Journal of Abnormal Child Psychology

, Volume 39, Issue 1, pp 109–123 | Cite as

Structure and Etiology of Co-occurring Internalizing and Externalizing Disorders in Adolescents

  • Victoria E. Cosgrove
  • Soo H. Rhee
  • Heather L. Gelhorn
  • Debra Boeldt
  • Robin C. Corley
  • Marissa A. Ehringer
  • Susan E. Young
  • John K. Hewitt
Article

Abstract

Several studies suggest that a two-factor model positing internalizing and externalizing factors explains the interrelationships among psychiatric disorders. However, it is unclear whether the covariation between internalizing and externalizing disorders is due to common genetic or environmental influences. We examined whether a model positing two latent factors, internalizing and externalizing, explained the interrelationships among six psychiatric disorders (major depressive disorder, generalized anxiety disorder, separation anxiety disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) in adolescents, and whether there are common genetic and environmental influences on internalizing and externalizing latent factors. Multivariate behavior genetic analyses of data from 1162 twin pairs and 426 siblings ascertained from the general population via the Colorado Center for Antisocial Drug Dependence (CADD) were conducted. We found support for a model positing two latent factors (internalizing and externalizing). These factors were moderately heritable and influenced by significant common genetic and nonshared environmental influences. These findings suggest that co-occurrence of internalizing and externalizing psychopathology in adolescents results from both genetic and environmental influences.

Keywords

Adolescence Psychopathology Comorbidity Genetics Environment 

References

  1. Achenbach, T. M. (1991). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  2. Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.CrossRefPubMedGoogle Scholar
  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: American Psychiatric Association.Google Scholar
  4. Burcusa, S. L., Iacono, W. G., & McGue, M. (2003). Adolescent twins discordant for major depressive disorder: shared familial liability to externalizing and other internalizing disorders. Journal of Child Psychology and Psychiatry, 44(7), 997–1005.CrossRefPubMedGoogle Scholar
  5. Burt, S. A. (2009). Rethinking environmental contributions to child and adolescent psychopathology: a meta-analysis of shared environmental influences. Psychological Bulletin, 135, 608–637.CrossRefPubMedGoogle Scholar
  6. Burt, S. A., Krueger, R. F., McGue, M., & Iacono, W. G. (2001). Sources of covariation among attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder: the importance of shared environment. Journal of Abnormal Psychology, 110, 516–525.CrossRefPubMedGoogle Scholar
  7. Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., et al. (2003). Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301, 386–389.CrossRefPubMedGoogle Scholar
  8. Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316–336.CrossRefPubMedGoogle Scholar
  9. Cole, D. A., Truglio, R., & Peeke, L. (1997). Relation between symptoms of anxiety and depression in children: a multitrait-multimethod-multigroup assessment. Journal of Consulting and Clinical Psychology, 65, 110–119.CrossRefPubMedGoogle Scholar
  10. Dick, D. M., Viken, R. J., Kaprio, J., Pulkkinen, L., & Rose, R. J. (2005). Understanding the covariation among childhood externalizing symptoms: genetic and environmental influences on conduct disorder, attention deficit hyperactivity disorder, and oppositional defiant disorder symptoms. Journal of Abnormal Child Psychology, 33, 219–229.CrossRefPubMedGoogle Scholar
  11. Derks, E. M., Dolan, C. V., & Boomsma, D. I. (2004). Effects of censoring on parameter estimates and power in genetic modeling. Twin Research, 7, 659–669.CrossRefPubMedGoogle Scholar
  12. Eaves, L. J., Silberg, J. L., Meyer, J. M., Maes, H. H., Simonoff, E., Pickles, A., et al. (1997). Genetics and developmental psychopathology: 2. The main effects of genes and environment on behavioral problems in the Virginia twin study of adolescent behavioral development. Journal of Child Psychology and Psychiatry, 38, 965–980.CrossRefPubMedGoogle Scholar
  13. Ehringer, M. A., Rhee, S. H., Young, S., Corley, R., & Hewitt, J. K. (2006). Genetic and environmental contributions to common psychopathologies of childhood and adolescence: a study of twins and their siblings. Journal of Abnormal Child Psychology, 34, 1–17.CrossRefPubMedGoogle Scholar
  14. Eley, T. C., Sugden, K., Corsico, A., Gregory, A. M., Sham, P., McGuffin, P., et al. (2004). Gene-environment interaction analysis of serotonin system markers with adolescent depression. Molecular Psychiatry, 9, 908–915.CrossRefPubMedGoogle Scholar
  15. Gjone, H., & Stevenson, J. (1997). The association between internalizing and externalizing behavior in childhood and early adolescence: genetic of environmental common influences? Journal of Abnormal Child Psychology, 25, 277–286.CrossRefPubMedGoogle Scholar
  16. Hannelius, U., Gherman, L., Makela, V. V., Lindstedt, A., Zucchelli, M., Lagerberg, C., et al. (2007). Large-scale zygosity testing using single nucleotide polymorphisms. Twin Research and Human Genetics, 10(4), 604–625.CrossRefPubMedGoogle Scholar
  17. Harrington, R., Fudge, H., Rutter, M., Pickles, A., & Hill, J. (1991). Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 434–439.CrossRefPubMedGoogle Scholar
  18. Hewitt, J. K., Silberg, J. L., Neale, M. C., Eaves, L. J., & Erickson, M. (1992). The analysis of parental ratings of children’s behavior using LISREL. Behavior Genetics, 22, 293–317.CrossRefPubMedGoogle Scholar
  19. Hewitt, J. K., Silberg, J. L., Rutter, M., Simonoff, E., Meyer, J. M., Maes, H., et al. (1997). Genetics and developmental psychopathology: 1. Phenotypic assessment in the Virginia Twin Study of Adolescent Behavioral Development. Journal of Child Psychology and Psychiatry, 38, 943–963.CrossRefPubMedGoogle Scholar
  20. Hicks, B. M., Blonigen, D. M., Kramer, M. D., Krueger, R. F., Patrick, C. J., Iacono, W. G., et al. (2007). Gender differences and developmental change in externalizing disorders from late adolescence to early adulthood: a longitudinal twin study. Journal of Abnormal Psychology, 116, 433–447.CrossRefPubMedGoogle Scholar
  21. Hudziak, J. J., Achenbach, T. M., Althoff, R. R., & Pine, D. S. (2007). A dimensional approach to developmental psychopathology. International Journal of Methods in Psychiatric Research, 16(S1)I, S16–S23.Google Scholar
  22. Jaffee, S. R., & Price, T. S. (2007). Gene-environment correlations: a review of the evidence and implications for prevention of mental illness. Molecular Psychiatry, 12, 432–442.PubMedGoogle Scholar
  23. Jensen, P. S., Watanable, H. K., & Richters, J. E. (1999). Who’s up first? Testing for order effects in structured interviews using a counterbalanced experimental design. Journal of Abnormal Child Psychology, 27(6), 439–445.CrossRefPubMedGoogle Scholar
  24. Kendler, K. S., Prescott, C. A., Myers, J., & Neale, M. C. (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60, 929–937.CrossRefPubMedGoogle Scholar
  25. Kendler, K. S., Gardner, C. O., & Lichtenstein, P. (2008). A developmental twin study of symptoms of anxiety and depression: evidence for genetic innovation and attenuation. Psychological Medicine, 38, 1567–1575.CrossRefPubMedGoogle Scholar
  26. Knapp, P., & Mastergeorge, A. M. (2009). Clinical implications of current findings in neurodevelopment. Psychiatric Clinics of North America, 32, 177–197.CrossRefPubMedGoogle Scholar
  27. Krueger, R. F. (1999). The structure of common mental disorders. Archives of General Psychiatry, 56, 921–926.CrossRefPubMedGoogle Scholar
  28. Krueger, R. F., Caspi, A., Moffitt, T. E., & Silva, P. A. (1998). The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study. Journal of Abnormal Psychology, 107, 216–227.CrossRefPubMedGoogle Scholar
  29. Krueger, R. F., McGue, M., & Iacono, W. G. (2001). The higher-order structure of common DSM mental disorders: internalization, externalization, and their connections to personality. Personality and Individual Differences, 30, 1245–1259.CrossRefGoogle Scholar
  30. Lahey, B. B., & Waldman, I. D. (2003). A developmental propensity model of the origins of conduct problems during childhood and adolescence. In B. B. Lahey, T. E. Moffitt, & A. Caspi (Eds.), Causes of conduct disorder and juvenile delinquency (pp. 76–117). New York: The Guilford.Google Scholar
  31. Lilienfeld, S. O. (2003). Comorbidity between and within childhood externalizing and internalizing disorders: reflections and directions. Journal of Abnormal Child Psychology, 31, 285–291.CrossRefPubMedGoogle Scholar
  32. Lopez Leon, S., Croes, E. A., Sayed-Tabatabaei, F. A., Claes, S., Van Broeckhoven, C., & van Duijn, C. M. (2005). The dopamine D4 receptor gene 48-base-pair-repeat polymorphism and mood disorders: a meta-analysis. Biological Psychiatry, 57, 999–1003.CrossRefPubMedGoogle Scholar
  33. McMahon, R. J., & Frick, P. J. (2005). Evidence-based assessment of conduct problems in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 34(3), 477–505.CrossRefPubMedGoogle Scholar
  34. Middeldorp, C. M., Cath, D. C., Van Dyck, R., & Boomsma, D. I. (2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychological Medicine, 35, 611–624.CrossRefPubMedGoogle Scholar
  35. Mik, H. M., Ehtesham, S., Baldassarra, L., De Luca, V., Davidge, K., Bender, D., et al. (2007). Serotonin system genes and childhood-onset aggression. Psychiatric Genetics, 17, 11.CrossRefPubMedGoogle Scholar
  36. Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychological Review, 100, 674–701.CrossRefPubMedGoogle Scholar
  37. Muris, P., & Ollendick, T. H. (2005). The role of temperament in the etiology of child psychopathology. Clinical and Child Family Psychology Review, 8, 271–288.CrossRefGoogle Scholar
  38. Muthén, L. K., & Muthén, B. O. (1998–2004). Mplus user’s guide (3rd ed.). Los Angeles: Muthén & Muthén.Google Scholar
  39. Nadder, T. S., Silberg, J. L., Eaves, L. J., Maes, H. H., & Meyer, J. M. (1998). Genetic effects on ADHD symptomatology in 7- to 13-year-old twins: results from a telephone survey. Behavior Genetics, 28, 83–99.CrossRefPubMedGoogle Scholar
  40. Nadder, T. S., Rutter, M., Silberg, J. L., Maes, H. H., & Eaves, L. J. (2002). Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (Odd/CD) symptomatologies across informant and occasion of measurement. Psychological Medicine, 32, 39–53.CrossRefPubMedGoogle Scholar
  41. Neale, M. C., Boker, S. M., Xie, G., & Maes, H. H. (2002). Mx: Statistical modeling (6th ed.). Richmond: Department of Psychiatry, Virginia Commonwealth University.Google Scholar
  42. Nigg, J. T. (2006). Temperament and developmental psychopathology. Journal of Clinical Psychology and Psychiatry, 47, 395–422.CrossRefGoogle Scholar
  43. O’Connor, T. G., McGuire, S., Reiss, D., Hetherington, E. M., & Plomin, R. (1998). Co-occurrence of depressive symptoms and antisocial behavior in adolescence: a common genetic liability. Journal of Abnormal Psychology, 107, 27–37.CrossRefPubMedGoogle Scholar
  44. Plomin, R., DeFries, J. C., & McClearn, G. E. (1990). Behavioral genetics: A primer (2nd ed.). New York: W.H. Freeman and Company.Google Scholar
  45. Plomin, R., Asbury, K., Dip, P. G., & Dunn, J. (2001). Why are children in the same family so different? Nonshared environment a decade later. Canadian Journal of Psychiatry, 46, 225–233.Google Scholar
  46. Posthuma, D., & Boomsma, D. I. (2000). A note on the statistical power in extended twin designs. Behavior Genetics, 30, 147–158.CrossRefPubMedGoogle Scholar
  47. Puig-Antich, J. (1982). Major depression and conduct disorder in prepuberty. Journal of the American Academy of Child and Adolescent Psychiatry, 21, 118–128.CrossRefGoogle Scholar
  48. Rhea, S. A., Gross, A. A., Haberstick, B. C., & Corley, R. P. (2006). Colorado twin registry. Twin Resesearch and Human Genetics, 9, 941–949.CrossRefGoogle Scholar
  49. Rowe, D. C., Stever, C., Chase, D., Sherman, S., Abramowitz, A., & Waldman, I. D. (2001). Two dopamine genes related to reports of childhood retrospective inattention and conduct disorder symptoms. Molecular Psychiatry, 6, 429–433.CrossRefPubMedGoogle Scholar
  50. Sakai, J. T., Young, S. E., Stallings, M. C., Timberlake, D., Smolen, A., Stetler, G. L., et al. (2006). Case-control and within-family tests for an association between conduct disorder and 5HTTLPR. American Journal of Medical Genetics B: Neuropsychiatric Genetics, 141B, 825–832.CrossRefGoogle Scholar
  51. Schwab-Stone, M. E., Shaffer, D., Dulcan, M. K., Jensen, P. S., Fisher, P., Bird, H. R., et al. (1996). Criterion validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC 2.3). Journal of the American Academy of Child and Adolescent Psychiatry, 35(7), 878–888.CrossRefPubMedGoogle Scholar
  52. Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M. E., et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the epidemiology of child and adolescent mental disorders study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865–877.CrossRefPubMedGoogle Scholar
  53. Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38.CrossRefPubMedGoogle Scholar
  54. Silberg, J. L., & Bulik, C. M. (2005). The developmental association between eating disorders symptoms and symptoms of depression and anxiety in juvenile twin girls. Journal of Child Psychology and Psychiatry, 46, 1317–1326.CrossRefPubMedGoogle Scholar
  55. Silberg, J., Rutter, M., Meyer, J., Maes, H., Hewitt, J., Simonoff, E., et al. (1996). Genetic and environmental influences on the covariation between hyperactivity and conduct disturbance in juvenile twins. Journal of Child Psychology and Psychiatry, 37, 803–816.CrossRefPubMedGoogle Scholar
  56. Silverman, W. K., & Ollendick, T. H. (2005). Evidence-based assessment of anxiety and its disorders in children and adolescents. Journal of Clincal Child and Adolescent Psychology, 34(3), 380–411.CrossRefGoogle Scholar
  57. Simonoff, E., Pickles, A., Hervas, A., Silberg, J. L., Rutter, M., & Eaves, L. (1998). Genetic influences on childhood hyperactivity: contrast effects imply parental rating bias, not sibling interaction. Psychological Medicine, 28, 825–837.CrossRefPubMedGoogle Scholar
  58. Stallings, M. C., Hewitt, J., Lessem, J. M., Young, S. E., Corley, R., Mikulich, S. K., et al. (2001). Modeling the familial transmission of alcohol dependence symptom counts in clinical and control family pedigrees [Abstract]. Behavior Genetics, 31, 470.Google Scholar
  59. Subbarao, A., Rhee, S. H., Young, S. E., Ehringer, M. A., Corley, R. P., & Hewitt, J. K. (2008). Common genetic and environmental influences on major depressive disorder and conduct disorder. Journal of Abnormal Child Psychology, 36, 433–444.CrossRefPubMedGoogle Scholar
  60. Thapar, A., Harrington, R., & McGuffin, P. (2001). Examining the comorbidity of ADHD-related behaviours and conduct problems using a twin study design. British Journal of Psychiatry, 179, 224–229.CrossRefPubMedGoogle Scholar
  61. Turkheimer, E., & Waldron, M. (2000). Nonshared environment: a theoretical, methodological, and quantitative review. Psychological Bulletin, 126, 78–108.CrossRefPubMedGoogle Scholar
  62. Waldman, I. D., Rhee, S. H., & Levy, F. (2001). Causes of overlap among symptoms of ADHD, oppositional defiant disorder, and conduct disorder. In F. Levy & D. A. Hay (Eds.), Attention, genes, and ADHD (pp. 115–138). New York: Brunner-Routledge.Google Scholar
  63. Wolff, J. C., & Ollendick, T. H. (2006). The comorbidity of conduct problems and depression in childhood and adolescence. Clinical Child and Family Psychology Review, 9, 201–220.CrossRefPubMedGoogle Scholar
  64. Young, S. E., Stallings, M. C., Corley, R. P., Krauter, K. S., & Hewitt, J. K. (2000). Genetic and environmental influences on behavioral disinhibition. American Journal of Medical Genetics, 96B, 684–695.CrossRefGoogle Scholar
  65. Zoccolillo, M. (1992). Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: a review. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 547–556.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Victoria E. Cosgrove
    • 1
    • 2
    • 5
  • Soo H. Rhee
    • 1
    • 2
  • Heather L. Gelhorn
    • 3
  • Debra Boeldt
    • 1
    • 2
  • Robin C. Corley
    • 2
  • Marissa A. Ehringer
    • 2
    • 4
  • Susan E. Young
    • 2
  • John K. Hewitt
    • 1
    • 2
  1. 1.Department of Psychology and NeuroscienceUniversity of Colorado at BoulderBoulderUSA
  2. 2.Institute for Behavioral GeneticsUniversity of ColoradoBoulderUSA
  3. 3.Division of Substance Dependence, Department of PsychiatryUniversity of Colorado Denver Health Sciences ProgramsDenverUSA
  4. 4.Department of Integrative PhysiologyUniversity of ColoradoBoulderUSA
  5. 5.VA Palo Alto Health Care SystemStanford University School of MedicinePalo AltoUSA

Personalised recommendations