Internalizing and Co-Occurring Behavior Problems In Young Children: The Role of the Family Environment During Infancy

Background and Purpose: Internalizing behaviors, such as fearfulness and withdrawal, can emerge very early in life and increase the risk that children will develop anxiety and depression, experience difficulties in relationships with peers and adults, and show poor academic achievement. Results from studies of toddlers and preschoolers point to several early factors, such as temperament, the parent-child relationship, and social stressors, that seem to be involved in the development of internalizing problems. There is a dearth of research, however, examining whether childhood internalizing behaviors can be explained by child characteristics and family processes that are at play during the period of infancy. Additionally, studies that have focused on infant temperament and internalizing behaviors have generally used samples of white, middle class families. The purpose of the proposed study is to examine the interaction of temperament, parenting, and family factors during infancy that are linked to the development of internalizing behaviors in early childhood using an ethnically and economically diverse sample.

Methods: The sample included 412 infants and their families (52% Latino, 27% Black, 21% White/Other) from the Project on Human Development in Chicago Neighborhoods. Infant temperament, maternal depressive/anxious symptoms, family conflict, and maternal hostility were assessed through maternal report and observation when infants were 6 months old. At ages 2.5 and 5, mothers completed the Child Behavior Checklist to evaluate internalizing and externalizing behaviors. At each follow-up age, children were placed into one of four groups based on their CBCL sums: “pure internalizing”, “pure externalizing”, “co-occurring behaviors”, and “no problem behaviors.” Multinomial logistic regressions were conducted to examine associations between temperament and family factors during infancy and membership in the various behavior categories.

Results: “Pure internalizing” behaviors at age 2.5 were related to observed hostile parenting during infancy. At age 5, higher levels of maternal depressive/anxious symptoms during infancy were associated with membership in the “pure internalizing” group after controlling for problem behaviors at age 2.5. Family conflict and maternal depressive/anxious symptoms increased the risk that children would have co-occurring internalizing and externalizing behaviors at ages 2.5 and 5. There were no associations between observed infant distress and early childhood internalizing problems. It was found, however, that highly distressed infants who experienced hostile parenting were at increased risk of having co-occurring problems at age 2.5 when using maternal report of temperament.

Conclusions and Implications: Understanding the early development of internalizing behaviors is important given that anxiety and depression are among the most prevalent types of mental health problems in childhood. This study highlights the contributions of very early parenting and family processes in the development of these problems. Because of the importance that social work places on context and environment, social workers can play a critical role in the prevention of such problems by supporting positive parent-infant interactions, identifying and providing treatment for mothers with depression, and helping families work through conflict in the home.