More than 75,000 articles have been published on internalizing and externalizing problems. To advance clinical and research applications of internalizing/externalizing concepts and data, our ...objectives were as follows: to provide an overview of recent research on internalizing/externalizing problems assessed at ages 1½ to 18 years; to identify issues raised by methods for assessing such problems; and to develop recommendations for more precise, consistent, informative, and productive assessment of such problems.
A total of 4,870 peer-reviewed articles published from January 1, 2012 through December 31, 2014 were systematically reviewed and identified by the search terms "internalizing" or "externalizing," followed by detailed coding of 693 articles that reported use of measures meeting criteria for methodologically sound assessment of internalizing/externalizing problems.
Many articles reported data based on measures that did not meet criteria for methodologically sound assessment of internalizing/externalizing problems. The 693 articles that used measures meeting criteria for methodological soundness and that qualified for detailed coding reported findings for 649,457 children living in 65 societies on all inhabited continents. Data were obtained from parents, teachers, children, clinicians, caregivers, and others. Samples included general population, clinical, school, at-risk, multicultural, welfare, and various ethnic/racial and socioeconomic groups. Many analytic methods were used to test associations of diverse variables with internalizing/externalizing problems.
The diverse procedures used to assess internalizing/externalizing problems pose challenges for clinical and research applications. To meet the challenges, recommendations are provided for using assessment instruments supported by published standardization, reliability, validity, and normative data to advance clinical services and research.
For more than a century, research on psychopathology has focused on categorical diagnoses. Although this work has produced major discoveries, growing evidence points to the superiority of a ...dimensional approach to the science of mental illness. Here we outline one such dimensional system—the Hierarchical Taxonomy of Psychopathology (HiTOP)—that is based on empirical patterns of co-occurrence among psychological symptoms. We highlight key ways in which this framework can advance mental-health research, and we provide some heuristics for using HiTOP to test theories of psychopathology. We then review emerging evidence that supports the value of a hierarchical, dimensional model of mental illness across diverse research areas in psychological science. These new data suggest that the HiTOP system has the potential to accelerate and improve research on mental-health problems as well as efforts to more effectively assess, prevent, and treat mental illness.
Shortcomings of approaches to classifying psychopathology based on expert consensus have given rise to contemporary efforts to classify psychopathology quantitatively. In this paper, we review ...progress in achieving a quantitative and empirical classification of psychopathology. A substantial empirical literature indicates that psychopathology is generally more dimensional than categorical. When the discreteness versus continuity of psychopathology is treated as a research question, as opposed to being decided as a matter of tradition, the evidence clearly supports the hypothesis of continuity. In addition, a related body of literature shows how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions, to specific and narrow clusters of symptoms. In this way, a quantitative approach solves the “problem of comorbidity” by explicitly modeling patterns of co‐occurrence among signs and symptoms within a detailed and variegated hierarchy of dimensional concepts with direct clinical utility. Indeed, extensive evidence pertaining to the dimensional and hierarchical structure of psychopathology has led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) Consortium. This is a group of 70 investigators working together to study empirical classification of psychopathology. In this paper, we describe the aims and current foci of the HiTOP Consortium. These aims pertain to continued research on the empirical organization of psychopathology; the connection between personality and psychopathology; the utility of empirically based psychopathology constructs in both research and the clinic; and the development of novel and comprehensive models and corresponding assessment instruments for psychopathology constructs derived from an empirical approach.
Abstract Background Originating in the 1960s, the Achenbach System of Empirically Based Assessment (ASEBA) comprises a family of instruments for assessing problems and strengths for ages 1½-90+ ...years. Purpose To provide an overview of the ASEBA, related research, and future directions for empirically based assessment and taxonomy. Content Standardized, multi-informant ratings of transdiagnostic dimensions of behavioral, emotional, social, and thought problems are hierarchically scored on narrow-spectrum syndrome scales, broad-spectrum Internalizing and Externalizing scales, and a Total Problems (General Psychopathology) scale. DSM -oriented and strengths scales are also scored. The instruments and scales have been iteratively developed from assessments of clinical and population samples of hundreds of thousands of individuals. Items, instruments, scales, and norms are tailored to different kinds of informants for ages 1½-5, 6–18, 18–59, and 60–90+ years. To take account of differences between informants' ratings, parallel instruments are completed by parents, teachers, youths, adult probands, and adult collaterals. Syndromes and Internalizing/Externalizing scales derived from factor analyses of each instrument capture variations in patterns of problems that reflect different informants' perspectives. Confirmatory factor analyses have supported the syndrome structures in dozens of societies. Software displays scale scores in relation to user-selected multicultural norms for the age and gender of the person being assessed, according to ratings by each type of informant. Multicultural norms are derived from population samples in 57 societies on every inhabited continent. Ongoing and future research includes multicultural assessment of elders; advancing transdiagnostic progress and outcomes assessment; and testing higher order structures of psychopathology.
Thomas Max Achenbach (1940-2023) Weisz, John R.; Ivanova, Masha Y.; Verhulst, Frank C.
The American psychologist,
07/2024, Volume:
79, Issue:
5
Journal Article
Peer reviewed
Memorializes Thomas Max Achenbach (1940-2023). He is known for groundbreaking contributions to developmental psychopathology, a field that was shaped in part by his 1974 book with that title, and for ...creating the Achenbach System of Empirically Based Assessment (ASEBA), arguably the world's most widely used suite of procedures for assessing child, youth, adult, and older adult strengths and emotional and behavioral problems. His research revealed robust broadband syndromes of psychopathology, giving rise to the terms "internalizing" and "externalizing." The Child Behavior Checklist, the first measure of the ASEBA suite, has been translated into more than 110 languages and is used in science and clinical service settings around the world. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Meta-analyses were used to test associations of parental depression with child internalizing and externalizing problems, based on 107 cross-sectional and 127 longitudinal effects for 164,047 ...parent-child pairs in 112 studies published between 2009 and 2020.
For each child, internalizing and externalizing problems were assessed with the same measure and source of data. Meta-analyses were conducted with random effects, multi-level Structural Equation Modeling with Bayesian estimation.
Mean Pearson rs between parental depression and children's internalizing and externalizing problems were statistically significant in both cross-sectional (rs = .267 and .264) and longitudinal (rs = .207 and .194) analyses. The difference between the correlations of parental depression with internalizing versus externalizing problems was not statistically significant for cross-sectional or longitudinal effects. For both internalizing and externalizing problems, the cross-sectional correlation was significantly larger than the longitudinal correlation. Using the Lag as Moderator Meta-Analyses (LAMMA), evidence of a linear negative effect of the measurement interval between parental depression and child internalizing problems was found. In addition, several significant methodological moderators were found, with most implicating informant factors. Significant non-methodological moderators included the proportion of girls in a sample and children's White ethnicity.
Overall, the study provided evidence of small but consistent associations between parental depression and child internalizing and externalizing problems, including that these associations are present over substantial periods of development.
We used population sample data from 25 societies to answer the following questions: (a) How consistently across societies do adolescents report more problems than their parents report about them? (b) ...Do levels of parent-adolescent agreement vary among societies for different kinds of problems? (c) How well do parents and adolescents in different societies agree on problem item ratings? (d) How much do parent-adolescent dyads within each society vary in agreement on item ratings? (e) How well do parent-adolescent dyads within each society agree on the adolescent's deviance status? We used five methods to test cross-informant agreement for ratings obtained from 27,861 adolescents ages 11 to 18 and their parents. Youth Self-Report (YSR) mean scores were significantly higher than Child Behavior Checklist (CBCL) mean scores for all problem scales in almost all societies, but the magnitude of the YSR-CBCL discrepancy varied across societies. Cross-informant correlations for problem scale scores varied more across societies than across types of problems. Across societies, parents and adolescents tended to rate the same items as low, medium, or high, but within-dyad parent-adolescent item agreement varied widely in every society. In all societies, both parental noncorroboration of self-reported deviance and adolescent noncorroboration of parent-reported deviance were common. Results indicated many multicultural consistencies but also some important differences in parent-adolescent cross-informant agreement. Our findings provide valuable normative baselines against which to compare multicultural findings for clinical samples.
The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder ...co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures.
General Scientific Summary
This article introduces a new classification of mental illness, the Hierarchical Taxonomy Of Psychopathology (HiTOP). It aims to address several major shortcomings of traditional taxonomies and provide a better framework for researchers and clinicians.
Objectives: To review international findings on the prevalence of diagnosed disorders, generalizability of dimensional scales, and distributions of dimensional scores for school-age children and to ...address the conceptual and clinical issues raised by the findings. Method: A review of findings for interviews (Development and Well-Being Assessment, Diagnostic Interview Schedule for Children) and dimensional rating instruments (Conners Rating Scales, Strengths and Difficulties Questionnaire SDQ) that have been used to assess general population samples of at least 300 children in at least five societies. Results: Prevalence estimates for diagnosed disorders varied greatly, owing at least in part to methodologic variations. A Goodman five-dimension model for the SDQ received some support, whereas a three-dimension internalizing-externalizing-prosocial model for the SDQ was supported for epidemiologic studies. The SDQ total difficulties scores varied less than the prevalence estimates for diagnoses, but population-specific norms may be needed. Conclusions: Numerous studies have shown the feasibility of assessing children in diverse societies with diagnostic interviews and dimensional ratings. However, the findings disclose challenges to be met to help clinicians take account of the similarities and differences found for psychopathology in different societies. (Contains 2 tables.)
Objective: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, ...and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. Method: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, "DSM"-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. Results: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation RMSEA), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. Conclusions: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children. (Contains 5 tables and 4 figures.)
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