Maternal Childhood Maltreatment History and Child Mental Health: Mechanisms in Intergenerational Effects.

The objectives of this study were to examine whether a maternal history of maltreatment in childhood has a detrimental impact on young children's mental health and to test theoretically and empirically informed pathways by which maternal history may influence child mental health. Mother-child dyads (N = 187) were evaluated between birth and 64 months of age via home and laboratory observations, medical and child protection record reviews, and maternal interviews to assess maternal history of childhood maltreatment and microsystem and exosystem measures of the caregiving context, including child maltreatment, maternal caregiving quality, stress exposures, and social support. When the children were 7 years of age, mothers and teachers reported on child emotional and behavioral problems. Analyses examined whether the caregiving context variables linked maternal maltreatment history with child emotional and behavioral problems, controlling for child sex (54% male), race/ethnicity (63% White), and family sociodemographic risk at birth. Maltreated mothers experienced greater stress and diminished social support, and their children were more likely to be maltreated across early childhood. By age 7, children of maltreated mothers were at increased risk for clinically significant emotional and behavioral problems. A path analysis model showed mediation of the effects of maternal childhood maltreatment history on child symptoms, with specific effects significant for child maltreatment. Interventions that reduce child maltreatment risk and stress exposures and increase family social support may prevent deleterious effects of maternal childhood maltreatment history on child mental health.

The legacy of early childhood violence exposure to adulthood intimate partner violence: Variable- and person-oriented evidence.

This study examined prospective pathways from exposure to interparental violence (EIPV) during infancy (ages 0-24 months) and toddlerhood/preschool (ages 25-64 months) to intimate partner violence (IPV) perpetration and victimization in adulthood (ages 23, 26, and 32 years) using 2 complementary approaches. Building on past findings, a variable-oriented approach was used to examine the effects of developmental timing of EIPV in infancy versus toddlerhood/preschool to IPV involvement in early adulthood, at age 23 years. A person-oriented approach next examined whether continuity and change in IPV (persisting, increasing, and decreasing vs. nonviolent patterns) across the transition from early adulthood to adulthood (ages 26 to 32 years) were predicted by developmental timing of EIPV within early childhood and/or contemporaneous adulthood factors (life stress and behavior problems). In this fully prospective longitudinal study beginning at birth, mothers reported on EIPV in infancy and toddlerhood/preschool, and participants (N = 179) reported on IPV and contemporaneous stress and behavior in early adulthood and adulthood. Results indicated that according to the variable-oriented approach, EIPV in toddlerhood/preschool but not in infancy predicted both IPV perpetration and victimization at age 23. The person-oriented approach revealed that, along with life stress and externalizing behavior, EIPV in toddlerhood/preschool, but not in infancy, also differentiated patterns of IPV from ages 26 to 32. Findings converge on toddlerhood/preschool as a particular promising developmental period to intervene and deter long-term effects of EIPV on IPV across the transition from early adulthood to adulthood. (PsycINFO Database Record

Mother-infant attachment and the intergenerational transmission of posttraumatic stress disorder.

Evidence for the intergenerational transmission of posttraumatic stress disorder (PTSD) is documented in the literature, although the underlying mechanisms are poorly understood. Attachment theory provides a framework for elucidating the ways in which maternal PTSD may increase offspring PTSD vulnerability. The current study utilized two independent prospective data sets to test the hypotheses that (a) maternal PTSD increases the probability of developing an insecure mother-infant attachment relationship and (b) an insecure mother-infant attachment relationship increases the risk of developing PTSD following trauma exposure in later life. In the first study of urban, primarily low-income ethnic/racial minority mothers and infants (N = 45 dyads), elevated maternal PTSD symptoms at 6 months were associated with increased risk for an insecure, particularly disorganized, mother-infant attachment relationship at 13 months. In the second birth cohort of urban, low-income mothers and children (N = 96 dyads), insecure (avoidant or resistant) attachment in infancy was associated in a dose-response manner with increased lifetime risk for a diagnosis of PTSD by adolescence. A history of disorganized attachment in infancy predicted severity of PTSD symptoms, including reexperiencing, avoidance, hyperarousal, and total symptoms, at 17.5 years. In both studies, associations between attachment and PTSD were not attributable to numerous co-occurring risk factors. The findings suggest that promoting positive mother-child relationships in early development, particularly in populations at high risk for trauma exposure, may reduce the incidence of PTSD.

Adolescent conflict as a developmental process in the prospective pathway from exposure to interparental violence to dating violence.

Within a developmental psychopathology framework, the current study examined adolescent conflict (age 16) with families, best friends, and dating partners as mediators in the prospective pathway from exposure to interparental violence (EIPV) in early childhood (0-64 months) to dating violence perpetration and victimization in early adulthood (age 23). Adolescent conflict was predicted to partially mediate EIPV and dating violence with significant direct paths from EIPV to dating violence, given the extant literature on the salience of early childhood EIPV for later maladjustment. Participants (N = 182; 99 males, 83 females; 67 % Caucasian, 11 % African-American, 18 % other, 4 % unreported) were drawn from a larger prospective study of high-risk mothers (aged 12-34 years) that followed their children from birth through adulthood. EIPV and adolescent conflict were rated from interviews with mothers and participants, and dating violence (physical perpetration and victimization) was assessed with the Conflict Tactics Scale. Path analyses showed that EIPV in early childhood (a) directly predicted dating violence perpetration in early adulthood and (b) predicted conflict with best friends, which in turn predicted dating violence perpetration. Although mediation of best friend conflict was not evident, indirect effects of EIPV to dating violence were found through externalizing behaviors in adolescence and life stress in early adulthood. Findings highlight that conflict with best friends is affected by EIPV and predicts dating violence, suggesting that it may be a promising target for relationship-based interventions for youth with EIPV histories. Furthermore, deleterious early experiences and contemporaneous risk factors are salient predictors of dating violence.

Developmental timing and continuity of exposure to interparental violence and externalizing behavior as prospective predictors of dating violence.

This study investigated the prospective pathways of children's exposure to interparental violence (EIPV) in early and middle childhood and externalizing behavior in middle childhood and adolescence as developmental predictors of dating violence perpetration and victimization at ages 23 and 26 years. Participants (N = 168) were drawn from a longitudinal study of low-income families. Path analyses examined whether timing or continuity of EIPV predicted dating violence and whether timing or continuity of externalizing behavior mediated these pathways. Results indicated that EIPV in early childhood directly predicted perpetration and victimization at age 23. There were significant indirect effects from EIPV to dating violence through externalizing behavior in adolescence and life stress at age 23. Independent of EIPV, externalizing behavior in middle childhood also predicted dating violence through externalizing behavior in adolescence and life stress at age 23, but this pathway stemmed from maltreatment. These results highlight that the timing of EIPV and both the timing and the continuity of externalizing behavior are critical risks for the intergenerational transmission of dating violence. The findings support a developmental perspective that negative early experiences and children's externalizing behavior are powerful influences for dating violence in early adulthood.

Genetic contributions to continuity and change in attachment security: a prospective, longitudinal investigation from infancy to young adulthood.

BACKGROUND: Longitudinal research has demonstrated that individual differences in attachment security show only modest continuity from infancy to adulthood. Recent findings based on retrospective reports suggest that individuals' genetic variation may moderate the developmental associations between early attachment-relevant relationship experiences and adult attachment security. The purpose of this study was to use a prospective, longitudinal design to investigate genetic contributions to continuity and changes in attachment security from infancy to young adulthood in a higher risk sample. METHODS: Infant attachment security was assessed using the Strange Situation Procedure at 12 and 18 months. Adults' general attachment representations were assessed using the Adult Attachment Interview at ages 19 and 26. Romantic attachment representations were assessed with the Current Relationship Interview (CRI) at ages 20-21 and ages 26-28. Individuals were genotyped for variants within the oxytocin receptor (OXTR), dopamine D4 receptor (DRD4), and serotonin transporter linked polymorphic region (5-HTTLPR). RESULTS: The continuity of attachment security from infancy into young adulthood was consistently moderated by OXTR genetic variation. Infant attachment security predicted the security of adults' general and romantic attachment representations only for individuals with the OXTR G/G genotype. This interaction was significant when predicting adult attachment security as measured by the Adult Attachment Interview at ages 19 and 26 and the CRI at ages 26-28. Dopamine D4 receptor and 5-HTTLPR genetic variation did not consistently moderate the longitudinal associations between attachment security during infancy and adulthood. CONCLUSIONS: This study provides initial longitudinal evidence for genetic contributions to continuity and change in attachment security from infancy to young adulthood. Genetic variation related to the oxytocin system may moderate the stability of attachment security across development.

The roles of antisocial history and emerging adulthood developmental adaption in predicting adult antisocial behavior.

Different trajectories of antisocial behavior in childhood and adolescence have been identified by several researchers. However, more needs to be known about the development of antisocial behavior in adulthood and about factors that account for continuity and change. In this study, we investigated the developmental course into adulthood of different trajectories of antisocial behavior in childhood and adolescence. Second, we examined the role of developmental adaptation in emerging adulthood in accounting for the continuity and change of antisocial behavior. The participants (N = 162) were drawn from an ongoing 28-year longitudinal study. Trajectory groups (EOP: Early Onset/Persistent, n = 30; AO: Adolescent Onset, n = 32; Other, n = 100) were based on measures of externalizing behavior assessed at six time points in childhood and adolescence. Through interviews and questionnaires in adulthood, the quality of romantic relationships and the participants' work ethic (age 23), duration of unemployment (between ages 23 and 26 years), the level of externalizing problems (ages 23 and 26), and the number of antisocial personality disorder symptoms (age 28) were assessed. Results indicated that individuals in the EOP group showed the highest levels of antisocial behavior throughout emerging and early adulthood. Negative experiences in the work and romantic relationship domains was related to the continuity of antisocial behavior in the EOP group. For the AO group, a shorter duration of unemployment was related to lower levels of antisocial behavior. This study shows that early history plays an important role in the development of antisocial behavior and in the way developmental adaptation in emerging adulthood accounts for continuity and change of antisocial behavior.

Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early life.

Young children are disproportionately exposed to interpersonal trauma (maltreatment, witnessing intimate partner violence [IPV]) and appear particularly susceptible to negative sequelae. Little is known about the factors influencing vulnerability to traumatic stress responses and other negative outcomes in early life. This study examined associations among interpersonal trauma exposure, sociodemographic risk, developmental competence, and posttraumatic stress disorder (PTSD) symptoms in 200 children assessed from birth to first grade via standardized observations, record reviews, and maternal and teacher interviews. More severe PTSD symptoms were predicted by greater trauma exposure (r = .43), greater sociodemographic risk (r = .22), and lower developmental competence (rs=−.31 and −.54 for preschool and school-age developmental competence, respectively). Developmental competence partially mediated the association between trauma exposure and symptoms. Trauma exposure fully mediated the association between sociodemographic risk and symptoms. Neither sociodemographic risk nor developmental competence moderated trauma exposure effects on symptoms. The findings suggest that (a)exposure to maltreatment and IPV has additive effects on posttraumatic stress risk in early life, (b) associations between sociodemographic adversity and poor mental health may be attributable to increased trauma exposure in disadvantaged populations, and (c) early exposures have a negative cascade effect on developmental competence and mental health.

The developmental significance of late adolescent substance use for early adult functioning.

This study examines the predictive significance of late adolescent substance use groups (i.e., abstainers, experimental users, at-risk users, and abusers) for early adult adaptation. Participants (N = 159) were drawn from a prospective longitudinal study of first-born children of low-income mothers. At 17.5 years of age, participants were assigned to substance use groups on the basis of their level of substance use involvement. At 26 years, early adult competence was assessed in the areas of education, work, romantic relationships, and global adaptation. Results indicate that 17.5-year substance use group membership significantly predicted high school completion, regular involvement in a long-term romantic relationship, good or better work ethic, and good or better global adjustment at 26 years when controlling for gender; IQ; 16-year internalizing and externalizing behavior problems, parental monitoring, and peer competence; and current substance use at 26 years. Group comparisons indicate that late adolescent substance use experimenters were significantly more likely in early adulthood to have (a) a high school diploma or higher level of education compared with abstainers (OR = 8.83); (b) regular involvement in long-term romantic relationships (OR = 3.23), and good or better global adaptation (OR = 4.08) compared with at-risk users; and (c) good or better work ethic (OR = 4.04) compared with abusers. This research indicates that patterns of late adolescent substance use has implications for early adult functioning in salient developmental domains.

Contributions of maltreatment and serotonin transporter genotype to depression in childhood, adolescence, and early adulthood.

BACKGROUND: Past findings on gene-by-environment (G×E) effects on depression have been mixed, leading to a debate of the plausibility of such mechanisms and methodological considerations that warrant attention. A developmental systems perspective postulates that complex, multi-level G×E effects are likely contributors to depression. METHODS: Participants from families experiencing low-income status at birth were followed over 28 years. Maltreatment was recorded prospectively using multiple means and sources. Depression was measured repeatedly using well-validated interviews in middle childhood, through adolescence, and into adulthood. RESULTS: Findings support a G×E effect where the less efficient form of the promoter region of the serotonin transporter gene (5-HTTLPR) contributes to a vulnerability to depressogenic aspects of maltreatment in childhood and adolescence. The presence of less efficient forms of the 5-HTTLPR polymorphism and maltreatment together raised risk for depression. This G×E effect was present generally and also among those who reported clinical levels of depression at only one point in time. LIMITATIONS: This study used a low-income sample which limits generalizability to other populations. Sample size and rates of different forms of depression and depression at individual developmental stages supported general analyses, but limited the sorts of specific sub-analyses that were possible. CONCLUSIONS: These findings support the plausibility of G×E effects on depression during childhood, adolescence, and early adulthood, key periods for the development of depression. Ongoing debates about the presence of G×E effects would be well served by additional work that was theoretically informed and employed prospective, longitudinal methodologies with well-validated measures of key constructs.

Genetic and caregiving-based contributions to infant attachment: unique associations with distress reactivity and attachment security.

In the longitudinal study reported here, we examined genetic and caregiving-based contributions to individual differences in infant attachment classifications. For 154 mother-infant pairs, we rated mothers' responsiveness to their 6-month-old infants during naturalistic interactions and classified infants' attachment organization at 12 and 18 months using the Strange Situation procedure. These infants were later genotyped with respect to the serotonin-transporter-linked polymorphic region (5-HTTLPR). Maternal responsiveness uniquely predicted infants' attachment security. Infants' 5-HTTLPR variation uniquely predicted their subtype of attachment security at 12 months and their subtype of attachment insecurity at 12 and 18 months. The short allele for 5-HTTLPR was associated with attachment classifications characterized by higher emotional distress. These findings suggest that 5-HTTLPR variation contributes to infants' emotional reactivity and that the degree to which caregivers are responsive influences how effectively infants use their caregivers for emotion regulation. Theoretical implications for the study of genetic and caregiving influences are discussed.

Interpersonal trauma exposure and cognitive development in children to age 8 years: a longitudinal study.

BACKGROUND: Childhood trauma exposure has been associated with deficits in cognitive functioning. The influence of timing of exposure on the magnitude and persistence of deficits is not well understood. The impact of exposure in early development has been especially under-investigated. This study examined the impact of interpersonal trauma exposure (IPT) in the first years of life on childhood cognitive functioning. METHODS: Children (N=206) participating in a longitudinal birth cohort study were assessed prospectively for exposure to IPT (physical or emotional abuse or neglect, sexual abuse, witnessing maternal partner violence) between birth and 64 months. Child intelligent quotient (IQ) scores were assessed at 24, 64 and 96 months of age. Race/ethnicity, gender, socioeconomic status, maternal IQ, birth complications, birth weight and cognitive stimulation in the home were also assessed. RESULTS: IPT was significantly associated with decreased cognitive scores at all time points, even after controlling for socio-demographic factors, maternal IQ, birth complications, birth weight and cognitive stimulation in the home. IPT in the first 2 years appeared to be especially detrimental. On average, compared with children not exposed to IPT in the first 2 years, exposed children scored one-half SD lower across cognitive assessments. CONCLUSION: IPT in early life may have adverse effects on cognitive development. IPT during the first 2 years may have particular impact, with effects persisting at least into later childhood.

Parenting and infant difficulty: testing a mutual exacerbation hypothesis to predict early onset conduct problems.

The prediction of conduct problems (CPs) from infant difficulty and parenting measured in the first 6 months of life was studied in a sample of 267 high-risk mother-child dyads. Stable, cross-situational CPs at school entry (5-6 years) were predicted by negative infancy parenting, mediated by mutually angry and hostile mother-toddler interactions at 24-42 months. Mother-child interactions late in toddlerhood were especially relevant for CPs. Contrary to predictions, difficult child behavior in the first 6 months of life was not consistently associated with CPs, either independently or in interaction with negative infancy parenting. The findings most strongly highlight the role of negative mothering in early infancy, and of changes in mother-toddler interaction, in early onset CPs.

Transactional relations across contextual strain, parenting quality, and early childhood regulation and adaptation in a high-risk sample.

This investigation examined transactional relations across contextual strain, parenting quality, and child adjustment in 209 mothers and children at 24, 42, and 72 months of age. Independent ratings of mothers' stressful life events, social support, and relationship quality provided an objective measure of maternal contextual strain. Observers evaluated parenting quality during parent-child interactions at each time point. Child regulatory functioning during laboratory tasks at 24 and 42 months was evaluated by independent observers based on both behavioral (e.g., noncompliance, distractibility) and emotional (e.g., frustration, anger) indices. At 72 months, teachers reported on children's externalizing behaviors, and children completed objective measures of academic achievement. Nested path analyses were used to evaluate increasingly complex models of influence, including transactional relations between child and parent, effects from contextual strain to parenting and child adaptation, and reciprocal effects from child and parent behavior to contextual strain. Over and above stability within each domain and cross-sectional cross-domain covariation, significant paths emerged from maternal contextual strain to subsequent child adjustment. Bidirectional relations between parenting and child adjustment were especially prominent among boys. These findings counter unidirectional models of parent-mediated contextual effects by highlighting the direct influences of contextual strain and parent-child transactions on early childhood behavioral and academic adjustment, respectively.

A prospective investigation of the development of borderline personality symptoms.

The antecedents and developmental course of borderline personality disorder symptoms were examined prospectively from infancy to adulthood using longitudinal data from a risk sample (N = 162). Borderline personality disorder symptom counts were derived from the Structured Clinical Interview for DSM Disorders diagnostic interview at age 28 years. Correlational analyses confirmed expected relations between borderline symptoms and contemporary adult disturbance (e.g., self-injurious behavior, dissociative symptoms, drug use, relational violence) as well as maltreatment history. Antecedent correlational and regression analyses revealed significant links between borderline symptoms in adulthood and endogenous (i.e., temperament) and environmental (e.g., attachment disorganization, parental hostility) history in early childhood and disturbance across domains of child functioning (e.g., attention, emotion, behavior, relationship, self-representation) in middle childhood/early adolescence. Process analyses revealed a significant mediating effect of self-representation on the relation between attachment disorganization on borderline symptoms. The findings are discussed within a developmental psychopathology framework in which disturbance in self-processes is constructed through successive transactions between the individual and environment.

Infancy parenting and externalizing psychopathology from childhood through adulthood: developmental trends.

Developmental models and previous findings suggest that early parenting is more strongly associated with externalizing problems in early childhood than it is in adolescence. In this article, the authors address whether the association of poor-quality infancy parenting and externalizing problems "rebounds" in adulthood. Poor-quality infancy parenting was associated with externalizing problems at kindergarten and first grade (mother report) as well as at 23 and 26 years (self report). Infancy parenting was not significantly associated with either mothers' or youths' reports of externalizing problems at 16 years. These findings are consistent with the notion that poor-quality infancy parenting is a risk factor for externalizing problems in developmental periods for which externalizing behavior is most deviant.

The relation of emotional maltreatment to early adolescent competence: developmental processes in a prospective study.

OBJECTIVES: This investigation examined developmental pathways between childhood emotional maltreatment and adaptational outcomes in early adolescence. This study utilized a developmental psychopathology perspective in adopting a multidimensional approach to the assessment of different forms of emotional maltreatment and later adjustment outcomes. Specifically, emotional abuse (i.e., verbal criticism, hostility) and emotional neglect (i.e., psychological unavailability) were compared using a process-level analytic approach to examine if and how different forms of emotional maltreatment would contribute to adolescent adjustment via aggression and social withdrawal in middle childhood. METHODS: The current study sample is drawn from a longitudinal, prospective study of a high-risk community sample (N=196), incorporating a multi-method and multi-informant design. Multiple mediator models were tested via bootstrapping regression techniques. RESULTS: Bivariate correlations revealed that both emotional neglect and emotional abuse were associated with increased aggression and social withdrawal in middle childhood, and lower ratings of socioemotional competence in early adolescence. However, the mediational model, which controlled for child gender and concurrent physical and sexual maltreatment, was only significant for the contribution of emotional abuse to lower adolescent competence via social withdrawal in middle childhood. Post hoc analyses revealed that this association was only significant for boys. CONCLUSIONS: While social withdrawal in middle childhood significantly explained the observed relation between emotional abuse and decreased competence in adolescence, this process did not emerge as salient in understanding the relation between emotional neglect and adolescent adaptation. Furthermore, these developmental processes appeared to vary by gender. The results are in need of replication and extension to other outcome domains, but represent an important contribution to the empirical study of specific forms of emotional maltreatment. PRACTICE IMPLICATIONS: Emotional maltreatment is generally overlooked and unrecognized as compared to physical or sexual forms of maltreatment. This study adds to the accumulating empirical evidence that the effects of emotional maltreatment are disabling, enduring, and should be carefully assessed by clinicians. Furthermore, this assessment should specify the particular form of emotional maltreatment that has occurred, as the results of the study indicate that developmental processes and adjustment outcomes may vary according the type of emotional maltreatment (i.e., emotional abuse, emotional neglect) that is experienced. Finally, clinicians must recognize that a single maltreatment type may vary in its impact on subsequent adjustment, as significant gender differences emerged in the current study that point to the role of individual differences that warrant further investigation.

Identification of child maltreatment using prospective and self-report methodologies: a comparison of maltreatment incidence and relation to later psychopathology.

OBJECTIVES: One of the greatest methodological problems in the study of childhood maltreatment is the discrepancy in methods by which cases of child maltreatment are identified. The current study compared incidents of maltreatment identified prospectively, retrospectively, or through a combination of both methods. METHOD: Within a cohort of 170 participants followed from birth to age 19, incidents of maltreatment which occurred prior to age 17.5 were identified via prospective case review and interviewer ratings of retrospective self-reports. Multi-informant measures of behavior problems were obtained at age 16, and diagnostic assessments of psychopathology were completed at age 17.5. RESULTS: While the maximal number of maltreatment cases was identified by using a combination of all available identification methods, the prospective method was the single most comprehensive method for identifying the most cases of childhood physical abuse, sexual abuse, and neglect. Those who were identified as maltreated by a combination of both prospective and self-report methods experienced the greatest number of incidences of maltreatment (i.e., 49% of this group experienced more than one type of maltreatment) and displayed the most emotional and behavioral problems in late adolescence (i.e., 74% met diagnostic criteria for a clinical disorder). CONCLUSIONS: This study emphasizes the variability in the incidence rates of maltreatment and the psychological outcomes that result from utilizing different methods of identification. The most severe cases of maltreatment are likely to be identified by both prospective and retrospective methods; however, cases that are identified solely through retrospective self-report may have unique relations to psychopathology in late adolescence. PRACTICE IMPLICATIONS: Reliance on a single method to identify childhood maltreatment incidents often overlooks many cases. Comparing both prospective case reviews and retrospective self-reports in late adolescence, the most severe cases of multiple incidents of abuse were most likely to be identified by both methodologies. The less severe maltreatment incidents were more likely to be missed, either by prospective methods or, more frequently, by self-report methods. Practitioners must be continually sensitive to possible abuse histories among their clients, seeking out information from multiple sources whenever feasible. Additionally, the potential effects of abuse disclosure on pre-existing or developing psychopathology should be considered.

Childhood and adolescent predictors of heavy drinking and alcohol use disorders in early adulthood: a longitudinal developmental analysis.

AIMS: To identify childhood and adolescent factors differentiating heavy alcohol users in early adulthood from more moderate users or abstainers. DESIGN: Low-income participants followed from birth to age 28 years. PARTICIPANTS: A total of 178 adults (95 males) who were first-born children of low-income mothers recruited in Minneapolis, Minnesota, during their third trimester of pregnancy. MEASUREMENTS: Maternal hostility (24/42 months), externalizing and internalizing behavior problems (9 years), peer acceptance and academic achievement (12 years), maternal alcohol use and participants' drinking behavior (16 years), quantity of alcohol use per occasion (19, 23 and 26 years), alcohol use disorders (28 years). FINDINGS: For men: (i) higher amounts of alcohol consumption at age 16 increased the odds of being a heavy drinker compared to an abstainer (age 19) and a moderate drinker (ages 23 and 26); (ii) lower achievement scores at age 12 and having a mother who drank more when the participant was age 16 increased the odds of being a heavy drinker compared to moderate drinker (age 26). Higher levels of externalizing behavior problems at age 9 and drinking more when the participants were age 16 increased the odds that men would have a current alcohol use disorder at age 28. For women: (i) drinking more at age 16 increased the odds of being a heavy drinker compared to being either an abstainer or a moderate drinker (age 26); (ii) having higher levels of achievement at age 12 increased the odds of being a heavy drinker compared to an abstainer at age 23. Adolescent alcohol use mediated the relation between externalizing behavior at age 9 and alcohol use at age 26 for women. CONCLUSIONS: Problem drinking may be the result of a long-term developmental process wherein childhood externalizing behavior problems sets a pathway leading to heavy drinking during and after adolescence.