Declining Trajectories of Co-occurring Psychopathology Symptoms in Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A 10-Year Longitudinal Study

Objective: Our objective was to examine developmental trajectories of co-occurring psychopathology symptoms from childhood to young adulthood in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), individuals with Autism Spectrum Disorder (ASD), and typically developing (TD) individuals.Method: We assessed co-occurring psychopathology symptoms in 61 individuals with ADHD, 26 with ASD, and 40 TD individuals at baseline (T1; Mage = 11.72, 64% boys), 2-year follow up (T2; Mage = 13.77), and 10-year follow up (T3; Mage = 21.35). We analyzed trajectories of internalizing behaviors, externalizing behaviors, and total problems with linear mixed models.Results: From T1 to T3, the ADHD group displayed a small decline in internalizing behaviors (d = −0.49) and large declines in externalizing behaviors (d = −0.78) and total problems (d = −0.71). The ASD group displayed large declines in internalizing behaviors (d = −0.79), externalizing behaviors (d = −0.80), and total problems (d = −0.89). From T1 to T2, the decline in externalizing behaviors and total problems were significantly smaller in the ADHD group compared with the ASD group. The ADHD and the ASD group displayed more co-occurring symptoms compared with the TD group at T3.Conclusion: Individuals with ADHD and ASD, respectively, displayed declines in co-occurring symptoms from childhood to young adulthood. Individuals with ASD displayed an earlier decline compared with individuals with ADHD. Compared with TD individuals, individuals with ADHD and ASD, respectively, continued to display elevated levels of co-occurring symptoms in young adulthood.

Quantifying Severity of Preschool-Aged Children’s Internalizing Behaviors: A Daily Diary Analysis

A subset of preschool-aged children meets criteria for impairing and persistent anxiety and depression. However, the overlap between normative emotional development and impairing symptoms complicates assessments of internalizing problems in early childhood. Given the benefits of early identification/prevention and avoiding overpathologizing typical development, empirical information is needed to norm expression of internalizing behaviors. In this 14-day online diary study, 609 primary caregivers of 3- to 5-year-old children reported the frequency of children’s daily separation and social anxiety and depressive behaviors and impairment. Item response theory analyses quantified specific frequencies at which each behavior was psychometrically severe/rare. Patterns varied for each behavior; for example, distress when anticipating separation had to occur at least 10 times and sadness at least 35 times over 14 days to be considered severe. Most social anxiety behaviors had to occur approximately every other day to be considered severe. Parameters did not vary by child age or sex, and behaviors were significantly associated with impairment. These data provide empirical information for refining internalizing behavior assessment in preschool-aged children and can be used as benchmarks by child practitioners to assess the extent to which frequencies fall in the range of developmentally typical behavior versus those that may be more severe.

Getting in synch: Unpacking the role of parent–child synchrony in the development of internalizing and externalizing behaviors

While substantial research supports the role of parent–child interactions on the emergence of psychiatric symptoms, few studies have explored biological mechanisms for this association. The current study explored behavioral and neural parent–child synchronization during frustration and play as predictors of internalizing and externalizing behaviors across a span of 1.5 years. Parent–child dyads first came to the laboratory when the child was 4–5 years old and completed the Disruptive Behavior Diagnostic Observation Schedule: Biological Synchrony (DB-DOS: BioSync) task while functional near-infrared spectroscopy (fNIRS) data were recorded. Parents reported on their child's internalizing and externalizing behaviors using the Child Behavior Checklist (CBCL) four times over 1.5 years. Latent growth curve (LGC) modeling was conducted to assess neural and behavioral synchrony as predictors of internalizing and externalizing trajectories. Consistent with previous investigations in this age range, on average, internalizing and externalizing behaviors decreased over the four time points. Parent–child neural synchrony during a period of play predicted rate of change in internalizing but not externalizing behaviors such that higher parent–child neural synchrony was associated with a more rapid decrease in internalizing behaviors. Our results suggest that a parent–child dyad's ability to coordinate neural activation during positive interactions might serve as a protective mechanism in the context of internalizing behaviors.

Now it’s your turn!: Eye blink rate in a Jenga task modulated by interaction of task wait times, effortful control, and internalizing behaviors

Dopamine is a versatile neurotransmitter with implications in many domains, including anxiety and effortful control. Where high levels of effortful control are often regarded as adaptive, other work suggests that high levels of effortful control may be a risk factor for anxiety. Dopamine signaling may be key in understanding these relations. Eye blink rate is a non-invasive proxy metric of midbrain dopamine activity. However, much work with eye blink rate has been constrained to screen-based tasks which lack in ecological validity. We tested whether changes in eye blink rate during a naturalistic effortful control task differ as a function of parent-reported effortful control and internalizing behaviors. Children played a Jenga-like game with an experimenter, but for each trial the experimenter took an increasingly long time to take their turn. Blinks-per-second were computed during each wait period. Multilevel modeling examined the relation between duration of wait period, effortful control, and internalizing behaviors on eye blink rate. We found a significant 3-way interaction between effortful control, internalizing behaviors, and duration of the wait period. Probing this interaction revealed that for children with low reported internalizing behaviors (-1 SD) and high reported effortful control (+1 SD), eye blink rate significantly decreased as they waited longer to take their turn. These findings index task-related changes in midbrain dopamine activity in relation to naturalistic task demands, and that these changes may vary as a function of individual differences in effortful control and internalizing behaviors. We discuss possible top-down mechanisms that may underlie these differences.

Internalizing and externalizing behaviors in school-aged children are related to state anxiety during magnetic resonance imaging

Magnetic resonance imaging (MRI) procedures often evoke anxiety in children. Further, anxious children may be less likely to participate in MRI research, leading to a possible selection bias, and may be more likely to move during image acquisition, resulting in lower image quality and possible information bias. Therefore, state anxiety is problematic for functional and structural MRI studies. Children with behavioral problems, such as internalizing and externalizing behaviors, may be more likely to experience state anxiety prior to and during MRI scanning. Therefore, our first aim was to investigate the relationship between internalizing/externalizing behavior and children′s MRI-related state anxiety. Our second aim was to investigate the relationship between internalizing and externalizing behavior and MRI research participation. Our final aim was to investigate the effect of internalizing and externalizing behavior as well as MRI-related anxiety on image quality in children. We included 1,241 six- to ten-year-old children who underwent a mock MRI. Afterwards, if not too anxious, these children were scanned using a 3-Tesla GE Discovery MRI system (n = 1,070). Internalizing and externalizing behaviors were assessed with the Child Behavior Checklist. State anxiety was assessed with a visual analogue scale. Internalizing behaviors were positively associated with child state anxiety, as reported by child, parent, and researcher. For state anxiety reported by the parent and researcher, this relationship was independent of externalizing behaviors. Externalizing behaviors were related to state anxiety reported by the researcher, but this difference was not independent of internalizing behaviors, pointing towards a relationship via the shared variance with internalizing behaviors. Further, children with more internalizing and externalizing behaviors were less likely to participate in the actual MRI scanning procedure. Lastly, internalizing and externalizing behaviors, as well as MRI-related state anxiety were associated with worse image quality. These results underscore the potential for biases and methodological issues caused by MRI-related state anxiety in children.