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How to Deal with Externalizing Behavior in Children

Externalizing behavior vs internalizing behavior | Why are behavioral issues problematic | Examples | Causes | How to treat externalizing behavior

What is externalizing behavior

Behavioral problems in childhood and adolescence can be categorized into being externalizing behavior or internalizing behavior. Externalizing behavior is behavior directed outwardly toward others or the social environment. It is characterized as an under-controlled and out-directed mode of responding​1​.

Rule-breaking behaviors or acts that violate social norms such as physical aggression and defiance are examples of externalizing behavior. They stem from externalizing emotions such as anger or hostility.

When left untreated, serious externalizing problems in children can lead to developmental disorders including oppositional defiant disorder, conduct disorder, or intermittent explosive disorder in adolescents. 

angry boy rips paper

Externalizing behavior vs internalizing behavior

While externalizing behavior is behavior directed to external parties, internalizing behavior is directed inwardly to the person themselves. Internalizing behaviors include sadness, fear, anxiety, depression, shame, and shyness.

Externalizing problems are more likely to be overt and obvious to others, but internalizing ones tend to be subtle and often go unnoticed by others​2​.

When parents and teachers seek intervention for behavioral problems, they often focus on children’s externalizing conduct.

Why are behavioral issues problematic

Children who externalize their behavior in childhood are at higher risk of juvenile delinquency and violence​3​.

Aggressive behavior in toddlerhood and childhood is also a strong predictor of adult crime and adult antisocial behavior.

Research suggests there are age differences at which children develop externalizing problems. Behavioral issues can begin in early childhood or in early adolescence in child development​4​.

If aggressive children exhibit persistent high levels of externalizing issues, they are at a high risk of developing bullying, lying, and fighting in childhood, as well as more serious behaviors, such as cruel animal treatment, vandalism, and aggressive criminal behavior in adolescence.

Social behavior problems can also start during early adolescence for some youth. This is usually the result of association with deviant peers.

High levels of externalizing problems are often accompanied by high levels of internalizing mental health problems. Many conduct problems are associated with failures in social situations that, in turn, lead to anxious children with depressive symptoms​5​.

Examples of externalizing behavior

Here are some externalizing behavior examples​6​.

Causes of externalizing behavior

The causes of behavioral problems involve a complex interplay among biological risk factors, family and social risk factors.

Psychologists and researchers have painstakingly gathered known causes and risk factors for childhood externalizing behavior. The risk factors can be divided into four groups – child characteristics, family factors, peer influences, and environment​7​.

Child characteristics

A number of child characteristics have been shown to be associated with high levels of behavior problems.

  • difficult-irritable-oppositional characteristics
  • Impulsive behavior and lack of inhibition
  • A deficit in executive function and attention
  • Lack of remorse, empathy, or emotional understanding​8​
  • Young maternal age, smoking, alcohol use, and drug abuse during pregnancy

Family Factors

Peer influences

  • Rejected by peers
  • Being bullied
  • Aggressive and deviant friends​10​

Environment

  • Low socioeconomic status (SES)​11​
  • Aggressive culture in community or school environment
  • Denser population
  • Higher crime rate

How to treat externalizing behavior

Parent management training (PMT)

PMT is found to be effective in treating oppositional, aggressive, and antisocial behavior in children.

In this treatment procedure, parents are trained to help children develop constructive behavior and decrease deviant behavior​12​.

According to research, response to parent training is often influenced by factors that aren’t directly related to the child, such as socioeconomic status and maternal mental health.

Parent-child interaction therapy (PCIT)

PCIT therapy is a widely available program for parents with children who exhibit problematic behavior at ages 2 to 7. 

The behavioral parent training intervention was developed based on social learning and attachment theories. It is designed to reduce problematic behavior by improving parenting skills and fostering positive interactions​13​.

Positive parenting

Positive parenting is a parenting philosophy that promotes positive interactions and mutual respect. Parents can teach their children proper behavior by using positive discipline instead of harsh punishment.

Positive parenting tends to result in less antisocial behavior and more social adjustment in children​14​.

Psychotherapy or cognitive behavioral therapy

Research shows that psychotherapy for children is also one of the best ways to deal with behavioral and emotional problems. The treatment can alleviate psychological distress, reduce maladaptive behavior, and increase adaptive behavior​15​.

References

  1. 1.
    Walker HM, Gresham FM. Handbook of Evidence-Based Practices for Emotional and Behavioral Disorders: Applications in Schools. Guilford Publications; 2013.
  2. 2.
    Rutherford RB, Quinn MM, Mathur SR. Handbook of Research in Emotional and Behavioral Disorders. Guilford Press; 2007.
  3. 3.
    Liu J. Childhood externalizing behavior: theory and implications. J Child Adolesc Psychiatr Nurs. 2004;17(3):93-103. doi:10.1111/j.1744-6171.2004.tb00003.x
  4. 4.
    Uggen C. Work as a turning point in the life course of criminals: A duration model of age, employment, and recidivism. American Sociological Review. 2000;65(4):529–546. https://doi.org/10.2307/2657381
  5. 5.
    Patterson GR, Capaldi DM. A mediational model for boys’ depressed mood. In: Risk and Protective Factors in the Development of Psychopathology . Cambridge University Press; 1990:141-163. https://doi.org/10.1017/CBO9780511752872.010
  6. 6.
    Hinshaw S. Externalizing behavior problems and academic underachievement in childhood and adolescence: causal relationships and underlying mechanisms. Psychol Bull. 1992;111(1):127-155. doi:10.1037/0033-2909.111.1.127
  7. 7.
    Hann DM. Taking Stock of Risk Factors for Child/Youth Externalizing Behavior Problems. .; 2001.
  8. 8.
    Pons F, Lawson J, Harris P, de R. Individual differences in children’s emotion understanding: effects of age and language. Scand J Psychol. 2003;44(4):347-353. doi:10.1111/1467-9450.00354
  9. 9.
    O’Leary S, Slep A, Reid M. A longitudinal study of mothers’ overreactive discipline and toddlers’ externalizing behavior. J Abnorm Child Psychol. 1999;27(5):331-341. doi:10.1023/a:1021919716586
  10. 10.
    Lynne S, Graber J, Nichols T, Brooks-Gunn J, Botvin G. Links between pubertal timing, peer influences, and externalizing behaviors among urban students followed through middle school. J Adolesc Health. 2007;40(2):181.e7-13. doi:10.1016/j.jadohealth.2006.09.008
  11. 11.
    Shaw DS, Winslow EB, Vondra JI, Cohn JF, Bell RQ. The development of early externalizing problems among children from low-income families: A transformational perspective. Journal of Abnormal Child Psychology. 1998;26(2):95–107. https://doi.org/10.1023/A:1022665704584
  12. 12.
    Kazdin A. Parent management training: evidence, outcomes, and issues. J Am Acad Child Adolesc Psychiatry. 1997;36(10):1349-1356. doi:10.1097/00004583-199710000-00016
  13. 13.
    Thomas R, Abell B, Webb H, Avdagic E, Zimmer-Gembeck M. Parent-Child Interaction Therapy: A Meta-analysis. Pediatrics. 2017;140(3). doi:10.1542/peds.2017-0352
  14. 14.
    Boeldt D, Rhee S, Dilalla L, et al. The Association between Positive Parenting and Externalizing Behavior. Infant Child Dev. 2012;21(1):85-106. doi:10.1002/icd.764
  15. 15.
    Garside RB, Klimes-Dougan B. Socialization of discrete negative emotions: Gender differences and links with psychological distress. Sex Roles: A Journal of Research. 2002;47(3):115-128. https://doi.org/10.1023/A:1021090904785

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