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The purpose of this study was to examine the outcomes and internal validity of the literature regarding the Incredible Years program’s impacts on externalizing behaviors and social-emotional learning for students from low SES backgrounds. A meta-analysis of behavioral and social-emotional outcomes from the child, parent, and teacher trainings for students from low SES backgrounds was conducted. Nine studies were eligible for inclusion using the defined eligibility criteria.Across the nine studies, data was collected for a total of 3,360 children, with all studies reporting greater than 50% of participants having an income in the low-socioeconomic range. The type of Incredible Years intervention program reported for each included study was the parent training program (four), teacher classroom management training (two), the combined parent training and teacher classroom management program (two), and one study which compared the child intervention program with the combined child intervention and parent training program. Teacher training and parent intervention sessions were largely led by certified trainers and sessions varied in number and length. Overall social validity was strong across all studies, suggesting high parent and teacher satisfaction with the program.The overall effect size reported for Incredible Years programming on social emotional learning and externalizing behavior outcomes was in the small to moderate range. Moderator analysis for externalizing behavior outcomes suggested variable effect sizes based on targeted training, with parent training resulting in a stronger effect size than teacher training. Combined parent and teacher training reported the smallest effect size for externalizing behavior outcomes. When outcomes were further analyzed based on externalizing behavior outcomes, number of hours/days of parent/teacher training, and training type, results indicated stronger correlation between amount of training for parents and effect size for externalizing behavior outcomes compared to outcomes related to amount of training for teachers.Assessment of internal validity found eight of nine studies to fall in the methodologically sound range. A limitation across studies was the use of parent and teacher report as an outcome measure for child behaviors. Although there are limitations to this analysis, the results expand upon the literature for students by providing a synthesis of behavioral and social-emotional outcomes from the child, parent, and teacher trainings for students from low SES backgrounds.The findings of this review have implications for practitioners and how they address externalizing behaviors and SEL outcomes for students from low-income backgrounds. Future research related to the impact of the Incredible Years on low-income students is needed, including longitudinal outcomes and outcomes related to the dinosaur school classroom intervention specifically. Future studies should examine the impact of length of training and attendance at sessions for parent training on outcomes for students and the use of blinded observation data as an outcome measure rather than parent and teacher rating scales.

Over the past several decades, a great deal of research has been conducted on the predictors of youth externalizing behavior and youth substance use. Both behaviors can have serious consequences, therefore a more nuanced understanding of their predictors is likely to have implications for knowledge development, and for the development of more effective policies, programs, and interventions. This dissertation examined new questions concerning youth externalizing behavior and substance use among diverse youth. Ecological Systems theory and the Integrative Model motivated the research studies. This dissertation had two primary aims. First, this dissertation aimed to provide a more contextually comprehensive perspective on youth externalizing behavior and substance use by examining a broader set of measures associated with youth development. The second aim of the dissertation was to examine Latino/a group variation in externalizing behavior and substance use. Most extant research has treated Latinos/as as a monolithic group, and thus it is important to examine the degree to which there may be between group differences or diversity in the experience of various Latino/a groups. In study one, using data from the Fragile Families and Child Wellbeing study (FFCWS), I examined the short- and long-term effects of childhood risk (physical punishment, family work-related stress) and protective factors (neighborhood collective efficacy) on externalizing behavior during adolescence. In this study, I also examined racial/ethnic (Black, Latino, and White) variation of short term and long-term consequences of the measures of interest. A series of multiple group structural equation models were carried out for analyses. Results from this study reveal that parenting, parent employment and neighborhoods are significantly related to youth externalizing behavior. In study two, I examined Latino/a variation of externalizing behaviors with data from the Fragile Families and Child Wellbeing study (FFCWS). Latino diversity that may exist is often masked when empirical research examines this group as one monolithic group. I examined multilevel models that accounted for the nested nature of the data. Results from this study show that cultural factors, parenting, parent employment, and neighborhoods are important for Latino youth externalizing behavior. Additionally, cultural factors did not vary across Latino groups. In Study 3, I examined within Latino/a substance use variation. The substances of focus were alcohol (past 12-month use and binge drinking), marijuana (past 12-month use), cigarettes (past 30-day use), and cocaine (past 12-month use). Most substance use empirical research that is Latino/a inclusive, does not take into account the heterogeneity of this population. This study provides a national perspective on substance use as it pertains to Latino groups. I carried out a series of survey weighted logistic regressions using data from the nationally representative Monitoring the Future study (MTF). Results suggest that some substance use variation exists, however, the trends in substance use across Latino groups is similar. Taken together the studies provide a comprehensive examination of related questions concerning youth externalizing behavior and substance use. Latino variation, while minor, was evident in the present studies. Additionally, Latino-unique measures are important for adolescent externalizing behaviors and substance use and they do not vary across groups. Therefore, implications for intervention efforts include sensitivity to cultural factors when working with this population.

The purpose of the current study was to examine the effect of restricted and repetitive behaviors (RRBs) on the relationship between sleep problems and externalizing behaviors in young children with autism spectrum disorder (ASD). Sixty-six participants with ASD and a mean age of 4 years and their parents participated in the study. Parents reported on their child’s sleep, ASD symptoms, and externalizing behavior during a one-time lab visit. Bivariate correlations and a mediation analysis were conducted to assess the associations between sleep problems, externalizing behavior, and RRB. Results suggested that children with higher scores in measures of RRB had higher scores in sleep problems and externalizing behavior. Results also suggested that RRB partially mediated the relationship between sleep problems and externalizing behavior. Implications for the early identification of sleep and behavior problems, as well as ASD symptoms, are discussed.

This starred paper is a review of literature that examines qualitative and quantitative studies conducted to explain the relationship between childhood adversity, childhood development, and externalizing behaviors. Additionally, this literature review further examines the impact of childhood adversity and trauma on student learning, teacher efficacy, and the need for trauma-sensitive school systems.

Despite the high rates of both internalizing and externalizing behavior problems in children with ASD (Simonoff et al., 2008; van der Meer et al., 2012), there are frequently inconsistencies between informants on behavioral rating scales, particularly when rating internalizing behavior (De Los Reyes et al., 2015; Stratis & Lecavalier, 2015). Discrepancies between raters can hinder treatment, as children, parents, and teachers frequently fail to agree on the target problem, making it difficult for all informants participating in treatment to work together to mitigate the problem (De Los Reyes & Kazdin, 2005). The aims of the current study are to examine discrepancies between parent and teacher ratings of behavior over time in a sample of young children with ASD, and to identify parent, child, and teacher characteristics associated with informant discrepancies. Participants in this study included 180 children with ASD ages 4 to 8 years old and their parents and teachers. Internalizing and externalizing behavior problems were measured using parent and teacher report on the Child Behavior Checklist and the corresponding Teacher Report Form (CBCL and TRF; Achenbach & Rescorla, 2001). Latent growth modeling was used to examine developmental trajectories of parent and teacher ratings of child behavior, as well as to examine informant discrepancies across time. The results indicate that, on average, parents tend to rate more problem behaviors, particularly internalizing behaviors. No significant change in parent-teacher discrepancies were found across time. The magnitude of parent-teacher discrepancies in behavior ratings as well as child, parent, and teacher characteristics which predict the discrepancies were also examined. Implications for research and practice are discussed.

Clinician treatment fidelity, consisting of treatment adherence and clinician competence, is commonly assessed during the implementation of evidence-based treatments to ensure that clinicians are delivering care according to an intended service model. Although resources are often expended in fidelity measurement, associations between fidelity and client outcomes has not been well established in the psychotherapy literature. The relationship between clinician fidelity and treatment outcomes was investigated in a longitudinal sample of clinicians (n = 17) and parent-child dyads (n = 32) following a statewide implementation of Parent-Child Interaction Therapy. Observer-rated measures of adherence and coaching competence collected from early treatment sessions were used to predict intake levels and growth trajectories of parent-reported behavior problems and positive parenting skills. Hierarchical linear modeling results indicated that higher levels of coaching competence were associated with greater behavior problem frequency at intake. Neither early session adherence nor early session competence, as they were measured in the current study, predicted changes in treatment outcomes over time. These results suggest that additional variables should be modeled alongside early treatment fidelity to predict treatment outcome change. Possible explanations for these findings, limitations of the current study, and directions for future research are discussed.

This study examined the relationship between executive function and externalizing behaviors within a student population that was assessed for special education services. Executive function was measured by using the Comprehensive Executive Function Inventory (CEFI). Externalizing behaviors and school problems was measured using the Behavior Assessment System for Children, Third Edition (BASC-3). Four separate structural equation models were produced and analyzed to examine this relationship. The results from this study indicate that there is a significant direct effect from executive function on externalizing behaviors and school problems, such that higher scores in executive function yielded lower externalizing behavior and school problems scores. Differences in average full scale CEFI scores were noted between types of special education placements and between various groupings of students in regards to what category they qualified in. The data indicates programs that facilitated more environmental supports and services had students with lower full scale CEFI scores, while students that qualified under Other Health Impairment and Emotional Disturbance shared comorbid features with other distinct processing deficits.

The current study aimed to examine whether the implementation of a mindfulness-based intervention in an urban public school led to improvements in student misbehavior, school attendance, and academic achievement. Twenty classrooms (K-8) were randomly assigned to either the intervention group (i.e., MBI group) or waitlist control group (i.e., WLC group). Following random assignment of classrooms to the intervention and waitlist control group, all teachers, students, and parents were invited to participate in the study. Although all randomized classrooms were part of the intervention, not all teachers, students, and parents agreed to take part in the evaluation of the mindfulness program. Of those who did agree to take part in the study, the current analyses included data for 130 students (nMBI = 81, nWLC = 49) from 19 classrooms (nMBI=9, nWLC=10) as well as 70 parents (nMBI = 38, nWLC = 32) who provided data (at one time point or more) speaking to the behavioral functioning of their child.Baseline study data were collected from all participating students prior to the start of the intervention in the fall of 2017. At the end of the fall semester, post-intervention data were collected from the intervention group, and pre-intervention data were collected from the waitlist control group. The final phase of data collection took place at the end of the 2018 school year, at which time post-intervention data were collected from the waitlist control group and 4-month follow-up data from the intervention group. Behavioral and academic functioning were assessed in the current study using multiple reporting sources including school records, teacher report, parent report, and student self-report. Teachers, parents, and students completed the Strengths and Difficulties Questionnaire (SDQ-Teacher/Parent/Youth versions; Goodman, 1997), which includes scales assessing conduct problems, hyperactivity/inattention problems, and peer relationship problems. School records of student absences, grades, standardized test scores, office referrals for misconduct, and suspensions were collected for all participating students. Contrary to hypotheses, students’ behavioral functioning (e.g., rates of office referrals, days suspended, days absent, and parent, teacher, and self-rated conduct problems, hyperactivity-inattention problems, and peer relationship problems) and academic functioning (e.g., standardized test scores and letter grades in Math, Reading, and ELA) were not found to improve to a statistically-significant degree following delivery of the mindfulness-based intervention. Despite absence of statistically-significant improvements, positive changes at the individual-level were captured in statistical analyses. These results and the implications of individual-level improvements are discussed within the context of the sociodemographic and socioeconomic characteristics of the current sample. Suggestions for future evaluations of mindfulness-based interventions are also proposed.

Although growing evidence suggests that biologically-based factors, such as variations in dopaminergic genes and early reactive temperament, may explain ‘differential susceptibility’ to both social stress and support, little is known about whether patterns of environmental sensitivity change across development. Thus, this dissertation employed a developmental psychopathology framework to test differential susceptibility theory in three longitudinal studies of youth at risk for externalizing behaviors (EB; e.g., aggression, substance use), while directly considering the developmental impact of previous adversity. Study 1 was based on a longitudinal study of children adopted from foster care. Generalized estimating equations examined whether reactive temperament heightened sensitivity to both pre-adoption maltreatment and later adoptive family support. Children with reactive temperament did not show heightened vulnerability to pre-adoption maltreatment; instead, maltreatment directly predicted more substance use by late-adolescence. Reactive temperament did heighten sensitivity to the protective effects of family cohesion in early adoption, although effects were not maintained in late-adolescence. Study 2 used latent growth curve analysis to model EB trajectories in a longitudinal sample of adolescents transitioning into adulthood. Employing a polygenic dopaminergic risk score (DRD4, DRD2, DAT1) previously linked to EB, we compared patterns of gene-environment interactions (GxE) between adolescents with and without histories of maltreatment. Polygenic risk moderated the association between parental closeness and concurrent adolescent EB, but these GxE effects did not predict EB changes over time. Furthermore, adolescents with maltreatment histories showed an overall blunted sensitivity to both parental closeness and friendship involvement, and these effects were largely unaffected by dopaminergic genes. Study 3 employed a longitudinal sample of children oversampled for ADHD, an early EB risk factor. Based on prenatal programming theory, a moderated mediation model tested how birth weight (a proxy for global prenatal stress) and dopaminergic genes independently and interactively influence formation of early reactive temperament. Dopaminergic genes interacted with birth weight to predict negative emotionality in a pattern consistent with differential susceptibility. Negative emotionality, in turn, directly predicted adolescent EB, beyond the direct and interactive effects of positive and negative parenting behavior. Overall, results partially support that genetic and temperamental variations influence sensitivity to the environment, although sensitivity was primarily limited to early developmental periods (prenatal period, childhood). We discuss these results in the context of prevailing developmental theories of EB and emphasize the importance of considering the dynamic nature of the environment when investigating individual differences in sensitivity to stress and support.

Child externalizing behavior (i.e., defiance, impulsivity, disruptiveness, aggression, delinquency, and hyperactivity) places children at risk for a broad range of adverse outcomes. Parenting has been implicated as a factor in the expression and maintenance of child externalizing behavior, but limitations exist that hinder the interpretation of findings from prior studies of associations between child externalizing behavior and parenting behavior. The current study used a large, nationally representative dataset that included multiple assessment points across child development and multiple informants and methods of assessment to examine the relationships between child externalizing behavior and parenting practices, including the moderating effect of child gender and elevated ADHD/ODD symptoms. Results of cross-lagged path model analyses revealed reciprocal relationships among child externalizing behavior and effective/ineffective parenting practices, though the pattern of results differed slightly between mothers and fathers. Child gender moderated these relationships such that some associations were stronger for males and others were stronger for females. Elevated ADHD/ODD symptoms did not emerge as a robust moderator, though group differences were identified for one model that was tested. These results underscore the need for early intervention that targets elevated child externalizing behavior and ineffective parenting practices, which may help to foster positive parent-child relationships and mitigate the risk of children with these problems developing more severe, clinically significant externalizing symptoms (e.g., ADHD and/or ODD).

Background and Aims. Externalizing behaviors, or more informally, aggressive or hyperactive behaviors, in young children are concerning to both parents and child care providers, and at clinical levels pose considerable social and economic costs to society. Externalizing behaviors amongst preschoolers involved with the child welfare system is of particular concern given its theoretical etiology wherein alienation by a primary caregiver, as well as trauma resultant from system involvement, presents increased risk of an externalizing diagnosis in early childhood. Thus, it is unsurprising that children with insecure attachments are at particular risk for externalizing behaviors. Moreover, it is therefore possible that early care and education (ECE) has the potential to differentially benefit child welfare-involved preschoolers by providing both the opportunity to develop a secure attachment and through modeling of prosocial behavior in a supportive environment. This dissertation examined the effects of attachment security, ECE participation, and the caregiving context on the externalizing trajectories of child welfare-involved preschoolers. Methods. This research utilized secondary data from the National Child and Adolescent Well-Being (NSCAW) II study, following a sample of n=221 preschoolers across three waves of data spanning approximately 36-months. Given the nested, repeated measures nature of the secondary data, this study employed a weighted two-level hierarchical linear model to assess the effects of attachment security, ECE participation, child’s language and the caregiving context (maternal depression, cognitive stimulation, and spanking), controlling for caregiver SES (marital status, caregiver education, and TANF participation), child characteristics (language, gender, race/ethnicity, and age), and child welfare involvement (substantiated, unsubstantiated, or removal from home), as well as the possible moderating effects of attachment and ECE participation. Results. Findings from hierarchical linear modeling demonstrate no association between attachment security at 18 months of age and externalizing behavior 36 months later. Moreover, this study found a significant negative relationship between ECE participation and externalizing behavior wherein participation in ECE was associated with an increase in externalizing. Maternal depression and spanking were also significantly associated with increased externalizing behavior. Child’s language and cognitive stimulation at home were protective factors and associated with decreased externalizing, though the magnitude of the effect of both were modest compared with maternal depression or corporal punishment. Moreover, there was a significant interaction between maternal depression and ECE participation wherein children with depressed caregivers differentially benefitted from ECE participation when compared with those of non-depressed caregivers. Conclusions. While this study is limited by its inability to control for the quality of ECE settings, which is of particular concern for this at-risk population, it adds to the emerging literature on the effects of ECE specific to child welfare-involved preschoolers. Social work policy and practice implications are discussed, such as the need for increased collaboration between ECE providers and the child welfare workers, as well as targeted or triaged support of clinically depressed caregivers.

Characterized by atypical behavioral (e.g., antisociality), interpersonal (e.g., egocentricity), and affective facets (e.g., low remorse), the phenomenological diversity of psychopathy likely consists of potentially etiologically distinct subtypes. Across community, clinic-referred, and adjudicated samples, anxiety and negative emotionality differentiated two subgroups of adolescents and adults with elevated psychopathic traits. In particular, secondary psychopathy was correlated with greater anxiety, negative emotionality, and stress reaction and lower control than primary psychopathy. Of central importance to the current study, primary and secondary psychopathy were conceptualized as being differentially sensitive to genetic and environmental influences. Specifically, primary psychopathy reflected more innate, genetically-based factors including affective disturbance (e.g., callousness) and minimal negative emotionality (e.g., anxiety), whereas secondary psychopathy was hypothesized to be an adaptation to environmental risk (e.g., maltreatment). However, empirical examinations of genetic and environmental contributions to subtypes provide inconsistent support for this theory, and knowledge about the mediational constructs and processes underlying the development of primary versus secondary subgroups of psychopathy is limited. Furthermore, anxiety-based distinctions of primary and secondary psychopathy have yet to be similarly evaluated in school-age children. This dissertation aimed to address these gaps directly. Using two independent, yet complementary, prospective longitudinal samples of 221 children with and without ADHD followed for two years (UCLA ADHD and Development Study) and a nationally representative sample of 15,701 adolescents followed prospectively across 14 years (National Longitudinal Study of Adolescent Health), we explored the validity of primary and secondary subgroups by examining their differential association with key correlates (e.g., maltreatment history, reactive aggression, antisocial behavior, delinquency, and emotional processing). Next, we tested whether individual differences in dimensions of temperament and self-regulation mediated predictions of primary and secondary psychopathy from a functional polymorphism regulating serotonin neurotransmission. Primary findings were three-fold. First, across both samples, secondary psychopathy demonstrated more anxiety and negative emotionality and engaged in greater total, nonviolent, and violent antisocial behavior than primary psychopathy. Second, secondary subgroups reported more diverse forms of childhood maltreatment relative to primary and comparison youth. Lastly, prosociality, but not negative emotionality, daring, or self-regulation, mediated predictions of psychopathy subgroups from 5-HTTLPR in childhood. In addition to providing support for primary and secondary psychopathy among children and non-adjudicated adolescents and adults, these findings also identify mediators of primary and secondary psychopathy. We discuss the utility of using population-based samples to examine individual differences within psychopathy, potential causal mechanisms that differentially contribute to psychopathy subgroups, as well as implications for tailored interventions targeting impairments associated with primary and secondary psychopathy.

This study investigated the impact of parenting and children’s self-control on children’s externalizing behavior problems among 167 predominantly African-American mothers and their 2-year-old children. Two hypotheses were considered based on two distinct theoretical origins of self-control. First, consistent with a behavioral perspective, exposure to positive parenting was hypothesized to indirectly affect externalizing behaviors through children’s self-control; that is, children’s self-control was expected to mediate the association between positive parenting and externalizing behaviors. Second, consistent with a temperamental perspective, self-control was expected to moderate the impact of positive parenting on levels of children’s externalizing behaviors such that only children with a propensity towards low self-control benefited from positive parenting. Results were not consistent with the mediational hypothesis and provided limited support for the moderational hypothesis. That is, only for children with characteristically low self-control was exposure to more positive parenting associated with fewer externalizing behavior problems, as rated by teachers, one year later.

The early experience of social and emotional neglect, such as that seen in institutions for the care of orphaned or abandoned children, is associated with altered neurobiological functioning and elevated risk for externalizing behavior problems; however, many post-institutionalized children appear resilient to these effects. This resiliency calls into question how post-adoption parenting practices may contribute to the heterogeneous outcomes seen in these children. This study examined the moderating role of current parent emotion socialization practices on the relation between early caregiving and indices of children's autonomic nervous system functioning at baseline and in response to ecologically valid challenges. Etiological factors, behavioral, and physiological correlates for externalizing behavior were also examined. The sample consisted of 8 to 9-year-olds, and compared post-institutionalized (PI) internationally-adopted children with children internationally-adopted from foster care (PFC) and children raised by their biological families (NA). Parents self-reported on their encouragement of emotional expression and distress reactions to children's negative emotions. Externalizing behavior was measured by parent report. Children's basal level of respiratory-sinus arrhythmia (RSA) and non-specific skin conductance response (NS.SCR) were measured as well as reactivity to challenge. Results indicated that under conditions of high parental distress, PI children displayed a unique autonomic pattern characterized by high basal RSA, and less RSA withdrawal and greater NS.SCR reactivity within interpersonal contexts involving their parent. High parental distress was associated with lower basal RSA for the PFC group. The PI group evidenced elevated externalizing behaviors compared to comparison groups. Greater externalizing behaviors were seen for those PI children who displayed high basal RSA and NS.SCR augmentation to challenge in the context of high parental distress. Results suggest that post-adoption parenting practices, in conjunction with the child's physiology, contribute to the emergence of externalizing problems in PI children.

There is an abundant amount of research examining the link between corporal punishment and youth outcomes in North America, Europe, and to a lesser extent in the Caribbean. However, there is little research examining this link within the Trinidadian setting. The current study addressed this gap within the literature by examining the association between corporal punishment and outcomes in Trinidadian youth. Specifically, this study investigated the relation between corporal punishment and subjective well-being and externalizing behaviors (bullying and delinquency). Additionally, it explored whether this relation was influenced by parental warmth or rejection and youth’s cultural beliefs about corporal punishment. Results of structural equation modeling revealed that there was a direct link between corporal punishment and youth subjective well-being. Furthermore, it highlighted an indirect link between corporal punishment and subjective well-being through the mediator of parental warmth. Youths’ cultural beliefs about corporal punishment were not a significant mediator in the model. These results were present when gender was used as a control. Additionally, multiple regression results indicated that corporal punishment was associated with both bullying and delinquency when parental warmth, youths’ cultural beliefs about corporal punishment, and gender were used as controls. However, the effect sizes were small. The implications of the results of this study for childrearing and public policy are discussed.

Many studies have shown a link between emotional and behavioral problems in youth. The nature of the longitudinal relationship between these two conditions, however, is not well understood. Thus the current study examines the developmental link between depressive symptoms and antisocial behavior during early adolescence. Results indicated that both males and females showed increases in externalizing behavior, while only females exhibited increases in depressive symptoms. In addition, examination of concurrent symptom levels suggests that while levels of antisocial behavior consistently influence levels of depressive symptoms in males, these two conditions become less related over time in females. Moreover, results indicate that at no point do symptoms of either condition appear to be driving subsequent symptoms of the other condition. Further gender differences were also found in the response to a family-focused intervention, with only males showing improvement in depressive symptoms. Theoretical and clinical implications of these findings are discussed.

Substantial research supports the association between corporal punishment and children's behavioral problems, suggesting that punishment leads to both internalizing and externalizing behaviors. However, this research has not been able to discern the direction of causality in this relationship for many reasons, including a lack of experimental data. The purpose of this study is to assess the causal effect of corporal punishment on internalizing and externalizing behaviors by using a Propensity Score Matching (PSM) analysis. This study uses data from waves 1 and 2 of the longitudinal cohort study of the Project on Human Development in Chicago Neighborhoods (PHDCN), including 6, 9, 12, and 15 year old cohorts. Results reveal two major findings as they relate to the effects of corporal punishment on children's behavioral outcomes. First, results show that a large amount of selection bias exists before matching occurred. Second, once matching was implemented no causal effect remained for corporal punishment on the proposed outcome measures. Limitations and ways of overcoming them in future research are also discussed.

Some degree of involvement in externalizing behavior is common for many children during adolescence, but participation is often time-limited. For others, there is considerable evidence for the continuity of externalizing behavior over time. Some individuals expand their involvement into increasingly deviant behaviors, including substance use. The continuity of externalizing behavior and the expansion of such behavior to include substance use was examined longitudinally (average = 5.4 years) for 114 participants, 61 with a history of chronic illness (i.e., cancer, sickle cell disease, juvenile rheumatoid arthritis) and 53 with no history of chronic illness. The associations with the quality of family relationships (i.e., family conflict, family support, and family control) were examined. Analyses revealed significant continuity of externalizing behavior from childhood/adolescence to young adulthood for both males and females, and greater continuity for females when the Child Behavior Checklist measure of externalizing behavior was used at Time I and Time II. Significant comorbidity of externalizing behavior and substance use in young adulthood was found. In terms of the effect of the quality of family relationships, significant and positive associations were found between family conflict and the concurrent level of externalizing behavior, and family support was significant and negatively associated with concurrent externalizing behavior. Family control was significantly negatively associated with the subsequent number of drugs used, the frequency of drug use, and the frequency of tobacco use. Despite these significant findings, the family relationship variables did not account for significant variance in predicting externalizing behavior/substance use in young adulthood beyond that accounted for by externalizing behavior in childhood/adolescence. These findings highlight the importance of taking early externalizing behavior seriously, especially in females, despite the more common focus on these behaviors in males. Also, because of the significant comorbidity of externalizing behavior and substance use, it is important to consider symptoms of both of these behaviors.