Children's Externalizing Research Articles

Child's Externalizing and Internalizing Problems and Caregiver Strain: Mediation of Child's Executive Functions.

The aim of the study is to explore the role of child's executive functions in the relation between child's externalizing and internalizing problems and caregiver strain in early school age children. The caregiver strain refers to providing nurture and care for a dependent family member. A sample includes 175 caregiver-child dyads and 36 school teachers. Participants completed the Family Strain Index which measures caregiver strain or burden (caregivers), the Strengths and Difficulties Questionnaire which measures child's externalizing and internalizing problems (teachers), and behavioral tasks that measure executive functions (children). Using structural equation modelling, the analysis resulted in a full mediation of the child's externalizing problems on the caregiver strain by child's executive functions. However, the association of child's internalizing problems with caregiver strain has not been confirmed. These results indicate that better child's executive functions buffer the negative effect of child's externalizing problems on caregiver perceived burden. Based on these results, we can suggest that interventions should be focused on programmes to improve the child's executive functions in the family and educational context, along with caregiver training aimed at providing emotional and social support, or individual therapy.

Mothers' Adverse Childhood Experiences Moderate the Association between Maternal Anger and Children's Externalizing Symptoms.

This study examined the association between maternal anger, children's externalizing symptoms, and the moderating impact of maternal adverse childhood experiences (ACEs) in the context of intimate partner violence (IPV). The primary objective was to investigate whether maternal ACEs alter the link between maternal anger and children's externalizing symptoms, guided by theoretical frameworks such as the stress sensitization and stress steeling models. A sample of 159 Portuguese mothers exposed to IPV participated in the study, completing a protocol of self-report measures. Measured variables included maternal anger, ACEs, children's externalizing symptoms, and IPV. Results indicate a significant moderation effect of ACEs on the association between maternal anger and externalizing symptoms at low levels of ACEs. Conversely, at moderate and high ACEs levels, no statistically significant association exists between maternal anger and children's externalizing symptoms. Clinical implications emphasize the importance of tailored parenting interventions to prevent externalizing symptoms in children, integrating diverse emotion regulation strategies while considering the impact of maternal ACEs.

Linking child externalising problems to psychological distress in parents: Mobile phone use by children as a mediator.

Child externalising problems, such as acting out and hostility, have been found to be significant stressors for parents, leading to increased distress levels. This cross-sectional study examined the mediating role of parents' use of mobile phones to soothe or engage children in the association between child externalising problems and distress in parents. Altogether 937 parents of children aged 5-12 reported their child's externalising problems, child's mobile phone use, and their distress through an online survey. The findings indicated that parents of children with high externalising problems are more likely to use mobile phones to soothe their children and keep them engaged in daily activities, which, in turn, is associated with higher distress in parents. Child externalising problems and distress in parents remained significantly and positively associated even after accounting for the mediating effect. The results highlight the child-driven effect on distress in parents through parenting behaviours, indicating the importance of providing alternative parenting strategies to cope with child externalising behaviours, in order to promote parental emotional well-being.

Paternal Activation as a Protective Factor against Problem Behaviors in Early Childhood.

Activation parenting includes behaviors that challenge children to approach novel situations, explore their environments, and take physical and socioemotional risks through a balance of encouragement and limit-setting. Although components of activation parenting have been linked to lower levels of children's problem behaviors, comprehensive measures of activation parenting and longitudinal research on families from low socioeconomic backgrounds are lacking. The goal of the present study was to test associations between paternal activation parenting at age 3 and children's externalizing and internalizing problems at age 5 in a sample of low-income, ethnically diverse fathers. Participating fathers (N = 171; 9% Black, 47% white, 8% Latinx; mean household income = $25,145) and their children (51% female) were drawn from the Early Steps Multisite Study. Activation parenting during a teaching task at child age 3 was associated with lower levels of internalizing problems at age 5 and decreases in externalizing problems from baseline (age 2). Implications of the current findings are presented for future research on associations between activation parenting and child problem behaviors, including the potential for the development of prevention and intervention programs.

Association of childhood externalizing, internalizing, comorbid problems with criminal convictions by early adulthood

Childhood externalizing problems have been linked with adult criminality. However, little is known about criminal outcomes among children with comorbid externalizing and internalizing problems. We examined the associations between profiles of behavioral problems during childhood (i.e., externalizing, internalizing, and comorbid) and criminality by early adulthood. Participants were N = 3017 children from the population-based Quebec Longitudinal Study of Kindergarten Children followed up from age 6–25. Multitrajectory modeling of teacher-rated externalizing and internalizing problems from age 6–12 years identified four distinct profiles: no/low, externalizing, internalizing, and comorbid problems. Juvenile (age 13–17) and adult (age 18–25) criminal convictions were extracted from official records. Compared to children in the no/low profile, those in the externalizing and comorbid profiles were at higher risk of having a criminal conviction, while no association was found for children in the internalizing profile. Children with comorbid externalizing and internalizing problems were most at risk of having a criminal conviction by adulthood, with a significantly higher risk when compared to children with externalizing or internalizing problems only. Similar results were found when violent and non-violent crimes were investigated separately. Specific interventions targeting early comorbid behavioral problems could reduce long-term criminality.

Testing reliability and validity of practitioner-rated parental sensitivity: A novel tool for practice.

Improving parental sensitivity is an important objective of interventions to support families. This study examined reliability and validity of parental sensitivity ratings using a novel package of an e-learning tool and an interactive decision tree provided through a mobile application, called the OK! package. Independent raters assessed parental sensitivity using the OK! package (N=11 raters) and the NICHD Parental Sensitivity rating scales (N=22 raters) on the basis of videotaped mother-child interactions at 10- or 12-months-old (N=294) and at 24-months-old (N=204) from the Dutch longitudinal cohort study Generation2 . Mothers reported on children's externalizing and internalizing problems and social competence when children were 4 and 7years old. Results showed excellent single interrater reliability for raters using the OK! package (mean ICC=.79), and strong evidence for convergent validity at 10- or 12-month-old (r=.57) and 24-month-old (r=.65). Prospective associations of neither parental sensitivity rated using the OK! package or the NICHD Parental Sensitivity rating scales with child developmental outcomes were statistically significant (p>.05), with overlapping 95% confidence intervals for both measures. The OK! package provides a promising direction for testing alternatives to current training and instruction modalities.

Parental guilt and children's internalizing and externalizing behavior: The moderating role of parental reflective functioning.

The immense responsibility inherent in parenthood makes feeling guilty highly prevalent among parents. Such feelings are natural, yet excessive guilt is related to depression and anxiety and could burden parents. Qualitative research suggested that guilt is predominant in parents whose children suffer from behavioral and emotional difficulties, making it necessary to quantify guilt and examine possible resilience factors that could alleviate the aversive aspects of it. In this study, we examined the association between children's externalizing and internalizing problems and different aspects of parental guilt, assessing whether parental reflective functioning (PRF) would moderate these associations. One hundred six parents of children aged 1.30-9.30 years were recruited from child daycare centers and community clinics. The Parent Development Interview was administered to measure PRF. Based on this interview, we created a new coding system, to quantify three aspects of parental guilt: intensity, reparation, and internal reaction to guilt. Children's difficulties as well as parents' depression and anxiety were assessed using validated self-report measures. We showed that children's difficulties were related to parental guilt, but only when levels of PRF were not high. Specifically, internalizing problems were related to greater intensity and negative internal reaction to guilt only when PRF was low or moderate, and externalizing problems were related to greater intensity of guilt only when PRF levels were low. These findings suggest that encouraging reflective functioning could reduce the burden of guilt. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parent-Child Inpatient Treatment in Child and Adolescent Mental Healthcare: Predictors of Child Outcomes.

Family inpatient units in child and adolescent mental health (CAMH) services engage all admitted family members in the treatment of children's symptoms. Studies demonstrated improvements in child and family functioning following family inpatient treatment, but evidence regarding predictors of treatment outcome is lacking. We analyzed data of families (n = 66) who received a four-week inpatient treatment for families with severe parent-child interaction problems. Hierarchical linear regression analyses revealed that parents who recalled harsher parenting practices of their own fathers reported greater improvements in their children's externalizing and internalizing problems. Greater improvements in externalizing problems were further predicted by lower parental educational level, less adverse impacts of stressful life events, and less internalizing child problems prior to admission. We therefore conclude that family inpatient treatment was particularly effective for children in families with lower parental education and a history of harsh parenting.

Mothers' and fathers' mentalization as moderators of the association between marital conflict and children's internalizing and externalizing behaviors

AbstractObjectiveInvestigating concordance between parents' mentalization and their moderating effects on the link between children's exposure to marital conflict and internalizing and externalizing behaviors.BackgroundMarital conflict is a risk factor for children's behavior. Mentalization is a parental strength that can protect children's well‐being in the face of adversity. Little is known about parental mentalization within the family context.MethodCohabiting, heterosexual Israeli couples (N = 89) with a 3‐ to 5‐year‐old child were interviewed individually to assess their mentalization skills (mind‐mindedness). Reports of the child's exposure to marital conflict using the O'Leary‐Porter Scale of Marital Conflict and externalizing and internalizing behaviors using the Child Behavior Checklist were obtained.ResultsThere was limited accord between parents' mentalization within each couple. The positive associations between conflict exposure and children's internalizing and externalizing behaviors were mitigated when the parents' mentalization skills were matched or when the mother's mentalization skills were high. A significant three‐way interaction emerged such that the contribution of the father's mentalization skills to the prediction of children's externalizing and internalizing behavior depended on the mentalization skills of the mother and the level of exposure to conflict.ConclusionCoordinated, high levels of parental mentalization can mitigate the negative impact of exposing children to parental conflict.ImplicationsParental mentalization can mitigate children's exposure to marital conflict. Enhancing parental mentalization is an important treatment goal for the family and for the child. Family interventions can benefit from evaluating each parent's initial parental mentalization skills to determine whether the parental couple share a similar level of this capacity. Detecting and addressing gaps between the parents in their parental mentalization skills can facilitate coordinated and shared parenting.

Generating Actionable Evidence for School-Based Mental Health Service Delivery: Public-Academic Partnership Based Evaluations.

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence.

The P3 ERP in Relation to General Versus Specific Psychopathology in Early Childhood.

There is considerable covariation between externalizing and internalizing problems across the lifespan. Partitioning general and specific psychopathology is crucial to identify (a) processes that confer specific risk for externalizing versus internalizing problems and (b) transdiagnostic processes that confer risk for the covariation between externalizing and internalizing problems. The oddball P3 event-related potential (ERP) component, thought to reflect attentional orienting, has been widely examined in relation to psychopathology. However, prior studies have not examined the P3-or other aspects of neural functioning-in relation to general versus specific psychopathology in children. The present study examined whether children's (N = 124, ages 3-7years) P3 amplitudes were associated with general versus specific psychopathology. Children's electroencephalography data were recorded during an oddball task. Parents rated their children's externalizing and internalizing problems. Using bifactor models to partition variance in parents' ratings of children's psychopathology symptoms, we examined children's P3 amplitudes in relation to three latent factors: (1) the general factor of psychopathology-the covariation of externalizing and internalizing psychopathology, (2) unique externalizing problems-the variance in externalizing problems after controlling for the general factor, and (3) unique internalizing problems. Results indicated that smaller P3 amplitudes were associated with unique externalizing problems at ages 3-5, and with general psychopathology at ages 6-7. Findings suggest that smaller P3 amplitudes may be associated with externalizing problems from a very young age. Moreover, there may be a developmental shift in the functional significance of the P3 in relation to general and specific psychopathology in childhood.

Compensatory effects of maternal and paternal supportive parenting in early childhood on children's school-age adjustment.

Both maternal and paternal supportive parenting (i.e., sensitivity, warmth, stimulation, and engagement) across early childhood have been found to be associated with multiple domains of children's positive socioemotional functioning. However, few studies have considered how maternal and paternal supportive parenting may interact to impact child development. Thus, the present study assessed direct and moderated longitudinal relations between maternal and paternal supportive parenting in toddlerhood (24 and 36 months, respectively) and fathers' and teachers' reports of children's socioemotional and behavioral adjustment in first grade. Data were drawn from a large, sample of Norwegian parents and children (N = 455, 51% female, 49% male, 10% endorsed financial strain, 75% of fathers and 86% of mothers born in Norway). After controlling for child temperamental activity level and soothability in infancy, path analysis revealed that higher paternal supportive parenting was associated with fewer symptoms of father-reported child hyperactivity/impulsivity in first grade. In addition, a significant interaction between maternal and paternal supportive parenting was evident for three out of the four assessed outcomes (per both father- and teacher-reports): externalizing problems, hyperactivity/impulsivity symptoms, and social skills. Simple slope analyses revealed a negative relation between parental supportive parenting and children's externalizing (father-reported) and hyperactivity/impulsivity problems (father- and teacher-reported) when the child's other parent engaged in low levels of supportive parenting. Similarly, paternal supportive parenting was positively associated with children's social skills (father-report) when mothers engaged in low levels of supportive parenting. Results are discussed with implications for including both mothers and fathers in early childhood research, intervention, and social policy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Teachers' self-efficacy and perceptions of school climate are uniquely associated with students' externalizing and internalizing behavior problems

Early externalizing and internalizing problems undermine children's school success and long-term well-being. Leveraging a large, U.S.-representative dataset (N ≈ 14,810), we examined how kindergarten teachers' self-efficacy and school climate perceptions were linked to students' behavior problems in kindergarten and first grade. Teachers' self-efficacy and school climate perceptions were uniquely linked to kindergarteners' externalizing and internalizing behaviors, after controlling for demographic covariates and children's executive functions. Kindergarten teachers' higher self-efficacy predicted lower levels of children's externalizing problems in first grade, while teachers' positive school climate perceptions predicted children's lower internalizing problems in first grade. Longitudinal models demonstrated that teachers' perceived school climate and self-efficacy were uniquely associated with decreases in children's externalizing and internalizing behaviors from kindergarten to first grade. Findings highlight the importance of teachers' self-efficacy and school climate for children's socio-emotional development and underscore an urgent need to determine how best to support teacher well-being to optimize children's outcomes.

African American, low‐income mothers’ negative emotional reactivity, punishment, and children's externalizing and internalizing behavior

AbstractObjectiveIn this study, we examined African American, low‐income mothers’ emotional reactivity and use of punishment in relation to determinants of parenting and children's behavior.BackgroundMore research is needed examining within‐group variation in parenting processes, including discipline, of African American parents. Parents’ negative emotion may have implications for children's behavior independent of punishment as a disciplinary strategy.MethodParticipants were 157 African American, low‐income mothers and their 4‐ to 7‐year‐old children. Mothers responded verbally to a questionnaire and were observed interacting in their natural home environment. Direct and indirect relations were examined from three determinants of parenting (i.e., depression, household disorganization, child difficulty) to negative emotional reactivity, punishment, sensitivity, and children's behavior.ResultsDepressive symptoms, household disorganization, and child difficulty were associated with children's externalizing and internalizing behavior indirectly through negative emotional reactivity. Household disorganization predicted externalizing behavior through verbal punishment. Physical punishment was not related to children's behavior above and beyond negative emotional reactivity.ConclusionThis study supports the proposal that parents’ ability to regulate negative emotional reactivity in stressful contexts may have important implications for parenting and children's development above and beyond punishment.ImplicationsIntervention and preventative parent education programs should consider adding components that help parents with emotion regulation during stressful parenting situations.

Polygenic risk for neuroticism is associated with externalizing symptoms in 2-year-old boys

Recent advances in genome-wide association studies have enabled the estimation of genetic risk of complex traits, including neuroticism, with polygenic risk scores (PRS). Neuroticism PRS has been associated with psychiatric disorders and symptoms in adults, but studies in children are scarce. We studied whether neuroticism PRS, and its subscales, worry PRS and depressive affect PRS, were associated with externalizing and internalizing symptoms in 2-year-olds. We also examined parental neuroticism PRSs' association with children's externalizing and internalizing symptoms and whether parental depressive symptoms mediated the effect. Participants from two Finnish birth cohorts, CHILD-SLEEP and FinnBrain Birth Cohort Study, who had DNA and data on Brief Infant-Toddler Social and Emotional Assessment (BITSEA) available were included in the study (N = 806 and N = 987, respectively). PRSs were calculated based on GWAS data from UK Biobank. Child's neuroticism PRS, and its subscale worry PRS, were positively associated with externalizing symptoms in 2-year-old boys, but not in girls. Mother's depressive symptoms mediated the association between maternal neuroticism PRS and externalizing and internalizing symptoms in boys, but not in girls. Our results suggest that neuroticism PRS, and its subscale worry PRS, are associated with externalizing symptoms in already as young as 2-year-old boys, and, that subclinical symptoms of maternal depression that are based on genetic disposition, have an effect on boy's internalizing and externalizing symptoms. As we did not find any associations in girls, our study supports the suggestion that girls and boys may differ in how genetic and environmental factors contribute to their development.

Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes

Little is known about the long-term economic and social outcomes for children with longitudinally assessed comorbid externalizing and internalizing symptoms, especially compared with children with externalizing symptoms or internalizing symptoms only. To examine the association between childhood trajectories of externalizing, internalizing, and comorbid symptoms and long-term economic and social outcomes. A 32-year prospective cohort study linked with administrative data was conducted in school-aged participants aged 6 to 12 years in the Québec Longitudinal Study of Kindergarten Children (N = 3017) followed up from 1985 to 2017. Data analysis was conducted between August 1, 2021, and March 31, 2022. Teacher-rated behavioral symptoms were used to categorize children from age 6 to 12 years into developmental profiles using group-based trajectory modeling. Multivariable regression models were used to test the association between childhood symptom profile group and adult employment earnings, welfare receipt, intimate partnership status, and having children living in the household. Participant sex, IQ, and socioeconomic background were adjusted for. Of 3017 participants in this sample, 1594 (52.8%) were male and 1423 (47.2%) were female. Per confidentiality rules established by Statistics Canada, income variables were rounded to base 100 and count variables were rounded to base 10; the mean (SD) age was 37 (0.29) years at follow-up. Four symptom profiles were identified: no/low (n = 1369 [45.4%]), high externalizing (882 [29.2%]), high internalizing (354 [11.7%]), and comorbid (412 [13.7%]) symptoms. Compared with the no/low symptom profile, participants in the high externalizing-only profile earned $5904 (95% CI, -$7988 to -$3821) less per year and had 2.0 (95% CI, 1.58-2.53) times higher incidence of welfare receipt, while participants in the high internalizing group earned $8473 (95% CI, -$11 228 to -$5717) less per year, had a 2.07 (95% CI, 1.51-2.83) higher incidence of welfare receipt, and had a lower incidence of intimate partnership (incident rate ratio [IRR], 0.89; 95% CI, 0.80-0.99). Participants in the comorbid profile fared especially poorly: they earned $15 031 (95% CI, -$18 030 to -$12 031) less per year, had a 3.79 (95% CI, 2.75-5.23) times higher incidence of annual welfare receipt, and were less likely to have an intimate partner (IRR, 0.71; 95% CI, 0.63-0.79) and children living in the household (IRR, 0.86; 95% CI, 0.80-0.92). Estimated lost earnings over a 40-year working career were $140 515 for the high externalizing, $201 657 for the high internalizing, and $357 737 for the comorbid profiles. In this cohort study, children exhibiting sustained childhood high externalizing, high internalizing, or comorbid symptoms were at increased risk of poor economic and social outcomes into middle age. These findings suggest that children exhibiting comorbid problems were especially vulnerable and that early detection and support are indicated.

Pathways from marital relationships to children's social-emotional development in Korea: The role of parenting and social support

Using three waves of data from the Panel Study of Korean Children (family N = 1,723), this study investigated whether and how the longitudinal effects of marital relationships on children's social-emotional development are mediated through parenting and the moderating role of social support in the mediating processes. Results showed that fathers’ coparenting and warmth and mothers’ parenting stress mediated the effects of marital relationships on children's externalizing and internalizing problems. Notably, some of the mediating processes were moderated by social support from extended family, friends, and neighbors. Our findings highlight the importance of considering both the proximal and broader family environment (e.g., social support from people outside the family) in understanding children's early social-emotional development.

Parental Rejection and School-aged Children's Externalizing Behavior Problems in China: The Roles of Executive Function and Callous-unemotional Traits.

This study examined the mediating role of children's executive function (EF) in the relation between parental rejection and children's externalizing behavior problems and whether this mediation varies depending on their callous-unemotional (CU) trait levels. Two hundred and eighty-four Chinese school-aged children and their fathers and mothers participated. Both fathers and mothers reported on parental rejection, children's externalizing behavior problems, EF, and CU traits. The results showed that EF mediated the association between parental rejection and externalizing behavior problems. Moreover, the negative link between EF and externalizing behavior problems was moderated by CU traits; in particular, the combination of higher-level CU traits and lower-level EF predicted more externalizing behavior problems. Our findings point to the importance of considering family context and multiple personal factors simultaneously to decrease children's behavior problems.

Association of childhood externalizing, internalizing and comorbid symptoms with long-term economic outcomes

IntroductionExternalising and internalising problems are common in school-aged children. Few studies have examined the association between comorbid externalising and internalising symptoms and adult-life economic participation.ObjectivesTo investigate associations of childhood externalising, internalising, and comorbid internalising-externalising symptoms with earnings and welfare receipt in adulthood.MethodsWe used group-based trajectory modeling to identify profiles of children with externalising, internalising, and comorbid symptoms from age 6-12 years. We estimated associations of the identified profiles with participants’ employment earnings at age 33-37 years and welfare receipt from age 18-35 years obtained from tax return records. The child’s IQ and family socioeconomic background were adjusted for.ResultsFour profiles were identified: no symptoms (45%), externalizing (29%), internalizing (11%) and comorbid symptoms (13%). Relative to the no-symptom profile, participants in the comorbid profile earned US$-18,323 less annually (95%CI=-20,925 to -15700) at age 33-37 years and were significantly more likely to receive welfare across follow-up (RR=6.30, 95%CI=5.4 to 7.2). Similarly, compared to the no-symptom profile, participants in the externalising profile earned US$-7,256 less per year (95%CI=-9,205 to -5,307), while participants in the internalising profile earned US$-9,716 less (95%CI=-12,358 to -7,074). Significant interactions by sex were observed. For participants in the comorbid profile, males were more likely to have lower earnings while females were more likely to receive welfare, relative to the no-symptom profile.ConclusionsChildren exhibiting comorbid externalising and internalising symptoms are at high risk of poor economic outcomes in adulthood. Early detection, prevention and management is crucial to improve the life chances of this vulnerable population.DisclosureNo significant relationships.

Parental Deportation, Safe-Zone Schools, and the Socio-Emotional and Behavioral Health of Children Left Behind.

Over four million US-born children living in households with at least one unauthorized immigrant parent are the unintended victims of intensified immigration enforcement. In an effort to address these disadvantages, many schools and school districts throughout the country have implemented “safe-zone” policies to limit their cooperation with immigration authorities, restrict agents' access to campuses, and provide resources for students and their immigrant families. Using data from a binational survey that collected information on children from mixed-status households, we document positive and significant correlations between safe-zone policies and children's externalizing, internalizing, and total difficulties scores, as well as their prosocial behaviors.