The development of a systematic approach to mental health screening in Child Advocacy Centers

We report on efforts to implement a new protocol of mental health screening for children seen in Child Advocacy Centers (CACs), including the results from the first year of implementation with 1685 families. The parent-reported child screening results (obtained on 46.3% of children) indicate that while many children were not experiencing significant symptoms of internalizing or externalizing problems, a subset of children had very elevated scores. At the one-week and one-month screening, consistent predictors of more severe internalizing problems included age, a parent or step-parent as the offender, and having been removed from the home. For externalizing problems, consistent predictors included Caucasian ethnicity and having been removed from the home. By the one-week follow-up, about half of those interviewed (50.8%) had entered counseling or had an appointment pending. The likelihood of initiating mental health services was increased when the alleged abuse type was sexual, when the child had been removed from the home, and when the child's internalizing and externalizing symptoms were more severe. Surveys of the CAC staff implementing the new process suggest that it helped them understand the needs of the children, though their ability to reach some families was a barrier to implementation.     

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.     

Caregiver qualities,family closeness,and the well-being of adolescents engaged in the child welfare system

Children who come into contact with the child welfare system are at greater risk of experiencing internalizing and externalizing behaviors. This secondary analysis of the National Survey of Child and Adolescent Well-Being explored how caregiver characteristics and behaviors, and caregiver–child closeness influence these outcomes over time. The final sample was 877 caregiver and adolescent (11–17 years old) dyads. Weighted multivariate regression analyses were performed. Caregiver characteristics associated with depressive symptoms included age and education; caregiver health was not associated with internalizing and externalizing behaviors. For adolescents, being female, older, or Hispanic was associated with internalizing behaviors. Although not significant for externalizing behaviors, caregiver–adolescent closeness was protective against internalizing behaviors. Understanding factors that contribute to the mental health of child-welfare-exposed adolescents has far-reaching implications for family-based interventions with child-welfare-involved youth.     

Neighborhood processes, self-efficacy, and adolescent mental health

Self-efficacy beliefs are central to mental health. Because adolescents' neighborhoods shape opportunities for experiences of control, predictability, and safety, we propose that neighborhood conditions are associated with adolescents' self-efficacy and, in turn, their internalizing problems (i.e., depression/anxiety symptoms). We tested these hypotheses using three waves of data from the Project on Human Development in Chicago Neighborhoods (N = 2,345). Results indicate that adolescents living in violent neighborhoods tended to report lower self-efficacy beliefs, partly because they were more likely to experience fear in their neighborhood. However, moving out of Chicago neighborhoods marked by violence and low collective efficacy to neighborhoods outside of the city was associated with adolescents' increased self-efficacy (vs. staying in such neighborhoods), an association explained by adolescents' school-related experiences. Finally, through self-efficacy, these neighborhood processes had an indirect association with adolescents' internalizing problems. Results partially support a model linking neighborhood conditions, cognitions about the self, and emotions.     

Examining the impact of gender, race/ethnicity, and family factors on mental health issues in a sample of court-involved youth

Faced with anywhere between one half and two thirds of its youth having a diagnosable mental illness, the identification and treatment of mental health concerns is a critically important endeavor for professionals working with youth who have contact with the juvenile justice system. In addition, the literature suggests that factors related to both the family and to the gender of the adolescent must be incorporated into any approach to assessment and intervention within this special population. Further, prior work that has documented the interaction of gender and family issues with adolescent race/ethnicity warrants further empirical attention, as does the intermediary role that the family may play in the development of both internalizing and externalizing behaviors. The present study extends this literature by examining factors related to gender, race/ethnicity, family factors, and mental health issues in a sample of 2,549 Caucasian and African American youth coming to the attention of juvenile courts. Multivariate analysis of variance results indicated significant main effects for gender and race/ethnicity, as well as a significant gender x race/ethnicity interaction for the family and externalizing variables. A multiple group structural equation modeling procedure was employed in order to test the hypothesis that family environment mediates the relationship between gender and mental health problems, as well as to test for potential differences in these relationships as a function of race/ethnicity. Results indicated support for the mediation model in the sample of African American youth but not in the sample of Caucasian youth.     

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.     

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.     

The Mental Health Advantage of Immigrant‐Background Youth: The Role of Family Factors

Children of immigrant background, despite problems with acculturation, poverty, and discrimination, have better mental health than children of native parents. We asked whether this is a result of immigrant families' characteristics such as family structure and relations. Using a new comparative study on the integration of immigrant‐background youth conducted in England, Germany, the Netherlands, and Sweden (N = 18,716), particularly strong associations with mental health (internalizing and externalizing problems) were found for family structure, family cohesion, and parental warmth. Overall, half of the advantage in internalizing and externalizing problems among immigrant‐background youth could be accounted for by our measures of family structure and family relations, with family cohesion being particularly important.     

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.     

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.     

Symptoms of Mental Health Problems: Children’s and Adolescents’ Understandings and Implications for Gender Differences in Help Seeking

Amidst concerns that young people’s mental health is deteriorating, it is important to explore their understandings of symptoms of mental health problems and beliefs around help seeking. Drawing on focus group data from Scottish school pupils, we demonstrate how they understood symptoms of mental health problems and how their characterisations of these symptoms as ‘rare’ and ‘weird’ informed participants’ perceptions that peers, teachers and parents would respond to disclosure in stigmatising ways. Consequently, participants suggested that they would delay or avoid disclosing symptoms of mental health problems. We highlight subtle gender and age differences and outline implications for policy and practice.     

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.     

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.     

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.     

Internalizing and Externalizing Symptoms and Marital Relationship Functioning: The Mediating Role of Demand–Withdraw Communication Processes

Marital outcomes are associated with internalizing and externalizing symptoms; however, the processes by which these domains are associated with marital outcomes are not well understood. This study examined how demand–withdraw (DW) couple communication accounts for the association between symptoms of mental illness and marital distress. A mediational model was tested in a sample of 100 newlywed couples to determine: (a) whether internalizing and externalizing symptoms influenced own and partner's level of DW communication, and (b) whether this communication pattern was associated with relationship outcomes, including lower marital satisfaction and presence of conflict. Results suggested that DW communication had significant effects on both partner's marital outcomes and mediated the association between externalizing symptoms (for husbands) and marital distress.     

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.     

Gender and the Mental–Physical Health Connection Among U.S. Adults

Using data from the 1995, 1998, and 2001 panels of Aging, Status, and Sense of Control (ASOC) Survey, we examine gender differences in the relationship between self‐rated physical health and mental health over time (n = 2,543). Gender‐stratified path models highlight how the nature of the mental–physical health relationship changes when we use indicators of mental health that have traditionally been labeled as female sensitive (depression) or male sensitive (heavy drinking). Results show that women and men are similar in that mental health has a stronger effect on physical health than the reverse. However, this is only the case when we use gender‐sensitive measures of mental distress: Men who drink heavily and women who are depressed report poorer self‐rated physical health over time, while heavy drinking for women and depression for men have no significant effects on their self‐rated physical well‐being. These results provide evidence of a health process that is gendered in its expression but more universal in its outcome—the exact measure might vary, but men and women alike are physically harmed by mental health problems.     

Substance use in youth adopted from foster care: Developmental mechanisms of risk

Children who enter foster care are at unique risk for developing substance abuse due to experiencing early life stressors. A large body of research has revealed robust effects of various stressors on later substance use, implicating the role of early neurobiological changes that create chronic internalizing problems. However, less literature has investigated externalizing behavior as a mechanism underlying this relationship. Moreover, few studies have examined these mechanisms through a model of cumulative risk. The present study examined whether the prospective association between cumulative pre-adoptive risk (e.g., maltreatment, age at placement, foster placement instability, ever having lived with birth parent) and adolescent/young-adult substance use was mediated by childhood internalizing and externalizing problems in youth adopted from foster care. Participants included 82 adoptees, most with histories of prenatal substance exposure (72%). We tested parent-rated internalizing and externalizing problems across 5 years in childhood as simultaneous mediators of cumulative risk and level of substance use 11–15 years later. Bootstrapping mediation procedures, controlling for age, prenatal substance exposure, adolescent/young adult mental health symptomatology, and youth participation in follow-up, revealed a significant indirect effect of cumulative risk on substance use through childhood internalizing problems, but not externalizing problems. These results underline the importance of mitigating early risk for children in the child welfare system and call for targeting childhood emotion dysregulation to reduce likelihood of substance abuse among previously high-risk adoptees. Nevertheless, low rates of substance use overall in the present sample underscore the positive impact of adoptive placement on mitigating risk for substance abuse among foster youth.     

Behavior problems and children's academic achievement: A test of growth-curve models with gender and racial differences

The aim of this study was to examine the longitudinal association between externalizing and internalizing behavior and children's academic achievement, particularly in terms of whether these variables varied as a function of gender and race. Data pertaining to externalizing and internalizing behavior, academic achievement, gender, and race from three waves of the Child Development Supplement of the Panel Study of Income Dynamics (N = 2028) were used. Results indicate that behavior problems had a negative relationship with academic performance and some of these associations endured over time. Externalizing behavior impacted reading scores more negatively for females compared to males at baseline, but the impact of externalizing behavior on long-term reading outcomes did not vary by gender. Externalizing behavior impacted reading scores more negatively for Black children than White children at multiple points in time. Differences between males, females, Black, and White children concerning behavior and achievement are explained. Implications, limitations, and ideas for future research are also presented.     

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.