Externalizing Problems of Childhood

Externalizing problems in childhood can be broadly defined as disorders characterized by behaviors directed outward. More specifically, these behaviors typically occur in interaction with another person and are represented by disobedience, aggression, temper tantrums, fidgetiness, and overactivity, and they often result in conflict. Beyond differing in their diagnostic criteria, externalizing problems differ from internalizing problems primarily in their expression. However, there is significant evidence that externalizing problems and internalizing problems occur comorbidly. Broadly speaking, the class of externalizing problems in childhood includes attention deficit disorder, attention deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder.

Though not comprehensive, the next section will provide an overview of some externalizing problems in childhood, guided by the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).

Attention Deficit/Hyperactivity Disorder

The causes of attention deficit/hyperactivity disorder (ADHD) are unknown, although it is one of the most commonly diagnosed of the externalizing problems. ADHD is divided into two distinct categories: the predominately inattentive type and the hyperactive inattentive type. A final category is a combined type. The types are categorized according to the symptoms most predominant in the child.

The most distinguishing characteristic of ADHD is marked difficulty focusing on a task or activity. Children with ADHD struggle with successful academic development and often experience challenges with peer relationships. When children struggle primarily with inattention, they have trouble completing tasks and listening to directions and appear to be disinterested even when spoken to directly. When hyper-activity is the predominant symptom set, children demonstrate a high degree of distractive physical and verbal activity, including fidgeting, pacing, and excessive talking. Finally, when the symptom set relates specifically to impulsivity, the children have difficulty waiting for their turn, answer questions before the other person completes the question, and often intrude on others’ play and interactions.

Conduct Disorder

The externalized problem of conduct disorder includes bullying behaviors that include threats to the well-being of people or of animals. Children with conduct-disordered behaviors often get their way through intimidation, including physical fighting. Nonaggressive behaviors may also be exhibited, such as damaging property, stealing, and fire setting. Children diagnosed with conduct disorder have difficulty reading social cues, leading them to interpret the behavior of others as aggressive or threatening. Additionally, these children fail to recognize the impact of their behavior on others and therefore do not empathize with emotional or physical pain or personal loss.

Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is characterized by the child exhibiting frequent displays of anger, arguing (typically with adults), and refusing to follow instructions. Children diagnosed with ODD often refuse to follow directions, refuse to take responsibility for their mistakes, and appear angry and hostile toward others. Often the child appears to be spiteful or vindictive in even the most mundane situations.

Diagnosing Externalizing Problems

It is important to note that to be considered significant, all symptoms associated with any of these externalizing problems must be present beyond what is to be expected with normal development and must cause problems with psychosocial and educational development. Any single symptom cannot lead to a diagnosis of one of the above externalizing disorders, and the behavior must occur in more than one setting, such as in school and at home.

References:

American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text rev.). Washington, DC: Author.
Beitchman, J. H., Inglis, A., & Schachter, D. (1992). Child psychiatry and early intervention: IV. The externalizing disorders. Canadian Journal of Psychiatry, 37(4), 245-249.
Farmer, E. Z. M., Compton, S. N., Burns, B. J., & Robertson, E. (2002). A review of the evidence base for treatment of childhood psychopathology: Externalizing disorders. Journal of Counseling and Community Psychology, 70, 1267-1302.
Gilliom, M., & Shaw, D. S. (2004). Codevelopment of externalizing and internalizing problems in early childhood. Development and Psychopathology, 16, 313-333.
Sourander, A., & Helstela, L. (2006). Childhood predictors of externalizing and internalizing problems in adolescents. European Child & Adolescent Psychiatry, 14, 415-123.