Self-Esteem Moderates the Relationship Between Secure Attachment and Internalizing and Externalizing Problems in Preadolescence

This longitudinal study examined the interactive effects of secure attachment and self-esteem on change in internalizing and externalizing problems in a sample of preadolescents. 407 youth ( Mage = 11.1 years) completed measures of self-esteem, secure attachment style, and peer nomination inventories tapping internalizing and externalizing problems at the beginning of the fourth and fifth grades. Results suggest that internalizing and externalizing problems may be reduced for securely attached youth with high self-esteem. Implications for future research are examined, along with a discussion on clinical applications of studies involving interaction effects.

Pre-pandemic psychological and behavioral predictors of responses to the COVID-19 pandemic in nine countries

Prior to the COVID-19 pandemic, adolescents (N = 1,330; Mages = 15 and 16; 50% female), mothers, and fathers from nine countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, United States) reported on adolescents’ internalizing and externalizing problems, adolescents completed a lab-based task to assess tendency for risk-taking, and adolescents reported on their well-being. During the pandemic, participants (Mage = 20) reported on changes in their internalizing, externalizing, and substance use compared to before the pandemic. Across countries, adolescents’ internalizing problems pre-pandemic predicted increased internalizing during the pandemic, and poorer well-being pre-pandemic predicted increased externalizing and substance use during the pandemic. Other relations varied across countries, and some were moderated by confidence in the government’s handling of the pandemic, gender, and parents’ education.

Internalizing and Externalizing Correlates of Parental Overprotection as Measured by the EMBU: A Systematic Review and Meta-Analysis

Aspects of parenting including overprotection explain individual differences in child adjustment. This review and meta-analysis summarizes studies on parental overprotection and internalizing and externalizing problems. To ensure that findings could be compared as systematically as possible, the focus is on studies that used the overprotection scale of the Egna Minnen Beträffande Uppfostran (“Memories of my Parents’ Upbringing”) (EMBU) questionnaire, a popular instrument to measure parental overprotection. In total, we extracted 176 effects from 29 studies. A modified version of the Newcastle-Ottawa Scale was used to perform quality assessments for the included studies. Parental overprotection was positively associated with offspring internalizing and externalizing problems, with overall estimates ranging from r = .14 to .18. Moderator analyses suggested that effects of maternal were larger than effects of paternal overprotection. Other factors that moderated the strength of the association between overprotection and maladjustment included whether outcomes were self-reported or parent-reported, the design was cross-sectional or longitudinal, and publication year. Cultural context, age at exposure, and child sex did not explain differences between effect sizes. Most findings were based on cross-sectional studies and therefore do not constitute proof of causal relations. Many studies were of less-than-satisfactory quality regarding representativeness of the sample, descriptions of the data collection, and statistical analyses. There is a clear need for well-powered longitudinal studies to strengthen inferences about associations between parental overprotection and internalizing and externalizing problems.

Assessment of Attachment Representations in Basque Adolescents and their Relationship with Internalizing and Externalizing Problems

Research has shown a relationship between attachment style and psychosocial adjustment in adolescents. Whereas secure attachment is related to fewer internalizing and externalizing symptoms, the opposite is the case for the various insecure attachment styles. The aim of the two studies reported in this paper was to adapt and validate the CaMir-R (a self-report measure of attachment that has shown adequate psychometric properties) for use among Basque adolescents, and to analyse the relationship between attachment and internalizing and externalizing symptoms. In Study 1, the instrument was adapted using the back translation method and applied to a sample of 203 adolescents and young adults. Confirmatory factor analysis supported the theoretical dimensions of the scale, and its psychometric properties were found to be adequate. In Study 2 we obtained additional validity evidence by applying, in a sample of 786 adolescents and young adults, the attachment representations section of the CaMir-R alongside other measures of attachment and clinical symptoms. The results once again supported the dimensional structure of the instrument, and evidence of convergent validity was obtained based on correlations between CaMir-R scores and scores on the Inventory of Parent and Peer Attachment (IPPA). In addition, scores on the five dimensions of attachment representations (Security, Family concerns, Parental interference, Self-sufficiency and resentment of parents and Childhood trauma) were correlated with scores on other measures of internalizing and externalizing symptoms. Based on these results, we conclude that the Basque version of the CaMir-R is a valid instrument for assessing the quality of attachment representations among adolescents, and also that internalizing and externalizing problems are related to attachment style. We discuss the importance of attachment in relation to behaviour problems and clinical symptoms.

Interaction Structures in Psychodynamic Psychotherapy for Adolescents

Despite advances in psychotherapy research showing an evidence-base for psychodynamic psychotherapy (PDT) in adolescents, developmentally specific treatment characteristics are under-researched. We aimed to identify interaction structures (IS: reciprocal patterns of in-session interactions involving therapist interventions, patient behaviors, and the therapeutic relationship) and assess associations between IS and outcome. The study cohort comprised 43 adolescents (Mage = 13.02 years) with nonclinical, internalizing, and comorbid internalizing–externalizing problems in PDT. A total of 123 sessions from different treatment phases were rated based on the Adolescent Psychotherapy Q-Set (APQ). Outcome was assessed with the Brief Problem Monitor-Youth (BPM-Y) administered repeatedly over the treatment course. Principal component analysis of APQ items resulted in five IS, named “Negative Therapeutic Alliance”, “Demanding Patient, Accommodating Therapist”, “Emotionally Distant Resistant Patient”, “Inexpressive Patient, Inviting Therapist”, and “Exploratory Psychodynamic Technique” (EPT). Multilevel modeling analyses with Bayesian Markov chain Monte Carlo (MCMC) estimations indicated a two-way interaction effect between EPT and problem levels at baseline such that patients with lower problems at baseline showed good outcome in the context of EPT, whereas an inverse relationship was found for patients with higher problems. Findings provide empirical evidence for characteristic components of PDT for adolescents and preliminary answers about who benefits from psychodynamic techniques.

Psychiatric Symptoms and Parental Stress in Children and Adolescents With Epilepsy

Introduction: The aim of this study was to identify the presence of emotional and behavioral symptoms in children and adolescents with epilepsy, to measure the stress levels in their parents, and to determine if and how parental stress was linked to emotional and behavioral symptoms of their children.Methods: We conducted a cross-sectional observational study including 103 children and adolescents with different form of epilepsy and 93 sex-/age-matched controls. Parental stress and emotional and behavioral symptoms were assessed through two standardized questionnaires: the Parenting Stress Index (PSI) and the Child Behavior Checklist (CBCL), respectively. We also considered the following variables: age, sex, maternal education level, family history of psychiatric disorders, duration of epilepsy, seizure frequency, seizure type, and number of antiseizure medications.Results: The statistical comparison showed that the epilepsy group obtained significantly higher scores than controls in almost all the CBCL and the PSI scales (p < 0.05). The correlation analysis revealed a significant relationship between the PSI Total Stress scale and the following CBCL scales: total problems, internalizing problems, and externalizing problems (p < 0.05). An earlier age of seizure onset was related to a greater presence of externalizing problems, total problems, and total stress (p < 0.05).Conclusion: In the epilepsy group, we found higher levels of parental stress and higher presence of emotional and behavioral symptoms compared to controls, mainly represented by internalizing problems (anxiety and depression symptoms). Therefore, it is important to precociously detect these symptoms and monitor them over time, in order to prevent psychiatric problems. In addition, parents of children with epilepsy should be offered psychological support to cope with parental stress and to improve the relationship with their children.

Influences of Maternal Parenting Stress on Child Behavior Problems: Examining Harsh and Positive Parenting as Mediators

Extant research demonstrates associations between parenting stress and child internalizing and externalizing problems, with evidence that parenting behaviors may mediate these associations; however, few studies have been longitudinal. The current study tested whether harsh and positive parenting mediated associations between maternal parenting stress and child internalizing and externalizing problems. Data from the Fragile Families and Child Wellbeing Study were utilized, with 2,606 families who completed the year nine wave included (37% less than high school; 60.2% married/cohabitating; 50% Black, non-Hispanic; 24% Hispanic; and 26% White, non-Hispanic). Analyses revealed parenting stress at age three was significantly associated with higher child internalizing and externalizing problems at age nine. Further, positive but not harsh parenting mediated the link between parenting stress and externalizing problems. Parenting did not mediate the association between parenting stress and internalizing problems. Findings suggest harsh and positive parenting differentially explains associations between parenting stress and child internalizing and externalizing problems.