Teens' Internalizing and Externalizing Behaviors and Their Effects

Guest post written by Michelle Ramos, PhD.

Adolescent behavior problems are often classified as either internalizing or externalizing behaviors. Internalizing behaviors include things like anxiety, withdrawal, and depression—signs that a teen is turning their distress inward (Campbell, 1995). Externalizing behaviors are outward behaviors such as acting out, aggression, and rule-breaking (Oldehinkel et al., 2004). These types of behaviors often bring the adolescent into conflict with others and can pave the way for risk-taking behavior. While there is a well-established link between externalizing disorders—such as attention deficit/hyperactivity disorder (ADHD)—and other problem behaviors, including increased risk-taking (De Alwis et al., 2014; Humphreys & Lee, 2011), we know less about how the path to risky behavior differs for teens who struggle with both internalizing and externalizing problems.

Adolescents who struggle with internalizing and externalizing behaviors may also have trouble managing their emotions. Emotion regulation is the effective management of emotional responses to everyday events, and we know that difficulty doing so underlies the development of issues with anxiety and depression (Mennin et al., 2007) and ADHD (Qian et al., 2016). When dealing with high levels of negative emotions, adolescents may engage in risky behavior in an attempt to decrease the associated distress. Therefore, individual differences in emotion regulation could be important for identifying which adolescents may be prone to problematic behavior, particularly among those experiencing difficulty with both internalizing and externalizing symptoms. Adolescence is a crucial period for the continued development of emotion regulation skills as well as the neural circuitry underlying emotion regulation capacity. One pattern in the brain thought to reflect emotion regulation is delta beta coupling, which is often associated with the overcontrolled nature of those who struggle with internalizing disorders, such as generalized anxiety and social anxiety. However, we know less about its role in externalizing problems.

Being interested in the unique patterns of internalizing and externalizing behaviors in adolescents, our lab interviewed youth between the ages of 12 and 15 years about their thoughts, feelings, and behaviors in situations when they may experience fear or anxiety. To make sure we captured a range of experiences including both internalizing and externalizing symptoms, we focused specifically on Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Major Depressive Disorder (MDD), Attention-Deficit/Hyperactivity Disorder (ADHD), For GAD, they were asked whether they had been worrying a lot recently about things like school, their health, or family matters, and if they experienced any physical symptoms such as difficulty relaxing or muscle aches. For SAD, the focus was on whether they felt scared or uncomfortable in social situations, like starting or joining in on conversations or inviting a friend to hang out. When screening for MDD, adolescents were asked if they had ever felt depressed and if those feelings had persisted for the past two weeks. Lastly, for ADHD, they were questioned about being easily distracted and whether they often have trouble staying in their seat. We identified three distinct patterns of varying levels of internalizing and externalizing symptoms:

1. Low Symptomatology

This group of adolescents reported experiencing the lowest number of symptoms related to GAS, SAD, MDD and ADHD.

2. Anxiety and ADHD

This group of adolescents reported the highest levels of both GAD and SAD, moderate levels of ADHD, and the lowest levels of MDD.

3. High Symptomatology

This group of adolescents reported moderate levels of GAD and SAD and the highest levels of both ADHD and MDD.

Source: Fernando@cferdophotography/ Unsplash

Next, we wanted to understand if these groups differed in emotion regulation, social skills (e.g., making friends) and problem behavior (e.g., breaking things when angry). Youth in the Low Symptomatology group have better social skills and engage in less problem behavior, while youth in the Anxiety and ADHD group experience the most difficulty with social skills and behavioral problems. Additionally, for adolescents in the High Symptomatology group, the pattern of neural regulation indicated greater difficulty with emotion regulation.

Our findings suggest that higher levels of anxiety, depression, and ADHD symptoms can interfere with healthy social and behavioral skills and emotion regulation. However, in the absence of depression, increased anxiety might help keep levels of problematic behaviors low. For adolescents struggling with both internalizing and externalizing symptoms, neural overcontrol may make it difficult to regulate distress resulting in more displays of problem behavior in efforts to cope.

About the guest author: Michelle Ramos, PhD, has been part of the Emotion Development Lab as a post doc since 2021. Her research centers on understanding factors that contribute to differences in the way children and adolescents participate in risky behavior. Her ongoing research is focused on the development of emotion regulation.