Effect of Environmental Risk and Externalizing Comorbidity on Internalizing Problems Among Economically Disadvantaged African American Youth

This study examined the effects of racial discrimination, community violence, and stressful life events on internalizing problems among African American youth from high‐poverty neighborhoods (N = 607; 293 boys; M_age = 16.0 years, SD = 1.44 years). Mediated effects via externalizing problems on these relations were also examined, given the high comorbidity rate between internalizing and externalizing problems. Externalizing problems partially mediated the effect of stressful life events on internalizing problems and fully mediated the effect of racial discrimination for boys but not for girls. Exposure to violence had a significant indirect effect on internalizing problems via externalizing problems. The findings call for greater attention to internalizing problems among African American youth and pathways to internalizing problems via externalizing problems.     

Relationships of sexual, physical, and emotional abuse to emotional and behavioral problems among incarcerated adolescents

This study examined the relationships of sexual, physical and emotional abuse to emotional (internalizing) and behavioral (externalizing) problems among incarcerated girls and boys. Participants were youth who were remanded to the correctional facilities within a statewide juvenile correctional system in a southern state in the United States of America. Each participant completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographic characteristics. Multiple regression analyses indicated that girls were more likely than boys to internalize their problems. The only abuse variable that was positively and significantly associated with emotional problems was emotional abuse. Greater behavioral problems were significantly related to youths being younger in age, white ethnicity, history of sexual abuse, and history of physical abuse. There were overall gender differences for internalizing problems, but not for externalizing problems among incarcerated adolescents. Furthermore, physical and sexual abuses were related to externalizing problems but not to internalizing problems. Thus, different types of abuse appear to have different effects on adolescent behavior. Implications for future research and practice are discussed.     

Maltreatment history as persistent risk: An extension of Li and Godinet (2014)

Using individual growth curves with mixed models, this study examined the influence of maltreatment on the trajectories of both internalizing and externalizing behavioral problems from early childhood (age 4) to late adolescence/emerging adulthood (age 16) in the LONGSCAN samples of children with early maltreatment exposure or early risk for maltreatment. Maltreatment reports for each child were used to create a time-varying predictor, which was assessed on an ongoing basis in the LONGSCAN study. Child/youth emotional and behavioral problems were measured at ages 4, 6, 8, 10, 12, 14, and 16 using the Child Behavior Checklist. Maltreatment allegations significantly predicted subsequent trajectories of both internalizing and externalizing problems. For both types of problems, the effect of repeated maltreatment was on the rate of change (the trajectory), and in the case of externalizing problems, this effect grew more pronounced through age 16. Although behavioral problems may not be seen in younger children who experience maltreatment, these children are at ongoing risk for such problems as they grow older, and this risk is either maintained through adolescence (in the case of internalizing problems) or increases in strength through adolescence (in the case of externalizing problems). Maltreatment history is a persistent risk factor for child outcomes through adolescence. Assessment for recent maltreatment, as well as for earlier history of maltreatment, in adolescent children would improve treatment and service plans for children with behavioral and emotional problems through adolescence.     

Gender Roles, Externalizing Behaviors, and Substance Use Among Mexican-American Adolescents

A sample of 60 male and 91 female Mexican-American adolescents (age 13-18) were administered measures of positive (i.e., assertive masculinity, affective femininity) and negative (i.e., aggressive masculinity, submissive femininity) gender roles, internalizing and externalizing problem behaviors, peer substance use, and own substance use (alcohol, cigarettes, marijuana). Negative gender roles were significantly correlated with internalizing and externalizing problems for both boys and girls, with aggressive masculinity also predicting peer substance use for both genders. Assertive masculinity significantly predicted lower alcohol use in boys, and this effect was not mediated by internalizing problems, externalizing problems, or peer substance use. Negative gender roles significantly predicted higher alcohol use in girls, but this effect was almost completely mediated by internalizing problems, externalizing problems, and peer substance use. Results are discussed in terms of gender role socialization among Mexican Americans.     

Change in externalizing problems over time among ethnic minority youth exposed to violence

Youth exposed to violence, many of whom are from racial/ethnic minority backgrounds, are at high risk for externalizing problems such as aggressive and oppositional behavior, conduct problems, and delinquency. Most interventions target youth with already high levels of such problems, while selective prevention efforts have received less attention. It is important for researchers, policy makers and practitioners to understand how such problems develop and change over time, and how selective prevention may impact externalizing problems. In this study, we examined one-year trajectories of externalizing problems in 883 low-income, ethnic minority youth exposed to violence who participated in randomized controlled trials testing a prevention program for high-risk youth called the Strengthening Families Program. We found three trajectories of externalizing problems: Low Externalizing (43% of the sample had consistently low levels of externalizing symptoms), Persisters (39% of the sample had consistently high levels of externalizing symptoms), and Improvers (18% of the sample had initially high levels of externalizing symptoms that decreased over time). There were demographic differences between the three trajectories with individuals in the Low Externalizing trajectory more likely to be female and younger than those in the other two trajectories and Persisters and Improvers had significantly more problems with baseline internalizing symptoms, family conflict, and parenting behavior compared to the Low Externalizing trajectory. Logistic regressions then tested several predictors of membership in the Persisters trajectory compared to the Improvers trajectory, controlling for all covariates simultaneously. Only baseline parenting behavior and intervention group membership significantly predicted trajectory membership, and these were small and unreliable effects. Thus, children with varying levels of violence exposure, co-occurring emotional/behavioral problems and family issues, and varying demographics (e.g., age and gender) may do equally well over time, but engagement in this type of intervention may increase the likelihood that high levels of externalizing problems are ameliorated over time.     

Gender‐ and Age‐Related Differences in the Association Between Social Relationship Quality and Trait Levels of Salivary Cortisol

The majority of studies linking individual differences in the quality of social relationships and activity of the hypothalamic‐pituitary‐adrenal (HPA) axis have focused on the early development of attachment between infants and their caregivers. Later in development, during middle childhood and adolescence, the parallel HPA links to age‐appropriate social relationships with peers, parents, and siblings remain largely unspecified. This study addressed this knowledge gap. Early morning saliva samples were obtained from 367 children in middle childhood (ages 6–10) and 357 adolescents (M age=11–16 years) on two successive days 1 year apart and assayed for cortisol. Latent state–trait modeling was employed to separate variance in cortisol levels attributable to “stable trait‐like” versus “state or situational specific” sources to minimize the high moment‐to‐moment variation in basal adrenocortical activity. During adolescence but not middle childhood, and for girls but not boys, lower levels of “trait cortisol” were associated with poor quality social relationships. The pattern was robust, extending to the quality of relationships with parents, siblings, and peers. Importantly, the relationship was independent of the rates of internalizing or externalizing problem behavior. We found that isolating the variance in cortisol levels attributable to stable intrinsic sources revealed an interpretable pattern that linked individual differences in basal HPA activity to social relationships during adolescence. Studies are needed to reveal the biosocial mechanisms involved in the establishment of this gender‐ and age‐specific phenomenon and to decipher whether or not individual differences in this hormone‐behavior link are adaptive.     

Relationships of Sexual,Physical, and Emotional Abuse to Emotional and Behavioral Problems Among Incarcerated Adolescents

ABSTRACT

This study examined the relationships of sexual, physical and emotional abuse to emotional (internalizing) and behavioral (externalizing) problems among incarcerated girls and boys. Participants were youth who were remanded to the correctional facilities within a statewide juvenile correctional system in a southern state in the United States of America. Each participant completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographic characteristics. Multiple regression analyses indicated that girls were more likely than boys to internalize their problems. The only abuse variable that was positively and significantly associated with emotional problems was emotional abuse. Greater behavioral problems were significantly related to youths being younger in age, white ethnicity, history of sexual abuse, and history of physical abuse. There were overall gender differences for internalizing problems, but not for externalizing problems among incarcerated adolescents. Furthermore, physical and sexual abuses were related to externalizing problems but not to internalizing problems. Thus, different types of abuse appear to have different effects on adolescent behavior. Implications for future research and practice are discussed.     

Co-development of internalizing and externalizing behavior problems during early childhood among child welfare-involved children

Using parallel-process latent growth curve modeling, we examine developmental trajectories of internalizing and externalizing behavior problems and identify early risk factors for behavior problems among 329 child welfare-involved children followed from age 2 years to 5 years. Data are drawn from the National Survey of Child and Adolescent Well-Being II. On average, internalizing behavior problems remained stable, while externalizing behavior problems decreased over time. Higher initial levels of internalizing behavior problems were associated with higher initial levels of externalizing behavior problems. Rates of change also had positive cross-domain relationships. Child neglect, exposure to intimate partner violence (IPV), insecure caregiver-child attachment, and caregiver mental health problems were associated with higher initial levels of internalizing and externalizing behavior problems. Exposure to IPV, out-of-home care, and caregiver drug use predicted rates of change in behavior problems. Our findings highlight the importance of comprehensive assessment and treatment for co-occurring internalizing and externalizing behavior problems in young children involved in the child welfare system. Results also indicate the need for identifying and addressing early risk factors to prevent early onset and continued development of behavior problems in high-risk children.     

Exploring Gender Differences on Internalizing and Externalizing Behavior Among Maltreated Youth: Implications for Social Work Action

This purpose of this study was to explore the moderating influence of gender on the relationship between child maltreatment and internalizing symptoms (e.g., affective and somatic problems) and externalizing behavior (e.g., rule breaking behavior and aggression) among children aged 7–12 years old. Using a longitudinal comparison group design and a sample of 300 youth of which 56% (n = 168) had substantiated cases of child maltreatment, results of a structural equation modeling revealed that internalizing symptoms exerted a mediating influence that was conditioned by gender. Only girls’ internalizing symptoms were found to mediate the link between child maltreatment and externalizing behavior while a direct relationship between maltreatment and externalizing behavior was found among boys. These findings provide evidence for gender differences in the pathways between being child maltreatment and maladaptive thoughts, feelings, and behaviors. Thus, adapting evidence-based strategies that target gender specific internalizing behaviors and externalizing behaviors among maltreated youth may significantly reduce the risk of short and long-term maladaptive behavior.     

Parents and Peers in Relation to Early Adolescent Problem Behavior

Concurrent and prospective associations between parent‐youth dyadic hostility and adolescent externalizing and internalizing problem behavior were examined in a sample of 416 families. Parenting control, parents’ well‐being, and youths’ affiliation with deviant peers were included as integral covariates. Information from multiple sources was analyzed using structural equation modeling. Concurrently, youth externalizing problems were associated with dyadic hostility, deviant peers, inadequate parenting control, and fathers’ well‐being (inversely). Internalizing problems were associated with inadequate parenting control and lower levels of fathers’ well‐being. Prospectively, some of these relations continued over 2 years, with a few new associations emerging. A process model is proposed in which parent‐youth dyadic hostility during early adolescence influences parenting, peer relations, and parents’ well‐being over time.     

Cumulative Environmental Risk and Youth Problem Behavior

Using data from Wave 1 (n = 5,070) and Wave 2 (n = 4,404) of the National Longitudinal Study of Adolescent Health, we examined the relationship between cumulative risk exposure and youth problem behavior. Cross‐sectional analyses revealed a positive, linear association between cumulative risk and problem behaviors. The association between cumulative risk and externalizing problems was stronger for White youth than for Black youth. The association between cumulative risk and internalizing problems was stronger for girls than for boys, and stronger for White youth than for Black and Hispanic youth. Cumulative risk predicted change over time in internalizing problems. Findings support the theoretical notion that adolescents experience diminished psychological comfort when risk factors are present across several social domains.     

Early Sexual Initiation and Mental Health: A Fleeting Association or Enduring Change?

The present research examined how the within‐person association between sexual initiation and internalizing symptoms decays over time, using data with annual measurement occasions across adolescence (N = 1,789) and statistical models of within‐person change. Sexual initiation was associated with increased levels of internalizing symptoms for early‐initiating girls (ninth grade, approximately age 15), but not for on‐time‐initiating girls or for boys. The association between girls' early sexual initiation and internalizing symptoms declined precipitously over time. Indeed, 1 year after sexual debut, early‐initiating girls were similar to on‐time or noninitiating girls on internalizing symptoms, suggesting early sexual initiation does not produce lasting detriments to girls' mental health. Findings inform how researchers perceive sexual initiation, both as a developmental milestone and as a prevention target.     

Briefly Noted

Internalizing and externalizing problems predicted onset of any tobacco use in youth; however, findings differed for internalizing and externalizing problems across tobacco products, researchers found in analyzing the Population Assessment of Tobacco and Health Study of 12‐ to 24‐year‐old never‐users. Self‐reported internalizing and externalizing symptoms were assessed at wave 1 (45,971 subjects), and past‐12‐month use of tobacco products was assessed at wave 2 (38,443 subjects). The researchers found that high‐severity internalizing symptoms at wave 1 increased the risk by 1.5 times of using tobacco by wave 2, and that high‐severity externalizing problems increased the risk of tobacco use by 1.3 times at wave 2. Low‐ and moderate‐severity problems did not predict tobacco onset. The study was funded by the National Institute on Drug Abuse and the Food and Drug Administration. Several authors declared conflicts of interest — one as an expert witness in a lawsuit against the tobacco industry. The article, “Mental Health Problems and Onset of Tobacco Use Among 12‐ to 24‐Year‐Olds in the PATH Study,” was published in the December 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry.     

Maternal Postpartum Depression Increases Vulnerability for Toddler Behavior Problems through Infant Cortisol Reactivity

The current study examined the role of hypothalamic‐pituitary‐adrenal reactivity (a physiological indicator of stress) in early infancy as a mediator of the relationship between maternal postpartum depression and toddler behavior problems. Participants were 137 at‐risk mothers and their children participating in a longitudinal study of intergenerational transmission of risk. Mothers’ depression was measured five times during the infants’ first 18 months. Infant cortisol was collected during a social stressor (the still‐face paradigm) when infants were 6 months old, and mothers reported on toddlers’ internalizing and externalizing symptoms at 18 months. Among this sample of high‐risk mother–infant dyads, early postpartum depression predicted atypical infant cortisol reactivity at 6 months, which mediated the effect of maternal depression on increased toddler behavior problems. Clinical implications are discussed.     

The Association of Sexual Behavior with Externalizing Behaviors in a Community Sample of Prepubertal Children

Abstract

On the basis of the problem-behavior theory for adolescence, we hypothesized that already during childhood sexual behavior is associated with (non-sexual) externalizing behaviors and tested the hypothesis in a community sample. In the context of a postal questionnaire survey of 6-10 year old children, the parents of 349 girls and 326 boys completed the Child Behavior Checklist (CBCL). The CBCL Sex Problems scale did not differ between genders, ethnic groups, or age groups. For both girls and boys, the scores on the Sex Problems scale correlated significantly but modestly (maximum r = 0.35) with all other CBCL scales; only in boys did the correlations with externalizing behaviors exceed those with other scales. We conclude that children from a community sample who show sexual behavior as defined by the CBCL tend to be the ones with increased behavioral/emotional problems in general, with only modest specificity in symptomatology.     

The Association of Birth Complications and Externalizing Behavior in Early Adolescents: Direct and Mediating Effects

Prior studies have shown that birth complications interact with psychosocial risk factors in predisposing to increased externalizing behavior in childhood and criminal behavior in adulthood. However, little is known about the direct relationship between birth complications and externalizing behavior. Furthermore, the mechanism by which the birth complications predispose to externalizing behavior is not well explored. This study aims to assess whether birth complications predispose to early adolescent externalizing behavior and to test whether Intelligence Quotient (IQ) mediates relationships between predictor and outcome variables. We used data from a prospective, longitudinal birth cohort of 1,795 3-year-old boys and girls from Mauritius to test hypotheses. Birth complications were assessed from hospital record data, malnutrition from a pediatric exam at age 3 years, psychosocial adversity from parental interviews at age 3 years, and externalizing behavior problems from parental ratings at age 11 years. We found that babies with birth complications are more likely to develop externalizing behavior problems at age 11. Low IQ was associated with birth complications and was found to mediate the link between early predictors and later externalizing behavior. These prospective, longitudinal findings have potential clinical implications for the identification of early adolescent externalizing behavior and for public health attempts to prevent the occurrence of child externalizing behavior problems.     

The mediational effect of affect regulation on the relationship between attachment and internalizing/externalizing behaviors in adolescent males who have sexually offended

Research has shown that adults who sexually offend frequently report perpetrating a sexual offense for the first time during childhood/adolescence; therefore in this preliminary study, we examine the possible covariates related to offending sexually in adolescents. For this study, 62 incarcerated adolescents at a correctional facility in Alabama completed self-report questionnaires regarding demographic information, internalizing/externalizing behavior problems, attachment, and affect regulation. The results of this study indicate that attachment is related to internalizing and externalizing behaviors, as well as, both adaptive affect regulation and maladaptive affect regulation. Through path analyses, this study was the first to test and find that affect regulation ability mediated the relationship between attachment and externalizing behavior; however, it did not mediate the relationship between attachment and internalizing behavior. Interestingly, maladaptive affect regulation appeared to have a stronger influence on problem behaviors than adaptive affect regulation for these adolescents. The findings from this study could help professionals identify more successful therapeutic interventions for these adolescents and consequently prevent later sexual offending and further negative, individual or societal outcomes.     

Residential Mobility and Adolescent Achievement and Behavior: Understanding Timing and Extent of Mobility

Residential mobility is generally viewed as an adverse event for adolescents' development. Less is known about whether moving during adolescence, childhood, or both periods explains this connection and whether the extent of mobility matters. Analytic shortcomings with much of the research call into question extant findings. We examined associations between childhood, adolescent, and child–adolescent mobility and adolescents' achievement (math and reading) and behavior problems (internalizing and externalizing). With a multisite, longitudinal sample (N = 1,056), we employed propensity score methods, which mitigate concerns about selection bias on observed variables, to investigate relationships. Results suggest that multiple, child–adolescent movers had more internalizing problems in adolescence than their stable peers, but did not differ on externalizing problems or achievement.     

Changes in Externalizing and Internalizing Problems of Adolescents in Foster Care

Using a developmental psychopathology framework, this study aimed to examine changes in externalizing and internalizing problems of adolescents in foster care and to determine whether type of maltreatment, gender, and age influenced trajectories. Authors used 3 waves of data from the National Survey of Child and Adolescent Well‐Being. Growth‐curve analyses of 106 adolescents aged 13–16 in foster care revealed that externalizing and internalizing problems decreased over time. Adolescents, particularly boys, placed in foster care as a result of sexual abuse, physical abuse, or neglect demonstrated faster decreases in externalizing problems and, similarly but to a weaker degree, internalizing problems than did those placed in foster care as a result of other forms of maltreatment.     

Parental Divorce and Offspring Depressive Symptoms: Dutch Developmental Trends During Early Adolescence

In this study, we investigated if the association between parental divorce and depressive symptoms changes during early adolescence and if developmental patterns are similar for boys and girls. Data were collected in a prospective population cohort of Dutch adolescents (N = 2,149), aged 10 – 15 years. Outcome variables were self‐reported and parent‐reported depressive symptoms. The effects of divorce were adjusted for parental depression. In both self‐reported and parent‐reported data, we found a three‐way interaction of gender, age, and parental divorce, indicating that with increasing age, parental divorce became more strongly associated with depressive symptoms among girls, but not boys. These results suggest that girls with divorced parents are at particularly high risk to develop depressive symptoms during adolescence.