A systematic literature review of childhood externalizing psychopathology and later psychotic symptoms

Abstract

Childhood onset mental health difficulties are known to be associated with later mental health disorders and worse prognoses in adulthood. Individuals who develop schizophrenia present, from childhood onwards, with cognitive deficits, psychotic‐like experiences (PLEs) and internalizing and externalizing problems (EPs). People with a diagnosis of a schizophrenia spectrum disorder (SSD) are also more likely than people without this diagnosis to engage in aggressive behaviour towards others. This systematic review examines the evidence base investigating associations between childhood EPs and later psychotic symptoms. Searches were conducted on Ovid (Medline and Psychinfo), Pubmed and Scopus. PRISMA best‐practice guidelines for conducting systematic literature reviews were followed. Data were extracted from predefined items and assessed using a quality rating scale. Fifteen studies were identified. Eleven of the 15 studies reported significant associations between childhood externalizing psychopathology and later psychotic symptoms, one study reported an association that did not reach significance, and three studies found no associations. Despite the substantial variations in conceptualization of EP, PLEs and SSD, this review found preliminary evidence for an association between childhood antisocial and aggressive behaviour and the later development of psychotic symptoms. Assessing children with EP for PLEs may be important to inform psychological therapies. More longitudinal studies are needed to better understand outcomes for children with presentations across the EP spectrum.

Internalizing and externalizing problems across childhood and psychotic-like experiences in young-adulthood: The role of developmental period

“…One explanation may be that by age 4 years most of the toddlers with very early externalizing symptoms would have shown symptom reduction, suggesting that those with high levels of externalizing symptoms at age 4 may be those more likely to be in the stable-high group (Fanti and Henrich, 2010). In turn, the persistent trajectory of externalizing behavior, which is also more easily observable than internalizing problems (Bongers et al, 2004;Wolff and Ollendick, 2006), has been associated with prenatal and perinatal medical risks, and these problems have been found to be related to neuropsychological deficits, in turn related to cognitive impairment and PLEs (Gin et al, 2020). Children exhibiting increasing internalizing problems on the other hand are often unable to form good peer relationships and are more likely to engage in isolating behaviors and social withdrawal, related to later PLEs (Matheson et al, 2013).…”

“…Although PLEs may be difficult to assess properly in early development, they have been found to co-occur with childhood psychopathology (Lancefield et al, 2016), commonly indexed by internalizing problem behaviors like anxiety and externalizing problem behaviors like hyperactivity and conduct problems. While limited research has explored the early childhood psychopathology/later PLEs relationship, the prospective and cross-sectional studies that do exist have found internalizing and externalizing problems in both younger children and adolescents in the community to predict later PLEs (Bird et al, 2017;Gin et al, 2020;Liu et al, 2019;Wong et al, 2014;Wong and Raine, 2019;. However, whether it is internalizing and externalizing problems in childhood or adolescence or both that may be related to later PLEs and whether any relationships found are not confounded have yet to be addressed.…”

Network Analysis of the Structure of the Core Symptoms and Clinical Correlates in Comorbid Schizophrenia and Gambling Disorder

“…Alterations to brain and neurobiological processes have also been proposed as an explanation for the reciprocal relationships between GD and SCZ (mainly disturbances in the motivation-reward and neurotransmitter systems including dopamine, serotonin, or glutamate) (Clark et al, 2019 ; Howes et al, 2015 ; Leicht et al, 2020 ; Potenza & Chambers, 2001 ; Ruiz et al, 2020 ; Selvaraj et al, 2014 ; Zack et al, 2020 ). Other psychological variables contributing to the dual presence of GD with SCZ are male sex and young age (Gin et al, 2021 ; Welte et al, 2015 ), typical cognitive distortions related with the gambling activity (di Trani et al, 2017 ; Lawlor et al, 2020 ; Liu et al, 2020 ; Livet et al, 2020 ; Mallorquí-Bagué et al, 2018a , b ; Yakovenko et al, 2016 ), severe difficulties in emotion regulation (Szerman et al, 2020 ), and personality profiles defined by high harm avoidance and low levels of self-directedness (Black et al, 2012 , 2013 ; Sundqvist & Wennberg, 2015 ).…”

Internalizing and externalizing problems across childhood and psychotic-like experiences in adulthood: The role of developmental period

“…One explanation may be that by age 4 years most of the toddlers with very early externalizing symptoms would have shown symptom reduction, suggesting that those with high levels of externalizing symptoms at age 4 may be those more likely to be in the stablehigh group (Fanti & Henrich, 2010). In turn, the persistent trajectory of externalizing behavior, which is also more easily observable than internalizing problems (Bongers et al, 2004;Wolff, & Ollendick, 2006), has been associated with prenatal and perinatal medical risks, and these problems have been found to be related to neuropsychological deficits, in turn related to cognitive impairment and PLEs (Gin et al, 2020). Children exhibiting increasing internalizing problems on the other hand are often unable to form good peer relationships and are more likely to engage in isolating behaviors and social withdrawal, related to later PLEs (Matheson et al, 2013).…”

“…Although PLEs may be difficult to assess properly in early development, they have been found to co-occur with childhood psychopathology (Lancefield et al, 2016), commonly indexed by internalizing and externalizing problem behaviors. While limited research has explored the early childhood psychopathology/later PLEs relationship, the prospective and cross-sectional studies that do exist have found internalizing and externalizing problems in both younger children and adolescents in the community to predict later PLEs (Bird et al, 2017;Gin et al, 2020;Wong et al, 2014;Liu et al, 2019). However, whether it is internalizing and externalizing problems in childhood or adolescence or both that may be related to later PLEs and whether any relationships found are not confounded have yet to be of 17 addressed.…”