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.     

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.     

A cumulative ecological–transactional risk model of child maltreatment and behavioral outcomes: Reconceptualizing early maltreatment report as risk factor

The current analysis was designed to critically examine the tendency to focus on child maltreatment as a unique risk factor and test the resulting assumption of a direct causal relationship between early maltreatment and later behavioral problems. The variation seen in behavioral outcomes among children reported for maltreatment early in life led us to hypothesize that the cumulative level of risk facing children and their families can, at least in part, account for that variation in outcome. Participants were 242 mothers of predominantly at-risk newborn infants who were interviewed shortly after giving birth. The State Central Registry of Maltreatment was then reviewed over each child's first four years of life to assess for early maltreatment. Following the neonatal interviews, mothers completed the Child Behavior Checklist when their children were 4, 6, 8, 10 and 12 years-of-age. Although early maltreatment report does appear to be important to early child functioning, the cumulative level of risk more strongly predicts long-term clinical behavioral difficulty. High-risk children who were not reported for maltreatment by age 4 demonstrate greater behavioral problem trajectories than did low-risk children with a maltreatment report. Maltreatment itself may be best conceptualized as an important, but not singularly so, risk factor for later behavioral problems. In focusing directly on reported maltreatment, our child protective systems may be paying too little attention to what else is going wrong in the lives of children and targeting intervention efforts in the wrong direction. When it comes to early maltreatment our child protective policy and practice need to broaden their lenses to include greater emphasis on overall family functioning, stress and well-being. Early maltreatment, it seems, may be a symptom of more profound problems in the early environments of our most vulnerable children, rather than the problem itself.     

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.     

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.     

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.     

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.     

Effects of kinship care on behavioral problems by child age: A propensity score analysis

When a child must be removed from the family home, placement with a relative is often sought because kinship care is the least restrictive and most family-like out-of-home placement. Although kinship care has become a preferred option in most U.S. child welfare systems, this preference is often based on “soft evidence” rather than rigorous evaluation of the risks and benefits of kinship care. Therefore, an evaluation of the impact of kinship care on child behavioral problems is needed to guide child welfare practice and policy. In addition, given that children of different ages and in different developmental stages are likely to have varying placement experiences, the evaluation of kinship care should explore the effect of kinship care on child behavioral problems across age groups. To fill these knowledge gaps, we compare the behavioral problems of 584 children in kinship care with those of 470 children in non-kinship care. Moreover, we examine the impact of kinship care on behavioral problems in 2 age groups: younger children (0 to 5 years) and older children (6 to 17.5 years). The analysis uses data from Waves 1 and 2 of the National Survey of Child and Adolescent Wellbeing, and applies propensity score methods to account for selection bias. Results show that older children in kinship care had significant lower levels of externalizing, internalizing, and total behavior problems. However, for younger children, the effects of kinship care on child behavioral problems did not reach statistical significance. The implications for practice, research and policy are discussed.     

Internalizing and externalizing behavioral problems of American Indian children in the child welfare system

Children involved in the child welfare system display elevated or clinically significant behavioral problems. However, there is a dearth of literature on the behavioral problems of American Indian children following child welfare involvement. Grounded in Patterson's Family Adjustment and Adaptation Response theory, this study fills that gap. Baseline, 18-month, and 36-month follow-up data from the National Survey of Child and Adolescent Well-being were utilized. The sample (n = 3498) consisted of American Indian, African American, and Caucasian children ages 2–16 at baseline (M = 8.13 years old, SD = 3.85) and 51.7% were female. Nearest neighbor propensity score matching analyses were used to estimate the effect of race on clinically significant internalizing and externalizing behavioral problems. Findings suggest that although externalizing behavioral problems do not differ based on race after controlling for other important factors, internalizing behavioral problems do differ. American Indian children are more likely to display clinically significant internalizing behavioral problems.     

Parents' Relationship Quality and Children's Behavior in Stable Married and Cohabiting Families

Although an extensive literature has shown that family structure is linked with child well‐being, less well understood is how the dynamics within families affect children, in particular the extent to which positive mother–father relationship quality is linked with children's outcomes. In this study the authors used data from the Fragile Families and Child Wellbeing Study (N = 773) to examine how couple supportiveness in stable coresident families is related to children's externalizing and internalizing behavioral problems over ages 3 through 9. Using latent growth curve and fixed effects models, they found that parents' greater supportiveness has a slight association with lower levels of children's behavioral problems. Using cross‐lagged structural equation models to examine the direction of the association, they also found some evidence that parents' relationship quality and children's behavioral problems are reciprocally related. Overall, this study suggests that more positive couple interactions are beneficial for children residing with both of their biological parents.     

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.     

Attention to Threat as a Predictor of Shyness in the Context of Internalizing and Externalizing Behavior

The duration of children's attention to putative threat has been documented as a consistent predictor of later anxiety in inhibited children across childhood (Fox, New Directions for Child and Adolescent Development, 127, 2010, 33; Pérez‐Edgar & Fox, Child and Adolescent Psychiatric Clinics of North America, 14, 2005, 681). However, attention to threat has not been broadly examined within existing behavioral contexts and has seldom been studied in very early childhood. Whereas toddlers with high levels of internalizing behavior may view fear‐inducing stimuli as a threat, toddlers with high levels of externalizing behavior may demonstrate attention out of interest or sensation seeking. Thus, attention to threat was expected to predict increased toddler shyness in the context of either high internalizing problems or low externalizing behavior. We examined 117 twenty‐four‐month‐old toddlers to determine whether attention to threat interacted with internalizing and externalizing behavior at 24 months of age to predict toddler shyness one year later. Results indicated that attention to threat predicted toddlers' lower shyness at 36 months when toddlers’ externalizing behavior at age 24 months were high, but there was no significant interaction between toddlers’ internalizing behavior and their attention to threat in predicting later shyness. These results expand our understanding of the contexts in which attention to threat in early childhood is a viable predictor of later shyness.     

Behavioral problems of special needs adopted children

Parents of 757 special needs adoptees completed the behavior problems section of the Achenbach Child Behavior Checklist. Significant behavioral problems were not indicated for those children aged 4–5 at the time of the study. For children aged 6 to 16, behavioral problem scores were elevated on the two major CBC scales, externalizing (aggressive, acting-out behavior) and internalizing (withdrawn, inhibited behavior). The degree of elevation was greater for externalizing. Elevated scores were also observed on the total behavioral problems scale and, in particular, on hyperactivity sub-scales.     

Moderating effects of race on internalizing and externalizing behaviors among children of criminal justice and child welfare involved mothers

This study examined whether the influences of multiple maternal criminal justice involvement (MCJI), community adversity, and violence exposure on children's internalizing and externalizing behaviors were moderated by race. The study included 409 children of criminal justice and child welfare involved mothers, ages 5–15 who participated in the National Survey on Child and Adolescent Well-Being (NSCAW). Results indicated that race, defined as Black vs. non-Black, moderated the associations between multiple MCJI and internalizing and externalizing behaviors. Decomposition of the regression effects indicated that non-Black children exposed to multiple MCJI, as compared to non-Black children who were not exposed to multiple MCJI, exhibited significant increases in both internalizing and externalizing behaviors, while Black children who experience multiple MCJI, on average, showed no increases. Similarly, race moderated the association between exposure to community adversity and externalizing behaviors. The decomposition of regression effects indicated that non-Black children who experienced higher levels of community adversity exhibited increases in externalizing behaviors, while Black children showed no increases. Criminal justice and child welfare practice and policy implications are discussed.     

Temperamental Vulnerability and Negative Parenting as Interacting Predictors of Child Adjustment

This study examines parenting by temperament interactions in predicting child adjustment. Participants included 40 first and second graders, their mothers, and teachers. Child report of maternal psychological control and hostility was assessed using the Child Puppet Interview. Mothers completed temperament scales from the Child Behavior Questionnaire, and teachers provided information on child adjustment. As expected, among children high in irritable distress, maternal psychological control was associated with internalizing problems and maternal hostility was associated with externalizing problems. Among children with poor effortful control, maternal hostility was associated with externalizing behavior. This study offers evidence that the effects of negative parenting are accentuated among children with temperamental vulnerabilities.     

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.     

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.     

A preliminary evaluation: Demographic and clinical profiles and changes in functioning in children receiving psychosocial rehabilitation

The present study is the first to examine the demographic and clinical profiles at intake of children, ages 4 to 18 years, who received Child Psychosocial Rehabilitation (CSPR), a relatively new community-based treatment model for children with emotional disturbance. In addition, the relationship between the relative change in psychosocial, emotional, and behavioral functioning as measured by CAFAS (Hodges, 1989, 1994, 2000) and PECFAS (1994, 2000) scores and the children's age, gender, ethnicity, current living arrangement, internalizing and externalizing behaviors, and severity of impairment at intake were evaluated. Fifty-three children received CPSR for a minimum of six months from a for-profit outpatient child and adolescent mental health clinic located in southwestern Idaho. Significant improvement in the children's overall functioning was found after six months of treatment. Middle or high school age children demonstrated significantly more impairment at intake compared with their younger counterparts. No significant differences in overall functioning were revealed considering the characteristic of gender, living arrangement and clinical profiles at intake.     

Child welfare caseworkers' perspectives on the challenges of addressing mental health problems in early childhood

Although nearly half of child maltreatment victims are under the age of five and at high risk for developing serious emotional or behavioral problems, few young children involved in the child welfare system receive treatment. As the first point of service contact, child welfare caseworkers can play a key role in quickly identifying children with mental health problems and linking them to services. This study examines caseworkers' perspectives on the challenges of addressing mental health problems in early childhood. Based on five focus groups conducted with 50 caseworkers from an urban, public child welfare agency, results suggest that although workers acknowledge the importance of early intervention, difficulty identifying mental health needs in early childhood and workplace barriers impede linkage to services. Given the lasting impacts of early experiences on children's development, it is imperative that these challenges be addressed. Implications for systematic mental health screening and caseworker training are discussed.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.