From child maltreatment to adolescent cannabis abuse and dependence: a developmental cascade model

A developmental cascade model tested associations among child maltreatment, internalizing and externalizing psychopathology, social competence, and cannabis abuse and dependence symptoms in a longitudinal cohort (N = 415). Nested structural equation models evaluated continuity and cross-domain influences among broad multi-informant constructs across four developmental periods: age 7 to 9, 10 to 12, 13 to 15, and 15 to 18. Results indicated significant paths from child maltreatment to early externalizing and internalizing problems and social competence, as well as to cannabis abuse and dependence (CAD) symptoms in adolescence. Youth CAD symptoms were primarily related directly to child maltreatment and externalizing problems. Childhood internalizing symptoms contributed to later childhood decreases in social competence, which predicted increases in late adolescent externalizing problems. Using a developmental psychopathology framework, results are discussed in relation to cascade and transactional effects and the interplay between problem behaviors during childhood and development of CAD symptoms during early and late adolescence.     

Treatment adherence, competence, and outcome in individual and family therapy for adolescent behavior problems

This study examined the impact of treatment adherence and therapist competence on treatment outcome in a controlled trial of individual cognitive-behavioral therapy (CBT) and multidimensional family therapy (MDFT) for adolescent substance use and related behavior problems. Participants included 136 adolescents (62 CBT, 74 MDFT) assessed at intake, discharge, and 6-month follow-up. Observational ratings of adherence and competence were collected on early and later phases of treatment (192 CBT sessions, 245 MDFT sessions) by using a contextual measure of treatment fidelity. Adherence and competence effects were tested after controlling for therapeutic alliance. In CBT only, stronger adherence predicted greater declines in drug use (linear effect). In CBT and MDFT, (a) stronger adherence predicted greater reductions in externalizing behaviors (linear effect) and (b) intermediate levels of adherence predicted the largest declines in internalizing behaviors, with high and low adherence predicting smaller improvements (curvilinear effect). Therapist competence did not predict outcome and did not moderate adherence-outcome relations; however, competence findings are tentative due to relatively low interrater reliability for the competence ratings. Clinical and research implications for attending to both linear and curvilinear adherence effects in manualized treatments for behavior disorders are discussed.     

Relations of effortful control, reactive undercontrol, and anger to Chinese children's adjustment

The purpose of the study was to examine the zero-order and unique relations of effortful attentional and behavioral regulation, reactive impulsivity, and anger/frustration to Chinese first and second graders' internalizing and externalizing symptoms, as well as the prediction of adjustment from the interaction of anger/frustration and effortful control or impulsivity. A parent and teacher reported on children's anger/frustration, effortful control, and impulsivity. Parents reported on children's internalizing symptoms, and teachers and peers reported on children's externalizing symptoms. Children were classified as relatively high on externalizing (or comorbid), internalizing, or nondisordered. High impulsivity and teacher-reported anger/frustration, and low effortful control, were associated with externalizing problems, whereas low effortful control and high parent-reported anger were predictive of internalizing problems. Unique prediction from effortful and reactive control was obtained and these predictors (especially when reported by teachers) often interacted with anger/frustration when predicting problem behavior classification.     

Parenting behavior dimensions and child psychopathology: specificity, task dependency, and interactive relations.

This study examined the specificity of relations between parent or caregiver behaviors and childhood internalizing and externalizing problems in a sample of 70 fourth-grade children (64% boys, M age = 9.7 years). Specificity was assessed via (a) unique effects, (b) differential effects, and (c) interactive effects. When measured as unique and differential effects, specificity was not found for warmth or psychological control but was found for caregiver's use of behavior control. Higher levels of behavior control were uniquely related to lower levels of externalizing problems and higher levels of internalizing problems; differential effects analyses indicated that higher levels of behavior control were related to decreases in the within-child difference in relative levels of level of internalizing versus externalizing problems. Interactive relations among the 3 parenting behavior dimensions also were identified. Although caregivers emphasized different parenting behavior dimensions across 2 separate caregiver-child interaction tasks, relations between parenting behavior dimensions and child psychopathology did not vary as a function of task. These findings indicate the importance of assessing and simultaneously analyzing multiple parenting behavior dimensions and multiple child psychopathology domains.     

Child behavior problems and family functioning as predictors of adherence and glycemic control in economically disadvantaged children with type 1 diabetes: a prospective study

OBJECTIVE: This prospective study examined how child behavior problems and family functioning predict adherence behavior and glucose regulation (glycemic control) in a sample of economically disadvantaged children. METHODS: Children with type 1 diabetes (N = 116; 58.6% African American) were assessed for externalizing and internalizing behavior problems and family adaptability and cohesion and followed for a mean of 3.8 years. Glycemic control (glycosylated hemoglobin [HbA1c]) was assessed at baseline and follow-up, and adherence was assessed at follow-up. RESULTS: Analyses controlled for baseline HbA1c and years to follow-up. Multivariate analyses indicated that better adherence was predicted by high family cohesion. Better glycemic control was predicted by high family cohesion, the absence of externalizing behavior problems, and the presence of internalizing behavior problems. In addition, tests of moderation indicated that better follow-up glycemic control occurred among girls from high cohesion families and younger children from low adaptability families. Although better adherence predicted better glycemic control, adherence did not mediate the relationships of behavior problems or family functioning with glycemic control. CONCLUSIONS: A child's behavior problems and family functioning may influence both adherence to the diabetes regimen and glycemic control several years later, suggesting the potential value of interventions that address child behavior and family functioning.     

Adrenocortical responses to strangers in preschoolers: relations with parenting, temperament, and psychopathology

Previous research has provided inconsistent evidence for the relations between young children's hypothalamic-pituitary-adrenal (HPA) functioning and their temperament, parenting, and adjustment. Building biopsychosocial models of adjustment, we examined how temperamental inhibition and maternal punishment contributed to preschoolers' adrenocortical activity while interacting with adult strangers. We also examined whether HPA functioning moderated relations between dispositional and familial factors and children's internalizing and externalizing problems. A total of 402 preschool-aged children from three independent samples with parallel and overlapping measures were studied. Salivary cortisol levels were measured twice while interacting with adult strangers during testing protocols. Mothers reported on temperamental inhibition, maternal punishment and children's problems. Maternal punishment predicted higher cortisol levels 20 and 65 min after meeting adult strangers. Prolonged cortisol elevation was associated with having fewer externalizing problems. Boys who experienced more maternal punishment and had higher cortisol 20 min after meeting strangers manifested more externalizing problems. Girls who were more inhibited and had prolonged cortisol elevations had more internalizing problems. In accord with biopsychosocial models of psychopathology, HPA functioning in preschoolers was sensitive to variations in socialization experiences, and moderated children's risk for emotional and behavioral problems.     

Personality of parents with bipolar disorder and interpersonal functioning among their offspring: a prospective 10-year study

A comparison of offspring of parents with bipolar disorder (OBD) and offspring of parents with no mental disorder (ONMD) showed that parents' neuroticism was associated with internalizing and externalizing problems among their children. The present study examined whether parents' neuroticism predicted poor interpersonal functioning among offspring 10 years later and whether the problems observed in middle childhood mediated the association between parents' neuroticism and offspring functioning. When offspring were in middle childhood, parents completed the revised NEO Personality Inventory and rated the child's behavior on the Child Behavior Checklist. Ten years later, 65 OBD and 59 ONMD completed interviews assessing mental disorders and interpersonal and noninterpersonal functioning. High neuroticism and low agreeableness in parents predicted poor interpersonal functioning in their offspring in late adolescence-early adulthood. The offspring's externalizing and internalizing problems in middle childhood partially mediated the association between parents' personality and offspring interpersonal functioning. Moreover, the association between parents' neuroticism and offspring internalizing problems was stronger among the OBD than the ONMD. Overall, the results suggested an intergenerational transmission of risk whereby high neuroticism and low agreeableness in parents were associated with behavioral problems among offspring in middle childhood that, in turn, predicted poor interpersonal functioning 10 years later.     

Exuberant and inhibited toddlers: stability of temperament and risk for problem behavior

Temperament, effortful control, and problem behaviors at 4.5 years were assessed in 72 children classified as exuberant, inhibited, and low reactive as 2-year-olds. Exuberant toddlers were more positive, socially responsive to novel persons, less shy, and rated as having more problem behaviors, including externalizing and internalizing behaviors, than other children as preschoolers. Two forms of effortful control, the ability to delay a response and the ability to produce a subdominant response, were associated with fewer externalizing behaviors, whereas expressing more negative affect (relative to positive/neutral affect) when disappointed was related to more internalizing behaviors. Interaction effects implicated high levels of unregulated emotion during disappointment as a risk factor for problem behaviors in exuberant children.     

Trait affectivity and non-referred adolescent conduct problems.

This study examined for profiles of positive trait affectivity (PA) and negative trait affectivity (NA) associated with adolescent conduct problems. Prior trait affectivity research has been relatively biased toward the assessment of adults and internalizing symptomatology. Consistent with recent developmental modeling of antisocial behavior, this study proposed that conduct problems are uniquely associated with 2 PA-NA profiles (i.e., high PA-high NA and low PA-low NA). A non-referred sample of 109 adolescents ages 12 to 19 was recruited to assess the independent relations between rating scale measures of the PA-NA dimensions and conduct problems, controlling for related internalizing (anxiety and depression) and externalizing (hyperactivity-impulsivity) symptomatology. The results generally confirmed the proposed interaction between the PA-NA dimensions in the prediction of adolescent conduct problems.     

Internalizing and externalizing problems in adolescence: general and dimension-specific effects of familial loadings and preadolescent temperament traits

BACKGROUND: We investigated the links between familial loading, preadolescent temperament, and internalizing and externalizing problems in adolescence, hereby distinguishing effects on maladjustment in general versus dimension-specific effects on either internalizing or externalizing problems.METHOD:In a population-based sample of 2230 preadolescents (10-11 years) familial loading (parental lifetime psychopathology) and offspring temperament were assessed at baseline by parent report, and offspring psychopathology at 2.5-years follow-up by self-report, teacher report and parent report. We used purified measures of temperament and psychopathology and partialled out shared variance between internalizing and externalizing problems.RESULTS:Familial loading of internalizing psychopathology predicted offspring internalizing but not externalizing problems, whereas familial loading of externalizing psychopathology predicted offspring externalizing but not internalizing problems. Both familial loadings were associated with Frustration, low Effortful Control, and Fear. Frustration acted as a general risk factor predicting severity of maladjustment; low Effortful Control and Fear acted as dimension-specific risk factors that predicted a particular type of psychopathology; whereas Shyness, High-Intensity Pleasure, and Affiliation acted as direction markers that steered the conditional probability of internalizing versus externalizing problems, in the event of maladjustment. Temperament traits mediated one-third of the association between familial loading and psychopathology. Findings were robust across different composite measures of psychopathology, and applied to girls as well as boys.CONCLUSIONS:With regard to familial loading and temperament, it is important to distinguish general risk factors (Frustration) from dimension-specific risk factors (familial loadings, Effortful Control, Fear), and direction markers that act as pathoplastic factors (Shyness, High-Intensity Pleasure, Affiliation) from both types of risk factors. About one-third of familial loading effects on psychopathology in early adolescence are mediated by temperament.     

Biological, behavioral, and relational levels of resilience in the context of risk for early childhood behavior problems

Longitudinal growth patterns of internalizing and externalizing behavior problems were examined in a community sample of 441 children across the ages of 2 to 5 using hierarchical linear modeling. Contextual risk was measured using five indicators (socioeconomic status, marital status, number of siblings, parent stress, parent psychopathology), and three levels of child resilience (biological, behavioral, and relational) were also assessed. Results indicate that a general pattern of decline in both types of behavior problems was observed for the entire sample across time, although considerable individual variability in this pattern was observed. Children's externalizing and internalizing behavior at age 5 was predicted by the level of risk at age 2. All three child resilience factors were also predictive of externalizing and internalizing behaviors at age 5. In the prediction of the slope of problem behavior over time, risk status interacted with both temperamental fearlessness and a mutually responsive orientation with the mother to predict the decline in externalizing and internalizing problem behavior. Results underscore the complex interactions of risk and multiple levels of resilience that are implicated in the maintenance of problem behavior over time. They highlight the importance of considering whether expected resilience factors operate similarly across different levels of risk.     

Measuring Cognitive Vulnerability to Depression in Adolescence: Reliability,Validity, and Gender Differences

Evaluated the psychometric properties of a newly created measure of cognitive vulnerability to depression for use with adolescents. Previous measures have shown poor internal consistency reliability and have not completely assessed all hypothesized components of cognitive vulnerability. High school students completed questionnaires assessing cognitive vulnerability to depression, negative life events, depressive symptoms, and general internalizing and externalizing symptoms. The Adolescent Cognitive Style Questionnaire (ACSQ) demonstrated excellent internal consistency reliability and good test-retest reliability. Confirmatory factor analysis showed there were 3 latent factors to the ACSQ. Construct validity was supported by significant correlations with another attributional style questionnaire, as well as with depressive and internalizing symptoms. The interaction of ACSQ with negative events significantly predicted concurrent depressive and internalizing symptoms but not externalizing problems. Last, cognitive vulnerability mediated the gender difference in depressive symptoms. Overall, results suggest that the ACSQ is a highly reliable and valid measure of cognitive vulnerability to depression in adolescence.     

Specificity of relations between children's control-related beliefs and internalizing and externalizing psychopathology

The authors examined the specificity of the relation between 3 types of control-related beliefs and internalizing and externalizing psychopathology in a sample of 290 clinic-referred children aged 7 to 17 years. Self-reported beliefs about control (the capacity to cause an intended outcome), contingency (the degree to which a desired outcome can be controlled by a relevant behavior), and competence (an individual's ability to produce the relevant behavior) across 3 domains (academic, behavioral, and social) showed more specific relations with psychopathology than have been previously reported. Among children with externalizing psychopathology, internalizing psychopathology may be specifically associated with increased self-critical awareness about their conduct; externalizing psychopathology may attenuate the specific negative relation between internalizing psychopathology and control-related beliefs in the social domain.     

Co-activation of SAM and HPA responses to acute stress: A review of the literature and test of differential associations with preadolescents’ internalizing and externalizing

Understanding co-activation patterns of the hypothalamic-pituitary-adrenal axis (HPA) and sympathetic adrenal medullary (SAM) during early adolescence may illuminate risk for development of internalizing and externalizing problems. The present study advances empirical work on the topic by examining SAM-HPA co-activation during both the reactivity and recovery phases of the stress response following acute stress exposure. Fourth and fifth grade boys and girls (N = 149) provided cortisol and alpha-amylase via saliva at seven times throughout a 95-min assessment in which they were administered the modified Trier Social Stress Test. Parents reported on adolescents’ life stress, pubertal development, medication use, and externalizing problems. Adolescents reported their own internalizing symptoms. Multiple linear regressions tested both direct and interactive effects of SAM and HPA reactivity and recovery on internalizing and externalizing problems. Results from these analyses showed that whereas SAM and HPA reactivity interacted to predict internalizing symptoms, it was their interaction during the recovery phase that predicted externalizing. Concurrent high SAM and HPA reactivity scores predicted high levels of internalizing and concurrently low SAM and HPA recovery scores predicted high levels of externalizing. Implications of the findings for further study and clinical application are discussed.     

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。     

Dimensions of child maltreatment and children's adjustment: contributions of developmental timing and subtype.

This investigation examined the dimensions of developmental timing, subtype, and severity of maltreatment and their relations with child adaptation. The 814 children who participated in a summer day camp, 492 of whom were maltreated and 322 of whom were nonmaltreated comparison children, were assessed by camp counselors on their internalizing and externalizing symptomatology, aggressive, withdrawn, and cooperative behavior, and on personality dimensions of ego resiliency and ego control, and were rated by peers on disruptive, aggressive, and cooperative behavior. The severity within each subtype of maltreatment and the developmental period in which each subtype occurred were examined through hierarchical regression analyses. Additionally, children with similar timing or subtype patterns were grouped to explore diversity in outcomes. Results highlighted the role of severity of emotional maltreatment in the infancy-toddlerhood period and physical abuse during the preschool period in predicting externalizing behavior and aggression. Severity of physical neglect, particularly when it occurred during the preschool period, was associated with internalizing symptomatology and withdrawn behavior. Additionally, maltreatment during the school-age period contributed significant variance after earlier maltreatment was controlled. Chronic maltreatment, especially with onset during infancy-toddlerhood or preschool periods, was linked with more maladaptive outcomes. The implications of measuring multiple dimensions for improving research in child maltreatment are discussed.     

Adrenocortical activity in at-risk and normally developing adolescents: individual differences in salivary cortisol basal levels, diurnal variation, and responses to social challenges

The purpose of this study was to examine adrenocortical activity (basal, diurnal variation, and responses to social stressors) in adolescents at risk for psychopathology. Salivary cortisol levels were examined in normally developing and at-risk youth with internalizing and externalizing symptoms ranging from subclinical to clinical levels. Adolescents showed expected patterns of diurnal variation, with high early morning cortisol levels and a pattern of decline throughout the day. Females showed higher midday and late afternoon levels than males, and these patterns interacted with risk status. Internalizing problems sometimes were associated with gradual rather than steep declines in basal cortisol production. Both immediate and delayed cortisol reactivity to a social performance stressor were associated with internalizing symptoms. There was no evidence of relations between externalizing problems and underarousal of the hypothalamic-pituitary-adrenal (HPA) system. These and other results suggest that gender is an important moderating factor linking psychopathology. development, and context with HPA axis functioning in adolescence.     

Attachment,autonomy, and multifinality in adolescent internalizing and risky behavioral symptoms

A diathesis-stress interaction model is used to describe multifinality in adolescent internalizing and risky behavioral outcomes. Problematic behavior associated with adolescent insecure preoccupation (a diathesis) was expected to interact with the level of maternal autonomous discourse (a stressor) to predict specific adolescent outcomes. Assessments of adolescent preoccupied attachment organization, observations of maternal displays of autonomy in mother-adolescent interactions, and adolescent reports of internalizing symptoms and risky behaviors were obtained at age 16. As predicted, maternal autonomy in the mother-adolescent relationship helped to explain multifinality in dysfunctional symptoms among preoccupied adolescents. Adolescent preoccupation was more strongly linked to internalizing behavior when mothers demonstrated low levels of autonomy in interactions with their adolescents and more strongly linked to risky behavior when mothers displayed extremely high levels of autonomy. Implications for autonomy processes in increasing our understanding of how adolescent insecure-preoccupation relates to profiles of specific problems during adolescence are discussed as is the importance of exploring the role of attachment in different contexts.     

Longitudinal links among parenting, self-presentations to peers, and the development of externalizing and internalizing symptoms in African American siblings

A longitudinal model that linked involved-supportive parenting and siblings' ability-camouflaging self-presentations to peers with the development of externalizing and internalizing symptoms was tested with 152 pairs of first- and second-born African American siblings (mean ages 12.7 years and 10.2 years at the first wave of data collection). Three waves of data were collected at 1-year intervals. Teachers assessed siblings' externalizing symptoms, internalizing symptoms, and academic competence; siblings reported their own self-presentations and desire for peer acceptance; and mothers and siblings provided multiinformant assessments of involved-supportive parenting. Involved-supportive parenting at Wave 1 was linked with peer-directed self-presentations at Wave 2. Wave 2 self-presentations were linked indirectly with changes from Wave 1 to Wave 3 in externalizing and internalizing symptoms through their association with academic competence.     

THE RELATION BETWEEN RISK AND PROTECTIVE FACTORS FOR PROBLEM BEHAVIORS AND DEPRESSIVE SYMPTOMS,ANTISOCIAL BEHAVIOR,AND ALCOHOL USE IN ADOLESCENCE

Both externalizing and internalizing psychopathology increase throughout adolescence and a similar set of risk and protective factors may underlie depressive symptoms, antisocial behavior, and alcohol use. Analyses test how risk and protective factors for externalizing behavior in community, school, family, peer, and individual domains are related to depressive symptoms, antisocial behavior, and alcohol use concurrently and longitudinally in a sample of 2,002 students assessed in 8^th and 10^th grades (52% male; 58% Caucasian). Findings indicate that risk and protective factors for antisocial behavior and alcohol use are also associated with depressive symptoms, both concurrently and longitudinally. Prevention approaches that target risk and protective factors for externalizing problems may have crossover effects on depressive symptoms during adolescence.