Journal of the American Academy of Child & Adolescent Psychiatry
ReviewInternalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications
Section snippets
DSM
In the introduction to the DSM-5, the American Psychiatric Association9 cites findings demonstrating that scientific efforts to validate disorders have been more useful for suggesting large groupings of disorders than for validating individual diagnostic categories. In particular, the
…clustering of disorders according to what has been termed internalizing and externalizing factors represents an empirically supported framework. Within both the internalizing group (representing disorders with
Method
We followed guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.17
Results
Not counting ad hoc items and scales that were idiosyncratic to particular studies, we found that 49 different measures were used to obtain internalizing and/or externalizing scores. In tallying the measures, we counted families of related instruments as a single measure; for example, the Achenbach System of Empirically Based Assessment (ASEBA) includes the Child Behavior Checklist for Ages 1½-5 and for Ages 6-18 (CBCL/1½-5 and CBCL/6-18), Caregiver-Teacher Report Form (C-TRF), Teacher’s Report
Discussion
Our review revealed that internalizing/externalizing problems have been assessed in thousands of studies that used a great variety of measures to assess children from diverse backgrounds for many different purposes. Differences among the measures pose challenges for integrating the findings, for drawing generalizable conclusions, and for advancing clinical and research applications. To focus on the most credible and generalizable findings, we limited our systematic review to measures that met
References (34)
- et al.
Reductions in the internalising construct following Internet-delivered treatment for anxiety and depression in primary care
Behav Res Ther
(2014) Pathways to early delinquency: exploring the individual and collective contributions of difficult temperament, low maternal involvement, and externalizing behavior
J Crim Just
(2014)- et al.
Internalizing symptoms and safe sex intentions among adolescents in mental health treatment: personal factors as mediators
Child Youth Serv Rev
(2014) - et al.
A general population twin study of the CBCL/6-18 DSM-oriented scales
J Am Acad Child Adolesc Psychiatry
(2007) The classification of children's psychiatric symptoms: a factor-analytic study
Psychol Monogr
(1966)- et al.
Multilevel approaches toward understanding antisocial behavior: current research and future directions
Dev Psychopathol
(2012) - et al.
Multilevel developmental perspectives toward understanding internalizing psychopathology: current research and future directions
Dev Psychopathol
(2014) Introduction to the special section: biopsychosocial processes in the etiology and development of internalizing problems
J Abnorm Child Psychol
(2015)- et al.
The significance of insecure attachment and disorganization in the development of children's externalizing behavior: a meta-analytic study
Child Dev
(2010) - et al.
A dimensional-spectrum model of psychopathology: progress and opportunities
Arch Gen Psychiatry
(2011)
Diagnostic and Statistical Manual of Mental Disorders. 3rd ed., 5th ed
Research Domain Criteria (RDoC): toward a new classification framework for research on mental disorders
Am J Psychiatry
The classification of child psychopathology: a review and analysis of empirical efforts
Psychol Bull
Classification
Manual for the Child Behavior Checklist and Revised Child Behavior Profile
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This work was funded by the nonprofit University of Vermont Research Center for Children, Youth, and Families (RCCYF), which publishes the Achenbach System of Empirically Based Assessment (ASEBA).
Disclosure: Dr. Achenbach is president of the nonprofit RCCYF, which publishes the ASEBA and from which he has received remuneration. He has received royalties from Guilford Press for a book published in 2007 and honoraria for invited presentations. Dr. Ivanova is corporate secretary of the nonprofit RCCYF, from which she has received remuneration. She has received honoraria for invited presentations. Dr. Rescorla is vice president of the nonprofit RCCYF, from which she has received remuneration. She has received royalties from Guilford Press for a book published in 2007 and honoraria for invited presentations. Dr. Althoff is employed, in part, by the nonprofit RCCYF. He has received grant or research support from the National Institute of Mental Health, the National Institute of General Medical Sciences, the Klingenstein Third Generation Foundation, and the Marcus Autism Center. He has received honoraria from Oakstone Medical Publishing. He is a partner of WISER Systems, LLC. Ms. Turner is employed by the nonprofit RCCYF. She reports no biomedical financial interests or potential conflicts of interest.