Linking Childhood Sexual Abuse and Early Adolescent Risk Behavior: The Intervening Role of Internalizing and Externalizing Problems

A robust literature links childhood sexual abuse (CSA) to later substance use and sexual risk behavior; yet, relatively little empirical attention has been devoted to identifying the mechanisms linking CSA to risky behavior among youth, with even less work examining such processes in boys. With the aim of addressing this gap in the literature, the current study examined the indirect effect of childhood sexual abuse (CSA; from age 2 to 12) trajectory group on risky behavior at age 14 (alcohol use & sexual intercourse) via the intervening role of caregiver-reported internalizing and externalizing problems at age 12. Analyses were conducted with a subsample of youth (n?=?657 sexual intercourse; n?=?667 alcohol use) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a multisite prospective study of youth at risk for maltreatment. For boys and girls, there was an indirect effect from CSA to sexual intercourse through externalizing problems. The same pattern emerged for alcohol use, but only for girls. Findings did not support an indirect path through internalizing problems for either boys or girls for either outcome. Findings suggest more focal targets for prevention efforts aimed at maintaining the health and safety of maltreated boys and girls during the adolescent transition.     

Differences in Internalizing and Externalizing Problems Among Early Adolescent Subtypes Based on Attachment Security

The study examined the influence of adolescents’ secure attachment to both versus one parent on their psychosocial adjustment in terms of self and parent evaluations of internalizing and externalizing behaviour problems. The sample consisting of 8th grade adolescents (n?=?406; 178 girls) aged 12–14 years were classified into four subgroups based on their attachment security to their father and mother. The study aimed to test the differences in internalizing and externalizing problems among the four subgroups- of adolescents with secure attachment to both parents, to only mother, to only father and insecure attachment to father and mother. The results showed that more number of adolescents were classified as securely attached to mothers than to fathers. The group of adolescents who felt securely attached to both parents was psychosocially most well adjusted, while those with insecure attachment to both parents were most vulnerable to maladjustment. In addition, secure attachment only to one’s mother and not to one’s father was a protective factor against maladjustment, while secure attachment to father alone was not. The study helps to understand how parent-adolescent secure attachment contributed to differences in psychosocial adjustment among these subgroups of normal adolescents.     

Brief Parenting Interventions for Children at Risk of Externalizing Behavior Problems: A Systematic Review

We systematically reviewed the evidence for the efficacy and effectiveness of brief parenting interventions, defined as <8 sessions in duration, in reducing child externalizing behaviors. While there is significant evidence to support the efficacy of parenting interventions of 8–12 sessions in duration, the public health benefit of these interventions is limited by low participation rates, high attrition rates and the lack of implementation by a wide range of practitioners. Brief parenting interventions have the potential to extend the reach and impact of parenting interventions and steer children away from a trajectory of life course persistent behavior problems. A search of four electronic databases was undertaken to identify RCTs conducted on brief parenting interventions. The primary outcome was child externalizing behaviors and secondary outcomes included parenting skills, parental self-efficacy, parental mental health and partner relationship functioning. The heterogeneity of included studies prevented a meta-analysis but characteristics of the studies were described. Nine papers summarising the results of eight studies with 836 families in five countries met inclusion criteria. All studies found significant improvements in parent-rated child externalizing behaviors, parenting skills and parenting self-efficacy, relative to control or comparison groups, with findings maintained at follow-up. Less consistent findings emerged for parental mental health and partner relationship functioning. This review provides initial evidence that brief parenting interventions may be sufficient to reduce child externalizing behavior problems for some families, however further research is needed.     

Predicting Growth Curves of Early Childhood Externalizing Problems: Differential Susceptibility of Children with Difficult Temperament

Using an accelerated longitudinal design, the development of externalizing problems from age 2 to 5 years was investigated in relation to maternal psychopathology, maternal parenting, gender, child temperament, and the presence of siblings. The sample consisted of 150 children selected at age 2–3 years for having high levels of externalizing problems. Parenting was measured using observational methods, and maternal reports were used for the other variables. Overall, mean levels of externalizing problems decreased over time, and higher initial levels (intercept) were related to a stronger decrease (negative slope) in externalizing problems. Results showed that higher levels of maternal psychopathology were related to less decrease in early childhood externalizing problems. Parental sensitive behavior predicted a stronger decrease in externalizing problems, but only for children with difficult temperaments. A stronger decrease of externalizing problems in children with older siblings also pertained only to children with difficult temperaments. Thus, temperamentally difficult children appear to be more susceptible to environmental influences on the development of externalizing behaviors. Our results indicate that the role of siblings in early childhood externalizing problems deserves more research attention, and that intervention efforts need to take into account temperamental differences in children’s susceptibility to environmental influences.     

The Development of Early Externalizing Problems Among Children from Low-Income Families: A Transformational Perspective

The present study examined pathways leading to early externalizing problems from age 1 to 31/2 in a design that took advantage of our knowledge of normative progression and normative socialization as well as findings from research on risk. A sample of 130 low-income participants was followed longitudinally from 12 to 42 months using observational measures of developmentally salient parenting and child disruptive behavior to predict early externalizing problems. Results are best accommodated by concepts such as transformation and transaction from developmental psychology. For boys, both child and parent variables predicted later externalizing. For girls and boys, the interaction between child noncompliance and maternal rejection was significant.     

Sympathetic Under-Arousal and Externalizing Behavior Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) commonly exhibit co-occurring externalizing behavior problems, which can impede learning opportunities and contribute significantly to caregiver stress. Substantial theory and research has linked under-arousal of the sympathetic nervous system to increased externalizing problems in children without ASD, but under-arousal has not been considered as an explanatory mechanism for individual differences among children with ASD. We tested the notion that lower electrodermal activity (EDA) would predict more externalizing problems in children with ASD, and considered the degree to which parent co-regulatory support could buffer this risk. Forty children with ASD between the ages of 4 and 11 years and their primary caregivers participated in a laboratory visit that included various play, compliance, and problem-solving regulatory tasks. EDA was measured through wireless wrist sensors, parental scaffolding was observed during a dyadic problem-solving task, and parents rated their children’s externalizing behavior problems. As predicted, low EDA during the compliance-oriented tasks directly predicted higher child externalizing problems. Parental scaffolding moderated the link between under-arousal during the problem-solving regulatory tasks and externalizing problems such that the relation was observed in the context of low, but not high, support. Implications for relevant theories (e.g., fearlessness theory, stimulation-seeking theory) are discussed, and the potential for psychophysiological patterns to inform intervention with these children is considered.     

First-Year Maternal Employment and Adolescent Externalizing Behavior

Associations between first-year maternal employment and mother—and youth-reported externalizing behavior at age 15 were examined paying attention to potential mediating roles of home and child care environments by 36?months, effortful control at 54?months, and externalizing behavior at 54?months and middle childhood. We used data from the NICHD Study of Early Child Care and Youth Development (n?=?922 non-Hispanic White children) which is a prospective birth cohort study that followed children from birth to age 15. Full-time first-year maternal employment was associated with higher levels of externalizing behavior at age 15 through higher maternal depressive symptoms by 36?months, lower effortful control at 54?months, and higher externalizing behavior at 54?months and middle childhood. Part-time first-year maternal employment was not associated with higher externalizing behavior at age 15.     

Executive Functions in Preschool Children with Externalizing Behavior Problems: A Meta-Analysis

Deficits in executive functions (EF) have been found in school-age children and adolescents with externalizing behavior disorders. Present meta-analysis was carried out to determine whether these EF impairments can also be found in preschool children with externalizing behavior problems. Twenty-two studies were included with a total of 4021 children. Four separate meta-analyses were conducted, concerning overall EF, working memory, inhibition and cognitive flexibility. A medium correlation effect size was obtained for overall EF (ESzr?=?0.22) and for inhibition (0.24), whereas a small effect size was found for working memory (0.17) and for cognitive flexibility (0.13). Moderator analyses revealed a stronger effect for older preschoolers compared to younger preschoolers, and for children from referred samples compared to community samples. These results show that EF, especially inhibition, is related to externalizing behavior problems already in preschool years.     

The Role of Maternal Depression on Treatment Outcome for Children with Externalizing Behavior Problems

Studies have shown that, on average, Parent Management Training combined with cognitive-behavioral therapy decreases children’s externalizing behavior, but some children do not improve through treatment. The current study aimed to examine the role of maternal depression in understanding this variability in treatment outcome. Children with externalizing behavioral problems and their parents were recruited from combined Parent Management Training and Cognitive-Behavioral programs in “real-world” clinical settings. At pre- and post treatment, maternal depression and children’s externalizing behavior were assessed. Results showed that treatment was less effective for children of depressed mothers compared to non-depressed mothers and that improvements in maternal depression were associated with improvements in children’s externalizing behavior. These findings suggest that treatment programs for children with externalizing problems may be able to improve outcomes if maternal depression is a target of intervention.     

Unintentional Injury Risk in Children with Externalizing Behavior Disorders at Summer Camp

Children with externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) have greatly increased risk of unintentional injury, but it is unclear what mechanisms are responsible for that increased risk. This study followed 22 children participating in a summer camp for children with ADHD. Injury incidents were recorded daily and a set of primary symptoms of behavioral disorders were recorded at 15-min intervals over the course of the 6-week summer camp experience (roughly 300 h of observing each child). We predicted symptoms of ODD and CD would be more strongly related to injury incidence than symptoms of ADHD. Results from univariate Poisson regression models confirmed our prediction. Symptoms of ODD and CD—violations and intentional aggression in particular—were related to injury incidence but symptoms of ADHD were not. This finding is consistent with a growing body of evidence that oppositional, noncompliant, and aggressive behavior patterns might be primarily responsible for increased risk for injury among children with externalizing behavior disorders. Thanks to Sylvie Mrug, Peter Winslett, and the other staff members of the STP camp for their cooperation.     

Prospective Associations of Internalizing and Externalizing Problems and Their Co-Occurrence with Early Adolescent Substance Use

The literature is equivocal regarding the role of internalizing problems in the etiology of adolescent substance use. In this study, we examined the association of internalizing and externalizing behavior problems and their co-occurrence with early adolescent substance use to help clarify whether internalizing problems operate as a risk or protective factor. A large community sample (N?=?387; mean age at the first assessment 12 years old; 83 % White/non-Hispanic) was assessed annually for 3 years. Externalizing problem behavior in the absence of internalizing problems showed the strongest prospective association with alcohol, cigarette, and marijuana use. A weaker, albeit statistically significant prospective positive association was found between co-occurring internalizing and externalizing behavior problems and substance use. Internalizing problems in the absence of externalizing problems protected adolescents against cigarette and marijuana use. Clarifying the role of internalizing problems in the etiology of adolescent substance use can inform the development of early intervention and prevention efforts. Our results highlight the importance of further considering the co-occurrence of internalizing and externalizing behavior problems in developmental pathways to substance use.     

Sexual and Physical Abuse Among Adolescent Girls with Disruptive Behavior Problems

We examined the prevalence and age of onset of physical and sexual abuse in a clinic-referred sample of adolescent girls, as well as differences in diagnoses and symptoms among abused and non-abused girls. Forty-nine girls (aged 13–17 years) with disruptive behavior were interviewed along with their primary caretaker. Data were gathered through both a structured interview with the girl and her parent, as well as self and parent-report questionnaires. Findings indicated that the prevalence of Conduct Disorder (CD) and Major Depression were higher for abused girls. Somatoform Pain Disorder was significantly less likely for physically abused girls, compared to girls who were both physically and sexually abused. Of CD symptoms, truancy was twice as high for the physically and sexually abused group, compared to the prevalence for non-abused girls. Internalizing symptoms were also highest for the dual abuse group. Onset graphs show that the onset of sexual abuse usually occurred at an earlier age than the onset of physical abuse. Abused girls showed an earlier age of onset of CD symptoms. Results indicated that the experience of combined types of abuse is associated with a poorer psychiatric prognosis.     

Predictors of Externalizing Behavior Problems in Early Elementary-Aged Children: The Role of Family and Home Environments

As children enter elementary school they display behavioral orientations that reveal potential developmental trajectories. Developmental transitions offer unique opportunities for examining developmental pathways and the factors that influence emerging pathways. The primary goal of this investigation was to examine characteristics of family and home contexts in predicting externalizing behavior problems among children transitioning into elementary school. Dimensions of the family and home environments of maltreated and nonmaltreated children (N = 177) were examined and used to predict externalizing behavior problems. Maltreatment was assessed using case file information, characteristics of the family and home environment were rated by interviewers, and externalizing behavior was assessed by mother's ratings on the Child Behavior Checklist. Relative to nonmaltreated children, the family environments of physically abused children were characterized by higher levels of negative social interactions. Also, in comparison to nonmaltreated children, the home environments of children who experienced neglect were characterized as less organized and clean. Hierarchical regression analyses revealed that physical abuse was the strongest predictor of externalizing behavior. After controlling for the contribution of physical abuse, mother's negative behavior toward the focal child, aggression between siblings, and the lack of an organized and clean home were each predictive of externalizing behavior.     

Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample

Research on bipolar spectrum disorders (BPSD) in adolescence has burgeoned in the last decade, but continued work is needed to identify endophenotypic markers associated with illness onset and course. The present study examined reward dysregulation—measured via the behavioral activation system (BAS)—as one putative marker of BPSD in adolescence. A diverse group of 425 outpatient adolescents between 11 and 17 years of age (52 % male) completed the Behavioral Inhibition and Activation Scale (BIS-BAS) scale to measure reward dysregulation. Semi-structured interviews determined diagnoses and severity of mood symptoms. Parent-reported BAS was associated with increased symptoms of mania, and parent and adolescent-reported BAS were associated with symptoms of depression. Parent-reported BIS scores were associated with increased symptoms of mania. Results held independent of diagnostic status. Furthermore, parent BIS/BAS reports were stronger predictors for manic symptoms compared to adolescent-reports. Results extend work in adults with BPSD, suggesting a transdiagnostic association between reward dysregulation and mood symptom severity in adolescence.     

Evaluation of the First 3 Years of the Fast Track Prevention Trial with Children at High Risk for Adolescent Conduct Problems

Fast Track is a conduct-problem prevention trial that derives its intervention from longitudinal research on how serious and chronic adolescent problem behaviors develop. Over 9,000 kindergarten children at 4 sites in 3 cohorts were screened, and 891 were identified as high risk and then randomly assigned to intervention or control groups. Beginning in Grade 1, high-risk children and their parents were asked to participate in a combination of social skills and anger-control training, academic tutoring, parent training, and home visiting. A multiyear universal classroom program was delivered to the core schools attended by these high-risk children. By the end of third grade, 37% of the intervention group was determined to be free of serious conduct-problem dysfunction, in contrast with 27% of the control group. Teacher ratings of conduct problems and official records of use of special education resources gave modest effect-size evidence that the intervention was preventing conduct problem behavior at school. Parent ratings provided additional support for prevention of conduct problems at home. Parenting behavior and children's social cognitive skills that had previously emerged as proximal outcomes at the end of the 1st year of intervention continued to show positive effects of the intervention at the end of third grade.     

Early Fathering as a Predictor of Later Psychosocial Functioning Among Preschool Children with Behavior Problems

The present study examined the role of early fathering in subsequent trajectories of social emotional and academic functioning of preschool children with behavior problems. Participants were 128 preschool-aged children (73 boys, 55 girls) with behavior problems whose biological fathers took part in a longitudinal study. Children were 3 years of age at the beginning of the study and were assessed annually for 3 years. Early paternal depressive symptoms predicted many aspects of children’s outcome 3 years later, including externalizing and internalizing problems, social skills deficits, and lower cognitive and academic functioning, and predicted changes in children’s externalizing, internalizing, and social problems across the preschool years. Paternal socioeconomic status (SES) also consistently predicted children’s later functioning across these domains. Furthermore, self-reported paternal attention-deficit hyperactivity disorder (ADHD) symptoms and laxness, as well as observed frequent commands were associated with later externalizing problems in children. Paternal depressive symptoms and laxness mediated the relation between paternal ADHD symptoms and child functioning. Results suggest that aspects of early father functioning play an important role in the psychosocial, cognitive, and academic development of preschool-aged children with behavior problems.     

The Differential Impact of Parental Warmth on Externalizing Problems Among Triangulated Adolescents

Triangulation is a family-wide process in which children are inappropriately involved in interparental conflict, placing them at heightened risk for adjustment problems. A common form of triangulation occurs by parents pressuring their children to take sides, which may result in feelings of being torn between parents. Externalizing behaviors in particular may develop as adolescents feel caught in the middle of conflict and forced to choose a side. However, the nature of the triadic process of triangulation may be impacted by dyadic-level relationships within the family. The authors thus explored how positive parenting processes may alter the relations between triangulation and adolescent externalizing problems. Mothers, fathers, and adolescents (n = 301 families) provided assessments of adolescent externalizing problems, triangulation, and maternal and paternal warmth. Analyses revealed a 3-way interaction among triangulation and maternal and paternal warmth predicting adolescent externalizing problems; child gender also moderated these relations. Among highly triangulated youth, boys displayed increased externalizing problems when both parents exhibited low or high warmth, whereas girls showed increased behavior problems in the context of low maternal but high paternal warmth. These findings indicate the importance of examining the broader family context and gender when considering the impact of triangulation during adolescence.