Papachristou, E; Flouri, E; (2020) Distinct developmental trajectories of internalising and externalising symptoms in childhood: Links with mental health and risky behaviours in early adolescence. Journal of Affective Disorders , 276 pp. 1052-1060. 10.1016/j.jad.2020.07.130.

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Abstract

Background: High or increasing trajectories of internalising and externalising symptoms in childhood are mutually re-enforcing and associated with poor emotional and behavioural outcomes in adolescence. This study sought to identify classes of children with similar trajectories of internalising and externalising symptoms after adjusting one domain's symptoms for the other's at the classification stage, and to relate them to emotional and behavioural outcomes in mid-adolescence. Methods: We used growth mixture modelling to classify 16,844 members of the Millennium Cohort Study (baseline N=19,244) into distinct classes based on their trajectories, across ages 3,5,7 and 11 years, of internalising and externalising symptoms adjusted for one another. We examined the predictive ability of these classes for depression, self-harm, trouble with police and drug use among 11,134 children with available data at age 14. Results: We identified four classes of children following distinct trajectories of ‘pure’ internalising and externalising symptoms. After adjustments for confounding, those with increasing or initially high yet decreasing levels of internalising symptomatology, and those with persistently high or increasing levels of externalising problems were at increased risk of depression in early adolescence. Having initially low yet increasing levels of internalising symptomatology was additionally associated with an increased risk of self-harm and drug use in early adolescence. Limitations: We cannot ascertain whether our longitudinal typology of internalising and externalising symptoms holds for outcomes later in adolescence or adulthood. Conclusions: Interventions aiming to prevent depression, drug use or self-harm in mid-adolescence may be more successful if they target children showing increasing internalising symptoms in the primary school years.

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