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.     

Predicting Well‐Being and Internalizing Symptoms in Late Adolescence From Trajectories of Externalizing Behavior Starting in Infancy

This study aimed to examine the long‐term prediction of well‐being and internalizing symptoms from trajectories of externalizing behavior problems in 921 children from a population‐based sample. We found that a high stable trajectory of externalizing behavior from infancy (age 1.5) to mid‐adolescence (age 14.5) predicted lower scores on life satisfaction and flourishing for both girls and boys (age 18.5). The high stable trajectory also predicted higher levels of depressive symptoms in boys and anxiety symptoms in girls (age 18.5). The findings are noteworthy as they document how a person‐oriented study of externalizing behavior problems starting in infancy can predict well‐being and internalizing in late adolescence. The findings underline the importance of early health promotion and problem intervention efforts.     

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.     

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.     

Perceived Marital Support and Incident Mental Illness: Evidence from the National Comorbidity Survey

Social support in marriage may be associated with reduced risk for mental illness. Past studies are limited by short follow up and a focus on depression. A two‐wave nationally representative survey in the United States (n = 2,503) is used to examine whether social support in marriage is associated with the onset of each of four clusters of disorders—internalizing, externalizing, phobic, and bipolar—10 years later. Results indicate that higher levels of perceived marital support were protective against internalizing, fear, and bipolar disorders, and against incident externalizing disorders for women. Protective effects of social support in marriage against mental illness are long‐lasting, and sometimes differ by gender. Findings suggest the importance of mental health assessment in clinical practice.     

The self and mental health: self-salience and the emergence of internalizing and externalizing problems

How do schemas about self-salience--the importance of the self versus the collective in social relations--affect mental health? We propose that self-salience shapes the likelihood of experiencing internalizing or externalizing problems. Schemas that privilege others over the self increase the risk of internalizing symptoms, including depressive symptoms and anxiety, whereas those that privilege the self over others predispose individuals to externalizing behaviors of antisocial behavior and substance abuse. Furthermore, we propose that these schemas contribute to the gender differences that exist in these problems. We test these predictions with data from adolescents, the stage at which these problems and the gender differences in them arise. Results show that self-salience underlies both internalizing and externalizing problems. In addition, schemas about self-salience help explain the gender differences found in mental health problems.     

Effects as a function of implementation fidelity of a transdiagnostic prevention program in young school-aged children

Super Skills for Life (SSL) is a transdiagnostic prevention program for school-aged children with internalizing problems. The current study aimed to examine the short- and long-term (12-month follow-up) effectiveness of SSL, depending on implementation fidelity. Participants were 123 Spanish-speaking children aged 6–8 years with internalizing symptoms and their parents. High (n = 41) and low fidelity (n = 26) groups were established and compared with a control group (CG) (n = 56). Compared to CG, the high-fidelity group (HFG) achieved better outcomes than the low-fidelity group (LFG) at short and long term, including symptoms of anxiety, depression, and internalizing problems, and also externalizing problems at long-term. The LFG improved key symptoms at short term (depression) and long term (anxiety and depression). Findings suggest that SSL is beneficial even if not delivered at maximum fidelity, although considering the influence of implementation fidelity is critical because the high-fidelity implementation yielded the greatest effects when compared to the CG. This research provides valuable data, analyzing for the first time the influence of fidelity on SSL outcomes in young school-aged children exhibiting internalizing symptoms, while there is still a lack of studies of these characteristics concerning transdiagnostic prevention programs targeting childhood anxiety and depression.     

Compulsory residential care: An examination of treatment improvement of individual and family functioning

The aim of the present study was to examine the treatment progress of both adolescent's and their families' functioning in a new compulsory residential treatment program. The sample consisted of 339 admitted adolescents (56.3% boys). The mean age at time of entry was 15.69 (SD = 1.30). Adolescents stayed on average 9.42 months (SD = 4.66) in a new residential treatment program. Data on adolescents' internalizing and externalizing problems were assessed using self-reports, parent reports, and group care worker reports. In addition, adolescents reported their substance use and delinquency and parents also reported family functioning and level of perceived parental stress. The findings revealed a significant decrease in adolescents' self-reported internalizing and externalizing problems, delinquency, and substance use. According to parent ratings, a significant improvement was found concerning adolescents' problem behaviors during treatment. However, according care worker ratings, adolescents showed no improvement on internalizing problems and showed an increase in externalizing problems. Concerning families, although there was no improvement in family functioning, parental stress significantly improved over time. Further research should examine whether improvements experienced during treatment are maintained after treatment.     

Nonsuicidal Self‐Injury in a Community Sample of Adolescents: Subgroups,Stability, and Associations With Psychological Difficulties

Patterns of nonsuicidal self‐injury (NSSI) and their association with other psychological difficulties were studied in a community sample of young Swedish adolescents, by a two‐wave longitudinal design with a 1‐year interval. Hierarchical cluster analysis at T1 identified eight NSSI subgroups in each gender, of which five were clearly replicated at T2. Among these were a subgroup with generalized high‐frequency NSSI, which was associated with both internalizing and externalizing problems, and a subgroup of girls who engaged primarily in cutting and showed mainly internalizing problems. In general, NSSI clusters among girls were more stable over time and associated with more psychological problems. The results indicate that different patterns of NSSI have different developmental and clinical implications.     

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.     

The Effects of a Family Systems Intervention on Co‐Occurring Internalizing and Externalizing Behaviors of Children with Substance Abusing Mothers: A Latent Transition Analysis

Children of substance abusing parents are at heightened risk to develop problem behaviors, yet little is known about the co‐occurring patterns of internalizing and externalizing behaviors among this population. With 183 children (M age = 11.54 years, SD = 2.55, range 8–16) whose mothers were diagnosed with a substance use disorder, the current study identified subgroups/classes of children that were clinically distinct in their co‐occurring patterns of internalizing and externalizing behaviors, and examined how children in different clinical subgroups responded to a family systems intervention. Latent class analyses identified four classes of internalizing and externalizing behaviors: internalizing only, externalizing only, comorbid, and normative. Latent transition analyses showed that participation in family systems therapy resulted in an increased likelihood of transitioning from the externalizing class at baseline to the normative class at 18 months post‐baseline, and from the comorbid class at baseline to the internalizing class at 18 months post‐baseline as well. The findings support the effectiveness of family systems therapy in interrupting the stability of children's problem behaviors and improving children's behavioral outcomes.     

The impact of repeated maltreatment on behavioral trajectories from early childhood to early adolescence

Using multilevel model for change, this study examined the trajectories of both internalizing and externalizing behavioral problems from early childhood to early adolescence among a cohort of 685 children with early alleged maltreatment from age 4 through age 12. These children were recruited from five study sites using the LONGSCAN archive data. Repeated allegation of maltreatment for each child was treated as a time-varying variable and was tracked continuously and assessed at each measurement of the child behavioral problems. Child behavioral problems were measured at ages 4, 6, 8, 10, and 12 using the Child Behavior Checklist. Findings indicated that repeated maltreatment significantly predicted subsequent trajectories of both internalizing and externalizing problems. In both cases, the effect of repeated maltreatment was on the slope, rather than on the intercept which was reflected in the trajectories. Repeated maltreatment was associated with significantly steeper increases in both internalizing and externalizing problems over time. Although there were no differences in early behavioral assessments (e.g., age 4 and age 6), both internalizing and externalizing behaviors emerged later and became more pronounced over time among those with repeated maltreatment (e.g., since age 8) compared to those without. Although behavioral problems may not be seen in younger children who experience multiple maltreatment, it is prudent to be aware that the impact may likely emerge in later ages of the child. Thus, ongoing monitoring and assessment of treatment needs for children who have had multiple occurrence of maltreatment becomes imperative.     

Behavioral adjustment of Chinese adoptees: The role of pre-adoption experiences

PurposeIn the current study we examined associations between children's pre-adoption experiences (type of pre-adoption care and early deprivation) and their adaptive and maladaptive behavioral adjustment. Associations with prosocial behavior, attention problems, internalizing and externalizing behavioral problems were investigated.MethodsParental ratings of pre-adoption experiences and behavioral adjustment of 891 adopted Chinese girls aged between 4 and 12 year were obtained. The children were adopted from institutional care (n = 595), foster care (n = 66) or a combination of institutional and foster care (n = 228). Prosocial behavior was assessed using the Strengths and Difficulties Questionnaire (SDQ). Attention problems, internalizing and externalizing behavioral problems were assessed using the Child Behavior Checklist for ages 4–18 (CBCL). In addition to the main effects of pre-adoption experiences, we tested interaction effects between pre-adoption experiences and age at adoption, controlling for several family and child background variables.ResultsHierarchical regression analyses revealed that type of pre-adoption care was not associated with behavioral adjustment. Early deprivation, on the other hand, was negatively associated with prosocial behavior, and positively associated with attention problems, internalizing and externalizing problems. Interaction analyses revealed no significant associations.ConclusionsThe results showed that pre-adoption deprivation increased the risk for less optimal behavioral adjustment. The effects however were small, leaving room for other explaining factors both in the pre- and post-adoption environment of the child.     

Gambling Behavior Among Adolescents with Attention Deficit/Hyperactivity Disorder

Impulsivity is inherent to both problem gambling and ADHD. The purpose of this study is to examine ADHD key symptoms, and gambling behaviors and problem severity among adolescents. Additionally, internalizing and externalizing behaviors exhibited among these individuals and the role of these symptoms in gambling are examined. We used a cross-sectional study design and survey 1,130 adolescents aged 12–19. Results indicated that adolescents who screened positive for ADHD were significantly more likely than non-ADHD adolescents to engage in gambling and significantly more likely to develop gambling problems. Those who screened positive as predominantly inattentive and those who screened positive for ADHD Combined (Inattention and Hyperactivity–Impulsivity) were equally likely to gamble, but the latter were twice as likely to have gambling problems. However, we found no significant interaction between the key ADHD symptoms and gambling as the severity of hyperactivity–impulsivity or inattention did not significantly differ with respect to gambling pathology. Emotional problems and depressive affect were the only variables that could significantly differentiate the ADHD types and gambling severity. Our Results highlight the clinical importance of considering the subtype of ADHD among gamblers and the greater association of depressive affect and emotional problems with gambling among adolescents.     

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.     

Psychosocial Adjustment of African American Children in Single‐Mother Families: A Test of Three Risk Models

Three models of risk were examined for 277 African American children from single‐mother‐headed homes: cumulative, additive, and indirect models. Risk factors were mother‐reported community risks, inadequate income, maternal depressive symptoms, and inadequate parenting. Child‐reported internalizing and externalizing difficulties served as dependent measures of adjustment. Whereas the cumulative risk model identified a subset of children within this group as at‐risk for adjustment difficulties, only more proximal family variables (maternal depressive symptoms and inadequate parenting) accounted for unique variance in child outcomes (additive risk model). However, the more distal risk factors—community risk and inadequate income—were linked to both internalizing and externalizing difficulties through the proximal family variables (indirect effects model).     

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.     

China's tobacco industry's communication practices: Paradoxes and proposals for public policymaking

The People's Republic of China's expanding tobacco-control efforts call for additional, urgent government action on two major fronts: (a) conducting comprehensive health-communication campaigns on the clinical and economic effects of tobacco use; and (b) requiring major policy changes in the (structural and administrative) relationships between the State Tobacco Monopoly Administration (STMA) and the industry at large, that is, primarily, the China National Tobacco Company (CNTC). China's signing (in 2003) and ratifying (in 2005) the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) place it in a position to adopt some of the anti-smoking measures common in some developed nations. Even though the country's tobacco industry acknowledges publicly health concerns over its products, it engages in communication practices that are paradoxical, in that they circumvent public-health initiatives and the expanding regulatory regimes of product-risk reduction even as the government promotes tobacco use. That paradox calls for three public-policymaking proposals: to conduct more comprehensive, nationwide health-communication campaigns; to use legislation to reduce tobacco use; and to restructure the tobacco industry.     

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.     

Transactional and Cascading Relations Between Early Spanking and Children's Social‐Emotional Development

The authors tested a series of models linking spanking and child social‐emotional outcomes using a sample of 3,870 families from the Fragile Families and Child Wellbeing study. Spanking was measured by the number of times the focal child was spanked by the mother at ages 1, 3, and 5. Internalizing and externalizing symptoms were assessed using the Child Behavior Checklist at ages 3 and 5. Child emotionality was used to index child behavior at age 1. A series of nested transactional and cascade models was tested through structural equation modeling. The final model supported transactional effects between spanking and child externalizing behaviors over child ages 1, 3, and 5. In addition, one cascade effect was found: Spanking at age 1 was related to greater externalizing behavior at age 3, which was related to greater internalizing behavior at age 5. Implications for family theory and future research are discussed.