Relations Between Internalizing and Externalizing Problems in Early Childhood

Between- and within-child level associations between externalizing and internalizing behavior problems in a nationally representative sample of US elementary school children

BACKGROUND

Both transactional and common etiological models have been proposed as explanations of why externalizing behavior problems (EBP) and internalizing behavior problems (IBP) co-occur in children. Yet little research has empirically evaluated these competing theoretical explanations. We examined whether EBP and IBP are transactionally related at the within-child level while also identifying antecedents commonly associated with between-child differences in underlying stability of both EBP and IBP across elementary school.

METHODS

We analyzed a nationally representative and longitudinal sample of US schoolchildren (N = 7,326; 51% male) using random-intercept cross-lagged panel modeling (RI-CLPM). We used teacher ratings of EBP and IBP as annually assessed from the spring of kindergarten (Mage = 6.12 years) through the spring of 5th grade (Mage = 11.09 years). Early childhood antecedents included child internal (i.e. inhibitory control, cognitive flexibility, working memory, and language/literacy) and external factors (i.e. parental warmth, harsh parenting, parenting stress, and maternal depressive symptoms).

RESULTS

We found little evidence for within-child, transactional relations between EBP and IBP. Both types of behavior problems instead were substantially associated at the between-child level. Inhibitory control was the strongest common antecedent that explained this longitudinal overlap. Cognitive flexibility, working memory, language/literacy skills, and maternal depression contributed specifically to the stability of IBP. Measures of parenting were specific to the stability of EBP.

CONCLUSIONS

Common etiological factors rather than transactional relations better explain the co-occurrence of EBP and IBP during elementary school. Inhibitory control is a promising target of early intervention efforts for schoolchildren at risk of displaying both EBP and IBP.

The effects of child maltreatment and exposure to intimate partner violence on the co-occurrence of anxious/depressive symptoms and aggressive behavior

BACKGROUND

Child maltreatment (CM) and exposure to intimate partner violence (IPV) pose significant threats to child behavioral health, particularly for young children in toddlerhood and early childhood. Children who experience CM and/or are exposed to IPV are more likely to develop anxious/depressive symptoms and aggressive behavior.

OBJECTIVE

This study is a three-year longitudinal examination of the effects of CM and exposure to IPV on the co-occurrence of anxious/depressive symptoms and aggressive behavior.

PARTICIPANTS AND SETTING

The sample included 459 children drawn from the National Survey of Child and Adolescent Well-Being II, a national longitudinal study that investigated the outcomes and well-being of children and families that were involved in Child Protective Services (CPS).

METHODS

Latent growth curve modeling was conducted to examine the correlation between the trajectories of anxious/depressive symptoms and aggressive behavior, and the effect of CM and IPV exposure on child behavioral outcomes.

RESULTS

A positive correlation was observed between anxious/depressive symptoms and aggressive behavior intercepts, and the slope parameters of both growth models were also positively correlated. CM and IPV exposure was associated with worse anxious/depressive symptoms and aggressive behavior over time.

CONCLUSIONS

The findings suggest the co-occurrence of anxious/depressive symptoms and aggressive behavior among CPS-involved children and demonstrate the negative effects of CM and IPV exposure on children over time. The findings pinpoint the necessity of comprehensive methodological considerations for research and a lens of trauma-informed care for practice.

Pathways to Children’s Behavioral Problems during the COVID-19 Pandemic: Fathers’ Parenting Stress and Parenting Approaches

Although the family stress model theoretically focuses on the roles of both mothers and fathers as predictors of children’s outcomes, studies generally have focused on mothers. The pandemic has brought additional burdens to parents’ daily functioning, including fathers’ involvement in childcare. The current study aimed to examine the contributions of fathers’ parenting stress and parenting approaches to their children’s behavior problems during the COVID-19 pandemic. Particularly, we examined the indirect effects of parenting stress on children’s behavior problems via parenting practices. The participants were 155 fathers (Mage = 36.87, SD = 5.11) and their children (71 girls, 84 boys; Mage = 59.52, SD = 14.98) from Turkish contexts. The fathers reported their parenting stress, approaches, and children’s behavioral problems. The results from the path analysis showed that parenting stress predicted children’s internalizing and externalizing behaviors. Parenting stress also predicted severe punishment and obedience as parts of the parenting approach. Finally, parenting stress was indirectly related to children’s externalizing behaviors via the punishment-based parenting approach of fathers. The findings of the current study highlighted the importance of examining the roles of fathers during the COVID-19 pandemic. Intervention programs targeting reducing fathers’ parenting stress and negative parenting approaches would also be beneficial for reducing children’s behavioral problems.

How does subjective social status affect internalizing and externalizing problems among Syrian refugee adolescents?

Although previous studies found the importance of community subjective social status for adolescent health, its relationship with mental health problems among refugee adolescents is unclear. To close this gap, we examined the nature of the relationship between subjective social status and externalizing problems in refugee adolescents. We carried out a cross-sectional study among three hundred and six 11–18-year-old Syrian refugee adolescents in Turkey. The measurements of the study were the MacArthur Scale of Subjective Social Status, Strengths and Difficulties Questionnaire (SDQ), the Depression Self Rating Scale for Children (DSRS-C), and the Spence Children’s Anxiety Scale (SCAS). The results supported the idea that adolescent’s community subjective social status may affect internalizing problems directly and externalizing problems indirectly via internalizing problems. The mediation effect of the internalizing problems on the relationship between subjective social status and externalizing problems were confirmed by three separate mediation models. The results were discussed in terms of previous literature.

Child behavior problems during COVID-19: Associations with parent distress and child social-emotional skills

The COVID-19 pandemic and associated government-mandated shutdowns disrupted schooling, socialization, and family life for school-aged children during spring 2020. These disruptions may have contributed to increased child behavior problems. Thus, we examined behavior problems in 247 children aged 7 to 9 years during Ohio's shutdown period. We investigated whether differences in parent-reported child behavior problems were associated with concurrent parent distress during spring 2020 and/or children's social-emotional skills measured via teacher-reports from the previous year (spring 2019). Parent distress significantly predicted behavior problems, such that more distressed parents also reported more child behavior problems. Child pre-pandemic peer social skills also significantly predicted behavior problems, such that more skilled children exhibited fewer behavior problems. There were no interaction effects between parent distress and children's social-emotional skills on child behavior problems. Further research is needed to understand how children's social-emotional skills impact their ability to cope during times of epidemiological crisis.

Examining Longitudinal Associations between Externalizing and Internalizing Behavior Problems at Within- and Between-Child Levels

Externalizing and internalizing behavior problems are known to often co-occur, but mechanisms underlying this co-occurrence remain unclear: whether the associations are due to causal influences of one domain on the other or due to common risk processes influencing both domains. This study aimed to better understand the sources of co-occurring behavior problems by disentangling within- and between-child levels of associations between the two across the five years of childhood, from pre-kindergarten to Grade 3. We analyzed a longitudinal sample of 1060 children from non-urban settings in the U.S. using random-intercept cross-lagged panel models (RI-CLPMs) as an alternative to the commonly-used standard CLPMs. Results indicate that co-occurring externalizing and internalizing problems can be explained partly by a unidirectional influence from externalizing to internalizing problems operating within children and partly by stable differences between children that influence both domains of problems. Further analyses indicate that an executive function deficit in early childhood is an important shared risk factor for both problems, suggesting the utility of executive function interventions in preventing or addressing externalizing and internalizing problems in childhood.

Bullying Victimization and Developmental Trajectories of Internalizing and Externalizing Problems: The Moderating Role of Locus of Control Among Children

This longitudinal study examined the developmental trajectories of internalizing and externalizing problems, as well as the moderating role of children's locus of control on the relations between traditional and cyberbullying victimization and developmental trajectories of internalizing and externalizing problems. A total of 4180 Chinese elementary school students (M_age = 9.90 years) completed measures of bullying victimization (Time 1), locus of control (Time 1), internalizing and externalizing problems (from Time 1 to Time 5, 6-month intervals). Latent growth curve analyses indicated (a) internalizing problems first gradually decreased and then increased across time, whereas externalizing problems decreased slowly and remained steady over time; (b) both traditional and cyberbullying victimization served as risk factors for internalizing and externalizing problems; however, the effects of traditional bullying victimization on internalizing and externalizing problems were stronger than those for cyberbullying victimization; (c) locus of control moderated the relations between traditional bullying victimization and developmental trajectories of internalizing and externalizing problems. Consistent with cognitive diathesis-stress models, children who experienced higher levels of traditional bullying victimization and reported an external locus of control were more likely to experience internalizing and externalizing problems. This study also identified meaningful gender differences. Implications for the prevention of behavior problems were discussed.

Effectiveness of Brief Psychodynamic Therapy With Children and Adolescents: An Outcome Study

Studies on the effectiveness of child and adolescent psychotherapy treatments provided by the Italian National Health Service lag behind, while the scientific community has rather focused on the value of cognitive-behavioral psychotherapeutic approaches. This paper evaluates the effectiveness of a one year psychodynamically-oriented intervention with children and adolescents-aged between 6 and 18 years (M = 12.08, SD = 3.7)-and their parents, carried out in a Child and Adolescent Neuropsychiatric Service (SCIAF), part of the Italian National Health System. Following a psychodiagnostic assessment, two types of therapeutic intervention were offered: children and adolescents allocated to Group 1 (N = 26) were offered individual psychodynamic psychotherapy alone, whilst youths in Group 2 (N = 31) were offered individual psychotherapy, accompanied by parental support. This study examines the effects of this time-limited (12 month) psychodynamically-oriented psychotherapy in terms of improvements in patients' symptoms (measured on the Achenbach's questionnaires: Child Behavior Checklist and Youth Self-Report 11-18). This study also examines the effects of treatment on parents' perception of their family empowerment. This domain is measured on the Family Empowerment Scale (FES). Our findings seem to be partly in line with published studies according to which poor parenting (i.e., characterized by lack of warmth, a rigid and/or negative parenting style, poor monitoring of the children, etc.) would be positively associated with Externalizing problems in childhood. Our preliminary findings suggest that brief psychodynamic therapy seemed to show positive outcomes in both "Internalizing" and "Externalizing" difficulties, accounting for age-related differences, ICD-10 (1) diagnoses, and the types of treatment offered. However, no statistically significant changes were detected in the parents' perceptions of empowerment at 12 months.