Multi-domain Models of Externalizing Disorders: Risk Factors and Complex Pathways

The process of developing and testing a longitudinal, multi-domain model of externalizing disorders in young children began with developing a prototype and then a formal model of identified risk factors and pathways between them. Because few studies had examined such a model, we first examined a cross-sectional, multi-domain model for Oppositional Defiant Disorder (ODD) symptoms. The results from those analyses were then used to develop a longitudinal model examining pathways between 11 risk factors across four domains, with risk factors assessed at ages 4 to 5 and linked to age six symptoms of ODD. This led to a model that included direct, autoregressive effects from ages 4 to 5 for five risk factors. Multiple pathways indicated the associations of contextual factors and parental depression with levels of ODD symptoms at age six were mediated by parenting and child temperamental factors. There were direct effects to age 6 ODD symptom levels for family conflict, hostility, scaffolding, effortful control, and negative affect. A similar model for age 6 ADHD symptoms found two significant direct effects for age 5 effortful control and sensory regulation skills to age 6 ADHD symptoms. Subsequent analyses examined the bidirectional effects of parenting and symptoms of ADHD and ODD.