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Understanding trajectories of externalizing problems: Stability and emergence of risk factors from infancy to middle adolescence

Published online by Cambridge University Press:  05 May 2020

Anne Kjeldsen*
Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway Bjørknes University College, Oslo, Norway
Ragnhild Bang Nes
Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway Department of Psychology, University of Oslo, PROMENTA Research Centre, Oslo, Norway
Ann Sanson
Department of Pediatrics, University of Melbourne, Parkville, Australia
Eivind Ystrom
Department of Psychology, University of Oslo, PROMENTA Research Centre, Oslo, Norway Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
Evalill Bølstad Karevold
Department of Psychology, University of Oslo, Oslo, Norway
Author for correspondence: Anne Kjeldsen, Bjørknes University College, Lovisenberggata 13, 0456Oslo, Norway; E-mail:


Despite considerable efforts to understand the processes that underlie the development of externalizing behavior problems, it is still unclear why externalizing problems remain chronically high for some children, emerge early and cease by late childhood for others, and arise in adolescence in some cases. The purpose of this study was to examine how a wide range of child and family risk factors are linked to trajectories of externalizing behavior and how these relationships vary from infancy to middle adolescence. We used data from the community-based Norwegian Tracking Opportunities and Problems (TOPP) study sample (n = 921). A Cholesky factorization model was specified to separate stable and emerging risk doses across four developmental periods (infancy, early and middle childhood, and middle adolescence). Children in the High Stable class were characterized by substantially elevated risk levels in multiple domains throughout the study period. Children in the High Childhood Limited class had very high levels of temperamental emotionality, internalizing symptoms, and maternal mental distress, suggesting a substantial intrinsic emotional basis for their externalizing problems. Intrinsic factors seemed less salient for the Adolescent Onset class. These findings emphasize the need for a dynamic perspective on risk factors and support the importance of prevention and intervention efforts across multiple domains from early childhood and throughout adolescence.

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