Exposure to Community Violence and the Trajectory of Internalizing and Externalizing Symptoms in a Sample of Low-Income Urban Youth

This study examined trajectories of psychopathology in a sample of low-income urban youth and tested exposure to community violence as a predictor of these trajectories. Self-report and parent-report survey measures of psychological problems and exposure to community violence were collected annually over 3 years from a sample of 364 fifth- to ninth-grade low-income urban youth (64% female; 95% youth of color). Linear growth models showed that youth experienced declines in both internalizing and externalizing symptoms across adolescence. Exposure to community violence was more strongly associated with externalizing symptoms than with internalizing symptoms but predicted declines in both types of symptoms. Results also indicated that youth reported more internalizing and externalizing symptoms than their parents reported for them. Exposure to community violence may explain unique trajectories of mental health problems among low-income urban youth. In addition, youth efforts to adopt a tough façade in the face of community violence could lead to higher rates of externalizing problems relative to internalizing problems, whereas desensitization processes may better explain reductions in both types of symptoms over time. Finally, youth report may be more valid than parent report in the context of urban poverty.     

Anger and Sadness Regulation: Predictions to Internalizing and Externalizing Symptoms in Children

Examined the relation between children's self-reported anger and sadness regulation and the presence of internalizing and externalizing symptoms. Participants were 121 boys and 106 girls in the fourth and fifth grades who completed the Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), Emotion Expression Scale for Children (EESC), and Children's Emotion Management Scales (CSMS, CAMS) and rated each other on aggressive behavior. Results of multiple regression analyses indicated that the inability to identify emotional states, the inhibition of anger, the dysregulation of anger and sadness, and the constructive coping with anger predicted internalizing symptoms. The dysregulated expression of sadness and constructive coping with anger were inversely related to externalizing symptoms.     

The Depression Prevention Initiative: Impact on Adolescent Internalizing and Externalizing Symptoms in a Randomized Trial

This randomized controlled trial examined the longitudinal effects of two school-based indicated depression prevention programs on adolescents’ internalizing and externalizing symptoms, as measured by adolescents, their parents, and their teachers. One hundred eighty-six adolescents participated in this study. The average age was 14.01 (SD = 1.22) years, and the sample was 66.7% female. One third of the sample belonged to a racial minority. Youth received either Interpersonal Psychotherapy–Adolescent Skills Training or group counseling. Symptoms were assessed using adolescent, parent, and teacher reports on the Achenbach System of Empirically Based Assessment at baseline, postintervention, and 6-month follow-up. Adolescents reported the most robust effects in favor of Interpersonal Psychotherapy–Adolescent Skills Training. Adolescents in Interpersonal Psychotherapy–Adolescent Skills Training reported significantly greater reductions in internalizing symptoms through the 6-month follow-up and significantly greater reductions in externalizing symptoms during the intervention as compared to group counseling. Less robust effects were found when examining parent and teacher reports, although there was evidence of significant within-group change in parent- and teacher-reported internalizing symptoms for both interventions and significant between-group differences in teacher-reported externalizing symptoms. This study provides additional evidence supporting the efficacy of Interpersonal Psychotherapy–Adolescent Skills Training as a depression prevention program for adolescents. Interpersonal Psychotherapy–Adolescent Skills Training appears to have fast-acting effects on broadband internalizing and externalizing symptoms as reported by adolescents. This suggests that Interpersonal Psychotherapy–Adolescent Skills Training may serve as a transdiagnostic preventive intervention. Moreover, given the disparate reports of adolescents, parents, and teachers, this study demonstrates the significance of collecting information from multiple sources when possible.     

Children's Internalizing and Externalizing Behaviors and Maternal Health Problems

Examined the impact of a range of health related constructsreflecting maternal physical symptomatology, health servicesutilization, subjective health status, depressed mood, medical-psychologicalcomplaints, and marital adjustment on children's internalizingand externalizing behavior problems in a community sample (N= 145). Physical symptomatology predicted a general second-orderlatent factor of children's behavior problems. Depressed moodpredicted a primary latent factor of internalizing child behaviorproblems. Seizure symptoms, and more health problems in thelast 4 years specifically predicted child psychosomatic complaints/anxiety.Thus, general physical symptoms predicted a broad spectrum ofproblem behaviors, whereas specific mental or physical healthproblems predicted similar distinct problem behavior syndromes.Implications of these results for identifying children at riskfor psychopathology, and the relevance of social learning theoryand a broader based family systems approach are discussed.     

Self-Esteem,Internalizing Symptoms,and Theory of Mind in Youth With Autism Spectrum Disorder

Self-esteem is a potent indicator of mental health in typically developing (TYP) individuals. It is surprising that there have been few comprehensive investigations of self-esteem in children and adolescents with autism spectrum disorder (ASD), given that they are at high risk for comorbid mental health problems, such as depression and anxiety. The objectives of the current study were to assess how youth with ASD rate their self-esteem compared to age-matched TYP youth and to examine how self-esteem relates to internalizing psychopathology and theory of mind in the two groups. Seventy-three children and adolescents, ages 9 to 17, were administered a battery of questionnaires assessing self-esteem and internalizing symptoms, as well as tasks designed to measure theory of mind. Results indicated that youth with ASD rated their self-esteem significantly lower than did TYP youth. Self-esteem was strongly related to depression in both groups but was negatively related to theory of mind only for youth with ASD. These results may provide important insights into how individuals with ASD form evaluations of their own self-worth and illustrate how increasing self-awareness in individuals with ASD is not without risks.     

Cognitive Specificity in Internalizing and Externalizing Problems in Community and Clinic-Referred Children

Examined whether cognitive features in Beck's (1967) model of depression and his cognitive content-specificity hypothesis (Beck, Brown, Steer, Eidelson, & Riskind, 1987) are broadband specific features that distinguish internalizing problems from externalizing problems. From a community (n = 389; 196 boys, 193 girls; age M = 9.98, SD = 1.52) and clinic (n = 82; 55 boys, 27 girls; age M = 10.42, SD = 2.91) sample, 4 groups were defined on behavioral measures and then examined on cognitive measures: externalizing only (n = 33), internalizing only (n = 41), comorbid externalizing and internalizing (n = 53), and control (neither externalizing nor internalizing; n = 35). Both the internalizing only and comorbid groups reported significantly more cognitive disturbances (negative cognitive triad, cognitive processing distortions, and "depressive" and "anxious" thought content) than both of the externalizing only and control groups in both the community and clinic samples. The results were not related to either overall level of psychopathology (as reported by mothers) or social desirability in children's reporting. These findings suggest that the cognitive features in Beck's model distinguish internalizing from externalizing problems and add to a growing literature that calls for further conceptual refinement of cognitive models for understanding both narrow-band and broadband syndromes.     

Examining Cognitive Models of Externalizing and Internalizing Problems in Subgroups of Juvenile Delinquents

The Emotion Expression Scale for Children (EESC) is a new self-report scale designed to examine 2 aspects of deficient emotion expression: lack of emotion awareness and lack of motivation to express negative emotion. Validity was assessed using self-report measures of emotion regulation and self- and peer-report of internalizing and externalizing symptoms. Using a community sample of 208 fourth- and fifth-grade children, reliability analyses revealed high internal consistency and moderate test-retest reliability of the EESC. The results provide initial support for concurrent validity for the EESC factors evidenced by relations with measures of emotion management. Associations were found between the EESC and measures of internalizing symptoms.     

Agreement Among Parents,Teachers, and Children on Internalizing and Externalizing Behavior Problems

Investigated agreement between mothers, fathers, teachers, and children on equivalent forms of a standardized measure of behavioral and emotional problems. Ninety-eight children, age 13 years, completed the Youth Self-Report (Achenbach, 1991d). Their mothers and fathers completed the Child Behavior Checklist (Achenbach, 1991b), and their teachers completed the Teacher Report Form (Achenbach, 1991c). Children generally reported the most problems and teachers the least. Agreement was highest between mothers and fathers on internalizing and externalizing problems, and lowest for rater pairs involving teachers on internalizing problems. Analyses of a multitrait-multimethod matrix for ratings of internalizing and externalizing problems indicated good convergent validity, large rater effects, and weaker discriminant validity. Conditional probabilities for agreement on deviant and nondeviant scores indicated that ratings by no informant could substitute for those of any other rater. Teacher ratings of externalizing problems were the best predictor of referral for mental health services.     

Interparental Agreement on Internalizing, Externalizing, and Total Behavior Problems: A Meta-analysis

Previous studies have addressed the degree of correspondence between interparental reports of children's behavior problems, but have not examined the discrepancies in these reports. A meta-analysis containing 60 studies and 126 independent effect sizes was conducted. Results suggest that maternal and paternal ratings exhibit moderate correspondence in ratings of internalizing behavior problems in children and large correspondence in ratings of externalizing and total behavior problems in children. In terms of discrepancy of reports, parents reported similar levels of all types of problems. Age, gender, and socioeconomic status were found to moderate correspondence between mothers' and fathers' ratings but did not moderate discrepancies in mothers' and fathers' ratings.     

Etiology of Stability and Growth of Internalizing and Externalizing Behavior Problems Across Childhood and Adolescence

Internalizing and externalizing behaviors are heritable, and show genetic stability during childhood and adolescence. Less work has explored how genes influence individual differences in developmental trajectories. We estimated ACE biometrical latent growth curve models for the Teacher Report Form (TRF) and parent Child Behavior Checklist (CBCL) internalizing and externalizing scales from ages 7 to 16 years in 408 twin pairs from the Colorado Longitudinal Twin Study. We found that Intercept factors were highly heritable for both internalizing and externalizing behaviors (a2 = .61–.92), with small and nonsignificant environmental influences for teacher-rated data but significant nonshared environmental influences for parent-rated data. There was some evidence of heritability of decline in internalizing behavior (Slopes for teacher and parent ratings), but the Slope genetic variance was almost entirely shared with that for the Intercept when different than zero. These results suggest that genetic effects on these developmental trajectories operate primarily on initial levels and stability, with no significant unique genetic influences for change. Finally, cross-rater analyses of the growth factor scores revealed moderate to large genetic and environmental associations between growth factors derived from parents' and teachers' ratings, particularly the Intercepts.     

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.     

Relations of Parenting to Adolescent Externalizing and Internalizing Distress Moderated by Perception of Neighborhood Danger

Parental monitoring and warmth have traditionally been studied in the context of White, middle-class families. This article explores optimal levels of these parenting behaviors in preventing adolescent psychopathology in impoverished, urban high-crime areas while accounting for child perceptions of neighborhood danger. In this study, data were collected longitudinally at 2 time points 1 year apart from a sample of 254 African American young adolescents (T1: M age = 12.6 years, 41% male) and their parents. Parental monitoring and warmth, child perception of neighborhood danger, and child internalizing and externalizing behaviors were measured using questionnaires. Child internalizing behaviors were also measured using a time sampling technique capturing in vivo accounts of daily distress. Findings indicated associations between parental monitoring and children's externalizing behaviors along with linear and quadratic associations between parental monitoring and internalizing behaviors. Monitoring and warmth were differentially related to symptoms depending on neighborhood danger level. When children perceived less danger, more monitoring related to less externalizing. When children perceived more danger, more warmth related to less internalizing. In addition, adolescents' perceptions of neighborhood danger emerged as equally strong as monitoring and warmth in predicting symptoms. This study underscores the influence of carefully considering parenting approaches and which techniques optimally prevent adolescents' externalizing, as well as prevent internalizing difficulties. It also highlights how context affects mental health, specifically how perceptions of danger negatively influence adolescents' psychopathology, emphasizing the importance of initiatives to reduce violence in communities.     

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.     

Longitudinal Associations Between Externalizing Problems and Symptoms of Depression in Children and Adolescents

The longitudinal links between symptoms of externalizing difficulties—oppositional defiant disorder (ODD) and conduct disorder (CD)—and symptoms of depression are unclear. Therefore, we were interested in examining the temporal relation of symptoms of ODD, CD, and depression across 7 years in a sample of 643 10-year-old children (M = 10.91, SD = 0.36) at Time 1 using cross-lagged path analysis. Although symptoms of ODD predicted depressive symptoms across most time points and CD at Time 1 negatively predicted depressive symptoms at Time 3, evidence of the inverse relation was also found for both ODD and CD. Sex differences did not emerge. These findings add to the mixed literature on the directionality of externalizing and internalizing difficulties in children and adolescents by suggesting the presence of a reciprocal relation.     

Socioeconomic Status,Amygdala Volume,and Internalizing Symptoms in Children and Adolescents

The associations among socioeconomic disadvantage, amygdala volume, and internalizing symptoms in children and adolescents are unclear and understudied in the extant literature. In this study, we examined associations between socioeconomic status (SES) and amygdala volume by age across childhood and adolescence to test whether socioeconomic disadvantage would be associated with larger amygdala volume at younger ages but with smaller amygdala volume at older ages. We then examined whether SES and amygdala volume were associated with children’s levels of anxiety and depression. Participants were 3- to 21-year-olds from the Pediatric Imaging, Neurocognition, and Genetics study (N = 1,196), which included structural magnetic resonance imaging. A subsample (n = 327; 7–21 years of age) completed self-report measures of anxiety and depression. Lower family income and parental education were significantly associated with smaller amygdala volume in adolescence (13–21 years) but not significantly associated with amygdala volume at younger ages (3–12 years). Lower parental education, but not family income, was significantly associated with higher levels of anxiety and depression, even after accounting for family history of anxiety/depression. Smaller amygdala volume was significantly associated with higher levels of depression, even after accounting for parental education and family history of anxiety/depression. These findings suggest that associations between SES and amygdala structure may vary by age. In addition, smaller amygdala volume may be linked with an increased risk for depression in children and adolescents.     

Using Shared and Unique Parental Views to Study the Etiology of 7-Year-Old Twins' Internalizing and Externalizing Problems

In a sample of 1,940 Dutch 7-year-old twin pairs we studied the etiology of individual differences in Internalizing and Externalizing behavioral problems. For the majority of twins in the sample, both maternal and paternal ratings of behavioral problems were obtained from the Child Behavior Checklist. This made it possible to take into account processes underlying agreement and disagreement between maternal and paternal ratings. For both problem behaviors, a Psychometric model fitted the data better than a Rater Bias model, implying that parents, in addition to the behaviors they similarly observed, also assessed unique aspects of their children's behaviors. Relatively large genetic influences were found for Externalizing problems, explaining over 50% of the variance in both boys and girls. For internalizing problems, the heritability was over 30% in both sexes. Shared environmental factors were nearly as important as genetic influences in explaining the variation in behavioral problems. For both Externalizing and Internalizing problems, around 30% of the variance was accounted for by the shared environmental factors.