Concomitant Trajectories of Internalising, Externalising, and Peer Problems Across Childhood: a Person-centered Approach

Lisa-Christine Girard

doi:10.1007/s10802-021-00851-8

Abstract

This study investigated trajectories of concomitant internalising, externalising, and peer problems, and associated risk factors for group-membership, using a person-centered approach to better understand heterogeneity in subgroups identified. A cohort of 7,507 children in Ireland was followed from infancy to late childhood (50.3%, males; 84.9% Irish). The parent-version of the Strengths and Difficulties Questionnaire was used when children were 3, 5, 7 and 9 years of age. Information on antecedent risk factors was collected when children were 9 months. Group-based multi-trajectory modelling and multinomial logistic regression were used. Six subgroups of children with distinct profiles were identified, evidencing both homotypic and heterotypic comorbidity. No support of a ‘pure’ internalising, externalising or peer problems group was found in any identified trajectory group. Difficulties in one problem domain indicated the presence of difficulty in another problem domain for all children in elevated groups. Risk factors associated with group-membership were complex, with only three common factors across elevated groups: prenatal exposure to smoking, maternal education, and maternal stress. Specific risk factors for group-membership included low birth weight, sex, maternal age, maternal depression, family composition, social class, medical card status and quality of attachment. Despite some overlap in predictors, the combination of predictors specific to each group would suggest tailored programming. For children with the most acute problems, programming targets should include families with boys, born with low birth weight, exposed to smoking prenatally, with mothers who have lower levels of education, postnatal depression, increased stress and fewer financial resources.

Highlights

To the best of my knowledge, this study is the first to have modelled concomitant trajectories of internalising, externalising, and peer problems from early to late childhood, using a group-based multi-trajectory approach, whilst examining antecedent risk factors associated with group membership
Whilst boys are routinely found at risk for elevated trajectories of externalising problems (e.g., Girard et al, 2019), the evidence is mixed when examining internalising problems (Dekker et al, 2007; Mesman et al, 2001). These results suggest that heterotypic comorbidity of internalising and externalising problems increases the risk of membership in elevated groups for boys in particular
Using a person-centered approach with a populationbased cohort, 6 distinct subgroups of children presenting with concomitant internalising, externalising, and peer problems was found, providing unbiased prevalence rates (Angold et al, 1999)

Summary

Methods

Participants included children and their families enrolled in the Growing Up in Ireland (GUI) Infant cohort study, identified from the Child Benefit Register. Attrition and non-response across waves resulted in 9,789 participants at the age of three having data on the main outcomes (i.e., internalising, externalising and peer problems), 8,998 participants at the age of five, 5,281 participants at the age of seven/eight, and 8,022 participants at the age of nine. Sampling weights were used, bringing the distribution of characteristics of the sample still participating at nine years, and across at least 4 waves, to within 0.5% of the population distribution (for a detailed description of the calculated sampling weights, see Quail et al, 2019). The final sample used in the current study includes 7,507 families who participated in at least 4 of the 5 waves, using the weighting factor to ensure generalizability to the population.

Results

Discussion

Conclusion