Oland Alyssa A, Shaw Daniel S
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Clin Child Fam Psychol Rev. 2005 Dec;8(4):247-70. doi: 10.1007/s10567-005-8808-z.
Co-occurring internalizing and externalizing disorders are moderately prevalent in children, adolescents, and adults (Anderson, Williams, McGee, & Silva, 1987; McConaughy & Skiba, 1994), but much remains to be understood regarding why some children show "pure" versus co-occurring internalizing and externalizing symptoms. One possible influence that has previously not been considered is the failure to attain socio-developmental milestones, which paradoxically may prevent the development of co-occurring symptoms for some children. The present study proposes a model in which failure to attain relevant socio-developmental milestones might explain why some children may not develop heterotypic co-occurring symptoms. Specifically, it is proposed that specific clusters of internalizing symptoms (i.e., high social anxiety, withdrawal, and inhibition) and externalizing symptoms (i.e., high impulsivity, hyperactivity, and emotional reactivity) may be associated with the failure to attain socio-developmental milestones (i.e., poor peer relations for anxious children, lack of self-reflection and evaluation for impulsive/reactive children) that, in turn, may prevent subgroups of children from developing co-occurring, heterotypic symptoms.
内化性障碍和外化性障碍共现的情况在儿童、青少年和成人中较为普遍（安德森、威廉姆斯、麦吉和席尔瓦，1987年；麦康纳希和斯基巴，1994年），但关于为什么有些儿童表现出“单纯”的内化性和外化性症状，而有些则是两者共现，仍有许多有待了解的地方。一个此前未被考虑的可能影响因素是未能达成社会发展里程碑，这看似矛盾地可能会阻止一些儿童出现共现症状。本研究提出了一个模型，其中未能达成相关社会发展里程碑或许可以解释为什么有些儿童可能不会出现异型共现症状。具体而言，研究认为内化性症状（即高度社交焦虑、退缩和抑制）和外化性症状（即高度冲动、多动和情绪反应性）的特定集群可能与未能达成社会发展里程碑有关（即焦虑儿童的同伴关系不佳，冲动/反应性儿童缺乏自我反思和评估），而这反过来可能会阻止部分儿童亚组出现共现的异型症状。
