Association of parental psychopathology to the comorbid disorders of boys with attention deficit-hyperactivity disorder

This study examined whether particular forms of parental psychopathology are related to similar forms of comorbid psychopathology in offspring with attention deficit-hyperactivity disorder (ADHD). Parental disorders were assessed using maternal interviews, and child disorders were assessed using multiple-informant interviews for 111 clinic-referred boys (aged 7-12) with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) ADHD. Associations between parental and child internalizing disorders and between parental and child externalizing disorders were found, but associations across categories of disorder (i.e., internalizing and externalizing) were not. Similar relationships were observed in 66 clinic-referred boys without ADHD. These findings support specific modes of familial transmission, in contrast to theories that comorbidity simply reflects more severe psychopathology in children with ADHD.     

The impact of child maltreatment and psychopathology on neuroendocrine functioning.

Cortisol regulation was investigated in a sample of school-aged maltreated (n = 167) and demographically comparable low-income nonmaltreated (n = 204) boys and girls in the context of a day camp research program. The presence of clinical-level internalizing and clinical-level externalizing symptomatology was determined through adult report and child self report. Children who exhibited clinical-level internalizing problems only, clinical-level externalizing problems only, and comorbid clinical-level internalizing and extemalizing problems were identified. Clinical-level cases were more prevalent among the maltreated children. Maltreated children with clinical-level internalizing problems were distinguished by higher morning, afternoon, and average daily cortisol levels across the week of camp attendance. In contrast, nonmaltreated boys with clinical-level externalizing problems emerged as distinct in terms of low levels of morning and average daily levels of cortisol. Maltreated children with comorbid clinical-level internalizing and externalizing problems were more likely not to show the expected diumal decrease in cortisol. The findings are discussed in terms of the joint impact of maltreatment and different forms of psychopathology on neuroendocrine regulation.     

Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression

The focus of this article is on internalizing problems that are experienced by children and adolescents. We provide an historical perspective, selectively examine the current state of knowledge, consider advances and gaps in what is known, and identify new research directions. Diagnosis, epidemiology, theory, and research first are considered separately for anxiety and depressive disorders. These internalizing problems, however, whether clinical or subclinical, share many common features and show high comorbidity rates. We emphasize the importance of systematic analysis of comorbid anxiety and depression, including their comorbidity with externalizing problems. This could lead to more valid classification of subtypes of internalizing problems and further an understanding of the diverse conditions that constitute internalized distress. We highlight the need to study anxiety and depression within a developmental psychopathology framework, as well as to include both categorical and dimensional assessments of these problems in the same research designs. This will be essential for understanding the complex interplay of biological and environmental processes that contribute to the emergence, progression, and amelioration of internalizing problems over time.     

Effect of Co-Occurrence on the Referability of Internalizing and Externalizing Problem Behavior in Adolescents

Assessed the effect of co-occurring versus not co-occurring internalizing and externalizing behavior problems on the reasons parents reported for clinical referral of their adolescent child. Reasons for referral were coded for 181 inpatient adolescents, and parent ratings of internalizing and externalizing behavior were obtained for a general population sample of 500 adolescents. Parents concurrently reported internalizing and externalizing behavior as reasons for referral less frequently (p < .0001) than would be expected given the correlation between these two domains in the general population sample. This suggests that the presence of externalizing problems may decrease parents' concern or awareness of internalizing problems, the presence of internalizing problems may decrease parents' concern or awareness of externalizing problems, or both Implications for the clinical referral of adolescents and for informal parental efforts at helping their children with externalizing and internalizing problems are discussed.     

Preschool children with disruptive behavior: three-year outcome as a function of adaptive disability

A significant discrepancy between intelligence and daily adaptive functioning, or adaptive disability (AD), has been previously found to be a associated with significant psychological morbidity in preschool children with disruptive behavior (DB). The utility of AD as a predictor of later developmental risks was examined in a 3-year longitudinal study of normal (N = 43) and DB preschool children. The DB children were grouped into those with AD (DB+AD; N = 28) and those without AD (DB-only; N = 98). All children were followed with annual evaluations to the end of second grade. Both DB groups demonstrated substantial and pervasive psychological and educational morbidity at 3-year follow-up. In comparison to DB-only children, DB+AD children had more symptoms of attention-deficit hyperactivity disorder (ADHD) and conduct disorder (CD), more severe and pervasive behavior problems at home, more parent-rated externalizing and internalizing, and lower academic competence and more behavioral problems at school. Parents of DB+AD children also reported greater parenting stress than did parents in the other groups. A significant contribution of AD to adverse outcomes in the DB group remained on some measures even after controlling for initial severity of DB. AD also contributed significantly to CD symptoms at follow-up after controlling for initial DB severity and initial CD symptoms. The results corroborate and extend earlier findings of the utility of AD as a risk indicator above severity of DB alone. They also imply that AD in the context of normal intellectual development may arise from both the deficient self-regulation associated with ADHD and from disrupted parenting. with exposure to kindergarten moderating these adverse effects.     

Corpus callosum morphology in children and adolescents with attention deficit hyperactivity disorder: a meta-analytic review

Several studies have examined corpus callosum (CC) morphology in children and adolescents with attention deficit hyperactivity disorder (ADHD). A meta-analysis of atypical brain morphology in children and adolescents with ADHD by Valera, Faraone, Murray, and Seidman (2006) reported a reduction in the splenium of the CC in this group compared with healthy controls. This meta-analysis undertook a more detailed examination of callosal morphology by also considering comorbid conditions and gender differences. The data from 13 studies were analyzed. Consistent with Valera et al. (2006), the splenium was smaller in children and adolescents with ADHD than in healthy controls. However, this result appears to be the result of a smaller splenium in females with ADHD. In addition, boys exhibited a smaller rostral body. There were no significant differences in CC measurements of studies that included ADHD samples with comorbid conditions. However, comorbidities were not consistently reported, making it difficult to accurately evaluate the impact of comorbidity on CC size. Additional research is needed to investigate whether gender differences reflect different ADHD subtypes. In addition, it is not known if these CC differences persist into adulthood.     

Missouri Children's Behavior Checklist profiles with developmentally disabled children: construct validity

The clinical utility and construct validity of seven new MCBC behavior profiles were evaluated and compared to the original four behavior profiles. The relationship between the seven new behavior profiles and the clinical findings and recommendations that stem from an interdisciplinary evaluation of children referred to a clinic for development disabilities was determined. The seven cluster solution classified equally as well as the four cluster solution, but with increased differentiation into more specific internalizing and externalizing behavior profile subgroups. Construct validity information was provided for several of the new profiles in terms of the association with clinical findings of behavior problems and recommendations for therapy.     

A preliminary study of cortisol reactivity and behavior problems in young children born premature

The purpose of the present study was to examine the relation between cortisol reactivity and comorbid internalizing and externalizing behavior problems among children born premature. Children between the ages of 18 and 60 months who were born <37 weeks gestation and presented with clinically significant externalizing behavior problems were included. Children were categorized based on those who mounted a cortisol response to a stressor and those who did not mount a cortisol response. Children demonstrating the cortisol response were reported to have more problems with attention, emotional reactivity, anxiety, and depression based on maternal report and displayed higher rates of negative verbalizations during a mother–child interaction than children without a cortisol response. These results extend the findings of the relation between cortisol reactivity and comorbid internalizing and externalizing behavior problems to a sample of children born premature. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 52: 574–582, 2010.     

Childhood psychiatric disorder and unintentional injury: findings from a national cohort study

OBJECTIVE: We set out to examine the relationship between unintentional injury and common child psychiatric disorders, including both internalizing and externalizing diagnoses. METHODS: The 1999 British Child and Adolescent Mental Health Survey provided a nationally representative sample of over 10,000 children aged 5-15 years. Measures included assessment of diagnoses of psychiatric disorder from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, unintentional injury, and a range of potentially related psychosocial factors. RESULTS: Children with psychiatric disorders had higher rates of unintentional injury. After accounting for psychosocial risk factors and comorbid psychopathology, oppositional defiant disorder (ODD) was independently associated with burns and poisoning. Attention deficit hyperactivity disorder (ADHD) was related to fractures, and depression and anxiety also showed independent links to some injury types. CONCLUSIONS: ODD and ADHD, rather than conduct disorder, appear to be the externalizing disorders associated with unintentional injury. We discuss possible models of the relationships between internalizing disorders and unintentional injury.     

Temperament profiles associated with internalizing and externalizing problems in preadolescence

This study investigates how temperament factors are linked to internalizing and externalizing problems in a Dutch population sample of preadolescents (N = 2230). Internalizing and externalizing problems were assessed by the Child Behavior Checklist and the Youth Self-Report and temperament was evaluated by the parent-version of the Revised Early Adolescent Temperament Questionnaire. Temperament profiles were examined in children with (a) neither internalizing nor externalizing problems, (b) only internalizing problems, (c) only externalizing problems, and (d) both internalizing and externalizing problems. The results suggest clearly diverging temperament profiles for these groups of children, with High-Intensity Pleasure and Shyness (representing the broad dimension of Surgency) steering the conditional probability of internalizing and externalizing problems (direction markers), Frustration mainly being related to maladaptation in general (severity marker), and Fear and Effortful Control being associated with both the severity and the direction of internalizing and externalizing problems, respectively. Girls and boys differed in the distribution across the problem groups, but the associations between temperament and psychopathology were comparable for both genders.     

Comorbidity of Attention‐Deficit/Hyperactivity Disorder and Early‐Onset Conduct Disorder: Biological,Environmental, and Developmental Mechanisms

[Clin Psychol Sci Prac 17: 327–336, 2010] Among boys, about one‐third who exhibit severe attention‐deficit/hyperactivity disorder (ADHD) in preschool follow a developmental trajectory to early‐onset conduct disorder (CD) in later childhood and adolescence. Moreover, the vast majority of adolescent boys with early‐onset CD also meet criteria for ADHD. Although trait impulsivity, a predisposing vulnerability to both ADHD and CD, is about 80% heritable, environmental risk factors play an important role in how impulsivity is expressed, including whether young children with ADHD eventually develop CD. In this article, we (a) describe how environmental risk potentiates early‐onset conduct problems among trait‐impulsive and therefore vulnerable individuals and (b) outline implications for conceptualizations of externalizing comorbidity. Although other pathways to CD exist, we focus on what is likely to be a common developmental trajectory to this costly psychiatric condition.     

Executive Functions in Preschool Children With ADHD and DBD: An 18-Month Longitudinal Study

In this longitudinal study, we examined the stability of the association between executive functions and externalizing behavior problems, and the developmental change of executive functions in a predominately clinically diagnosed preschool sample (N = 200). Inhibition and working memory performance were assessed three times in 18 months. Across time, poorer inhibition performance in young children was associated with attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD), and poorer working memory performance was associated with ADHD. Inhibition and working memory performance increased over time, especially in the early preschool period. The improvement of inhibition performance was more pronounced in the clinically diagnosed children compared to the TD children.     

大学生问题行为及其与大五人格和自我控制的关系

目的:考察广州市大学生问题行为的现状及其与大五人格和自我控制的关系。方法:本研究采用问卷法对551名广州市大学生的大五人格、自我控制以及问题行为进行测量。结果:1广州市大学生的内化和外化问题水平较低;2除开放性外,其余4个大五人格维度以及自我控制均与内化和外化问题行为呈显著相关关系(r=-0.02~0.81,P0.01);3大五人格与自我控制共同解释39.1%内化问题和31.0%外化问题的方差变异,两者既共同又独立解释内化和外化问题的方差;开放性(B=0.09,P0.01)、外向性(B=-0.10,P0.01)、宜人性(B=-0.07,P0.05)、神经质(B=0.25,P0.01)与自我控制(B=-0.05,P0.05)显著预测内化问题行为;开放性(B=0.05,P0.05)、严谨性(B=-0.08,P0.01)、宜人性(B=-0.18,P0.01)、神经质(B=0.13,P0.01)和自我控制(B=-0.06,P0.01)显著预测外化问题行为。结论:广州市大学生的问题行为总体程度较轻,大五人格特质和自我控制是大学生问题行为的重要保护性因子。     

Low Vagal Tone Magnifies the Association Between Psychosocial Stress Exposure and Internalizing Psychopathology in Adolescents

Vagal tone is a measure of cardiovascular function that facilitates adaptive responses to environmental challenge. Low vagal tone is associated with poor emotional and attentional regulation in children and has been conceptualized as a marker of sensitivity to stress. We investigated whether the associations of a wide range of psychosocial stressors with internalizing and externalizing psychopathology were magnified in adolescents with low vagal tone. Resting heart period data were collected from a diverse community sample of adolescents (ages 13–17; N = 168). Adolescents completed measures assessing internalizing and externalizing psychopathology and exposure to stressors occurring in family, peer, and community contexts. Respiratory sinus arrhythmia (RSA) was calculated from the interbeat interval time series. We estimated interactions between RSA and stress exposure in predicting internalizing and externalizing symptoms and evaluated whether interactions differed by gender. Exposure to psychosocial stressors was associated strongly with psychopathology. RSA was unrelated to internalizing or externalizing problems. Significant interactions were observed between RSA and child abuse, community violence, peer victimization, and traumatic events in predicting internalizing but not externalizing symptoms. Stressors were positively associated with internalizing symptoms in adolescents with low RSA but not in those with high RSA. Similar patterns were observed for anxiety and depression. These interactions were more consistently observed for male than female individuals. Low vagal tone is associated with internalizing psychopathology in adolescents exposed to high levels of stressors. Measurement of vagal tone in clinical settings might provide useful information about sensitivity to stress in child and adolescent clients.     

Psychiatric comorbidity in Korean children and adolescents with attention-deficit hyperactivity disorder: psychopathology according to subtype

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.     

Young adults face major barriers to seeking help from mental health services

OBJECTIVE: Mental health problems often emerge in young adulthood. Although effective treatments are available, young adults are unlikely to seek professional help. This study examined barriers-to-care in young adults with serious internalizing or externalizing problems. METHODS: Population-based study among 2258 19-32-year olds in the south-west region of the Netherlands. Barriers-to-care were examined in participants with serious internalizing or externalizing problems who did not seek professional help. A potential barrier was that participants denied that they had mental health problems. In those admitting problems, barriers were assessed with the Barriers-to-Care checklist and analyzed with Latent Class Analysis. RESULTS: Of 362 participants with serious internalizing or externalizing problems 237 (65.5%) did not seek professional help. Of non-help-seeking young adults 36% denied having problems; additionally Latent Class Analysis revealed that 37% Perceived Problems as Self-Limiting (e.g., they believed that problems were not serious) and 24% Perceived Help-Seeking Negatively (e.g., they believed that treatment would not help). CONCLUSIONS: Young adults' barriers-to-care reflect limitations in their knowledge of mental health problems and available treatments, but possibly also a failure of existing mental health services to engage young people. More knowledge is urgently needed about the effectiveness of mental health treatments for young adults specifically. PRACTICE IMPLICATIONS: Treatment accessibility for young adults may be augmented by improving their mental health literacy.     

The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems.

In a sample of 578 children assessed in kindergarten through the eighth grade, we used growth modeling to determine the basic developmental trajectories of mother-reported and teacher-reported externalizing and internalizing behaviors for three physical maltreatment groups of children-early-harmed (prior to age 5 years), later-harmed (age 5 years and over), and nonharmed--controlling for SES and gender. Results demonstrated that the earlier children experienced harsh physical treatment by significant adults, the more likely they were to experience adjustment problems in early adolescence. Over multiple domains, early physical maltreatment was related to more negative sequelae than the same type of maltreatment occurring at later periods. In addition, the fitted growth models revealed that the early-harmed group exhibited someswhat higher initial levels of teacher-reported externalizing problems in kindergarten and significantly different rates of change in these problem behaviors than other children, as reported by mothers over the 9 years of this study. The early-harmed children were also seen by teachers, in kindergarten, as exhibiting higher levels of internalizing behaviors. The later-harmed children were seen by their teachers as increasing their externalizing problem behaviors more rapidly over the 9 years than did the early- or nonharmed children. These findings indicate that the timing of maltreatment is a salient factor in examining the developmental effects of physical harm.     

Sibling relationship quality and psychopathology of children and adolescents: A meta-analysis

In the current meta-analysis, we investigated the link between child and adolescent sibling relationship quality (warmth, conflict and differential treatment) and internalizing and externalizing problems, and potential moderators of these associations. From 34 studies, we obtained 85 effect sizes, based on 12,257 children and adolescents. Results showed that more sibling warmth, less sibling conflict and less differential treatment were all significantly associated with less internalizing and externalizing problems. Effect sizes for sibling conflict were stronger than for sibling warmth and differential treatment, and associations for internalizing and externalizing problems were similar in strength. Effect sizes were moderated by sibling gender combination (stronger effects for higher percentage brother pairs), age difference between siblings (stronger effects for smaller age differences), and developmental period (stronger effect sizes for children than for adolescents). These results indicate that the sibling context is important when considering psychopathology. In addition to the overwhelming evidence of the impact of parent–child and marital relationships on child and adolescent development, the present meta-analysis is a reminder that the sibling relationship warrants more attention in research as well as in clinical settings.     

Protective Factors for Youth Exposed to Violence in Their Communities: A Review of Family,School, and Community Moderators

This review provides a comprehensive investigation of the pattern and strength of findings in the literature regarding the environmental moderators of the relationship between exposure to community violence and mental health among children and adolescents. Twenty-nine studies met criteria for inclusion in our analysis of family, school, and community variables as moderators. Dependent variables included internalizing (e.g., anxiety, depression, posttraumatic stress disorder) and externalizing symptoms (e.g., aggression, substance use). Effect sizes for the interactions of exposure to violence and potential moderators were summarized by their patterns of protective processes. The majority of studies in the literature examined family characteristics as moderators of the exposure to violence–symptom relationship, rather than school- or community-level factors. Our results indicated more consistent patterns for (a) close family relationships and social support for internalizing symptoms and (b) close family relationships for externalizing symptoms. Overall, the most common type of protective pattern was protective-stabilizing, in which youth with higher levels of the environmental attribute demonstrate relative stability in mental health despite exposure to violence. We found no consistent evidence that parental monitoring—a dimension inversely associated with exposure to violence in prior studies—moderated the relationship between exposure to violence and symptoms. The study emphasizes the importance of strengthening family support for young people's exposure to community violence; more research is needed to provide a solid evidence base for the role of school and community-level protective factors for youth exposed to violence.     

Bias in Self-Perceptions and Internalizing and Externalizing Problems in Adjustment During Early Adolescence: A Prospective Investigation

We investigated bias in self-perceptions of competence (relative to parent ratings) for family, school, and peer domains as predictors of adjustment problems among 139 young adolescents over a 1-year period using a prospective design. Regressions examined measures of bias at Time 1 (T1) as predictors of ratings of internalizing and externalizing problems at Time 2 (T2), controlling for T1 adjustment ratings. For the family domain, curvilinear trends were found. Follow-up analyses revealed that for this domain both negative bias (self-perceptions less favorable than parent ratings) and positive bias (self-perceptions more favorable than parent ratings) predicted greater internalizing and externalizing problems as rated by youth, parents, and teachers. For the peer domain, higher scores on the measure of bias predicted greater internalizing and externalizing problems as rated by teachers. These findings are consistent with the view that accuracy in self-perceptions of competence can have important implications across multiple domains of development.