The dynamics of internalizing and externalizing comorbidity across the early school years

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 influence of socio-economic status on child temperament and psychological symptom profiles

The influence of socio-economic status (SES) on child temperament and psychological symptoms was examined using a nationally representative sample in Singapore. Data were available for 2169 children from 1987 families. Caregivers' reports were obtained on children aged 4-6. SES was operationalized as an aggregation of household income per capita, parental education level and housing type. Compared to their counterparts from higher SES families, children from low-SES families tended to exhibit (a) higher negative affectivity but lower effortful control, and (b) higher internalizing and externalizing symptoms. In addition, children with a 'resilient' temperamental profile (i.e. low negative affectivity and high effortful control) were more likely to come from families with much higher SES, relative to children with other profiles. Children with high internalizing symptoms tended to come from low-SES backgrounds, regardless of their externalizing symptoms. Among children with low internalizing symptoms, those with high externalizing symptoms came from lower SES backgrounds compared to those with low externalizing symptoms. Parental warmth and distress mediated the association between SES and child temperament and symptom profiles, with the exception of distress in the SES-temperament link. These findings supported the family stress model and highlighted the novel perspective of SES's influence on configurations of child temperament and symptom characteristics.

Emotion dysregulation mediates the relationship between sleep problems and externalizing symptoms in early adolescents: A four-wave longitudinal study

BACKGROUND

Despite the growing body of longitudinal research linking sleep problems and externalizing symptoms, regarding the direction of the effects of both variables, the results have been inconsistent. Given the mixed findings and inconsistent results in the literature, we propose that emotion dysregulation may link sleep problems and externalizing symptoms.

METHODS

The participants (N = 1281, 49.65 % female; M = 12.73 years at time 1, SD = 0.68) were middle school students who completed assessments for sleep problems, externalizing symptoms, and emotion dysregulation. The interval between each wave was six months, for two consecutive years. Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared through structural equation modeling.

RESULTS

The results revealed that severe sleep problems (at T1, T2, or T3) were associated with higher levels of externalizing symptoms later in adolescence (at T2, T3, or T4), but not vice versa. In addition, analyses of indirect effects indicated that emotion dysregulation mediated this link, such that greater sleep problems led to more emotion dysregulation, which, in turn, led to more externalizing symptoms.

CONCLUSION

The findings highlight the critical role that emotional regulation plays in the link between sleep problems and externalizing symptoms and emphasize the need for students as well as middle school administration to pay close attention to both the sleep and externalizing symptoms of early adolescents.

Family and Peer Social Capital and Child Behavioral Outcomes in Japan

BACKGROUND/OBJECTIVES

Child problem behaviors have been linked to immediate and long-term negative outcomes. Research has found that family and peer social capital have a strong influence on child behavioral outcomes. However, most research about social capital and child behavior problems has been conducted in Western contexts. Social capital may influence child behavior problems differently in non-Western sociocultural environments due to different family and peer dynamics.

METHODS

Using a sample from the Japan Household Panel Survey and Japan Child Panel Survey (N = 182), we expand this literature on various forms of social capital to the Japanese context with data that were collected between 2009 and 2014. We examine the relationship of family and peer social capital with children internalizing and externalizing problem behaviors using OLS linear regression.

RESULTS

Our results differ from what is commonly found in Western contexts. Whereas family and peer social capital are typically associated with both internalizing and externalizing problem behaviors in Western countries, we find that greater family social capital is associated with decreased externalizing problem behaviors but not internalizing problem behaviors in Japan, and peer social capital has no association on either type of problem behaviors.

CONCLUSIONS

Our findings emphasize the importance of considering social and cultural contexts when exploring how social capital might encourage prosocial child outcomes.

Dynamic interplay of developing internalising and externalising mental health from early childhood to mid-adolescence: Teasing apart trait, state, and cross-cohort effects

The current study examined the within-child, between-child, and between-cohort effects in the longitudinal relations between and within the internalising and externalising mental health symptoms' domains. Leveraging the data of 5998 children (ages 4, 6, 8, 10, 12, 14 years; 49% female) from the sequential Growing Up in Australia dual-cohort, multigroup longitudinal measurement invariance, and random-intercept cross-lagged panel models were deployed. Multigroup longitudinal measurement invariance revealed that the measurements of peer problems, emotional symptoms, and hyperactivity were strictly invariant, whereas conduct problems were partially strictly invariant across cohorts over time. The two cohorts did not display significant differences in the structural relations between internalising and externalising mental health symptoms, indicating the stability of the findings. In the internalising symptoms' domain, moderate to strong reciprocal effects were found from middle childhood onwards. In the externalising symptoms' domain, the results of reciprocal effects between conduct problems and hyperactivity were mainly not significant. Across domains, the reciprocal associations of emotional symptoms with hyperactivity and conduct problems were sporadic or non-existent. Peer problems were reciprocally associated with conduct problems and hyperactivity from middle childhood onwards. Overall, the findings clearly highlight the interdependence of developing internalising and externalising symptoms and reveal new insights about the early life-course development of internalising and externalising mental health symptoms.

Threat, Emotion Dysregulation, and Parenting in a Clinical Sample of Children with Disruptive Behaviour

Early-life adversity is associated with the development of internalizing and externalizing problems in children. Despite this, there is a need to understand the mechanisms linking these experiences to psychopathology, especially in clinical samples. This cross-sectional study tested emotion dysregulation as a mechanism linking early-life threat to psychopathology in a clinical sample of children with disruptive behavior problems. We also explored parental positive reinforcement as a protective factor in these pathways. A clinical sample of 606 children aged 6-12 years, referred to a mental healthcare hospital, were included. Parent-reported child threat, and parent- and teacher-reported child emotion dysregulation and psychopathology, were collected. Path analysis was used to explore the mediating effect of emotion dysregulation in the relation between threat and psychopathology. The moderating effects of parental positive reinforcement were explored through moderated-mediation analyses. Emotion dysregulation partially mediated the association between threat and both internalizing (β = .18, P = .006) and externalizing (β = .19, P = .002) problems. Positive reinforcement did not buffer the association between threat and emotion dysregulation (β = .09, P = .62) or the association between emotion dysregulation and internalizing (β = - .003, P = .20) or externalizing (β = - .002, P = .35). Poor emotion regulation may be a transdiagnostic mechanism linking early-threat with internalizing and externalizing problems in clinic-referred children with disruptive behaviors. Factors aside from parental positive reinforcement should be explored as protective factors in these pathways, including those directly implicated in the purported mechanisms linking these factors over time.

Adaptative Skills and Global Functioning of Unaccompanied Migrant Minors in Europe: A Systematised Review

Objectives

This systematised review aimed to examine European literature reporting data about adaptative skills and global external functioning of unaccompanied minors (UAMs).

Methods

We conducted a systematised screening of four databases (APA PsycINFO Ovid, Medline Ovid ALL, Embase.com and Web Of Science Core Collection) using a research strategy including social, scholarly and behavioural abilities as well as externalising problems associated with the target population of UAMs. Thirty articles were included using pre-defined inclusion and exclusion criteria.

Results

Our review showed that despite high levels of internalising disorders, socio-behavioural and educational adjustment of UAMs remained positive. It demonstrated how this population displays a strong desire for academic success and prosocial behaviours instead of aggressivity in everyday life. Nevertheless, our review drew attention to the strong tendency of UAMs to internalise their disorders and display chronic distress and problematic behaviours which increased with time spent in the host country.

Conclusion

Our study draws attention to the risk of underestimating the real mental health needs of refugees, due to preserved external functioning combined with significant settlement pressures.

Exploring the Co-Occurrence of Depressive Symptoms and Aggression among Chinese Adolescents: Patterns and Stability

Depressive symptoms and aggression frequently occur together, and this co-occurrence may result in more severe developmental problems. However, it is unclear if there are distinct patterns of co-occurrence. This study investigated the co-occurrence patterns of depressive symptoms and aggression, and examined their stability and demographic characteristics. A total of 1010 Chinese adolescents (50.6% girls; mean age at T1 = 12.54 years, SD = 0.42) participated in annual surveys over three years (2019-2021). Three different patterns of co-occurrence were found except for the normal group: depression-dominant co-occurrence (13.6%), aggression-dominant co-occurrence (3.2%), and moderate co-occurrence (6.0%) (T1). In these co-occurrence patterns, adolescents classified as aggression-dominant co-occurrence exhibited the most instability and frequent changes, while adolescents classified as depression-dominant co-occurrence exhibited the most stability. Boys or younger adolescents were more likely to exhibit the aggression-dominant co-occurrence, while girls or older adolescents were more likely to exhibit the depression-dominant co-occurrence. The findings indicate that the co-occurrence patterns observed are distinct and are dominated by aggression or depression, which implies the need for targeted intervention practices.

Adolescent Developmental Pathways Among Depression, Conduct Problems, and Rejection: Integrative Data Analysis Across Three Samples

OBJECTIVE

The current study investigated sex differences in longitudinal associations among youth depression, conduct problems, and peer rejection from ages 11 to 16. We hypothesized that girls would follow the irritable depression model, which posits that depression leads to conduct problems, and that peer rejection would mediate this relationship. We hypothesized that boys would follow the cumulative failure model, which suggests that conduct problems predict future depression, mediated by peer rejection.

METHOD

We used integrative data analysis to combine three datasets, creating an aggregate sample of 2,322 adolescents, 58.4% of an ethnic minority group, and 51.3% boys. Using random-intercept cross-lagged panel modeling with data from ages 11-16, we conducted a nested model comparison.

RESULTS

Results indicated that a model which allowed paths to differ by sex demonstrated better model fit than a constrained model. While depression, conduct problems, and peer rejection were relatively stable over time and had correlated random intercepts, there were few crossover paths between these domains for either sex. When the strengths of individual crossover pathways were compared based on sex, only the path from conduct problems at age 13 to depression at age 14 was significantly different, with this path being stronger for girls.

CONCLUSIONS

These results suggest that stable, between-person effects largely drive relationships between depression, conduct problems, and peer rejection during adolescence, whereas there are few transactional, within-person pathways between these domains. This pattern of findings demonstrates the utility of random intercept cross-lagged panel modeling for disentangling between- and within-person effects.

On the complex relationship between resilience and hair cortisol levels in adolescence despite parental physical abuse: a fourth wave of resilience research

Introduction

To understand the family's role in adolescents' mental health development and the connection to neurodevelopmental disorders related to experienced parental physical abuse, we first explored resilience pathways longitudinally and secondly, connected the identified patterns to adolescents' hair cortisol levels that are rooted in the hypothalamic-pituitary-adrenal axis as the main stress response system and connected brain structure alterations.

Methods

We analyzed longitudinal online questionnaire data for three consecutive high school years (from seventh to ninth grade) and four survey waves from a representative sample of n = 1609 high school students in Switzerland on violence-resilience pathways. Furthermore, we collected students' hair samples from a subsample of n = 229 at survey wave 4. About 30% of the participating adolescents had been physically abused by their parents. Out of the overall sample, we drew a subsample of adolescents with parental abuse experiences (survey wave 1 n = 509; survey wave 2 n = 506; survey wave 3 n = 561; survey wave 4 n = 560).

Results

Despite the odds, about 20-30% of adolescents who have experienced parental physical abuse escaped the family violence cycle and can be called resilient. By applying a person-oriented analytical approach via latent class and transition analysis, we longitudinally identified and compared four distinct violence-resilience patterns. We identified violence resilience as a multidimensional latent construct, which includes hedonic and eudaimonic protective and risk indicators. Because resilience should not solely be operationalized based on the lack of psychopathology, our latent construct included both feeling good (hedonic indicators such as high levels of self-esteem and low levels of depression/anxiety and dissociation) and doing well (eudaimonic indicators such as high levels of self-determination and self-efficacy as well as low levels of aggression toward peers).

Discussion

The present study confirmed that higher cortisol levels significantly relate to the comorbid pattern (internalizing and externalizing symptoms), and further confirmed the presence of lasting alterations in brain structures. In this way, we corroborated the insight that when studying the resilience pathways and trajectories of abused adolescents, biological markers such as hair cortisol significantly enhance and deepen the understanding of the longitudinal mechanisms of psychological markers (e.g., self-determination, self-esteem, self-efficacy) that are commonly applied in questionnaires.

Somatic and Depressive Symptoms Among Children From Latin America and the English-Speaking Caribbean

BACKGROUND

The extent to which depression is associated with somatic complaints in children from the English-speaking Caribbean and Latin America is not well established.

OBJECTIVE

We sought to explore the association between depressive and somatic symptoms among children from the English-speaking Caribbean and Latin America, while accounting for age, sex, socioeconomic status, cultural background, and anxiety score.

METHOD

1541 elementary school children, ages 9-12 years, from the English-speaking Caribbean and Latin America completed the Adolescent Depression Rating Scale (ARDS), the Numeric 0-10 Anxiety Self-Report Scale and the Children's Somatic Symptom Inventory-24 (CSSI-24). T-tests and ANOVA's were used to compare CSSI-24 and ARDS scores among countries, and the CSSI-24 scores of children with (ARDS ≥ 4) and without likely clinically significant depression. Regression analyses assessed possible predictors of CSSI-24 score.

RESULTS

Depressive and somatic symptom scores were highest among the Jamaican children and lowest among the Colombian children (p < .001). Children with likely clinically significant depression exhibited higher mean somatic symptom scores (p < .001). Depressive symptom scores predicted somatic symptom scores (p < .001).

CONCLUSIONS

Depressive symptoms were a strong predictor of reporting somatic symptoms. Knowledge of this association may facilitate better recognition of depression among youth.

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.

Bidirectional associations between mental health problems and language ability across 8 years of childhood

Research examining the development of behavior, emotions and language, and their intertwining is limited as only few studies had a longitudinal design, mostly with a short follow-up period. Moreover, most studies did not evaluate whether internalizing symptoms and externalizing symptoms are independently associated with language ability. This study examines bidirectional associations between internalizing symptoms, externalizing symptoms and language ability in childhood in a large, population-based cohort. Longitudinal data from the Millennium Cohort Study, a cohort of children in the United Kingdom followed from birth to 11 years (n = 10,878; 50.7% boys), were analyzed. Internalizing and externalizing symptoms were based on parent reports. Language ability (higher scores reflecting poorer ability) was assessed by trained interviewers at ages 3, 5, 7 and 11 years. Structural Equation Models (SEM) were performed, including random-intercept cross-lagged panel models (RI-CLPM) and cross-lagged panel models (CLPM). Internalizing symptoms, externalizing symptoms and language ability were stable over time and co-occur with each other from early life onwards. Over time, externalizing symptoms in early childhood were associated with less growth in language skills and with increases in internalizing symptoms. In late childhood, language ability was negatively associated with later internalizing and externalizing symptoms. The early start, co-occurrence and persistent nature of internalizing symptoms, externalizing symptoms and (poorer) language ability highlights the importance of comprehensive assessments in young children who present problems in one of these domains. Specifically, among children in the early grades of elementary school, those with language difficulties may benefit from careful monitoring as they are more likely to develop difficulties in behavior and emotions.

Hot and cool executive function in the development of behavioral problems in grade school

Despite the well-established link between children's executive function and behavioral adjustment, it remains unclear whether the hot and cool aspects of executive function are uniquely associated with children's behavioral problems. Using longitudinal data spanning in the grade school (N = 1,140), this study aimed to examine whether hot and cool executive function skills may be uniquely related to the development of behavioral problems. Hot and cool executive function skills were measured with tasks, standardized tests, and questionnaires at 54 months and in the first grade, respectively. Internalizing and externalizing problems were evaluated by teachers using questionnaires throughout the grade school. The results indicated that, independent of each other, hot and cool executive function skills were uniquely and negatively related to the development of internalizing and externalizing problems over time at the between-individual level, adjusting for within-individual fluctuations. Moreover, internalizing and externalizing problems were positively related at the between-individual level across the grade school. Findings provide needed evidence to clarify the relations between hot and cool executive function and children's behavioral problems, emphasizing the importance of both aspects of executive function in understanding the development of behavioral problems in school-age children.

Developmental trajectories of internalizing distress among ethnic minoritized mothers following childbirth: Associations with early child psychological adjustment

A substantial body of work has established that mothers' internalizing distress can negatively affect children's socioemotional development. Yet few studies have examined how distinct patterns of mothers' distress over time differentially impact child behaviors across early childhood. To address this gap, the current study explored developmental trajectories of mothers' internalizing distress and examined the associations of these patterns with child adjustment outcomes. Mexican immigrant, Dominican immigrant, and African American mothers (N = 272) were annually assessed for internalizing distress over the first 6 years following childbirth. Children's psychological adjustment (internalizing, externalizing, and hyperactivity behaviors) was measured at the last yearly assessment in first grade. A growth mixture model revealed two distinct classes of distress where mothers were classified as having low stable distress (82.4%) or moderate distress that began as stable then declined when their children were 64 months old (17.6%). Children of mothers in the moderate, late decline class showed greater internalizing, externalizing, and hyperactivity behaviors in the first grade compared to children of mothers in the low stable class. Findings highlight the necessity of supporting the mental health of ethnic minoritized mothers following childbirth and further expand our knowledge of family psychopathology to promote healthy psychological adjustment in children.

Joint developmental trajectories of internalizing and externalizing problems from mid-childhood to late adolescence and childhood risk factors: Findings from a prospective pre-birth cohort

There is limited evidence on heterogenous co-developmental trajectories of internalizing (INT) and externalizing (EXT) problems from childhood to adolescence and predictors of these joint trajectories. We utilized longitudinal data from Raine Study participants (n = 2393) to identify these joint trajectories from 5 to 17 years using parallel-process latent class growth analysis and analyze childhood individual and family risk factors predicting these joint trajectories using multinomial logistic regression. Five trajectory classes were identified: Low-problems (Low-INT/Low-EXT, 29%), Moderate Externalizing (Moderate-EXT/Low-INT, 26.5%), Primary Internalizing (Moderate High-INT/Low-EXT, 17.5%), Co-occurring (High-INT/High-EXT, 17%), High Co-occurring (Very High-EXT/High-INT, 10%). Children classified in Co-occurring and High Co-occurring trajectories (27% of the sample) exhibited clinically meaningful co-occurring problem behaviors and experienced more adverse childhood risk-factors than other three trajectories. Compared with Low-problems: parental marital problems, low family income, and absent father predicted Co-occurring and High Co-occurring trajectories; maternal mental health problems commonly predicted Primary Internalizing, Co-occurring, and High Co-occurring trajectories; male sex and parental tobacco-smoking uniquely predicted High Co-occurring membership; other substance smoking uniquely predicted Co-occurring membership; speech difficulty uniquely predicted Primary Internalizing membership; child's temper-tantrums predicted all four trajectories, with increased odds ratios for High Co-occurring (OR = 8.95) and Co-occurring (OR = 6.07). Finding two co-occurring trajectories emphasizes the importance of early childhood interventions addressing comorbidity.

Conduct disorder - a comprehensive exploration of comorbidity patterns, genetic and environmental risk factors

Conduct disorder (CD), a common mental disorder in children and adolescents, is characterized by antisocial behavior. Despite similarities with antisocial personality disorder (ASPD) and possible diagnostic continuity, CD has been shown to precede a range of adult-onset mental disorders. Additionally, little is known about the putative shared genetic liability between CD and adult-onset mental disorders and the underlying gene-environment interplay. Here, we interrogated comorbidity between CD and other mental disorders from the Norwegian Mother, Father and Child Cohort Study (n = 114 500) and investigated how polygenic risk scores (PRS) for mental health traits were associated with CD/CD traits in childhood and adolescence. Gene-environment interplay patterns for CD was explored with data on bullying and parental education. We found CD to be comorbid with several child and adult-onset mental disorders. This phenotypic overlap corresponded with associations between PRS for mental disorders and CD. Additionally, our findings support an additive gene-environment model. Previously conceptualized as a precursor of ASPD, we found that CD was associated with polygenic risk for several child- and adult-onset mental disorders. High comorbidity of CD with other psychiatric disorders reflected on the genetic level should inform research studies, diagnostic assessments and clinical follow-up of this heterogenous group.

Involuntary delayed retirement and mental health of older adults

OBJECTIVE

This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (≥ 65 years) in the USA.

METHODS

Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95% confidence intervals (CIs).

RESULTS

Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03-9.88), anxiety (OR = 2.12, CI = 1.00-5.18), and anger-in (OR = 1.71, CI = 1.12-2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age.

CONCLUSION

The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age.

Prenatal exposures to phthalates and life events stressors in relation to child behavior at age 4-6: A combined cohort analysis

Prenatal exposures to chemical and psychosocial stressors can impact the developing brain, but few studies have examined their joint effects. We examined associations between prenatal phthalate exposures and child behavior, hypothesizing that prenatal stressful life events (PSLEs) may exacerbate risks. To do so, we harmonized data from three U.S. pregnancy cohorts comprising the ECHO-PATHWAYS consortium. Phthalate metabolites were measured in single mid-pregnancy urine samples. When children were ages 4-6 years, mothers completed the Child Behavior Checklist (CBCL), from which a Total Problems score was calculated. Mothers additionally provided recall on their exposure to 14 PSLEs during pregnancy. Primary models examined problem behaviors in relation to: (1) phthalate mixtures calculated through weighted quantile sums regression with permutation test-derived p-values; and (2) joint exposure to phthalate mixtures and PSLEs (counts) using interaction terms. We subsequently refitted models stratified by child sex. Secondarily, we fit linear and logistic regression models examining individual phthalate metabolites. In our main, fully adjusted models (n = 1536 mother-child dyads), we observed some evidence of weak main effects of phthalate mixtures on problem behaviors in the full cohort and stratified by child sex. Interaction models revealed unexpected relationships whereby greater gestational exposure to PSLEs predicted reduced associations between some phthalates (e.g., the metabolites of di-2-ethylhexyl phthalate, di-n-octyl phthalate, di-iso-nonyl phthalate) and problem behaviors, particularly in males. Few associations were observed in females. Additional research is needed to replicate results and examine potential mechanisms.

Behavioural outcomes of children exposed to antidepressants and unmedicated depression during pregnancy

BACKGROUND

Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression.

METHODS

Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure.

RESULTS

When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated.

LIMITATIONS

The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems.

CONCLUSIONS

Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.

Vagal Flexibility Moderates the Links between Observed Sensitive Caregiving in Infancy and Externalizing Behavior Problems in Middle Childhood

This study explored how patterns of physiological stress reactivity underpin individual differences in sensitivity to early rearing experiences and childhood risk for psychopathology. To examine individual differences in parasympathetic functioning, past research has largely relied on static measures of stress reactivity (i.e., residual and change scores) in infancy which may not adequately capture the dynamic nature of regulation across contexts. Using data from a prospective longitudinal study of 206 children (56% African Americans) and their families, this study addressed these gaps by employing the latent basis growth curve model to characterize the dynamic, non-linear patterns of change in infants' respiratory sinus arrhythmia (i.e., vagal flexibility) across the Face-to-Face Still-Face Paradigm. Furthermore, it investigated whether and how infants' vagal flexibility moderates the links between sensitive parenting, observed during a free play task when children were 6 months of age, and parent-report of children's externalizing problems at 7 years of age. Results of the structural equation models revealed that infants' vagal flexibility moderates the predictive relations between sensitive parenting in infancy and children's later externalizing problems. Simple slope analyses revealed that low vagal flexibility, characterized by less suppression and flatter recovery patterns, exacerbated risk for externalizing psychopathology in the context of insensitive parenting. Children with low vagal flexibility also benefited most from sensitive parenting, as indicated by the lower number of externalizing problems. Findings are interpreted in the light of the biological sensitivity to context model and provide evidence for vagal flexibility as a biomarker of individual's sensitivity to early rearing contexts.

Common and disorder-specific cortical thickness alterations in internalizing, externalizing and thought disorders during early adolescence: an Adolescent Brain and Cognitive Development study

BACKGROUND

A growing body of neuroimaging studies has reported common neural abnormalities among mental disorders in adults. However, it is unclear whether the distinct disorder-specific mechanisms operate during adolescence despite the overlap among disorders.

METHODS

We studied a large cohort of more than 11 000 preadolescent (age 9-10 yr) children from the Adolescent Brain and Cognitive Development cohort. We adopted a regrouping approach to compare cortical thickness (CT) alterations and longitudinal changes between healthy controls (n = 4041) and externalizing (n = 1182), internalizing (n = 1959) and thought disorder (n = 347) groups. Genome-wide association study (GWAS) was performed on regional CT across 4468 unrelated European youth.

RESULTS

Youth with externalizing or internalizing disorders exhibited increased regional CT compared with controls. Externalizing (p = 8 × 10-4, Cohen d = 0.10) and internalizing disorders (p = 2 × 10-3, Cohen d = 0.08) shared thicker CT in the left pars opercularis. The somatosensory and the primary auditory cortex were uniquely affected in externalizing disorders, whereas the primary motor cortex and higher-order visual association areas were uniquely affected in internalizing disorders. Only youth with externalizing disorders showed decelerated cortical thinning from age 10-12 years. The GWAS found 59 genome-wide significant associated genetic variants across these regions. Cortical thickness in common regions was associated with glutamatergic neurons, while internalizing-specific regional CT was associated with astrocytes, oligodendrocyte progenitor cells and GABAergic neurons.

LIMITATIONS

The sample size of the GWAS was relatively small.

CONCLUSION

Our study provides strong evidence for the presence of specificity in CT, developmental trajectories and underlying genetic underpinnings among externalizing and internalizing disorders during early adolescence. Our results support the neurobiological validity of the regrouping approach that could supplement the use of a dimensional approach in future clinical practice.

Longitudinal network relations between symptoms of problematic internet game use and internalizing and externalizing problems among Chinese early adolescents

OBJECTIVE

There has been growing evidence of comorbidity between problematic internet game use and internalizing and externalizing problems in young people. However, little is known about the directionality and gender differences in these longitudinal relations at the symptoms level in the framework of network theory among youth. This study estimated the longitudinal relations between the symptoms of problematic internet game use, internalizing and externalizing problems, and the gender differences of these relations in Chinese youth using cross-lagged panel network modeling (CLPN).

METHODS

A sample of 1269 Chinese youth (M age = 10.35 years) participated in this study semi-annually at two time points. CLPN analysis was used to calculate the network model of problematic internet game use and internalizing and externalizing problems to explore bridge symptoms and find transmission pathways between problematic internet game use and internalizing and externalizing problems.

RESULTS

The CLPN revealed significant gender differences. For boys, depressed mood, which leads to relationships turning sour in order to play online games, bridges the relations between internalizing symptoms and problematic internet game use. For girls, irritability is the central predictive symptom, causing a range of problems related to problematic internet game use, which can, in turn, lead to fights or feelings of worthlessness. However, the effect sizes for the pathways between problematic internet game use and internalizing/externalizing problems were relatively weak, and the comorbidity between their relations should not be over-interpreted.

CONCLUSIONS

The current findings provide new evidence for understanding the directional relationship between the central characteristics of problematic internet game use and internalizing and externalizing problems in boys and girls. Gender-specific interventions targeting the central symptoms of internalizing and externalizing problems and problematic internet game use can help mitigate the vicious cycle of comorbidity among adolescents.

Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems-A Group Comparison and Developmental Psychological Consideration

Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others' feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample meanage = 5.5 years +/- 0.8 years, range= 4.2-6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η2 = 0.266), attention to others' feelings (p = 0.0049, η2 = 0.222), and prosocial action (p = 0.0070, η2 = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = -0.501), cognitive ToM (r = -0.425), and attention to others' feelings (r = -0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.

Intelligence, motoric and psychological outcomes in children from different ART treatments: a systematic review and meta-analysis

BACKGROUND

Subtle abnormalities in children's intelligence, motor skills, and psychology from various assisted reproductive treatments (ARTs) might be underdiagnosed. Understanding the prognosis of intelligence, motor skills, and psychology in children from ART would provide parents with reasonable expectations and enable them to plan relevant support to achieve the optimum potential in ART children.

METHODS

We searched PubMed, EMBASE, Ovid, Google Scholar, and Scopus databases until April 13, 2021, to identify relevant studies. Thirty-four studies met the inclusion and exclusion criteria. The meta-analysis employed a standardized mean difference model. The outcome of this study is to compare intelligence quotient (IQ), motoric ability, and behavioral problems between all ARTs, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) to naturally conceived (NC) children. Subdomains of intelligence based on the Cattell, Horn, and Carroll Model (CHC Model) of cognitive architecture, including fluid reasoning, short-term and working memory, processing speed, visual-spatial ability, long-term memory retrieval, and crystalized intelligence (knowledge), were evaluated and summarized in details. Motor skill was stratified into two domains: gross motoric and fine motoric. Behavioral problem was categorized as externalizing and internalizing behavior.

RESULTS

Meta-analysis showed that verbal intelligence score in IVF toddlers is significantly lower than NC toddlers (p = 0.02); conversely, ICSI toddlers scored significantly higher verbal intelligence score compared to NC toddlers (p = 0.005). Toddlers born after ART had significantly lower non-verbal intelligence score (p = 0.047). IVF toddlers scored significantly lower fine motor score (p = 0.01) compared to naturally conceived toddlers. Based on parent's CBCL, NC toddlers had higher total (p = 0.01) and externalizing behavior (p = 0.001) scores  compared to ART toddlers. Evaluation of full scale IQ and all domains of intelligence in preschool and primary school children revealed that no significant differences exist between ART and NC children. Based on preschool and primary school parents' CBCL, IVF children had significantly lower externalizing behavior score compared to NC children (p = 0.04). Meta-analyses of studies on young adolescents revealed that ART young adolescents scored higher academically than their NC counterparts, including on mathematics (p < 0.00001) and reading or language (p < 0.00001).

CONCLUSIONS

Despite differences in certain aspects, this finding suggests that ART is unlikely to cause negative impacts on children's neurodevelopment.

Neurodevelopmental risk and adaptation as a model for comorbidity among internalizing and externalizing disorders: genomics and cell-specific expression enriched morphometric study

BACKGROUND

Comorbidity is the rule rather than the exception for childhood and adolescent onset mental disorders, but we cannot predict its occurrence and do not know the neural mechanisms underlying comorbidity. We investigate if the effects of comorbid internalizing and externalizing disorders on anatomical differences represent a simple aggregate of the effects on each disorder and if these comorbidity-associated cortical surface differences relate to a distinct genetic underpinning.

METHODS

We studied the cortical surface area (SA) and thickness (CT) of 11,878 preadolescents (9-10 years) from the Adolescent Brain and Cognitive Development Study. Linear mixed models were implemented in comparative and association analyses among internalizing (dysthymia, major depressive disorder, disruptive mood dysregulation disorder, agoraphobia, panic disorder, specific phobia, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder), externalizing (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder) diagnostic groups, a group with comorbidity of the two and a healthy control group. Genome-wide association analysis (GWAS) and cell type specificity analysis were performed on 4468 unrelated European participants from this cohort.

RESULTS

Smaller cortical surface area but higher thickness was noted across patient groups when compared to controls. Children with comorbid internalizing and externalizing disorders had more pronounced areal reduction than those without comorbidity, indicating an additive burden. In contrast, cortical thickness had a non-linear effect with comorbidity: the comorbid group had no significant CT differences, while those patient groups without comorbidity had significantly higher thickness compare to healthy controls. Distinct biological pathways were implicated in regional SA and CT differences. Specifically, CT differences were associated with immune-related processes implicating astrocytes and oligodendrocytes, while SA-related differences related mainly to inhibitory neurons.

CONCLUSION

The emergence of comorbidity across distinct clusters of psychopathology is unlikely to be due to a simple additive neurobiological effect alone. Distinct developmental risk moderated by immune-related adaptation processes, with unique genetic and cell-specific factors, may contribute to underlying SA and CT differences. Children with the highest risk but lowest resilience, both captured in their developmental morphometry, may develop a comorbid illness pattern.

Effects of emotionally oriented parental interventions: a systematic review and meta-analysis

Objective

This systematic review and meta-analysis investigates the effects of emotionally oriented parental interventions.

Background

Several emotionally oriented parental interventions have been developed during the last decade. Some of these have gained popularity and spread across several continents. The literature is growing and consists of qualitative studies; intervention only, quasi-experimental, case-control studies; and randomized controlled trials. They indicate effects for parents and children. However, no systematic review or meta-analysis has, to our knowledge, summarized the results.

Method

Using several search engines, we located 8,272 studies. After abstract and full-text screening, 33 studies were assessed for bias and included in the study. Outcomes for parents and children were extracted and combined into three constructs for parents and two for children. Meta-analyses were conducted for each construct to estimate the effect of the interventions using a robust Bayes meta-analysis.

Results

The results indicate the presence of a small to medium effect on parents' mental health, behavior, and use of emotionally oriented parenting, as well as on children's internalizing and externalizing difficulties. Most participants were recruited from the general population, and clinical settings were rare. The results show little evidence of publication bias.

Conclusion

There is evidence of a small to medium effect of emotionally oriented interventions on parents and children.

Systematic review registration

https://osf.io/un3q4/.

Developmental trajectories of behavioral inhibition from infancy to age seven: The role of genetic and environmental risk for psychopathology

The present study leveraged data from a longitudinal adoption study of 361 families recruited between 2003 and 2010 in the United States. We investigated how psychopathology symptoms in birth parents (BP; Mage  = 24.1 years; 50.5-62.9% completed high school) and adoptive parents (AP; Mage  = 37.8 years; 80.9% completed college; 94% mother-father couples) influenced children's behavioral inhibition (BI) trajectories. We used latent growth models of observed BI at 18 and 27 months, and 4.5 and 7 years in a sample of adopted children (Female = 42%, White = 57%, Black = 11%, Multi-racial = 21%, Latinx = 9%). BI generally decreased over time, yet there was substantial variability in these trajectories. Neither BP nor AP psychopathology symptoms independently predicted systematic differences in BI trajectories. Instead, we found that AP internalizing symptoms moderated the effects of BP psychopathology on trajectories of BI, indicating a gene by environment interaction.

The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children

This study examined the relationship between adherence to 24 h movement guidelines (24 h MGs) and internalising and externalising behavioural problems in Chinese children aged 3-6 years, with a specific focus on the differences between weekdays and weekends. The guidelines include recommendations for physical activity (PA), screen time (ST), and sleep duration (SD). The results indicated a stronger association between adherence to these guidelines and behavioural problems on weekends compared to weekdays. Specifically, the odds of experiencing internalising problems were 1.33 higher (95% CI: 1.05-1.69) when not satisfying all three behaviours compared to not satisfying one or two. Moreover, on weekends, when ST was not fulfilled, there was a higher likelihood of externalising behaviour problems compared to when it was fulfilled (OR, 1.18, 95% CI, 1.01-1.38), and when all three behaviours were not met, the likelihood was even higher (OR, 1.50, 95% CI, 1.04-2.18). Children who met all three guidelines had fewer internalising and externalising behavioural problems, suggesting a potential beneficial effect on mental health. The study revealed that a higher adherence to these recommendations corresponded to a lower risk of mental health problems. Additionally, higher screen time was linked to an increase in externalising behavioural issues. These findings underscore the importance of adherence to 24 h MGs for optimal mental health in children. Future interventions should consider these behavioural factors and incorporate strategies to promote adherence to these guidelines, particularly on weekends.

Witnessing Parental Arrest As a Predictor of Child Internalizing and Externalizing Symptoms During and After Parental Incarceration

Purpose

One in fourteen children in the United States experiences the incarceration of a parent with whom they have lived. Although prior research has established that witnessing the arrest of a parent is a common occurrence for children of criminal justice-involved parents, child outcomes following such an event are understudied. Little is known about the long-term impacts of witnessing an arrest on children and the extent to which they may vary by child age.

Methods

Using longitudinal data from the Parent Child Study of mothers and fathers incarcerated in state prison, we examine the witnessing of parental arrest as an acute traumatic event and identify the extent to which this type of trauma predicts externalizing and internalizing symptoms for children during their parents' incarceration and following release.

Results

Witnessing a parent's arrest predicted greater internalizing behavior concerns while parents were incarcerated, with a greater magnitude of effect for children under eight years of age. Six months post-release of the parent, children younger than age eight who witnessed the arrest showed significantly higher internalizing and externalizing behaviors. No effect was found for children ages eight years or older.

Conclusion

Implications for future policies to reduce the likelihood of children witnessing parental arrests, as well as the potential benefit of screening for trauma when working with children with incarcerated parents, are discussed.

Multivariate brain-based dimensions of child psychiatric problems: degrees of generalizability

Multivariate machine learning techniques are a promising set of tools for identifying complex brain-behavior associations. However, failure to replicate results from these methods across samples has hampered their clinical relevance. This study aimed to delineate dimensions of brain functional connectivity that are associated with child psychiatric symptoms in two large and independent cohorts: the Adolescent Brain Cognitive Development (ABCD) Study and the Generation R Study (total n =8,605). Using sparse canonical correlations analysis, we identified three brain-behavior dimensions in ABCD: attention problems, aggression and rule-breaking behaviors, and withdrawn behaviors. Importantly, out-of-sample generalizability of these dimensions was consistently observed in ABCD, suggesting robust multivariate brain-behavior associations. Despite this, out-of-study generalizability in Generation R was limited. These results highlight that the degree of generalizability can vary depending on the external validation methods employed as well as the datasets used, emphasizing that biomarkers will remain elusive until models generalize better in true external settings.

Social, Emotional and Behavioral Screening Profiles Among Students in a Large Urban School District

Social, emotional, and behavioral (SEB) screening frequently employs a variable-based approach wherein individual scale scores indicate risk. However, a person-centered approach wherein risk is indicated by profiles, or constellations of scores across all scales, could help schools prioritize students based on the pervasiveness of SEB needs and match students to appropriate interventions. This study used latent profile analysis (LPA) to identify profiles within two diverse student samples ( n = 16,270 in year one; n = 4019 in year two) based on teacher ratings on the Behavior Intervention Monitoring Assessment System, Second Edition (BIMAS-2). Results suggested four profiles including one profile with elevated risk across all scales, one profile with low behavioral risk and above average social functioning, one profile with borderline risk across all scales, and one profile with typical scores across most scales. Implications for linking universal screening to intervention are discussed. Impact and Implications: Many school districts employ universal screening to prevent and address wide-ranging student needs. Grouping students based on shared sets of needs has the potential to efficiently identify and prioritize students with pervasive risk in order to match them to comprehensive services. Results from this study capture the first attempt to identify student need profiles using BIMAS-2 scores. Future research should refine this process to derive more usable and consistent student profiles allowing direct links to comprehensive student services.

Effectiveness of Group Parent-Child Interaction Therapy on Problem Behaviors in Chinese Kindergartners

Problem behaviors in early childhood may put young children at risk for negative behavioral and psychosocial problems. This study examined the effectiveness of group PCIT on Chinese young children's externalizing and internalizing problems. The participants were 58 mothers with their children aged 2-3 years (M = 2.95 years, SD = 0.22), assigned to an immediate treatment (n = 26) group or to a waitlist (n = 32) control group. The program involved comprehensive group intervention and featured weekly 60-90-min sessions, totaling ten sessions over three months. Results indicate that group PCIT not only significantly improved teacher-reported problem behaviors in children, but also improved observed maternal parenting behavior. These findings support the use of group PCIT in Chinese children and provide mothers with an evidence-based tool to address problem behaviors in a non-clinical population.

Joint developmental trajectories and correlates of internalizing and externalizing problems among Chinese adolescents

BACKGROUND

Internalizing and externalizing problems are the most prevalent health problems among adolescents. However, few studies have examined co-occurring internalizing and externalizing problems from a longitudinal perspective.

METHODS

A total of 1051 seventh-grade students from two junior high schools were recruited at baseline. Among them, 932 valid participants were reassessed 1 year and 2 years later. Data were analyzed using parallel-process latent class growth analysis and multinominal logistic regression.

RESULTS

Four joint trajectories of internalizing and externalizing problems were identified. Compared with the low-risk group, adolescents in the moderate and chronic co-occurring group had lower resilience, higher levels of insecure attachment, family conflicts, and academic pressure. Adolescents in the pure internalizing group had higher levels of family conflicts and academic pressure compared with the low-risk group.

CONCLUSIONS

Co-occurrence of symptoms is very high in adolescents. More individualized intervention programs should be provided to these specific groups.

Stepping Up to the Plate-The Role of Pediatricians in Addressing the Child and Adolescent Mental Health Crisis

This commentary discusses how pediatricians can become involved in improving the mental health system for children and adolescents.

Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes

IMPORTANCE

Little is known about the long-term economic and social outcomes for children with longitudinally assessed comorbid externalizing and internalizing symptoms, especially compared with children with externalizing symptoms or internalizing symptoms only.

OBJECTIVE

To examine the association between childhood trajectories of externalizing, internalizing, and comorbid symptoms and long-term economic and social outcomes.

DESIGN, SETTING, AND PARTICIPANTS

A 32-year prospective cohort study linked with administrative data was conducted in school-aged participants aged 6 to 12 years in the Québec Longitudinal Study of Kindergarten Children (N = 3017) followed up from 1985 to 2017. Data analysis was conducted between August 1, 2021, and March 31, 2022.

EXPOSURES

Teacher-rated behavioral symptoms were used to categorize children from age 6 to 12 years into developmental profiles using group-based trajectory modeling.

MAIN OUTCOMES AND MEASURES

Multivariable regression models were used to test the association between childhood symptom profile group and adult employment earnings, welfare receipt, intimate partnership status, and having children living in the household. Participant sex, IQ, and socioeconomic background were adjusted for.

RESULTS

Of 3017 participants in this sample, 1594 (52.8%) were male and 1423 (47.2%) were female. Per confidentiality rules established by Statistics Canada, income variables were rounded to base 100 and count variables were rounded to base 10; the mean (SD) age was 37 (0.29) years at follow-up. Four symptom profiles were identified: no/low (n = 1369 [45.4%]), high externalizing (882 [29.2%]), high internalizing (354 [11.7%]), and comorbid (412 [13.7%]) symptoms. Compared with the no/low symptom profile, participants in the high externalizing-only profile earned $5904 (95% CI, -$7988 to -$3821) less per year and had 2.0 (95% CI, 1.58-2.53) times higher incidence of welfare receipt, while participants in the high internalizing group earned $8473 (95% CI, -$11 228 to -$5717) less per year, had a 2.07 (95% CI, 1.51-2.83) higher incidence of welfare receipt, and had a lower incidence of intimate partnership (incident rate ratio [IRR], 0.89; 95% CI, 0.80-0.99). Participants in the comorbid profile fared especially poorly: they earned $15 031 (95% CI, -$18 030 to -$12 031) less per year, had a 3.79 (95% CI, 2.75-5.23) times higher incidence of annual welfare receipt, and were less likely to have an intimate partner (IRR, 0.71; 95% CI, 0.63-0.79) and children living in the household (IRR, 0.86; 95% CI, 0.80-0.92). Estimated lost earnings over a 40-year working career were $140 515 for the high externalizing, $201 657 for the high internalizing, and $357 737 for the comorbid profiles.

CONCLUSIONS AND RELEVANCE

In this cohort study, children exhibiting sustained childhood high externalizing, high internalizing, or comorbid symptoms were at increased risk of poor economic and social outcomes into middle age. These findings suggest that children exhibiting comorbid problems were especially vulnerable and that early detection and support are indicated.

A Longitudinal Examination of Child Maltreatment Dimensions, Emotion Regulation, and Comorbid Psychopathology

Childhood maltreatment is a toxic stressor that occurs in the family context and is related to adverse outcomes including elevations in internalizing symptomology and externalizing symptomology. In the present study, we tested the role of threat and deprivation dimensions of child maltreatment in the etiology of comorbid psychopathology in emerging adulthood. Additionally, we investigated emotion regulation and emotion lability/negativity as mechanisms underlying the relationship between child maltreatment dimensions and emerging adult psychopathology. To address these aims, we used a longitudinal sample of emerging adults (N = 413, Mage = 19.67, 78.0% Black, 51.1% female) who had previously participated in research assessments at age 10-12. Using a person-centered approach with latent profile analysis, we identified three classes of emerging adulthood psychopathology characterized by different levels of symptom severity and comorbidity between internalizing and externalizing symptoms. Emerging adults who experienced deprivation only, compared to those who were not maltreated, were more likely to belong to a comorbid and severe psychopathology class versus the other identified psychopathology classes. There was also a significant indirect pathway from experiences of both threat and deprivation to a high externalizing class via emotion lability/negativity. Our results contribute to current models of childhood adversity and psychopathology and have implications for interventions to prevent psychopathology among emerging adults exposed to child maltreatment.

Diagnostic profiles in adolescence and emerging adulthood: Transition patterns and risk factors

INTRODUCTION

Complex diagnostic profiles (i.e., clusters of comorbid disorders) may be present in adolescence with long-lasting effects later in life. Little is known about their developmental transitions to adulthood as well as potential risk factors. This study aimed to identify the diagnostic profiles in adolescence and emerging adulthood, patterns of transitions and risk factors.

MATERIAL AND METHODS

A sample of 1062 Mexican adolescents (43.22% men, M=14.19 years at baseline, SD=1.68) was assessed for psychiatric disorders at adolescence and emerging adulthood. Latent class analysis was used to identify diagnostic profiles. Profile transition was studied using multi-state modeling between the life periods. Logistic regression was utilized to study risk factor influence on profile development in adulthood.

RESULTS

Three diagnostic profiles (i.e., minimal disorder/no-psychopathology; and two clinical profiles: internalizing and externalizing) were identified in both periods. Anxiety disorders were the most frequent psychiatric presentation in adolescence, while depression was the most prevalent disorder in adulthood. More than 15% of participants showed a clinical profile regardless life period. Comorbidity was present in 57% of participants with a clinical psychiatric profile. Finally, common (suicidal behavior) and specific risk factors (sex, parents' education and income) predicted transitions to profiles from adolescence to emerging adulthood.

CONCLUSIONS

Psychiatric disorders are frequently observed adopting a complex diagnostic profile in both adolescence and emerging adulthood. Comorbidity seems to be common in both life periods. Developmental issues and comorbidity should be considered for health service provision and treatment choice.

Comorbidity Between Internalising and Externalising Disorders Among Adolescents: Symptom Connectivity Features and Psychosocial Outcome

Internalising disorders are highly prevalent conditions in adolescence and tend to co-occur with externalising disorders. The present study used a symptom network approach to examine the interplay between symptoms of internalising disorders among adolescents with comorbid internalising and externalising disorders. Data comes from the National Comorbidity Survey-Adolescent Supplement, a nationally representative survey of adolescents aged 13 to 18 years. The most central symptoms across the disorders in the network were poor self-esteem and worry. The comorbidity between anxiety and depression increases the probability of having comorbid externalising disorders. Adolescents with both internalising and externalising disorders had the highest rate of health service utilisation. Comorbidity group, lifestyle factors, deficits in cognitive and academic competence and coping skills were significant covariates of the mental health outcomes. Understanding comorbidity profile of internalising and externalising disorders and central symptoms that bridge these disorders could have important clinical implications.

A history of high-risk and destructive behaviors predict COVID-19 infection: A preliminary study

BACKGROUND

The COVID-19 pandemic has heightened mental health concerns, but the temporal relationship between these conditions and SARS-CoV-2 infection has not yet been investigated. Specifically, psychological issues, violent behaviors, and substance abuse problems were reported higher during the COVID-19 pandemic when compared to pre-pandemic levels. However, it is unknown whether a pre-pandemic history of these conditions increase an individual's susceptibility for SARS-CoV-2.

OBJECTIVE

To better understand the psychological risks underlying COVID-19, it is important to investigate how destructive and risky behaviors (related to externalizing behaviors, substance use, and crime and violence) may increase a person's susceptibility to COVID-19.

METHODS

Here, we analyzed data from a survey of 366 adults across the United States (ages 18-70); this survey was administered between February and March of 2021. Participants were asked to complete the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) questionnaire which indicates a history of high-risk and destructive behaviors and high likelihood of meeting diagnostic criteria. The GAIN-SS includes seven questions related to externalizing behaviors, eight related to substance use issues, and five related to crime and violence. Responses were given on a temporal scale of "0" (never a given behavior) to "4" (experienced a behavior in the past month). Participants were also asked if they ever tested positive for COVID-19 and/or if they ever received a clinical diagnosis of COVID-19. GAIN-SS responses were compared between those reporting and not reporting COVID-19 to deduce if those reporting COVID-19 experienced GAIN-SS behaviors more recently (Wilcoxon Rank Sum test, α=0.05). Three hypotheses surrounding the temporal relationships between the recency of GAIN-SS behaviors to COVID-19 infection were tested using proportions tests (α=0.05). GAIN-SS behaviors that significantly differed (proportions tests, α=0.05) between COVID-19 responses were included as independent variables in multivariable logistic regression (MVLR) models with iterative downsampling. This was performed to assess how well a history of GAIN-SS behaviors statistically discriminated between those reporting, and not reporting, COVID-19.

RESULTS

Those reporting COVID-19 more frequently indicated past GAIN-SS behaviors (Q<.05). Further, the proportion of those reporting COVID-19 was higher (Q<.05) in those also reporting a history of GAIN-SS behaviors; specifically, gambling and selling drugs were common across the three proportion tests. MVLR revealed that GAIN-SS behaviors, particularly gambling, selling drugs, and attention problems, accurately modeled self-reported COVID-19 with model accuracies ranging from 77.42-99.55% ± 4.49-5.86%. That is, those that exhibited destructive and high-risk behaviors prior to, and during, the pandemic could be discriminated from those that did not exhibit these behaviors when modeling self-reported COVID-19.

CONCLUSIONS

Together, this preliminary study provides insight into how a history of destructive and risky behaviors influence infection susceptibility - offering possible explanations for why some persons may be more susceptible to COVID-19, potentially in relation to reduced adherence to prevention guidelines or seeking vaccination.

CLINICALTRIAL

Signal in the noise: Altered brain activation among adolescent alcohol users detected via the analysis of intra-individual variability1

RATIONALE

Unlike its average level, the variability in brain activation over time or trials can capture subtle and brief disruptions likely to occur among participants with low-to-moderate levels of substance use or misuse.

OBJECTIVE

The present study used this intra-individual variability measurement approach to detect neural processing differences associated with light-to-moderate use of alcohol among 14-19-year-old adolescents.

METHOD

A total of 128 participants reporting any level of alcohol use during the previous 6 months and 87 participants reporting no use during this period completed intake questionnaires and interviews as well as an assessment of P300 electroencephalographic responses to novel stimuli recorded during two separate tasks.

RESULTS

In addition to differing in recent alcohol use, the groups differed in nicotine and cannabis use, risk-taking behavior and conduct disorder symptoms, and P300 amplitude inter-trial variability (ITV) across both tasks. Across all participants, P300 ITV was positively correlated with a family history of depression but not with a family history of alcohol dependence. There were no group differences in P300 amplitude averaged across trials.

CONCLUSIONS

Recent reports attributing brain volume or brain function differences to an effect of light-to-moderate alcohol use should be viewed with great caution. In the present analysis of brain function differences among substance-using adolescents, the group differences were small, complicated by many factors coinciding with or preceding alcohol use, and not reflected in a stable central tendency.

Internalizing-Externalizing Comorbidity and Impaired Functioning in Children

BACKGROUND

The comorbidity of mental illnesses is common in child and adolescent psychiatry. Children with internalizing-externalizing comorbidity often experience worse health outcomes compared to children with a single diagnosis. Greater knowledge of functioning among children with internalizing-externalizing comorbidity can help improve mental health care.

OBJECTIVE

The objective of this exploratory study was to examine whether internalizing-externalizing comorbidity was associated with impaired functioning in children currently receiving mental health services.

METHODS

The data came from a cross-sectional clinical sample of 100 children aged 4-17 with mental illness and their parents recruited from an academic pediatric hospital. The current mental illnesses in children were measured using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and the level of functioning was measured using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0. Linear regression was used to estimate the association between internalizing-externalizing comorbidity and level of functioning, adjusting for demographic, psychosocial, and geographic covariates.

RESULTS

Internalizing-externalizing comorbidity in children was associated with worse functioning compared to children with strictly internalizing comorbidities, β = 0.32 (p = 0.041). Among covariates, parent's psychological distress, β = 0.01 (p = 0.004), and distance to the pediatric hospital, β = 0.38 (p = 0.049) were associated with worse functioning in children.

CONCLUSIONS

Health professionals should be mindful that children with internalizing-externalizing comorbidity may experience worsening functioning that is disruptive to daily activities and should use this information when making decisions about care. Given the exploratory nature of this study, additional research with larger and more diverse samples of children is warranted.

Intergenerational transmission of psychopathology: An examination of symptom severity and directionality

The present study examined the intergenerational transmission of internalizing and externalizing symptom severity, which indexes comorbidity, and symptom directionality, which indicates differentiation toward externalizing versus internalizing problems. Data are from 854 male and female, same-sex adult twin pairs born between 1926 and 1971 (32-60 years old, M = 44.9 years, SD = 4.9 years) from the Twin and Offspring Study in Sweden and their adolescent offspring (11-22 years old, M = 15.7 years, SD = 2.4 years, 52% female). Children-of-twins models revealed additive (9%) and dominant (45%) genetic and nonshared environmental (47%) influences on twins' symptom severity, and additive genetic (39%) and nonshared environmental (61%) influences on twins' symptom directionality. Both comorbid problems and preponderance of symptoms of a particular - internalizing versus externalizing - spectrum were correlated across parent and child generations, although associations were modest especially for directionality (i.e., transmission of specific symptom type). By interpreting findings alongside a recent study of adolescent twins, we demonstrate that the intergenerational transmission of symptom severity and symptom directionality are both unlikely to be attributable to genetic transmission, are both likely to be influenced by direct phenotypic transmission and/or nonpassive rGE, and the intergenerational transmission of symptom severity is also likely to be influenced by passive rGE.

Supporting Access to Mental Health Services for Patients Who Use Augmentative and Alternative Communication: A Proposed Framework and Suggestions for Future Directions

PURPOSE

The purpose of this review article is to examine interacting factors that affect the psychotherapeutic process for patients who use augmentative and alternative communication (AAC). This is examined from two perspectives: (a) how the skills and needs brought by the individual with communication disabilities influence the process of therapy and (b) how the individual's ecological systems may affect an individual's mental health and their access to mental health supports. Understanding these factors will guide future efforts aimed at ensuring that individuals with communication disorders have adequate access to services and supports for mental health.

METHOD

A narrative synthesis approach was used to explore the interaction of psychotherapy and the use of AAC. Existing research in the fields of psychotherapy and speech-language pathology was examined for its relevance to issues of communication using AAC. Specifically, information was synthesized concerning mental health, prevalence rates of mental health diagnoses, the provision of traditional psychotherapy, and communicating via AAC in order to describe the intersection of psychotherapy and AAC. This narrative synthesis approach sought to initiate discussion of relevant factors that may affect the psychotherapeutic process for patients who use AAC.

RESULTS

A variety of factors may affect the psychotherapeutic process for patients who use AAC. Bronfenbrenner's (1977) Ecological Systems Theory was used to explore access to mental health services for individuals who use AAC at the levels of microsystem, mesosystem, exosystem, and macrosystem. Such factors include alterations to communication between patient and psychotherapist, skills brought by the patient, involvement of a communication assistant and/or speech-language pathologist, education and skill level of the psychotherapist, appropriateness of billing codes, and system and policy factors that may affect the provision of mental health services to patients who use AAC.

CONCLUSION

It is necessary to explore the factors that affect the provision of psychotherapy for patients who use AAC in order to more fully address the mental health needs of individuals with communication disorders. Further research is needed to determine the impacts of these factors and ways to address those impacts.

Parent Interventions Improve Behavior After Pediatric Traumatic Brain Injury: A Systematic Review and Meta-analysis

OBJECTIVE

To examine child behavior change scores from randomized controlled trials (RCTs) of parent interventions for pediatric traumatic brain injury (TBI).

METHODS

MEDLINE, EMBASE, PsycINFO, and CINAHL were searched to identify studies that examined parent interventions for pediatric TBI. Inclusion criteria included (i) a parent intervention for children with TBI; (ii) an RCT study design; (iii) statistical data for child behavior outcome(s); and (iv) studies that were published in English.

RESULTS

Seven studies met inclusion criteria. All interventions reported improved child behavior after pediatric TBI; however, child and parent factors contributed to behavior change scores in some interventions. Factors found to contribute to the level of benefit included age of child, baseline behavior levels, sociodemographics (eg, parent income, parent education), and parent mental health.

CONCLUSION

Improved child behavior outcomes resulting from parent interventions for pediatric TBI are well supported by the evidence in the peer-reviewed literature. Clinicians are encouraged to consider child and parent factors as they relate to child behavior outcomes.

Child Maltreatment and Substance Use in Emerging Adulthood: Internalizing and Externalizing Behaviors at the Transition to Adolescence as Indirect Pathways

One well-established outcome of child maltreatment is an increased likelihood of substance use in emerging adulthood. However, research identifying the indirect pathways that explain this relation is lacking, thereby limiting substance use prevention efforts for the child maltreatment population. The present study helped address this gap by accessing data from The Longitudinal Studies on Child Abuse and Neglect (LONGSCAN; n = 1,136), a prospective cohort study of child maltreatment from birth through age eighteen. Internalizing and externalizing problems at age twelve were examined as indirect effects of the relation between child maltreatment prior to age four and substance use at age eighteen. A multiple mediator model tested the total and specific indirect effects of internalizing and externalizing concerns while controlling for demographic risk factors. Results demonstrated that the total indirect effect for internalizing and externalizing behaviors was statistically significant, Standardized Point Estimate = 0.01, 95% CI: 0.00-0.02. Examination of the specific indirect effects revealed that only externalizing behaviors constituted an indirect pathway, Standardized Point Estimate = 0.01, 95% CI: 0.00-0.03. These results suggest that externalizing behaviors at the transition to adolescence are important intervention targets for reducing the risk for substance use in emerging adulthood in the child maltreatment population.

Assessing measurement equivalence of PSC-17 across teacher and parent respondents

The Pediatric Symptom Checklist-17 (PSC-17) is a popular screening instrument used by parents and clinicians to assess children's behavioral functioning. However, more schools are examining the potential of the PSC-17 as part of a Multi-Tier System of Support framework. To investigate the potential of the PSC-17 in the schools, a sample of 1,779 U.S. preschool and kindergarten-aged children rated by parents (n = 667) and teachers (n = 1,112) was used to assess the measurement invariance of the PSC-17 across respondent groups. Multiple-group Confirmatory Factor Analysis supported partial scalar invariance for the PSC-17, indicating functional equivalence across teacher and parent respondents. Latent mean testing revealed teachers rated children as exhibiting a lower level of Externalizing Problems relative to parents; however, no significant differences in children's Internalizing Problems and Attention Problems were found between teacher and parent ratings.

A longitudinal resource for studying connectome development and its psychiatric associations during childhood

Most psychiatric disorders are chronic, associated with high levels of disability and distress, and present during pediatric development. Scientific innovation increasingly allows researchers to probe brain-behavior relationships in the developing human. As a result, ambitions to (1) establish normative pediatric brain development trajectories akin to growth curves, (2) characterize reliable metrics for distinguishing illness, and (3) develop clinically useful tools to assist in the diagnosis and management of mental health and learning disorders have gained significant momentum. To this end, the NKI-Rockland Sample initiative was created to probe lifespan development as a large-scale multimodal dataset. The NKI-Rockland Sample Longitudinal Discovery of Brain Development Trajectories substudy (N = 369) is a 24- to 30-month multi-cohort longitudinal pediatric investigation (ages 6.0-17.0 at enrollment) carried out in a community-ascertained sample. Data include psychiatric diagnostic, medical, behavioral, and cognitive phenotyping, as well as multimodal brain imaging (resting fMRI, diffusion MRI, morphometric MRI, arterial spin labeling), genetics, and actigraphy. Herein, we present the rationale, design, and implementation of the Longitudinal Discovery of Brain Development Trajectories protocol.

A person-centered analysis of emotional-behavioral functioning profiles in adolescents: Associations with teacher autonomy support and growth mindset

Anchored in the socio-ecological framework, the current study examined the association of teacher autonomy support with emotional-behavioral functioning profiles using a person-centered approach and investigated whether growth mindset and adolescents’ gender would moderate this association. To achieve these research objectives, this study involved 1741 adolescents (54.1% girls; Mage = 12.62; SD = 1.50) who were uniformly instructed to fill in a set of self-report questionnaires. Results based on latent profile analysis revealed four emotional-behavioral functioning profiles: primarily externalizing (6.2%), comorbid (32.9%), well-adjusted (53.7%), and high-risk (7.2%). Adolescents with high teacher autonomy support were more likely to be group members of the well-adjusted profile than the remaining three emotional-behavioral functioning profiles. Moreover, interaction analyses demonstrated that girls benefited more when teacher autonomy support and growth mindset were congruently high, whereas boys did not. The current findings suggest that teachers should be equipped with sufficient skills and training to maintain an autonomy-supportive classroom climate. Meanwhile, growth mindset intervention may develop into an integral part of the school’s activities to facilitate adolescents’ optimal emotional-behavioral functions, but distinctly gendered pathways for these activities should be carefully considered.