Transdiagnostic clinical staging for childhood mental health: An adjunctive tool for classifying internalizing and externalizing syndromes that emerge in children aged 5-11 years

Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

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.

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.

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.

Pilot Randomized Controlled Trial Protocol Evaluating an Evidence-based Parenting Intervention among Filipino Parents (Preprint)

BACKGROUND Filipino Americans underutilize mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse and teen pregnancy, while adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years® (IY) Parent Training Program improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. OBJECTIVE The aims of this manuscript are to 1) describe the design and rationale of a randomized controlled trial evaluating the effects of the on-line IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and 2) describe the impact of COVID-19 on our study protocols. METHODS This study uses a randomized controlled two-arm individually randomized group treatment pretest posttest design for 180 parent-child dyads. Individuals are eligible if they are 18 years or older, live in California, and have at least one Filipino child aged 8-12 years old. Consenting participants are randomly allocated to receive: (1) the 12-week Incredible Years parenting intervention (intervention arm), or (2) American Academy of Pediatrics’ Bright Future handouts and placed on a waitlist to receive IY post-trial (waitlist control arm). Primary outcomes include the Parent Practices Interview (PPI) and Parenting Stress Index (PSI). Secondary outcomes will be measured by the Child Behavior Checklist (CBCL, completed by Parent and Child) and will include child externalizing and externalizing behaviors, and total problems. Data is collected at baseline, 3-month and 6-month follow-ups. RESULTS Recruitment is currently ongoing. Changes made to the protocol due to COVID-19 include administration of surveys remotely and implementation of the intervention online. The pandemic has provided an opportunity to evaluate the effectiveness of an online version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed in one year. CONCLUSIONS Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors among Filipino families with children ages 8-12 years old. It will also uplift cultural narratives and add to the evidence based supporting online parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk ethnic minority communities. CLINICALTRIAL ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170

The Relation between Maternal Personality and Internalizing/Externalizing Behaviors: Mediating Role of Maternal Alexithymia, Children’s Alexithymia and Emotional Regulation

Objective: Although many studies have investigated the effect of maternal personality on internalizing and externalizing behaviors of a child, the role of both mother and child’s emotional mechanisms in these behaviors is little explored. The present study was focused on the relationship between the mother’s personality, and internalizing and externalizing behaviors of children with the mediating role of children’s alexithymia, mother’s alexithymia, and children’s emotion regulation (ER). Method: 162 mothers and elementary school-aged children were recruited regarding their demographics and completed the NEO personality inventory, Child behavior checklist, Toronto alexithymia scale, Children’s alexithymia measure, and Children’s emotion regulation checklist. Data were analyzed using SPSS (ver.23), and AMOS (ver.23). Results: Structural equations modeling demonstrated an acceptable model fit to data (CMIN/DF = 1.233, RSME = 0.038, GFI = 0.962). Mother’s alexithymia predicted internalizing problems whereas it didn’t predict externalizing problems in children. Also, the bootstrap results indicated that the mother and children’s alexithymia and children’s ER had mediating roles between mother’s personality and externalizing and internalizing problems. Conclusion: The present results demonstrated that mother’s personality can indirectly, through mother and children’s alexithymia and children’s ER act as an important factor in development of mental problems. In other words, findings indicated that children’s emotional development is not a one-way road, but it is a mutual process that involves both the mother and the child.