Externalizing and Internalizing behavioral problems in Adolescents

Dijana Z. Sulejmanovic

doi:10.5937/sinteze13-55273

Dijana Z. Sulejmanovic University of Bihać https://orcid.org/0000-0001-6745-9623

DOI: https://doi.org/10.5937/sinteze13-55273

Keywords: adolescents, behavioral problems, externalizing problems, internalizing problems

Abstract

Socio-emotional problems and behavioral issues in children and adolescents can pose a risk for the development of more serious disorders later in life. As part of mental health care, it is essential to pay special attention to measuring the overall emotional state and health problems that are becoming increasingly frequent and visible. The prevalence of behavioral problems among youth is a growing concern. These issues are typically categorized into externalizing and internalizing disorders, reflecting the various ways adolescents manifest and cope with internal and external conflicts.

The aim of this study was to examine the prevalence of externalizing and internalizing behavioral problems in adolescents, explore potential sociodemographic differences, and investigate the relationship between these two types of behavioral issues. The research applied the YEPS questionnaire to meeasure externalizing problems and the DASS-21 scale to measure internalizing problems. The study sample consisted of 1086 adolescents, aged 14 to 19 years (M = 16.98, SD = 1.58), with the majority being female (678, or 62.4%).

The main findings of the study indicate the presence of both externalizing and internalizing behavioral problems among adolescents, with externalizing issues being more prevalent in males and internalizing problems more common in females. The results indicate moderate symptoms of behavioral problems, while statistically significant intercorrelations were found between externalizing and internalizing behavioral problems.

References

Achenbach, T. M., & Edelbrock, C. S. (1978). The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin, 85(6), 1275–1301. https://doi.org/10.1037/0033-2909.85.6.1275

American psychological association. (2015). Mental disorder. In G. R. VandenBos (Ed.), APA dictionary of psychology (Second edition, p. 639). American psychological association.

Arsić, B., & Gajić, A. (2024). Primena funkcionalnog komunikacionog treninga za redukciju problema u ponašanju kod dece sa autizmom. Sinteze - Časopis Za Pedagoške Nauke, Književnost i Kulturu, 25, 13–28. https://doi.org/10.5937/sinteze13-50786

Ashford, J., Smit, F., Van Lier, P. A. C., Cuijpers, P., & Koot, H. M. (2008). Early risk indicators of internalizing problems in late childhood: A 9‐year longitudinal study. Journal of Child Psychology and Psychiatry, 49(7), 774–780. https://doi.org/10.1111/j.1469-7610.2008.01889.x

Barkley, R. A. (2006). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (3rd ed). Guilford Press.

Bašić, J., & Novak, M. (2008). Internalizirani problemi kod djece i adolescenata: Obilježja i mogućnosti prevencije. Ljetopis Socijalnog Rada, 15(3), 473–498.

Begić, D. (2014). Psihopatologija. Medicinska naklada.

Biglbauer, S., & Lauri Korajlija, A. (2020). Društvene mreže, depresivnost i anksioznost. Socijalna Psihijatrija, 48(4), 404–425. https://doi.org/10.24869/spsih.2020.404

Bitsko, R. H., Claussen, A. H., Lichstein, J., Black, L. I., Jones, S. E., Danielson, M. L., Hoenig, J. M., Davis Jack, S. P., Brody, D. J., Gyawali, S., Maenner, M. J., Warner, M., Holland, K. M., Perou, R., Crosby, A. E., Blumberg, S. J., Avenevoli, S., Kaminski, J. W., Ghandour, R. M., … Meyer, L. N. (2022). Mental Health Surveillance Among Children—United States, 2013–2019. MMWR Supplements, 71(2), 1–42. https://doi.org/10.15585/mmwr.su7102a1

Bongers, I. L., Koot, H. M., Van Der Ende, J., & Verhulst, F. C. (2004). Developmental Trajectories of Externalizing Behaviors in Childhood and Adolescence. Child Development, 75(5), 1523–1537. https://doi.org/10.1111/j.1467-8624.2004.00755.x

Boričević Maršanić, V., Zečević, I., Paradžik, Lj., & Karapetrić Bolfa, Lj. (2017). Probir i rana detekcija psihičkih odstupanja/poremećaja kod djece u predškolskim ustanovama i adolescenata u osnovnim školama Grada Zagreba Σ rezultati probnog projekta. Socijalna Psihijatrija, 45(3), 169–186.

Bornstein, M. H., Hahn, C.-S., & Haynes, O. M. (2010). Social competence, externalizing, and internalizing behavioral adjustment from early childhood through early adolescence: Developmental cascades. Development and Psychopathology, 22(4), Article 4. https://doi.org/10.1017/S0954579410000416

Bouillet, D., & Uzelac, S. (2007). Osnove socijalne pedagogije. Školska knjiga.

Brumariu, L. E., & Kerns, K. A. (2022). Parent–Child Attachment in Early and Middle Childhood. In P. K. Smith & C. H. Hart (Eds.), The Wiley‐Blackwell Handbook of Childhood Social Development (1st ed., pp. 425–442). Wiley. https://doi.org/10.1002/9781119679028.ch23

Carter, A. S., Briggs‐Gowan, M. J., & Davis, N. O. (2004). Assessment of young children’s social‐emotional development and psychopathology: Recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry, 45(1), 109–134. https://doi.org/10.1046/j.0021-9630.2003.00316.x

Davison, G. C., & Neale, J. M. (2002). Psihologija abnormalnog doživljavanja i ponašanja (L. Arambašić, Trans.; Prijevod 6. prerađenog izd). Naklada Slap.

Erikson, E. H. (1994). Identity and the Life Cycle (1st ed). W. W. Norton & Company.

Farrington, D. P. (2007). Childhood risk factors and risk-focused prevention. In M. Maguire, R. Morgan, & R. Reiner (Eds.), The Oxford handbook of criminology (4th ed, pp. 1–61). Oxford University Press Inc.

Gore, F. M., Bloem, P. J., Patton, G. C., Ferguson, J., Joseph, V., Coffey, C., Sawyer, S. M., & Mathers, C. D. (2011). Global burden of disease in young people aged 10–24 years: A systematic analysis. The Lancet, 377(9783), 2093–2102. https://doi.org/10.1016/S0140-6736(11)60512-6

Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101(3), 443–463. https://doi.org/10.1037/0033-2909.101.3.443

Horney, K. (1992). Our inner conflicts: A constructive theory of neurosis. Norton.

Hunter‐Rue, D. S., Miller, P., Hanson, J. L., & Votruba‐Drzal, E. (2024). Relations between adolescent perceptions of household chaos and externalizing and internalizing behaviors in low‐ and middle‐income families. Journal of Research on Adolescence, 34(4), 1500–1516. https://doi.org/10.1111/jora.13016

Khanal, P., Ståhlberg, T., Luntamo, T., Gyllenberg, D., Kronström, K., Suominen, A., & Sourander, A. (2022). Time trends in treated incidence, sociodemographic risk factors and comorbidities: A Finnish nationwide study on anxiety disorders. BMC Psychiatry, 22(1), 144. https://doi.org/10.1186/s12888-022-03743-3

Koller-Trbović, N. (2004). Poremećaji u ponašanju djece i mladih. In J. Bašić, N. Koller-Trbović, & S. Uzelac (Eds.), Poremećaji u ponašanju i rizična ponašanja: Pristupi i pojmovna određenja (pp. 83–97). Edukacijsko-rehabilitacijski fakultet Sveučilišta u Zagrebu.

Koller-Trbović, N., & Žižak, A. (2012). Problemi u ponašanju djece i mladih i odgovori društva: Višestruke perspektive. Kriminologija & Socijalna Integracija, 20(1), 49–62.

Koller-Trbović, N., Žižak, A., & Jeđud Borić, I. (2011). Standardi za terminologiju, definiciju, kriterije i način praćenja pojave poremećaja u ponašanju djece i mladih. Povjerenstvo za prevenciju poremećaja u ponašanju djece i mladih Vlade Republike Hrvatske. Ministarstvo obitelji, branitelja i međugeneracijske solidarnosti.

Lebedina Manzoni, M. (2007). Psihološke osnove poremećaja u ponašanju. Naklada Slap.

Leijdesdorff, S., Van Doesum, K., Popma, A., Klaassen, R., & Van Amelsvoort, T. (2017). Prevalence of psychopathology in children of parents with mental illness and/or addiction: An up to date narrative review. Current Opinion in Psychiatry, 30(4), 312–317. https://doi.org/10.1097/YCO.0000000000000341

Liu, J. (2004). Childhood Externalizing Behavior: Theory and Implications. Journal of Child and Adolescent Psychiatric Nursing, 17(3), 93–103. https://doi.org/10.1111/j.1744-6171.2004.tb00003.x

Loades, M. E., Chatburn, E., Higson-Sweeney, N., Reynolds, S., Shafran, R., Brigden, A., Linney, C., McManus, M. N., Borwick, C., & Crawley, E. (2020). Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. Journal of the American Academy of Child & Adolescent Psychiatry, 59(11), 1218-1239.e3. https://doi.org/10.1016/j.jaac.2020.05.009

Loeber, R., & Hay, D. (1997). Key Issues In The Development Of Aggression And Violence From Childhood To Early Adulthood. Annual Review of Psychology, 48(1), 371–410. https://doi.org/10.1146/annurev.psych.48.1.371

Lovibond, S. H., & Lovibond, P. F. (1995). The Depression Anxiety Stress Scales. UNSW.

Macuka, I. (2008). Uloga dječje percepcije roditeljskoga ponašanja u objašnjenju internaliziranih i eksternaliziranih problema. Društvena Istraživanja, 17(6), 1179–1202.

Macuka, I. (2016). Emocionalni i ponašajni problemi mlađih adolescenata – zastupljenost i rodne razlike. Annual of Social Work, 23(1), 65–86. https://doi.org/10.3935/ljsr.v23i1.97

Maglica, T., & Jerković, D. (2014). Procjena rizičnih i zaštitnih čimbenika za internalizirane probleme u školskom okruženju. Školski Vjesnik - Časopis Za Pedagoška i Školska Pitanja, 63(3), 413–431.

Marković, M., & Lakićević, M. (2020). Porodične prilike i odnosi kao faktor kriminaliteta kod dece. Sinteze - Časopis Za Pedagoške Nauke , Književnost i Kulturu, 17, 113–134. https://doi.org/10.5937/sinteze9-24202

Mastrotheodoros, S., Canário, C., Cristina Gugliandolo, M., Merkas, M., & Keijsers, L. (2020). Family Functioning and Adolescent Internalizing and Externalizing Problems: Disentangling between-, and Within-Family Associations. Journal of Youth and Adolescence, 49(4), 804–817. https://doi.org/10.1007/s10964-019-01094-z

Mazzucchelli, T. G., & Sanders, M. R. (2017). Children with Externalizing Behavior Problems. In T. G. Mazzucchelli & M. R. Sanders (Eds.), The power of positive parenting: Transforming the lives of children, parents, and communities using the Triple P system (pp. 85–96). Oxford University Press. https://doi.org/10.1093/med-psych/9780190629069.003.0006

McKay, M. T., & Andretta, J. R. (2017). Evidence for the Psychometric Validity, Internal Consistency and Measurement Invariance of Warwick Edinburgh Mental Well-being Scale Scores in Scottish and Irish Adolescents. Psychiatry Research, 255, 382–386. https://doi.org/10.1016/j.psychres.2017.06.071

Merikangas, K. R. (2017). Anxiety Disorders: Introduction and Overview. In Benjamin J. Sadock, Virginia A. Sadock, & Pedro Ruiz (Eds.), Kaplan & Sadock’s comprehensive textbook of psychiatry (Tenth edition, pp. 4407–4414). Wolters Kluwer.

Mikas, D. (2012). Utjecaj emocionalnih i ponašajnih problema na uspjeh učenika. Pedagogijska Istraživanja, 9(1/2), 83–99.

Mulaosmanović, N., & Ivanišević, D. (2023). Povezanost internaliziranih i eksternaliziranih problema u ponašanju sa školskim uspijehom mladih. Društvene Devijacije, 8(1), 634–643. https://doi.org/10.7251/ZCMZ0123634M

Nolen-Hoeksema, S. (2001). Gender Differences in Depression. Current Directions in Psychological Science, 10(5), 173–176. https://doi.org/10.1111/1467-8721.00142

Oatley, K., & Jenkins, J. M. (2007). Razumijevanje emocija (L. Arambašić, Trans.; 2. izd). Naklada Slap.

Oland, A. A., & Shaw, D. S. (2005). Pure Versus Co-occurring Externalizing and Internalizing Symptoms in Children: The Potential Role of Socio-Developmental Milestones. Clinical Child and Family Psychology Review, 8(4), 247–270. https://doi.org/10.1007/s10567-005-8808-z

Panić, M., & Bouillet, D. (2021). Pojavnost problema u ponašanju djece u ustanovama ranog i predškolskog odgoja i obrazovanja. Hrvatska Revija Za Rehabilitacijska Istraživanja, 57(2), 73–91. https://doi.org/10.31299/hrri.57.2.5

Parkitny, L., & McAuley, J. (2010). The Depression Anxiety Stress Scale (DASS). Journal of Physiotherapy, 56(3), 204. https://doi.org/10.1016/S1836-9553(10)70030-8

Price, J. S. (2013). An Evolutionary Perspective on Anxiety and Anxiety Disorders. In F. Durbano (Ed.), New Insights into Anxiety Disorders (pp. 3–20). IntechOpen. https://doi.org/10.5772/52902

Renshaw, T. L., & Cook, C. R. (2019). Preliminary Psychometrics of Responses to the Youth Externalizing Problems Screener. Journal of Psychoeducational Assessment, 37(8), 1016–1022. https://doi.org/10.1177/0734282918809814

Ričković, V., & Ladika, M. (2021). Mentalno zdravlje djece i adolescenata: Prevalencija i specifičnosti mentalnih poremećaja. Hrvatski Časopis Za Javno Zdravstvo, 17(56), 32–38.

Samek, D. R., & Hicks, B. M. (2014). Externalizing disorders and environmental risk: Mechanisms of gene–environment interplay and strategies for intervention. Clinical Practice, 11(5), 537–547. https://doi.org/10.2217/cpr.14.47

Sjöman, M., Granlund, M., & Almqvist, L. (2016). Interaction processes as a mediating factor between children’s externalized behaviour difficulties and engagement in preschool. Early Child Development and Care, 186(10), 1649–1663. https://doi.org/10.1080/03004430.2015.1121251

Slavković, A. (2022). Vaspitanje adolescenata u porodici. Sinteze - Časopis Za Pedagoške Nauke, Književnost i Kulturu, 21, 11–21. https://doi.org/10.5937/sinteze11-36762

Subotić, S., Brajša-Žganec, A., & Merkaš, M. (2008). Školski stres i neka obilježja ličnosti kao prediktori suicidalnosti adolescenata. Psihologijske Teme, 17(1), 111–131.

Sun, Y., Wu, Y., Fan, S., Dal Santo, T., Li, L., Jiang, X., Li, K., Wang, Y., Tasleem, A., Krishnan, A., He, C., Bonardi, O., Boruff, J. T., Rice, D. B., Markham, S., Levis, B., Azar, M., Thombs-Vite, I., Neupane, D., … Thombs, B. D. (2023). Comparison of mental health symptoms before and during the covid-19 pandemic: Evidence from a systematic review and meta-analysis of 134 cohorts. BMJ, 380, e074224. https://doi.org/10.1136/bmj-2022-074224

Uzelac, S. (1995). Osnove socijalne edukologije mladih s poremećajima u socijalnom ponašanju. Segena.

Vulić-Prtorić, A. (2007). Depresivnost u djece i adolescenata (2. izd). Naklada Slap.

World Health Organization. (2005). Child and adolescent mental health policies and plans. World Health Organization. https://iris.who.int/handle/10665/43068

Wu, L., Zhang, D., Cheng, G., Hu, T., & Rost, D. H. (2015). Parental emotional warmth and psychological Suzhi as mediators between socioeconomic status and problem behaviours in Chinese children. Children and Youth Services Review, 59, 132–138. https://doi.org/10.1016/j.childyouth.2015.09.019

Žunić-Pavlović, V., & Kovačević-Lipojević, M. (2011). Prevalencija i razvoj poremećaja ponašanja u detinjstvu. Specijalna Edukacija i Rehabilitacija, 10(4), 725–742.