Internalizing and Externalizing Behaviors Share a Common Predictor: the Effects of Early Maladaptive Schemas Are Mediated by Coping Responses and Schema Modes

We investigated the relationships of adolescents’ internalizing and externalizing behaviors with their early maladaptive schemas (EMS), coping responses, and schema modes. We focused on EMS related to experiences of disconnection and rejection that comprise vulnerable emotions, such as shame, mistrust, deprivation, abandonment, and isolation/alienation. This cross-sectional study included a total of 699 adolescents (combined clinical and non-referred sample) who were 11 to 18 years old (M?=?14.6; SD?=?1.6), and of which 45% was male. All participants completed self-report questionnaires on EMS, coping responses, schema modes, and behavior problems. We aimed to clarify the relationships between these variables by testing mediation, moderation, and moderated mediation models. In general, coping responses functioned as mediators rather than moderators in the relationships between EMS and schema modes. Furthermore, EMS regarding experiences of disconnection and rejection were related to both internalizing and externalizing behavior problems, and coping responses and schema modes mediated these effects. In conclusion, although adolescent internalizing and externalizing behavior problems manifest quite differently, they seem related to the same EMS.     

Interplay between Attachment to Peers and Parents in Korean Adolescents’ Behavior Problems

The present study investigated the relative contribution of style of peer attachment (secure, anxious, avoidant) and quality of attachment to parents on behavior problems in Korean adolescents. In addition, we examined the role of paternal and maternal attachment separately as a potential moderator in the relationship between style of peer attachment and internalizing and externalizing behavior problems. Middle school students (245 males, 209 females) completed the Korean version of the Adolescent Friendship Attachment Scale, Inventory of Parental and Peer Attachment-Revised, and Youth Self-Report. Attachment to peers and parents as predictors of behavior problems were tested via hierarchical multiple regression analyses. Results revealed that anxious peer attachment remained the strongest predictor of behavior problems among adolescents (internalizing behavior problems β?=?.18, p?<?.01; externalizing behavior problems β?=?.21, p? <?.001), indicating the relative importance of peer relationship compared to attachment to parents. Paternal attachment significantly moderated the relationship between avoidant peer attachment and externalizing behavior problems (β?=?.15, p?<?.05), even when the main effect of avoidant peer attachment on externalizing behavior problems was not significant. Results highlight the role of both attachments to peers and parents on adolescents’ psychological adjustment.     

Maternal Incarceration,Children’s Psychological Adjustment,and the Mediating Role of Emotion Regulation

Children who live in the context of maternal incarceration (MI) are exposed to both general environmental risk and incarceration-specific risk increasing the probability of their developing externalizing and internalizing behaviors problems. Little research has examined the socio-emotional mechanisms that account for the psychological effects of MI. This research examined children’s anger and sadness regulation as mediators between environmental and incarceration-specific risk and psychological functioning. Participants were 117 children (60% Black; 52% boys; M age = 9.85 years, SD = 1.65 years), their incarcerated mother, and current caregiver. All informants completed questionnaires assessing children’s anger and sadness regulation as well as externalizing and internalizing behaviors. Mothers and caregivers provided information concerning children’s exposure to environmental risk and all three reporters provided information on incarceration-specific risk experiences (ISRE). Structural equation modeling was used to test indirect effects of risk variables (ISRE, environmental) on psychological functioning (externalizing, internalizing behaviors) via emotion regulation (anger, sadness). Gender, age, and race were covariates. The analyses revealed significant indirect effects of incarceration-specific risk on both externalizing and internalizing behavior problems via anger regulation but not via sadness regulation. The findings highlight the centrality of emotion regulation as a mechanism that helps explain the negative psychological outcomes experienced by children exposed to ISRE with implications for preventive interventions.     

Longitudinal Associations between Depression and Aggression in Children and Adolescents

Due to the longstanding and detrimental effects of engaging in aggressive behaviour and of experiencing symptoms of internalizing problems in children and adolescents, there is an increasing interest in identifying the temporal sequence between these 2 problems with previous research yielding inconsistent findings. Therefore, the longitudinal links between relational aggression, physical aggression, and depression were examined across 7 years in a sample of 643 children (54 % girls) aged 10 at Time 1. Three models were compared— (1) the failure model, in which aggression predicted depression, (2) the acting out model, in which depression predicted aggression, and (3) a reciprocal model, in which both aggression and depression shared a reciprocal relation over time. Cross-lagged path analyses using structural equation modeling supported the failure model (i.e., engaging in relational and physical aggression predicts subsequent depressive symptoms). Findings were similar for boys and girls. These findings add to the literature suggesting that externalizing problems precede internalizing problems.     

Sex Differences in the Contribution of Respiratory Sinus Arrhythmia and Trauma to Children’s Psychopathology

Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activity, has been shown to moderate the relation between adversity and child behavioral outcomes; however, this work has been conducted in primarily Caucasian samples and limited in focus to family-level adversity. The current analysis extends the previous literature to examine the co-contribution of exposure to potentially traumatic events (PTEs), baseline RSA, and RSA withdrawal to internalizing and externalizing behavior in a sample of primarily African American youth (n = 92) recruited using neighborhood mapping techniques from communities high in epidemiological indicators of adversity. Exposure to PTEs was associated with lower baseline RSA. Complex interactions were observed between sex of the child, baseline RSA and RSA withdrawal, and PTE exposure predicting to internalizing behaviors. Among girls with high (4+) levels of PTEs, high baseline RSA and RSA withdrawal predicted higher internalizing; for RSA withdrawal only, the inverse was observed for girls with low PTE exposure, for whom high RSA withdrawal predicted lower internalizing. No associations were observed from RSA to externalizing, or among boys to internalizing. Findings are consistent with distinct patterns among primarily African American samples and suggest the need for sex-specific conceptualizations of the link between environmental adversity, physiological reactivity, and internalizing behaviors.     

Emotional Desensitization to Violence Contributes to Adolescents’ Violent Behavior

Many adolescents are exposed to violence in their schools, communities and homes. Exposure to violence at high levels or across multiple contexts has been linked with emotional desensitization, indicated by low levels of internalizing symptoms. However, the long-term consequences of such desensitization are unknown. This study examined emotional desensitization to violence, together with externalizing problems, as mediators of the relationship between exposure to violence in pre-adolescence and violent behavior in late adolescence. A community sample of youth (N?=?704; 48 % female; 76 % African American, 22 % Caucasian) reported on their exposure to violence in multiple settings at ages 11, 13 and 18. Internalizing and externalizing problems were assessed at ages 11 and 13; violent behavior was measured at age 18. Structural Equation Modeling showed that exposure to high levels of violence at age 11 was associated with lower levels of internalizing problems (quadratic effect) at age 13, as was exposure to violence across multiple contexts (linear effect). In turn, fewer internalizing problems and more externalizing problems at age 13 predicted more violent behavior at age 18. The results suggest that emotional desensitization to violence in early adolescence contributes to serious violence in late adolescence.     

Seesaw Discipline: The Interactive Effect of Harsh and Lax Discipline on Youth Psychological Adjustment

Although extant research documents the negative consequences of harsh and lax discipline for youth, little empirical attention has been devoted to understanding the impact when parents utilize both strategies. As such, the current study was designed to explore the interaction of harsh and lax discipline on youth internalizing and externalizing symptoms in three developmental periods (early childhood, middle childhood, and adolescence). Participants were 615 parents (55 % female) and one of their 3–17 year old children (45 % female). Parents provided reports of their harsh and lax parenting tactics as well as offspring internalizing and externalizing symptoms. Multiple linear regression analyses were utilized to examine the relations between the interaction of harsh and lax parenting on youth symptoms. The interaction between harsh and lax discipline was significantly related to youth internalizing, but not externalizing, problems in the both the young and middle childhood samples and marginally significant in the adolescence sample: seesaw discipline—a novel construct indicative of high levels of both harsh and lax discipline—was associated with the highest levels of youth internalizing problems. Parents who engage in seesaw parenting have children and adolescents who are more likely to evidence internalizing symptoms. Such findings may inform prevention and intervention efforts that target dysfunctional discipline.     

High-Risk Behavior Among Young Adolescents in The Central and Northern Region of Peninsular Malaysia: Baseline Data from The MyHeART Study

The onset of high-risk behaviors in adolescents are associated with family, social and behavioral factors. This study aims to describe the prevalence of high-risk behaviors among young adolescents in Peninsular Malaysia and determine the relationship between high-risk behaviors and family sociodemographics and behaviors. The data utilized are from the Malaysian Health and Adolescents Longitudinal Research Study, a prospective cohort analysis conducted in three large states of Peninsular Malaysia: Selangor, Perak, and the Federal Territory of Kuala Lumpur. The sample included 13-year-old adolescents in their first year of secondary school. Students and parents or guardians were given separate, standardized self-administered questionnaire. A high-risk behavior variable was determined on the basis of exposure to substance use (tobacco, alcohol, and illicit drugs), gambling, and online pornography or violence. The exploratory variable of interest (family sociodemographics) was defined as parents’ demographics, employment status, education level, and socioeconomic status. The analysis included 1341 adolescents and 1146 parents. Of the school-going adolescents, 4.7?% (n?=?52) reported HRBs. Tobacco use (9?%, n?=?1 19) and watching pornography or violent content on the Internet (5?%, n?=?72) accounted for most of the behaviors, whereas illicit drug use contributed the least (2?%, n?=?32). More adolescents from the higher socioeconomic groups, than from the middle groups exhibited high-risk behaviors (odds ratio ?=?3.039, 95?% confidence interval?=?2.884–3.202); by contrast, the odds ratio of high-risk behavior among adolescents with a low socio-economic status was 2.246 (95?% CI?=?2.014–2.397). Future intervention programs for adolescents should focus on overcoming high-risk behaviors and sustain behavioral changes.     

An Imbalance of Approach and Effortful Control Predicts Externalizing Problems: Support for Extending the Dual-Systems Model into Early Childhood

Although the association between deficits in effortful control and later externalizing behavior is well established, many researchers (Nigg Journal of Child Psychology and Psychiatry, 47(3-4), 395–422, 2006; Steinberg Developmental Review, 28(1), 78–106, 2008) have hypothesized this association is actually the product of the imbalance of dual systems, or two underlying traits: approach and self-regulation. Very little research, however, has deployed a statistically robust strategy to examine that compelling model; further, no research has done so using behavioral measures, particularly in longitudinal studies. We examined the imbalance of approach and self-regulation (effortful control, EC) as predicting externalizing problems. Latent trait models of approach and EC were derived from behavioral measures collected from 102 children in a community sample at 25, 38, 52, and 67 months (2 to 5 ½ years), and used to predict externalizing behaviors, modeled as a latent trait derived from parent-reported measures at 80, 100, 123, and 147 months (6 ½ to 12 years). The imbalance hypothesis was supported: Children with an imbalance of approach and EC had more externalizing behavior problems in middle childhood and early preadolescence, relative to children with equal levels of the two traits.     

Latent Classes of Psychiatric Symptoms Among Chinese Children Living in Poverty

Describing co-occurring symptom patterns among children in nonwestern contexts may have important implications for how emotional and behavior problems are defined, conceptualized, studied, and ultimately prevented. A latent profile analysis (LPA) was conducted on the co-occurring psychiatric symptoms of 196 Chinese children living in poverty. Child depression, anxiety, aggression, and self-esteem scores were used as indicators in the LPA. Three classes of symptoms best described the symptom presentations of children in this study. Ninety-one percent of the youth in the sample were assigned to a class without clinically significant elevations on any symptom index. Six percent fell into an externalizing class, and 3% were assigned to a class with elevated internalizing symptoms. The three classes met empirical criteria for distinctiveness and were validated against parent- and child-rated family characteristics and resources. Children in the externalizing class were more likely to experience harsh and neglectful parenting and their parents were more likely to report avoidant coping styles. In addition to some parenting behaviors (overprotection and low parental support), internalizing symptoms were uniquely associated with low levels of education, housing, economic, and social resources. Implications for preventive interventions are discussed.     

The Effectiveness of Psychosocial Interventions Delivered by Teachers in Schools: A Systematic Review and Meta-Analysis

The growing mental health needs of students within schools have resulted in teachers increasing their involvement in the delivery of school-based, psychosocial interventions. Current research reports mixed findings concerning the effectiveness of psychosocial interventions delivered by teachers for mental health outcomes. This article presents a systematic review and meta-analysis that examined the effectiveness of school-based psychosocial interventions delivered by teachers on internalizing and externalizing outcomes and the moderating factors that influence treatment effects on these outcomes. Nine electronic databases, major journals, and gray literature (e.g., websites, conference abstract) were searched and field experts were contacted to locate additional studies. Twenty-four studies that met the study inclusion criteria were coded into internalizing or externalizing outcomes and further analyzed using robust variance estimation in meta-regression. Both publication and risk of bias of studies were further assessed. The results showed statistically significant reductions in students’ internalizing outcomes (d = .133, 95% CI [.002, .263]) and no statistical significant effect for externalizing outcomes (d = .15, 95% CI [?.037, .066]). Moderator analysis with meta-regression revealed that gender (%male, b = ?.017, p < .05), race (% Caucasian, b = .002, p < .05), and the tier of intervention (b = .299, p = .06) affected intervention effectiveness. This study builds on existing literature that shows that teacher-delivered Tier 1 interventions are effective interventions but also adds to this literature by showing that interventions are more effective with internalizing outcomes than on the externalizing outcomes. Moderator analysis also revealed treatments were more effective with female students for internalizing outcomes and more effective with Caucasian students for externalizing outcomes.     

<Emphasis Type="Italic">DSM-5</Emphasis> Posttraumatic Stress Disorder Symptom Structure in Disaster-Exposed Adolescents: Stability across Gender and Relation to Behavioral Problems

Given the significant modifications to posttraumatic stress disorder (PTSD) symptom criteria from DSM-IV to DSM-5, a better understanding of the dimensionality underlying DSM-5 PTSD symptoms among adolescents is needed. However, to date, whether gender moderates the latent structure of DSM-5 PTSD symptoms in youth remains unclear. Meanwhile, little is known about how distinct PTSD dimensions relate to adolescent behavioral problems. The aim of this study was to fill these gaps. A sample of 1184 disaster-exposed Chinese adolescents (53.8 % girls) with age ranging from 13 to 17 years (M = 14.3, SD = 0.8) completed the PTSD Checklist for DSM-5, and the Withdrawn, Aggressive Behavior, and Delinquent Behavior subscales of the Youth Self-Report. Confirmatory factor analyses revealed that the seven-factor hybrid PTSD model provided the best fit to the data for both girls and boys. Measurement equivalence of this model held across gender, although girls had higher mean scores than boys on some factors. Differential patterns of associations emerged between PTSD dimensions and behavioral problems, with anhedonia symptoms most strongly relating to social withdrawal, and externalizing behavior symptoms most strongly relating to aggression and delinquency. These findings further support the gender invariance and external criterion validity of the newly refined hybrid model that best represents DSM-5 PTSD symptom structure in youth, and carry implications for accurate assessment, diagnosis, and gender comparison of DSM-5 PTSD symptomatology, and potential symptom targets for PTSD intervention among adolescent disaster survivors.     

Maternal Sensitivity: a Resilience Factor against Internalizing Symptoms in Early Adolescents Born Very Preterm?

Compared with full-terms, preterm individuals are more at risk from infancy to adulthood for developing internalizing symptoms. Early maternal interactive behavior, especially maternal sensitivity, has been found to be a resilience factor in the developmental outcome of preterm children. The present longitudinal study aimed at examining whether early interactive parenting behaviors have a long term impact on the internalizing symptoms of preterm-born young adolescents. A total sample of 36 very preterm and 22 full-term children participated in an 11-year follow-up study. Maternal interactive behavior was assessed during a mother–infant interaction when the infant was 18 months old. At 11 years, internalizing symptoms were assessed with the Child Behavior Checklist (CBCL). Hierarchical regression analyses revealed that the interaction between groups (preterm/full-term) and maternal sensitivity at 18 months significantly explained CBCL internalizing symptoms at 11 years (β = ?0.526; p < 0.05). Specifically, although prematurity was related to internalizing problems, preterm children with higher maternal sensitivity did not differ from their full-term-born peers on the CBCL internalizing problems domain. These results suggest that maternal sensitivity is a long-term resilience factor preventing the development of internalizing problems at early adolescence in very preterm individuals.     

Structure and Etiology of Co-occurring Internalizing and Externalizing Disorders in Adolescents

Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two latent factors, internalizing and externalizing, explained the interrelationships among six psychiatric disorders (major depressive disorder, generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) in adolescents, and whether there are common genetic and environmental influences on internalizing and externalizing latent factors. Multivariate behavior genetic analyses of data from 1162 twin pairs and 426 siblings ascertained from the general population via the Colorado Center for Antisocial Drug Dependence (CADD) were conducted. We found support for a model positing two latent factors (internalizing and externalizing). These factors were moderately heritable and influenced by significant common genetic and nonshared environmental influences. These findings suggest that co-occurrence of internalizing and externalizing psychopathology in adolescents results from both genetic and environmental influences.     

Internalizing and Externalizing Problem Behavior: a Test of a Latent Variable Interaction Predicting a Two-Part Growth Model of Adolescent Substance Use

Externalizing symptoms robustly predict adolescent substance use (SU); however, findings regarding internalizing symptoms have been mixed, suggesting that there may be important moderators of the relationship between internalizing problems and SU. The present study used a longitudinal community sample (N?=?387, 55% female, 83% White) to test whether externalizing symptoms moderated the relationship between internalizing symptoms and trajectories of alcohol and marijuana use from early (age 11–12 years old) to late (age 18–19 years old) adolescence. Two-part latent growth models were used to distinguish trajectories of probability of use from trajectories of amount of use among users. Results suggested that externalizing symptoms moderated the association between internalizing symptoms and probability of alcohol, but not marijuana use. The highest probability of alcohol use was observed at high levels of externalizing symptoms and low levels of internalizing symptoms. A negative protective effect of internalizing symptoms on probability of alcohol use was strongest in early adolescence for youth high on externalizing symptoms. Although moderation was not supported for amount of use among users, both domains of symptomology were associated with amount of alcohol and marijuana use as first-order effects. High levels of externalizing symptoms and low levels of internalizing symptoms were associated with high levels of amount of use among users. These findings suggest that developmental models of substance use that incorporate internalizing symptomology should consider the context of externalizing problems and distinguish probability and amount of use.     

Callous-Unemotional Traits and Autonomic Functioning in Toddlerhood Interact to Predict Externalizing Behaviors in Preschool

Callous-unemotional (CU) traits are one meaningful risk factor which helps to explain heterogeneity in the emergence of externalizing behavior problems. While the extant literature demonstrates links between early CU traits and later externalizing problems, there is a dearth of research examining for whom early CU traits confer risk. Data from a longitudinal study (n?= 108) were used to examine the extent to which parasympathetic functioning moderated links between CU traits in toddlerhood (m _age ?=?24.99 months) and externalizing behavior problems at preschool-age (m _age ?=?51 months). Neither CU traits nor parasympathetic functioning at age 2 directly predicted later externalizing behaviors. However, results show that high levels of CU traits predict elevated externalizing behavior problems, but only for toddlers exhibiting either high baseline respiratory sinus arrhythmia (RSA) or little to no RSA suppression in response to a fear stimulus.     

Assessing Attachment to Parents and Peers in Middle Childhood: Psychometric Studies of the Portuguese Version of the People in My Life Questionnaire

The People in My Life questionnaire (PIML) is one of the few available self-report measures for assessing children’s representations of the relationship with attachment figures (parents and peers) in middle childhood. The current study presents validation studies of the PIML in a sample of Portuguese children aged between 8 and 12 years (N?=?314) and adolescents aged between 13 and 18 years (N?=?281). The original factor structure, composed of a second-order factor of attachment and three first-order factors (Trust, Communication, and Alienation), was confirmed for both scales (Parents Attachment and Peers Attachment) in the sample of children and replicated in the sample of adolescents using confirmatory factor analyses. The Portuguese version of the PIML showed adequate internal consistency and correlated as expected with measures of intrapersonal and interpersonal functioning (internalizing and externalizing problems, prosocial behavior, quality of life, self-compassion, and emotion regulation strategies). The PIML proved to be a psychometrically robust measure of children’s representations of their relationships with parents and peers, representing an important advance in the measurement of attachment in middle childhood.     

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review &amp; Meta-Analysis

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.     

Two-Year Findings from a National Effectiveness Trial: Effectiveness of Behavioral and Non-Behavioral Parenting Programs

Long-term follow-up studies of selective parent training (PT) programs are scarce, particularly in the case of effectiveness trials conducted within regular care settings. This study evaluated the 2-year effects of 4 programs: Comet, Incredible Years, Cope, and Connect and differences in the rate of change among programs were investigated using Latent Growth Modeling (LGM). Participants were parents who had sought help at 30 local service sector units (e.g., child psychiatric clinics and social services centers) for major problems in managing their children’s externalizing behavior. Parents of 749 children (63 % boys) with moderate levels of externalizing behavior, aged 3–12, were randomized to one of the 4 PT programs. Assessments included parent-reported measures of child externalizing, hyperactivity and inattention, as well as parenting practices, sense of competence, and parents’ stress and depressive symptoms. At 2-year follow-up, there were no differences in any of the child outcomes among the programs. All programs had reduced externalizing behaviors with large effect sizes (d = 1.21 to d = 1.32), and negative parenting practices with moderate to large effect sizes (d = 0.49 to d = 0.83). LGM analyses showed that the 2 behavioral programs, Comet and Incredible Years, produced more rapid reductions in externalizing behavior during the course of the intervention than the non-behavioral program, Connect. Connect, however, was the only program where children continued to improve after the intervention. Overall, the results indicate that the 4 programs were equally effective in a clinical setting, despite differences in their theoretical origin.     

The Impact of Maternal Depression and Parenting Behaviors on Adolescents' Psychological Functioning in Romania

We examined the impact of maternal depression and parenting behaviors on adolescents' psychological functioning in Romania. The direct and indirect links between maternal depression, maternal acceptance, behavioral control, psychological control and adolescent internalizing and externalizing behaviors were analyzed. The sample consisted of 239, 12–14 year-old adolescents and their mothers. Results indicated that higher maternal depression were associated with higher levels of psychological control and higher levels of internalizing and externalizing behaviors. Higher levels of behavioral control were associated with higher levels of internalizing and externalizing behaviors in adolescents.