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Internalizing and Externalizing Symptoms Are Associated With Different Trajectories of Cortical Development During Late Childhood

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Objective

Investigation of neurobiological differences between internalizing and externalizing symptoms in children is needed to better understand the unique pathophysiology of each, which may ultimately better target treatments and interventions. Longitudinal studies are critical, given the marked brain development that occurs in childhood; however, few such studies exist, and results are inconsistent. The aim of this study was to longitudinally investigate associations between internalizing and externalizing symptoms, and cortical thinning during late childhood.

Method

Participants were 105 children (49 male) from the community, who underwent magnetic resonance imaging (MRI) brain scans, and completed questionnaire measures of depressive and anxiety symptoms at two time points (mean age: 8.4 years at baseline, 10.0 years at follow-up); and, mothers, who reported on child internalizing and externalizing symptoms at both time points. Whole-brain vertex-wise regression analyses were performed to assess associations between change in cortical thickness and symptoms between baseline and follow-up.

Results

Increases in internalizing symptoms over time were associated with reduced thinning in the orbitofrontal cortex, whereas increases in externalizing symptoms were associated with reduced thinning in the postcentral gyrus. The interaction between internalizing and externalizing symptom change was not associated with cortical thinning.

Conclusion

Results suggest that the development of internalizing and externalizing symptoms are associated with unique neurodevelopmental patterns in late childhood, potentially implicating differential deficits in affective reactivity, emotion regulation, and social cognition. Further research is required to elucidate the implications of these patterns for ongoing brain development, psychopathology, and behavior.

Section snippets

Participants and Procedure

Participants were from the Families and Childhood Transitions Study (FACTS), who were recruited from lower socioeconomic areas in Melbourne, Australia, as described in detail elsewhere.25 The study involved two waves of data collection, both involving magnetic resonance imaging (MRI) of the brain, and self- and parent-report questionnaires of child internalizing/externalizing symptoms. Exclusion criteria included MRI contraindications, history of head trauma or loss of consciousness, history of

Results

Table S1 (available online) reports bivariate correlations between symptom measures and demographics.

Repeated-measures analysis of variance showed main effects of time for parent-report externalizing (p < .001) and child-report depressive symptoms (p = .020), whereby symptoms decreased over time. There was no effect of time for parent-report internalizing or child-report anxiety symptoms (p > .05), and no main effects of sex, or time-by-sex interactions for any symptom type (p > .05). Although

Discussion

During a discrete period in late childhood (ie, age 8−10 years), we found evidence for distinct neurodevelopmental correlates of changes in parent-reported internalizing compared to externalizing symptoms. Although increases in both symptom types over time were associated with reduced cortical thinning, increases in internalizing symptoms over time were associated with reduced thinning in the bilateral orbitofrontal cortex, whereas increases in externalizing symptoms over time were associated

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  • Cited by (0)

    This research was supported by the Australian Research Council (Discovery Grant ID DP130103551). Dr. Whittle is supported by an NHMRC Career Development Fellowship (ID: 1125504). The funding sources had no involvement in the study design, the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the article for publication.

    The authors thank the Royal Children’s Hospital Medical Imaging staff, for their assistance and expertise in the collection of the MRI data included in this study, Sally Richmond, PhD, Camille Deane, PhD, and Isabel Zwaan, Research Master, of the University of Melbourne, for their contribution to image processing.

    Disclosure: Drs. Whittle, Vijayakumar, Simmons, and Allen have reported no biomedical financial interests or potential conflicts of interest.

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