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SOCIO-EMOTIONAL DEVELOPMENT
INTERNALIZING/EXTERNALIZING BEHAVIOR PROBLEMS OPTIONS DOCUMENTS
DOMAIN AND CONSTRUCT DEFINITIONS AND JUSTIFICATION
Domain
Socio-Emotional Well-Being
Definition
For this project, socio-emotional well-being is defined as children’s social behaviors (e.g., acting out and sharing) and their emotional status (e.g., adjustment). Socio-emotional development is an important feature of general child well-being, and research suggests that socio-emotional aspects in early childhood are related to a wide array of developmental outcomes, ranging from school success to future adult behavior (National Research Council & Institute of Medicine, 2000; Soares, Fremmer-Bombik, Grossman, & Silva, 2000). Socio-emotional well-being is a domain of inherent value to be included in any study or effort that hopes to address child development and is of particular relevance to this project because it is examined in eight of the nine EDCP evaluations. Although the domain is included in most evaluations and studies, the constructs and measurement of those constructs shows variation across studies. Because of this variation, this is an area in which measurement guidance is both needed and welcomed.
Construct
Internalizing/Externalizing Behavior Problems
Definition
Studies will vary in which types of socio-emotional outcomes that they choose to measure. Two of the most commonly measured constructs are internalizing (e.g., depression, anxiety) and externalizing (e.g., acting out) behaviors. The full definitions are listed below. These constructs are closely related, both conceptually and statistically, with some studies addressing them as separate constructs and others collapsing them under the broader heading of “Behavior Problems.” For current purposes, we note all three conceptualizations, based on the level of detail used in the studies reviewed: internalizing and externalizing as separate constructs and behavior problems as the sum of the two.
Global Justification for Inclusion of Construct: Externalizing
Background:
At reasonable levels (which vary greatly by cultural context), anger and aggression contribute to survival through their self-regulation and social communication functions (Stenberg & Campos, 1990). But beginning in childhood, when anger and aggression exceed certain levels, they are linked with unfavorable developmental outcomes. Attention problems are often considered together with anger and aggression under the construct of externalizing because of their high comorbidity rates. However, there is disagreement regarding causal relationships, etiology, and pathways through which each lead to unfavorable outcomes (Coie & Dodge, 1998).
Studies have shown that children exhibiting problems with noncompliance, discipline, and impulsivity in early childhood more often show a range of externalizing behavior problems in later childhood, including diagnosed conduct disorders (Campell & Ewing, 1990; Richman, Stevensen, & Graham, 1982). These associations have more often been documented for males than for females, though some have questioned whether this reflects the appropriateness of widely used measures of externalizing for girls. In addition, there is a growing set of longitudinal studies showing that aggression and conduct problems in middle childhood are related to delinquency and antisocial behavior in adolescence, as well as adulthood (Coie, Terry, Lenox, Lochman, & Hyman, 1995; Enron, Huesmann, Dubow, Romanoff, & Yarmel, 1987; Haapsalo & Tremblay, 1994). For males, this relationship has been linked with time of onset, with earlier onset of antisocial behavior predicting greater risk of the antisocial behavior continuing throughout the lifespan (Farrington, Loeber, & Van Kammen, 1990).
Correlates of Externalizing:
Research suggests a range of possible contributors to individual differences in aggression and antisocial behavior. Possible biological bases of individual differences include hormone and neurotransmitter activity, toxin exposure, and traits such as temperament, hyperactivity, and attention deficit. Aspects of children’s care environments that have been found to be related to individual differences in aggression and antisocial behavior include family poverty, neighborhood characteristics, and family stress. Variation in parenting has also been extensively explored, with harsh and inconsistent discipline patterns and abuse found to be predictive of child aggression and antisocial behavior (Coie & Dodge, 1998).
Rather than a direct and simple causal pathway between any individual feature of children’s environment and their antisocial and aggressive behavior, research suggests interactions among contributors (see Cicchetti & Lynch, 1993). It also cautions that the prevalence of antisocial and aggressive behaviors can function as an important defining feature of an environment, rather than serving as only an outcome of environments. For example, although violent neighborhoods predict aggressive outcomes, the more aggressive and antisocial individuals there are, the more violent the neighborhood will be. Externalizing is useful as both an explanatory mechanism and an outcome in itself.
Importance of Externalizing as a Construct:
Given the linkages between aspects of children’s care environments and their aggressive and antisocial behavior, interventions that either aim to alter the care environments of children directly (for example, by seeking to improve the quality of child care) or that have the potential to alter care environments through other effects on the family (for example, by seeking to increase employment and income or by seeking to increase marital stability) have the potential to affect children’s externalizing behavior problems.
Global Justification for Inclusion of Construct: Internalizing
Background:
Unlike externalizing, which is manifested by outward acts of aggression or “acting out” behavior, internalizing is manifested in internal reactions and states (Achenbach & Rescorla, 2000a). Frequently used measures of internalizing seek to capture symptoms of depression, anxiety, and somatization; and construct validation work is reported by Achenbach and Rescorla (2000a), LaFreniere and Dumas (1995), Reynolds and Kamphaus (1998), and Gresham and Elliott (1990).
Internalizing problems tend to co-occur with other disorders. For instance, 40 to 70 percent of depressed children/adolescents have been diagnosed with another disorder, with 20 to 50 percent showing two or more co-occurring disorders (Cicchetti & Toth, 1998). The most common concomitant disorders include anxiety disorders and substance abuse (Harington, Rutter, & Fombonne, 1996).
Internalizing and externalizing behaviors are correlated in both clinical and normative samples (Achenbach & Rescorla, 2000a; Greenbaum & Dedrick, 1998). Although they have differing behavioral manifestations, they are not mutually exclusive.
Like externalizing behavior problems, internalizing behaviors such as depression and anxiety can be seen as negative outcomes in themselves. They involve substantial suffering in the individual; are associated with occupational, interpersonal, and familial stress; and predict a higher risk of suicidal behavior (Cicchetti & Toth, 1998). The annual societal cost to address just depression is estimated at $43 billion. This figure reflects the cost of treatment, absenteeism from work, loss of productivity, and premature death (Hirshfield et al., 1997).
Both children and adults have been found to be undertreated for major depressive disorder (Beardslee, Keller, Lavori, Staley, & Sacks, 1993; Cicchetti & Toth, 1998; Hirshfield et al., 1997). There is evidence that the age of onset is related to future episodes (Kovacs, Akiskal, Gatsonis, & Parrone, 1994).
Correlates of Internalizing:
As with externalizing behavior problems, a range of factors have been shown to contribute to the extent of internalizing behaviors. These include factors related to physiological development (e.g., genetics, brain and neurological mechanisms, and child gender) and to the child’s environment (e.g., parenting, family socioeconomic status, and neighborhood). As with externalizing, rather than operating separately, there appear to be interactions among the contributing factors. Evidence indicates that a number of these factors have links to internalizing throughout development (DeRosier, Kupersmidt, & Patterson, 1994; Harrington et al., 1993; Messman & Koot, 2000; Pittman & Chase-Lansdale, 2001; Smider et al., 2002; Weis, Dodge, Bates, & Pettit, 1992; Yazici et al., 1993).
The evidence points to a balancing of factors that make one susceptible to internalizing problems (“potentiating” factors) and resistant to them (“compensatory” factors; Cicchetti & Lynch, 1993; Cicchetti & Toth, 1998). For example, potentiating factors might include having both a genetic predisposition for depression as well as a parent who is depressed. A compensatory factor might involve participation in high-quality child care, where the experiences support and secure attachment to caregivers.
Importance of Internalizing as a Construct:
In sum, the research points to a range of factors that can increase or decrease the risk of child internalizing behavior problems. The evaluation studies included in the EDCP project focus on programs that have the potential to affect a number of the potentiating and compensatory factors identified in the research. For example, Head Start and Early Head Start target parenting behavior and parental mental health, both of which have been found to be related to child internalizing behavior problems. The Head Start and child care subsidy evaluations have implications for the quality of the early care and education environments that children participate in, again factors found to be related to internalizing behavior problems. Likewise, the programs focusing on parental employment have the potential to affect the further contributing factors of family socioeconomic status and neighborhood. Evaluations of related welfare to work demonstration programs have found that they have the potential to affect child internalizing (and externalizing) behavior problems (McGroder, Zaslow, Moore, & LeMenestrel, 2000; Miller et al, 2000).
References
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