Externalizing behavior from early childhood to adolescence: Prediction from inhibition, language, parenting, and attachment

Parent-child relationship measures and pre-post treatment changes for a clinical preschool sample using DC:0-3R

BACKGROUND

To reduce psychopathologies in children, various treatment approaches focus on the parent-child relationship. Disruptions in the parent-child relationship are outlined in the most recently revised versions of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-3R/DC:0-5). The measures used to assess the parent-child relationship include the Parent-Infant Relationship Global Assessment Scale (PIRGAS) and the Relationship Problems Checklist (RPCL), which cover, e.g., essential concepts like over- or underinvolvement of the caregiver. However, not much is known about the cross-sectional and predictive value of PIRGAS and RPCL scores at admission to discharge, namely whether changes in these scores are correlated with child and maternal psychopathologies and changes through treatment.

METHODS

Based on clinical records of 174 preschool-aged children of the Family Day Hospital, we report related basic descriptive data and changes from admission to discharge for the parent-child relationship, child behaviour, and maternal psychopathology. We used a Pearson correlation or a point-biserial correlation to describe the associations and performed a paired t-test to examine differences before and after measurement.

RESULTS

Our results show overall improvements in our parent-child relationship measures and in child and maternal psychopathology. However, we observed little or no correlation between the parent-child relationship measures and child or maternal psychopathology.

CONCLUSIONS

We highlight potential drawbacks and limitations of the two relationship measures used that may explain the results of this study on the associations between the variables assessed. The discussion emphasizes the assessment of DC:0-3R/DC:0-5, which are popular in clinical practice for economic reasons.

Associations Between Adult Attachment, Maternal Emotion Socialization and Child Behavior

BACKGROUND

Attachment theories suggest that the adult attachment styles of mothers may influence behavior problems among their children; however, empirical studies examining the direct role of maternal adult attachment styles and the mechanisms through emotion-related parenting are scarce.

OBJECTIVE

This study examined the influence of maternal adult attachment styles and emotion-related parenting on child internalizing and externalizing problems.

METHODS

The participants were 409 mothers with children aged 4-5 years. A questionnaire survey was conducted to obtain their adult attachment styles to their mothers, maternal emotion socialization, and their children's behavior problems.

RESULTS

The results of structural equation modelling (SEM) analyses revealed that maternal adult attachment influenced child behavior problems directly and indirectly through maternal emotion socialization. (1) Maternal attachment anxiety directly affected child externalizing problems, and indirectly affected them via mothers' higher unsupportive emotion socialization (dismissing and dysfunction). Moreover, attachment anxiety influenced child internalizing problems directly, and indirectly via mothers' higher unsupportive emotion socialization (dysfunction). (2) Furthermore, attachment avoidance indirectly impacted child externalizing problems via mothers' lower supportive emotion socialization (coaching).

CONCLUSIONS

These results suggested that maternal adult attachment styles and emotion-related parenting have important implications for the development of child behaviors. Future interventions should target parental factors to mitigate the risk of behavior problems among preschoolers.

Internalizing and Externalizing Disorder Levels among Adolescents: Data from Poland

This article concerns internalizing and externalizing behaviors among Polish adolescents attending primary schools in a medium-sized city in Poland. The aim of the study was to examine the levels of select problem behaviors (i.e., depression, withdrawal, somatic complaints, aggressive behaviors, delinquent behaviors, thought problems, and internalizing and externalizing disorders) in early adolescence. Another important aim was to establish the ranges of the norm and deviation which would indicate the need for intervention aimed at internalizing and externalizing disorders in the sample. The relationships between variables such as age, gender, and school achievement (grade average) and the groups of problem behaviors and externalizing and internalizing disorders were also examined. To diagnose the occurrence of internalizing and externalizing behaviors, a sample of 550 students (55.3% girls, 46.7% boys) were measured using the Youth Self-Report (YSR) questionnaire. The results showed statistically significant differences in internalizing and externalizing behaviors between boys and girls. Girls achieved higher scores on most of the YSR scales, including internalizing and externalizing disorders, as well as on the total score. The student subgroup scores were also differentiated in terms of age and their average grades. The results also have practical implications; namely, the need for obligatory screening tests of students' emotional states; encouraging preventive measures in schools, including diagnosis and psychological support in the context of depression; monitoring aggressive behaviors and social problems, both in boys and girls; and implementing universal, selective, and indicated prevention through complex, empirically validated educational-therapeutic programs.

Sex differences in the course of autistic and co-occurring psychopathological symptoms in adolescents with and without autism spectrum disorder

LAY ABSTRACT

There is an ongoing debate as to whether autism spectrum disorder (ASD) is expressed differently in women than men. Studies on sex differences in autistic symptoms and symptoms of other psychiatric problems present in individuals with autism generally do not include a general population comparison group, making it unclear whether differences are specific to autism or merely reflecting development in the general population. In this study, we compared sex differences in the course of autistic and at the same time present symptoms of other psychiatric problems in adolescents with milder forms of ASD to those in a group of the general population with an equal intelligence quotient (IQ) and socioeconomic status. Data of five assessment moments from ages 11 to 22 years were analyzed using a statistic procedure that allowed us to determine which factors affect the course of symptoms over time. We found that in adolescence, sex differences in the course of psychopathological symptoms specific for autism are confined to the repetitive stereotyped domains. Males had higher scores on the sensory/stereotypic and resistance to change domains, the latter difference disappeared during the course of adolescence due to an increase of these problems in autistic females. Other sex differences, among which an increase over time in mood and anxiety problems in females was the most outstanding, were also observed in females without autism. These sex-specific differences have relevance in the clinical care of autistic men and women, although they are subtle compared to differences between individuals with and without autism.

Child executive function and future externalizing and internalizing problems: A meta-analysis of prospective longitudinal studies

To determine the association between executive function and later externalizing and internalizing problems, we conducted a meta-analysis of 167 studies (1098 effect sizes, total N = 66,119) that explored the longitudinal associations between executive functions in children and subsequent externalizing and internalizing problems. The results indicated that greater child executive function was prospectively associated with fewer attention-deficit/hyperactivity disorder (ADHD) symptoms, fewer conduct problems, fewer oppositional defiant disorder symptoms, less substance use, fewer broad externalizing problems, fewer depression symptoms, and fewer broad internalizing problems, but not with subsequent anxiety symptoms. Moderator analyses revealed that the sample type moderated the associations of executive function with both ADHD symptoms and conduct problems. Age of assessment moderated the association with broad externalizing problems, and executive function context moderated associations with both substance use and broad internalizing problems. These findings suggest that executive function in children prospectively predicts numerous externalizing and internalizing behaviors, suggesting that executive function may be an important target for psychopathology prevention programs and interventions.

A Prospective Longitudinal Study of Mother-Child Attachment and Externalizing Trajectories in Boys and Girls

In clinically referred children, boys and those with disorganized mother-child attachments tend to show the most maladaptive externalizing trajectories; however, additional research is necessary to test whether these findings hold in a community sample. Therefore, 235 community children (106 boys) were followed from ages 6 to 15 years across six time points. Multiple-group linear growth curves with mother-child attachment as a time-invariant covariate were fit to the data to explore externalizing trajectories for boys and girls. Results showed that boys had higher initial externalizing levels than girls, and children generally experienced a decline in symptoms over time. No significant trajectory differences were found for girls, and boys with different attachment classifications did not differ on their initial externalizing levels; however, boys with avoidant attachments (with resistant attachments trending) experienced a steeper decline in externalizing symptoms longitudinally. Implications for intervention and prevention are discussed.

Externalizing behavior in preschool children in a South African birth cohort: Predictive pathways in a high-risk context

Mental health problems often begin in early childhood. However, the associations of various individual and contextual risk factors with mental health in the preschool period are incompletely understood, particularly in low- to middle-income countries (LMICs) where multiple risk factors co-exist. To address this gap, we prospectively followed 981 children in a South African birth cohort, the Drakenstein Child Health Study, assessing pre-and postnatal exposures and risk factors. The predictive value of these factors for child mental health (assessed by the Child Behavior Checklist) was modeled using structural equation modeling. We identified two key pathways to greater externalizing behavior: (1) prenatal exposure to substances (alcohol and smoking) directly predicted increased externalizing behavior (β = 0.24, p < 0.001); this relationship was partially mediated by an aspect of infant temperament (negative emotionality; β = 0.05, p = 0.016); (2) lower socioeconomic status and associated maternal prenatal depression predicted more coercive parenting, which in turn predicted increased externalizing behavior (β = 0.18, p = 0.001). Findings in this high-risk LMIC cohort cohere with research from higher income contexts, and indicate the need to introduce integrated screening and intervention strategies for maternal prenatal substance use and depression, and promoting positive parenting across the preschool period.

Perceived Parenting and Borderline Personality Features during Adolescence

This study investigates the associations between perceived parenting and borderline personality disorder (BPD) in adolescents. The relations between components of parenting and BPD features were explored. Participants (N = 270; mean age = 15.3) assessed their own BPD features (Personality Assessment Inventory) and both of their parents' parenting practices (Parents as Social Context Questionnaire; Perceived Parental Autonomy Support Scale). SEM results suggest that controlling, rejecting and chaotic parenting all predicted global BPD, and all these parenting components were significantly associated with at least one BPD feature. Chaotic parenting, a relatively neglected construct in the BPD literature, seems to play an important role in early BPD.

Children's emotion recognition and aggression: A multi-cohort longitudinal study

Difficulty recognizing negative emotions (NEs) in children is linked to increased antisocial traits and externalizing problems. However, crucial aspects of this relation remain unclear, such as: whether NE recognition is associated with externalizing problems in general or only a particular subcomponent (i.e., aggression); whether subcomponents of NE recognition (i.e., insensitivity and misspecifications) are relatively more important; and how these relations change over the course of development. We assessed emotion recognition, overt aggression, attention deficit hyperactivity disorder (ADHD) symptoms, and oppositional defiant disorder (ODD) symptoms in an ethnically diverse sample of Canadian children (N = 150; 4-year-olds, N = 148; 8-year-olds) and followed up with them 1 year later (86.9% retention). Emotion recognition was assessed using a behavioral task and caregivers reported on children's externalizing symptoms. Children with lower NE recognition had higher initial, but not subsequent, overt aggression, even when controlling for nonaggressive externalizing symptoms (i.e., ADHD and ODD symptoms). NE recognition was not concurrently or longitudinally associated with nonaggressive externalizing symptoms. Age and gender did not moderate these findings. Both higher NE insensitivity (e.g., reporting a sad face appears neutral) and misspecifications (e.g., reporting a sad face appears angry) were significantly associated with higher concurrent overt aggression. In conclusion, both NE insensitivity and misspecifications were found to be uniquely important for children's overt aggression. These findings highlight the importance of different forms of NE recognition and differentiating between aggressive and nonaggressive externalizing problems in children.

Intraindividual reaction time variability as an index of attentional control acts as a moderator of the longitudinal relationships between marital quality and children's externalizing problems

The current study investigated whether trial-to-trial intraindividual reaction time variability (IIRTV), which serves as an index of attentional control fluctuations, moderates the effect of marital quality at 7 years of age on the development of children's externalizing problems from 7 to 9 years of age (N = 197). At the first assessment (T1), a flanker task was administered to children for assessing their IIRTV. The Chinese version of a marital quality questionnaire (Evaluating and Nurturing Relationship Issues, Communication, and Happiness [ENRICH]) and the Chinese version of the Child Behavior Checklist (CBCL) were completed by children's mothers to assess marital quality and children's externalizing problems. At the second and third assessments (T2 and T3), children's externalizing problems were reassessed by their mothers. Growth curve analyses showed that boys' externalizing problems were relatively high and significantly decreased over time, whereas girls' externalizing problems were relatively low and stable. Importantly, the results indicated that boys' IIRTV (but not girls' IIRTV) and parental marital quality interactively predict the concurrent and developmental trajectories of externalizing problems. Specifically, boys with greater IIRTV were found to exhibit a relatively persistent high level of externalizing problems in the context of poor parental marital quality, whereas boys with lower IIRTV were found to exhibit a relatively low level of externalizing problems over time regardless of their parental marital quality. The findings suggest that poorer attentional control indexed by greater IIRTV is a robust predictor of boys' externalizing problems and that better attentional control indexed by lower IIRTV may buffer the negative impact of adverse family environment on the development of boys' externalizing problems.

Construct-Specific and Timing-Specific Aspects of the Home Environment for Children's School Readiness

Prior evidence supports that the home environment is related to children’s development of school readiness skills. However, it remains unclear how construct- and timing-specific aspects of the home environment are related to children’s school readiness skills, unique from overall, stable aspects of home quality. Unpacking associations due to specific constructs and timing of the home environment may provide insights on the theoretical processes that connect the home environment to school readiness. Using data from the NICHD Study of Early Child Care and Youth Development (N = 1,364), the current study examines how timing (36 and 54 months) and constructs (educational stimulation and socio-emotional responsivity) of the home environment, relative to overall levels across time, relate to children’s language skills, math skills, and externalizing behaviors. The overall, stable aspects of the home environment were significantly associated with children’s language skills and externalizing problems. Additionally, there were significant paths from the stimulation construct at 54 months to math skills, language skills, and externalizing problems. These findings provide evidence that although the overall home environment is predictive of school readiness, the stimulation construct of the home environment at 54 months has additional concurrent relations to children’s school readiness. Implications for the role of the home environment and children’s school readiness are discussed.

Antisocial Disorders in Adolescence and Youth, According to Structural, Emotional, and Cognitive Transdiagnostic Variables: A Systematic Review

Transdiagnostic causal variables have been identified that have allowed understanding the origin and maintenance of psychopathologies in parsimonious explanatory models of antisocial disorders. However, it is necessary to systematize the information published in the last decade. The aim of the study was to identify through a systematic review, the structural, emotional and cognitive transdiagnostic variables in antisocial disorders of adolescence and youth. Recommendations for systematic reviews and meta-extraction and analysis of information according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), the Cochrane Collaboration and Campbell were followed. We found 19 articles from 110 reviewed documents. The results indicated that at a structural level there is a general psychopathological factor (psychopathy or externalizing), non-emotional callousness and impulsivity from behavioral inhibition and activation systems, and negative affect traits as base structures. In the emotional level, the study found a risk component from emotional dysregulation and experiential avoidance. In the cognitive level, a key role of anger-rumination and violent ideation as explanatory variables of antisocial disorders. We concluded that the interaction of these identified variables makes it possible to generate an evidence-based transdiagnostic model.

Frühkindliche Prädiktoren externalisierender Verhaltensauffälligkeiten

Zusammenfassung. Externalisierende Verhaltensauffälligkeiten sind mit hohen gesellschaftlichen Kosten verbunden. Damit wirksame Präventions- und frühe Therapieprogramme entwickelt werden können, ist es notwendig, bereits in den ersten Lebensjahren Risiken für einen externalisierenden Entwicklungsverlauf zu identifizieren. In einer systematischen Literaturrecherche konnten aus 21 Publikationen zu 12 längsschnittlichen Geburtskohorten mit insgesamt 55 077 Kindern frühe Risiken bezogen auf eine elterliche Psychopathologie, einen niedrigen sozio-ökonomischen Status und ungünstige Eltern-Kind-Interaktionen identifiziert werden. Insbesondere eine mütterliche Depression, ein niedriger sozio-ökonomischer Status und ein harsches Erziehungsverhalten in den ersten Lebensjahren waren prädiktiv für externalisierende Verhaltensauffälligkeiten im Kindergarten und bei Schuleintritt. Implikationen für die klinische Praxis werden vorgestellt.