Behavioral and Emotional Disorders in Children

Behavioural and emotional disorders in children are patterns of conduct, attention, mood, or anxiety that are unusual for a child's age, persist over time, and impair functioning at home, at school, or with peers. They are commonly grouped into externalising problems, which are outwardly disruptive, and internalising problems, which are inward-directed forms of distress.

Definition

Behavioural and emotional disorders in children are clinically significant disturbances of behaviour, attention, mood, or anxiety in childhood or adolescence that exceed the expected range for a child's developmental stage and cause distress or impairment across settings.

Scope

The entry describes the broad categories of childhood behavioural and emotional disorders, the internalising-externalising distinction, how such disorders are recognised and measured with rating scales and clinical assessment, and their population frequency. It is a reference overview and does not provide diagnostic criteria for individual cases or treatment guidance.

Core questions

• How is a clinically significant disorder distinguished from age-typical behaviour and transient distress?
• What separates externalising from internalising problems, and how often do they co-occur?
• How are these disorders measured across multiple informants and settings?
• Which childhood disorders tend to persist into adolescence and adulthood?

Key concepts

• Externalising disorders (e.g., conduct, oppositional, attention-deficit/hyperactivity)
• Internalising disorders (e.g., anxiety, depression)
• Impairment across settings
• Comorbidity
• Dimensional rating scales and screening
• Developmental continuity of disorder

Clinical relevance

The internalising-externalising framework and standardised rating scales such as the Strengths and Difficulties Questionnaire structure how clinicians recognise, screen for, and measure childhood difficulties across home and school (Goodman, 1997, 2001; Silverman & Ollendick, 2005). This entry describes how such disorders are categorised and assessed and is not a basis for diagnosing or treating an individual child.

Epidemiology

Behavioural and emotional disorders are among the most common health conditions of childhood. A worldwide meta-analysis estimated the pooled prevalence of any childhood mental disorder at about 13 percent (Polanczyk et al., 2015), and a separate meta-analysis estimated the prevalence of attention-deficit/hyperactivity disorder at roughly 7 percent in those under 18 (Thomas et al., 2015). Comorbidity between internalising and externalising problems is common.

Evidence & guidelines

Evidence-based assessment of childhood anxiety and related disorders relies on combining validated, multi-informant rating scales with structured clinical interview rather than any single measure (Silverman & Ollendick, 2005).

History

The empirical study of child psychopathology was advanced by mid-to-late-twentieth-century work that derived the internalising-externalising distinction from statistical analysis of behaviour ratings and built standardised, norm-referenced checklists, moving the field toward quantitative, multi-informant assessment.

Debates

Categorical diagnosis versus dimensional measurement

Whether childhood problems are best captured by discrete diagnostic categories or by continuous dimensions of severity is debated, given high comorbidity and the graded nature of impairment; rating-scale traditions emphasise the dimensional view.

Key figures

• Thomas Achenbach
• Robert Goodman
• Michael Rutter

Seminal works

• goodman-1997
• polanczyk-2015

Frequently asked questions

What is the difference between externalising and internalising disorders?

Externalising disorders involve outwardly directed, disruptive behaviour such as aggression, defiance, or inattention, while internalising disorders involve inward-directed distress such as anxiety or low mood.

How common are behavioural and emotional disorders in children?

They are common: a worldwide meta-analysis estimated that roughly one in seven children and adolescents meets criteria for a mental disorder at a given time.