Stress impacts all individuals during each developmental period of their lives. Stress has been linked to various physical and mental health outcomes across the lifespan. However, adolescence may prove to be a unique time to examine stress and its potential effects on various health outcomes, as well as possible mediating or moderating factors. The purpose of this study is to examine the link between stress and body mass index (BMI) percentile while incorporating the potential mediators of anxiety, depression, and externalizing behaviors as well as the moderators of social support and self-regulation. Using a sample of 500 adolescents living in the Pacific Northwest, moderated mediation SEM models were estimated to test for these relationships. The full mediation model was selected, which included only indirect paths from predictors to the outcome through the mediators. Daily hassles was a significant positive predictor of depression and externalizing behavior, while family chaos was a significant positive predictor only for externalizing behavior. None of the three mediators significantly predicted BMI. When the moderators were added, two significant interactions were found between family chaos and parent social support for anxiety and externalizing behavior with another significant interaction found between family chaos and peer social support for depression. Specifically, the positive link between family chaos and these three mediators was weaker at higher levels of parent and peer social support. Thus, parent and peer social support may buffer the effect of familial stress on mental health. Future research can examine these relationships, as well as other potential moderators between stress and health outcomes during adolescence.

This study examined the relationship between executive function and externalizing behaviors within a student population that was assessed for special education services. Executive function was measured by using the Comprehensive Executive Function Inventory (CEFI). Externalizing behaviors and school problems was measured using the Behavior Assessment System for Children, Third Edition (BASC-3). Four separate structural equation models were produced and analyzed to examine this relationship. The results from this study indicate that there is a significant direct effect from executive function on externalizing behaviors and school problems, such that higher scores in executive function yielded lower externalizing behavior and school problems scores. Differences in average full scale CEFI scores were noted between types of special education placements and between various groupings of students in regards to what category they qualified in. The data indicates programs that facilitated more environmental supports and services had students with lower full scale CEFI scores, while students that qualified under Other Health Impairment and Emotional Disturbance shared comorbid features with other distinct processing deficits.

Objectives: A meta-analysis was conducted to determine the average effect size of internalizing and externalizing symptoms after pediatric traumatic brain injury across a range of severity (mild, moderate, and severe). Two-meta-regressions were also conducted to determine the role of age at injury at time since injury on these effect sizes.Participants and Methods: 9725 titles and abstracts were collected from PubMed, PsycInfo, and Web of Science. Of these, 63 full-text articles were examined for inclusion criteria to determine eligibility for the study. To be included, the studies needed to be published prior to March 2017 in English, needed to have a control group of either orthopedically injured or typically developing peers, and required a reliable and valuable measure of internalizing and externalizing symptoms in children. Studies were excluded for non-accidental head injuries or if the sample recruited was outside the range of 2-17 years old at the time of injury. The analysis was based on 16 studies including 1083 cases of mild TBI, 184 cases of moderate TBI, 214 cases of severe TBI, and 1605 control cases.Results: Analyses revealed a large effect size for internalizing symptoms of children with mild TBI (Hedges g = -0.624, p = 0.009), a small effect size for moderate TBI (Hedges g = -0.238, p = 0.029), and a large effect size for severe TBI (Hedges g = -0.923, p < .001). These findings indicate that parents rate childrens internalizing symptoms more severely for brain injured children than for typically developing or non-brain injured peers. These children may be experiencing more severe symptoms such as anxiety and depression regardless of injury severity. For externalizing symptoms, analyses demonstrated a moderate effect size for mild TBI (Hedges g = -0.531, p = 0.003), a small effect size for moderate TBI (Hedges g = -0.257, p = 0.007), and a large effect size for severe TBI (Hedges g = -0.909, p < .001). Thus, children who experienced a TBI demonstrated externalizing symptoms including hyperactivity and impulsivity with the largest effect size associated with severe TBI. The results of the meta-regressions indicated that only injury severity was a significant predictor of symptom severity.Conclusions: Using meta-analytic methods, we found that children who experience traumatic brain injury are rated as exhibiting more severe internalizing and externalizing symptoms across levels of severity. This effect was largest for severe injury and smallest for moderate injury. Caregivers and healthcare practitioners can use this information to better screen for and treat internalizing and externalizing symptoms in children after a traumatic brain injury.

Objectives: A meta-analysis was conducted to determine the average effect size of internalizing and externalizing symptoms after pediatric traumatic brain injury across a range of severity (mild, moderate, and severe). Two-meta-regressions were also conducted to determine the role of age at injury at time since injury on these effect sizes.Participants and Methods: 9725 titles and abstracts were collected from PubMed, PsycInfo, and Web of Science. Of these, 63 full-text articles were examined for inclusion criteria to determine eligibility for the study. To be included, the studies needed to be published prior to March 2017 in English, needed to have a control group of either orthopedically injured or typically developing peers, and required a reliable and valuable measure of internalizing and externalizing symptoms in children. Studies were excluded for non-accidental head injuries or if the sample recruited was outside the range of 2-17 years old at the time of injury. The analysis was based on 16 studies including 1083 cases of mild TBI, 184 cases of moderate TBI, 214 cases of severe TBI, and 1605 control cases.Results: Analyses revealed a large effect size for internalizing symptoms of children with mild TBI (Hedges g = -0.624, p = 0.009), a small effect size for moderate TBI (Hedges g = -0.238, p = 0.029), and a large effect size for severe TBI (Hedges g = -0.923, p <<> .001). These findings indicate that parents rate childrens internalizing symptoms more severely for brain injured children than for typically developing or non-brain injured peers. These children may be experiencing more severe symptoms such as anxiety and depression regardless of injury severity. For externalizing symptoms, analyses demonstrated a moderate effect size for mild TBI (Hedges g = -0.531, p = 0.003), a small effect size for moderate TBI (Hedges g = -0.257, p = 0.007), and a large effect size for severe TBI (Hedges g = -0.909, p <<> .001). Thus, children who experienced a TBI demonstrated externalizing symptoms including hyperactivity and impulsivity with the largest effect size associated with severe TBI. The results of the meta-regressions indicated that only injury severity was a significant predictor of symptom severity.Conclusions: Using meta-analytic methods, we found that children who experience traumatic brain injury are rated as exhibiting more severe internalizing and externalizing symptoms across levels of severity. This effect was largest for severe injury and smallest for moderate injury. Caregivers and healthcare practitioners can use this information to better screen for and treat internalizing and externalizing symptoms in children after a traumatic brain injury.

The current study examined the role that parent-child attachment plays in the relationship between marital conflict and the development of behavior problems in adolescents. To evaluate the hypothesis that attachment moderates this relationship, 57 families were recruited via e-mail invitation sent to families that participated in local church youth groups, school organizations, and a treatment program designed for adolescents with behavior problems. One custodial parent and his/her adolescent child completed an online or paper version of a survey consisting of the Achenbach’s Behavior Checklists, the Inventory of Parent and Peer Attachment, and the Children’s Perception of Interparental Conflict Scale. Hypotheses were evaluated using Baron and Kenny’s (1986) procedures to test moderating effects with multiple regression analyses. Mother attachment demonstrated a significant moderation effect between the intensity of interparental conflict and the parent’s report of externalizing behavior problems. Specifically, at low conflict intensity levels, relative to low attachment security, high attachment security was associated with fewer externalizing behavior problems, whereas at high intensities of interparental conflict high attachment security was associated with more externalizing behavior problems.

Pathological gambling and substance use disorders are highly prevalent and comorbid among veteran populations. These disorders also share genetic influences, although the underlying constructs and magnitude of their influence remain unclear. This project utilized the Hierarchical Taxonomy of Psychopathology (HiTOP) as a framework for modeling the underlying dimensions of psychopathology as latent factors and modeled genetic and environmental influences on substance use disorders and pathological gambling. Study 1 examined the structure of psychopathology for 15 common mental disorders in a sample of Vietnam-era veteran twins from the Harvard Drug Study (nMZ = 3,748 and nDZ = 2,996) to determine the appropriate location for pathological gambling within the HiTOP framework. The best fitting model included internalizing and externalizing spectra and an illicit substance use subfactor. Pathological gambling (loading = .30) loaded onto the externalizing spectrum with legal substance use, conduct disorder, antisocial personality disorder, and a subfactor that subsumed all six illicit substance use disorders. The best fitting model in Study 1 did not support the existence of a ‘p’ factor underlying all psychopathology. In Study 2, genetic and environmental components were modeled for the 15 disorders and 3 latent factors modeled in Study 1. Additive genetics explained from 10% (generalized anxiety disorder, panic disorder) to 49% (nicotine use) of the variance in specific disorders and from 24% (internalizing) to 46% (externalizing) of the variance of latent factors. Only cocaine use and conduct disorder demonstrated significant variance attributable to shared environment, the entirety of which occurred at the disorder-specific level. Only 9% of the genetic variance associated with alcohol use was shared across disorders, whereas 100% of genetic variance in cocaine and hallucinogen use was shared with latent factors. In total, 12% of the variance in risk for pathological gambling was associated with additive genetics, and 13% of that variance was shared via the externalizing spectrum. Findings highlight shared risk among illicit substance use disorders and among other disorders on the externalizing spectrum. These findings suggest externalizing and illicit substance use as transdiagnostic targets for treatments aimed at individuals with comorbid substance use disorders, pathological gambling, and other externalizing disorders.

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