W3: Subcultures and Social Control Theory
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Associations_of_parenting_dime.pdf
Associations of Parenting Dimensions and Styles With Externalizing Problems of Children and Adolescents: An Updated Meta-Analysis
Martin Pinquart Philipps University
The present meta-analysis integrates research from 1,435 studies on associations of parenting dimensions and styles with externalizing symptoms in children and adolescents. Parental warmth, behavioral control, autonomy granting, and an authoritative parenting style showed very small to small negative concurrent and longitudinal associations with externalizing problems. In contrast, harsh control, psychological control, authoritarian, permissive, and neglectful parenting were associated with higher levels of externalizing problems. The strongest associations were observed for harsh control and psychological control. Parental warmth, behavioral control, harsh control, psychological control, autonomy granting, authoritative, and permissive parenting predicted change in externalizing problems over time, with associations of externalizing problems with warmth, behavioral control, harsh control, psychological control, and authoritative parenting being bidirectional. Moderating effects of sampling, child’s age, form of externalizing problems, rater of parenting and externalizing problems, quality of measures, and publication status were identified. Implications for future research and practice are discussed.
Keywords: parenting, aggression, antisocial behavior, delinquency, externalizing behavior problems
Supplemental materials: http://dx.doi.org/10.1037/dev0000295.supp
Externalizing problem behaviors are defined as undercontrolled behaviors that manifest as aggression, disruptiveness, defiance, hyperactivity, and impulsivity (Achenbach & Edelbrock, 1978). Different forms of externalizing behavior problems are interre- lated. For example, a meta-analysis by Card, Stucky, Sawalani, and Little (2008) found a large mean correlation between direct (physical) and indirect (relational) aggression (r � .76), and a medium to large correlation of both forms of aggression with delinquency (r � .58 and r � .45, respectively). Externalizing problems are the most common and persistent form of childhood maladjustment with long-term negative psychosocial outcomes, such as an increased risk for psychiatric disorders (Campbell, Shaw, & Gilliom, 2000).
Several theoretical models suggest that parents’ behaviors con- tribute to the development of externalizing behavior in their off- spring (e.g., Bandura, 1977; Gottfredson & Hirschi, 1990; Reid, Patterson, & Snyder, 2002). However, many models and empirical studies addressed few aspects, or even only one aspect, of parent- ing, and the results of the individual studies are, in part, inconsis- tent. Therefore, the main goals of the present meta-analysis were to integrate the results of available studies and (a) to analyze which parenting dimensions and styles show the strongest associations with externalizing problems, and (b) to test whether these associ- ations vary by study characteristics, such as whether the studies analyzed bivariate concurrent associations or tested the statistical effect of parenting at pretest on externalizing problems at follow-up after adjusting for initial levels of externalizing behav-
ior. Knowledge on these topics is relevant for planning measures aimed to prevent and reduce externalizing problems.
Two perspectives have been adopted in parenting literature: a dimensional approach focusing on individual dimensions of pa- rental behaviors, such as responsiveness (warmth) and demand- ingness (control), and a categorical approach that categorizes par- ents, according to a combination of parenting dimensions, into parenting styles (Baumrind, 1966; Maccoby & Martin, 1983). With regard to central parenting dimensions, high levels of paren- tal responsiveness (warmth) can be defined as being accepting, nurturing, supportive, sensitive, and warm while low levels indi- cate insensitive, unresponsive, and rejecting parental behavior (e.g., Maccoby & Martin, 1983). Different forms of parental de- mandingness may have differing effects on child development: Behavioral control has been conceptualized as a set of active parental strategies involving the communication of clear and con- sistent expectations for appropriate behavior and efforts to monitor the child’s behavior related to these expectations (e.g., Akcinar & Baydar, 2014). While behavioral control has often been linked to positive outcomes for the child, harsh control (physical or verbal punishment and intrusiveness) has often been related to negative developmental outcomes (e.g., Janssens, Goossens, Van Den Noortgate, Colpin, Verschueren, & Van Leeuwen, 2015). Behav- ioral and harsh control should be distinguished from psychological control. This kind of control is defined as parental attempts to manipulate their children’s psychological experiences, for example by using guilt induction, shaming, and conditional loving to pres- sure their children (Barber, 1996).
Furthermore, research has been conducted on parental autonomy granting. This concept emerged as the opposite of psychological control (Schaefer, 1965) and as an aspect of authoritative parenting in families with adolescents (Steinberg, 2001; Steinberg, Lamborn,
Correspondence concerning this article should be addressed to Martin Pinquart, Department of Psychology, Philipps University, Gutenbergstr, 18, D-35032 Marburg, Germany. E-mail: [email protected]
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Developmental Psychology © 2017 American Psychological Association 2017, Vol. 53, No. 5, 873–932 0012-1649/17/$12.00 http://dx.doi.org/10.1037/dev0000295
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Darling, Mounts, & Dornbusch, 1994). Autonomy granting is defined as parental encouragement of the child’s individual ex- pression and decision making, such as allowing the child to make choices about activities and behavior, and encouraging the devel- opment of independence (Silk, Kanaya, Morris, & Steinberg, 2003; Steinberg et al., 1994). Silk et al. (2003) showed that psychological control and autonomy granting are distinct con- structs rather than opposite poles of a common parenting dimen- sion, and that these constructs are only weakly interrelated. For example, whether the child has some say in family decisions and whether he or she is pushed to think independently are indicators of autonomy granting, while making the child feel guilty in the case of poor grades would be a sign of psychological control (Silk et al., 2003).
In contrast to dimensional approaches to the study of parenting, parenting styles are defined by combinations of parenting dimen- sions. Based on the work of Baumrind (1966); Maccoby and Martin (1983) distinguished four parenting styles according to the two-dimensional framework of responsiveness/warmth and behav- ioral control: an authoritative style (high warmth and high behav- ioral control), an authoritarian style (low warmth and high/harsh control), a permissive style (high warmth and low control), and a neglectful style (low warmth and low control).
Associations of Parenting Dimensions and Styles With Externalizing Problems
Several theoretical models suggest that ineffective parenting contributes to the development of externalizing problem behavior, while other parental behaviors or styles may prevent or reduce externalizing problems. For example, Gottfredson and Hirschi’s (1990) theory of crime suggests that parental behavioral control (rule setting, monitoring, and effective discipline) promotes the development of self-control in the child which, again, inhibits externalizing problems. With regard to harsh control, social learn- ing theory (e.g., Bandura, 1977) and coercion theory (Reid et al., 2002) suggest that parents model aggressive behavior of their children when punishing their children in a coercive manner. Coercion theory also emphasizes that parents reinforce external- izing problem behavior when they give the child what he or she wants because the child antagonistically demands it instead of using effective discipline and reinforcing positive behavior. In addition, based on attachment theory, researchers have suggested that insensitive, unresponsive, and rejecting parental behaviors promote an insecure parent– child attachment, which may lead to the perception of other individuals as unreliable and hostile (Michiels, Grietens, Onghena, & Kuppens, 2008). These percep- tions may provoke aggressive and norm-breaking behavior within social relationships (Michiels et al., 2008). Similarly, psycholog- ical control has been suggested to undermine attachment security, which may promote the development of aggressive and norm- breaking behavior (Soenens, Vansteenkiste, Goossens, Duriez, & Niemiec, 2008). According to the self-determination theory, op- positional defiance may occur when the child’s needs for auton- omy are not met by overcontrolling or psychologically controlling parents (Soenens, Vansteenkiste, & van Petegem, 2015). Given the suggested negative associations of parental responsiveness and demandingness (behavioral control) with externalizing problems, it could be expected that an authoritative parenting style (parental
warmth plus behavioral control) would be associated with low levels of externalizing problems, while a neglectful parenting style (low warmth plus low behavioral control) should be associated with high levels of aggression and delinquency.
Seven meta-analyses have addressed associations of parenting with externalizing problems in general or with an aspect of these problems in particular. Rothbaum and Weisz (1994) conducted a meta-analysis of 47 studies dealing with the relation between parental behaviors and externalizing behavior in nonclinical sam- ples. They concluded that parental guidance (clarity of rules, r � �.23) and approval (r � �.11) are associated with low levels of externalizing behavior, while the reverse is true in regards to coercive behaviors, such as physical punishment (r � .21). Two meta-analyses by Gershoff (2002) and Gershoff and Grogan- Kaylor (2016) concluded that harsh parenting (corporeal punish- ment) is associated with higher levels of aggression (r � .18) and delinquent/antisocial behavior (r � .21 and .20).
Based on 161 studies on association of parenting with delin- quency (including aggressive behavior), Hoeve et al. (2009) re- ported that an authoritative parenting style (r � �.19), parental support (r � �.19), behavioral control in general (r � �.19), and monitoring in particular (r � �.26) show inverse associations with delinquency. In contrast, higher levels of psychological control (r � .23), harsh control (“authoritarian control”; r � .12), and overprotection (r � .21) were associated with higher levels of delinquency. Some analyses were based on small numbers of effect sizes (such as three effect sizes on overprotection and eight effect sizes on authoritative parenting).
Two meta-analyses addressed relational aggression, a subaspect of externalizing behavior. Kawabata, Alink, Tseng, van IJzen- doorn, and Crick (2011) found small to very small associations of harsh control (r � .11 to .12) and psychological control (r � .04 to .05) with relational aggression. Somewhat larger associations of psychological control with relational aggression were identified in the meta-analysis by Kuppens, Laurent, Heyvaert, and Onghena (2013; r � .17).
Finally, a meta-analysis of results from longitudinal studies by Ferguson (2013) found a positive association of initial levels of harsh parenting (corporal punishment) with externalizing problems at follow-up (r � .18). The strength of the association was reduced when relating initial levels of harsh parenting with change in externalizing problems (r � .07).
Although these meta-analyses provided valuable insights, they were limited in addressing some important points: First, with the exception of Ferguson (2013), no analyses were reported on cross- lagged associations between parenting and externalizing problems. Analysis of cross-lagged effects is important as correlative data do not allow for testing whether parenting may have an effect on children’s behaviors or vice versa, and ignoring child effects will inflate estimates of the parents’ contribution to children’s devel- opment. From a socialization perspective, parental behaviors (e.g., nurturance, discipline practices) and parenting styles have been considered to shape children’s social, emotional, and behavioral competencies and to affect trajectories of behavior problems (e.g., Baumrind, 1966; Steinberg, 2001). However, other theoretical approaches highlighted that problem behaviors and other charac- teristics of the child also have an effect on the subsequent parental behaviors. For example, Bell’s model of bidirectionality in parent– child relations proposes that family members increase control to
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maintain each other’s behavior within a tolerable range (Bell, 1977). Similarly, coercion theory suggests that dysfunctional par- enting and children’s problem behaviors reinforce each other (Reid et al., 2002).
Second, the numbers of studies included in the individual anal- yses were limited, as was the statistical test power of the analysis of main effects and moderating effects. Third, three out of four parenting styles defined by Baumrind (1966) and successors have not been addressed in the previous meta-analyses. Thus, compar- isons of the size of associations of externalizing problems with the four parenting styles could not been made. These points are ad- dressed in the present meta-analysis.
Impact of Moderator Variables
We were interested in study characteristics that may moderate the size of association between parenting and externalizing prob- lems of the child. The following moderator variables were consid- ered.
Sample. Externalizing problems and inadequate parental be- haviors are less prevalent in community-based (school-based) samples than in clinical and forensic studies (e.g., those comparing children with and without conduct disorders; Berg-Nielsen, Vikan, & Dahl, 2003). Thus, associations of parenting and externalizing problems may be weaker in community-based samples because of restricted variance. Therefore, we tested whether associations of parenting with externalizing problems are weaker in community- based samples than in clinical/forensic samples.
Age of child. On the one hand, associations between parenting and externalizing problems may be strongest in younger children when there are fewer competing socialization agents, such as teachers and peers. On the other hand, the size of correlations between parenting and externalizing problems may become stron- ger in late childhood and adolescence as a result of cumulative, reciprocal influences of each member of the dyad on the other over time (Reid et al., 2002; Rothbaum & Weisz, 1994). Results of previous meta-analyses are contradictory. While Hoeve et al. (2009) found a weaker association of general parenting with de- linquency in older samples, Rothbaum and Weisz (1994) observed that the association of parenting with externalizing problems is stronger in older children and adolescents than in toddlers and preschoolers. The present meta-analysis tested whether some of these results can be replicated in the present meta-analysis.
Child gender. Boys show higher levels of externalizing be- haviors than girls. Thus, parenting may have weaker effects on externalizing behavior in girls than in boys because of restricted variance of the outcome variable. While the meta-analysis by Rothbaum and Weisz (1994) found support for this suggestion, two recent meta-analyses could not replicate this finding (Kawa- bata et al., 2011; Kuppens et al., 2013). We tested whether the moderator effect of child gender that was found by Rothbaum and Weisz (1994) could be replicated.
Parental gender. In most families mothers are the primary caregiver, and children may be more influenced by the caregiver who is most involved in their lives (Rothbaum & Weisz, 1994). Thus, we were interested in whether maternal parenting shows stronger associations with externalizing problems of their off- spring than paternal parenting. While Rothbaum and Weisz (1994) found some support for this suggestion, Kuppens et al. (2013) did
not find a moderating effect of gender. Hoeve et al. (2009) ob- served even stronger negative associations of delinquency with paternal support than with maternal support.
Form of externalizing problems. Broader measures of be- havior problems were expected to show stronger associations with parenting dimensions and styles than narrower measures that focus only on aggression or delinquency or even on a subaspect of these two kinds of problem behavior (e.g., relational aggression). As parents may find it easier to detect and counteract some problem behaviors compared to others (e.g., overt as compared with covert problem behaviors; Hoeve et al., 2009), broader measures of externalizing problems are more likely to detect effects of parent- ing dimensions or styles.
Rater. Parental reports on their parenting and the problem behavior of their children are often biased as parents tend to give socially desirable answers and avoid reporting problematic behav- iors to a third party (Morsbach & Prinz, 2006). This source of bias could reduce the size of association between parenting and exter- nalizing problems. In fact, Hoeve et al. (2009) found, in part, weaker associations if parental reports on parenting, rather than child reports, are used. The present meta-analysis tested whether this moderator effect can be replicated. The meta-analysis by Kuppens et al. (2013) found stronger effect sizes when information on parenting and externalizing symptoms came from the same source. Thus, we tested whether stronger associations could be found if information on parenting and internalizing problems came from the same source because of shared methods variance.
Quality of the measures. As differences in study findings are often related to methodological differences of the studies included, meta-analysis should empirically examine the relationships be- tween method characteristics and study findings (Lipsey & Wil- son, 2001). While measures with low reliability underestimate the size of the associations between variables, restrictions of validity could lead to overestimations as well as underestimations of effect sizes (Hunter & Schmidt, 1994). In our meta-analyses on associ- ations of parenting with academic achievement and internalizing symptoms, we found, in part, stronger associations in studies that provided support for the reliability and validity of their measures (Pinquart, 2016). We tested whether the same would be found in the present meta-analysis.
Publication status. Nonsignificant results may be less likely to be published—the so-called “file-drawer problem” (e.g., Lipsey & Wilson, 2001). Thus, the present meta-analysis tested whether unpublished studies report lower effect sizes than published stud- ies. Kawabata et al. (2011) found some evidence for a possible file-drawer problem with regard to one out of five assessed aspects of parenting.
Research Questions
In the present meta-analysis, the selection of parenting dimen- sions (responsiveness/warmth; demandingness/control) and styles is based on the influential work by Baumrind (1966) and Maccoby and Martin (1983), the recent distinctions of three forms of control (behavioral control, harsh control, and psychological control; Jans- sens et al., 2015), and the distinction between psychological con- trol and autonomy granting (Silk et al., 2003). The first research question asked whether parental warmth, behavioral control, au- tonomy granting, and authoritative parenting are associated with
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875PARENTING AND EXTERNALIZING PROBLEMS
lower levels of externalizing problems and whether the reverse is true for harsh control, psychological control, neglectful, permis- sive, and authoritarian parenting. The second research question asked whether stronger associations are found in cross-sectional studies than in longitudinal studies relating parenting at first as- sessment to externalizing problems at follow-up. Effect sizes tend to be smaller in longitudinal studies than in cross-sectional studies because changes in the predictor variable over time lead to a reduction of predictive power of the initial level of this variable, and because concurrent correlations are often based on bidirec- tional effects of the two assessed variables (Adachi & Willoughby, 2015).
Given the fact that associations between parenting and external- izing problems may be based on parent effects as well as child effects (e.g., Bell, 1977; Reid et al., 2002), the third research question asked whether parenting dimensions and styles predict change in externalizing problems and whether initial levels of externalizing problems predict changes in parenting. The final research question asked whether associations between parenting and externalizing problems vary by sample, child’s age, parental gender, aspects of externalizing problems assessed, reporter, qual- ity of the measure, and publication status.
Method
Sample
Studies were identified through electronic databases (Google Scholar, MEDLINE, PSYCINFO, PSYNDEX [an electronic database of psycho- logical literature from German-speaking countries) – search terms: [parenting or child rearing] and [externalizing or delinquen� or aggress�
or antisocial]) and cross-referencing. Criteria for inclusion of studies in the present meta-analysis were:
1. The studies assessed parental warmth, behavioral control, harsh control, psychological control, autonomy granting (vs. overprotection), and/or parenting styles defined by Maccoby and Martin (1983).
2. They assessed externalizing problems of the children (e.g., aggressive behavior, delinquency, and sum mea- sures of externalizing problems).
3. Statistical associations between parenting and externaliz- ing problems were reported or could be computed.
4. The mean age of the sample was �20 years, thus includ- ing children and teenagers.
5. The studies were completed before August, 2016.
To include studies from different regions of the world, we did not limit the included studies to those written in English. Unpub- lished studies identified by the literature search (e.g., dissertations) were also included. We identified 3,543 studies. After screening and assessing for eligibility, we were able to include 1,435 studies in the meta-analysis. A flowchart of the search for studies and selected characteristics of the included studies are available online as supplementary material files 1 and 2.
All studies were coded by the author, and approximately 20% were also coded by a graduate student. Differences were resolved by discussion. We entered the number of children or adolescents (interrater agreement: intraclass coefficient ICC � .98), mean age (ICC � 1.0), percentage of girls (ICC � 1.0), publication status (1 � published, 2 � unpublished; ICC � 1.0), sample (1 � clinical/forensic [part/all children scored above the cutoff for ex- ternalizing problems or were diagnosed with conduct disorders/ oppositional defiant disorders or were convicted of a crime], 0 � nonclinical/nonforensic; ICC � .98), rater of parenting (1 � child, 2, � parent, 3 � others/multiinformant; interrater agreement 96%), rater of externalizing problems (1 � child, 2 � parent, 3 � others/multiinformant; interrater agreement 97%), kind of exter- nalizing problems assessed (1 � aggression, 2 � nonaggressive delinquency, 3 � sum of aggressive and delinquent behaviors; interrater agreement 94%), quality of the measures of parenting and externalizing problems (2 � support for validity and reliability provided, 1 � no such support provided; ICC � .93), and the size of association between parenting and child outcome; ICC � .94).
Bivariate correlations were usually reported in the included articles. In contrast, cross-lagged associations (e.g., partial corre- lations between parenting at Time 1 and externalizing behavior at Time 2, adjusting for initial levels of externalizing problems at Time 1) usually had to be computed manually based on correla- tional tables of the individual study.
If associations were provided for several subgroups within the same publication (e.g., for girls and boys), we entered them sep- arately in our analysis. If data from more than one rater and/or for delinquency and aggression were reported, we also entered the effect sizes separately, thus leading to dependent effect sizes. The analysis of dependent effect sizes causes two sources of bias (Hedges, Tipton, & Johnson, 2010): Studies with multiple effect sizes have a larger influence than those with one effect size, and dependent effect sizes may be more similar that could lead to an underestimation of the SEM effect size. To avoid the first bias, we weighted the studies in proportion to the number of research results they yield (Rosenthal, 1991, p. 27) and divided the weights of the effect sizes by the number of effect sizes per study. Scam- macca, Roberts, and Stuebing (2014) reported that including all dependent effect sizes in the analysis as if they were independent leads to mean effect sizes and 95% confidence intervals (CIs) that are very similar to the averaging of dependent effect sizes within studies and to randomly selecting only one effect size per study. As we did not want to lose important information (e.g., on associa- tions of parenting with delinquency vs. aggressive behavior), we decided to ignore the dependence of some effect sizes. This pro- cedure can lead to conservative results for tests of the difference between average effects of different types, which would be suffi- cient for rough inferences (Hedges et al., 2010).
Alternatively, the dependence of effect sizes could be statisti- cally modeled using multivariate models or three-level meta- analysis (Hedges et al., 2010; Van den Noortgate, López-López, Marin-Martinez, & Sánchez-Meca, 2015. Unfortunately, we could not apply multivariate models because knowledge of the covari- ance structure of the effect size estimation errors was lacking in many studies. Van den Noortgate et al. (2015) reported that a three-level meta-analysis works well with two outcomes per study, but more research is needed on the situation in which most studies only report one effect size. As most of the studies of the present
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meta-analysis reported only one effect size for a parenting dimen- sion or style, multilevel meta-analysis cannot (yet) be recom- mended.
Measures
The parenting dimensions and styles were classified into nine categories on the basis of the literature on parenting (Barber, 1996; Hoeve et al., 2009; Janssens et al., 2015; Maccoby & Martin, 1983; Silk et al., 2003) and of the description of the scales in the individual articles (interrater agreement: 98%). Parental respon- siveness/warmth refers to measures of the amount of accepting, nurturing, supportive, sensitive, and/or warm parental behaviors, such as whether the parent shows positive feelings toward his or her child. It was most often assessed with behavioral observations (100 studies), the Children’s Report of Parent Behavior Inventory (CRPBI; Schaefer, 1965; 67 studies), the Egna Minnen Beträf- fande Uppfostran (EMBU; Perris, Jacobsson, Lindstrom, von Knorring, & Perris, 1980; 29 studies), the Parental Bonding In- strument (PBI; Parker, Tupling, & Brown, 1979; 25 studies), and related measures (347 studies). Behavior control was coded if the measure assesses whether the parents have clear and consistent expectations to encourage desired child behavior, monitor the child, have knowledge about his or her whereabouts, and work with consequences of nondesired behavior that are not aggressive or psychologically controlling. Behavior control was most often assessed with the CRPBI (57 studies), the Alabama Parenting Questionnaire (APQ; Frick, 1991; 47 studies), the Authoritative Parenting Measure (APM; Steinberg et al., 1994; 43 studies), monitoring scales by Kerr and Stattin (2000; 30 studies), and related measures (448 studies). Harsh control was coded if the measure addressed physical punishment (e.g., spanking), harsh verbal punishment (e.g., yelling, shouting), and/or parental intru- siveness. Harsh control was most often assessed with the Parent- Child Conflict Tactics Scales (Straus, Hamby, Finkerlhor, Moore, & Runyan, 1998; 49 studies), observations (38 studies), the APQ (31 studies), the Parenting Scale (Arnold, O’Leary, Wolff, & Acker, 1993; 30 studies), and related instruments (345 studies). Psychological control was coded if the measure assessed parental attempts to manipulate children’s psychological and emotional experiences by using guilt induction, shaming, and conditional loving. This aspect of parenting was most often measured with Barber’s Psychological Control Scale (Barber, 1996; 45 studies), the CRPBI (32 studies), and related scales (68 studies). Measures of parental autonomy granting versus overcontrol assess whether parents encourage the child’s individual expression and decision making, such as allowing the child to make choices about activities and behavior, and encouraging the development of independence. These measures included scales from the PBI (25 studies), the EMBU (23 studies), and other scales (77 studies). Finally, mea- sures of parenting styles either classify parents according to their levels of responsiveness and demandingness into the styles defined by Maccoby and Martin (1983) or assess parenting styles as a continuous variable based on information about demandingness and responsiveness (e.g., Buri, 1991). Parenting styles were most often assessed with the Parenting Styles and Dimensions Ques- tionnaire (Robinson, Mandleco, Frost Olsen, & Hart, 1995; 49 studies), the Parental Authority Questionnaire (Buri, 1991; 33 studies), the APM (15 studies), and related instruments (112 stud-
ies). Finally, externalizing problems were most often measured with the Child Behavior Problems Checklist (Achenbach, 1991; 331 studies), the Youth Self-Report (Achenbach, 1991; 131 stud- ies), the Strengths and Difficulties Questionnaire (Goodman, 1997; 47 studies), the Teacher Rating Form (Achenbach, 1991; 43 stud- ies), clinical interviews (39 studies), observations (21 studies), and related instruments (821 studies).
Statistical Integration of the Findings
Calculations for the meta-analysis were performed in five steps, based on standardized procedures outlined by Lipsey and Wilson (2001). Random-effects models and the method of moments were computed that are most adequate if not all sources of heterogeneity between the results of individual studies might be identified (Lipsey & Wilson, 2001).
1. The correlations were transformed using Fisher’s r-to-z transformation. Outliers that were more than 2 SD from the mean of the effect sizes were recoded to the value at 2 SD.
2. Weighted mean z-scores and 95% CIs were computed. The significance of the mean was tested by dividing the weighted mean effect size by the standard error of the mean. To compare the mean effect sizes with the effect sizes reported in the single studies, the mean effect sizes were later converted to the original metric of product— moment correlations.
3. Homogeneity of effect sizes was tested by use of the Q statistic.
4. To test the influence of moderator variables, we used an analogue of an analysis of variance and a weighted or- dinary least squares regression analysis. In univariate analyses, a significant Qb score indicates heterogeneity of the effect sizes between the compared conditions. Which conditions differ is tested by comparing the 95% CIs. Differences between two conditions are significant if the CIs of two effect sizes do not overlap (Lipsey & Wilson, 2001).
5. The trim-and-fill algorithm by Duval and Tweedie (2000) was used to check whether the results could have been influenced by a publication bias.
Results
The 1,435 included studies provided data on 1,053,288 children and adolescents with a mean age of 10.70 years (SD � 4.61). About 49% of the participants were female (SD � 24.0) and 39.9% (SD � 31.5) belonged to an ethnic minority. In total, 169 studies were unpublished, 454 studies provided data from longitudinal studies, and 256 studies provided cross-lagged effects.
With regard to the first research question, studies on concurrent associations found that higher levels of parental warmth (r � �.18), behavioral control (r � �.19), autonomy granting (r � �.11), and authoritative parenting (r � �.16) were associ- ated with lower levels of externalizing problems (see Table 1). In
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T ab
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95 %
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r �
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p �
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p �
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p �
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.
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s do
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en t
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py ri
gh te
d by
th e
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er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
878 PINQUART
contrast, harsh control (r � .21), psychological control (r � .22), as well as an authoritarian (r � .16), permissive (r � .08), and neglectful parenting style (r � .19) were associated more with externalizing problems. According to Cohen (1992), these effect sizes are small or very small.
All concurrent associations were replicated in longitudinal stud- ies that relate parenting at first assessment to externalizing prob- lems at follow-up. Regarding the second research question, the nonoverlap of the 95% CIs indicates that associations of warmth, behavioral control, harsh control, and neglectful parenting with externalizing problems were stronger in cross-sectional studies than in longitudinal studies (see Table 1).
To answer the third research question, we analyzed cross-lagged associations between parenting and externalizing problems. Partial correlation coefficients controlling for initial levels of externaliz- ing problems showed that initial levels of parental warmth (r � �.07), behavioral control (r � �.07), autonomy granting (r � �.05), and authoritative parenting (r � �.07) predicted declines in externalizing problems over time (mean time interval: 3.6 years) while harsh control (r � .08), psychological control (r � .06), authoritarian parenting (r � .11), and permissive parenting (r � .06) predicted an increase in these problems. In addition, initial levels of externalizing problems predicted declines in pa- rental warmth (r � �.06), behavioral control (r � �.05), and authoritative parenting (r � �.09), as well as increases in harsh control (r � .11) and psychological control (r � .09). Therefore, associations of externalizing problems with warmth, behavioral control, harsh control, psychological control, and authoritative parenting were bidirectional. Nonetheless, cross-lagged associa- tions were very small (see Table 1).
The final research question addressed the influence of moder- ating variables on the size of bivariate association between par- enting and externalizing problems (combining cross-sectional and longitudinal studies). No moderator analyses were computed for cross-lagged effects because of the limited number of available effect sizes for parenting styles and autonomy granting (k � 0 –31).
Associations of parental warmth (� � �.16, p � .001), behav- ioral control (� � �.16, p � .001), harsh control (� � .07, p � .05), psychological control (� � .19, p � .001), authoritative parenting (� � �.28, p � .001), and neglectful parenting (� � �.21, p � .05), with externalizing problems were stronger in older samples. In contrast, associations of authoritarian (� � �.28, p � .001) and permissive parenting (� � �.23, p � .01) with externalizing problems were weaker in older samples. We found no moderating effect of child gender (� � �.02 to .09, p � .05).
In the analysis of categorical moderator variables, we found that associations of parental warmth, behavior control, and harsh con- trol were stronger in clinical or forensic samples than in nonclini- cal samples (see Table 2). Broader measures of behavior problems that include aggressive and delinquent behaviors showed stronger associations with behavior control, harsh control, psychological control, autonomy granting, authoritative as well as authoritarian parenting than narrower measures that focus only on aggressive behaviors or nonaggressive forms of delinquency.
We did not find stronger associations of problem behaviors with maternal as compared with paternal parenting. With weighted ordinary least squares regression analyses, we also checked whether there would be interaction effects of child gender and
parental gender on the size of the association of parenting with externalizing problems. No such effects were found.
Child reports on parental warmth, behavior control, psycholog- ical control, and authoritative parenting showed stronger associa- tions with externalizing problems than parental reports. However, the reverse was true for reports on the authoritarian and permissive parenting styles.
Moderating effects of the source of information about external- izing problems were highly inconsistent. Child reports were more strongly correlated with levels of warmth and behavioral control than parental reports as were child reports with authoritative par- enting scores compared with reports from persons who are no family members (e.g., peers, teachers). In addition, child and parent reports on externalizing problems showed stronger associ- ations with psychological control than reports from other sources. Furthermore, parental reports on externalizing problems showed stronger associations with levels of harsh control, authoritarian and permissive parenting than child reports and, in part, reports from other sources. Five out of nine parenting behaviors/styles were more strongly related with externalizing problems if reports on parenting and problems came from the same source rather than from different sources.
Associations of parental warmth, harsh control, authoritarian parenting, and permissive parenting with externalizing problems were stronger if studies provided support for the reliability and validity of the parenting measures. However, the opposite was found for associations of authoritative parenting with externalizing problems. In addition, associations of warmth, harsh control, au- thoritarian parenting, and permissive parenting with externalizing problems were stronger if there was support for the reliability and validity of the measure of externalizing problems.
Comparisons of the results of published and unpublished studies did not provide evidence for a publication bias. Associations of authoritarian parenting with externalizing problems were even stronger in unpublished studies than in published studies (see Table 2). The potential influence of publication bias on the effect size estimates was also examined by using a trim and fill analysis. Fifteen out of 35 effect sizes slightly decreased when a trim and fill analysis was applied, while 7 effect sizes increased (supplementary material file 3). While most statistically significant effect sizes remained significant after applying this procedure, associations of permissive parenting with externalizing symptoms at Time 1 and Time 2 were no longer significant as were associations of permis- sive parenting with change in externalizing symptoms. In addition, while externalizing problems at first assessment did not predict change in autonomy granting in the original analysis, externalizing problems predicted a significant, very small decrease in autonomy granting after applying the trim and fill procedure.
Discussion
The present meta-analysis analyzed associations of parental behaviors and parenting styles with externalizing problems based on a very large number of empirical studies. It is the first meta- analysis that has analyzed associations of externalizing problems with the four parenting styles defined by Maccoby and Martin (1983) and cross-lagged effects across a broad range of parenting variables. We observed small concurrent and longitudinal bivariate associations of the assessed parenting dimensions and most par-
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
879PARENTING AND EXTERNALIZING PROBLEMS
T ab
le 2
In fl
u en
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g o ri
ca l
M o d er
a to
rs o n
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o n
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w ee
n P
a re
n ti
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er n a li
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b le
m s
M od
er at
or s
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m th
B eh
av io
ra l
co nt
ro l
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sh co
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l
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55
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
880 PINQUART
T ab
le 2
(c o n ti
n u ed
)
M od
er at
or s
P sy
ch ol
og ic
al co
nt ro
l A
ut on
om y
gr an
ti ng
A ut
ho ri
ta ti
ve pa
re nt
in g
k r
95 %
C I
Z Q
k r
95 %
C I
Z Q
k r
95 %
C I
Z Q
S am
pl e
1. 08
.7 7
1. 63
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cl in
ic al
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li ni
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fo re
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el in
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cy 55
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3
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r: P
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ed 24
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ed 12
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Q ua
li ty
of pa
re nt
in g
m ea
su re
3. 33
1. 51
8. 53
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L ow
95 .1
9 .1
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69
Q ua
li ty
of m
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re of
ex te
rn al
iz in
g pr
ob le
m s
2. 15
2. 08
.1 1
L ow
11 9
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49 (t
a b le
co n ti
n u es
)
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
881PARENTING AND EXTERNALIZING PROBLEMS
T ab
le 2
(c o n ti
n u ed
)
M od
er at
or s
A ut
ho ri
ta ri
an pa
re nt
in g
P er
m is
si ve
pa re
nt in
g N
eg le
ct fu
l pa
re nt
in g
k r
95 %
C I
Z Q
k r
95 %
C I
Z Q
k r
95 %
C I
Z Q
S am
pl e
.0 3
.9 3
.1 6
N on
cl in
ic al
33 3
.1 6
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17 .6
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1 7.
66 � � �
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8 .1
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1 13
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li ni
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83 � �
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6
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m of
be ha
vi or
pr ob
le m
s 13
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14 8.
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re ss
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5. 23
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4 D
el in
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cy 53
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1 .2
0 7.
29 � � �
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4 S
um ex
te rn
al iz
in g
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76 53
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5
T ar
ge t
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nt .0
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ot he
rs 11
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5. 70
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9 F
at he
rs 65
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3. 58
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1 19
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1
R ep
or te
r: P
ar en
ti ng
40 .1
4� � �
25 .3
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ld 17
7 .1
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4 11
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18 1.
52 13
8 .0
4 .0
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7 3.
35 � � �
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6� � �
87 .6
0 P
ar en
t 15
9 .2
3 .2
0 .2
5 16
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10 5.
34 12
6 .1
6 .1
2 .1
9 8.
61 � � �
81 .5
5 8
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3. 32
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7 O
th er
/m ix
ed 16
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26 6.
86 5
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2. 66
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.3 8
R ep
or te
r: E
xt er
na li
zi ng
pr ob
le m
s 51
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17 .4
9� � �
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ld 17
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9� � �
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3 P
ar en
t 78
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8 70
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9 10
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6 O
th er
/m ix
ed 10
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80 .9
8 Q
ua li
ty of
pa re
nt in
g m
ea su
re 19
.6 5�
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27 .8
6� � �
2. 37
L ow
11 3
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ig h
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5 9.
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22 39
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.2 5
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46 .1
0 Q
ua li
ty of
m ea
su re
of ex
te rn
al iz
in g
pr ob
le m
s 46
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� �
19 .2
4� � �
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10 4
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84 .1
2 79
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6 1.
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5 .2
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3 H
ig h
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21 48
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8. 20
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59 .2
1
P ub
li ca
ti on
st at
us 4.
61 �
3. 90
.7 8
U np
ub li
sh ed
57 .2
0 .1
6 .2
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6 37
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P ub
li sh
ed 29
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19
N o te
. k
� nu
m be
r of
ef fe
ct si
ze s
in cl
ud ed
; r
� ef
fe ct
si ze
(w ei
gh te
d m
ea n
co rr
el at
io n
co ef
fi ci
en t)
; Z
� te
st fo
r si
gn if
ic an
ce of
r; 95
% C
I �
lo w
er an
d up
pe r
li m
it s
of 95
% co
nf id
en ce
in te
rv al
; Q
� te
st fo
r ho
m og
en ei
ty of
ef fe
ct si
ze s.
� p
� .0
5. � �
p �
.0 1.
� � �
p �
.0 01
.
T hi
s do
cu m
en t
is co
py ri
gh te
d by
th e
A m
er ic
an P
sy ch
ol og
ic al
A ss
oc ia
ti on
or on
e of
it s
al li
ed pu
bl is
he rs
. T
hi s
ar ti
cl e
is in
te nd
ed so
le ly
fo r
th e
pe rs
on al
us e
of th
e in
di vi
du al
us er
an d
is no
t to
be di
ss em
in at
ed br
oa dl
y.
882 PINQUART
enting styles with externalizing problems. The strongest bivariate associations were observed for psychological control and harsh control, thus indicating that these dimensions in particular might be relevant for preventing and reducing externalizing problems in children and adolescents. Parental warmth, behav- ior control, harsh control, psychological control, autonomy granting as well as authoritative, authoritarian, and permissive parenting predicted change in externalizing problems over time, although these associations proved to be very small. In addition, associations of externalizing problems with parental warmth, behavioral control, harsh control, psychological control, and authoritative parenting were found to be bidirectional. Further- more, moderating effects of sampling, child’s age, kind of dependent variable, rater of parenting and externalizing prob- lems, quality of measures, and publication status were identi- fied. Because some of our results are similar to those of previ- ous meta-analyses (e.g., Hoeve et al., 2009) we put the main emphasis of our discussion on new results.
While—with the exception of Ferguson (2013)—previous meta- analyses addressed only concurrent associations of parenting with externalizing problems, we also analyzed longitudinal associations in general and cross-lagged associations in particular. As concur- rent bivariate associations could be based on effects of parenting on the child as well as on effects of the child on parenting (e.g., Bell, 1977), longitudinal data provide deeper insights in the direc- tion of the effects. When initial problem levels were controlled for, eight out of nine aspects of parenting predicted change in exter- nalizing problems over time, and seven effect sizes can be inter- preted as very small (Cohen, 1992). Thus, readers may ask whether the observed effects of parenting on change in externalizing be- havior are of practical relevance. First, we have to be aware that the analyzed effects of parenting on change in externalizing prob- lems ignore the effect that parenting may have had before the first assessment of parental behaviors. Longitudinal studies with more time points could identify accumulating effects of parenting. Sec- ond, the combination of different behaviors of one parent and of parenting behaviors and styles of mothers and fathers could be expected to explain more variance than the present focus on single aspects of behavior of the individual parent (Berkien, Louwerse, Verhulst, & van der Ende, 2012). Third, the present meta-analysis analyzed average effects of parenting styles and dimensions. Ef- fects of parenting tend to be stronger for some children than for others as children differ in their susceptibility to parenting influ- ences, depending on their genes, temperament, and broader envi- ronments. For example, Bakermans-Kranenburg, and van IJzen- doorn (2006) found an effect of maternal sensitivity on externalizing problems of their children only if the child carried the Dopamine receptor D4 7-repeat allele. Furthermore, Beyers, Bates, Pettit, and Dodge (2003) found stronger associations of parental monitoring with externalizing problems if the families lived in neighborhoods with more residential instability. Thus, although average effects of individual parenting dimensions and styles on change in externalizing problems are very small in a statistical sense, effects of parenting are of practical relevance.
The present meta-analysis provides support for bidirectional models of associations between the parent– child relationship and externalizing problems of the child (Bell, 1977; Reid et al., 2002). Five out of nine associations of parenting (warmth, behavioral control, harsh control, psychological control, and authoritative
parenting style) with externalizing problems were bidirectional, while three analyses found only evidence for “parent effects” (autonomy granting, authoritarian and permissive parenting) on externalizing problems. Note that the term parent effect is used in a statistical rather than causal sense, as causal relations can only be tested in experiments. The identified child effects on change in parenting indicate that parents tend to respond to external- izing problems by increasing harsh control and psychological control (that could, again, increase future externalizing prob- lems) and/or by raising their tolerance level for deviant behav- ior (decreasing behavioral control and authoritative parenting). Coercion theory indicates that the perceived lack of success of harsh and/or psychological control attempts finally leads to a decrease in parental control attempts (Reid et al., 2002). None- theless, as the average child effects were very small, many parents seem not to respond to externalizing problems of their children by decreasing desirable and increasing undesirable forms of parenting.
An important question of meta-analyses and systematic re- views is whether the reported results are robust and valid: The number of included studies of the present meta-analysis is about nine times larger than the previously largest meta-analysis in that field (Hoeve et al., 2009); thus, increasing the robustness of the reported effects. A common threat to the validity of meta- analytic results is the file-drawer problem: Included published research reports may overestimate the true effect sizes if jour- nals prefer to accept articles that report strong significant as- sociations over publications with nonsignificant or small effects (Lipsey & Wilson, 2001). Comparisons of the results of pub- lished and unpublished studies as well as the trim and fill procedure (Duval & Tweedie, 2000) indicate that the file drawer problem was not a serious problem in most of our analyses. However, results on permissive parenting were con- tradictory. Associations of this parenting style with externaliz- ing problems were lost in the trim and fill procedure while the explicit comparison of published and unpublished studies showed even a slightly stronger effect size in unpublished than in published work. The trim and fill procedure is based on the addition of studies to the funnel plot so that it becomes sym- metrical (Duval & Tweedie, 2000). It does not take into account reasons for funnel plot asymmetry other than publication bias. Seven effect sizes of the present meta-analysis slightly in- creased after applying the trim and fill procedure that could not be based on a classical file-drawer problem (Lipsey & Wilson, 2001). Thus, factors other than publication bias probably con- tributed to the observed funnel plot asymmetry. Given the contradictory findings, our results on associations of permissive parenting with externalizing problems have to be interpreted with caution.
Moderator effect of sampling (clinical/forensic vs. school- based), form of problem behavior (sum measures vs. aggressive or delinquent behavior), source of information about parenting, and quality of the measures were in line with our expectations and, in part, with previous meta-analyses and will, therefore, not be fur- ther discussed. Effects of the source of information about exter- nalizing problems were unsystematic and will also not be dis- cussed here. As previous meta-analyses reported inconsistent moderator effects of child age and parental gender, we want to discuss our results on these moderators.
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883PARENTING AND EXTERNALIZING PROBLEMS
Similar to the meta-analysis by Rothbaum and Weisz (1994) and in contrast to Hoeve et al. (2009), we found that many associations of the assessed parenting dimensions and styles with externalizing problems were stronger in older samples. Although it has been suggested that parental influences decline with the increasing age of the child, there is increasing evidence that parents remain important socialization agents of their adolescent children (Har- ter, 2008). The observed stronger associations of parenting with externalizing symptoms in older samples may, at least in part, be because of the fact that externalizing problem behaviors become more common in adolescence, which provides more opportunities and needs for counteracting these behaviors (Mof- fitt, Caspi, Rutter, & Silva, 2001). With increasing age, ado- lescents also evaluate the behaviors of their parents more crit- ically (Levpušček, 2006) that could increase the negative effects of problematic parental behaviors, such as harsh or psychological control.
In line with Kawabata et al. (2011) and Kuppens et al. (2013), we did not find moderator effects of child gender. Thus, ob- served higher levels of externalizing problems in boys than girls (Moffitt et al., 2001) cannot be explained by differential effects of parenting. Other factors may explain gender differences in externalizing behavior, such as higher levels of risk factors and/or lower levels of protective factors in boys than girls (Moffitt et al., 2001).
We had expected that maternal parenting would show stronger associations with externalizing problems than paternal parenting because children may be more influenced by the caregiver who is most involved in their lives. In contrast to Rothbaum and Weisz (1994) and Hoeve et al. (2009) and in line with Kuppens et al. (2013), we observed similar associations of maternal and paternal parenting behaviors/styles with externalizing problems. Although fathers tend to have more distant relationships with their children compared with mothers (Lewis & Lamb, 2003), mothers and fathers tend to show similar parenting behaviors both according to their own reports and child reports (Bögels & van Melick, 2004). In addition, selection effects may play a role in studies on parental reports as fathers are less likely to participate in parenting research than mothers (Lewis & Lamb, 2003), and participating fathers may be more involved and influential in child rearing than nonpartici- pating fathers.
Limitations and Conclusions
Several limitations of the present meta-analysis have to be mentioned. First, despite the very large number of included studies, limited numbers of studies were available on cross- lagged associations of autonomy granting and parenting styles with externalizing behavior. More bidirectional effects might be identified if more studies on cross-lagged associations of au- tonomy granting and parenting styles with externalizing prob- lems become available, and the statistical test power increases. Although longitudinal and cross-lagged analyses in particular offer some insight into the direction of effects, they do not allow for analyzing causal relations. Second, the selection of the assessed parenting dimensions and styles was mainly based on the work of Baumrind (1966) and successors (e.g., Janssens et al., 2015; Maccoby & Martin, 1983). Some parenting scales assess additional dimensions such as verbosity (Arnold et al.,
1993) that were not included in our meta-analysis. In addition, some included parenting dimensions could be further divided into subdimensions (e.g., behavioral control in different forms of monitoring, rule setting, consistency of discipline etc.). How- ever, Hoeve et al. (2009) had found that most subdimensions showed similar associations with delinquent behavior. Third, although data were excluded if the measure of parenting could not be categorized into one of the selected dimensions or styles, minor overlap of item contents of the measures of different forms of control could not be avoided. Fourth, we had to restrict the number of moderator variables and did not, for example, compare different ethnic groups. Fifth, as many moderator variables consisted of several categories and information on individual moderators was lacking in a number of the studies, we did not compute multivariate analyses of moderator vari- ables. Finally, we did not analyze the interplay of maternal and paternal parenting.
Despite these limitations, several conclusions can be drawn. First, the present meta-analysis indicates that practitioners and researchers should expect only small to very small effects of the assessed parenting dimensions/styles on change in externalizing problems. Second, analyses of cross-lagged associations indi- cate that correlations of parenting with externalizing problems cannot exclusively be interpreted as effects of parenting on the child outcome. Associations are in most cases bidirectional. Third, our results indicate that parenting is more important for externalizing problems in clinical and forensic samples that already show high levels of these problem behaviors. Fourth, as validated measures of parenting and externalizing problems tend to produce stronger effect sizes than other measures, we recommend the use of these validated measures. Fifth, given the fact that psychological and harsh control showed the strongest associations with externalizing problems, avoiding or reducing these forms of control could be a focus of parenting interven- tions aimed at reducing externalizing problems. Parenting train- ings tend to produce, on average, small to moderate effects on externalizing problems of young people (McCart, Priester, Da- vies, & Azen, 2006). Addressing parenting behaviors that show the strongest associations with externalizing problems might further increase the effect of these interventions.
Finally regarding future research needs, experimental studies are recommended to test causal effects of parenting on change in externalizing problems. For example, increases in authorita- tive parenting of participants of a randomized controlled par- enting training trial have been found to explain declines in adolescent delinquency (Kauser & Pinquart, under review). More research is also recommended on variables that mediate the effect of parenting styles and parental behaviors on exter- nalizing problems.
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931PARENTING AND EXTERNALIZING PROBLEMS
�Zhou, Q., Wang, Y., Deng, X., Eisenberg, N., Wolchik, S. A., & Tein, J. Y. (2008). Relations of parenting and temperament to Chinese chil- dren’s experience of negative life events, coping efficacy, and external- izing problems. Child Development, 79, 493–513. http://dx.doi.org/10 .1111/j.1467-8624.2008.01139.x
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�Žukauskiene, R., Raižiene, S., Malinauskiene, O., & Pilkauskaite- Valickiene, R. (2014). Perceived parental rearing practices, supportive school environment, and self-reported emotional and behavioral prob- lems among Lithuanian secondary school students. International Jour- nal of Psychological Studies, 6, 68 –78. http://dx.doi.org/10.5539/ijps .v6n1p68
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Received May 6, 2016 Revision received December 2, 2016
Accepted December 6, 2016 �
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932 PINQUART
- Associations of Parenting Dimensions and Styles With Externalizing Problems of Children and Adol ...
- Associations of Parenting Dimensions and Styles With Externalizing Problems
- Impact of Moderator Variables
- Sample
- Age of child
- Child gender
- Parental gender
- Form of externalizing problems
- Rater
- Quality of the measures
- Publication status
- Research Questions
- Method
- Sample
- Measures
- Statistical Integration of the Findings
- Results
- Discussion
- Limitations and Conclusions
- References
