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

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.

Multi-Trajectories of Conduct Problems, Hyperactivity/Inattention, and Peer Problems Across Childhood: Results from the Growing Up in Scotland Birth Cohort

“…The non-engager and the normative group, a combined estimated 38.2% of children in the sample, exhibited low or declining symptoms in conduct problems, hyperactivity/inattention, and peer problems. These two low risk groups are in line with previous findings in the developmental literature (e.g., Fanti & Henrich, 2010;Girard, 2021;Patalay et al, 2017), suggesting that behavioural problems in preschool children may be normative, particularly as children enter into the classroom setting and are learning to navigate social relationships with peers. For most children, these early difficulties are expected to decline as higher-order skills are better developed, resulting in low-risk trajectories of externalising behaviours and peer problems after entry into formal schooling.…”

“…Three factors were common for elevated groups and included child sex, receptive language skills, and belonging to single parent households. In line with the literature (e.g., Girard, 2021;Girard et al, 2019;Teymoori et al, 2018), boys were more likely to belong to elevated groups with the largest odds (i.e., 3.1 higher odds) of belonging to the multimorbid moderate-high chronic group. It has been suggested that social determinants for males and females, such as parental and environmental socialisation, impact gender roles behaviours and, in turn, sex differences in childhood problems .…”

“…Therefore, our study findings add that when conduct problems, hyperactivity/inattention, and peer problems occur together, boys are more likely to belong to groups with greater problems than the non-engagers and normative groups. This result may reflect that boys are more vulnerable to multimorbid childhood problems, as similarly stated in studies modelling joint externalising problems and internalising problems (Fanti & Henrich, 2010;Girard, 2021;Murray et al, 2021). However, further research inspecting the role of social and genetic determinants is needed to better comprehend aetiology and sex differences in multimorbid problems.…”

“…Finally, as expected, we identified a smaller group of children following a high-risk multimorbid trajectory across all externalising behaviours and peer problems (i.e., the multimorbid moderate-high chronic group), which included an estimated 8.6% of children. Previous developmental studies examining individual and joint trajectories of externalising behaviours and peer problems have also identified smaller groups of children at high-risk for elevated levels of chronically stable and/or increasing problems, however identified groups in these studies have typically consisted of a smaller proportion of the sampled population (i.e., between 3-6%; Shaw et al, 2005;Barker et al, 2008;Girard, 2021;Girard et al, 2019;Nagin & Tremblay, 1999;Patalay et al, 2017). As compared to these other studies, a higher proportion of children in the GUS cohort were identified as belonging to the high-risk group with increasing-chronic problems across multiple domains in childhood.…”

“…Nevertheless, despite increased research on individual trajectories of conduct problems, hyperactivity/inattention, and peer problems, only one study has examined concomitant trajectories of these behaviours across childhood (Girard, 2021 ). Using a person-centred approach in a European cohort (Ireland; Growing Up in Ireland), Girard ( 2021 ) examined the longitudinal presentation of internalising, externalising, and peer problems from three to nine years old, identifying six subgroups who evidenced multimorbidity across behaviours.…”