalizing symptoms (r = 0.16, 95% CI = 0.11, 0.21) symptoms. For toddler/preschool irritability (13-60 months), small-to-moderate pooled associations were observed for internalizing (r = 0.21, 95% CI = 0.14, 0.28) and externalizing (r = 0.24, 95% CI = 0.18, 0.29) symptoms. These associations were not moderated by the lag between irritability and outcome assessment, although the strength of the associations varied according to irritability operationalization.

CONCLUSION

Early irritability is a consistent transdiagnostic predictor of internalizing and externalizing symptoms in childhood and adolescence. More work is required to understand how to accurately characterize irritability across this developmental period, and to understand mechanisms underlying the relationship between early irritability and later mental health problems.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

STUDY PREREGISTRATION INFORMATION

Early irritability as a transdiagnostic neurodevelopmental vulnerability to early onset mental health problems: A systematic review; https://www.crd.york.ac.uk/prospero/; CRD42020214658.

Polygenic risk for neuroticism is associated with externalizing symptoms in 2-year-old boys

Recent advances in genome-wide association studies have enabled the estimation of genetic risk of complex traits, including neuroticism, with polygenic risk scores (PRS). Neuroticism PRS has been associated with psychiatric disorders and symptoms in adults, but studies in children are scarce. We studied whether neuroticism PRS, and its subscales, worry PRS and depressive affect PRS, were associated with externalizing and internalizing symptoms in 2-year-olds. We also examined parental neuroticism PRSs' association with children's externalizing and internalizing symptoms and whether parental depressive symptoms mediated the effect. Participants from two Finnish birth cohorts, CHILD-SLEEP and FinnBrain Birth Cohort Study, who had DNA and data on Brief Infant-Toddler Social and Emotional Assessment (BITSEA) available were included in the study (N = 806 and N = 987, respectively). PRSs were calculated based on GWAS data from UK Biobank. Child's neuroticism PRS, and its subscale worry PRS, were positively associated with externalizing symptoms in 2-year-old boys, but not in girls. Mother's depressive symptoms mediated the association between maternal neuroticism PRS and externalizing and internalizing symptoms in boys, but not in girls. Our results suggest that neuroticism PRS, and its subscale worry PRS, are associated with externalizing symptoms in already as young as 2-year-old boys, and, that subclinical symptoms of maternal depression that are based on genetic disposition, have an effect on boy's internalizing and externalizing symptoms. As we did not find any associations in girls, our study supports the suggestion that girls and boys may differ in how genetic and environmental factors contribute to their development.

Heritability of Psychological Traits and Developmental Milestones in Infancy: A Systematic Review and Meta-analysis

IMPORTANCE

Although infancy is the most rapid period of postnatal growth and development, factors associated with variation in infant traits are not well understood.

OBJECTIVE

To synthesize the large twin study literature partitioning phenotypic variance in psychological traits and developmental milestones in infancy into estimates of heritability and shared and nonshared environment.

DATA SOURCES

PubMed, PsycINFO, and references of included publications were searched up to February 11, 2021.

STUDY SELECTION

Peer-reviewed publications using the classical twin design to study psychological traits and developmental milestones from birth to 2 years old were included.

DATA EXTRACTION AND SYNTHESIS

Data were extracted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and categorized using the International Classification of Functioning, Disability and Health: Children and Youth Version. Data were pooled in 3-level random effects models, incorporating within-cohort variance in outcome measurement and between-cohort variance. Data were analyzed from March 2021 through September 2021.

MAIN OUTCOMES AND MEASURES

The primary outcomes were monozygotic and dizygotic twin correlations. These were used to calculate genetic and shared and nonshared environment estimates.

RESULTS

Among 139 publications that were systematically retrieved, data were available on 79 044 twin pairs (31 053 monozygotic and 47 991 dizygotic pairs), 52 independent samples, and 21 countries. Meta-analyses were conducted on psychological traits and developmental milestones from 106 publications organized into 10 categories of functioning, disability, and health. Moderate to high genetic estimates for 8 categories were found, the highest of which was psychomotor functions (pooled h2, 0.59; 95% CI, 0.25-0.79; P < .001). Several categories of traits had substantial shared environment estimates, the highest being mental functions of language (pooled c2, 0.59; 95% CI, 0.24-0.86; P = .001). All examined categories of traits had moderate or high nonshared environment estimates, the highest of which were emotional functions (pooled e2, 0.42; 95% CI, 0.33-0.50; P < .001) and family relationships (pooled e2, 0.42; 95% CI, 0.30-0.55; P < .001).

CONCLUSIONS AND RELEVANCE

These findings may be an important source of information to guide future gene discovery research, public perspectives on nature and nurture, and clinical insights into the degree to which family history and environments may estimate major domains of infant functioning, disability, and health in psychological traits and developmental milestones.

Toddler risk and protective characteristics: Common and unique genetic and environmental influences

The goal of this study was to disentangle the common and unique genetic and environmental influences on social-emotional competence, problem behavior, physiological dysregulation, and negative emotionality (NE) in toddlers. The sample consisted of 243 twin pairs (mean age = 31.94 months) rated by primary caregivers (>95% mothers) on the Children's Behavior Questionnaire and the Infant-Toddler Social and Emotional Assessment. A multivariate Cholesky Decomposition revealed three shared environmental factors, with one set of environmental influences common to competence, problem behavior, and physiological dysregulation, a second common to problem behavior and physiological dysregulation, and a third common to physiological dysregulation and NE. Also, there were two additive genetic factors, with one explaining variance in competence, NE, and a small amount of variance in problem behavior, and a second explaining variance in problem behavior and NE. Given the common shared environmental factors across outcomes, these results suggest that toddlerhood could be a particularly important time to intervene, as interventions could simultaneously improve competencies and reduce problem behaviors. This study also highlights the need for genetically informed research to examine the etiology of multiple outcomes and address overlap.

Self-Conscious Shyness: Growth during Toddlerhood, Strong Role of Genetics, and No Prediction from Fearful Shyness

Fearful and self-conscious subtypes of shyness have received little attention in the empirical literature. Study aims included: 1) determining if fearful shyness predicted self-conscious shyness, 2) describing development of self-conscious shyness, and 3) examining genetic and environmental contributions to fearful and self-conscious shyness. Observed self-conscious shyness was examined at 19, 22, 25, and 28 months in same-sex twins (MZ = 102, DZ = 111, missing zygosity = 3 pairs). Self-conscious shyness increased across toddlerhood, but onset was earlier than predicted by theory. Fearful shyness (observed [6 and 12 months] and parents' reports [12 and 22 months]) was not predictive of self-conscious shyness. Independent genetic factors made strong contributions to parent-reported (but not observed) fearful shyness (additive genetic influence = .69 and .72 at 12 and 22 months, respectively) and self-conscious shyness (additive genetic influence = .90 for the growth model intercept). Results encourage future investigation of patterns of change and interrelations in shyness subtypes.

Comorbidity Among Dimensions of Childhood Psychopathology: Converging Evidence from Behavior Genetics

In this article, we review evidence from recent behavior genetic studies that examined the covariance among common childhood psychopathological conditions and tested specific hypotheses regarding common and broadband-specific underlying features of childhood psychopathology. Specifically, we review the distinction between internalizing and externalizing disorders, the support for the generalist genes and specialist environments model, negative emotionality as a heritable underlying feature common to both internalizing and externalizing disorders, and daring as a heritable broadband-specific underlying feature that distinguishes externalizing disorders from internalizing disorders. We also discuss the implications of research in the search for specific genes that influence childhood psychopathology and suggest avenues for new research.

Personality dimensions as common and broadband-specific features for internalizing and externalizing disorders

Several researchers have suggested that the nature of the covariation between internalizing and externalizing disorders may be understood better by examining the associations between temperament or personality and these disorders. The present study examined neuroticism as a potential common feature underlying both internalizing and externalizing disorders and novelty seeking as a potential broad-band specific feature influencing externalizing disorders alone. Participants were 12- to 18-year-old twin pairs (635 monozygotic twin pairs and 691 dizygotic twin pairs; 48 % male and 52 % female) recruited from the Colorado Center for Antisocial Drug Dependence. Genetic and nonshared environmental influences shared in common with neuroticism influenced the covariation among distinct internalizing disorders, the covariation among distinct externalizing disorders, and the covariation between internalizing and externalizing disorders. Genetic influences shared in common with novelty seeking influenced the covariation among externalizing disorders and the covariation between major depressive disorder and externalizing disorders, but not the covariation among internalizing disorders or between anxiety disorders and externalizing disorders. Also, after accounting for genetic and environmental influences shared in common with neuroticism and novelty seeking, there were no significant common genetic or environmental influences among the disorders examined, suggesting that the covariance among the disorders is sufficiently explained by neuroticism and novelty seeking. We conclude that neuroticism is a heritable common feature of both internalizing disorders and externalizing disorders, and that novelty seeking is a heritable broad-band specific factor that distinguishes anxiety disorders from externalizing disorders.

Childhood temperament: passive gene-environment correlation, gene-environment interaction, and the hidden importance of the family environment

Biological parents pass on genotypes to their children, as well as provide home environments that correlate with their genotypes; thus, the association between the home environment and children's temperament can be genetically (i.e., passive gene-environment correlation) or environmentally mediated. Furthermore, family environments may suppress or facilitate the heritability of children's temperament (i.e., gene-environment interaction). The sample comprised 807 twin pairs (mean age = 7.93 years) from the longitudinal Wisconsin Twin Project. Important passive gene-environment correlations emerged, such that home environments were less chaotic for children with high effortful control, and this association was genetically mediated. Children with high extraversion/surgency experienced more chaotic home environments, and this correlation was also genetically mediated. In addition, heritability of children's temperament was moderated by home environments, such that effortful control and extraversion/surgency were more heritable in chaotic homes, and negative affectivity was more heritable under crowded or unsafe home conditions. Modeling multiple types of gene-environment interplay uncovered the complex role of genetic factors and the hidden importance of the family environment for children's temperament and development more generally.

Negative affect shares genetic and environmental influences with symptoms of childhood internalizing and externalizing disorders

The co-occurrence of internalizing and externalizing disorders suggests that they may have common underlying vulnerability factors. Research has shown that negative affect is moderately positively correlated with both internalizing and externalizing disorders in children. The present study is the first to provide an examination of negative affect in relation to a wide spectrum of childhood internalizing and externalizing problems using a biometric model. This study extends prior findings of more narrowly focused associations by using a factor approach including multiple disorders. The sample for this study included families of 691 same-sex 7- to 13-year old twin pairs. A multifactorial independent pathway model was used to examine the genetic and environmental influences underlying the covariation of parent-reported negative affect, internalizing symptoms, and externalizing symptoms. Results of the current study suggest that negative affect shares genetic and environmental influences with both internalizing and externalizing disorders in childhood. These common influences may partially explain their comorbidity. Understanding that negative affect is at least one contributor to the covariation among these disorders may highlight avenues for early risk assessment, intervention, and perhaps prevention.

Attention-deficit/hyperactivity disorder comorbidity in a sample of veterans with posttraumatic stress disorder

This study examined attention-deficit/hyperactivity disorder (ADHD) comorbidity in military veterans with a high prevalence of posttraumatic stress disorder (PTSD) and evaluated the relationships between the 2 disorders and exposure to traumatic events. The sample included 222 male and female military veterans who were administered structured clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Results show that 54.5% met the criteria for current PTSD, 11.5% of whom also met the criteria for current adult ADHD. Level of trauma exposure and ADHD severity were significant predictors of current PTSD severity. Evaluation of the underlying structure of symptoms of PTSD and ADHD using confirmatory factor analysis yielded a best-fitting measurement model that comprised 4 PTSD factors and 3 ADHD factors. Standardized estimates of the correlations among PTSD and ADHD factors suggested that the largest proportion of shared variance underlying PTSD-ADHD comorbidity is related to problems with modulating arousal levels that are common to both disorders (ie, hyperarousal and hypoarousal).

The magnitude of genetic and environmental influences on parental and observational measures of behavioral inhibition and shyness in toddlerhood

Behavioral inhibition is a temperamental trait that refers to slow approach to novel items, shyness towards new people, and fearfulness in new situations, and individuals may develop inhibited response styles by as early as 2 years of age. There are important methodological considerations in the assessment of early temperament, with parental report and observational measures providing both corroborative and unique data. The present study examined behavioral inhibition measured by parental report and observational measures in a genetically informative sample to delineate the agreement between the methods and the uniqueness of each method, and to estimate the magnitude of genetic and environmental influences on the common and unique variance. The biometric, psychometric, and rater bias models were conducted to study the covariance between measurement modalities. Overall, the results suggested a common phenotype was assessed by both parents and observers. The latent phenotype underlying parental and observational measures of behavioral inhibition was moderately to substantially heritable.

Parental negative control moderates the shyness-emotion regulation pathway to school-age internalizing symptoms

Models of developmental psychopathology emphasize both mediation and moderation processes among child and caregiving attributes; however, little research has examined both these processes simultaneously on the development of internalizing problems. This study tested a moderated mediation model that related early childhood shyness, emotion regulation and maternal negative control to school-age internalizing problems among 257 boys from low-income families. Shyness and maternal negative control was assessed at ages 1.5-2, emotion regulation was observed at age 3.5, and internalizing symptoms were assessed by mothers and teachers at age 6 or 7. Results indicated that 1) the active distraction regulation strategy mediated the relations between early shyness and maternal report of internalizing symptoms; 2) the passive/dependent regulation strategy mediated the relations between shyness and teacher report of internalizing symptoms; and 3) both mediation processes were moderated by maternal negative control. The results are discussed in relation to implications for early prevention and intervention.

Contributions of parent-adolescent negative emotionality, adolescent conflict, and adoption status to adolescent externalizing behaviors

Although most adopted children are well adjusted, research has consistently found that adopted adolescents are at an increased risk for externalizing behaviors. The present investigation tested a model whereby parent-adolescent negative emotionality traits, adolescent conflict, and adoption status contribute to adolescent externalizing behaviors. The study included 616 families with at least one parent and two adolescent siblings with a maximum 5-year age difference. The analyses used data from the mothers (M age = 45.56, SD = 4.23), fathers (M age = 48.23, SD = 4.42), and the elder sibling (M age = 16.14, SD = 1.5). Findings support two conflict-mediated family processes that contributed to externalizing behaviors: one initiated by parent-adolescent traits and one by adoption status. Findings also underscore the salience of conflict in families and the significance of aggressive traits and negative emotionality. Contrary to previous research, we found that adoption status did not directly add to our explanation of adolescent externalizing behaviors beyond our proposed process. Instead, adoption status was indirectly associated with externalizing problems through a conflict-mediated relationship.

Brain substrates of behavioral programs associated with self-regulation

The present paper proposes that four neuromodulator systems underpin highly generalized behavioral sets, but each targets either dorsomedial or ventrolateral cortical systems, where it produces its effects in either a proactive or reactive orientation to the environment. This way systems are discriminated that control reactive approach (dopaminergic), reactive avoidance (cholinergic), proactive behavior (noradrenergic), and withdrawal (serotonergic). This model is compared with models of temperament, affect, personality, and so-called two-system models from psychology. Although the present model converges with previous models that point to a basic scheme underlying temperamental and affective space, at the same time it suggest that specific additional discriminations are necessary to improve descriptive fit to data and solve inconsistencies and confusions. We demonstrate how proactive and reactive actions and controls can be confused, and that this has many potential implications for psychology and neurobiology. We uncover conceptual problems regarding constructs such as effortful control, positive affect, approach-avoidance, extraversion, impulsivity, impulse-control, and goal-directedness of behavior. By delineating those problems, our approach also opens up ways to tackle them.