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Joint developmental trajectories of internalizing and externalizing disorders between childhood and adolescence

  • Michel G. Nivard (a1), Gitta H. Lubke (a1) (a2), Conor V. Dolan (a1), David M. Evans (a3) (a4), Beate St. Pourcain (a5), Marcus R. Munafò (a4) and Christel M. Middeldorp (a1) (a6)...


This study sought to identify trajectories of DSM-IV based internalizing (INT) and externalizing (EXT) problem scores across childhood and adolescence and to provide insight into the comorbidity by modeling the co-occurrence of INT and EXT trajectories. INT and EXT were measured repeatedly between age 7 and age 15 years in over 7,000 children and analyzed using growth mixture models. Five trajectories were identified for both INT and EXT, including very low, low, decreasing, and increasing trajectories. In addition, an adolescent onset trajectory was identified for INT and a stable high trajectory was identified for EXT. Multinomial regression showed that similar EXT and INT trajectories were associated. However, the adolescent onset INT trajectory was independent of high EXT trajectories, and persisting EXT was mainly associated with decreasing INT. Sex and early life environmental risk factors predicted EXT and, to a lesser extent, INT trajectories. The association between trajectories indicates the need to consider comorbidity when a child presents with INT or EXT disorders, particularly when symptoms start early. This is less necessary when INT symptoms start at adolescence. Future studies should investigate the etiology of co-occurring INT and EXT and the specific treatment needs of these severely affected children.


Corresponding author

Address correspondence and reprint requests to: Michel G. Nivard, van der Boechorststraat 1, 1081BT, Amsterdam, The Netherlands; E-mail:


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We are extremely grateful to all of the families who took part in this study, the midwives for their help in recruiting them, and the whole Avon Longitudinal Study of Parents and Children (ALSPAC) team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses. The UK Medical Research Council and the Wellcome Trust (Grants 092731 and 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors, and Michel G. Nivard serves as guarantor for the contents of this paper. This project was supported by ZonMW 912-10-020 and ERC-230374. Support was also provided by Royal Netherlands Academy of Science Professor Award PAH/6635 (to M.G.N.) and ACTION (to G.H.L.). ACTION receives funding from the European Union Seventh Framework Program (FP7/2007-013) under Grant 602768.



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Joint developmental trajectories of internalizing and externalizing disorders between childhood and adolescence

  • Michel G. Nivard (a1), Gitta H. Lubke (a1) (a2), Conor V. Dolan (a1), David M. Evans (a3) (a4), Beate St. Pourcain (a5), Marcus R. Munafò (a4) and Christel M. Middeldorp (a1) (a6)...


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