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. Author manuscript; available in PMC: 2023 Jul 1.
Published in final edited form as: J Clin Child Adolesc Psychol. 2020 Oct 30;51(4):566–576. doi: 10.1080/15374416.2020.1833336

Peer Victimization in Late Childhood Moderates the Relationship Between Childhood Fear/Inhibition and Adolescent Externalizing Symptoms

Simone Imani Boyd 1, Daniel M Mackin 1, Daniel N Klein 1,2
PMCID: PMC8085170  NIHMSID: NIHMS1637287  PMID: 33125291

Abstract

Objective:

Studies of the association between early childhood low temperamental fearfulness or behavioral inhibition (BI) and later externalizing symptoms are few and results are inconsistent, despite research from outside the temperament field that has linked fearlessness with externalizing problems. There is also a large literature showing that peer victimization (PV) predicts externalizing symptoms. However, no prior studies have examined the joint effect of low temperamental fearfulness/BI and PV on externalizing psychopathology. The current study examined the main and joint effects of low temperamental fearfulness/BI and PV on broad internalizing and externalizing problems, as well as more narrow forms of externalizing psychopathology.

Method:

Participants included 559 children (86.5% white, 54% male) assessed at ages 3, 6, 9, and 12. Temperamental fearfulness/BI was assessed using laboratory observations at age 3. PV was assessed via semi-structured interviews at ages 6 and 9. Finally, internalizing and externalizing psychopathology were each assessed at ages 3 and 12.

Results:

After accounting for sex, race, and age 3 symptomatology, the joint effect of low temperamental fearfulness/BI and PV predicted higher levels of externalizing problems overall and specific externalizing symptom domains, but not internalizing problems.

Conclusion:

These results suggest that there is an association between low temperamental fearfulness/BI and later externalizing psychopathology, but that it depends on moderating factors such as PV.

Behaviorally inhibited children tend to be fearful, reticent, and avoidant with unfamiliar people and in unfamiliar situations (Garcia-Coll, Kagan, & Reznick, 1984; Kagan, Reznick, & Snidman, 1988). Temperamental fearfulness, or behavioral inhibition (BI), has largely been studied in the context of risk for internalizing, and particularly anxiety, disorders (Degnan, Almas, & Fox, 2010; Goldsmith & Lemery, 2000; Lemery, Essex, & Smider, 2002). Numerous studies have shown that children with high levels of temperamental fear/inhibition, primarily assessed using structured laboratory observations, are at increased risk for developing anxiety disorders, especially social anxiety disorder (Clauss & Blackford, 2012; Klein & Mumper, 2018). However, temperamental fearfulness/BI can be viewed as a bipolar construct, with some children exhibiting higher than typical and others lower than typical levels, both of which may be associated with negative outcomes (Ryan & Ollendick, 2018).

Several investigators have suggested that low temperamental fearlessness/BI may be associated with externalizing outcomes (Fox, Henderson, Marshall, Nichols, & Ghera, 2005; Hirshfeld-Becker et al., 2003). However, few empirical studies have examined this question, and findings have been somewhat inconsistent. In a cross-sectional study comparing children classified as inhibited or uninhibited, Biederman and colleagues (2001) reported that non-inhibited children had a greater likelihood of being diagnosed with a concurrent disruptive disorder. Thorell and colleagues (2004) found that low inhibition was associated with concurrent hyperactivity in children. In a study comparing children at high and low risk for psychopathology by virtue of parental anxiety disorders, Biederman and colleagues (1990) found that low laboratory-assessed BI in 21-month-old children predicted the development of oppositional defiant disorder (ODD) in middle to late childhood. Williams and colleagues (2010) reported that low laboratory-observed BI in early childhood predicted greater substance abuse in adolescence among females, however, high BI predicted greater substance abuse in males. Finally, Lahat and colleagues (2012) reported an interaction between laboratory-assessed BI in childhood, striatal response to monetary reward in adolescence, and substance use in young adulthood. Among youth with low striatal activation to reward, BI was unrelated to later substance use. Surprisingly however, among youth with high striatal activation to reward, higher BI predicted greater substance use.

Finally, several studies have examined the association between temperamental exuberance, defined as a combination of lab-observed low BI and high positive affect, and externalizing problems (Degnan et al., 2011; McDoniel & Buss, 2018). McDoniel and Buss (2018) reported that higher levels of laboratory assessed exuberance at age 3 was associated with increased behavioral problems in kindergarten. Degnan and colleagues (2011) found that high stable exuberance in early childhood predicted greater externalizing problems at age 5, but only among children who also exhibited increased left frontal electroencephalogram asymmetry.

Although only a handful of studies have examined the association between temperamental fear/inhibition and externalizing outcomes, a much larger and separate body of research on psychopathy, callous-unemotional traits, and related conditions has long been interested in the role of fearlessness in externalizing psychopathology (Frick & Morris, 2004; Hoppenbrouwers et al., 2016; Lykken, 1957). Unlike the work on BI, which has emphasized laboratory observations of young children’s behavior, this literature has assessed fearfulness using a variety of methods, including questionnaires, rating scales, cognitive tasks, and psychophysiological and neuroimaging measures (Hoppenbrouwers et al., 2016). In addition, this literature has generally focused on older children, adolescents, and adults, although some studies have examined younger children.

Barker, Oliver, Viding, Salekin, and Maughan (2011) reported that, as early as age 2, mother-reported fearlessness predicted adolescent conduct problems and callous-unemotional traits, even after controlling for other risk factors such as prenatal conditions. In a sample of lower income boys, laboratory-assessed fearlessness at age two in combination with other temperamental factors preceded the development of stable levels of externalizing problems in later childhood (Gilliom & Shaw, 2004). In a third study, children between the ages of three and seven characterized as having high levels of fearlessness by their teachers exhibited greater concurrent levels of conduct problems and callous-unemotional traits throughout childhood (Klingzell et al., 2016). Cote and colleagues reported that teacher-rated fearlessness in boys in kindergarten through sixth grade was associated with a higher risk for developing conduct disorder (CD) in early adolescence (Cote, Tremblay, Nagin, Zoccolillo, & Vitaro, 2002). Finally, low levels of parent-reported fearfulness/inhibition in early childhood predicted externalizing problems in middle childhood (Song, Waller, Hyde, & Olson, 2016).

Although studies examining the association between temperamental fearfulness/BI and subsequent externalizing outcomes are limited and the results are somewhat inconsistent, findings from the literature on psychopathy and related conditions suggest that temperamental fear/BI may be associated with lower levels of externalizing outcomes. In addition, the literature on BI and exuberance suggests that a relationship between low temperamental fearfulness/BI and externalizing problems may be contingent on the presence of other variables that moderate this association.

Peer Victimization

One potential moderator may be peer victimization (PV). PV is a powerful correlate and predictor of externalizing problems in childhood and adolescence (Bowes et al., 2013; Laird, Jordan, Dodge, Pettit, & Bates, 2001). For example, experiencing PV in late childhood increases the likelihood of adolescents engaging in violent behavior such as fighting or carrying weapons (Nansel, Overpeck, Haynie, Ruan, & Scheidt, 2003). Similarly, girls who experienced PV at age 5 exhibited more externalizing symptoms at age 7 (Arsenault et al., 2006; Arsenault et al., 2010).

It is important to consider duration and timing when examining the association between PV and externalizing problems. In middle childhood, children begin to become more aware of their peers, compare themselves to their peers, and participate in activities such as teasing and bullying to maintain or distinguish their social status (Parker & Gottman, 1989; Parker, Rubin, Erath, Wojslawowicz, & Buskirk, 2006). Thus, measurement of peer victimization in middle childhood is paramount, as it is a developmental period when social comparison and bullying behaviors increase and becomes more salient to children. Furthermore, chronic PV has been demonstrated to have more deleterious effects on psychopathology than less persistent PV. In a community sample, children who experienced chronic peer rejection prior to third grade demonstrated elevated risk for clinically significant conduct problems compared to children who had not experienced peer rejection by that time (Laird et al., 2001). Additionally, recurrent peer victimization has been linked to increases in conduct and behavioral problems in youth (McDougall & Vaillancourt, 2015; Reijntjes, Kamphuis, Prinzie, Boelen, Van der Schoot, & Telch, 2011). Taken together, these findings suggest that children who experience PV in childhood are at a high risk for subsequent externalizing behaviors, and those who experience chronic/recurrent PV may be at the greatest risk.

The Current Study

Although prior literature has demonstrated a robust association between temperamental fearfulness/BI and social anxiety (Lemery, Essex, & Smider, 2002; Clauss & Bickford, 2012; Klein & Mumper, 2018), it has been hypothesized that there may also be a relationship between low temperamental fear/inhibition and externalizing psychopathology (Fox et al., 2005). However, few studies have investigated this link and findings have been mixed, perhaps because little attention has been paid to potential environmental moderators.

There is some evidence supporting the possibility of moderation from studies of traits that overlap with temperamental fearlessness/low BI. For example, the relationship between callous-unemotional traits and later externalizing problems appears to be moderated by a number of contextual factors, including parental warmth, parental harshness, and coercive discipline (Kimonis, Frick, & McMahon, 2014). Moreover, studies of children with high levels of early BI have reported that social involvement moderates the effects of BI on subsequent internalizing psychopathology (Frenkel et al., 2015). Taken together, these findings raise the possibility that children with low levels of temperamental fearfulness/BI may be especially prone to develop externalizing problems in the context of environmental adversity, such as PV.

Externalizing and internalizing behavior emerging in early adolescence has been demonstrated to be stable throughout adolescence and into young adulthood, and has important implications for adult functioning (Copeland, Wolke, & Costello, 2015; Ferdinand, Verhulst, & Wiznitzer, 1995; Reitz, Dekovic, & Meijer, 2005). Thus, it is imperative to determine the predictors of early adolescent psychopathology, a potential precursor for longstanding problems. The present study examined whether low temperamental fearfulness/BI in preschoolers predicted subsequent externalizing problems. In addition, we investigated whether PV moderated this relationship. We hypothesized that that preschool-age children who exhibit low temperamental fearfulness/BI and experience PV during middle childhood (ages 6 and/or 9) will exhibit increased levels of externalizing symptomatology in early adolescence (age 12). In order to control for internalizing and externalizing symptoms at baseline, age 3 internalizing and externalizing symptoms were included as covariates in relevant models.

Method

Participants

This study draws on the Stony Brook Temperament Study, a community sample of 559 children and at least one biological parent who were recruited via commercial mailing lists. The study took place in a suburban community (Stony Brook, New York). Families were screened to ensure that the parent spoke English and that children did not have significant developmental or medical conditions. Written consent from a primary caregiver was obtained, and families were compensated for participation in the study. All procedures were approved by the Stony Brook University Institutional Review Board. The current study includes data from 392 (70%) of the initial 559 participants. At the first wave of data collection (T1), children were approximately 3 years old (M = 3.50 years, SD = 0.26). The majority of the sample was White/European-American (86.5%), had household incomes of $50,000 per year or greater (76.0%), and were male (54.0%). Participants were asked to return for three subsequent waves of data collection at age six (T2), age nine (T3), and age 12 (T4).

Four participants were missing observational temperament data at T1, 95 and 113 were missing parent-reported PV data at T2 and T3, respectively, and 7 and 121 were missing parent-reported data on externalizing and internalizing symptoms at T1 and or T4, respectively. We employed FIML estimation techniques to estimate missing date, allowing us to incorporate data from all 559 participants.

Measures

Temperament.

Children completed 12 standardized laboratory tasks at T1 to assess different aspects of temperament. Eleven of the tasks were part of the Laboratory Temperament Assessment Battery (Lab-TAB; Goldsmith, Reilly, Lemery, Longley, & Prescott, 1995) and one was adapted from other Lab-TAB tasks. Three of the tasks were specifically designed to elicit fearfulness/BI (e.g., children encountering ambiguous and novel objects in a room; interacting with an adult stranger); other tasks were designed to elicit other kinds of emotional reactions but were often also informative about fearfulness/BI. The behavioral and emotional responses elicited from these tasks were coded and scored according to the methods described by Dyson, Olino, Durbin, Goldsmith, and Klein (2012). After achieving reliability with an expert rater, separate raters coded each of the episodes. Variables were summed across episodes, and submitted to an exploratory factor analysis which yielded five factors (Dougherty et al., 2010). Fearful facial, vocal, and bodily expressions, behavioral indicators of BI such as latency to touch objects, gaze aversion, latency to vocalize, and approach/avoidance of stranger, and a behavioral rating of clinginess loaded together on one factor, labelled fear/inhibition (Dyson et al., 2012). Coefficient alpha for fear/inhibition was .71; interrater reliability between raters in this study, assessed using an intraclass correlation, was .82 (Dougherty et al., 2010). Following the literature, we assessed fearfulness/behavioral inhibition as a temperament trait that is manifest early in development, typically in early childhood (Lemery, Goldsmith, Klinnert, & Mrazek, 1999; Mumper & Klein, in press; Prior, Sanson, Oberklaid, & Northam, 1987).

Peer Victimization.

PV was assessed with items from semi-structured interviews administered to the participating parent at T2 and T3. At T2, parents were asked if their child had experienced bullying at any time between T1 and T2, and interviewers rated bullying as present or absent. At T3, both the parent and child were asked if the child had been a victim of PV and to what extent, and PV was rated on a four-point scale (never/rarely, sometimes, often, or very often). When parent and child-report differed, the rating was based on the judgment of the interviewer after hearing both accounts separately. If the interviewer was still unable to make a judgment, they met with both parent and child to discuss it further. In order to maintain consistency with T2, reports of PV at T3 were dichotomized (never/rarely versus sometimes, often, or very often). A three-point composite PV variable for T2 and T3 was created, reflecting the absence of PV at both assessments, the presence of PV at only one assessment, or the presence of PV at both assessments. Kappa coefficients for interrater reliability of PV were 1.00 at T2 and .67 at T3.

Youth Psychopathology.

The Child Behavior Checklist 1.5–5 (CBCL 1.5–5; Achenbach & Rescorla, 2000) was administered at T1 and the Child Behavior Checklist 6–18 (CBCL 6–18; Achenbach & Rescorla, 2001) was administered at T4 in order to assess internalizing and externalizing psychopathology. The CBCL is a parent-report questionnaire assessing children’s behavioral and emotional problems. The CBCL 1.5–5 and CBCL 6–18 contain 99 and 112 items, respectively. Each item is rated on a three-point scale ranging from 0 (not true) to 2 (very true or often true). At T1, the internalizing behavior scale comprised 36 items, and the externalizing behavior scale had 24 items. At T4, the internalizing behavior scale comprised 32 items and the externalizing behavior scale had 35 items. The CBCL 6–18 externalizing scale includes two subscales, rule breaking behavior (17 items) and aggressive behavior (18 items). In the current study, both mothers and fathers completed the CBCL about their children at both assessment waves. Mother- and father-reports at T4 had moderate-large associations for internalizing problems (r = .53), externalizing problems (r = .62), rule breaking behavior (r = .61), aggressive behavior (r = .58). When analyzed separately, mother- and father-report yielded the same interactive effects. In order to limit the number of statistical tests, mothers’ and fathers’ reports in each wave were averaged to create a composite parent-report score for each scale (Schroeder, Hood, & Hughes, 2010; Seiffge-Krenke & Kollmar, 1998). Each of the scales demonstrated excellent reliability at T1 (α’s=.84-.93) and T4 (α’s=.66-.88) in the current study.

Data Analyses

Attrition analyses were conducted to examine whether there were differences between participants with complete and incomplete data. The two groups were compared on relevant demographic characteristics using independent samples t-tests and chi-squared analyses when appropriate. Preliminary analyses included bivariate correlations between predictor and outcome variables. It was determined that the data met all assumptions for linear regression, including linearity, normality of residuals, homoscedasticity, and the absence of multicollinearity. Then, two multiple linear regressions models examined the main and interaction effects of T1 fear/inhibition and T2-T3 PV on T4 internalizing and externalizing problems. Consistent with the Lab-TAB battery protocol, the T1 fear/inhibition variable was standardized. Similarly, all T4 outcome variables were standardized to allow for comparison across models. All other continuous predictors were mean centered before entry into the regression models. Sex and race were entered as covariates in all the models in order to adjust for associations of sex and race with predictor and outcome variables. T1 internalizing problems were included as a covariate in the model predicting internalizing problems to account for the effects of previous symptoms, and in all models to account for differences between individuals with complete and incomplete data. T1 externalizing problems were included as a covariate in models predicting externalizing problems in order to account for effects of previous symptoms. To follow up significant analyses, separate multiple linear regressions were conducted to examine the main and interactive effects of fear/inhibition and PV on the aggressive and rule-breaking problems subscales of the higher-order externalizing factor.

In order to account for possible interactions with sex that have previously found to be associated with externalizing problems (Williams et al., 2010), interactions between PV, fear/inhibition, and sex were examined. Again, sex, race, and T1 internalizing problems were included as covariates in the analyses. Because the versions of the CBCL for preschoolers and for school-age children and adolescents have different externalizing subscales, the T1 externalizing problems scale was included as a covariate rather than using the externalizing subscales.

In models with a significant interaction, tests of simple slopes were conducted. Descriptive statistics, attrition analyses, and bivariate correlations were conducted using IBM SPSS 24 (IBM, Armonk, N.Y.). All regression and simple slopes analyses were estimated in Mplus 8 (version 8.3; Muthen & Muthen, 2012–2018) using a maximum likelihood estimator in order to employ FIML to utilize data from the complete sample.1

Results

Attrition Analyses

Attrition analyses indicated that participants with complete data did not differ from those with incomplete data in terms of race, sex, T1 fear/inhibition, T2 and T3 PV, T4 internalizing symptoms, and T1 and T4 externalizing problems (all p’s > .05). However, there was a significant difference in internalizing problems at T1 (t(550) = 2.20, p = .03). Individuals with incomplete data reported significantly higher levels of T1 internalizing symptoms (meanattritors= .94; meanparticipants= −.38), hence T1 internalizing symptoms were included as a covariate in all regression models to account for this difference.

Bivariate Associations

Means, standard deviations, and bivariate correlations are reported in Table 1. There was a small but significant effect of sex on fear/inhibition at T1 (Cohen’s d = .26, p = .01) and rule breaking behavior at T4 (Cohen’s d = .20, p < .05), indicating that female participants scored higher on fear/inhibition than males, and that male participants scored higher on the rule breaking behavior subscale than female participants. Moreover, there was a small but significant effect of race on internalizing problems at T4 (Cohen’s d = .28, p = .04), indicating that white participants had higher levels of internalizing problems than non-white participants. There was a significant correlation between T1 fear/inhibition and T1 internalizing problems. Additionally, there were small but significant correlations between T2/T3 PV and T4 internalizing problems, T4 externalizing problems, T4 rule-breaking behaviors, and T4 aggressive behaviors, such that children who experienced more PV exhibited greater levels of subsequent psychopathology.

Table 1.

Bivariate Correlations

1 2 3 4 5 6 7 8 M(SD)/N(%) N
1. T1 Fear/Inhibition 0.00 (1.00) 555
2. T1 Internalizing Problems .17** 8.95 (6.22) 552
3. T1 Externalizing Problems .04 .05 12.82 (7.57) 552
4. T2 Peer Victimization .01 .09 .05 27 (5.8%) 464
5. T3 Peer Victimization .02 .08 .04 .32*** 114 (25.6%) 446
6. T4 Internalizing Problems .02 .31*** .30*** .14** .15** 3.70 (4.22) 438
7. T4 Externalizing Problems −.04 .27*** .44*** .09 .11* .53*** 3.80 (4.40) 438
8. T4 Rule Breaking Behavior −.04 .22*** .37*** .09 .10 .40*** .86*** 1.11 (1.50) 438
9. T4 Aggressive Behavior −.04 .27*** .43*** .08 .11* .53*** .97*** .71*** 2.69 (3.20) 438
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*

p < .05

**

p < .01

***

p < .001.

T1 = age 3 wave, T2 = age 6 wave, T3 = age 9 wave, T4 = age 12 wave.

Multiple Linear Regression Models

Interactions with sex.

Main effects, covariates and cross-product terms for T1 fear/inhibition X sex, T2/T3 PV X sex, and T1 fear X T2/T3 PV X sex were entered as predictors in models predicting T4 internalizing problems, T4 externalizing problems, T4 rule breaking behavior, and T4 aggressive behavior. There were no significant interactions with sex within any of the models, therefore interactions with sex were removed from the models.

T4 internalizing problems.

Results are presented in Table 2. T1 fear/inhibition, T2/T3 PV, T1 fear/inhibition X T2/T3 PV, and covariates (T1 internalizing problems, race, and sex) were entered as predictors of T4 internalizing problems. There were significant main effects for race, T1 internalizing problems, and T2/T3 PV on T4 internalizing problems. However, the T1 fear/inhibition X T2/T3 PV interaction term was non-significant.

Table 2.

Multiple Regression Models

R2 b SE B β t p R2 b SE B β t p
T4 Internalizing 0.15 <.001 T4 Rule Breaking 0.17 <.001
 Race −0.26 0.13 −0.26 −2.00 0.05  Race −0.01 0.13 −0.004 −0.10 0.92
 Sex −0.01 0.09 −0.01 −0.15 0.88  Sex −0.15 0.09 −0.08 −1.74 0.08
 T1 Internalizing 0.05 0.01 0.31 6.32 <.001  T1 Internalizing 0.01 0.01 0.04 0.64 0.53
 T1 Fear/Inhibition 0.00 0.05 0.00 0.08 0.94  T1 Externalizing 0.04 0.01 0.34 6.22 <.001
 T2/T3 PV 0.27 0.09 0.15 3.18 <.01  T1 Fear/Inhibition 0.06 0.05 0.06 1.12 0.26
 Fear/Inhibition x PV −0.15 0.09 −0.10 −1.73 0.09  T2/T3 PV 0.20 0.09 0.11 2.30 0.02
 Fear/Inhibition x PV −0.27 0.08 −0.17 −3.20 <.01
T4 Externalizing 0.24 <.001 T4 Aggressive 0.21 <.001
 Race −0.11 0.13 −0.04 −0.90 0.36  Race −0.15 0.13 −0.05 −1.18 0.24
 Sex −0.11 0.09 −0.13 −1.30 0.20  Sex −0.08 0.09 −0.04 −0.95 0.34
 T1 Internalizing 0.01 0.01 0.07 1.21 0.23  T1 Internalizing 0.01 0.01 0.08 1.35 0.18
 T1 Externalizing 0.05 0.01 0.39 7.46 <.001  T1 Externalizing 0.05 0.01 0.38 7.20 <.001
 T1 Fear/Inhibition 0.04 0.05 0.04 0.90 0.37  T1 Fear/Inhibition 0.03 0.05 0.03 0.68 0.50
 T2/T3 PV 0.20 0.08 0.11 2.44 0.02  T2/T3 PV 0.18 0.08 0.10 2.21 0.03
 Fear/Inhibition x PV −0.27 0.08 −0.17 −3.25 <.01  Fear/Inhibition x PV −0.24 0.08 −0.15 −2.88 <0.01
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T1 = age 3, T2 = age 6, T3 = age 9, T4 = age 12. PV = Peer Victimization. Race was entered as non-white vs. white, with higher values representing non-white participants. Sex was entered as male vs. female, with higher values representing female participants.

T4 externalizing problems.

Results are presented in Table 2. T1 fear/inhibition, T2/T3 PV, and T1 fear/inhibition X T2/T3 PV, as well as relevant covariates (T1 internalizing problems, T1 externalizing problems, race, and sex) were entered as simultaneous predictors of T4 externalizing problems. There were significant main effects of T1 externalizing problems and T2/T3 PV on T4 externalizing problems. However, these effects were qualified by a significant T1 fear/inhibition X T2/T3 PV interaction. Simple slopes tests indicated that the relationship between T1 fear/inhibition and T4 externalizing problems was significant when PV was experienced at one or both waves, but not when PV was absent (Table 3). This relationship was strongest for children who experienced recurrent PV (i.e., PV at both T2 and T3; see Figure 1A).

Table 3.

Decomposition of Significant Interactions

Simple Slope
Outcome Measure PV Absent PV at One Time Point PV at Both Time Points
T4 Externalizing Problems 0.04 −0.22** −0.49***
T4 Rule Breaking Behavior 0.06 −0.21** −0.48***
T4 Aggressive Behavior 0.03 −0.21** −0.45**
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Figure 1.

Figure 1.

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The effect of the interaction of fear/inhibition with peer victimization (PV) on (A) externalizing problems, (B) rule breaking behavior, and (C) aggressive behavior.

To test whether this association was observed across dimensions of externalizing psychopathology, additional models predicting T4 rule breaking behavior and T4 aggressive behavior were examined.

T4 rule breaking behavior.

Results are presented in Table 2. T1 fear/inhibition, T2/T3 PV, T1 fear/inhibition X T2/T3 PV, and covariates (T1 internalizing problems, T1 externalizing problems, race and sex) were entered simultaneously as predictors of T4 rule breaking behavior. There were significant main effects of T1 externalizing problems and T2/T3 PV on T4 rule breaking. However, these findings were qualified by a significant T1 fear/inhibition X T2/T3 PV interaction. Simple slopes tests indicated that the relationship between T1 fear/inhibition and T4 rule breaking behavior was significant when PV was experienced at one or both time points, but not when PV was absent (Table 3). Again, this was strongest for individuals experiencing PV at both T2 and T3 (see Figure 1B).

T4 aggressive behavior.

Results are presented in Table 2. T1 fear/inhibition, T2/T3 PV, T1 fear/inhibition X T2/T3 PV, and covariates (T1 internalizing problems, T1 externalizing problems, race and sex) were entered simultaneously as predictors of T4 aggressive behavior. Again, there were significant main effects of T1 externalizing problems and T2/T3 PV on T4 aggressive behavior. However, this was qualified by a significant T1 fear/inhibition X T2/T3 PV interaction. Similar to the analysis for rule-breaking behavior, simple slopes tests demonstrated that the relationship between T1 fear/inhibition and T4 rule breaking behavior was significant in the presence of PV, with individuals experiencing recurrent PV having the strongest association, but not for individuals who did not experience PV (see Table 3 and Figure 1C).

Discussion

The current study investigated the main and interactive effects of early childhood fear/inhibition and PV on adolescent internalizing and externalizing psychopathology. After accounting for sex, race, and baseline symptoms, there was a significant interaction between T1 fear/inhibition and T2/T3 PV on T4 externalizing, but not internalizing, problems. Young children with lower levels of fear/inhibition who were victimized exhibited higher levels of externalizing problems in adolescence, and youngsters who experienced recurrent PV had the strongest association between low temperamental fear/inhibition and externalizing behavior. Examination of the lower order T4 externalizing syndromes indicated that, consistent with the results for T4 externalizing as a whole, T1 fear/inhibition interacted with T2/T3 PV to predict both rule breaking and aggressive behavior. Again, children with low levels of fear/inhibition who were victimized displayed more rule breaking and aggressive behaviors in adolescence, with the strongest association evident for children who experienced recurrent PV. These results indicate that PV moderates the relationship between low early temperamental fear/inhibition and adolescent externalizing, but not internalizing, symptoms. Of note, the main effects of T1 fear/inhibition on T4 internalizing and T4 externalizing problems were not significant. T1 fear/inhibition may not have predicted T4 internalizing problems because CBCL internalizing includes a wide range of problems, including depression, anxiety, and somatic symptoms, whereas fear and BI appear to be more specific to anxiety symptoms (Klein & Mumper, 2018).

Although it has been hypothesized that low BI may predispose to externalizing disorders (Fox et al., 2005), temperament researchers have primarily been interested in the role of high temperamental fearfulness/BI as an antecedent of anxiety disorders (Goldsmith & Lemery, 2000; Klein & Mumper, 2018). In contrast, theorists and researchers in the area of psychopathy and related conditions have long been interested in the role of fearlessness in aggressive and antisocial behavior (Lykken, 1957; Hoppenbrouwers et al., 2016). The present study linked these disparate literatures and examined the implications of low temperamental fearfulness/BI for later psychopathology. Importantly, the current findings indicate that PV moderates the relationship between low temperamental fear/BI and externalizing problems, suggesting that additional variables are critical for understanding the association between low BI and externalizing psychopathology. To our knowledge, this is the first study to examine the joint effect of temperamental fearfulness/BI and PV on externalizing psychopathology. Future studies should investigate other potential moderators of the relationship between low BI and externalizing symptoms, such as exposure to violence, which is also associated with conduct problems (Cooley-Strickland et al., 2009).

A significant portion of the PV literature focuses on internalizing outcomes in victims (Arsenault et al., 2010). However, the current findings contribute to our understanding of how PV is also associated with externalizing outcomes. While there was a significant main effect of PV on subsequent internalizing and externalizing psychopathology, only PV moderated the effect of temperamental fear/BI on externalizing outcomes. Importantly, the present results may identify a subgroup of children who are at risk for developing externalizing problems after experiencing PV. The present findings suggest that targeted PV intervention programs may be effective in the prevention of externalizing psychopathology, particularly when these interventions target youth with low BI/fear. Previous studies have demonstrated that PV prevention programs are efficacious in buffering the development of externalizing problems, especially when selecting children who are at higher risk for developing these problems (King, Vidourek, Davis, & McClellan, 2002; Vreeman & Carroll, 2007). Children who are low in temperamental fear/BI may be a particularly appropriate focus for preventive interventions targeting PV to reduce the risk of developing externalizing problems.

The present study had multiple strengths, including utilization of gold-standard observational measures of temperament, a relatively large sample, and a longitudinal design that followed a cohort of children over a nine-year span. However, the study also had several limitations. First, both PV and psychopathology were assessed based on parent reports. This may have resulted in underreporting of these problems, as parents are not aware of all of their child’s experiences and behaviors. However, parents are often reliable reporters of PV and psychopathology in children (Arsenault et al., 2010; Cantwell, Lewinsohn, Rohde, & Seeley, 1997). Second, our measures of PV were based on single items and categorical scoring, which may have reduced sensitivity and statistical power. Third, we used FIML to deal with missing data. Although missing data estimation procedures are still being developed for categorical moderators with missing data and high or low prevalence rates, this is the best approach that is currently available (Enders, 2016). To test the sensitivity of our findings, we also ran these analyses using listwise deletion and found an identical pattern of results, increasing confidence in the validity of these findings. Fourth, our sample consisted of mostly European-American youth, hence it will be important to replicate these findings using more diverse samples. Finally, we analyzed the data using multiple regression, examining predictors of CBCL scores at T4, adjusting for CBCL scores at T1. Limitations of this approach are that it did not include CBCL scores from the T2 and T3 waves, and cannot distinguish within- from between-person effects. While other approaches, such as latent growth curve models, do not have these limitations, they are best suited to designs in which the dependent variable is identical at each wave. Unfortunately, that is not always possible in developmental research where the same measure may not be appropriate across the range of ages in the study. The early childhood version of the CBCL, administered at T1 in our study, differs from the CBCL for school-age children and adolescents, administered in subsequent waves, in its structure (the narrow-band scales differ between the two versions) and content (in terms of the specific items and the numbers of items in the scales). In light of these problems, multiple regression appeared to be a reasonable alternative.

In summary, the current study extends the literature on temperamental fearfulness/BI by demonstrating that low fear/inhibition in early childhood predicts externalizing problems in early adolescence when children have been exposed to PV. This provides empirical support for earlier suggestions that both high and low levels of temperamental fearfulness/BI are associated with risk for psychopathology (Fox et al., 2005; Ryan & Ollendick, 2018), and may be useful in prevention and early intervention efforts in early childhood.

Acknowledgments

This study was supported by National Institute of Mental Health grant R01 MH069942 awarded to D.N.K. Findings from the current manuscript were presented at the 31st Association for Psychological Science Annual Convention in Washington, D.C. on May 26th, 2019.

Footnotes

1

The pattern of results for all regression models was identical when employing listwise deletion instead of FIML estimation.

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