Measurement issues also complicate observed comorbidity of internalizing and externalizing problems. As described, self-report measures of internalizing and externalizing behaviors are often highly correlated because of the overlap in symptoms that comprise the two constructs (Willner, Gatzke-Kopp, & Bray, 2016). If kicking, crying, and running away, for instance, are characteristics of both internalizing and externalizing problems, then children with internalizing symptoms also will have externalizing symptoms. Second, when relying on self- report measures, the same questionnaire is often used to measure internalizing and externalizing symptoms; shared method variance may inflate the level of comorbidity (Goodman & Scott, 1999). Shared method variance reflects covariation which is due to the common perspective used to rate both constructs (Goodman & Scott, 1999). One way to reduce, but not eliminate, the effect of shared method variance and the naturally occurring covariation between internalizing and externalizing symptoms is to statistically control the level of internalizing symptoms, for instance, when estimating externalizing symptoms and vice versa. In the present study, all statistical models will control for the covariation of internalizing and externalizing behaviors. Variations in temperamental fear and children’s problem behaviors
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Conclusion: Child-centered play therapy is an effective therapy for externalizing problems and this effect is more obvious for aggressive behaviors. Additionally, most remedy is occurred between first sessions and last sessions and the process was not salient in middle sessions.
became distressed during frustrating situations scored higher on concurrent measures of aggressive acting-out behaviors than children who were less easily distressed. In addition to concurrent associations, early child distress has been linked to more externalizing problems during the preschool period. For example, Hagekull (1994) found that negative emotionality during the toddler years predicted externalizing behavior problems at age 4. Similarly, children who were rated as highly reactive and emotionally negative during observational interactions with mothers at age 2 were rated as having more behavior problems than their peers upon entry into school (Rubin, Burgess, Dwyer, & Hastings, 2003; Shaw, Owens, Vondra, & Keenan, 1996). Taken together, these results suggest that children’s propensity towards negative emotional reactivity during the toddler years may be associated with increased risk for
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As compared to the toddler period, the preschool years may be a time when language delays become more consistently linked to serious behavior problems. Using a parenting report measure of children‟s behavior problems, Kaiser, Hancock, & Qui (2000) found a marginally significant relationship between children‟s language delay and externalizing problems. Results of past studies, however, are more robust when looking at teacher‟s reports of behavior problems. For instance, preschool-aged children with specific language impairment seem to be rated by teachers and parents as being less socially competent and having more behavior problems (e.g., McCabe, 2005). Additionally, Qui and Kaiser (2004) found that preschool-aged children with language delay had significantly higher disruptive behaviors scores, as rated by their teachers, during structured activities than non-language delayed children. Kindergarten, language delays have been found to be significantly related to both school functioning and behavior problems, with school functioning mediating the relationship between language delay and behavior problems (Bowman, Barnett, Johnson, & Reeve, 2006). Taken together, results suggest that language problems evidenced during early childhood increase children‟s risk for developing problem behaviors during later developmental periods.
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With respect to these questions, Stegge and Terwogt (2007) have argued that children and adolescents with internalizing problems (e.g., depression) are not only more likely to endorse maladaptive strategies, such as cognitive and behavioral avoidance and rumination, but also less likely to advocate adaptive strategies, such as active problem-solving strategies and cognitive reappraisals. Likewise, in line with the social information processing model (Crick & Dodge, 1994), they outline that many disorders comprised in the externalizing spec- trum are characterized by an anger bias that may lead to maladaptive responses to anger-eliciting situations as well as a biased appraisal of such situations. This bias may also inhibit an adequate use of adaptive anger regula- tion strategies, such as cognitive reappraisal or acceptance. Therefore, adolescents with a profile characterized by a lack of adaptive and a frequent use of maladaptive anger regulation strategies may be more likely to suffer from both internalizing and externalizing problems than adolescents with high values on both dimensions. In another theoretical approach, Cole, Michel, and Teti (1994) differentiated two forms of dysregulation—defined as overregulation or underregulation—of the intensity or expression of particular emotions. According to these assumptions, Mullin and Hinshaw (2007) argue that externalizing problems might particularly be linked with an underregulation of emotions, whereas internalizing problems might be more likely to be related to an overregu- lation of emotions. From this point of view, adolescents with high values on both adaptive and maladaptive an- ger regulation strategies should predominantly show higher internalizing problems, whereas adolescents who are low on both dimensions should be predominantly linked to higher externalizing problems.
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Background: Given mixed findings as to whether stressful experiences and relationships are associated with increases or decreases in children’s cortisol reactivity, we tested whether a child’s developmental history of risk exposure explained variation in cortisol reactivity to an experimentally induced task. We also tested whether the relationship between cortisol reactivity and children’s internalizing and externalizing problems varied as a function of their developmental history of stressful experiences and relationships. Method: Participants included 400 children (M = 9.99 years, SD = 0.74 years) from the Children’s Experiences and Development Study. Early risk exposure was measured by children’s experiences of harsh, nonresponsive parenting at 3 years. Recent risk exposure was measured by children’s exposure to traumatic events in the past year. Children’s cortisol reactivity was measured in response to a social provocation task and parents and teachers described children’s internalizing and externalizing problems. Results: The effect of recent exposure to traumatic events was partially dependent upon a child’s early experiences of harsh, nonresponsive parenting: the more traumatic events children had recently experienced, the greater their cortisol reactivity if they had experienced lower (but not higher) levels of harsh, nonresponsive parenting at age 3. The lowest levels of cortisol reactivity were observed among children who had experienced the most traumatic events in the past year and higher (vs. lower) levels of harsh, nonresponsive parenting in early childhood. Among youth who experienced harsh, nonresponsive parent–child relationships in early childhood and later traumatic events, lower levels of cortisol reactivity were associated with higher levels of internalizing and externalizing problems. Conclusions: Hypothalamic–pituitary–adrenal (HPA) axis reactivity to psychological stres- sors and the relationship between HPA axis reactivity and children’s internalizing and externalizing problems vary as a function of a child’s developmental history of exposure to stressful relationships and experiences. Keywords: Cortisol reactivity, stress, parenting, internalizing, externalizing.
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The results of this study showed the decrease of externalizing problems within 12 months period in 2−5 years old children sample. These results are similar to those other researchers have presented (Campbell, 1995; Prinzie et al, 2006; Leve et al, 2005). However the decrease of behavior problems in our study is relatively very 273stma (effect 273stma of 0.2 are considered 273stma (Cohen, 1988)), in this case the effect size reaches only 0.008). Although the change of externalizing problems was statistically significant, it was 273stma because the participants in this study were normally developing children’s sample, with no major stressful events in family life, so the change effect was 273stma.
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Parent and teacher ratings of attention and internalizing and externalizing problems were subjected to multivariate analysis of variance (MANOVA) with group as between-subject factor (TBI-TC), and ANOVA assessed group differences in FSIQ. To assess alerting, orienting, and executive attention, MRT was subjected to 3 repeated-measures ANOVAs, with group as between- subject factor (TBI-TC) and trial type as within-subject factor (no cue/ central cue, central cue/valid spatial cue, and valid spatial cue/invalid spatial cue). Differences between groups in (1) processing speed, (2) lapses of attention, and (3)
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The goal of this study was to address this gap in knowledge. Does the adverse influence of attention problems persist through the entire period of school attendance, up to the end of high school? We exam- ined the contributions of attention and internalizing and externalizing problems at school entry to aca- demic achievement at the end of high school (ages 17–18) in a longitudinally followed, ethnically and socioeconomically diverse sample. Assessments of be- havior problems at school entry were based on teacher ratings, using a standardized and empirically sup- ported measure, the Teacher Rating Form (TRF). Ac- ademic achievement at age 17 was assessed by using the Woodcock-Johnson Psycho-Educational Battery- Revised (WJ-R), a standardized academic achieve- ment test that assesses math and reading achievement independent of teacher assessments conveyed in grades or school evaluations. The contribution of early behavior problems to later academic achievement was evaluated taking into account children’s early cogni- tive abilities, as measured by IQ tests. In addition, we tested whether attention problems at age 6 uniquely predicted achievement in math and reading at age 17, when its correlation with other behavioral problems was taken into account.
Another special social factor that may influence the behavior and developmental patterns of children in China is the ‘one child’ policy. There are over 80 % children who are the only child in their families in China. These children have much less social interaction with peers than children have siblings, which cannot be replaced by parents . Earlier studies from other coun- tries indicated that the only children are often over- protected and self-centered, which may have a negative effect on their psychological development [14–16], and especially on the externalizing problems . However, in Bayer’s study, the absence of older siblings was a key pre- dictor of internalizing problems . Research in Japan has also revealed that children with a larger number of older brothers/sisters had a smaller incidence of problem- atic behaviors  . On the other hand, the cross-sectional research in China has found that the children with siblings had worse mental health based on the resource dilution theory which asserts that family resources are divided by the number of children . Although there were many studies focused on the only children, there is no population-based literature that dealt with the trajec- tory of their behavior problems.
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correlated (with correlation coefficient ⫽ 0.49), these 2 indices may not capture the same behavioral dimension. In 7-year-olds, there is no effect of blood lead concen- tration at age 2. However, for the blood lead level at 7 years, there are direct, relatively large effects on the TRS of BASC (behavioral symptoms index, externalizing problems, and school problems); indirect effects on these are smaller (the indirect effect on externalizing problems was only borderline significant). For adaptive skills, the indirect effect is significant. Internalizing problems (ex- cessive anxiety or worry) is the scale with the least effects, with a small but significant indirect effect and a similar but less precisely estimated direct effect. The results from the parent rating scale of the BASC are consistent with teacher report, showing a large direct effect on externalizing problems and a smaller but sig- nificant indirect effect on adaptive skills. In general, the results are consistent with a direct effect at age 7 of contemporaneously measured blood lead level on be- havior, specifically, conduct and school problems, and an indirect effect through IQ on most other neuropsy- chological test scores.
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A lack of self-control may be one mechanism that increases children’s risk for developing externalizing behavior problems. For example, inadequate control skills are one criterion of the definition of childhood externalizing problems (e.g., Bridgett et al., 2015; Mischel et al., 1989; Olson et al., 2002; Olson, Sameroff, Kerr, Lopez, & Wellman, 2005; Rothbaum & Weisz, 1994; Woltering, Lishak, Hodgson, Granic, & Zelazo, 2016). Inadequate control skills also are identified in major behavior disorders, such as ADHD and oppositional defiant and/or conduct disorder (e.g., August, Realmuto, MacDonald, Nugent, & Crosby, 1996; Campbell et al., 2000; Martel & Nigg, 2006; Raaijmakers et al., 2008). Aggressive, noncompliant and impulsive children tend to show early deficits controlling their negative behavior during challenging situations and tend to be rated higher on externalizing scales such as the Child Behavioral Checklist (CBCL; Achenbach, 1991; Calkins & Fox, 2002).
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The current study found evidence for the ef ﬁ cacy of Op Koers (a group in- tervention for children with various chronic diseases) and for the added value of involving their parents in this intervention. The interventions had a positive effect on parent-reported internalizing problems, child-reported externalizing problems, and disease- related copings skills (information seek- ing, social competence, and positive thinking). The additional effect of pa- rental involvement was observed on parent-reported internalizing problems, child-reported externalizing problems, and disease-related coping skills (in- formation seeking and social com- petence). These ﬁ ndings were expected, because parental support is considered necessary to successfully apply adap- tive coping skills in everyday life. 13,14
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and behavior problems as reported by parents. Scores of items were as fol- lows, on the basis of the preceding 6 months: 0 ⫽ not true; 1 ⫽ somewhat or sometimes true; and 2 ⫽ very true or often true. The CBCL yields scores for a total problem scale (overall be- havior problems) and the “broad band” syndrome scales internalizing and externalizing problems. The inter- nalizing scale consists of items that cover withdrawn behavior, somatic complaints, anxiety, and depression. The externalizing scale consists of items that cover delinquent and ag- gressive behavior. Raw scores on each scale can be converted into standard- ized T scores, which are based on nor- mative data of the Dutch general pop- ulation. 21 T scores have a mean of 50
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attacks it was found that, “persisting in problem- focused coping in a situation that cannot be changed can lead to undesirable consequences” . Research among Palestinian youth found that active coping was not effective in protecting children’s mental health . Similarly, Elklit et al.  found that problem- focused and avoidant coping strategies were related to higher levels of PTSD among trauma-affected youth in Bosnia and noted that the inability to impact life decisions may explain this finding . Another study among Bosnian adolescents found that engagement coping strategies increased PTSD symptoms, whereas disengagement coping strategies were associated with fewer PTSD symptoms . In the context of conflict and other humanitarian contexts, problem-focused coping as a strategy used alone may worsen internal- izing and externalizing problems and reduce self- esteem and prosocial behavior. Research suggests that without effective emotional regulation, trauma af- fected children may exhibit increased aggressive be- havior, a form of externalizing behavior . It is also plausible that some of the problem-focused strategies youth employ, such as stealing to reduce economic stress or consuming alcohol to reduce emotional stress, may be harmful. Problem-focused coping strategies may add additional stress if the stressors the youth are trying to “fix” cannot be changed. Inter- estingly, problem-focused coping was associated with lower prosocial behavior scores in both girls and boys. This finding suggests that problem-focused coping may involve maladaptive strategies used in isolation instead of strategies that utilize social sup- port to achieve objectives.
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much younger than the children in the present study (age two to four years, compared to age four to 16 years in the present study clinic sample), which could have had an effect on the results. Perhaps children with comorbid difficulties are more responsive to earlier intervention than those with pure externalizing problems. Younger children can be more responsive to interventions than older children and adolescents which could partially explain this discrepancy in results (Hautmann et al., 2011; Weisz, Weiss, Alicke, & Klotz, 1987). It could be that the hyperactivity expressed by children with externalizing problems only was a simpler problem that was more directly related to poor parenting skills, which could then be ameliorated by improving the strategies used by parents while interacting with their children (Gilliom & Shaw, 2004; Reitz et al., 2006). It is possible that the hyperactivity seen in the children with comorbid difficulties could be related to more complicated issues than parenting, such as anxiety, or other disorders that are present.
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Table 2 shows the unadjusted ORs (95% CIs [confi- dence intervals]) for parent-reported psychological problems in subgroups of children with daytime wetting. Among the children with daytime wetting, 206 (32%) had some externalizing problems, and 188 (29.2%) had some internalizing problems. The rate of externalizing problems (attention and activity problems, oppositional behavior, and conduct problems) was higher in children whose daytime wetting was severe enough to meet DSM-IV criteria (of the 643 children with daytime wet- ting, 12.7% met DSM-IV criteria), but there was no increased rate of internalizing problems in these chil- dren. There was also evidence for a higher rate of exter- nalizing problems in children with daytime wetting who were reported by parents to have to dash to the toilet straight away when they felt the need to urinate, who had ⱖ 10 toilet trips a day, who suffered from associated soiling or bedwetting, and in boys. Of the children with daytime wetting, 6.4% had suffered from a UTI in the past 12 months and, although not statistically signifi- cant, the results suggested an increased rate of both externalizing and internalizing problems in children with a UTI.
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Third, the inter-informant agreement in this study was generally low and also in line with results of other studies [20,22]. The large discrepancies indicate the importance of good communication between the school and the family for a better joint understanding and overall view of the child’s behaviour in all social settings. It is especially im- portant that professionals are aware of these discrepancies so they can be taken into account in planning interven- tions. In a review article by De Los Reyes & Kazdin (2005) higher agreement was found in externalizing problems compared to internalizing problems and that is in line with our results in boys, but not in girls . This is Table 3 Differences in mean scores in the index a - and reference b group, with corresponding p-value, regarding mental health in reports by teachers (TRF), parents (CBCL) and children (SDQ)
The impact of psychosocial problems on the development of psychopathology (depression/anxiety) among university students is an area that greatly remains unexplored leading to insufficient assessment of the mental health status of the students. Consequently, students’ psychosocial problems and psychopathology if left untreated and unchecked, they may severely interfere in their everyday functioning and manifest compromised social cohesion, mental health and wellbeing, with the increased likelihood of future instability and conflict. The aim of the study was to address a broader understanding of a multidimensional aspect of psychosocial problems to the development of psychopathology (anxiety, depression) for university students in Uganda. It was hypothesized that there is no relationship between exposure to psychosocial problems and the development of psychopathology. This cross-sectional study was a secondary analysis of data from the PhD study on development and validation of an instrument to measure psychosocial problems of university students. The University Students Evaluation of Psychosocial Problems (USEPP) instrument was used to evaluate psychosocial problems. The two symptoms of psychopathology denoting common mental disorders were measured using the Hopkins Symptom Checklist 10 (HSCL-10). Regression analysis was performed to establish the relationship between psychosocial problems and psychopathology. The findings of this study revealed that students having psychosocial problems were significantly related to the development of psychopathology. The findings highlight to the need to put intervention measures to address the students’ psychosocial problems and mental health disorders by putting counselling infrastructure in institutions of learning to address the mental health needs of the students.
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Behaviour and Aggressive Behaviour. The Internalizing scale can be derived from the first three syndrome scales (in the present study Cronbach’s alpha =.86), and the Externalizing scale from the last two (in the present study Cronbach’s alpha =.85). The Total Problems scale was determined by summing the individual item scores (in the present study Cronbach’s alpha =.84). Thus, 55 of the items are summed to yield six DSM-oriented scales: Affective Problems, Anxiety Problems, Somatic Problems, Attention Deficit/Hyperactivity Problems, Oppositional Defiant Problems, and Conduct Problems. Good test–retest reliability, cross- informant agreement, and success in discriminating between referred and non-referred adolescents have been demonstrated for the CBCL (Achenbach & Rescorla, 2001; Frigerio et al., 2004).
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