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The dynamics of internalizing and externalizing comorbidity across the early school years

Published online by Cambridge University Press:  14 October 2016

Cynthia J. Willner*
Pennsylvania State University
Lisa M. Gatzke-Kopp
Pennsylvania State University
Bethany C. Bray
Pennsylvania State University
Address correspondence and reprint requests to: Cynthia J. Willner, Yale Child Study Center, Yale University School of Medicine, 230 South Frontage Road, NIHB G03, New Haven, CT 06520; E-mail:


High rates of comorbidity are observed between internalizing and externalizing problems, yet the developmental dynamics of comorbid symptom presentations are not yet well understood. This study explored the developmental course of latent profiles of internalizing and externalizing symptoms across kindergarten, first grade, and second grade. The sample consisted of 336 children from an urban, low-income community, selected based on relatively high (61%) or low (39%) aggressive/oppositional behavior problems at school entry (64% male; 70% African American, 20% Hispanic). Teachers reported on children's symptoms in each year. An exploratory latent profile analysis of children's scores on aggression/oppositionality, hyperactivity/inattention, anxiety, and social withdrawal symptom factors revealed four latent symptom profiles: comorbid (48% of the sample in each year), internalizing (19%–23%), externalizing (21%–22%), and well-adjusted (7%–11%). The developmental course of these symptom profiles was examined using a latent transition analysis, which revealed remarkably high continuity in the comorbid symptom profile (89% from one year to the next) and moderately high continuity in both the internalizing and externalizing profiles (80% and 71%, respectively). Internalizing children had a 20% probability of remitting to the well-adjusted profile by the following year, whereas externalizing children had a 25% probability of transitioning to the comorbid profile. These results are consistent with the hypothesis that a common vulnerability factor contributes to developmentally stable internalizing–externalizing comorbidity, while also suggesting that some children with externalizing symptoms are at risk for subsequently accumulating internalizing symptoms.

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Achenbach, T. M., & Edelbrock, C. S. (1978). The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin, 85, 12751301.CrossRefGoogle ScholarPubMed
Akaike, H. (1974). A new look at the statistical model identification. IEEE Transactions on Automatic Control, 19, 716723.CrossRefGoogle Scholar
Andrews, M. M., Meda, S. A., Thomas, A. D., Potenza, M. N., Krystal, J. H., Worhunsky, P., et al. (2011). Individuals family history positive for alcoholism show functional magnetic resonance imaging differences in reward sensitivity that are related to impulsivity factors. Biological Psychiatry, 69, 675683.CrossRefGoogle ScholarPubMed
Asparouhov, T., & Muthén, B. (2009). Exploratory structural equation modeling. Structural Equation Modeling, 16, 397438.CrossRefGoogle Scholar
Basten, M. M. G. J., Althoff, R. R., Tiemeier, H., Jaddoe, V. W. V., Hofman, A., Hudziak, J. J., et al. (2013). The dysregulation profile in young children: Empirically defined classes in the Generation R study. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 841850.CrossRefGoogle ScholarPubMed
Beauchaine, T. P. (2015). Future directions in emotion dysregulation and youth psychopathology. Journal of Clinical Child and Adolescent Psychology, 44, 875896.CrossRefGoogle ScholarPubMed
Beauchaine, T. P., & McNulty, T. (2013). Comorbidities and continuities as ontogenic processes: Toward a developmental spectrum model of externalizing psychopathology. Development and Psychopathology, 25, 15051528.CrossRefGoogle Scholar
Beitchman, J. H., Baldassarra, L., Mik, H., De Luca, V., King, N., Bender, D., et al. (2006). Serotonin transporter polymorphisms and persistent, pervasive childhood aggression. American Journal of Psychiatry, 163, 11031105.CrossRefGoogle ScholarPubMed
Bird, H. R., Gould, M. S., & Staghezza, B. M. (1993). Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years. Journal of the American Academy of Child & Adolescent Psychiatry, 32, 361368.CrossRefGoogle Scholar
Brenner, S. L., & Beauchaine, T. P. (2011). Pre-ejection period reactivity and psychiatric comorbidity prospectively predict substance use initiation among middle-schoolers: A pilot study. Psychophysiology, 48, 15881596.CrossRefGoogle ScholarPubMed
Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21, 230258.CrossRefGoogle Scholar
Bulotsky-Shearer, R. J., Fantuzzo, J. W., & McDermott, P. A. (2010). Typology of emotional and behavioral adjustment for low-income children: A child-centered approach. Journal of Applied Developmental Psychology, 31, 180191.CrossRefGoogle Scholar
Burke, J. D., Loeber, R., Lahey, B. B., & Rathouz, P. J. (2005). Developmental transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry, 46, 12001210.CrossRefGoogle ScholarPubMed
Canli, T., & Lesch, K.-P. (2007). Long story short: The serotonin transporter in emotion regulation and social cognition. Nature Neuroscience, 10, 11031109.CrossRefGoogle ScholarPubMed
Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32, 10631080.CrossRefGoogle ScholarPubMed
Carragher, N., Krueger, R. F., Eaton, N. R., & Slade, T. (2015). Disorders without borders: Current and future directions in the meta-structure of mental disorders. Social Psychiatry and Psychiatric Epidemiology, 50, 339350.CrossRefGoogle ScholarPubMed
Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233255.CrossRefGoogle Scholar
Clark, L. A. (2005). Temperament as a unifying basis for personality and psychopathology. Journal of Abnormal Psychology, 114, 505521.CrossRefGoogle ScholarPubMed
Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis. Hoboken, NJ: Wiley.Google Scholar
Collins, L. M., & Wugalter, S. E. (1992). Latent class models for stage-sequential dynamic latent variables. Multivariate Behavioral Research, 27, 131157.CrossRefGoogle Scholar
Coplan, R. J., & Arbeau, K. A. (2008). The stresses of a “Brave New World”: Shyness and school adjustment in kindergarten. Journal of Research in Childhood Education, 22, 377389.CrossRefGoogle Scholar
Cosgrove, V. E., Rhee, S. H., Gelhorn, H. L., Boeldt, D., Corley, R. C., Ehringer, M. A., et al. (2011). Structure and etiology of co-occurring internalizing and externalizing disorders in adolescents. Journal of Abnormal Child Psychology, 39, 109123.CrossRefGoogle ScholarPubMed
Cremers, H. R., Veer, I. M., Spinhoven, P., Rombouts, S. A. R. B., & Roelofs, K. (2015). Neural sensitivity to social reward and punishment anticipation in social anxiety disorder. Frontiers in Behavioral Neuroscience. Advance online publication.CrossRefGoogle ScholarPubMed
DiStefano, C., & Kamphaus, R. W. (2006). Investigating subtypes of child development: A comparison of cluster analysis and latent class cluster analysis in typology creation. Educational and Psychological Measurement, 66, 778794.CrossRefGoogle Scholar
Dougherty, L. R., Smith, V. C., Bufferd, S. J., Kessel, E., Carlson, G. A., & Klein, D. N. (2015). Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine. Journal of Child Psychology and Psychiatry, 56, 9991007.CrossRefGoogle ScholarPubMed
Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K. E., et al. (2012). An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from a national sample. Journal of Abnormal Psychology, 121, 282288.CrossRefGoogle ScholarPubMed
Eaton, N. R., Keyes, K. M., Krueger, R. F., Noordhof, A., Skodol, A. E., Markon, K. E., et al. (2013). Ethnicity and psychiatric comorbidity in a national sample: Evidence for latent comorbidity factor invariance and connections with disorder prevalence. Social Psychiatry and Psychiatric Epidemiology, 48, 701710.CrossRefGoogle Scholar
Edelbrock, C., & Achenbach, T. M. (1980). A typology of child behavior profile patterns: Distribution and correlates for disturbed children aged 6–16. Journal of Abnormal Child Psychology, 8, 441470.CrossRefGoogle ScholarPubMed
Epkins, C. C. (2000). Cognitive specificity in internalizing and externalizing problems in community and clinic-referred children. Journal of Clinical Child Psychology, 29, 199208.CrossRefGoogle ScholarPubMed
Forbes, E. E., & Dahl, R. E. (2005). Neural systems of positive affect: Relevance to understanding child and adolescent depression? Development and Psychopathology, 17, 827850.CrossRefGoogle ScholarPubMed
Frankel, F., Hanna, G. L., Cantwell, D. P., Shekim, W., & Ornitz, E. (1992). Cluster analysis of child behavior checklists of 6- to 11-year-old males with varying degrees of behavior disorders. Child Psychiatry and Human Development, 23, 6985.CrossRefGoogle ScholarPubMed
Gatzke-Kopp, L. M. (2016). Diversity and representation: Key issues for psychophysiological science. Psychophysiology, 53, 313.CrossRefGoogle ScholarPubMed
Gatzke-Kopp, L. M., Beauchaine, T. P., Shannon, K. E., Chipman, J., Fleming, A. P., Crowell, S. E., et al. (2009). Neurological correlates of reward responding in adolescents with and without externalizing behavior disorders. Journal of Abnormal Psychology, 118, 203.CrossRefGoogle ScholarPubMed
Gatzke-Kopp, L. M., Greenberg, M. T., Fortunato, C. K., & Coccia, M. A. (2012). Aggression as an equifinal outcome of distinct neurocognitive and neuroaffective processes. Development and Psychopathology, 24, 9851002.CrossRefGoogle ScholarPubMed
Gilliom, M., & Shaw, D. S. (2004). Codevelopment of externalizing and internalizing problems in early childhood. Development and Psychopathology, 16, 313333.CrossRefGoogle ScholarPubMed
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581586.CrossRefGoogle ScholarPubMed
Gooren, E. M. J. C., van Lier, P. A. C., Stegge, H., Terwogt, M. M., & Koot, H. M. (2011). The development of conduct problems and depressive symptoms in early elementary school children: The role of peer rejection. Journal of Clinical Child and Adolescent Psychology, 40, 245253.CrossRefGoogle ScholarPubMed
Gresham, F. M., MacMillan, D. L., Bocian, K. M., Ward, S. L., & Forness, S. R. (1998). Comorbidity of hyperactivity-impulsivity-inattention and conduct problems: Risk factors in social, affective, and academic domains. Journal of Abnormal Child Psychology, 26, 393406.CrossRefGoogle ScholarPubMed
Harrist, A. W., Zaia, A. F., Bates, J. E., Dodge, K. A., & Pettit, G. S. (1997). Subtypes of social withdrawal in early childhood: Sociometric status and social-cognitive differences across four years. Child Development, 68, 278294.CrossRefGoogle ScholarPubMed
Horn, J. L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30, 179185.CrossRefGoogle ScholarPubMed
Hymel, S., Rubin, K. H., Rowden, L., & LeMare, L. (1990). Children's peer relationships: Longitudinal prediction of internalizing and externaliziing problems from middle to late childhood. Child Development, 61, 20042021.Google Scholar
Ialongo, N., Edelsohn, G., Werthamer-Larsson, L., Crockett, L., & Kellam, S. (1996). The course of aggression in first-grade children with and without comorbid anxious symptoms. Journal of Abnormal Child Psychology, 24, 445456.CrossRefGoogle ScholarPubMed
Kamphaus, R. W., Huberty, C. J., DiStefano, C., & Petoskey, M. D. (1997). A typology of teacher-rated child behavior for a national U.S. sample. Journal of Abnormal Child Psychology, 25, 453463.CrossRefGoogle ScholarPubMed
Kamphaus, R. W., Petoskey, M. D., Cody, A. H., Rowe, E. W., Huberty, C. J., & Reynolds, C. R. (1999). A typology of parent rated child behavior for a national U.S. sample. Journal of Child Psychology and Psychiatry, 40, 607616.CrossRefGoogle ScholarPubMed
Karg, K., Burmeister, M., Shedden, K., & Sen, S. (2011). The serotonin transporter promoter variant (5-HTTLPR), stress, and depression meta-analysis revisited: Evidence of genetic moderation. Archives of General Psychiatry, 68, 444454.CrossRefGoogle ScholarPubMed
Keiley, M. K., Bates, J. E., Dodge, K. A., & Pettit, G. S. (2000). A cross-domain growth analysis: Externalizing and internalizing behaviors during 8 years of childhood. Journal of Abnormal Child Psychology, 28, 161179.CrossRefGoogle ScholarPubMed
Ladd, G. W. (2006). Peer rejection, aggressive or withdrawn behavior, and psychological maladjustment from ages 5 to 12: An examination of four predictive models. Child Development, 77, 822846.CrossRefGoogle ScholarPubMed
Ladd, G. W., & Burgess, K. B. (1999). Charting the relationship trajectories of aggressive, withdrawn, and aggressive/withdrawn children during early grade school. Child Development, 70, 910929.CrossRefGoogle ScholarPubMed
Ladd, G. W., & Troop-Gordon, W. (2003). The role of chronic peer difficulties in the development of children's psychological adjustment problems. Child Development, 74, 13441367.CrossRefGoogle ScholarPubMed
Lahey, B. B., Van Hulle, C. A., Singh, A. L., Waldman, I. D., & Rathouz, P. J. (2011). Higher-order genetic and environmental structure of prevalent forms of child and adolescent psychopathology. Archives of General Psychiatry, 68, 181189.CrossRefGoogle ScholarPubMed
Lahey, B. B., & Waldman, I. D. (2007). Personality dispositions and the development of violence and conduct problems. In Flannery, D. J., Vazsonyi, A. T., & Waldman, I. D. (Eds.), Behavior and aggression (pp. 260287). New York: Cambridge University Press.Google Scholar
Lavigne, J. V., Arend, R., Rosenbaum, D., Binns, H. J., Christoffel, K. K., & Gibbons, R. D. (1998). Psychiatric disorders with onset in the preschool years: I. Stability of diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 12461254.CrossRefGoogle ScholarPubMed
Lesch, K.-P., Bengel, D., Heils, A., Sabol, S. Z., Greenberg, B. D., Petri, S., et al. (1996). Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science, 274, 15271531.CrossRefGoogle ScholarPubMed
Lesch, K.-P., & Merschdorf, U. (2000). Impulsivity, aggression, and serotonin: A molecular psychobiological perspective. Behavioral Sciences & the Law, 18, 581604.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Lilienfeld, S. O., Waldman, I. D., & Israel, A. C. (1994). A critical examination of the use of the term and concept of comorbidity in psychopathology research. Clinical Psychology: Science and Practice, 1, 7183.Google Scholar
Marsh, H. W., Morin, A. J. S., Parker, P. D., & Kaur, G. (2014). Exploratory structural equation modeling: An integration of the best features of exploratory and confirmatory factor analysis. Annual Review of Clinical Psychology, 10, 85110.CrossRefGoogle ScholarPubMed
McConaughy, S. H., Stanger, C., & Achenbach, T. M. (1992). Three-year course of behavioral/emotional problems in a national sample of 4- to 16-year-olds: I. Agreement among informants. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 932940.CrossRefGoogle Scholar
McDermott, P. A., & Weiss, R. V. (1995). A normative typology of healthy, subclinical, and clinical behavior styles among American children and adolescents. Psychological Assessment, 7, 162170.CrossRefGoogle Scholar
McLoyd, V. C. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185204.CrossRefGoogle ScholarPubMed
Mikolajewski, A. J., Allan, N. P., Hart, S. A., Lonigan, C. J., & Taylor, J. (2013). Negative affect shares genetic and environmental influences with symptoms of childhood internalizing and externalizing disorders. Journal of Abnormal Child Psychology, 41, 411423.CrossRefGoogle ScholarPubMed
Moilanen, K. L., Shaw, D. S., & Maxwell, K. L. (2010). Developmental cascades: Externalizing, internalizing, and academic competence from middle childhood to early adolescence. Development and Psychopathology, 22, 635653.CrossRefGoogle ScholarPubMed
Murphy, S. E., Norbury, R., Godlewska, B. R., Cowen, P. J., Mannie, Z. M., Harmer, C. J., et al. (2013). The effect of the serotonin transporter polymorphism (5-HTTLPR) on amygdala function: A meta-analysis. Molecular Psychiatry, 18, 512520.CrossRefGoogle ScholarPubMed
Muthén, B., & Asparouhov, T. (2002). Latent variable analysis with categorical outcomes: Multiple-group and growth modeling in Mplus. Mplus Web Notes: No. 4, v. 5. Retrieved from Google Scholar
Muthén, L. K., & Muthén, B. O. (2012). Mplus users guide (7th ed.). Los Angeles: Author.Google Scholar
Neuhaus, E., & Beauchaine, T. (2013). Impulsivity and vulnerability to psychopathology. In Beauchaine, T. P. & Hinshaw, S. P. (Eds.), Child and adolescent psychopathology (2nd ed., pp. 197226). Hoboken, NJ: Wiley.Google Scholar
Nobile, M., Colombo, P., Bellina, M., Molteni, M., Simone, D., Nardocci, F., et al. (2013). Psychopathology and adversities from early- to late-adolescence: A general population follow-up study with the CBCL DSM-oriented scales. Epidemiology and Psychiatric Sciences, 22, 6373.CrossRefGoogle ScholarPubMed
Polier, G. G., Vloet, T. D., Herpertz-Dahlmann, B., Laurens, K. R., & Hodgins, S. (2011). Comorbidity of conduct disorder symptoms and internalising problems in children: Investigating a community and a clinical sample. European Child and Adolescent Psychiatry, 21, 3138.CrossRefGoogle Scholar
Rhee, S. H., Lahey, B. B., & Waldman, I. D. (2015). Comorbidity among dimensions of childhood psychopathology: Converging evidence from behavior genetics. Child Development Perspectives, 9, 2631.CrossRefGoogle ScholarPubMed
Rosenbaum, J. F., Biederman, J., Bolduc-Murphy, E. A., Faraone, S. V., Chaloff, J., Hirshfeld, D. R., et al. (1993). Behavioral inhibition in childhood: A risk factor for anxiety disorders. Harvard Review of Psychiatry, 1, 216.CrossRefGoogle ScholarPubMed
Sagvolden, T., Johansen, E. B., Aase, H., & Russell, V. A. (2005). A dynamic developmental theory of attention-deficit/hyperactivity disorder (ADHD) predominantly hyperactive/impulsive and combined subtypes. Behavioral and Brain Sciences, 28, 397419.CrossRefGoogle ScholarPubMed
Schmitz, S., Fulker, D. W., Plomin, R., Zahn-Waxler, C., Emde, R. N., & DeFries, J. C. (1999). Temperament and problem behaviour during early childhood. International Journal of Behavioral Development, 23, 333355.CrossRefGoogle Scholar
Schwartz, G. (1978). Estimating the dimension of a model. Annals of Statistics, 6, 461464.CrossRefGoogle Scholar
Sclove, S. L. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52, 333343.CrossRefGoogle Scholar
Sourander, A., Jensen, P., Davies, M., Niemelä, S., Elonheimo, H., Ristkari, T., et al. (2007). Who is at greatest risk of adverse long-term outcomes? The Finnish From a Boy to a Man study. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 11481161.CrossRefGoogle Scholar
Sroufe, L. A. (1997). Psychopathology as an outcome of development. Development and Psychopathology, 9, 251268.CrossRefGoogle ScholarPubMed
Tackett, J. L., Lahey, B. B., van Hulle, C., Waldman, I., Krueger, R. F., & Rathouz, P. J. (2013). Common genetic influences on negative emotionality and a general psychopathology factor in childhood and adolescence. Journal of Abnormal Psychology, 122, 11421153.CrossRefGoogle Scholar
Tolan, P. H., & Henry, D. (1996). Patterns of psychopathology among urban poor children: Comorbidity and aggression effects. Journal of Consulting and Clinical Psychology, 64, 10941099.CrossRefGoogle ScholarPubMed
Treadway, M. T., & Zald, D. H. (2014). Translational models of dopaminergic mechanisms for motivational deficits in anhedonic patients. In Ritsner, M. S. (Ed.), Anhedonia: A comprehensive handbook: Vol. 1. Conceptual issues and neurobiological advances (pp. 107117). New York: Springer.Google Scholar
Vaidyanathan, U., Patrick, C. J., & Iacono, W. G. (2011). Patterns of comorbidity among mental disorders: A person-centered approach. Comprehensive Psychiatry, 52, 527535.CrossRefGoogle ScholarPubMed
van Lier, P. A. C., & Koot, H. M. (2010). Developmental cascades of peer relations and symptoms of externalizing and internalizing problems from kindergarten to fourth-grade elementary school. Development and Psychopathology, 22, 569582.CrossRefGoogle ScholarPubMed
Velicer, W. F. (1976). Determining the number of components from the matrix of partial correlations. Psychometrika, 41, 321327.CrossRefGoogle Scholar
Verhulst, F. C., & Althaus, M. (1988). Persistence and change in behavioral/emotional problems reported by parents of children aged 4–14: An epidemiological study. Acta Psychiatrica Scandinavica, 77, 128.CrossRefGoogle Scholar
Weiss, B., Süsser, K., & Catron, T. (1998). Common and specific features of childhood psychopathology. Journal of Abnormal Psychology, 107, 118127.CrossRefGoogle ScholarPubMed
Werthamer-Larsson, L., Kellam, S., & Wheeler, L. (1991). Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems. American Journal of Community Psychology, 19, 585602.CrossRefGoogle ScholarPubMed
Whittle, S., Allen, N. B., Lubman, D. I., & Yücel, M. (2006). The neurobiological basis of temperament: Towards a better understanding of psychopathology. Neuroscience & Biobehavioral Reviews, 30, 511525.CrossRefGoogle ScholarPubMed
Yang, C.-C. (2006). Evaluating latent class analysis models in qualitative phenotype identification. Computational Statistics & Data Analysis, 50, 10901104.CrossRefGoogle Scholar
Yoo, J. P., Brown, P. J., & Luthar, S. S. (2009). Children with co-occurring anxiety and externalizing disorders: Family risks and implications for competence. American Journal of Orthopsychiatry, 79, 532540.CrossRefGoogle ScholarPubMed
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