The pathway of internalizing and externalizing problems from childhood to adolescence: a prospective study from age 7 to 14-16 in Korea

This study prospectively investigated developmental psychopathology pathway from the age of 7 to ages 14–16. The subjects (N = 1,857) were evaluated using the Korean version of the Child Behavior Checklist and reassessed using the Korean Youth Self Report. In path analyses, total problems, externalizing problems, and internalizing problems in childhood associated significantly with problems in adolescence. In particular, childhood externalizing problems associated with adolescent externalizing problems, for both genders. However, our results differ from those of previous studies in that internalizing problems showed a restrictive stability by gender and in that early externalizing problems correlated negatively with later internalizing problems for girls. In the syndrome scales analyses, we confirmed that some syndromes showed heterotypic pathways, despite the general continuity of the developmental psychopathology. The importance of Anxiety/Depression and Attention problems in childhood suggested that adolescent difficulties are a consequence of an accumulation of such risk factors.     

Childhood predictors of externalizing and internalizing problems in adolescence

Abstract The aim of this study was to assess the childhood predictors of externalizing and internalizing symptoms in adolescence in an epidemiological sample. Behavior ratings were obtained from 609 children at two time-points, accounting for 71% of the target sample. At age 8, children were evaluated with parental and teacher Rutter scales, and with the Child Depression Inventory (CDI), and at age 16 with the Child Behavior Checklist. Evaluations by all informants had a unique contribution to later outcome. In multivariate analysis, among boys, parental reports of hyperactivity independently predicted externalizing problems and teacher reports of hyperactivity independently predicted internalizing problems. Teacher reports of conduct problems independently predicted externalizing problems among both boys and girls. Furthermore, parent reports of emotional problems independently predicted internalizing problems among both boys and girls. Children’s own reports of internalized distress measured with CDI predicted a high level of internalizing problems among girls. Perceived need of treatment was the strongest predictor for outcome among girls. Change in family structure (e. g., divorce or remarriage) during follow-up independently predicted externalizing and internalizing problems among boys. The study supports the findings from earlier studies showing that the stability of behavior problems from childhood to adolescence is substantial. This implies a need for early recognition and initiation of treatment efforts.     

Correction of distortion in distressed mothers' ratings of their preschool-aged children's Internalizing and Externalizing scale score

Increased maternal psychopathology may bias mothers' ratings about child psychopathology. In this study we examined whether internalizing and externalizing behavior problems in young children were biased through maternal psychopathology. The clinical sample comprised 247 preschool-age patients who attended the Family Day Hospital in Münster, Germany. Internalizing and externalizing behavior problems were assessed by the CBCL/1.5-5, and maternal psychopathology was assessed by the SCL-90-R Global Severity Index (GSI). Three theoretical perspectives were tested by comparing the model fit of three structural equation models, namely the accuracy, distortion, and combinatory model. All of the models aimed to integrate multi-informant ratings from mother, therapists, and kindergarten teachers, but differed in the question which paths had to be significant. The distortion model fit the data best and supported the notion that there was a psychopathology-related bias in mothers' ratings. On the basis of this finding, we developed correction formulas comparable to Müller and Furniss (2013), in order to statistically control for this distortion. We discussed post-hoc explanations about why mothers with increased psychopathology gave higher ratings on the CBCL/1.5-5, including a better recall of internalizing symptoms, less flexible and effective parenting, and more perceived distress by child externalizing behavior.     

Early preschool predictors of preadolescent internalizing and externalizing DSM-IV diagnoses

OBJECTIVE: To investigate the independent predictive value of parent-reported psychopathology and family risk factors in early preschool in relation to parent-reported internalizing and externalizing psychopathology in preadolescence. METHOD: Subjects were participants in a longitudinal study of 420 two- to three-year-olds from the general population of Zuid-Holland, the Netherlands, which started in 1989. At a second follow-up 8 years later (ages 10-11 years), 358 children participated. For this study, 332 children were included for whom DSM-IV diagnoses (derived from the Diagnostic Interview Schedule for Children-Version 4-Parent Version) were obtained at age 10 to 11 years. Preschool risk factors were obtained through the Child Behavior Checklist for ages 2 to 3 years and a parent interview. RESULTS: Early preschool internalizing and externalizing problems were predictive of their DSM-IV counterparts 8 years later, independent of the influence of early parent-reported family risk factors. Preschool child physical problems were independently predictive of both internalizing and externalizing diagnoses in preadolescence. Of the environmental risk factors, only stressful life events contributed independently to the prediction of later externalizing problems. CONCLUSION: Early adverse family circumstances and parenting characteristics do not contribute to the prediction of later psychopathology once child characteristics are accounted for.     

Predicting internalizing and externalizing problems at five years by child and parental factors in infancy and toddlerhood

This study examined child and parental factors in infancy and toddlerhood predicting subclinical or clinical levels of internalizing and externalizing problems at 5 years of age. Ninety-six children and their families participated. They were assessed when the children were 4–10 weeks old (T1), 2 years (T2) and 5 years old (T3). Child risks (difficult temperament, health problems, early emotional and behavioral problems), parental risks (psychopathology, parenting stress and perception of the child) and family risks (socio-economic status, quality of marital relationship and family violence) were examined. At 5 years, internalizing problems were predicted by family violence during the child’s infancy and parenting stress at age 2. Externalizing problems were predicted by psychiatric problems of the mother before pregnancy and child’s externalizing problems at 2 years of age. When interventions aiming at preventing emotional and behavioral problems in children are considered, these issues should be recognized early and effective intervention initiated.     

Early predictors of parent- and self-reported perceived global psychological difficulties among adolescents

Aims To study predictors at age 3 and at age 12 for parent and self-reported perceived global psychological difficulties at age 15. Method A representative birth cohort was prospectively followed from early childhood to age 15. Ratings of children’s behavioral and emotional problems were collected at age 3 (Child Behavior Check List 2/3) and at age 12 (Child Behavior Check List 4–16, Youth Self Report). Mothers and fathers separately completed a questionnaire on their own well-being, health and mental distress when the child was 12. At the same time-point, family functioning was measured with the Family Assessment device. Outcome variables included both parent and self-reports of children’s perceived psychological difficulties at age 15. Results At age 15, of the 707 children with both parent and self-reports on perceived difficulties available, 10% had more perceived difficulties than peers of the same age in parent or self-reports. There was a significant increase in perceived difficulties from age 12 to age 15 in self-reports but not in parent reports. The parent–child agreement on difficulties at both time-points was very low (proportion of agreement 0.12–0.17). At age 3, externalizing problems, especially aggressiviness, predicted parent reports of child’s difficulties at 15 years of age in univariate analysis. At age 12, parent-reported child’s externalizing symptoms and perceived difficulties, poor social competence in self-reports, and mothers’ reports of her own poor well-being, independently predicted parents’ reporting of their child’s perceived difficulties at age 15. Self-reports of internalizing problems and mother’s own reports of her depressiviness when the child was 12 independently predicted the 15-year old’s self-reported difficulties. Furthermore, in univariate analysis, poor family functioning at age 12 predicted perceived difficulties in parent and self-reports. Conclusions Both parent and self-reports of a child’s difficulties are the outcome of an accumulation of the child’s psychopathology, parental distress, and family dysfunction. The results emphasize the importance of early detection of children at risk of negative developmental pathways. In clinical practice and in prevention interventions, it is important to take into account the child’s individual psychopathology, parental distress, and family dysfunction.     

Do Antenatal and Postnatal Parental Psychological Distress, and Recognized Need of Help Predict Preadolescent’s Psychiatric Symptoms? The Finnish Family Competence Cohort Study

In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child’s first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents’ well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers’ postnatal distress predicted subsequent internalizing problems. Furthermore, mother’s depressed mood in the first trimester best predicted the child’s externalizing problems at age 12. Nurses’s ratings of mother’s antenatal and perinatal need for support, perinatal distress, and family’s need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring’s externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.     

Childhood sleep problems,early onset of substance use and behavioral problems in adolescence

BackgroundVery few prospective studies examine the relationship between childhood sleep problems and subsequent substance use. In this study, we examined how sleep problems at ages 3–8 predicted onset of alcohol, cigarette, and marijuana use in adolescence. We also investigated the relationships between childhood sleep problems and adolescent internalizing and externalizing problems.MethodsStudy participants were 292 boys and 94 girls from a community sample of high risk families and controls in an ongoing longitudinal study.ResultsControlling for parental alcoholism, sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use among boys and onset of alcohol use among girls. Childhood sleep problems were related to maternal ratings of internalizing and externalizing problems during adolescence for both boys and girls. Adjusting for these problems did not weaken the effects of sleep problems on onset of substance use.ConclusionsThis is to our knowledge the first study that prospectively examines gender differences in the relationship between sleep problems and early onset of substance use. Childhood sleep problems predicted early onset of substance use for boys but not girls. If childhood sleep problems indeed increase the probability of substance use onset, greater attention by parents to sleep problems in children and adolescents would potentially have ameliorative long-term effects. Parents are encouraged to explore different ways to help their children sleep better, including obtaining information and suggestions from their primary care physicians.     

Developmental Pathway Modeling in Considering Behavior Problems in Young Russian Children

In planning interventions it is essential to understand how adverse risk factors in early childhood are associated with child mental health problems, whether some types of problems can be better explained by the specific risk factors, and whether early risk factors are differently related to different types of child behavior problems. A community sample of 692 1.5–3.5-year-old children from Northern Russia was assessed by means of maternal reports. The study compared two models for the development of internalizing (withdrawn, anxious/depressed) and externalizing (aggressive, destructive) behavior problems in relation to the same early risk factors using structural equation modeling. Findings suggested that the development of these problems is related to maternal psychological problems and alcohol use during pregnancy, and mediated by the continuing maternal and family dysfunction and compromised postnatal condition of the child. Results indicated good model fit for both internalizing and externalizing problems, and neither of the models fit significantly better than the other. Findings are discussed in terms of understanding developmental risk and informing intervention and prevention efforts.     

Predicting adult emotional and behavioral problems from externalizing problem trajectories in a 24-year longitudinal study

The aim of this study was to examine the prediction of adult behavioral and emotional problems from developmental trajectories of externalizing behavior in a 24-years longitudinal population-based study of 2,076 children. The adult psychiatric outcome of these trajectories has not yet been examined. Trajectories of the four externalizing behavior types: aggression, opposition, property violations and status violations were determined separately through latent class growth analysis using data of five waves, covering ages 4–18 years. We used regression analyses to determine the associations between children’s trajectories and adults’ psychiatric problems based on the Adult Self-Report. The developmental trajectories of the four types of externalizing behavior mostly predicted intrusive, aggressive and rule-breaking behavior in adulthood. Non-destructive behaviors in childhood such as opposition and status violations predict adult problems to a larger extent than destructive behaviors such as aggression and property violations. In general, children who develop through high-level trajectories are likely to suffer from both internalizing and externalizing problem behavior in adulthood, regardless the direction of change (i.e. increasing/decreasing/persisting) of the high-level trajectory. We can conclude that the level rather than the developmental change of externalizing behavior problems has a larger impact on adult outcome.     

Preschoolers’ Psychosocial Problems: In the Eyes of the Beholder? Adding Teacher Characteristics as Determinants of Discrepant Parent–Teacher Reports

In this study, we explored informant characteristics as determinants of parent–teacher disagreement on preschoolers’ psychosocial problems. Teacher characteristics were included in the analyses, in addition to child and parent factors. Psychosocial problems of 732 4-year olds from a Norwegian community sample were assessed by parents and teachers (CBCL-TRF). Furthermore, teachers reported on their education, experience and relationship to the child. Parental stress and psychopathology were also measured. Teachers rated children considerably lower than their parents did, especially on internalizing problems. When teachers rated more child problems, this was strongly associated with conflict in the teacher–child relationship, which predicted disagreement more than other factors. The highest agreement was on boys’ externalizing problems. Girls’ behavior was rated much lower by teachers than boys’ behavior compared to parents’ ratings. Possible teacher perception biases are discussed, such as teacher–child conflict, non-identification of internalizing problems, and same-gender child preference.     

Depressive symptoms and associated psychopathology in urban adolescents: a cross-cultural study of three countries

The study aimed to compare cross-cultural trends of comorbid internalizing and externalizing psychopathology, prosocial beliefs, and perceptions of risk in adolescents with and without clinical levels of self-reported depressive symptoms. The Social and Health Assessment, a self-report survey, was conducted in a representative sample of 3309 adolescents 14 to 17 years old from urban communities in the United States (N = 1343), Belgium (N = 946), and Russia (N = 1009). In all three countries, girls reported higher levels of depressive symptoms than boys. The findings also demonstrate that in both genders, depressive symptoms were associated with increased levels of internalizing and externalizing problems, as well as lower levels of prosocial beliefs and low perceptions of harm from risk-taking behavior. Depressed boys had relatively higher levels of externalizing problems than depressed girls. Greater levels of internalizing problems observed in depressed youth, as compared with their nondepressed counterparts, were not gender-specific. Current findings suggest that the relationships between depression and comorbid psychopathology are not culture-specific and have similar patterns in different populations.     

Agreement between youth-reported and parent-reported psychopathology in a referred sample

Objective  The study examined parent-youth agreement regarding reports on psychopathology among adolescents suffering from psychiatric disorders. Method  A total of 1,718 patients between the age of 11 and 18, as well as their parents, were assessed using the child behavior checklist (CBCL), and the youth self-report (YSR). Results  Poor to low agreement between parent- and adolescent-reported problem behavior on the internalizing scale, the total problem scale and moderate agreement concerning the externalizing scale of the CBCL and the YSR were found. Independent from the amount of psychiatric diagnoses, adolescents reported significantly less behavioral problems than their parents. Concerning externalizing problems, parent-youth disagreement was stronger for patients suffering from comorbid psychiatric disorders, than for adolescents displaying only one psychiatric disorder. Conclusion  In clinically referred children, parents are likely to emphasize the severity of the difficulties, whereas adolescents’ under-report symptoms.     

Neonatal neural networks predict children behavioral profiles later in life

This study aimed to examine heterogeneity of neonatal brain network and its prediction to child behaviors at 24 and 48 months of age. Diffusion tensor imaging (DTI) tractography was employed to construct brain anatomical network for 120 neonates. Clustering coefficients of individual structures were computed and used to classify neonates with similar brain anatomical networks into one group. Internalizing and externalizing behavioral problems were assessed using maternal reports of the Child Behavior Checklist (CBCL) at 24 and 48 months of age. The profile of CBCL externalizing and internalizing behaviors was then examined in the groups identified based on the neonatal brain network. Finally, support vector machine and canonical correlation analysis were used to identify brain structures whose clustering coefficients together significantly contribute the variation of the behaviors at 24 and 48 months of age. Four meaningful groups were revealed based on the brain anatomical networks at birth. Moreover, the clustering coefficients of the brain regions that most contributed to this grouping of neonates were significantly associated with childhood internalizing and externalizing behaviors assessed at 24 and 48 months of age. Specially, the clustering coefficient of the right amygdala was associated with both internalizing and externalizing behaviors at 24 months of age, while the clustering coefficients of the right inferior frontal cortex and insula were associated with externalizing behaviors at 48 months of age. Our findings suggested that neural organization established during fetal development could to some extent predict individual differences in behavioral‐emotional problems in early childhood. Hum Brain Mapp 38:1362–1373, 2017. © 2016 Wiley Periodicals, Inc.     

A Multivariate Model of Parent–Adolescent Relationship Variables in Early Adolescence

Given the importance of predicting outcomes for early adolescents, this study examines a multivariate model of parent–adolescent relationship variables, including parenting, family environment, and conflict. Participants, who completed measures assessing these variables, included 710 culturally diverse 11–14-year-olds who were attending a middle school in a Southeastern state. The parents of a subset of these adolescents (i.e., 487 mother–father pairs) participated in this study as well. Correlational analyses indicate that authoritative and authoritarian parenting, family cohesion and adaptability, and conflict are significant predictors of early adolescents’ internalizing and externalizing problems. Structural equation modeling analyses indicate that fathers’ parenting may not predict directly externalizing problems in male and female adolescents but instead may act through conflict. More direct relationships exist when examining mothers’ parenting. The impact of parenting, family environment, and conflict on early adolescents’ internalizing and externalizing problems and the importance of both gender and cross-informant ratings are emphasized.     

Temperament Traits and Psychopathology in Young Clinically Referred Children Compared to a General Population Sample

Evidence from general population studies shows the contribution of various temperament traits to the development of child psychopathology. Little is known about which traits are associated with internalizing and externalizing problems in young clinically referred children. The current study assessed temperament and internalizing and externalizing problems in 216 referred children (M?=?4.35 years, SD 0.89, 81% boys). A comparison was made with an age and gender matched general population sample. Referred children showed less effortful control than general population children. Less effortful control and more negative affectivity were associated with more internalizing and externalizing problems across groups. Surgency, and specifically temperamental impulsivity, was more strongly associated with externalizing problems in referred children compared to general population. Less soothability, less inhibitory control and more frustration predicted (sub)clinical levels of comborbid internalizing and externalizing problems in referred children. The results can be used in diagnostic and treatment procedures in early childhood.     

Links Between Maternal and Child Psychopathology Symptoms: Mediation Through Child Emotion Regulation and Moderation Through Maternal Behavior

This study examined the intergenerational transmission of psychopathology symptoms with 7–12 year-old children (N = 97; 44 boys, 53 girls, M age = 9.14, SD = 1.38) and their mothers (M age = 38.46, SD = 6.86). Child emotion regulation mediated the links between maternal psychopathology and child internalizing and externalizing symptoms. In turn, the indirect effect was dependent on the level of maternal support in response to youth’s expressions of negative emotions when considering particular constellations of maternal reactions and type of psychopathology symptoms. The findings indicate that the relations between maternal and child psychopathology symptoms and child emotion regulation are complex and vary by context. Regardless of the complexity, however, for both internalizing and externalizing symptoms in youth, the results suggest that building adaptive emotion regulation skills is an important target for prevention among children who are at risk for problems due to exposure to maternal psychopathology.     

Early childhood heart rate does not predict externalizing behavior problems at age 7 years

OBJECTIVE: In previous research, low resting heart rate in childhood and adolescence has been shown to predict aggressive and/or delinquent behavior at subsequent ages. It has been found that heart rate recorded as early as age 3 years could predict externalizing behavior at age 11 years. This study explored the possibility of a similar relationship between heart rate and externalizing behavior problems. METHOD: Heart rate recorded at ages 14, 20, 24, 36 months and 7 years was used to predict combined parental ratings on the Aggressive and Delinquent Behavior scales of the Child Behavior Checklist (CBCL/4-18) as well as the Externalizing composite scale measured at age 7 years. Subjects consisted of same-sex twin pairs, treated as singletons in the present study, participating in the MacArthur Longitudinal Twin Study. Subjects were grouped into high and low heart rate groups and also into high CBCL/4-18 scoring and low CBCL/4-18 scoring groups. RESULTS: Heart rate was not significantly related to scores on either of the 2 subscales or the Externalizing composite scale at any age. Heart rate group membership did not predict CBCL/4-18 scores. Conversely, CBCL/4-18 group membership did not predict heart rate at any age. CONCLUSION: In this sample, heart rate does not predict externalizing behavior at age 7.     

Sex differences in child psychiatric outpatients: Cognitive,personality, and behavioral characteristics

This paper describes sex differences in a clinically referred sample on direct measures of child competence and ratings of psychopathology. The sample comprised 117 6-12 year-old boys and 63 girls referred to a psychiatric outpatient service. The results indicated that although boys and girls did not differ in overall problems or on externalizing problems, girls had significantly more internalizing problems and were more impaired as measured by both individual and composite measures of competence.     

Relationships Between Perceived School Climate and Adolescent Mental Health Across Genders

The current study explored the relationship between school climate perceptions and self-reported mental health among 415 high school students. Mental health was defined comprehensively via indicators of positive functioning (life satisfaction) and psychopathology (internalizing and externalizing problems). Regression analyses indicated that students’ perceptions of six dimensions of school climate (sharing of resources, order and discipline, parent involvement, school building appearance, student interpersonal relations, and student–teacher relations) accounted for a total of 15–22 % of the variance in indicators of their mental health, above and beyond between-school differences in outcomes. Bivariate links emerged between positive perceptions of each school climate dimension and better mental health. Parent involvement was the most consistent unique predictor of mental health. Worse perceptions of the peer interpersonal relations, equal sharing of school resources, and physical appearance of one’s school building uniquely predicted greater psychopathology (externalizing and internalizing problems, respectively), whereas teacher–student relations were particularly associated with wellness (among girls only). Across indicators, school climate was more highly associated with girls’ mental health. Directions for future research and implications for educators are discussed.