Depressed mood, inattention and worry might influence the risk for other symptoms in youth

Last updated 12 January 2024

Youth psychopathology has traditionally been conceptualized and measured at the level of disorders, which are highly heterogeneous and comorbid. However, there is growing evidence that focusing on the causes of individual symptoms might be useful.1 Adding to this evidence base, researchers in the USA have now studied the longitudinal relationships between internalizing, externalizing and attention symptoms using a cross-lagged panel network analysis approach.

To do this, they harnessed data from a large cohort of 4,093 9- and 10-year-olds who were enrolled in the Adolescent Brain Cognitive Development study.2 These children were assessed for symptoms using the Brief Problem Monitor, three times over the course of 12 months. Then, they estimated the relationships between symptoms at the two earliest time points and evaluated how well they could predict symptoms at the final 12-month time point.

“We found that individual symptoms were differentially related to risk for other symptoms 6 months later”, says lead author Carter Funkhouser. “For example, depressed mood, worry, and inattention strongly predicted other individual symptoms 6 months later, whereas other symptoms such as guilt and destructiveness did not. Considering the clinical presentation of children is a story of co-occurring disorders, focusing on individual symptoms might be a useful path forward.”

This study’s observational design and methodological considerations implies that causal inferences cannot be made at this stage. However, the researchers believe that there is a possibility that individual symptoms can cause each other. Now, studies that aim to delineate the nature and underlying mechanisms of the relationships between depressed mood, inattention, and worry and other symptoms are warranted. The researchers hope that eventually we might move a step closer to understanding the viability of intervening on these specific symptoms in affected children.

Referring to:

Funkhouser, C.J., Chacko, A.A., Correa, K.A., Kaiser, A.J.E. & Shankman, S.A. (2020), Unique longitudinal relationships between symptoms of psychopathology in youth: A cross‐lagged panel network analysis in the ABCD study. J. Child Psychol. Psychiatr. doi: 10.1111/jcpp.13256.


1Borsboom, D. (2017), A network theory of mental disorders. World Psychiatry, 16,5-13. doi: 10.1002/wps.20375.

Garavan, H. et al. (2018), Recruiting the ABCD sample: Design considerations and procedures. Dev. Cogn. Neurosci. 32, 16-22. doi: 10.1016/j.dcn.2018.04.004.


Internalizing problems: individuals with internalizing problems typically attempt to conceal their maladaptive emotions and cognitions. This internalizing approach can manifest as depression, withdrawal, low self-esteem, anxiety and/or loneliness. Some affected individuals might also exhibit suicidal behaviours.

Externalizing problems: individuals with externalizing problems exhibit their maladaptive thoughts and emotions externally. Characteristic behaviours include impulsivity, and antisocial or aggressive behaviours. Adult manifestations of externalizing problems can include alcohol-related or substance-related disorders.

Brief Problem Monitor (BPM): The BPM assesses symptoms over the past week using 19 items drawn from the Child Behaviour Checklist, Teacher Report Form, and Youth Self Report. The items are rated as 0 (‘not true’), 1 (‘somewhat true’), or 2 (‘very true’) and are categorized into three domains (Attention, Internalizing, Externalizing).

Dr Jessica Edwards
Jessica received her MA in Biological Sciences and her DPhil in Neurobehavioural Genetics from the University of Oxford (Magdalen College). After completing her post-doctoral research, she moved into scientific editing and publishing, first working for Spandidos Publications (London, UK) and then moving to Nature Publishing Group. Jessica is now a freelance editor and science writer, and started writing for “The Bridge” in December 2017.

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