Internalizing Behavior Problems Research Articles

Evaluation of ANKOMMEN as a group intervention based on life story work for adolescents in residential care in Germany: a single-arm pilot study

BackgroundAdolescents face many challenges when coping with out-of-home placement, and life story work can be helpful in this context. Typically conducted in individual settings, life story work’s high resource requirements pose a challenge for implementation in the standard care of youth welfare institutions. To address this issue, the ANKOMMEN intervention was developed as a manualized group program for adolescents in residential care focusing on processing and coping with experiences associated with their out-of-home placement.MethodThe intervention was evaluated in a single-arm pilot study with questionnaires administered at three time points (pre-intervention, post-intervention, and 3-month follow-up). The primary outcome was self-efficacy, while secondary outcomes included self-esteem, depressive symptoms, posttraumatic stress symptoms, and behavioral problems. A total of 31 intervention groups with 115 adolescents (M = 14.91 years; SD = 1.45; 52.2% male) were conducted between October 2020 and September 2022 in Germany. Data were analysed using mixed effect models.ResultsPre-post comparisons revealed increased self-efficacy (d = −0.80) and self-esteem (d = −0.68) among participants with below-average scores prior to the intervention. Additionally, there was a decrease in self-reported depressive symptoms (d = 0.76), self-reported posttraumatic stress symptoms (d = 0.58), self-reported internalizing behavior problems (d = 0.74), caregiver-reported internalizing behavior problems (d = 0.76), and self-reported externalizing behavior problems (d = 0.52) for participants with clinically relevant scores prior to the intervention. These improvements were stable in the 3-month follow-up assessment. Furthermore, the intervention proved its feasibility in standard care within the context of the evaluation study.ConclusionsThe results of the pilot study provide preliminary evidence for the feasibility and potential effectiveness of ANKOMMEN but further research is needed to obtain valid evidence for the efficacy of the intervention.

Peer attachment in adolescence: What are the individual and relational associated factors?

AbstractThe quality of peer attachment in adolescence is an important determinant of psychosocial adjustment. To date, few clear conclusions can be drawn about the most important factors associated with the quality of peer attachment. This study aimed to identify the most important individual and relational factors associated with peer attachment quality, and to establish their relative contribution. Early adolescents (N = 634, 45.7% girls), 11.29 years on average at the first measurement time, participated in the longitudinal study. Individual and relational factors were measured at T1; parent and peer attachment quality were measured at T2, 2 years later. First, a multiple linear regression analysis was performed using the global score for peer attachment as the outcome variable. Second, a path model, including the three specific attachment dimensions (trust, communication, and alienation), was tested. The invariance of the models by sex was also examined. The analyses showed that peer attachment was associated positively with the adolescent–parent attachment relationship, the adolescent's age, as well as the teacher–student relationship, and associated negatively with the presence of internalizing behavior problems and social rejection. These variables helped explain 21.3% of the total variance. Give or take a few nuances, these same variables were also related to the three specific peer attachment dimensions. Sex differences were observed for the associated factors of these specific dimensions. This study highlights the importance of certain relational variables, in both family and school contexts, as correlates of peer attachment.

Emotional Competences in Adolescents Exposed to Colombian Armed Conflict During Their Childhood

AbstractObjective: Analyse the mediation role of emotional competences on behavior problems in adolescents exposed to Armed-Conflict Childhood Adversities (ACCA). Method: Families with adolescent children who studied in three schools in the municipality of Soacha, Colombia, were invited to participate in the study. One hundred and sixty-one participants were selected and pooled into three groups according to their Adverse Childhood Experiences (ACE) scores: lower-ACE (LACE), higher-ACE (HACE), and ACCA using the Adverse Childhood Experiences Questionnaire for Adolescents (ACE-QA). The Emotion Recognition Task, the Empathy for Pain Task, and the Child Behavior Checklist assessed teenagers’ emotional functioning. Results: Teenagers exposed to ACCA more frequently experienced childhood adversities such as domestic violence, child abuse, and parental neglect. Moreover, these adolescents were less accurate in discriminating angry faces, reported higher control perception after social stressors, were more rigorous in punishing those who intentionally harmed others, and showed more internalizing behavior problems. In the mediational model, we found that: the control perception after social stress mediated the reduction of depressive symptoms in adolescents with ACCA history. Additionally, inaccuracy in perceiving angry faces and harsh punishment toward behaviors that intentionally harm others mediated the presence of thinking problems, anxiety, and rule-breaking behaviors. Conclusions: Colombian adolescents who experienced ACCA showed specific changes in their emotional competences, which mediate the parental report of behavioral problems. These results indicate the need for more focused interventions aimed at improving the emotional competences and mental health of adolescent victims of armed conflicts.

Social Skills and Behavioral Problems in Children with a History of Institutionalization and Foster Care

The aim of the study was to analyze whether there were significant differences in social skills and in externalizing and internalizing behavior problems among three groups of children in Argentina: one group of adopted children with a history of institutional care, another group of adopted children with a history of foster care, and a third group of children with no history of alternative care who have lived with their biological family since birth. A non-experimental, descriptive, cross-sectional study was conducted. The sample consisted of 119 Argentine parents with children between the ages of 3 and 7. Of these, 41 parents had adopted a child with a history of institutional care, 38 had adopted a child with a history of foster care, and 40 were biological parents whose children had no history of alternative care. The Preschool and Kindergarten Behavior Scale (PKBS) by Merrell (2003), adapted in Argentina by Reyna and Brussino (2009), was used to measure the variables studied. Adopted children with a history in institutional care obtained significantly lower scores in the three social skills assessed (social cooperation, social interaction, and social independence) and significantly higher scores in the two behavior problems assessed (internalizing and externalizing) compared to the other two groups. No significant differences were found in social skills and behavioral problems between the group of adopted children with a history of foster care and the group of children without a history of alternative care who have lived with their biological family since birth. Foster care could be considered a protective factor for children at risk.

Harsh Versus Supportive (Grand)parenting Practices and Child Behaviour Problems in Urban Chinese Families: Does Multigenerational Coresidence Make a Difference?

ABSTRACTParent–grandparent coparenting is increasingly prevalent worldwide, but whether and how parenting behaviours differ across generations and the influence of such potential discrepancies on child behaviour problems are still unclear. This study compares differences in parenting practices between parents and grandparents—specifically, harsh versus supportive parenting—and examines both the associations of these practices with child behaviour problems and the role of multigenerational coresidence in these associations. We recruited 404 parent–grandparent coparenting dyads from two highly industrialized urban cities in China. The results showed that coresiding grandparents tended to display less supportive parenting behaviours than parents. Parental harsh discipline and grandparental harsh discipline were both positively associated with child externalizing behaviour problems. Larger directional differences in harsh discipline between parents and grandparents were associated with more internalizing behaviour problems in their children. A larger absolute difference in self‐perceived supportiveness between parents and grandparents was negatively associated with children's internalizing behaviour problems only when parents and grandparents lived separately. This study suggests (grand)parenting style matters to children's externalizing behaviour problems, while the discrepancies between parenting and grandparenting practices have stronger influences on children's internalizing behaviour problems. These findings underscore the significance of promoting effective collaborative parenting in intergenerational families.

Social impacts of inclusive education: On the requirement for an emphasis on girls with emotional and behavioral disorders (EBD) in research on inclusion

While there is an extensive and substantial body of epidemiological research on gender-specific differences regarding the prevalence, persistence, and comorbidity of Emotional and Behavioral Disorders (EBD) in childhood and adolescence, empirical research on inclusive education largely lacks a differentiated and gender-sensitive research approach. However, initial empirical findings indicate that girls with internalizing behavior problems are to be considered a particularly vulnerable group in school regarding their social integration, their self-concept, their well-being in school and their perception and interpretation of social interaction processes. Can girls with internalizing behavior problems thus be referred to as the 'forgotten gender' of empirical research on inclusive education? The following article aims to address the existing tension between gender-specific epidemiological data, school-related practices, and empirical research approaches. In this context, we first (I) summarize the available empirical findings, (II) outline the methodological foundations of an ongoing research project, and (III) discuss the social implications of a predominantly one-sided empirical approach and outline a call to action for practice and research.

Family and Peer Social Capital and Child Behavioral Outcomes in Japan.

Child problem behaviors have been linked to immediate and long-term negative outcomes. Research has found that family and peer social capital have a strong influence on child behavioral outcomes. However, most research about social capital and child behavior problems has been conducted in Western contexts. Social capital may influence child behavior problems differently in non-Western sociocultural environments due to different family and peer dynamics. Using a sample from the Japan Household Panel Survey and Japan Child Panel Survey (N = 182), we expand this literature on various forms of social capital to the Japanese context with data that were collected between 2009 and 2014. We examine the relationship of family and peer social capital with children internalizing and externalizing problem behaviors using OLS linear regression. Our results differ from what is commonly found in Western contexts. Whereas family and peer social capital are typically associated with both internalizing and externalizing problem behaviors in Western countries, we find that greater family social capital is associated with decreased externalizing problem behaviors but not internalizing problem behaviors in Japan, and peer social capital has no association on either type of problem behaviors. Our findings emphasize the importance of considering social and cultural contexts when exploring how social capital might encourage prosocial child outcomes.

Health-related quality of life and problem behaviour after GH cessation in adults born SGA: a 12-year follow-up study.

Long-term data regarding HRQoL and problem behaviour in adults born SGA who were treated with GH during childhood are lacking. To investigate longitudinal changes in HRQoL and problem behaviour in adults born SGA during 12 years after cessation of childhood GH-treatment (SGA-GH), and compare these with 3 control groups at age around 30 years. 176 SGA-GH adults and 3 untreated age-matched control groups: 50 born SGA with short stature (SGA-S), 77 born SGA with spontaneous catch-up growth to normal height (SGA-CU) and 99 born appropriate-for-gestational-age with normal height (AGA). HRQoL and problem behavior were assessed using TNO-AZL Adults Quality of Life questionnaire (TAAQoL) and Adolescent Behavior Check List (ABCL) at 6 months, 2, 5 and 12 years after GH-cessation. Data at 12-years after GH-cessation were compared with 3 control groups. During 12 years after GH-cessation, HRQoL remained similar on 9 subscales in SGA-GH adults, but decreased on 3 subscales (gross motor functioning, pain, sleep). Externalizing problem behaviour decreased significantly and internalizing problem behaviour tended to decrease. SGA-GH and SGA-S adults had similar HRQoL and problem behaviour. SGA-GH adults had, compared to AGA adults, similar HRQoL on 7 subscales, lower HRQoL on 5 subscales and more internalizing and externalizing problem behaviour. All SGA adults had lower HRQoL and more internalizing problem behaviour than AGA adults. Adult height associated negatively with externalizing problem behaviour, but the influence was small. During 12 years after GH-cessation, HRQoL remained mostly similar and problem behaviour decreased in SGA-GH adults. SGA-GH and SGA-S adults had similar HRQoL and problem behaviour. All SGA adults had lower HRQoL and more internalizing problem behaviour than AGA adults.

Exposure to Violence and Mental Health Outcomes Among Pre-schoolers in a South African Birth Cohort.

Little is known about the relationship between violence exposure and mental health in preschoolers living in low- and middle-income countries (LMICs).Multiple regression analyses investigated associations between violence exposure and mental health in the Drakenstein Child Health Study (N = 978), a South African birth cohort. Lifetime violence exposure was assessed at age 4.5 years using the parent-report Child Exposure to Community Violence Checklist (CECV). Mental health was assessed at age 5 years using the Child Behaviour Checklist (CBCL 1.5-5).Eighty-three percent of the children were exposed to some form of violence. Internalising and externalising behaviours were positively associated with overall violence exposure (β per one unit change in the overall score = 0.55 [0.16, 0.94] and β = 0.53 [0.23, 0.84], respectively), domestic victimisation (β per one unit change in the subscore = 1.28 [0.28, 2.27]; β = 1.14 [0.37, 1.90]) and witnessing community violence (β = 0.77 [0.15, 1.39]; β = 0.68 [0.19, 1.18]). There was a positive association between polyvictimisation and externalising (β = 1.02 [0.30, 1.73]) but not internalising (β = 0.87 [-0.06, 1.80]) behaviour problems. Evidence for an association of witnessing domestic violence with internalising (β = 0.63 [-0.97, 2.24]) or externalising (β = 1.23 [-0.04, 2.50]) behaviours was less robust. There was no association between community victimisation and internalising or externalising behaviours (β = 0.72 [-1.52, 2.97; β = 0.68 [ -1.06, 2.41]).Observations highlight the risk for mental health problems among preschoolers living in high-violence contexts and emphasize the need for early interventions.

Family Stress Processes Underlying COVID‐19–Related Economic Insecurity for Mothers and Fathers and Children's Internalizing Behaviour Problems

ABSTRACTCOVID‐19 and its economic fallout have resulted in unprecedented financial insecurity and material hardship for many American families, with a disproportionately negative impact on children and families from socioeconomically disadvantaged contexts. The current study applied the family stress model to examine the family processes underlying pandemic‐related economic insecurity and children's internalizing behaviours. Online survey data from an economically diverse sample of mothers and fathers, who experienced at least one type of pandemic‐related economic insecurity in the United States (N = 259), were collected across two longitudinal time points in the early weeks of COVID‐19: (1) 14 April and (2) 30 April of 2020. Parental depressive symptoms, negative partner relationship quality and harsh parenting were tested as mediators. Results from the path model showed that pandemic‐related economic insecurity was associated with higher levels of parental depressive symptoms, which were then associated with higher levels of negative partner relationship quality. Negative partner relationship quality was subsequently associated with more harsh parenting, which was then associated with increased child internalizing behaviours. Indirect effects were found for all hypothesized mediators. The family stress model can be applied and extended to the early COVID‐19 period. Child and family social work implications include targeting parents' mental health, relationship quality and parenting behaviours, as well as directly addressing financial and material hardship, to mitigate the adverse effects of pandemic‐related economic insecurity on children's mental health.

Contamination bias in the estimation of child maltreatment causal effects on adolescent internalizing and externalizing behavior problems.

When unaddressed, contamination in child maltreatment research, in which some proportion of children recruited for a nonmaltreated comparison group are exposed to maltreatment, downwardly biases the significance and magnitude of effect size estimates. This study extends previous contamination research by investigating how a dual-measurement strategy of detecting and controlling contamination impacts causal effect size estimates of child behavior problems. This study included 634 children from the LONGSCAN study with 63 cases of confirmed child maltreatment after age 8 and 571 cases without confirmed child maltreatment. Confirmed child maltreatment and internalizing and externalizing behaviors were recorded every 2 years between ages 4 and 16. Contamination in the nonmaltreated comparison group was identified and controlled by either a prospective self-report assessment at ages 12, 14, and 16 or by a one-time retrospective self-report assessment at age 18. Synthetic control methods were used to establish causal effects and quantify the impact of contamination when it was not controlled, when it was controlled for by prospective self-reports, and when it was controlled for by retrospective self-reports. Rates of contamination ranged from 62% to 67%. Without controlling for contamination, causal effect size estimates for internalizing behaviors were not statistically significant. Causal effects only became statistically significant after controlling contamination identified from either prospective or retrospective reports and effect sizes increased by between 17% and 54%. Controlling contamination had a smaller impact on effect size increases for externalizing behaviors but did produce a statistically significant overall effect, relative to the model ignoring contamination, when prospective methods were used. The presence of contamination in a nonmaltreated comparison group can underestimate the magnitude and statistical significance of causal effect size estimates, especially when investigating internalizing behavior problems. Addressing contamination can facilitate the replication of results across studies.

Direct and Indirect Longitudinal Associations of Mother and Father Engagement in Middle Childhood on Adolescent Externalizing and Internalizing Behaviors.

Parent engagement is an important aspect of parenting during childhood. However, little is known about the unique longitudinal associations of mother and father engagement with adolescents' externalizing and internalizing problem behaviors. This study uses Future of Families and Child Wellbeing Study data to examine the potential direct and indirect associations of parent engagement at age 9 on adolescent externalizing and internalizing behaviors at age 15. The analytic sample size is 1349, and at age 9, the mean age of children was 9.40 years (SD = 0.37). Forty-eight percent of children were female and 68% of them were from the married families. The results show that while controlling for mother engagement, higher father engagement at age 9 was directly associated with fewer adolescent internalizing behaviors, only among adolescent boys and in married families. In addition, among adolescent boys, father engagement had an indirect association with externalizing behaviors through father-child closeness. Mother engagement, however, is only found to have an indirect association with adolescents' externalizing and internalizing behaviors through maternal hostility (while controlling for father engagement). The results for mother engagement held for boys and in married families only. The findings indicate that both mother and father engagement during childhood is important and helpful to prevent adolescent problem behaviors directly or indirectly via parent-child relationship.

Parental differential warmth, hostility, and sibling differences in internalizing and externalizing behavior problems: A meta-analysis.

Parental differential treatment (PDT) of siblings is associated with differences in children's behavioral adjustment. The current meta-analysis examined the extent to which associations between relative PDT and sibling differences in behavior problems differ by type of parenting behavior (i.e., differential hostility vs. differential warmth) and type of behavior problems (i.e., differential externalizing vs. internalizing behavior problems). In September 2021, we systematically searched APA PsycInfo and Web of Science, yielding 2,259 unique hits with 19 eligible publications reporting on 215 effect sizes from 13 unique samples. The overall association between relative PDT (i.e., receiving less warmth and more hostility than one's sibling) and sibling differences in behavior problems was small but significant. Associations were stronger for differential hostility compared to differential warmth and for differential externalizing compared to differential internalizing behavior problems. Particularly marked was the finding that siblings who received more hostility from their parents showed higher levels of externalizing behavior problems. Future research investing in further dismantling the association between within-family PDT and sibling differences in adjustment is warranted to better understand why parents treat siblings differentially and to guide family support initiatives. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Emotion regulation and internal behavior problems in young autistic children-preliminary study

Emotion regulation and internal behavior problems in young autistic children-preliminary study

어머니의 사회경제적 배경에 따른 양육 특성이 유아의 문제행동에 미치는 영향

Objectives The purpose of this study is to investigate the discrimination of mothers' parenting characteristics according to socioeconomic background and analyze the effects of parenting characteristics on the young children's problem behaviors.
 Methods It was analyzed the socioeconomic background, parenting characteristics, and problem behavior of 2,150 mothers with 5-year-old children, using the 7th panel data of the Panel Study on Korean Children. Using the program SPSS 21.0, the mean differences in parenting characteristics according to the mother's socioeconomic background were analyzed using t-test and one-way ANOVA. In addition, after analyzing the correlation between the mother's parenting characteristics and the young children's problem behavior, hierarchical multiple regression analysis was conducted to analyze the influence of the mother's parenting characteristics on the young children's problem behavior.
 Results Mothers' parenting characteristics differed depending on the mother's age, education level, and household income level, and the correlation between parenting characteristics and young children's problem behavior was low. As a result of analyzing the factors affecting children's internalizing problem behavior, the higher the income in the socioeconomic background, the less internalizing problem behavior, and among parenting characteristics, the higher the parenting stress and the less parent-child interaction, the more internalizing problem behavior increased. As a result of the analysis of externalizing problem behavior, it was found that for male young children, the greater the parenting stress, and the less paternalistic parenting behavior and parent-child interaction, the more the infant's externalizing problem behavior increased.
 Conclusions System establishment and policy support are required to minimize the interdependence and connection between socioeconomic background, parenting characteristics, and problem behavior. Additionally, because mothers' parenting stress has the greatest impact on their children's problem behavior, mothers should seek ways to reduce stress themselves. Additionally, a consensus on co-parenting must be formed at the community and government levels, breaking away from the framework that childrearing is the mother's responsibility.

Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds

ABSTRACT Importance Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. Objective We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent–Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. Method Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. Results Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. Conclusions Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

The double jeopardy of low family income and negative emotionality: The family stress model revisited.

The family stress model has, for decades, guided empirical work linking poverty with increased risk of child social-emotional dysfunction. The present study extends this line of work by examining whether child negative emotionality moderates associations between family income, family stress (maternal distress, parental locus of control, and relationship dissatisfaction), and later externalizing and internalizing behavior problems. In a longitudinal population-based sample (n ~ 80,000) of Norwegian children followed from birth through age five (The Norwegian Mother, Father, and Child Cohort Study; MoBa), we examined whether high (vs. moderate or low) negative emotionality families would display: (a) compounding stress (i.e., particularly strong associations between low family income and family stress), (b) diathesis-stress (i.e., particularly strong associations between family stress and behavior problems), or (c) double jeopardy (i.e., both compounding stress and diathesis-stress moderating effects). Negative emotionality significantly moderated the association between family income and behavior problems in a manner most consistent with double jeopardy. As a result, compared with children with moderate/low negative emotionality, the family income-behavior problems association was two to three times larger for those with higher negative emotionality. These findings underscore the active role children may play in family processes that link low family income with behavior problems.

Finding the balance: The influence of movement behaviours on childhood behaviour problems

Background and aimsThe Canadian 24-h movement guidelines have led to an increased focus on movement behaviours (sleep, screen, sedentary, and physical activity) throughout the day. MethodsWe examined the cross-sectional and longitudinal associations between 24-h movement behaviours and parent-reported levels of internalizing, externalizing, and total behaviour problems in a subset of the CHILD birth cohort study at ages 3 (N Age 3 = 541, 48.1% girls) through 5 (N Age 5 = 575, 49.6% girls). Physical activity, sedentary time, and sleep were measured using an accelerometer worn on the non-dominant wrist for seven days following a 24-h protocol. Screen time was measured via parent-report and date-matched to daily accelerometer recordings. Compositional isotemporal substitution models predicted change in behaviour problems with reallocating time between movement behaviours. ResultsCross-sectional analysis indicated that screen time relative to other movement behaviours was associated with greater externalizing behaviours at age 3 and greater internalizing and total problem behaviours at ages 3 and 5. This was supported in the longitudinal analysis, where increased screen time at 3 was associated with increased internalizing, externalizing, and total problem behaviours at 5. Cross-sectional reallocation from screen to non-screen sedentary time was associated with reductions in internalizing and total behaviour problems at 3 and 5 years and reductions in externalizing at 3. Contrary to previous findings, cross-sectional proportional increases in moderate-to-vigorous-intensity physical activity were associated with increased externalizing and total problem behaviours at 5. ConclusionsClinicians should prioritize supporting families to find a balanced approach rather than promoting specific movement behaviours.

Between- and within-child level associations between externalizing and internalizing behavior problems in a nationally representative sample of US elementary school children.

Both transactional and common etiological models have been proposed as explanations of why externalizing behavior problems (EBP) and internalizing behavior problems (IBP) co-occur in children. Yet little research has empirically evaluated these competing theoretical explanations. We examined whether EBP and IBP are transactionally related at the within-child level while also identifying antecedents commonly associated with between-child differences in underlying stability of both EBP and IBP across elementary school. We analyzed a nationally representative and longitudinal sample of US schoolchildren (N = 7,326; 51% male) using random-intercept cross-lagged panel modeling (RI-CLPM). We used teacher ratings of EBP and IBP as annually assessed from the spring of kindergarten (Mage = 6.12 years) through the spring of 5th grade (Mage = 11.09 years). Early childhood antecedents included child internal (i.e. inhibitory control, cognitive flexibility, working memory, and language/literacy) and external factors (i.e. parental warmth, harsh parenting, parenting stress, and maternal depressive symptoms). We found little evidence for within-child, transactional relations between EBP and IBP. Both types of behavior problems instead were substantially associated at the between-child level. Inhibitory control was the strongest common antecedent that explained this longitudinal overlap. Cognitive flexibility, working memory, language/literacy skills, and maternal depression contributed specifically to the stability of IBP. Measures of parenting were specific to the stability of EBP. Common etiological factors rather than transactional relations better explain the co-occurrence of EBP and IBP during elementary school. Inhibitory control is a promising target of early intervention efforts for schoolchildren at risk of displaying both EBP and IBP.

Disrupted Maturation of White Matter Microstructure After Concussion Is Associated With Internalizing Behavior Scores in Female Children

BackgroundSome children who experience concussions, particularly females, develop long-lasting emotional and behavioral problems. Establishing the potential contribution of preexisting behavioral problems and disrupted white matter maturation has been challenging due to a lack of preinjury data. MethodsFrom the Adolescent Brain Cognitive Development cohort, 239 (90 female) children age 12.1 ± 0.6 years who experienced a concussion after study entry at 10.0 ± 0.6 years were compared to 6438 (3245 female) children without head injuries who were age 9.9 ± 0.6 years at baseline and 12.0 ± 0.6 years at follow-up. The Child Behavior Checklist was used to assess internalizing and externalizing behavior at study entry and follow-up. In the children with magnetic resonance imaging data available (concussion n = 134, comparison n = 3520), deep and superficial white matter was characterized by neurite density from restriction spectrum image modeling of diffusion magnetic resonance imaging. Longitudinal ComBat harmonization removed scanner effects. Linear regressions modeled 1) behavior problems at follow-up controlling for baseline behavior, 2) impact of concussion on white matter maturation, and 3) contribution of deviations in white matter maturation to postconcussion behavior problems. ResultsOnly female children with concussion had higher internalizing behavior problem scores. The youngest children with concussion showed less change in superficial white matter neurite density over 2 years than children with no concussion. In females with concussion, less change in superficial white matter neurite density was correlated with increased internalizing behavior problem scores. ConclusionsConcussions in female children are associated with emotional problems beyond preinjury levels. Injury to superficial white matter may contribute to persistent internalizing behavior problems in females.