The dynamics of internalizing and externalizing comorbidity across the early school years

Abstract

High rates of comorbidity are observed between internalizing and externalizing problems, yet the developmental dynamics of comorbid symptom presentations are not yet well understood. This study explored the developmental course of latent profiles of internalizing and externalizing symptoms across kindergarten, 1st, and 2nd grade. The sample consisted of 336 children from an urban, low-income community, selected based on relatively high (61%) or low (39%) aggressive/oppositional behavior problems at school entry (64% male; 70% African American, 20% Hispanic). Teachers reported on children’s symptoms in each year. An exploratory latent profile analysis of children’s scores on aggression/oppositionality, hyperactivity/inattention, anxiety, and social withdrawal symptom factors revealed 4 latent symptom profiles: comorbid (48% of the sample in each year), internalizing (19–23%), externalizing (21–22%), and well-adjusted (7–11%). The developmental course of these symptom profiles was examined using a latent transition analysis, which revealed remarkably high continuity in the comorbid symptom profile (89% from one year to the next) and moderately high continuity in both the internalizing and externalizing profiles (80% and 71%, respectively). Internalizing children had a 20% probability of remitting to the well-adjusted profile by the following year, whereas externalizing children had a 25% probability of transitioning to the comorbid profile. These results are consistent with the hypothesis that a common vulnerability factor contributes to developmentally stable internalizing-externalizing comorbidity, while also suggesting that some children with externalizing symptoms are at risk for subsequently accumulating internalizing symptoms.

Developmental stability of general and specific factors of psychopathology from early childhood to adolescence: dynamic mutualism or p‐differentiation?

“…For example, person-centered studies have identified unique classes that describe patterns of co-occurring symptomatology both cross-sectionally (Vaidyanathan, Patrick, & Iacono, 2011) and longitudinally through childhood (Patalay, Moulton, Goodman, & Ploubidis, 2017). Recent research investigating transitions between these cross-sectional classes over time indicate that transitions between 'pure' psychopathological classes (e.g., predominantly internalizing or externalizing) and comorbid classes are relatively common, with transitions more often observed to and from comorbid and predominantly externalizing classes (Basten et al, 2016;Kim & Eaton, 2017;McElroy, Shevlin, & Murphy, 2017;Willner, Gatzke-Kopp, & Bray, 2016). The findings of the present variable-centered study mirror these results; externalizing and p demonstrated stronger reciprocal relationships over time than internalizing and p. Indeed, it appears that those who score high on p initially could potentially develop more specific psychopathology in any of the three specific domains.…”

Cross-Domain Symptom Development Typologies and Their Antecedents: Results From the UK Millennium Cohort Study

“…3 externalising, or comorbid groupings at cross-sections in development, 14,15 and some studies have estimated the probabilities of transitioning between these groups over time. 16,17 This body of research suggests that to a greater extent, behavioural symptoms precede emotional symptoms, 11,12 a probably unsurprising finding given the former is more prevalent in childhood and the latter in adolescence. 18 Although there has been much focus on understanding longitudinal "which-comes-first" relationships between these domains, there have been no identified studies jointly identifying heterogeneous typologies of symptom development across both these domains longitudinally.…”

The association between early life mental health and alcohol use behaviours in adulthood: A systematic review

“…Many factors may contribute to this inconsistency [15,16]. First, the high and stable comorbidity between EXT and INT in youth [25,26] may confound the association of each with alcohol use when the other one is not well adjusted for in the model [27]. Second, differing forms of internalising problems (global indices, depression, anxiety) may represent a different pathway to alcohol use [16].…”