The Effects of a Family Systems Intervention on Co‐Occurring Internalizing and Externalizing Behaviors of Children with Substance Abusing Mothers: A Latent Transition Analysis

Abstract

Children of substance abusing parents are at heightened risk to develop problem behaviors, yet little is known about the co-occurring patterns of internalizing and externalizing behaviors among this population. With 183 children (M age = 11.54 years, SD = 2.55, range 8-16) whose mothers were diagnosed with a substance use disorder, the current study identified subgroups/classes of children that were clinically distinct in their co-occurring patterns of internalizing and externalizing behaviors, and examined how children in different clinical subgroups responded to a family systems intervention. Latent class analyses identified four classes of internalizing and externalizing behaviors: internalizing only, externalizing only, comorbid, and normative. Latent transition analyses showed that participation in family systems therapy resulted in an increased likelihood of transitioning from the externalizing class at baseline to the normative class at 18 months post-baseline, and from the comorbid class at baseline to the internalizing class at 18 months post-baseline as well. The findings support the effectiveness of family systems therapy in interrupting the stability of children's problem behaviors and improving children's behavioral outcomes.

Youth Risk Profiles and their Prediction of Distal Cannabis and Tobacco co-use in the Population Assessment of Tobacco Health (PATH)

“…To our knowledge, only one study has explored latent classes based on youth internalizing and externalizing 25 . Their four classes (i.e., internalizing, externalizing, comorbid, and normative) have both similarities and differences when compared to the constellation of class number and type found in the current study.…”

“…That said, most person-centered, youth substance use research has focused on use profiles (classes based on substance use or patterns), or risk profiles (classes based on factors that influence youth risk) for outcomes other than substance use (e.g., behavioral or emotional disorders) 22 , 24 . One study that has deviated from these, examining the effects of family systems therapy, identified four classes of youth; internalizing, externalizing, comorbid, and normative 25 . This study provided us with information that was useful in the development of our hypothesis relating to expected number of subgroups and also provided an opportunity to fill gaps left by their study with our addition of family variables to the analyses and use of a nationally representative sample of youth.…”

Risk, Symptoms, and Well‐Being: Emerging Adult Latent Profiles During Treatment

“…The Life Satisfaction subscale items were unique to the adult form and were treated as missing data on the adolescent version. This permitted us to retain a large enough sample with sufficient power for conducting LTA (e.g., Zhang & Slesnick, 2018), particularly given evidence of acceptable separation between subgroups (Burton et al 2018), which is reported below.…”

“…Zhang and Slesnick (2018), for example, examined the effectiveness of relational treatment with mother‐child dyads. Effectiveness was demonstrated by the high likelihood of children switching from a high‐risk behavior subgroup, and a high symptoms and risk subgroup, to a subgroup with normative levels of symptoms and risk behaviors.…”

Ten frequently asked questions about latent transition analysis.

“…Nevertheless, LTA has helped researchers answer an array of meaningful research questions. Some examples include the identification and tracking of (a) dual-factor mental health classes throughout high school (Moore et al, 2019); (b) changes in children’s mental health profiles in response to family interventions (Connell et al, 2008; Zhang & Slesnick, 2018); (c) the stability of elementary students’ risk profiles regarding reading disabilities (Swanson et al, 2016); (d) the acculturation process of immigrant Hispanic adolescents (Lee et al, 2020); and (e) psychiatric comorbidity from middle childhood to adolescence (McElroy et al, 2017). Each of these applications addresses a critical question-involving a developmentally salient transition period.…”