The Development of Co-Occurrent Anxiety and Externalizing Problems from Early Childhood: a Latent Transition Analysis Approach.

Research into co-occurrent internalizing and externalizing problems during childhood is flourishing. In particular, investigation on the association between anxiety and externalizing problems has yielded mixed findings, focused mainly on the issue of which problem might precede the other, and what role anxiety plays with respect to externalizing problems. Relatively little attention has been paid to the developmental patterns of these behaviors from early childhood, despite the potential of such knowledge to fully delineate etiological models of co-occurrence. This study aimed to examine the longitudinal association of anxiety and externalizing problems in a community sample of preschoolers (ELISA Project; N = 2,341; 48.2% girls), by identifying empirically derived profiles and then describing their change and stability through the use of Latent Transition Analysis. Gender differences were explored. Four different profiles were identified: "typically developing", "mainly anxious", "modestly externalizing" and "co-occurrent". Membership in these profile groups showed high stability over a two-year period. However, children in the "co-occurrent" profile group were the most likely to show changes, predominantly towards "modestly externalizing". Furthermore, a significant gender difference for transitions towards the "co-occurrent" profile group was found, with girls showing less likelihood of being assigned to such profile. These findings show that it is possible to identify an early persistent course of co-occurrent anxiety and externalizing problems, as well as observe changes in co-occurrence towards a simpler externalizing behavioral expression. Further research should explore predictors of group membership and changes in membership, that are malleable and therefore open to preventative intervention.