Executive Functioning and the Interplay of Internalizing and Externalizing Symptoms – Understanding Developmental Dynamics Through Panel Network Approaches

Early adolescence is an important transition period during which many mental disorders emerge. The interplay between different internalizing and externalizing mental health problems in adolescence is poorly understood at the within-person level. Executive functioning (EF) in early adolescence has been shown to constitute a transdiagnostic risk factor, but the specificity of the associations between different domains of EF and internalizing/externalizing mental health problems remains unclear. Leveraging data from a large longitudinal panel study of adolescents (TRAILS, n > 1641) assessed at ages 11, 13, and 15, we investigated the network dynamics of different internalizing and externalizing symptoms. We showcase the use of two novel methodological panel network approaches: cross-lagged panel network models (CLPN) and graphical vector autoregressive (GVAR) models. Moreover, we used hierarchical regression models to investigate prospective associations between different measures of EF (working memory, sustained attention, shifting attention) and broadband transdiagnostic dimensions (internalizing/externalizing symptoms). Depressive symptoms emerged as an important bridge connecting clusters of internalizing and externalizing mental health problems in the cross-sectional networks. Importantly, depressive symptoms predicted a range of other internalizing symptoms (i.e., panic, somatic problems, separation anxiety, general anxiety, social phobia) over time, in particular during early adolescence. In contrast, social phobia symptoms were most strongly predicted by other symptoms. Externalizing symptoms, such as oppositional-defiant problems and inattention/hyperactivity predicted depressive and OCD symptoms at the within-person level respectively. We identified important feedback loops with reciprocal associations between different anxiety symptoms (e.g., separation anxiety – general anxiety, and panic symptoms – somatic problems). Different facets of EF assessed at age 11, in particular sustained attention, showed weak but significant prospective associations with internalizing and externalizing symptoms at age 13 and 15. Our findings speak to the importance of attending to depressive symptoms in early adolescence to prevent a spiral of different internalizing symptoms from arising later on.