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.     

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.     

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.     

The Intergenerational Consequences of Parental Health Limitations

Scholars have theorized interrelationships between family members' health and well‐being. Though prior research demonstrates associations between parents' and children's health, less is known about the relationship between parental health limitations and children's behavioral and academic outcomes. This article uses data from the Fragile Families and Child Well being Study (N = 3,273) to estimate the relationship between parental health limitations and four aspects of children's well‐being. Findings reveal that mothers' health limitations, especially when they occur in middle childhood or chronically, are independently associated with greater internalizing and externalizing behaviors, lower verbal ability, and worse overall health at age 9. Fathers' health limitations are not associated with children's well‐being. Fathers exert influence in other ways, as the relationship between mothers' chronic health limitations and children's internalizing behaviors is concentrated among children not residing with their fathers. These findings support the development of policies and interventions aimed at families.     

Family Socialization and Chinese Youth Children’s Development: Does psychosocial Maturity Matter?

The present study examined the effects of family socialization in the form of family processes and parenting practices on youth children’s internalizing and externalizing problems concomitantly in a sample of Chinese parent–child dyads. The results generally support that (1) family socialization is crucially influential on the youth outcomes, in which parenting is a function of family processes; (2) youth’s psychosocial maturity significantly mediates the effects of family socialization on their outcomes; (3) effects of family processes are observed more pronounced as compared with parenting practices; and (4) more complicatedly varying effects of family processes and parenting practices on the youth outcomes appear when setting free the mediations of psychosocial maturity across different structural models. Service implications of the findings and future research directions are briefly discussed.     

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.     

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.     

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.     

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.     

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.     

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 Link Between the Marital Bond and Future Triadic Family Interactions

This study examined how the marital bond, as indexed through the Oral History Interview (OHI), is related to future triadic family interactions. Families (N = 108), with a 7–9‐year‐old child, participated in a longitudinal study (the Family Health Project) examining children's emotional development throughout the transition to adolescence. Parental cohesion and family cohesion, warmth, structure, and problem solving were assessed via behavioral observation during family problem‐solving discussions and parent‐child teaching interactions 18–24 months after the OHI. Results indicated that the marital bond was predictive of parental cohesion, family cohesion, warmth, and structure during teaching interactions. The marital bond was not significantly predictive of family problem solving or parental cohesion in problem‐solving interactions.     

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.     

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.     

Mothering and Peer Associations Mediate Cumulative Risk Effects for Latino Youth

The present study examined whether positive parenting and deviant peer associations mediated the relations between a cumulative risk composite comprising financial strain, neighborhood problems, and maternal psychological distress and subsequent youth adjustment problems. Drawn from the Welfare, Children, and Families: A Three City Study, the sample consisted of 449 economically disadvantaged Latino families. Structural equation modeling showed that after controlling for baseline levels of youth adjustment problems, cumulative risk, assessed when adolescents were 10 to 14 years old, was directly and indirectly predictive of youths’ deviant peer associations 16 months later, through mother’s positive parenting. Deviant peer associations, in turn, were proximally associated with youth externalizing and internalizing problems. Findings underscore the role of mothers and peers in Latino youth adjustment problems.     

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.     

Does Family Intervention for Adolescent Substance Use Impact Parental Wellbeing? A Longitudinal Evaluation

Adolescent substance abuse is a common problem and family interventions are emerging as a strategy to prevent it and assist family coping. The effectiveness of a prevention‐focussed family intervention was evaluated for its secondary impacts on improving parental mental health and family functioning. Twenty‐four secondary schools in Melbourne Victoria were randomly assigned to either a control condition or an intervention titled Resilient Families. The two intervention levels analysed were: (1) a parenting booklet only and; (2) combining the booklet with face‐to‐face parent education sessions. Parent surveys at baseline were followed up one year and four years later. Repeated‐measures analysis (n = 560) found parents attending parent education demonstrated reductions in mental health symptoms, however this had negative effects on family cohesion and no impact on family conflict. These findings were interpreted in terms of parent education assisting parent mental health by promoting assertive parenting styles that may increase adolescent‐parent tension by encouraging firmer parental boundaries and strategies to reduce adolescent substance use.     

Family Loyalty and Adolescent Problem Behavior: The Validity of the Family Group Effect

Erratum . Journal of Law and Society Volume 32 Issue 3 The present study examined the relation between perceived justice and trust within family relationships and adolescent internalizing and externalizing problem behavior. Data were gathered from the father, the mother, and two of their adolescent children in 288 families. The social relations model was used to assess perceived justice and trust at the family level and the individual level. Adolescent internalizing and externalizing problem behavior turned out to be best predicted at the family level. Adolescents from families with less just or trustworthy climates showed more of these problem behaviors. Also associations between adolescent problem behavior and individual characteristics of the adolescents were found: adolescents who were generally viewed as less just/trustworthy were reported to have more problems. Our findings suggest that processes at different levels of family functioning (i.e., individual, whole‐family) should be taken into account when investigating associations between family characteristics and children's outcomes.     

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.