Impulsivity Symptoms as Core to the Developmental Externalizing Spectrum

Impulsivity is posited to be a key part of the externalizing spectrum during childhood, but this idea has received minimal empirical attention. The goal of the present investigation was to utilize network analysis to determine whether behavioral impulsivity symptoms are key components of the externalizing network across several developmental periods from preschool into adolescence. Participants were 109 preschoolers (64 % male) ages 3 to 6, 237 children (59 % male) ages 6 to 9, 372 children (59 % male) ages 10 to 13, and 357 adolescents (59 % male) ages 13 to 17 and their parents. Parents completed ratings of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) symptoms on a well-validated rating scale. Network analyses indicated that ADHD and ODD were somewhat differentiated in preschool, becoming united by behavioral impulsivity symptoms during early childhood, and then differentiating into inattention versus externalizing clusters later during childhood and in adolescence. Behavioral impulsivity symptoms were core to the externalizing spectrum across most developmental periods, but core inattentive and ODD symptoms were also identified in line with progressive differentiation. These results suggest the increasing importance of impulsivity symptoms across development, explaining externalizing comorbidity and potentially serving as a viable target for childhood interventions for externalizing problems.     

Developmental and Sex Differences in Types of Conduct Problems

Maternal report of types of conduct problems in a high-risk sample of 228 boys and 80 girls (ages 4–18) were examined, using a version of the Child Behavior Checklist, expanded to include a range of covert and overt antisocial items (stealing, lying, physical aggression, relational aggression, substance use, and impulsivity). Age and sex effects were investigated. Boys were significantly more physically aggressive than girls. There were no sex differences for stealing, lying, relational aggression, and substance use. Lying and substance use increased with age, whereas relational aggression and impulsivity peaked during early adolescence. A small group of girls had pervasive conduct problems across multiple domains. For some domains such as stealing, lying, and relational aggression, girls showed at least as many problems as boys. Girls, in general, tended to have fewer conduct problems. On the other hand, when assessed across multiple domains, conduct problems in high-risk girls were possibly more pervasive than in high-risk boys, suggesting the possibility of a gender paradox.     

Nonsuicidal self-injury: relationship to behavioral and self-rating measures of impulsivity and self-aggression

Previous research using self-report measures has shown an association between nonsuicidal self-injurious behavior (NSSI) and impulsive tendencies. However, self-injurers have not been shown to be different from comparison groups on laboratory tasks putatively assessing impulsive behavior. One explanation for these contradictory findings is that self-report and laboratory measures of impulsive behavior tap into distinct but related constructs. Moreover, performance on laboratory measures of impulsive behavior can be influenced by myriad contextual and affective factors not present during past self-reported NSSI events. Accordingly, a relationship between behavioral tasks of impulsivity and self-injurious behavior could emerge if both are assessed relatively close in time under controlled laboratory conditions. To test this possibility, both self-ratings and laboratory task measures of self-injurious and impulsive behavior were employed in the current study. This multi-modal assessment approach revealed that self-rated impulsivity was associated with both self-report and behavioral measures of self-injurious behavior. Moreover, behavioral measures of impulsivity were associated with self-injurious behavior, but not NSSI history. These results provide support for the notion that a multi-modal approach to assessing self-injurious behavior is important for better understanding the correlates of nonsuicidal self-injury.     

Child Effortful Control as a Mediator of Parenting Practices on Externalizing Behavior: Evidence for a Sex-Differentiated Pathway across the Transition from Preschool to School

An explanatory model for children’s development of disruptive behavior across the transition from preschool to school was tested. It was hypothesized that child effortful control would mediate the effects of parenting on children’s externalizing behavior and that child sex would moderate these relations. Participants were 241 children (123 boys) and their parents and teachers. Three dimensions of parenting, warm responsiveness, induction, and corporal punishment, were assessed via maternal report when children were 3 years old. Child effortful control at age 3 was measured using laboratory tasks and a mother-report questionnaire. Mothers and teachers contributed ratings of child externalizing behavior at age 6. Results showed that the hypothesized model fit the data well and that the pattern of associations between constructs differed for boys and girls. For boys, parental warm responsiveness and corporal punishment had significant indirect effects on children’s externalizing behavior three years later, mediated by child effortful control. Such relations were not observed for girls. These findings support a sex-differentiated pathway to externalizing behavior across the transition from preschool to school.     

Profiles of externalizing behavior problems for boys and girls across preschool: the roles of emotion regulation and inattention

Although externalizing behavior typically peaks in toddlerhood and decreases by school entry, some children do not show this normative decline. A sample of 383 boys and girls was assessed at ages 2, 4, and 5 for externalizing behavior and at age 2 on measures of emotion regulation and inattention. A longitudinal latent profile analysis was performed and resulted in 4 longitudinal profiles of externalizing behavior for each gender. Poor emotion regulation and inattention were important predictors of membership in the chronic-clinical profile for girls, whereas socioeconomic status and inattention were important predictors of membership in the chronic-clinical profile for boys. Results are discussed with respect to the development of adaptive skills that lead to normative declines in externalizing behavior across childhood.     

Gender Differences in Young Children's Temperament Traits: Comparisons Across Observational and Parent‐Report Methods

Evidence supporting the continuity between child temperament and adult personality traits is accumulating. One important indicator of continuity is the presence of reliable gender differences in traits across the lifespan. A substantial literature demonstrates gender differences on certain adult personality traits and recent meta‐analytic work on child samples suggests similar gender differences for some broad and narrow domains of temperament. However, most existing studies of children rely only on parent‐report measures. The present study investigated gender differences in temperament traits assessed by laboratory observation, maternal‐report, and paternal‐report measures. Across three independent samples, behavioral observations, maternal‐report, and paternal‐report measures of temperament were collected on 463 boys and 402 girls. Across all three methods, girls demonstrated higher positive affect and fear and lower activity level than boys. For laboratory measures, girls demonstrated higher levels of sociability and lower levels of overall negative emotionality (NE), sadness, anger and impulsivity than boys. However, girls demonstrated higher levels of overall NE and sadness than boys when measured by maternal reports. Finally, girls demonstrated lower levels of sociability based on paternal reports. Results are discussed in relation to past meta‐analytic work and developmental implications of the findings.     

Proactive and reactive aggression in early adolescence as precursors to anti- and prosocial behavior in young adults

Three groups of adolescents who were 14 years old in 1974 were formed on the basis of peer nominations and teacher ratings in an ongoing longitudinal study: 1) reactively aggressive (REA) individuals who displayed reactive, that is, self-defensive aggression but not proactive aggression (43 boys, 35 girls); 2) proactively aggressive (PROA) individuals who attacked another person without a reason (56 boys, 35 girls); and 3) nonaggressive (NONA) individuals who were low in proactive and reactive aggression (48 boys, 45 girls). The groups were compared at ages 8, 14, and 27 in variables representing the constructs of a two-dimensional model of emotional and behavioral regulation. The REA Ss were characterized by higher self-control, especially constructiveness, at each age and better adult adjustment than the PROA Ss. The PROA males were prone to externalizing problems and criminality in adulthood, whereas the PROA females were prone to internalizing problems and neuroticism in adulthood. Both exhibited conduct problems in adolescence, and became heavy users of alcohol in adulthood. The PROA Ss had more children at age 27 than the other Ss. © 1996 Wiley-Liss, Inc.     

Attention-Deficit/Hyperactivity Disorder,Trait Impulsivity,and Externalizing Behavior in a Longitudinal Sample

Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid with and predictive of externalizing behavior, yet is most often examined categorically, not dimensionally. We tested a recently proposed trait impulsivity model by dimensionally examining measures of childhood inattention and hyperactivity/impulsivity separately as predictors of later externalizing behavior in an all-female longitudinal sample of 228 young women. We also examined influences of parenting and peer relations, given the transactional nature and importance of environmental factors. We analyzed the relative contribution of hyperactive/impulsive (HI) and inattentive (IA) symptoms of girls with and without childhood-diagnosed ADHD (M age?=?9.5; 140 ADHD and 88 Comparison) to the development of externalizing behaviors in adolescence (M age?=?14.2) and early adulthood (M age?=?19.6). Authoritarian parenting was examined as a moderator and adolescent externalizing behavior as a mediator of the relation between childhood HI and later externalizing behavior. Childhood HI symptoms significantly predicted multiple externalizing behaviors in adolescence and early adulthood, after accounting for IA and covariates (ΔR ² ranged from 2.6 to 7.5 %). Mother’s authoritarian parenting moderated this relation. Adolescent externalizing behavior mediated the relation between childhood HI symptoms and early adult externalizing behavior. In no case did childhood IA significantly predict externalizing behavior after accounting for HI symptoms. Findings support a trait impulsivity model, as HI symptoms, but not IA symptoms, significantly predicted later externalizing behavior. Results support the importance of dimensional predictors of developmental trajectories. We discuss implications for assessment, intervention, and future research.     

Correlates of MMPI–A Scales in Acute Psychiatric and Forensic Samples

The purpose of this study was to expand the empirical basis for interpretation of the Minnesota Multiphasic Personality Inventory–Adolescent (MMPI–A; Butcher et al., 1992). Participants were 157 boys from a forensic setting and 197 girls from an acute psychiatric inpatient setting. Criterion variables were identified from sources such as psychiatrist report, parent report, and psychosocial history. Results generally support the construct validity of MMPI–A scales. Scales measuring internalizing problems were more highly correlated with criterion measures of internalizing behaviors than measures of externalizing behaviors, whereas scales measuring externalizing problems were more highly correlated with externalizing variables than with internalizing criteria. Implications of this study include an expanded empirical foundation for interpretation of the MMPI–A, greater understanding of the constructs it measures, and evidence supporting the generalizability of these constructs across settings.     

Aggressivity,inattention, hyperactivity,and impulsivity in boys at high and low risk for substance abuse

Aggressivity, inattention, hyperactivity, and impulsivity are cardinal dimensions of externalizing behavior problems of childhood. They are diagnostic and clinical features of childhood disorders, and are thought to be linked to the subsequent development of adult disorders such as substance abuse (SA). Little is known, however, about the convergent and discriminant validity of these four constructs. We used multiple measures to develop indices of aggressivity, inattention, hyperactivity, and impulsivity in a sample of 10- to 12-year-old boys (N=183) with and without a family history of SA. Data were taken from mother reports, child reports, teacher reports, and laboratory tasks. The study aims were (1) to test the convergent and discriminant validity of aggressivity, inattention, hyperactivity, and impulsivity; (2) to examine whether the data were consistent with a model specifying the four constructs as indicators of one superordinate factor; and (3) to differentiate boys with and without a family history of SA in construct scores. The results supported the convergent and discriminant validity of the four constructs. Although discriminable, the constructs covaried strongly and were consistent with a model specifying them as indicators of a single superordinate factor. Boys with a family history of substance abuse scored higher than control boys on aggressivity, inattention, and impulsivity scores, but the groups did not differ on hyperactivity scores. The results are discussed in terms of the role of childhood behavior problems in vulnerability to SA.This work was supported by the National Institute on Drug Abuse grant No. DA 05605.     

The relations of problem behavior status to children's negative emotionality, effortful control, and impulsivity: concurrent relations and prediction of change

The relations of children's internalizing and externalizing problem behaviors to their concurrent regulation, impulsivity (reactive undercontrol), anger, sadness, and fearfulness and these aspects of functioning 2 years prior were examined. Parents and teachers completed measures of children's (N = 185; ages 6 through 9 years) adjustment, negative emotionality, regulation, and behavior control; behavioral measures of regulation also were obtained. In general, both internalizing and externalizing problems were associated with negative emotionality. Externalizers were low in effortful regulation and high in impulsivity, whereas internalizers, compared with nondisordered children, were low in impulsivity but not effortful control. Moreover, indices of negative emotionality, regulation, and impulsivity with the level of the same variables 2 years before controlled predicted stability versus change in problem behavior status.     

Psychosocial health of 4-year-old boys and girls,as observed by parents and teachers

Both parents and teachers assessed the psychosocial health of 228 4-year-old children at the start of elementary school in the Netherlands. Assessments were conducted using the Child Behaviour Checklist (CBCL; ages 1 ½–5) and the Caregiver–Teacher Report Form (C-TRF; ages 1½–5). Results were compared to epidemiological studies with respect to informants, instruments, gender and age of the children. Most children in this study were thriving. The percentage of children without problems varied from 88 to 98%. The difference depended on the informant (parent or teacher) and the gender. Teachers recognized significantly more externalizing problems among girls and anxious/depressed problems among boys and girls. Parents reported more somatic complaints among girls. The problems identified by parents and teachers did not predominantly concern the same children. This has to be taken into account in the case of screening on psychosocial problems.     

Gender biases in children's appraisals of injury risk and other children's risk-taking behaviors

Children ages 6, 8, and 10 years were given tasks designed to assess their beliefs about risk of injury from activities. Children were asked to appraise the risk of injury for boys and girls engaging in various play behaviors and to judge the sex of the character in stories about children engaging in activities that result in injuries. Results revealed gender biases in children's appraisals of injury risk: Both boys and girls rated boys as having a lower likelihood of injury than girls even though the boys and girls were engaging in the exact same activities. Children also showed higher accuracy in identifying the sex of the character in stories of boys' injuries than girls' injuries, and accuracy improved with the participant's age. Overall, the results indicate that by the age of 6 years children already have differential beliefs about injury vulnerability for boys and girls. Although boys routinely experience more injuries than girls, children rate girls as having a greater risk of injury than boys. With increasing age, school-age children develop a greater awareness of the ways in which boys and girls differ in risk-taking activities that lead to injury outcomes.     

Neurocognitive development and externalizing problems: the role of inhibitory control deficits from 4 to 6 years

Executive processes have been posited as important regulators of externalizing problems (EP), but there has been little research on the relation between executive dysfunction and EP in early childhood. During the preschool period, maturation of the prefrontostriatal circuitry parallels increases in inhibitory control (IC). Poor IC development could result in elevated levels of aggressive, disruptive, and impulsive behavior. In this investigation, the development of the relation between IC and EP was examined in preschool and early elementary school children using the Day/Night and Tapping tasks. Children with more EP made more incorrect responses on both IC tasks, consistently across age and sex. The associations between EP and response latencies differed across children, however, with longer latencies on the Tapping task being most characteristic for boys with high levels of EP. This association was not apparent for girls. Two prominent aspects of early EP, aggressive and inattentive behavior, showed only weak unique associations with IC performance. These findings imply that diminished IC accompanies elevated EP as early as the preschool years, and that this decrement persists into the elementary school-age years for both girls and boys, and that accuracy and response latency may confer different information about the development of IC.     

Early Developmental Precursors of Externalizing Behavior in Middle Childhood and Adolescence

This study examined the infancy- and toddler-age precursors of children's later externalizing problem behavior. Risk constructs included suboptimal patterns of observed caregiver-child interaction and the caregiver's perception of child difficultness and resistance to control. In addition, a novel dimension of caregiver-child relationship quality, the caregiver's perception of her toddler's unresponsiveness to her, was examined as a possible precursor of children's externalizing behavior. Externalizing problem outcomes were assessed throughout the school-age period and again at age 17, using multiple informants. As toddlers, children at risk for later externalizing behavior were perceived as difficult and resistant to control, and relationships with their caregivers were relatively low in warmth and affective enjoyment. Finally, the caregiver's perception of her toddler as emotionally unresponsive to her was a consistent predictor of later externalizing behavior, suggesting that negative maternal cognitions associated with child conduct problems may begin in toddlerhood. These predictive patterns were similar for boys and girls, and with minor exceptions, generalized across different subdimensions of externalizing problem behavior. Our findings underscore the importance of the infancy and toddler periods to children's long-term behavioral adjustment, and indicate the desirability of further research into the nature of caregivers' early perceptions of child unresponsiveness.     

Behavior Problems in Middle Childhood: The Predictive Role of Maternal Distress, Child Attachment, and Mother-Child Interactions

The objective of the study was to examine the longitudinal relation between early school-age measures of maternal psychosocial distress, quality of mother-child interactions, and child attachment behavior, and behavior problem profiles in middle childhood using a multi-informant design. Participants were 243 French-speaking mother-child dyads (122 girls) who were part of an ongoing longitudinal project. Maternal psychosocial distress was assessed when children were between 4 and 6 years of age. Mother-child interactive quality and attachment patterns were observed at age 6 during a laboratory visit. At age 8.5, externalizing and internalizing problems were assessed using mother and child reports. Results show that maternal psychosocial distress predicted later social adaptation reported by the child through the mediation of mother-child interactions. Analyses also revealed that higher maternal psychosocial distress and controlling attachment patterns, either of the punitive or caregiving type, significantly predicted membership in both child internalizing and externalizing clinical problem groups. Lower mother-child interactive quality, male gender, and child ambivalent attachment were also predictors of externalizing clinical problems.     

The relationship between Turkish children's perceptions of marital conflict and their internalizing and externalizing problems

The present study investigated the relationship between children's perceptions of marital conflict and children's internalizing and externalizing problems. Additionally, investigating gender and age differences in children's perceptions and the type of problems they exhibited were the other purposes of the study. The sample consisted of 9‐ to 12‐year‐old, nonclinical children from intact families (N = 232), one of their parents, and teachers. The data were gathered by administering the Child Behavior Checklist for Ages 4–18 and the Teacher's Report Form to adult participants and the Children's Perception of Interparental Conflict Scale and the Children's Depression Inventory to the child participants. Findings indicated that there was a significant relationship between children's perceptions of marital conflict and their internalizing and externalizing problems. More specifically, children's perceptions of conflict properties were associated with their internalizing problems in parents', teachers', and children's reports. Children's perceptions of threat were associated with child‐reported depression. Children's perceptions of self‐blame were associated with child‐reported depression, parent‐reported internalizing and externalizing problems, and teacher‐reported externalizing problems. Furthermore, it was found that there were gender and age differences in children's perceptions of marital conflict and their internalizing and externalizing problems. Findings indicated that boys have higher self‐blame scores and teacher‐reported externalizing problems than girls and that girls have more parent‐ and teacher‐reported internalizing problems than boys. Additionally, it was found that 9‐year‐old children have more teacher‐reported internalizing and externalizing problems than 12‐year‐old children. Also, 9‐year‐old boys have higher parent‐reported externalizing problems than 9‐year‐old girls and 9‐year‐old boys have higher parent‐reported externalizing problems than 12‐year‐old boys.     

Relations between first grade stress, temperament, and behavior problems

This paper examines relations between first grade stress, temperament, and behavior problems in 164 children after the completion of first grade. Specifically, the goals of the study were (a) to examine relations between both child and parent reports of the child's stress in first grade and behavior problems in school, (b) to determine if school stress interacts with the moderator variable temperament in predicting behavior problems, and (c) to examine such relations separately for boys and girls to assess if gender differences are present. Child and parent reports of the occurrence and upsettingness of 18 items associated with first grade were collected. Parents completed a temperament inventory; behavior problems were assessed by teacher ratings. Both child and parent reports of event upsettingness correlated significantly with externalizing behavior problems for boys, and with both internalizing and externalizing problems for girls. There was also evidence for interactions between first grade stress and temperamental characteristics in predicting externalizing behavior problems. Implications for research on childhood stress resulting from developmentally relevant life transitions are discussed.     

Diagnostic status and symptomatic behavior of hard-to-manage preschool children in middle childhood and early adolescence

Followed 2 cohorts of hard-to-manage preschool children and comparison children without early problems to middle childhood and early adolescence. Children with early problems, especially problems that were still evident at school entry, were more likely to meet diagnostic criteria for an externalizing diagnosis at follow-up. Hard-to-manage children in Cohort 1 with problems that persisted from ages 3 through 9 years were much more likely to meet diagnostic criteria at age 13 than children whose early problems were less stable in elementary school. Similarly, hard-to-manage boys in Cohort 2 whose problems persisted at age 6 were more likely to meet criteria for an externalizing diagnosis at age 9 than hard-to-manage boys whose problems appeared less stable at age 6. Across cohorts, children with persistent problems had higher levels of symptoms and more varied symptoms at ages 3 and 4 and over the course of development.     

Predictors of Social Anxiety in Children and Adolescents with Sickle Cell Disease

The aim of this study was to examine the potential moderating effect of age on the child-reported pain–social anxiety relationship in children and adolescents with sickle cell disease (SCD). Participants were children and adolescents (ages 8–17; 33 girls, 25 boys) diagnosed with SCD who completed measures of social anxiety and severity of usual pain. Caregivers provided demographic information, and mean hemoglobin levels were computed as a measure of objective disease severity. Ratings of more severe pain were associated with greater social anxiety, including fear of negative evaluation, for older children and adolescents only, revealing a moderating effect of age. Increased relevancy of peer relationships in adolescence, limited social contacts due to SCD complications, and misreading of social cues (e.g., maladaptive coping response to pain) may explain why older children and adolescents reported greater social anxiety in the presence of a stressor such as pain.