The document discusses internalizing and externalizing behaviors in children. It defines internalizing behaviors as problems that affect a child's internal psychological state, such as anxiety, withdrawal, depression, and somatic complaints. It outlines some specific internalizing disorders like depression, anxiety, and somatic complaints. It discusses causes like familial and genetic factors, temperament, life events, and social relationships. It also notes high rates of comorbidity between internalizing disorders and with other externalizing disorders. Internalizing problems in children are risk factors for continued internalizing issues and other disorders in adulthood.

1. Internalising / Externalising Behaviour
THERE IS A DISTINCTION BETWEEN EXTERNALIZING AND INTERNALIZING BEHAVIOURS (ACHENBACH, 1978)
 EXTERNALIZING BEHAVIOURS: REFERS TO GROUPING OF BEHAVIOUR PROBLEMS THAT ARE MANIFESTED IN
CHILDREN’S OUTWARD BEHAVIOUR AND NEGATIVELY ACTING ON THE EXTERNAL ENVIRONMENT.
EXTERNALIZING DISORDERS CONSIST OF DISRUPTIVE, HYPERACTIVE, AGGRESSIVE BEHAVIOURS,
DELINQUENCY, UNDER- CONTROLLED AND ANTI- SOCIAL BEHAVIOURS.
• INTERNALIZING BEHAVIOURS: REFERS TO PROBLEMS THAT MORE CENTRALLY AFFECT CHILD’S INTERNAL
PSYCHOLOGICAL ENVIRONMENT RATHER THAN THE EXTERNAL WORLD. THIS INCLUDES: ANXIOUS,
WITHDRAWN, INHIBITED AND DEPRESSED, NEUROTIC AND OVER- CONTROLLED BEHAVIOURS.
(EISENBERG, 2001)
 EXTERNALIZING BEHAVIOURS ARE STRONG PREDICTOR OF DELINQUENT ADOLESCENT BEHAVIOUR AND
LATER CRIMINAL AND/ OR VIOLENT BEHAVIOUR IN ADULTHOOD, WHICH INCLUDES HYPERACTIVE CHILDREN
AS WELL, ALTHOUGH OUTCOMES FOR HYPERACTIVE CHILDREN QUITE VARIOUS, WHILE INTERNALIZING
CHILDREN ARE MORE LIKELY TO GROW UP AND BECOME DEPRESSED OR ANXIOUS ADULTS
(FARRINGDON, 1997, APA, 1994)

2. Aggression:
 Generally speaking, aggression is one component of conduct disorder; it consists of physical
or verbal behaviours that harm or threaten to harm others, including children, adults, and
animals
 In addition, aggression may be either appropriate and self-protective or destructive to the
self and others
 Early onset of childhood aggression was found to be the strongest predictior of later
convictions
 Aggression is found more in boys than in girls. While boys engage in more physical
aggression, girls are more likely to exhibit “relational aggression”, i.e. excludinh others from
social group or slander.
(Farringdon, 2001)

3. Hostile and Instrumental Aggression
Coined by Feshbach (1970). Most prominent and influential model.
 Hostile aggression: can be viewed as a response to physical or verbal aggression initiated
by others with violence that is relatively uncontrolled and emotionally charged, and which
causes injury or pain on the victim with little or no advantage to the aggressor. This form of
aggression is called "affective,“ "reactive," "defensive," "impulsive," or "hot- blooded“
aggression
 instrumental aggression: is more "predatory," "instrumental”, "proactive," "attack," or "cold-
blooded" in nature. This type of aggression is characterized as controlled, purposeful
aggression lacking in emotion that is used to achieve a desired goal, including the
domination and control of others

4. Biosocial Interaction Model
 Increasingly, a more integrative approach is being taken to understand
aggression, that recognizes the role of biological and social factors equally.
 In all likelihood, there are both genetic/biological and environmental
contributions toward aggressive behaviour.
 In 1,500 pairs of Swedish and British twins, researchers found that aggressive
and nonaggressive antisocial behaviour have both environmental and
hereditary influences
(Eley et al, 1999).
 development of childhood aggression, they generally can be categorized
into two main types: biological and psychosocial. The integration of both of
these types is the key point of the biosocial interaction approach.
 Emphasizes the more dynamic roles played by risk factors in the
development of childhood aggression
(Raine, 2002).

5. Raine et al (1997)
 Indicates relationship between risk- factors and outcome
 The model also includes mediating processes that account for the relationship between
predictors and the outcome variable, and moderator processes that may disrupt or
enhance the interaction relationship.
 Early Risk factors: includes parental and maternal pathophysiological factors. maternal
malnutrition, illness during pregnancy, smoking, using drugs and alcohol during pregnancy,
a genetic predisposition to externalizing behaviour from both the mother and father, and
birth complications. In theory, of particular importance are factors that affect fetal neural
maldevelopment, such as fetal alcohol syndrome, which damages regions of the brain
including the corpus callosum
(Stoff et al, 1997).
 Interaction effect: The model argues that the likelihood of later externalizing behaviour
would be strongly increased when biological risk factors combine with social risk factors.
This interaction effect would be thought of as predisposing to significantly more
externalizing behavioural problems than what would be expected from the simple
addition of the separate effects of biological and social risk factors
(drug abuser mother – prenatal exposure to drugs + abuse of child)

6.  Mediator Effect: A mediator variable is a variable that accounts for a significant
portion of the relationship between the predictor and the outcome variable.
Mediators can explain the mechanism of action (Low IQ as mediator to delinquency
outcome)
 Moderator effect: A moderator variable is a variable that moderates, or changes, the
relationship between risk factors and the outcome. For example, the interaction
between biological and social risk factors may predispose to externalizing behavior in
boys, but not girls.
(Raine et al,1992, Liu, 2004)

7. Delinquency
 Broad and heterogeneous concept.
 Includes diverse antisocial acts such as theft, burglary, robbery, vandalism, drug
use, and violence.
 In case of children it includes antisocial behaviours reflected in Child Behaviour
Checklist (CBCL) such as lying, cheating, stealing, and committing antisocial acts
with bad companions. Thus antisocial behaviours that do not include violent act.
 As with aggression, boys are found to be more involved than girls. Psychosocial and
environmental factors have been strongly implicated in the aetiology of both
delinquency and aggression.
(Achenbach & Edelbrock, 1983),
 Quay's Revised Behaviour Problem Checklist (1983,1993):
conduct disorder includes aggressive forms of antisocial behaviour such as fighting,
cruelty, and bullying. The subscale of socialized aggression does not contain any
aggression items, but instead assesses behaviours such as lying, cheating, and
stealing, which are frequently carried out in the company of other delinquent boys.

8. Hyperactivity
 It is has long been known that hyperactivity is predictive of later antisocial behaviour
 Follow-up studies of young children with hyperactivity show they have higher rates of
conduct problems in later childhood and adolescence
 A detailed review of longitudinal, family, and adoption studies also show that hyperactive
children are more likely to develop adult antisocial behaviour problems
(Lilienfeld & Waldman, 1990)
 A substantial proportion of children referred to clinics with Attention Deficit/Hyperactive
Disorder also have Oppositional Defiant Disorder, Conduct Disorder
(APA, 1994,).

9. Risk Factors
 impulsiveness, hyperactivity, restlessness, clumsiness, not considering consequences before
acting, a poor ability to plan ahead, short time horizons, low self control, sensation-seeking,
risk-taking and a poor ability to delay gratification.
 Generally, the verbal behaviour rating tests produced stronger relationships with offending
than the psychomotor performance tests, suggesting that cognitive impulsiveness was
more relevant than behavioural impulsiveness
(White et al, 1994)
 low IQ and low school achievement, poor parental supervision, child physical abuse,
punitive or erratic parental discipline, cold parental attitude, parental conflict, disrupted
families, antisocial parents, large family size, low family income, antisocial peers, high
delinquency-rate schools and high crime neighbourhoods.
(Farringdon, 2005)

10. Other factors
 Furthermore, research has found that ethnic bias, ethnic conflict, and
prejudice contribute to aggression at the elementary, middle, and high
school levels and that empathy training in school could help bring about
more positive social behaviours and a more positive self-evaluation in
aggressive children
 Another important influence on both delinquency and aggression is
exposure to physical and sexual abuse
(Feshbach & Feshbach, 1998),
 Others have argued for the importance of transactional influences on
antisocial behaviour involving a complex interplay among parental stress,
parental responsiveness, discipline practices, and infant temperament
 Studies on convicted adoptees showed significant relationship between
adoptees and biological parents’ convictions. In fact, the higher the
parental convictions were the more likely the adopted-away child’s violent
crime behaviour
(Shaw & Winslow, 1997).

11. ICAP model (Farringdon, 2005)
 Integrated cognitive antisocial potential
 its key construct is antisocial potential (AP) and it assumes that the
translation from antisocial potential to antisocial behaviour depends on
cognitive (thinking and decision-making) processes that consider
opportunities and victims
 (AP) refers to the potential to commit antisocial acts.
 Long-term persisting between-individual differences in AP depends on
impulsiveness, on strain, modelling and socialization processes and on life
events. Tends to be consistent over time.
 Short-term within-individual variations in AP. Long-term AP, while short-term
variations in AP depend on motivating and situational factors.
 main energizing factors that potentially lead to high long-term AP are
desires for material goods, status among intimates, excitement and sexual
satisfaction, attachments and socialization processes
 It integrates ideas from many other theories, including strain, control,
learning, labelling and rational choice approaches
(Cullen & Agnew, 2003)

12.  According to the ICAP theory, the commission of offenses and other types of
antisocial act depends on the interaction between the individual (with his immediate
level of AP) and the social environment (especially criminal opportunities and victims).
 Short-term AP varies within individuals according to short-term energizing factors such
as being bored, angry, drunk or frustrated or being encouraged by male peers.
 Whether a person with a certain level of AP commits a crime in a given situation
depends on cognitive processes, including considering the subjective benefits, costs
and probabilities of the different outcomes and stored behavioural repertoires or
scripts (based on previous experiences). The subjective benefits and costs include
immediate situational factors such as the material goods that can be stolen and the
likelihood and consequences of being caught by the police.

13. Critical points to consider
 Definition of Internalizing and externalizing behaviours are far from complete.
Internalized behaviour can affect family members as well, just like
externalizing behaviours not only effect the environment but suffers
psychologically internally as well.
 Distinguishing between aggressive and non-aggressive froms of antisocial
behaviour is questionable, as children who score high on one, they score
high on the other. Therefore, it does not tell which behaviours are specific to
one or the other group of behaviour
(Liu, 2004)
 there is comorbidity of internalizing and externalizing behaviour. Externalizing
children suffer from anxiety, and internalizing children may exhibit conduct
disorder.
 Externalized behaviour is often used as synonymous to antisocial. It is
because professionals use externalizing behaviours to discuss less severe
form of aggressive or antisocial behaviour. However, externalizing
behaviours include hyperactivity, yet many hyperactive children are not
antisocial, therefore distinction need to be drawn.
(Shaw and Winslow, 1997)

14. Internalizing Behaviours
 Internalizing behaviours: refers to problems that more centrally affect child’s internal
psychological environment rather than the external world. This includes: anxious, withdrawn,
inhibited and depressed, neurotic and over- controlled behaviours.
 (Eisenberg, 2001)
 Depression: Depression is a psychiatric mood disorder characterized by excessive sadness
and loss of interest in usually enjoyable activities. Depression occurs in 1% of preschoolers,
2% of school-aged children, and 5–8% of adolescents. Split in two types: major depression
and dysrhythmia (APA, 1994)
 Anxiety: most common psychiatric disorder in children. Anxiety can be described as a
‘state of apprehension without cause’ Anxiety disorders result when anxiety is consistent
and negatively interferes with school, social interactions, activities or family functioning. Five
main types: separation anxiety, social anxiety disorder, general anxiety disorder, PTSD, OCD.
(Tandon et al, 2009)
 Somatic complaints: Somatic complaints are physical symptoms with no identfiable,
specific physiological cause. Common paediatric somatic complaints include headaches,
nausea or abdominal pain. Non-specific causes usually include psychological distress,
anxiety, family patterns and life events (Chapman 2005)
 Teenage suicide

15. Causes
 Familiality is considered one of the most highly implicated factors in the development of
depression and anxiety Negative life events in the social environment, particularly violence,
poverty, abuse, bereavement/loss of loved ones, or parental separation
(Tully et al. 2008)
 Interpersonal relationships and social interactions influence development of anxiety and
somatic problems.
 Behavioural inhibition (BI), which occurs when a child retreats and withdraws from a novel
situation or stimulus, may increase likelihood of an anxiety disorder
(Schwartz et al. 1999)
 Temperament, parental somatic complaints and parental stress have all been implicated as
potential risk factors
(Carig et al, 2009)

16. Comorbidity
 they are often co-morbid with each other as well as other psychiatric, non-internalizing disorders.
 Depression with anxiety (62 % ) and conduct disorder (35 % )
 Anxiety with other types of anxiety disorders, depression, ADHD, opposition defiant disorder,
conduct disorder
 15 % - 62% of children who are diagnosed with anxiety disorder, has another comorbid disorder
 Somatic complaints are comorbid with most disorders, particularly anxiety disorder (60 % of
cases)
(Egger & Angold, 2009)
 Childhood anxiety disorders are often associated with development of adult anxiety disorders,
major depressive disorder, suicidal behaviour and psychiatric hospitalization
 Somatic complaints in toddlers have been linked to internalizing or externalizing problems in
adolescence and may make diagnosis of somatization disorder in adulthood more likely.
 higher occurrence of somatic complaints predicted poorer academic performance for
schoolchildren
(Hughes et al. 2007).