Externalizing and internalizing problems in relation to autonomic function: a population-based study in preadolescents.
OBJECTIVE
To investigate whether externalizing and internalizing problems are related to lower and higher heart rate (HR), respectively, and to explore the relationship of these problems with respiratory sinus arrhythmia (RSA) and baroreflex sensitivity (BRS). Moreover, to study whether problems present at both preschool and preadolescent age show stronger associations with autonomic function than those that were not.


METHODS
In a population cohort of 10- to 13-year-old children (N = 931; 11.6 +/- 0.5 years; 47% boys), autonomic measurements in supine and standing position were performed at school. RSA and BRS were determined by spectral analysis. Current externalizing and internalizing problems were assessed by the Child Behavior Checklist and problems at age 4 to 5 retrospectively by the Preschool Behavior Questionnaire.


RESULTS
At supine rest, current externalizing problems were associated with lower HR and higher RSA, but not with BRS and current internalizing problems with higher HR and lower RSA, but not with BRS. These results were specifically found in children with problems that were retrospectively reported to have been also present at preschool age. Standing-induced changes in autonomic parameters were unrelated to the behavioral dimensions.


CONCLUSIONS
Externalizing and internalizing problems are associated with divergent autonomic patterns, suggesting autonomic underarousal and overarousal, respectively. Problems starting early in life may specifically account for this. This should be confirmed in prospective studies.
Dietrich
Andrea
A
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands. Electronic address: A.Dietrich@med.umcg.nl.
Riese
Harriëtte
H
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Sondeijker
Frouke E P L
FEPL
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Greaves-Lord
Kirstin
K
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
van Roon
Arie M
AM
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Ormel
Johan
J
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Neeleman
Jan
J
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Rosmalen
Judith G M
JGM
Ms. Dietrich and Drs. Riese, Ormel, Neeleman, and Rosmalen are with the Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, and Dr. van Roon is with the Department of Internal Medicine, University Medical Center Groningen, University of Groningen; Ms. Sondeijker and Ms. Greaves-Lord are with the Department of Child and Adolescent Psychiatry, Erasmus Medical Center Rotterdam; Drs. Ormel, Neeleman, and Rosmalen are with the Graduate School for Experimental Psychopathology, University of Groningen; and Dr. Neeleman is with the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
D001146:Arrhythmia, Sinus / Q000453:epidemiology* / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D012021:Reflex, Abnormal / Q000502:physiology*; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires