Co-occurring internalizing and externalizing psychopathology in childhood and adolescence: a network approach

Abstract

The network approach suggests that psychopathology arises from complex associations between symptoms and may offer insight into the mechanisms that underpin psychiatric comorbidities. The transition from childhood to adolescence is a key period in the development of psychopathology, yet has rarely been considered from a network perspective. As such, the present study examined the network structure of internalizing and externalizing psychopathology from middle childhood through adolescence using data from the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 4405). Eight DSM-IV disorders were assessed using maternal reports when children were aged 7.5, 10.5 and 14 years. Weighted, undirected networks were estimated and the relative importance of each node was assessed using three common measures of node centrality; strength, betweenness, and closeness. A consistent network structure emerged at all three time points; nodes clustered together in two regions of space broadly reflecting the internalizing and externalizing spectra. Permutation tests supported structural invariance across this developmental period. These spectra were bridged by numerous disorder-level interactions, the most consistent of which was between depression and oppositional defiant disorder (ODD). Furthermore, inspection of the centrality indices indicated that generalised anxiety disorder and ODD were the most central disorders in the networks. These findings demonstrate that symptom/disorder-level interplay and reciprocal influence are plausible mechanisms for the association between internalizing and externalizing psychopathology in childhood/adolescence.

Unique longitudinal relationships between symptoms of psychopathology in youth: A cross‐lagged panel network analysis in the ABCD study

“…Worry had the third highest out‐EI. Although worry or generalized anxiety disorder (which is characterized by excessive worry) were among the most central nodes in cross‐sectional networks of internalizing symptoms (Beard et al, 2016) or internalizing and externalizing disorders (McElroy, Shevlin, et al, 2018), Fisher et al (2017) reported that worry was among the least central symptoms in a network estimated from intensive longitudinal data. It remains unclear whether this inconsistency in the centrality rank‐order of worry is due to differences in sample characteristics, methodological differences (e.g., different time lags), differences in network estimation, sampling variability, or some other factor.…”

“…In addition to modeling and interpreting individual edges between symptoms, we computed symptom centrality indices to identify which symptoms were most central in terms of prospectively predicting, and being predicted by, other symptoms. Based on findings from previous transdiagnostic cross‐sectional network analyses (Boschloo et al, 2016; McElroy et al, 2018; McElroy, Shevlin, Murphy, & McBride, 2018; Rouquette et al, 2018), it was hypothesized that depressed mood, inattention, anxiety, and oppositional defiant disorder (ODD) symptoms would be among the most central in predicting other symptoms. As there is ongoing controversy regarding the replicability of network models (e.g., Forbes, Wright, Markon, & Krueger, 2019; Funkhouser et al, 2020) and symptoms were assessed at three time points, we examined the replicability of the CLPN by comparing the results of a CLPN using T1 symptoms to predict T2 symptoms to an identical model using T2 symptoms to predict T3 symptoms.…”

Longitudinal Relationships Between Reflective Functioning, Empathy, and Externalizing Behaviors During Adolescence and Young Adulthood

“…From a statistical standpoint, network analyses allow the investigation of the connections (edges) between a series of variables (nodes). In essence, network analyses provide an informative way to describe the complex relationships between a varied set of key variables, focusing on the local interactions and determining the role played by each node in the network (Borsboom and Cramer 2013;McElroy et al 2018).…”

The Effectiveness of Cognitive-Behavioral Therapy on Internalizing Problems of Children With Externalizing Disorders

“…Comorbid psychiatric disorders happen more often and are associated with increasing severity of the syndrome and poor prognosis [4]. Many studies have shown that externalizing and internalizing problems simultaneously occur in close relation with each other.…”