Child Psychiatry & Human Development

, Volume 43, Issue 2, pp 153–170 | Cite as

Predicting Internalizing and Externalizing Problems at Five Years by Child and Parental Factors in Infancy and Toddlerhood

  • Mirjami MäntymaaEmail author
  • Kaija Puura
  • Ilona Luoma
  • Reija Latva
  • Raili K. Salmelin
  • Tuula Tamminen
Original Article


This study examined child and parental factors in infancy and toddlerhood predicting subclinical or clinical levels of internalizing and externalizing problems at 5 years of age. Ninety-six children and their families participated. They were assessed when the children were 4–10 weeks old (T1), 2 years (T2) and 5 years old (T3). Child risks (difficult temperament, health problems, early emotional and behavioral problems), parental risks (psychopathology, parenting stress and perception of the child) and family risks (socio-economic status, quality of marital relationship and family violence) were examined. At 5 years, internalizing problems were predicted by family violence during the child’s infancy and parenting stress at age 2. Externalizing problems were predicted by psychiatric problems of the mother before pregnancy and child’s externalizing problems at 2 years of age. When interventions aiming at preventing emotional and behavioral problems in children are considered, these issues should be recognized early and effective intervention initiated.


Internalizing problems Externalizing problems Children Predicting 


  1. 1.
    Angold A, Egger HL (2004) Psychiatric diagnosis in preschool children. In: DelCarmen-Wiggins R, Carter A (eds) Handbook of infant, toddler and preschool mental health assessment. Oxford University Press Inc., Oxford, pp 123–139Google Scholar
  2. 2.
    Skovgaard AM, Houmann T, Christiansen E, Landorph S, Jørgensen T, CCC 2000 Study Team et al (2007) The prevalence of mental health problems in children 11/2 years of age—the Copenhagen Child Cohort 2000. J Child Psychol Psychiatry 48:62–70CrossRefPubMedGoogle Scholar
  3. 3.
    Keenan K, Shaw D, Delliquadri E, Giovannelli J, Walsh B (1998) Evidence for the continuity of early problem behaviors: application of a developmental model. J Abnorm Child Psychol 26:441–454CrossRefPubMedGoogle Scholar
  4. 4.
    Lavigne JV, Arend R, Rosenbaum D, Binns HJ, Kaufer Christoffel K, Gibbons RD (1998) Psychiatric disorders with the onset in the preschool years: I. Stability of diagnoses. J Am Acad Child Adolesc Psychiatry 37:1246–1254CrossRefPubMedGoogle Scholar
  5. 5.
    Hofstra MB, Van der Ende J, Verhulst FC (2000) Continuity and change of psychopathology from childhood into adulthood: a 14-year follow-up study. J Am Acad Child Adolesc Psychiatry 39:850–858CrossRefPubMedGoogle Scholar
  6. 6.
    Briggs-Gowan MJ, Carter AS, Bosson-Heenan J, Guyer AE, Horwitz SM (2006) Are infant-toddler social-emotional and behavioral problems transient? J Am Acad Child Adolesc Psychiatry 45:849–858CrossRefPubMedGoogle Scholar
  7. 7.
    Pihlakoski L, Sourander A, Aromaa M, Rautava P, Helenius H, Sillanpää M (2006) The continuity of psychopathology from early childhood to preadolescence. A prospective cohort study of 3–12-year-old children. Eur Child Adolesc Psychiatry 15:409–417CrossRefPubMedGoogle Scholar
  8. 8.
    Achenbach TM, Rescorla LA (2000) Manual for ASEBA preschool forms & profiles. University of Vermont, Research Center for Children, Youth & Families, BurlingtonGoogle Scholar
  9. 9.
    Mesman J, Koot HM (2001) Early preschool predictors of preadolescent internalizing and externalizing DSM-I V diagnoses. J Am Acad Child Adolesc Psychiatry 40:1029–1036CrossRefPubMedGoogle Scholar
  10. 10.
    Fite P, Stoppelbein L, Greening L, Dhossche D (2008) Child internalizing and externalizing behavior as predictors of age at first admission and risk for repeat admission to a child inpatient facility. Am J Orthopsychiatry 78:63–69CrossRefPubMedGoogle Scholar
  11. 11.
    Fanti KA, Henrich CC (2010) Trajectories of pure and co-occurring internalizing and externalizing problems from age 2 to age 12: findings from the National Institute of Child Health and Human Development Study of Early Child Care. Dev Psychol 46:1159–1175CrossRefPubMedGoogle Scholar
  12. 12.
    Zeanah CH, Boris NW, Larrieu JA (1997) Infant development and developmental risk: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 36:165–178CrossRefPubMedGoogle Scholar
  13. 13.
    Olson SL, Bates JE, Sandy JM, Lanthier R (2000) Early developmental precursors of externalizing behavior in middle childhood and adolescence. J Abnorm Child Psychol 28:119–133CrossRefPubMedGoogle Scholar
  14. 14.
    Luoma I, Tamminen T, Kaukonen P, Laippala P, Puura K, Salmelin R et al (2001) Longitudinal study of maternal depressive symptoms and child well-being. J Am Acad Child Adolesc Psychiatry 40:1367–1374CrossRefPubMedGoogle Scholar
  15. 15.
    Luoma I, Kaukonen P, Mäntymaa M, Puura K, Salmelin R, Tamminen T (2004) A longitudinal study of maternal depressive symptoms, negative expectations and perceptions of child problems. Child Psychiatry Hum Dev 35:37–52CrossRefPubMedGoogle Scholar
  16. 16.
    Shaw DS, Vondra JI, Hommerding KD, Keenan K, Dunn M (1994) Chronic family adversity and early child behavior problems: a longitudinal study of low income families. J Child Psychol Psychiatry 35:1109–1122CrossRefPubMedGoogle Scholar
  17. 17.
    Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KL (2002) Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 288:728–737CrossRefPubMedGoogle Scholar
  18. 18.
    Wallander JL, Varni JW (1998) Effects of pediatric chronic physical disorders on child and family adjustment. J Child Psychol Psychiatry 39:29–46CrossRefPubMedGoogle Scholar
  19. 19.
    Östberg M, Hagekull B (2000) A structural modeling approach to the understanding of parenting stress. J Clin Child Psychol 29:615–625CrossRefPubMedGoogle Scholar
  20. 20.
    Teerikangas OM, Aronen ET, Martin RP, Huttunen MO (1998) Effects of infant temperament and early intervention on the psychiatric symptoms of adolescents. J Am Acad Child Adolesc Psychiatry 37:1070–1076CrossRefPubMedGoogle Scholar
  21. 21.
    Cummings EM, Davies PT (1994) Maternal depression and child development. J Child Psychol Psychiatry 35:73–112CrossRefPubMedGoogle Scholar
  22. 22.
    Murray L, Cooper P (1997) Effects of postnatal depression on infant development. Arch Dis Child 77:99–101CrossRefPubMedGoogle Scholar
  23. 23.
    Murray L, Sinclair D, Cooper P, Ducournau P, Turner P (1999) The socioemotional development of 5-year-old children of postnatally depressed mothers. J Child Psychol Psychiatry 40:1259–1271CrossRefPubMedGoogle Scholar
  24. 24.
    Ramchandani PG, Stein A, O’Connor TG, Heron J, Murray K, Evand J (2008) Depression in men in the postnatal period and later child psychopathology: a population cohort study. J Am Acad Child Adolesc Psychiatry 47:390–398CrossRefPubMedGoogle Scholar
  25. 25.
    Hill SY, Tessner KD, McDermott MD (2011) Psychopathology in offspring from families of alcohol dependent female probands: a prospective study. J Psychiatr Res 45:285–294CrossRefPubMedGoogle Scholar
  26. 26.
    Suveg C, Shaffer A, Morelen D, Thomassin K (2011) Links between maternal and child psychopathology symptoms: mediation through child emotion regulation and moderation through maternal behavior. Child Psychiatry Hum Dev 42:507–520CrossRefPubMedGoogle Scholar
  27. 27.
    Ashford J, Smith F, van Lier PAC, Cuijpers P, Koot HM (2008) Early risk indicators of internalizing problems in late childhood: a 9-year longitudinal study. J Child Psychol Psychiatry 49:773–780CrossRefGoogle Scholar
  28. 28.
    Murray L, Fiori-Cowley A, Hooper R, Cooper P (1996) The impact of postnatal depression and associated adversity on early mother–infant interactions and later infant outcome. Child Dev 67:2512–2526CrossRefPubMedGoogle Scholar
  29. 29.
    Goodman SH, Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106:458–490CrossRefPubMedGoogle Scholar
  30. 30.
    Pajulo M, Savonlahti E, Sourander A, Piha J, Helenius H (2001) Prenatal maternal representations: mothers at psychosocial risk. Infant Ment Health J 22:529–544CrossRefGoogle Scholar
  31. 31.
    Ramchandani P, Psychogiou L (2009) Paternal psychiatric disorders and children’s psychosocial development. Lancet 374:646–653CrossRefPubMedGoogle Scholar
  32. 32.
    Elgar FJ, McGrath PJ, Waschbusch DA, Stewart SH, Curtis LJ (2004) Mutual influences on maternal depression and child adjustment problems. Clin Psychol Rev 24:441–459CrossRefPubMedGoogle Scholar
  33. 33.
    Cicchetti D, Toth SL (2009) The past achievements and future promises of developmental psychopathology: the coming of age of a discipline. J Child Psychol Psychiatry 50:16–25CrossRefPubMedGoogle Scholar
  34. 34.
    Gross HE, Shaw DS, Burwell RA, Nagin DS (2009) Transactional processes in child disruptive behavior and maternal depression: a longitudinal study from early childhood to adolescence. Dev Psychopathol 21:139–156CrossRefPubMedGoogle Scholar
  35. 35.
    Mäntymaa M, Puura K, Luoma I, Salmelin RK, Tamminen T (2006) Mother’s early perception of her infant’s difficult temperament, parenting stress and early mother–infant interaction. Nord J Psychiatry 60:379–386CrossRefPubMedGoogle Scholar
  36. 36.
    Williford AP, Calkins SD, Keane SP (2007) Predicting change in parenting stress across early childhood: child and maternal factors. J Abnorm Child Psychol 35:251–263CrossRefPubMedGoogle Scholar
  37. 37.
    Appleyard K, Egeland B, van Dulmen MH, Sroufe LA (2005) When more is not better: the role of cumulative risk in child behavior outcomes. J Child Psychol Psychiatry 46:235–245CrossRefPubMedGoogle Scholar
  38. 38.
    Puura K, Davis H, Papadopoulou K, Tsiantis J, Ispanovic-Radojkovic V, Rudic N et al (2002) The European Early Promotion Project: a new primary health care service to promote children’s mental health. Infant Ment Health J 23:606–624CrossRefGoogle Scholar
  39. 39.
    Davis H, Tsiantis J (2005) Promoting children’s mental health: the European Early Promotion Project (EPPP). Int J Ment Health Promot 7:4–16Google Scholar
  40. 40.
    Puura K, Davis H, Cox A, Tsiantis J, Tamminen T, Ispanovic-Radojkovic V et al (2005) The European Early Promotion Project: description of the service and evaluation study. Int J Ment Health Promot 7:17–31Google Scholar
  41. 41.
    Brown E, Rutter M (1966) The measurement of family activities and relationships: a methodological study. Hum Relat 19:241–263CrossRefGoogle Scholar
  42. 42.
    Quinton D, Rutter M, Rowlands O (1976) An evaluation of an interview assessment of marriage. Psychol Med 6:577–586CrossRefPubMedGoogle Scholar
  43. 43.
    Rutter M, Brown E (1966) The reliability and validity measures of family life and relationships in families containing a psychiatric patient. Soc Psychiatry 1:38–53CrossRefGoogle Scholar
  44. 44.
    Spitzer RL, Williams JB, Gibbon M, First MB (1989) Instruction manual for the structured clinical interview for DSM-III-R. New York State Psychiatric Institute, Biometrics Research Department, New York cityGoogle Scholar
  45. 45.
    Mäntymaa M, Tamminen T, Puura K, Luoma I, Koivisto AM, Salmelin RK (2006) Early mother–infant interaction: associations with the close relationships and mental health of the mother. J Reprod Infant Psychol 24:213–231CrossRefGoogle Scholar
  46. 46.
    Bates JE, Freeland CA, Lounsbury ML (1979) Measurement of infant difficultness. Child Dev 50:794–803CrossRefPubMedGoogle Scholar
  47. 47.
    Campbell SB (1979) Mother–infant interaction as a function of maternal ratings of temperament. Child Psychiatry Hum Dev 10:67–76CrossRefPubMedGoogle Scholar
  48. 48.
    Abidin R (1990) Parenting stress index. Paediatric Psychology Press, University of Virginia, CharlottesvilleGoogle Scholar
  49. 49.
    Achenbach TM (1992) Manual for the child behavior checklist/2–3 and 1992 profile. University of Vermont, Department of Psychiatry, BurlingtonGoogle Scholar
  50. 50.
    Mäntymaa M, Puura K, Luoma I, Salmelin RK, Tamminen T (2004) Early mother–infant interaction, parental mental health and symptoms of behavioral and emotional problems in toddlers. Infant Behav Dev 27:134–149CrossRefGoogle Scholar
  51. 51.
    Schmidt LA, Fox NA, Hamer DH (2007) Evidence for a gene–gene interaction in predicting children’s behavior problems: association of serotonin transporter short and dopamine receptor D4 long genotypes with internalizing and externalizing behaviors in typically developing 7-year-olds. Dev Psychopathol 19:1105–1116CrossRefPubMedGoogle Scholar
  52. 52.
    O’Connor TG, Heron J, Golding J, Beveridge M, Glover V (2002) Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 180:502–508CrossRefPubMedGoogle Scholar
  53. 53.
    Areias ME, Kumar R, Barros H, Figueiredo E (1996) Correlates of postnatal depression in mothers and fathers. Br J Psychiatry 169:36–41CrossRefPubMedGoogle Scholar
  54. 54.
    Dudley M, Roy K, Kelk N, Bernard D (2001) Psychological correlates of depression in fathers and mothers in the first postnatal year. J Reprod Infant Psychol 19:187–202Google Scholar
  55. 55.
    Kovacs M, Devlin B (1998) Internalizing disorders in childhood. J Child Psychol Psychiatry 39:47–63CrossRefPubMedGoogle Scholar
  56. 56.
    Ormel J, Oldehinkel AJ, Ferdinand RF, Hartman CA, De Winter AF, Veenstra R et al (2005) Internalizing and externalizing problems in adolescence: general and dimension-specific effects of familial loadings and preadolescent temperament traits. Psychol Med 35:1825–1835CrossRefPubMedGoogle Scholar
  57. 57.
    Bayer JK, Sanson AV, Hemphill SA (2006) Parent influences on early childhood internalizing difficulties. J Appl Dev Psychol 27:542–559CrossRefGoogle Scholar
  58. 58.
    Bayer JK, Hiscock H, Ukoumunne OC, Price A, Wake M (2008) Early childhood aetiology of mental health problems: a longitudinal population-based study. J Child Psychol Psychiatry 49:1166–1174PubMedGoogle Scholar
  59. 59.
    Mathiesen KS, Sanson A (2000) Dimensions of early childhood behavior problems: stability and predictors of change from 18 to 30 months. J Abnorm Child Psychol 28:15–31CrossRefPubMedGoogle Scholar
  60. 60.
    Mathiesen KS, Sanson A, Stoolmiller M, Karevold E (2009) The nature and predictors of undercontrolled and internalizing problem trajectories across early childhood. J Abnorm Child Psychol 37:209–222CrossRefPubMedGoogle Scholar
  61. 61.
    Essex MJ, Kraemer HC, Armstrong JM, Boyce T, Goldsmith HH, Klein MH et al (2006) Exploring risk factors for the emergence of children’s mental health problems. Arch Gen Psychiatry 63:1246–1256CrossRefPubMedGoogle Scholar
  62. 62.
    Briggs-Gowan MJ, Carter AS, Clark R, Augustyn M, McCarthy KJ, Ford JD (2010) Exposure to potentially traumatic events in early childhood: differential links to emergent psychopathology. J Child Psychol Psychiatry 51:1132–1140CrossRefPubMedGoogle Scholar
  63. 63.
    Perry BD, Pollard RA, Blakley TI, Baker WL, Vigilante D (1995) Childhood trauma, the neurobiology of adaptation, and “use-dependent” development of the brain: how “states” become “traits”. Infant Mental Health J 16:271–291CrossRefGoogle Scholar
  64. 64.
    Mesman J, Bongers IL, Koot HM (2001) Preschool developmental pathways to preadolescent internalizing and externalizing problems. J Child Psychol Psychiatry 42:679–689CrossRefPubMedGoogle Scholar
  65. 65.
    Puura K (1998) What children tell and adults notice. Academic dissertation. Acta Universitatis Tamperensis 605. Vammalan Kirjapaino Oy, VammalaGoogle Scholar
  66. 66.
    Luoma I, Puura K, Tamminen T, Kaukonen P, Piha J, Räsänen E et al(1999) Emotional and behavioural problems in 8–9-year-old children in relation to family structure. Eur Child Adolesc Psychiatry 8(Suppl 4):IV/29–IV/40Google Scholar
  67. 67.
    Najman JM, Williams GM, Nikles J, Spence S, Bor W, O’Callaghan MJ et al (2001) Bias influencing maternal reports of child behavior and emotional state. Soc Psychiatry Psychiatr Epidemiol 36:186–194CrossRefPubMedGoogle Scholar
  68. 68.
    Feldman R, Greenbaum CW, Mayes LC, Erlich SH (1997) Change in mother–infant interactive behavior: relations to change in the mother, the infant, and the social context. Infant Behav Dev 20:151–163CrossRefGoogle Scholar
  69. 69.
    Egger HL, Angold A (2004) The Preschool Age Psychiatric Assessment (PAPA): a structured parent interview for diagnosing psychiatric disorders in preschool children. In: DelCarmen-Wiggins R, Carter A (eds) Handbook of infant, toddler and preschool mental health assessment. Oxford University Press Inc., Oxford, pp 223–243Google Scholar
  70. 70.
    Laucht M, Esser G, Schmidt MS (1994) Parental mental disorder and early child development. Eur Child Adolesc Psychiatry 3:125–137CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Mirjami Mäntymaa
    • 1
    • 2
    Email author
  • Kaija Puura
    • 1
    • 2
  • Ilona Luoma
    • 2
    • 1
  • Reija Latva
    • 2
    • 1
  • Raili K. Salmelin
    • 3
    • 2
  • Tuula Tamminen
    • 1
    • 2
  1. 1.University of Tampere, School of MedicineTampereFinland
  2. 2.Department of Child PsychiatryTampere University HospitalTampereFinland
  3. 3.University of Tampere, School of Health SciencesTampereFinland

Personalised recommendations