Cognitive functioning in children with internalising, externalising and dysregulation problems: a population-based study

Abstract

Psychiatric symptoms in childhood are closely related to neurocognitive deficits. However, it is unclear whether internalising and externalising symptoms are associated with general or distinct cognitive problems. We examined the relation between different types of psychiatric symptoms and neurocognitive functioning in a population-based sample of 1177 school-aged children. Internalising and externalising behaviour was studied both continuously and categorically. For continuous, variable-centred analyses, broadband scores of internalising and externalising symptoms were used. However, these measures are strongly correlated, which may prevent identification of distinct cognitive patterns. To distinguish groups of children with relatively homogeneous symptom patterns, a latent profile analysis of symptoms at age 6 yielded four exclusive groups of children: a class of children with predominantly internalising symptoms, a class with externalising symptoms, a class with co-occurring internalising and externalising symptoms, that resembles the CBCL dysregulation profile and a class with no problems. Five domains of neurocognitive ability were tested: attention/executive functioning, language, memory and learning, sensorimotor functioning, and visuospatial processing. Consistently, these two different modelling approaches demonstrated that children with internalising and externalising symptoms show distinct cognitive profiles. Children with more externalising symptoms performed lower in the attention/executive functioning domain, while children with more internalising symptoms showed impairment in verbal fluency and memory. In the most severely affected class of children with internalising and externalising symptoms, we found specific impairment in the sensorimotor domain. This study illustrates the specific interrelation of internalising and externalising symptoms and cognition in young children.

Keywords: Cognition; Externalising symptoms; Internalising symptoms.

Fig. 1

Associations between the internalising class, the externalising class and the dysregulation class and performance on domains of the NEPSY-II-NL (n = 1177). The no problems class (n = 838) is the reference. There were 171 children in the externalising class, 105 children in the internalising class and 63 children in the dysregulation class. Regression model was adjusted for gender, age at the time of the CBCL/1.5-5, and age at the NEPSY-II NL. *p < 0.01, **p < 0.001. Error bars represent 95 % confidence intervals of the regression coefficients. The no problems class is the reference and has no error bars