Abstract
Early childhood is a common period for the onset of internalizing and externalizing problems. Many are the risk factors that contribute to the emergence of these types of problems. Literature enhances the importance of viewing the child as part of a system, in order to better understand the origin, the trajectory and the impact of risk factors in child mental health in preschool age. The current systematic literature review aims to examine empirical evidence based on the Child Behavior Checklist 1½–5 for risk factors related to the presence of internalizing and externalizing problems in children aged between 3 and 6 years old. The literature review includes articles published from January 2001 to December 2014. Twenty-eight articles that attend to pre-established inclusion and exclusion criteria were reported throughout the review. In general, results indicate that risk factors for internalizing and externalizing problems in preschool age can be organized into three main groups of risks: environment factors, parental/parenting factors, and child factors. It is clear that frequently more than one risk related to the emergence of internalizing and externalizing problems in preschool age children are reported. It is also possible to note that are few risks factors consistently studied in this age, highlighting the need for further investigation.
This is a preview of subscription content, access via your institution.

References
Accornero, V., Morrow, C., Bandstra, E., Johnson, A., & Anthony, J. (2002). Behavioral outcome of preschoolers exposed prenatally to cocaine: Role of maternal behavioral health. Journal of Pediatric Psychology, 27, 259–269. doi:10.1093/jpepsy/27.3.259.
Achenbach, T., & Rescorla, L. (2000). Manual for the ASEBA preschool forms & profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
Achenbach, T. (2009). The achenbach system of empirically based assessment (ASEBA): Development, findings, theory, and applications. Burlington, VT: University of Vermont Research Center for Children, Youth, & Families.
Bayer, J., Hiscock, H., Ukoumunne, O., Price, A., & Wake, M. (2008). Early childhood aetiology of mental health problems: A longitudinal population-based study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 49, 1166–1174. doi:10.1111/j.1469-7610.2008.01943.x.
Bayer, J., Ukoumunne, O., Mathers, M., Wake, M., Abdi, N., & Hiscock, H. (2012). Development of children’s internalising and externalising problems from infancy to five years of age. The Australian and New Zealand Journal of Psychiatry, 46, 659–668. doi:10.1177/0004867412450076.
Belsky, J. (1997). Variation in susceptibility to rearing influence: An evolutionary argument. Psychological Inquiry, 8, 182–186. doi:10.1207/s15327965pli0803_3.
Bennett, D. S., Bendersky, M., & Lewis, M. (2002). Children’s intellectual and emotional-behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk. Developmental Psychology, 38, 648–658. doi:10.1037//0012-1649.38.5.648.
Cabrera, N., Fagan, J., Wight, V., & Schadler, C. (2011). Influence of mother-father, and child risk on parenting and children’s cognitive and social behaviors. Child Development, 82(6), 1985–2005. doi:10.1111/j.1467-8624.2011.01667.x.
Chartrand, M., Frank, D., White, L., & Shope, T. (2008). Effect of parents’ wartime deployment on the behavior of young children in military families. Archives of Pediatrics and Adolescent Medicine, 162, 1009–1014. doi:10.1001/archpedi.162.11.1009.
Ciciolla, L., Gerstein, E., & Crnic, K. (2014). Reciprocity among maternal distress, child behavior, and parenting: Transactional processes and early childhood risk. Journal of Clinical Child and Adolescent Psychology, 43, 751–764. doi:10.1080/15374416.2013.812038.
Coyne, L., & Thompson, A. (2011). Maternal depression, locus of control, and emotion regulatory strategy as predictors of preschoolers’ internalizing problems. Journal of Child and Family Studies, 20, 873–883. doi:10.1007/s10826-011-9455-2.
Ellis, L., Berg-Nielsen, T., Lydersen, S., & Wichstrom, L. (2012). Smoking during pregnancy and psychiatric disorders in preschoolers. European Child and Adolescent Psychiatry, 21, 635–644. doi:10.1007/s00787-012-0300-y.
Else-Quest, N., Hyde, J., Goldsmith, H., & Van Hulle, C. (2006). Gender differences in temperament: A meta-analysis. Psychological Bulletin, 132, 33–72. doi:10.1037/0033-2909.132.1.33.
Evans, G., Li, D., & Whipple, S. (2013). Cumulative risk factors and child development. Psychological Bulletin, 139, 1342–1396. doi:10.1037/a0031808.
Ezpeleta, L., Granero, R., de la Osa, N., Penelo, E., & Dòmenech, J. (2012). Dimensions of oppositional defiant disorder in 3-year-old preschoolers. Journal of Child Psychology and Psychiatry, 53, 1128–1138. doi:10.1111/j.1469-7610.2012.02545.x.
Fox, N., & Rutter, M. (2010). Introduction to the special section on the effects of early experience on development. Child Development, 81, 23–27. doi:10.1111/j.1467-8624.2009.01379.x.
Ghera, M., Marshall, P., Fox, N., Zeanah, C., Nelson, C., Smyke, A., & Guthrie, D. (2008). The effects of foster care intervention on socially deprived institutionalized children’s attention and positive affect: Results from the BEIP study. The Journal of Child Psychology and Psychiatry, 50, 246–253. doi:10.1111/j.1469-7610.2008.01954.x.
Gleason, M., Zamfirescu, A., Egger, H., Nelson, A., Fox, N., & Zeanah, C. (2011). Epidemiology of psychiatric disorders in very young children in a Romanian pediatric setting. European Child Adolescent Psychiatry, 20, 527–535. doi:10.1007/s00787-011-0214-0.
Gross, D., Fogg, L., Young, M., Ridge, A., Cowell, J., Richardson, R., & Sivan, A. (2006). The equivalence of the child behavior checklist 1½–5 across parent race/ethnicity, income level, and language. Psychological Assessment, 18, 313–323. doi:10.1037/1040-3590.18.3.313.
Henrichs, J., Rescorla, L., Donkersloot, C., Schenk, J., Raat, H., Jaddoe, V., et al. (2013). Early vocabulary delay and behavioral/emotional problems in early childhood: The generation R study. Journal of Speech, Language, and Hearing Research: JSLHR, 56, 553–566. doi:10.1044/1092-4388(2012/11-0169).
Herba, C., Roza, S., Govaert, P., van Rossum, J., Hofman, A., Jaddoe, V., et al. (2010). Infant brain development and vulnerability to later internalizing difficulties: The generation R study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1053–1063. doi:10.1016/j.jaac.2010.07.003.
Hughes, E., & Gullone, E. (2008). Internalizing symptoms and disorders in families of adolescents: A review of family systems literature. Clinical Psychology Review, 28, 92–117. doi:10.1016/j.cpr.2007.04.002.
Kersten-Alvarez, L., Hosman, C., Riksen-Walraven, J., van Doesum, K., Smeekens, S., & Hoefnagels, C. (2012). Early school outcomes for children of postpartum depressed mothers: Comparison with a community sample. Child Psychiatry and Human Development, 43, 201–218. doi:10.1007/s10578-011-0257-y.
Knudsen, A., Skogen, J., Ystrom, E., Siversten, B., Tell, S., & Torgersen, L. (2014). Maternal pre-pregnancy risk drinking and toddler behavior problems: The Norwegian mother and child cohort study. European Child and Adolescent Psychiatry, 23, 901–911. doi:10.1007/s00787-014-0588-x.
Kovacs, M., & Lopez-Duran, N. (2010). Prodromal symptoms and atypical affectivity as predictors of major depression in juveniles: Implications for prevention. Journal of Psychology and Psychiatry, 51, 472–496. doi:10.1111/j.1469-7610.2010.02230.x.
LaGasse, L., Derauf, C., Smith, L., Newman, E., Shah, R., Neal, C., et al. (2013). Prenatal methamphetamine exposure and childhood behavior problems at 3 and 5 years of age. Pediatrics, 129, 681–688. doi:10.1542/peds.2011-2209.
Lebeau, R., Glenn, D., Hanover, L., Beesdo-Baum, K., Wittchen, H., & Craske, M. (2012). A dimensional approach to measuring anxiety for DSM-5. International Journal of Methods in Psychiatric Research, 21, 258–272. doi:10.1002/mpr.1369.
Liles, B., Newman, E., LaGasse, L., Derauf, C., Shah, R., Smith, L., et al. (2012). Perceived child behavior problems, parenting stress, and maternal depressive symptoms among prenatal methamphetamine users. Child Psychiatry and Human Development, 43, 943–957. doi:10.1007/s10578-012-0305-2.
Liu, J., Hanlon, A., Ma, C., Zhao, S., Cao, S., & Compher, C. (2014a). Low blood zinc, iron, and other sociodemographic factors associated with behavior problems in preschoolers. Nutrients, 6, 530–545. doi:10.3390/nu6020530.
Liu, J., Leung, P. L., McCauley, L., Ai, Y., & Pinto-Martin, J. (2013). Mother’s environmental tobacco smoke exposure during pregnancy and externalizing behavior problems in children. Neurotoxicology, 3, 4167–4174. doi:10.1016/j.neuro.2012.11.
Liu, J., Liu, X., Wang, W., McCauley, L., Pinto-Martin, J., Wang, Y., et al. (2014b). Blood lead concentrations and children’s behavioral and emotional problems: A cohort study. JAMA Pediatrics, 168, 737–745. doi:10.1001/jamapediatrics.2014.332.
Mash, E., & Hunsley, J. (2007). Assessment of child and family disturbance. In E. Mash & R. Barkley (Eds.), Assessment of childhood disorders. New York: The Guilford Press.
Mistry, K., Minkovitz, C., Strobino, D., & Borzekowski, L. (2007). Children’s television exposure and behavioral and social outcomes at 5.5 years: Does timing of exposure matter? Pediatrics, 120, 762–769. doi:10.1542/peds.2006-3573.
Moher, D., Liberati, A., Tetzlaff, J., Altman, D., & The PRISMA Group. (2009). Preffered reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6, 1–6. doi:10.7326/0003-4819-151-4-200908180-00135.
NICHD Early Child care Research Network. (1999). Chronicity of maternal depressive symptoms, maternal, sensitivity, and child functioning at 36 months. Developmental Psychology, 35(5), 1297–1310. doi:10.1037/0012-1649.35.5.1297.
Ogg, J., Dedrick, R., Brinkman, T., & Carlson, J. (2010). Factor structure and invariance across gender of the Devereaux early Childhood Assessment Protective Factor Scale. School Psychology Quarterly, 25, 107–118. doi:10.1037/a0020251.
Paterson, J., Carter, S., Gao, W., Cowley-Malcolm, E., & Iusitini, L. (2008). Maternal intimate partner violence and behavioural problems among Pacific children living in New Zealand. Journal of Child Psychology and Psychiatry and Allied Disciplines, 49, 395–404. doi:10.1111/j.1469-7610.2007.01841.x.
Paterson, J., Taylor, S., Schluter, P., & Iusitini, L. (2013). Pacific Islands Families (PIF) study: Behavioral problems during childhood. Journal of Child and Family Studies, 22, 231–243. doi:10.1007/s10826-012-9572-6.
Poehlmann, J., Hane, A., Burnson, C., Maleck, S., Hamburger, E., & Shah, P. (2012). Preterm infants who are prone to distress: Differential effects of parenting on 36-month behavioral and cognitive outcomes. Journal of Child Psychology and Psychiatry, 53, 1018–1025. doi:10.1111/j.1469-7610.2012.02564.x.
Poehlmann, J., Schwichtenberg, A., Shah, P., Shlafer, R., Hahn, E., & Maleck, S. (2010). The development of effortful control in children born preterm. Journal of Clinical Child and Adolescent Psychology, 39, 522–536. doi:10.1080/15374416.2010.486319.
Rast, P., & Hofer, S. (2014). Longitudinal design considerations to optimize power to detect variances and covariances among rates of change: Simulation results based on actual longitudinal studies. Psychological Methods, 19, 133–154. doi:10.1037/a0034524.
Rescorla, L. (2005). Assessment of young children using the Achenbach system of empirically based assessment (ASEBA). Mental Retardation and Development Disabilities, 11, 226–237. doi:10.1002/mrdd.20071.
Rescorla, L., Achenbach, T., Ivanova, M., Harder, V., Otten, L., Bilenberg, N., & Verhulst, F. (2011). International comparisons of behavioral and emotional problems in preschool children: Parents’ reports from 24 societies. Journal of Clinical Child and Adolescent Psychology, 40, 456–467. doi:10.1080/15374416.2011.563472.
Ronan, K., Canoy, D., & Burke, K. (2009). Child maltreatment: Prevalence, risk, solutions, obstacles. Australian Psychologist, 44, 195–213. doi:10.1080/00050060903148560.
Rothbart, M., Ahadi, S., Hershey, K., & Fisher, P. (2001). Investigations of temperament at 3–7 years: The children’s behavior questionnaire. Child Development, 72, 1394–1408. doi:10.1111/1467-8624.00355.
Ruiter, K., Dekker, M., Verhulst, F., & Koot, H. (2007). Developmental course of psychopathology in youths with and without intellectual disabilities. Journal of Child Psychology and Psychiatry, 48, 498–507. doi:10.1111/j.1469-7610.2006.01712.x.
Steenweg-de Graaff, J., Roza, S., Steegers, E., Hofman, A., Verhulst, F., Jaddoe, V., & Tiemeier, H. (2012). Maternal folate status in early pregnancy and child emotional and behavioral problems: The generation R study. The American Journal of Clinical Nutrition, 95, 1413–1421. doi:10.3945/ajcn.111.030791.
Steenweg-de Graaff, J., Tiemeier, H., Steegers-Theunissen, R. M., Hofman, A., Jaddoe, V., Verhulst, F., & Roza, S. (2014). Maternal dietary patterns during pregnancy and child internalising and externalising problems. The generation R study. Clinical Nutrition (Edinburgh, Scotland), 33, 115–121. doi:10.1016/j.clnu.2013.03.002.
Trentacosta, C., Hyde, L., Shaw, D., Dishion, T., Gardner, F., & Wilson, M. (2008). The relations among cumulative risk, parenting, and behavior problems during early childhood. Journal of Child Psychology and Psychiatry, 49, 1211–1219. doi:10.1111/j.1469-7610.2008.01941.x.
Twomey, J., LaGasse, L., Derauf, C., Newman, E., Shah, R., Smith, L., et al. (2013). Prenatal methamphetamine exposure, home environment, and primary caregiver risk factors predict child behavioral problems at 5 years. American Journal of Orthopsychiatry, 83, 64–72. doi:10.1111/ajop.12007.
Utendale, W., & Hastings, P. (2011). Developmental changes in the relations between inhibitory control and externalizing problems during early childhood. Infant and Child Development, 20, 181–193. doi:10.1002/icd.691.
Van Batenburg-Eddes, T., Brion, M., Henrichs, J., Jaddoe, V., Hofman, A., Verhulst, F., et al. (2013). Parental depressive and anxiety symptoms during pregnancy and attention problems in children: A cross-cohort consistency study. Journal of Child Psychology and Psychiatry, 54, 591–600. doi:10.1111/jcpp.12023.
Velders, F., Dieleman, G., Henrichs, J., Jaddoe, V., Hofman, A., Verhulst, F., et al. (2011). Prenatal and postnatal psychological symptoms of parents and family functioning: The impact on child emotional and behavioral problems. European Child and Adolescent Psychiatry, 20, 341–350. doi:10.1007/s00787-011-0178-0.
Verlinden, M., Tiemeier, H., Hudziak, J., Jaddoe, V., Raat, H., Guxens, M., et al. (2012). Television viewing and externalizing problems in preschool children: The generation R study. Archives of Pediatrics and Adolescent Medicine, 166, 919–925. doi:10.1001/archpediatrics.2012.653.
Watamura, S., Philips, D., Morrissey, T., McCartney, K., & Bub, K. (2011). Double Jeopardy: Poorer social emotional outcomes for children in the NICHD SECCYD experiencing HOME and child-care environments that confer risk. Child Development, 82, 48–65. doi:10.1111/j.1467-8624.2010.01540.x.
Westfall, J., Keny, D., & Judd, C. (2014). Statistical power and optimal design in experiments in which samples of participants respond to samples of stimuli. Journal of Experimental Psychology: General, 143, 2020–2045. doi:10.1037/xge0000014.
Zeanah, C. H., Boris, N. W., & Larrieu, J. A. (1997). Infant development and developmental risk: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 165–178. doi:10.1097/00004583-199702000-00007.
Acknowledgments
This work has been supported by Fundação para a Ciência e a Tecnologia with the grant SFRH/BD/82020/2011.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Carneiro, A., Dias, P. & Soares, I. Risk Factors for Internalizing and Externalizing Problems in the Preschool Years: Systematic Literature Review Based on the Child Behavior Checklist 1½–5. J Child Fam Stud 25, 2941–2953 (2016). https://doi.org/10.1007/s10826-016-0456-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-016-0456-z
Keywords
- Risk factors
- Preschool age
- CBCL 1½–5
- Internalizing problems
- Externalizing problems