Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence

Introduction: This report examines between- and within-person associations between youth irritability and concurrent and prospective internalizing and externalizing symptoms from early childhood through adolescence. Distinguishing between- and within-person longitudinal associations may yield distinct, clinically relevant information about pathways to multifinality from childhood irritability. Methods: Children’s irritability and co-occurring symptoms were assessed across five waves between ages 3 and 15 years using the mother-reported Child Behavior Checklist (N = 605, 46% female). Parental history of depressive disorders was assessed with a clinical interview. Results: Results demonstrated that between- and within-person irritability were uniquely associated with concurrent depressive, anxiety, and defiance symptoms, but not ADHD. Prior wave within-person irritability also predicted next wave depressive, anxiety, and defiance symptoms, controlling for prior symptoms; these prospective associations were bidirectional. Child sex and parental depressive disorders moderated associations. Discussions: Findings identify pathways from within- and between-person irritability to later internalizing and externalizing psychopathology. Results demonstrate the importance of parsing within- and between-person effects to understand nuanced relations among symptoms over childhood.

An examination of the relations between effortful control in early childhood and risk for later externalizing psychopathology: A bi-factor structural equation modeling approach

Effortful control (EC) is characterized by regulatory strategies that contribute to patterns of (mal)adaptation across development. Deficits in EC pose risk for externalizing psychopathology, but whether and how subfactors of EC differentially influence children’s conduct problems (CP), attention deficit disordered behaviors (ADD), and callous-unemotional (CU) traits remains unknown. Research on EC may benefit from alternative modeling strategies that allow for comparisons of overall EC scores and its subfactors in the prediction of externalizing outcomes. The current study uses a bi-factor structural equation modeling approach to examine if general EC and its subfactors (i.e., attentional focusing, low-intensity pleasure, perceptual sensitivity, inhibitory control) at 36 months differentially predict CP, ADD, and CU traits at 84 months. Using a longitudinal sample of 206 children followed from age three to seven years (47.8% female, 42.6% European-American), results indicated that increased general EC at 36 months predicted reduced CU traits and ADD at 84 months. Attentional focusing was the only subfactor to uniquely predict later CU traits, suggesting that attentional abilities hold particular significance for buffering against psychopathy. Findings are interpreted in the context of methodological and theoretical significance for future developmental research, as well as implications for interventions targeting regulatory strategies in early childhood.

Psychometric Properties of the Millon Clinical Multiaxial Inventory–III in an Arabic Clinical Sample Compared With American, Italian, and Dutch Cultures

Millon Clinical Multiaxial Inventory MCMI–III is a multidimensional measure of psychopathology with excellent construct validity, test-retest reliability as well as internal consistency. Factor analysis of the MCMI-III has produced mixed results, extracting parsimonious three-factor solutions, or replicating the original four-factor solution in psychiatric samples from Western countries. However, little work has been done on the psychometric properties of the MCMI–III, using non-Western psychiatric samples. Outpatients (N = 212) completed the MCMI–III during a semi-structured interview. Eight exploratory factor analysis (EFA) methods were used to explore the underlying structure of MCMI–III. Skewness, kurtosis, and descriptive statistics confirmed that scales of MCMI–III were normally distributed. High-internal consistency was found. The eight EFA methods applied to the 24 clinical scales identified a consensual three-factor solution: factor I (internalizing psychopathology; 18 scales), factor II (externalizing psychopathology; 4 scales) and factor III (psychological disturbance; 2 scales), accounting for a total of 72% of the common variance. Regarding the cross-cultural equivalence of the MCMI–III structure, Tucker's congruence coefficient (Φ) was used and confirmed that internalizing (F1) and externalizing psychopathology (F2) factors obtained in this study are similar to high vs. low psychopathology and emotional constraint factors provided by American study of Haddy et al. (2005) (Φ was 0.86 and 0.97). These two factors are also similar to the general adjustment and antisocial acting out factors provided by the American study of Craig and Bivens (1998) (Φ was 0.82 and 0.96). The first two factors in this study also reflect high similarity with the factor solutions obtained with the Italian and Dutch versions of MCMI-III (Rossi et al., 2007; Pignolo et al., 2017). Despite using a psychiatric sample from a non-Western culture, the two factors identified for this MCMI–III Arabic version were similar to those reported on studies with MCMI–III, using primarily Western samples (Craig and Bivens, 1998; Rossi et al., 2007).

Transdiagnostic mechanisms in internalizing and externalizing psychopathology: The role of effortful control in reflexive responding to emotion

Emotion-based impulsivity is a transdiagnostic construct related to both internalizing and externalizing behaviors. The Reflexive Responding to Emotion (RRE) framework proposes one possible mechanism through which emotion-based impulsivity predicts two phenotypically different presentations – poor effortful control in the face of strong negative and positive affect can result in either approach or avoidance tendencies. In the present study, we tested this theoretical model in a large developmental community sample, the Enhanced NKI-RS sample (Adult n = 708, Adolescent n = 367), which has a wide range of psychopathology and healthy functioning. Using structural equation path modeling, we tested our primary hypothesis that heightened negative or positive affect would be associated with internalizing and externalizing behaviors indirectly through activation control (avoidance) or inhibitory control (approach) facets of effortful control. In adolescents, pathways consistent with the RRE framework for negative urgency emerged such that there was a significant indirect path from negative affect to activation control to internalizing and from negative affect to inhibitory control to externalizing. There was no evidence of positive urgency pathways in the adolescent sample. In contrast, distinct pathways emerged for negative and positive affect in the adult sample – both indirectly led to internalizing psychopathology through activation control and externalizing psychopathology through inhibitory control. Results provide empirical support for the theoretical RRE model and highlight differential cognitive mechanisms through which heightened emotion states may lead to distinct impulsive action or inaction. Implications of these results are discussed, particularly as they relate to differential intervention targets for emotion-based impulsivity in transdiagnostic populations.

Promoting youth mental health during the COVID-19 pandemic: A longitudinal study

The COVID-19 pandemic has introduced novel stressors into the lives of youth. Identifying factors that protect against the onset of psychopathology in the face of these stressors is critical. We examine a wide range of factors that may protect youth from developing psychopathology during the pandemic. We assessed pandemic-related stressors, internalizing and externalizing psychopathology, and potential protective factors by combining two longitudinal samples of children and adolescents (N = 224, 7–10 and 13–15 years) assessed prior to the pandemic, during the stay-at-home orders, and six months later. We evaluated how family behaviors during the stay-at-home orders were related to changes in psychopathology during the pandemic, identified factors that moderate the association of pandemic-related stressors with psychopathology, and determined whether associations varied by age. Internalizing and externalizing psychopathology increased substantially during the pandemic. Higher exposure to pandemic-related stressors was associated with increases in internalizing and externalizing symptoms early in the pandemic and six months later. Having a structured routine, less passive screen time, lower exposure to news media about the pandemic, and to a lesser extent more time in nature and getting adequate sleep were associated with reduced psychopathology. The association between pandemic-related stressors and psychopathology was reduced for youths with limited passive screen time and was absent for children, but not adolescents, with lower news media consumption related to the pandemic. We provide insight into simple, practical steps families can take to promote resilience against mental health problems in youth during the COVID-19 pandemic and protect against psychopathology following pandemic-related stressors.

Characterizing Typologies of Polytraumatization: A Replication and Extension Study Examining Internalizing and Externalizing Psychopathology in an Urban Population

A person-centered approach to examining trauma has uncovered typologies of polytraumatization that are differentially associated with psychopathology. However, previous research is limited by narrow conceptualizations of trauma, limited distal outcomes, and underrepresentation of racially marginalized groups. To address these gaps, we used latent profile analysis to uncover distinct polytraumatization typologies and examine four symptom-based (posttraumatic stress disorder, depression, aggression, and substance abuse) and two behavior-based (self-harm, jail counts) outcomes in a sample of adults with low socioeconomic resources ( N = 7,426, 94% African American). The models were indicated by 19 traumatic experiences (e.g., accident, sexual assault, witnessing/experiencing violence). The best fitting model uncovered five classes: minimal trauma, physical abuse, violence exposure, sexual abuse, and polytrauma. Classes characterized by significant and varied trauma were higher on both internalizing and externalizing psychopathology, whereas those characterized by specific types of trauma were higher on only one type of psychopathology. Implications for the assessment and treatment of trauma-related disorders are discussed.

Primary and secondary callous–unemotional traits in adolescence are associated with distinct maladaptive and adaptive outcomes in adulthood

While phenotypically indistinguishable with respect to callousness, individuals with primary and secondary callous–unemotional (CU) traits may show different developmental outcomes. This research predominantly comprised cross-sectional studies of male participants with a focus on maladaptive correlates. Thus, the present study examined whether youth with primary and secondary CU traits identified in Grade 7 reported distinct maladaptive outcomes (internalizing, externalizing, and substance use problems; criminal offenses; and sexual and partner experiences) and adaptive outcomes (health and wellbeing, education, and employment) in adulthood at age 25. We also examined sex differences. Participants included the high-risk control and normative samples from the Fast Track project (N = 754, male = 58%, Black = 46%). Youth with secondary CU traits reported higher levels of adult internalizing and externalizing psychopathology, a greater number of sexual partners and risky sexual behavior, and a greater number of violent offenses, compared with individuals with primary CU traits and those with low CU and anxiety symptoms. Conversely, youth with primary CU traits and low symptoms had higher wellbeing and happiness scores than those with secondary CU traits. Finally, there was differentiation on outcomes between female primary and secondary CU variants and male primary and secondary CU variants.