Relationships among internalizing and externalizing problems, attachment and alexithymia in high-risk and community adolescents: a multi-method comparative study.

Late-adopted (i.e. adopted after 12months) and residential-care adolescents, due to higher rates of adverse childhood experiences, show high rates of internalizing-externalizing problems and they are at high-risk to show attachment insecurity and alexithymia, which are risk-factors that may increase psychopathological vulnerability during adolescence. However, no studies before compare in the same occasion these two high-risk groups of adolescents with community peers in internalizing-externalizing problems, attachment and alexithymia, which were never assessed simultaneously in these groups. This mixed-method comparative research involved 174 non-clinical adolescents aged 10-19 years (M = 15.55, SD = 2.02, 53% boys) matched for age and gender in 3 groups: two "high-risk groups" of 33 late-adoptees (LA, i.e. adopted after 12 months) and 50 in residential-care (RC), and 91 community teens as low-risk control group (C), with two main aims: 1) to compare groups in internalizing-externalizing problems, attachment and alexithymia with a mixed-method, multi-informant approach, in order to check the assumed vulnerability of high-risk adolescents in these variables. 2) to explore relationships between internalizing-externalizing problems, attachment and alexithymia through groups, exploring the cumulative and interactive effects of attachment and alexithymia as possible risk factors for more internalizing-externalizing problems during adolescence. After the approval of the University's Research Ethic Commitee, formal agreements with the Social and Health Services for adoption and residential-care and high-school for the recruitment of participants,and the signature by legal care-takers of an informed consent for the voluntarly participation of the adolescent in the research, each participant was assessed in two meetings in home visiting. Measures were: The Child Behavior Check List 6-18 years (CBCL, filled by a biological or adoptive parent and by the educator in the RC group) and the Youth Self Report 11-18 years (YSR) to assess internalizing-externalizing problems; the Friends and Family Interview (FFI) and the Inventory for Parent and Peer Attachment (IPPA) to assess attachment representations and relationships; the Toronto Alexithymia Scale 20 item (TAS-20) and the Toronto Structured Interview for Alexithymia (TSIA) to assess alexithymia; the verbal comprehension index of the Weschler Intelligence Scale for Children 4th edition (ICV-WISC-IV) to control the confounding effect of participant's verbal skills in the interview, plus a socio-demographic data form to collect demographic and anamnestic data (e.g. age and lenght of adoption or institituionalization, reasons). Main results were: 1) Residential-care adolescents were confirmed the group more vulnerable to internalizing-externalizing problems, attachment insecurity and higher alexithymia, while late-adopted and community adolescents did not show differences each other. 2) Attachment insecurity and higher alexithymia were related to total and internalizing problems in all groups, while no relations with externalizing problems were found. 3) Alexithymia was a common risk-factors for more total and internalizing problems through groups, while attachment patterns had different group-specific roles. Overall, models of prediction inclusive of attachment and alexithymia allowed the prediction of 4%-39% of total problems and 20%-66% of internalizing problems through groups, with higher vulnerability for girls and a certain variability related to the problem's informant (care-giver or adolescent). In the discussion, shared and specific vulnerabilities of each group from a clinical point of view were discussed, commenting on the practical implications and suggesting ways of using these risk prediction models in clinical practice. In the conclusion, the utility of a mixed-method multi-informant approach was highlighted.