Prospective effects of violence exposure across multiple contexts on early adolescents’ internalizing and externalizing problems

Background: Violence exposure within each setting of community, school, or home has been linked with internalizing and externalizing problems. Although many children experience violence in multiple contexts, the effects of such cross‐contextual exposure have not been studied. This study addresses this gap by examining independent and interactive effects of witnessing violence and victimization in the community, home, and school on subsequent internalizing and externalizing problems in early adolescence. Methods: A community sample of 603 boys and girls (78% African American, 20% Caucasian) participated in a longitudinal study of youth violence. During two assessments 16 months apart, adolescents reported on witnessing violence and victimization in the community, school, and home, and their internalizing and externalizing problems. Results: Multiple regressions tested the independent and interactive effects of witnessing violence or victimization across contexts on subsequent adjustment, after controlling for initial levels of internalizing and externalizing problems and demographic covariates. Witnessing violence at school predicted anxiety and depression; witnessing at home was related to anxiety and aggression; and witnessing community violence predicted delinquency. Victimization at home was related to subsequent anxiety, depression, and aggression; victimization at school predicted anxiety; and victimization in the community was not independently related to any outcomes. Finally, witnessing violence at home was associated with more anxiety, delinquency, and aggression only if adolescents reported no exposure to community violence. Conclusions: Violence exposure at home and school had the strongest independent effects on internalizing and externalizing outcomes. Witnessing community violence attenuated the effects of witnessing home violence on anxiety and externalizing problems, perhaps due to desensitization or different norms or expectations regarding violence. However, no comparable attenuation effects were observed for victimization across contexts.     

Screening for childhood mental health problems: outcomes and early identification

Background: Many childhood psychiatric problems are transient. Consequently, screening procedures to accurately identify children with problems unlikely to remit and thus, in need of intervention, are of major public health concern. This study aimed to develop a universal school‐based screening procedure based on the answers to three questions: (1) What are the broad patterns of mental health problems from kindergarten to grade 5? (2) What are the grade 5 outcomes of these patterns? (3) How early in school can children likely to develop the most impairing patterns be identified accurately? Methods: Mothers and teachers reported on a community sample (N = 328) of children’s internalizing and externalizing symptoms in kindergarten and grades 1, 3, and 5. In grade 5, teachers reported on children’s school‐based functional impairments, physical health problems, and service use; mothers reported on children’s specialty mental health care. Results: Four patterns distinguished children who (1) never evidenced symptoms; (2) evidenced only isolated symptoms; or evidenced recurrent symptoms, either (3) without or (4) with comorbid internalizing and externalizing. By grade 5, children with recurrent comorbid symptoms had the greatest impairments, physical health problems, and service use. These children can be identified quite accurately by grade 1. Conclusions: Universal screening at school entry can effectively identify children likely to develop recurrent comorbid symptoms, and would provide a basis for developing optimal targeted intervention programs.     

Dynamic changes in anger,externalizing and internalizing problems: attention and regulation

Background: Low levels of dispositional anger and a good attention span are critical to healthy social emotional development, with attention control reflecting effective cognitive self‐regulation of negative emotions such as anger. Using a longitudinal design, we examined attention span as a moderator of reciprocal links between changes in anger and changes in externalizing and internalizing problems from 4.5 to 11 years of age. Method: Participants were children from the Study of Early Child Care and Youth Development (SECCYD), assessed four times between 4.5 and 11 years. Composite scores for anger and attention were computed using indicators from multiple informants. Externalizing and internalizing problems were reported by mothers. Results: Latent difference score analysis showed reciprocal lagged effects between increased anger and elevated levels of externalizing or internalizing problems. Significant moderating effects of attention indicated more persistent effects of anger on externalizing problems in the poor attention group. Although the poor and the good attention groups did not differ regarding the effects of anger on internalizing problems, significant moderating effects of attention indicated stronger and more persistent reciprocal effects of internalizing problems on anger in the poor attention group. Conclusions: Attention control mechanisms are involved in self‐regulation of anger and its connections with changes in behavioral and emotional problems. Strong attention regulation may serve to protect children with higher levels of dispositional anger from developing behavioral and emotional problems in middle childhood.     

Social-psychological correlates of peer victimization in children with endocrine disorders

OBJECTIVE: To examine the relation between victimization by peers and child and parent reports of social-psychological adjustment. STUDY DESIGN: The Social Experience Questionnaire, Children's Depression Inventory, Social Anxiety Scale for Children-Revised, and Asher Loneliness Scale were administered to 93 children diagnosed with various endocrine disorders. The child's parent/guardian completed the Child Behavior Checklist. RESULTS: For the entire sample, peer victimization was positively related to child-reported depression, social anxiety, loneliness, and parent-reported externalizing symptoms. Those children with endocrine disorders without observable features had a stronger relation between peer victimization and depression and internalizing and externalizing behavior problems than did those who had endocrine disorders with observable physical features. CONCLUSIONS: Recognition of the magnitude of the problem and means of evaluating for peer victimization is important for clinicians who see children with chronic diseases.     

Risk Factors and Psychological Outcomes of Bullying Victimization: A Community-based Study

To understand the negative impact of bullying on the psychological well-being of children and adolescents we need to examine the associated context of adverse home life, problem peer relationships and school experience. Standardized retrospective in-depth interviews provide a useful method. A sample of 160 high-risk community-based emerging adults in the UK (age 16–30) were interviewed to rate familial and peer/school relationships, and severity of bullying with or without aggression before age 17. A clinical interview assessed psychiatric disorders in teenage years. Statistical analyses showed a differential model for bullying victims versus aggressive victims and internalizing versus externalizing disorders. Both types of bullying experiences were associated with parental neglect and abuse, parental discord and inadequate supervision; victimization alone related to problem school context and internalizing disorders (anxiety disorders and major depression); in contrast, bullying victimization with aggression was distinctly associated with experiences of violence in family, problem peer group, and externalizing disorders (conduct disorder and substance use disorder). Thus differentiation of context of young people’s experience can inform effective psychosocial, educational and clinical approaches to reduce the risks associated with bullying victimization.     

Psychopathology in thalassemia major

Background: Thalassemia major (TM) is a chronic disease with adverse emotional effects on both the child and the family. The aim of this study was to investigate the psychiatric state and behavioral problems of children with TM. Methods: Twenty children diagnosed with TM and 34 healthy children were enrolled in this study carried out by the Pamukkale University Faculty of Medicine, Department of Pediatrics. Mothers of the children of both the groups were handed a child behavior check‐list for 4–18‐year‐old children and adolescents as well as a short questionnaire requesting demographic information. Results: The psychiatric diagnosis was significantly higher in the children with TM (55.0%) as compared to the control group (14.7%). The thalassemic children showed an anxiety disorder frequency of 30.0% and a depressive disorder frequency of 15.0%. T scores of the indicators of internalizing problems, externalizing problems, attention problems and social problems contained in the child behavior check‐list were shown to be higher in children with TM than in the control group. The TM group demonstrated significantly higher problems in peer relationships and educational success in comparison with the controls. Conclusion: Children with TM are posed with an increased risk of psychopathology.     

Infant-mother attachment and the growth of externalizing problems across the primary-school years

Background: Some contend that attachment insecurity increases risk for the development of externalizing behavior problems in children. Method: Latent‐growth curve analyses were applied to data on 1,364 children from the NICHD Study of Early Child Care to evaluate the association between early attachment and teacher‐rated externalizing problems across the primary‐school years. Results: Findings indicate that (a) both avoidant and disorganized attachment predict higher levels of externalizing problems but (b) that effects of disorganized attachment are moderated by family cumulative contextual risk, child gender and child age, with disorganized boys from risky social contexts manifesting increases in behavior problems over time. Conclusions: These findings highlight the potentially conditional role of early attachment in children’s externalizing behavior problems and the need for further research evaluating causation and mediating mechanisms.     

Childhood emotional and behavioural problems: A comparison of children's reports with reports from parents and teachers

Abstract Paediatricians are often asked to assess children with emotional and behavioural problems and are faced with the dilemma that reports about the children's behaviour obtained from the children, and from their parents and teachers, may differ. This study compares the number of childhood emotional and behavioural problems reported by children living in the community, with the number of problems reported by their parents and teachers. When describing both internalizing and externalizing problems, the children consistently reported that they had more problems than were reported by either their parents or teachers. This pattern was particularly evident with reports from older female children who reported many more internalizing problems than were reported by their parents and teachers. Possible reasons for the differences between reports from children and the other informants are discussed.     

Agreement Between Parents'' and Teachers'' Ratings of Behavioral/Emotional Problems of Children aged 4–12.

Parents' and teachers' reports of behavioral/emotional problems in 1161 children aged 4-12 from the general population and assessed via the Achenbach Child Behavior Checklist were compared. Low to moderate agreement was found, with parents reporting more problems than teachers. Agreement was higher for externalizing problems than for internalizing problems and higher for children receiving special education than for those receiving regular education. Agreement was slightly higher for older than younger children. Sex of the child did not influence parent-teacher agreement. Teachers scored children higher on problems related to peer relations and on problems interfering with academic functioning, whereas parents scored their children higher on problems associated more strongly with externalizing than with internalizing syndromes.     

Self-concept and psychopathology in deaf adolescents: preliminary support for moderating effects of deafness-related characteristics and peer problems

Background: High rates of psychopathology were found amongst deaf adolescents, but little is known about the psychosocial risk factors. This study investigated whether (1) less severe deafness and/or acquired or otherwise complicated deafness, and (2) having mainly contacts with hearing people, each represent chronic stressful conditions that moderate the associations between self‐esteem and emotional problems. In addition, the moderating effect of observed peer rejection on the association between social acceptance and behavioural problems was explored. Method: Deaf adolescents of normal intelligence (N = 68) completed the Self Perception Profile for Adolescents. Psychopathology was assessed using a semi‐structured interview with adolescents and reports by parents, teachers and expert ratings. Data on moderator variables were collected from school records, parental and teachers’ reports. Results: Emotional mental health problems were negatively associated with self‐esteem and positively with peer rejection. The association between self‐esteem and emotional problems was moderated by the deafness variable less severe deafness or acquired or otherwise complicated deafness. Behavioural mental health problems were positively associated with social acceptance and peer rejection but negatively with the amount of involvement with hearing people. Peer rejection moderated the association between social acceptance and behavioural problems. Conclusions: The findings emphasise the importance of considering self‐concept dimensions, peer problems and deafness‐ and context‐related characteristics when assessing and treating deaf adolescents.     

Difficult temperament moderates links between maternal responsiveness and children’s compliance and behavior problems in low‐income families

Background: Research has shown that interactions between young children’s temperament and the quality of care they receive predict the emergence of positive and negative socioemotional developmental outcomes. This multimethod study addresses such interactions, using observed and mother‐rated measures of difficult temperament, children’s committed, self‐regulated compliance and externalizing problems, and mothers’ responsiveness in a low‐income sample. Methods: In 186 thirty‐month‐old children, difficult temperament was observed in the laboratory (as poor effortful control and high anger proneness), and rated by mothers. Mothers’ responsiveness was observed in lengthy naturalistic interactions at 30 and 33 months. At 40 months, children’s committed compliance and externalizing behavior problems were assessed using observations and several well‐established maternal report instruments. Results: Parallel significant interactions between child difficult temperament and maternal responsiveness were found across both observed and mother‐rated measures of temperament. For difficult children, responsiveness had a significant effect such that those children were more compliant and had fewer externalizing problems when they received responsive care, but were less compliant and had more behavior problems when they received unresponsive care. For children with easy temperaments, maternal responsiveness and developmental outcomes were unrelated. All significant interactions reflected the diathesis‐stress model. There was no evidence of differential susceptibility, perhaps due to the pervasive stress present in the ecology of the studied families. Conclusions: Those findings add to the growing body of evidence that for temperamentally difficult children, unresponsive parenting exacerbates risks for behavior problems, but responsive parenting can effectively buffer risks conferred by temperament.     

Longitudinal pathways linking child maltreatment,emotion regulation,peer relations,and psychopathology

Background: The aim of this study was to investigate longitudinal relations among child maltreatment, emotion regulation, peer acceptance and rejection, and psychopathology. Methods: Data were collected on 215 maltreated and 206 nonmaltreated children (ages 6–12 years) from low‐income families. Children were evaluated by camp counselors on emotion regulation and internalizing and externalizing symptomatology and were nominated by peers for peer acceptance and rejection. Results: Structural equation modeling analyses revealed that experiencing neglect, physical and/or sexual abuse, multiple maltreatment subtypes, and earlier onset of maltreatment were related to emotion dysregulation. Lower emotion regulation (Time 1) was associated with higher externalizing symptomatology (Time 1) that contributed to later peer rejection (Time 2), which in turn was related to higher externalizing symptomatology (Time 2). Conversely, higher emotion regulation was predictive of higher peer acceptance over time, which was related to lower internalizing symptomatology controlling for initial levels of symptomatology. Conclusions: The findings emphasize the important role of emotion regulation as a risk or a protective mechanism in the link between earlier child maltreatment and later psychopathology through its influences on peer relations.     

Gene-environment interaction in teacher-rated internalizing and externalizing problem behavior in 7- to 12-year-old twins

Background: Internalizing and externalizing problem behavior at school can have major consequences for a child and is predictive for disorders later in life. Teacher ratings are important to assess internalizing and externalizing problems at school. Genetic epidemiological studies on teacher‐rated problem behavior are relatively scarce and the reported heritability estimates differ widely. A unique feature of teacher ratings of twins is that some pairs are rated by different and others are rated by the same teacher. This offers the opportunity to assess gene–environment interaction. Methods: Teacher ratings of 3,502 7‐year‐old, 3,134 10‐year‐old and 2,193 12‐year‐old twin pairs were analyzed with structural equation modeling. About 60% of the twin pairs were rated by the same teacher. Twin correlations and the heritability of internalizing and externalizing behavior were estimated, separately for pairs rated by the same and different teachers. Socioeconomic status and externalizing behavior at age 3 were included as covariates. Results: Twin correlations and heritability estimates were higher when twin pairs were in the same class and rated by the same teacher than when pairs were rated by different teachers. These differences could not be explained by twin confusion or rater bias. When twins were rated by the same teacher, heritability estimates were about 70% for internalizing problems and around 80% in boys and 70% in girls for externalizing problems. When twins were rated by different teachers, heritability estimates for internalizing problems were around 30% and for externalizing problems around 50%. Conclusions: Exposure to different teachers during childhood may affect the heritability of internalizing and externalizing behavior at school. This finding points to gene–environment interaction and is important for the understanding of childhood problem behavior. In addition, it could imply an opportunity for interventions at school.     

The Transition to Adolescence: the Role of Gender and Stress in Problem Behavior and Competence

The differential change of boys and girls across pre-adolescence, early adolescence, and middle adolescence was examined. The participants were 259 children, their mothers, and their social studies teachers. The children completed a measure of internalizing problems and adults completed measures of the child's externalizing and internalizing problems and competence. Relative to girls, boys had more problems and less competence at pre-adolescence and/or less problems and more competence by mid-adolescence. A stressor, parental divorce, did not exacerbate the gender by developmental age period interaction. The differential vulnerability of boys and girls at different developmental periods is considered.     

Predictive power of peer behavioral assessment for subsequent maladjustment in community samples of disruptive and nondisruptive children

In a prospective, longitudinal study with community samples of disruptive and nondisruptive children, the predictive relations between peer-assessed dimensions of behavioral reputation in elementary school and teacher-rated behavioral adjustment and test scores of academic achievement were examined over a 4-year period. The Revised Class Play (RCP), a social role matching instrument completed by students about their classmates, was used to assess behavioral dimensions of children's peer reputation at baseline. Regression analyses showed that the RCP dimensions of aggressive-disruptive, sensitive-isolated, and social etiquette were the best predictors of later teacher-rated externalizing problems, internalizing problems, and subsequent adaptive skills respectively. Only IQ predicted later academic achievement. When IQ and disruptive/nondisruptive group status were added to each regression equation they further contributed as significant predictors. When parent and teacher ratings of behavior problems at baseline were entered jointly with RCP dimensions into regression equations, the peer dimensions further explained outcome variance. Additive effects of the RCP dimensions were found only for the externalizing problems outcome. Disruptive children with mild levels of aggressive behavior and high levels of sensitive-isolated behavior had less externalizing problems at outcome. A comparison of the difference between disruptive and nondisruptive groups in the relationship of baseline RCP scores to teacher outcomes showed no difference between groups, suggesting that the groups did not depart appreciably from their initial differences relative to each other over time.     

Development of ethnic disparities in internalizing and externalizing problems from adolescence into young adulthood

BACKGROUND: Little is known about changes in ethnic disparities in mental health during the development of adolescents into young adults. The aim of this study was to study the development of disparities in internalizing and externalizing problems between Dutch natives and Turkish migrant children from adolescence into adulthood. METHODS: Turkish migrants (n = 217) and Dutch natives (n = 723) completed two comparable questionnaires about internalizing and externalizing problems: the Youth Self-Report at age 11-18 and the (Young) Adult Self-Report ten years later, at age 21-28. We used mixed linear regression models to model development of mental health problems and to test changes in disparities in mental health between Turkish migrants and Dutch natives. RESULTS: Both in adolescence and in adulthood migrants reported more internalizing and externalizing problems than natives, most pronounced for internalizing problems. Disparities decreased from adolescence into adulthood for both internalizing problems (-52%, p < .0001) and externalizing problems (-67%, p = .01), independently of gender, age, country of birth of Turkish adolescents, and parental socio-economic position. The favorable changes in the disparities over time were due to more favorable development among Turkish migrants than among natives. CONCLUSIONS: In this prospective study, ethnic disparities in internalizing and externalizing problems decreased as adolescents entered adulthood. Different explanations are discussed.     

Delighted when approved by others, to pieces when rejected: children's social anxiety magnifies the linkage between self- and other-evaluations

Background: Socially anxious children tend to attach great importance to others’ evaluations of them. However, the extent to which they base their momentary feelings of self‐worth (i.e., state self‐esteem) on social (dis)approval is unclear. It is also unclear whether this exceedingly approval‐based self‐esteem is a common correlate of social anxiety and depression, or specifically linked to one or the other. Methods: Changes in children’s state self‐esteem were obtained in response to a manipulated peer evaluation outcome. Participants (N = 188) aged 10 to 13 took part in a rigged online computer contest and were randomized to receive positive or negative peer feedback. Self‐reported state self‐esteem was assessed via computer at baseline and immediately post‐feedback. The predictive effects of self‐reported social anxiety and depression symptoms on changes in state self‐esteem were investigated. Results: Hierarchical multiple regression analyses showed that children with higher social anxiety, as indexed by the fear of negative evaluation component, experienced significantly stronger increases in state self‐esteem following peer approval (β = .26, p < .05), and significantly stronger decreases in state self‐esteem following peer disapproval (β =?.23, p < .05). In both conditions depressive symptoms did not predict changes in state self‐esteem (ps > .20). Conclusions: Socially anxious children’s state self‐esteem is strongly contingent on social approval. Because basing one’s self‐esteem on external validation has multiple negative consequences, these findings highlight the importance of teaching these children skills (e.g., making cognitive reappraisals) to weaken the linkage between other‐ and self‐evaluations.     

Testing a maternal attachment model of behavior problems in early childhood

BACKGROUND: The purpose of the present study was to test a maternal attachment model of behavior problems in early childhood using phase I data from the NICHD Study of Early Child Care, a prospective study of 1,364 children from birth through sixth grade. METHODS: Mothers' and caregivers' ratings of children's internalizing and externalizing problems at age three were regressed separately on a set of fifteen predictors that included security and disorganization scores from 15, 24, and 36 months using hierarchical and logistical modeling. RESULTS: There were three main findings. First, Q-set mother-child attachment security, based on home observations at 24 months, provided the best evidence that attachment was associated with behavior problems, especially above-average levels of problems. Second, insecurity in the 36-month modified Strange Situation predicted mothers' and caregivers' ratings of internalizing problems for boys and girls as well as their ratings of externalizing problems for boys. Third, maternal depressive symptoms predicted mothers' ratings of internalizing and externalizing problems. CONCLUSIONS: There are meaningful associations between attachment insecurity and behavior problems as assessed not only by mothers but also by caregivers.     

Language skills, peer rejection, and the development of externalizing behavior from kindergarten to fourth grade

Background: Children with poorer language skills are more likely to show externalizing behavior problems, as well as to become rejected by their peers. Peer rejection has also been found to affect the development of externalizing behavior. This study explored the role of peer rejection in the link between language skills and the development of externalizing behavior. Methods: Six hundred and fifteen (615) children were followed from kindergarten to grade 4. Receptive language skills were measured with the Peabody Picture Vocabulary Test in grade 2. Teachers reported externalizing behavior and peer reports of social rejection were measured annually. Results: Children with poorer receptive language skills showed increasing externalizing behavior, while children with better receptive language skills showed decreases in externalizing behavior. Children with poorer receptive language skills experienced peer rejection most frequently. The link between receptive language skills and the development of externalizing behavior was mediated by the development of peer rejection. Findings suggested that this mediational link applied mostly to boys. Conclusion: Children with poorer language skills are at increased risk of becoming rejected by mainstream peers, which adds to the development of externalizing behavior.     

5‐HTTLPR moderates the effect of relational peer victimization on depressive symptoms in adolescent girls

Background: Relational peer victimization is associated with internalizing symptoms. Compared to boys, girls are more likely to be both relationally victimized by peers and distressed by the victimization. While previous studies have reported that a functional polymorphism in the promoter region of the serotonin transporter gene (5‐HTTLPR) moderates the effect of stressful life events on depressive symptoms, the present study is the first to evaluate the interaction of this polymorphism with relational peer victimization to predict level of depressive symptoms in young girls. Methods: Participants were 78 girls ages 10 to 14 who had no current or past Axis I disorder. Girls were genotyped for 5‐HTTLPR; peer victimization was assessed with the Social Experiences Questionnaire, and depressive symptoms with the Children’s Depression Inventory. Results:  The 5‐HTTLPR polymorphism alone did not predict level of depressive symptoms; the interaction of 5‐HTTLPR and relational peer victimization, however, was a significant predictor of depressive symptoms. Follow‐up analyses indicated that peer victimization significantly predicted level of depressive symptoms only for girls who were homozygous for the short allele, and not for girls homozygous for the long allele or who were heterozygous for the short and long alleles. Conclusions: The findings support the diathesis‐stress model of depression: having two 5‐HTTLPR short alleles confers vulnerability to depressive symptoms in adolescent girls when they experience relational peer victimization. These findings also suggest that relational peer victimization, at least for girls with genetic vulnerability, is a significant source of stress and should be recognized in the monitoring and prevention of bullying.