Psychological Bulletin Copyright 1992 by the American Psychological Association, Inc.

1992, Vol. 111, No. 1,127-155 0033-2909/92/$3.00

Externalizing Behavior Problems and Academic Underachievement

in Childhood and Adolescence: Causal Relationships
and Underlying Mechanisms
Stephen P. Hinshaw
University of California, Berkeley

Conceptual and measurement issues surrounding externalizing behavior problems and academic
underachievement, the strength and specificity of the covariation between these domains, and the
viability of explanatory models that link these areas are reviewed. In childhood, inattention and
hyperactivity are stronger correlates of academic problems than is aggression; by adolescence,
however, antisocial behavior and delinquency are clearly associated with underachievement.
Whereas investigations with designs that allow accurate causal inference are scarce, unidirectional
paths from 1 domain to the other have received little support. Indeed, the overlap of externalizing
problems with cognitive and readiness deficits early in development suggests the influence of
antecedent variables. Low socioeconomic status, family adversity, subaverage IQ, language deficits,
and neurodevelopmental delay are explored as possible underlying factors.

Links between academic underachievement and difficulties
in behavioral adjustment have long been noted (Sampson,
1966; see also historical review of McGee, Share, Moffitt, Wil-
liams, & Silva, 1988). When several British epidemiologic in-
vestigations in the 1960s and early 1970s yielded clear evidence
of overlap between reading deficits and behavioral problems of
an acting-out or externalizing nature, interest in the phenome-
non was rekindled (see review of Rutter, 1974). This association
continues to generate research and lively debate (e.g., McGee &
Share, 1988; Patterson, 1990; Rourke, 1988; Rutter, 1989;
Schonfeld, 1990; Silver, 1990) for several reasons: First, in terms
of prevalence rates, personal and societal suffering, and resis-
tance to most intervention strategies, both externalizing behav-
ior problems and achievement difficulties constitute major
problems of childhood (Kazdin, 1987; Taylor, 1988). Second,
each domain strongly predicts later maladjustment, in that ex-
ternalizing problems often lead to antisocial behavior and sub-
stance abuse (Eron, 1987; Gittelman, Mannuzza, Shenker, &
Bonagura, 1985), and severe underachievement in reading not
only persists but also carries a poor prognosis for other domains
(Rutter & Yule, 1975; Spreen, 1988). Third, elucidation of un-
derlying mechanisms may yield theoretical insights into behav-
ior-cognition links in both normal and atypical development,
an important tenet of the field of developmental psychopathol-
ogy (Cicchetti, 1989). Fourth, the association has direct impli-
cations for policy, as evidenced by recent efforts toward modify-
ing U.S. law to include attentional deficits as a distinct category
Work on this article was supported by National Institute of Mental
Health Grant No. MH 45064.
I acknowledge the insightful comments of three anonymous re-
viewers, whose critiques facilitated the development of the arguments
herein.
Correspondence concerning this article should be addressed to Ste-
phen P. Hinshaw, Department of Psychology, Tolman Hall, University
of California, Berkeley, California 94720.
deserving of special education services (Professional Group for
ADD and Related Disorders, 1991).
Definition of Domains
Externalizing Behavior
Childhood behaviors marked by defiance, impulsivity,
disruptiveness, aggression, antisocial features, and overactivity
are called undercontrolled, or externalizing (see Achenbach &
Edelbrock, 1978). The distinctiveness of such features from be-
havior patterns termed overcontrolled, or internalizingevi-
denced by withdrawal, dysphoria, and anxietyhas been es-
tablished in numerous investigations (for a review, see Quay,
1986).1 Most notably, externalizing problems are more stable
than internalizing behaviors, carrying (except in instances of
severe inhibition or depression) a worse prognosis as well as
resistance to most forms of intervention (Robins, 1979).
In child psychopathology, behavioral deviance can be char-
acterized in several ways. For example, to convey a dimension of
behavior, investigators typically sum or average data gathered
from rating scales or behavior observations, yielding a quantita-
tive score. Through application of cutoff scores or multivariate-
clustering strategies, the same instruments may yield a category
that is, a subgroup of children with common characteristics.
When investigators use extensive clinical judgments, inclusion-
ary markers, and clear exclusionary criteria, they obtain diag-
noses. Finally, alternative definitions, such as the legal entity of
juvenile delinquency, are sometimes invoked with respect to
antisocial activities. This review includes reports that make use
1
The domains are not completely independent, however. In fact,
correlations between externalizing and internalizing behaviors are of-
ten moderate to high, especially when considerable psychopathology
exists and particularly in young children (Achenbach & Edelbrock,
1983; Rose, Rose, & Feldman, 1989).

127
128 STEPHEN P. HINSHAW
of each of these means of defining externalizing behavior prob-
lems.
A major issue for the field is the validity of narrower dimen-
sions or categories within the externalizing domain. Such valid-
ity depends on the potential separability of dimensions or sub-
groups, not only on the basis of defining criteria, butmore
importanton their degree of independence or divergent valid-
ity concerning such external variables as family history, patho-
physiology, course, and response to intervention. Although
opinion was strong in the recent past that undercontrolled be-
havior was unidimensional and that externalizing subtypes of
children were not distinct (e.g, Quay, 1979; Sandberg, Wiesel-
berg, & Shaffer, 1980), consensus has emerged that two major
types of externalizing behavior, inattention and hyperactivity
on the one hand and aggression-conduct problems on the
other, show at least partial independence and some degree of
divergent validity (Hinshaw, 1987). Thus, despite their consider-
able overlap (e.g., Offord, Alder, & Boyle, 1986; Szatmari, Boyle,
& Offord, 1989a), I consider these features separately in relation
to academic underachievement.2
Prevalence estimates for externalizing disorders vary with
the stringency of definitional criteria. For categories that are
based on quantitative instruments, cutoff scores of 1.5 or 2
standard deviations above the population mean are often used,
yielding from about 2% to over 15% of the population, depend-
ing on the skewness of the distribution of scores. Because of the
heterogeneity of categories defined solely on the basis of cutoff
scores, their validity is often limited. Regarding formal diag-
nostic criteria, the official psychiatric nosology in the US.
Diagnostic and Statistical Manual of Mental Disorders (DSM-
III-R) lists several disruptive behavior disorders (American Psy-
chiatric Association [APA], 1987). Conduct disorder, which in-
volves persistent patterns of rule-breaking and violent behav-
ior, is estimated to have a prevalence of 9% for boys and 2% for
girls (see also Offord et al, 1986). Attention-deficit hyperactiv-
ity disorder (ADHD), signifying developmental^ inappropri-
ate levels of inattention, impulsivity, and overactivity, is believed
to have an overall prevalence of approximately 3%; boys out-
number girls by a considerable margin, particularly in clinical
samples (APA, 1987; see also Szatmari, Offord, & Boyle, 1989).
Oppositional-defiant disorder, a controversial category that
may constitute a precursor of conduct disorder, has an un-
known prevalence, in large measure because of its marginal
reliability and questionable validity (Key et al, 1988). Precise
prevalence figures for these disorders await (a) investigations of
the validity of various definitions and (b) continued refinement
of sampling and instrumentation in epidemiologic studies.
The significance of externalizing behaviors is indicated by
their correlates and their persistent course. Attentional prob-
lems are associated with such variegated features as develop-
mental immaturity, language delays, and accidents (e.g., poison-
ing and bone fractures); conduct problems, on the other hand,
are correlated with both low family income and dysfunctional
family systems (e.g., Offord et al, 1986; Szatmari, Offord, &
Boyle, 1989). Furthermore, both attention-disordered and con-
duct-disordered children have noteworthy difficulties in peer
relationships (Milich & Landau, 1989), and follow-up studies
have documented the intransigence of both inattentive-hyper-
active behavior patterns (e.g, Barkley, Fischer, Edelbrock, &
Smallish, 1990; Weiss & Hechtman, 1986) and aggressive-con-
duct-disordered behavior (e.g, Eron, 1987; Robins, 1970; Rut-
ter, Tizard, Yule, Graham, & Whitmore, 1976). In all, given
their prevalence, correlates, and persistence, externalizing be-
havior problems constitute a major problem for society (Kaz-
din, 1987).
Academic Underachievement
Below-average academic attainment can be classified in sev-
eral ways. In the first place, the achievement domain of interest
must be specified. Because of the need for literacy in industri-
alized societies, proficiency in reading is essential, and those
who investigate achievement difficulties focus nearly exclu-
sively on problems in reading decoding and reading compre-
hension. Difficulties in spelling, particularly those of a pho-
netically inaccurate nature, are correlated strongly with reading
deficiencies (Sweeney & Rourke, 1985); I do not consider them
separately. Although increasing interest has been shown in chil-
dren with arithmetic and mathematics disorders (e.g, Strang &
Rourke, 1985), I focus on deficient reading achievement herein.
Next, the degree of underachievement and its relation to
measured intelligence must be considered. In the classic study
of Rutter and Yule (1975), subaverage reading achievement was
subdivided into two categories: (a) reading achievement signifi-
cantly behind the level expected for the child's age (termed gen-
eral reading backwardness, or GRB) versus (b) reading achieve-
ment significantly behind the level predicted from intelligence
as well as age (specific reading retardation, or SRR). Both the
nature of these definitional criteria and the sizable association
between IQ and reading scores dictate that GRB children
usually display somewhat subaverage intellectual performance
(particularly in the verbal domain), which is invoked as the
major explanation for their reading difficulties, whereas
youngsters with SRR typically have average or above-average
IQ scores. Although considerable overlap between these groups
exists (i.e, nearly all children with SRR can also be classified as
GRB; about half of the youngsters with GRB also have specific
reading deficits), meaningful comparisons can be made be-
tween "pure" GRB childrenthose without IQ-discrepant
reading scoresversus those with "specific" reading deficits.
Rutter and \ule (1975) revealed a pattern of differential corre-
lates for these two groups. Compared with GRB children, chil-
dren with SRR overwhelmingly were boys, had fewer neurologi-
cal signs, and displayed a somewhat better outcome in arithme-
tic but had a far worse prognosis in reading and spelling.
Although replication efforts have not confirmed all such differ-
ences (e.g, Silva, McGee, & Williams, 1985), the separability of
2
Recent reports have explored the potential validity of further sub-
divisions. For example, evidence exists that inattention and motoric
overactivity constitute separable subdimensions of hyperactivity and
that antisocial behaviors may profitably be subdivided into those that
are overtly aggressivefighting, defiance, tantrumsversus those
that are clandestine or covertfire setting, truancy, cheating, stealing
(see Loeber & Lahey, 1989, for a review). In focusing on the two major
subdivisions, I use the terms attention deficits, attention-deficit hyperac-
tivity disorder (ADHD), and hyperactivity interchangeably to refer to one
type and aggression, antisocial behavior, and conduct disorder to de-
note the other dimension/category.
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
these two groups is at least partially validated, mandating the
specification of IQ levels in children with reading difficulties
(see also Aman & Singh, 1983).3 Furthermore, to ensure that
measures of intellectual ability are not confounded with read-
ing skill, individual (as opposed to group-administered) IQ
tests are necessary.
As with externalizing behavior, the prevalence of under-
achievement varies with the stringency of the denning criteria.
With a relatively stringent cutoff of reading scores at least 28
months below age norms, the prevalence of GRB for 10-year-
old boys was found to be approximately 7% in a rural setting
(Isle of Wight) and nearly 20% in inner London (Rutter et al.,
1974). Regarding SRR, defined by a reading score at least 2
standard errors of estimate below the level predicted from IQ,
the respective rates were approximately 4% and 10%. Current
American estimates for specific (i.e., IQ-discrepant) reading dis-
abilities are similar, from 2% to 8% of the school-age population
(APA, 1987). Although boys are considered at higher risk to
display specific (but not necessarily general) reading delays,
recent data indicate that the preponderance of boys referred for
learning difficulties may reflect biases in teacher identification
procedures and in the greater amounts of problem behavior
displayed by reading disabled boys (McGee et al, 1988; Shay-
witz, Shaywitz, Fletcher, & Escobar, 1990).
The problems of children who display academic under-
achievement are not limited to the academic domain. Indeed,
self-esteem deficits, problems in language skills, and interper-
sonal difficulties are common (e.g, Mann & Brady, 1988; Stone
& LaGreca, 1990). Also, as noted above, youngsters with IQ-
discrepant reading deficits tend to remain well behind their
peers in reading skills during their educational careers (McGee
et al., 1988; Rutter et al, 1976; see review of Spreen, 1988).
Thus, like externalizing behavior, underachievement in read-
ing has meaningful correlates and a persistent course.
Perhaps because of the rather inexplicable nature of the per-
sistent reading problems of children with SRRwho, with nor-
mal IQs and few neurological signs, would be expected to make
adequate gainsconsiderable research interest has focused on
this group. In the United States, the educational term learning
disability and the psychiatric term specific developmental dis-
order (APA, 1987) are used to describe the problems of these
children, who are the subjects of most investigations in the
field.4 \fet I do not limit my coverage to specific (IQ-discrepant)
reading problems. In the first place, the majority of children
with achievement deficits do not display intelligence-attain-
ment disparities (e.g, Rutter, Tizard, & Whitmore, 1970); thus,
the exclusion of such problems as low grades, special class place-
ment, or general reading problems could severely limit general-
izability. Second, the separation of specific from general read-
ing delay is often problematic, especially for young children:
The categories overlap considerably and their distinctiveness is
unstable across development (e.g, McGee, Williams, Share,
Anderson, & Silva, 1986). Finally, because recent longitudinal
findings demonstrate provocative links between early verbal
deficits and externalizing behavior in adolescence (Schonfeld,
Shaffer, O'Connor, & Portnoy, 1988), low verbal intelligence
may be an important domain in its own right. On the other
hand, the relatively unequivocal causal link between globally
retarded intellectual performance and a host of behavioral and
129
emotional problems (see Rutter et al, 1970) dictates that I do
not consider studies of children with clear mental retardation.
Conceptual, Developmental, and Measurement Issues
Before reviewing relevant empirical research, I should high-
light several thorny issues regarding the domains under consid-
eration. Discussion of these conceptual and methodologic
points focuses attention on the many difficulties that arise in
attempting to draw conclusions regarding causal precedence or
explanatory mechanisms. In the first place, as noted above,
both domains under consideration are extremely heteroge-
neous: Externalizing behavior problems comprise a wide vari-
ety of constituent behaviors, and definitions of underachieve-
ment also include a host of problems (e.g, subaverage IQ, spe-
cific achievement deficits, grade retention, poor marks in
school). Because some of the components within each area (e.g,
hyperactivity vs. aggression; specific vs. general reading defi-
cits) have been validated as partially independent, global state-
ments concerning linkages between underachievement and ex-
ternalizing behavior should often be replaced by models involv-
ing narrower variables. \fet much research in the field does not
make use of measurement strategies that can adequately distin-
guish among such subdivisions (see discussion of Loney & Mi-
lich, 1982), limiting the specificity of causal models that can be
formulated.5
Next, some of the components of each domain may be quite
contaminated with aspects of the alternate domain. For exam-
ple, retention and poor marks may be as closely related to behav-
ior as to achievement deficits per se (e.g, Mantzicopoulos,
Morrison, Hinshaw, & Carte, 1989). Thus, I focus primarily, but
3
Considerable controversy exists about the use of intelligence scores
as the criterion from which specific deficiencies in reading achieve-
ment are judged. For example, intelligence does not not constitute a
fixed capacity for academic attainment, as attested by recent evidence
that it does not place a rigid ceiling on reading levels (Share, McGee, &
Silva, 1989). Furthermore, the achievement problems of children with
marked reading deficits are real, regardless of their IQ scores. \et
knowledge of a child's intellectual level in relation to reading level may
still be important.
4
Indeed, the underlying deficits of this group often are presumed to
be of a subtle neurological variety, given their adequate intelligence
and given the typical exclusion of such factors as poor schooling and
cultural deprivation in diagnosis. Yet such diagnostic labels as dys-
lexia, which connotes an underlying neurological deficit for reading
disabilities, have been severely criticized because of the heterogeneity
of children with severe reading deficits and the lack of a consistent
neurological or neuropsychological explanation for specific reading
deficiencies (e.g., Rourke, 1985; Rutter & Yule, 1975). I make neither
assumptions of homogeneity nor automatic etiological inferences
about either academic underachievement or externalizing behavior
problems in this review.
5
Note that although components of a broadband construct may be
partially independent, these components may still coexist. For exam-
ple, regarding the externalizing domain, hyperactivity and aggression
often overlap (Hinshaw, 1987). Because achievement difficulties may
pertain chiefly to those youngsters displaying both types of external-
izing difficulty (e.g., McGee, Williams, & Silva, 1984b), a focus on
narrowband conceptions or on differentiated subgroups should not
overlook the frequent comorbidity between them.
130 STEPHEN P. HINSHAW
not exclusively, on appraisal of underachievement by individual
test administration. In addition, substantial debate centers
around whether inattention, considered heretofore as a type of
externalizing behavior, is actually a cognitive deficit (for debate,
see Barkley, 1989; Douglas, 1983; Sergeant, 1989). An associa-
tion between inattention (even if measured by adult ratings) and
underachievement may thus signify a link within the general
realm of cognitive deficits rather than a behavior-cognition
correlation.
Third, manifestations of both externalizing behavior and
underachievement change markedly over time. For example,
the same youngsters who display delinquency in adolescence
and severe antisocial behavior in adulthood often show comor-
bid aggression and hyperactivity during the grade school years
(Magnusson, 1988; Moffitt, 1990). Furthermore, many of these
same youngsters are quite likely to have displayed difficult tem-
peraments in infancy and marked oppositionality in the pre-
school era. In short, there may be a heterotypic continuity
across seemingly different aspects of externalizing behavior.
Similarly, many grade school children with reading deficits evi-
dence language delays during the preschool years, suggesting
that early linguistic deficits become commensurate with under-
achievement when academic curricula are introduced (e.g,
Mann & Brady, 1988). It follows that (a) measures must be tai-
lored to children's developmental levels and (b) the status of a
variable as a cause of problems in the counterpart domain (as
opposed to its status as a consequence of the alternate domain)
may be confused unless careful attention is paid to developmen-
tally sensitive measurement.
A hypothetical example may help to illustrate this last point.
Suppose it is discovered that in a given sample, acting-out behav-
ior in the first gradenot accompanied by underachievement
predicts IQ-discrepant reading deficits 3 years later. One
might be tempted to conclude that a unidirectional causal link-
age between early externalizing behavior and subsequent learn-
ing disabilities is supported. For one thing, however, it may be
nearly impossible to find IQ-discrepant reading failure in first
graders, because children cannot be 1 to 2 years behind pre-
dicted reading levels when they have been exposed to less than
one grade of formal schooling. In other words, methods of de-
fining underachievement in later years may be notably insensi-
tive at earlier phases of development. Furthermore, these hypo-
thetical first graders might well display delays (preexisting as
well as concurrent) in receptive or expressive language abilities,
delays that often translate directly into difficulties with the
phonologic processing necessary for proficiency in reading.
Such language deficits could actually be causative of early exter-
nalizing behavior and of subsequent underachievement. With-
out assessment of antecedent variables and without knowledge
of developmental trajectories, erroneous causal precedence
may well be inferred.
An additional issue pertains to the source of assessment data
regarding the domains under consideration, particularly exter-
nalizing behavior. Although adult informants provide the pri-
mary information regarding behavioral symptomatology, key
informants (e.g., parents vs. teachers) show rather modest corre-
spondence regarding their appraisals (see Achenbach, McCon-
aughy, & Howell, 1987). Furthermore, recent evidence suggests
that not only the prevalence but also the correlates of childhood
disorders vary when different sources are used to identify dis-
ordered behavior (Offord, Boyle, & Racine, 1989). Thus, associa-
tions with underachievement might pertain to externalizing
behavior as defined by one set of informants but not another.
This latter scenario would be particularly likely, for example,
when teacher ratings were used to define externalizing behav-
ior and when grades (given by teachers) indicated under-
achievement: Shared method variance might account for a
good deal of the cross-domain linkage.
For all of the reasons highlighted in this section, measure-
ment issues play a key role in explanatory accounts of overlap
between externalizing behavior and underachievement. Inves-
tigators must use both developmental ly sensitive measures and
designs that afford inference of causal precedence, including
assessment of antecedent variables, if cross-domain links are to
be elucidated fully. I therefore highlight factors related to meth-
odology in this review.
Evidence for the Association
Primarily to discover the specific types of underachievement
that are linked to subcategories of externalizing behavior, I now
review empirical evidence regarding the strength of the linkage
between domains. An initial question pertains to the degree of
covariation that would be meaningful or significant. Assuming
an upper bound estimate of 10% for the domain of IQ-discrep-
ant underachievement and a similar upper bound estimate of
10% for noteworthy externalizing behavior problems, the de-
gree of overlap would be 1%the product of the independent
probabilitiesif the domains were associated at chance levels.
In fact, however, some contend that the overlap between atten-
tional disorders and underachievement exceeds 50% (McGee &
Share, 1988). The wide range of comorbidity estimates
currently in the literature mandates careful appraisal of the
evidence.
Because of the well-documented problems associated with
inferring both prevalence and comorbidity rates from clinical
samples, which are typically biased toward extreme pathology
and toward frequent co-occurence of a wide range of associated
problems (see Rutter, 1989), the preferred database would com-
prise epidemiologic investigations of unselected populations.
Inspection of the major child epidemiologic studies from the
1970s and 1980s, however, reveals that very few studies of this
scope used individualized tests of achievement or intelligence,
reflecting the need for most epidemiologic investigators to
trade depth of assessment for breadth of coverage (for a review
of recent population surveys of child disorders, see Branden-
burg, Friedman, & Silver, 1990). Thus, I include only a handful
of relevant epidemiologic reports, beginning with ground-
breaking work by Rutter and colleagues (see Rutter, 1974, for a
review of earlier studies).
Key Epidemiologic Investigations
Isle of Wight and inner London studies. The epidemiologic
study that reawakened the field to the association of interest
was the Isle of Wight investigation of Rutter et al. (1970). This
pioneering study made use of a two-stage procedure for assess-
ing both underachievement and psychiatric disturbance. First,
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
the general population of 9- to 11-year-olds on this rural island
was screened for (a) intellectual and academic retardation, by
means of group achievement tests, and (b) psychiatric distur-
bance, by means of parent and teacher behavioral question-
naires. Children considered at risk for intellectual-scholastic
impairment, plus a randomly selected group of children from
the general population, then received individual testing; those
thought to manifest psychiatric disorder received semistruc-
tured parent-and-child interviews and additional adult ratings.
So as not to confound appraisal of the overlap between do-
mains, the cognitive and psychiatric evaluations were per-
formed independently.
Relevant to the topic of interest, children with SRR were
over four times more likely than the general population to dis-
play antisocial behavior, whether the latter was appraised from
teacher ratings, parent ratings, or child interviews. This overlap
was significantly larger than the association that would be ex-
pected by chance. For example, using data from the teacher
rating instrument, Rutter's Scale B (see Rutter, 1967), 24% of
the youngsters with SRR displayed above-cutoff levels of anti-
social behavior, compared with approximately 5% of the gen-
eral population. Furthermore, the reverse conditional probabili-
ties were similar, in that over a third of the youngsters meeting
criteria for antisocial behavior had SRR, a rate far higher than
would be expected by chance (see Rutter & Yule, 1970). This
epidemiologic investigation was replicated in an inner London
borough (see Berger, Yule, & Rutter, 1975), with similar but not
identical screening methods. The base rates of both SRR and
antisocial behavior were higher than on the Isle of Wight, and
the degree of overlap was also greater: Nearly half of the chil-
dren with SRR scored above cutoffs for antisocial behavior on
teacher ratings (see Sturge, 1982).
As regards specificity, several findings are noteworthy. First,
significant comorbidity was not found between SRR and classi-
fications of internalizing (neurotic) behavior on the Isle of
Wight. That is, SRR children did not have high levels of neu-
rotic behavior, and children classified as neurotic did not have
elevated levels of SRR, arguing for a specific link between SRR
and acting-out behavior problems. Second, although children
with GRB also had greater levels of problem behavior than did
the general population, this association was not specific to anti-
social behavior; GRB overlapped significantly with neurotic as
well as with antisocial behavior. It was therefore concluded that
antisocial behavior correlates more strongly and specifically
with achievement failure than with subaverage intelligence.
Although the formal classification of antisocial disturbance
in this investigation was made from interviews as well as rat-
ings, the figures presented above arose from the use of cutoffs
on teacher rating scales. The common use of such ratings to
ascertain externalizing behavior mandates brief comment.
First, although such ratings constitute an economical and gener-
ally accepted mechanism for obtaining information about chil-
dren's behavior, they are subject to distortions and bias (Saal,
Downey, & Lahey, 1980). They may be less sensitive to internal-
izing than to externalizing aspects of behavior, especially when
teachers are informants (e.g., Aman & Singh, 1983; Hinshaw,
Han, Erhardt, & Dressier, 1991); for adolescents, they may be
less sensitive to acting-out behavior than are self-reports (Of-
ford et al., 1986). Next, the dimensions and categories yielded
131
by a particular scale can incorporate only those domains ade-
quately represented in the item pool. As for the Rutter Scale B,
only two general, broadband dimensions (antisocial vs. neu-
rotic behavior) were available; the few items pertaining to inat-
tention and overactivity did not form a separate scale with early
use of this instrument (Rutter, 1967).6 Refinement of rating
instruments and interview protocols has led to respecification
of the linkage between externalizing behavior and under-
achievement for preadolescents.
Waltham Forest report. In a replication of the Isle of Wight
and inner London methodologies with a younger cohort, Rich-
man, Stevenson, and Graham (1982) studied linkages between
cognitive-reading difficulties and behavior problems in a mid-
dle-class outer borough of London. Data collection began with
over 800 three-year-olds, with follow-up at ages 4 and 8 for both
behavior-problem and nonrisk subsamples. I focus here on age
8 data; preschool precursors of both behavioral disturbance
and learning problems are addressed in a subsequent section.
To avoid "empty sets" of reading-delayed children, Richman
et al. (1982) eased the criteria for defining GRB and SRR from
28 to 18 months below age- or IQ-expected performance. Re-
garding cross-domain associations, children with behavioral
deviance (defined by parent and teacher ratings in addition to
global clinical severity ratings) were more likely than compari-
son youngsters to display underachievement, although the find-
ing fell short of statistical significance. In addition, for boys
only, GRB was associated with neurotic (but not with antiso-
cial) behavior. As noted by Richman et al., the relatively small
numbers of reading-delayed or behaviorally deviant children
may have reduced the power to ascertain overlap.
Dunedin study. A more recent source of epidemiologic data
is the Dunedin Multidisciplinary Child Development Study, a
major prospective study of a birth cohort in New Zealand.
Throughout this continuing investigation, which has followed
the cohort during odd-numbered years of life beginning at age
3, the association between cognitive-achievement delays and
externalizing behavior has been explored.
When the cohort was 7 years old, the Dunedin team per-
formed factor analyses with the Rutter teacher scale, yielding a
three-item Hyperactivity factor (composed of the items restless/
overactive, squirmy, and poor concentration/short attention
span) that was separate from the usual externalizing dimension
of aggressive and antisocial behavior (McGee, Williams, et al.,
1985; see also Schachar, Rutter, & Smith, 1981). Each of the
three dimensions of deviant behaviorAggressive-Antisocial,
Hyperactive, and Anxious-Fearful (corresponding to neurotic
or internalizing behavior)was examined for partial correla-
tions with Verbal and Performance IQ and with the Burt Read-
ing Test, controlling for the effects of the other two behavioral
dimensions. The partial correlations of the aggression and in-
ternalizing factor scores with the cognitive variables were es-
sentially zero, whereas the Hyperactivity dimension correlated
6
Also, because diagnostic interviews used in the Isle of Wight study
relied on British conceptions of hyperkinesis as a severe syndrome of
pervasively overactive behavior, usually accompanied by mental retar-
dation, the more formal diagnoses yielded by the Isle of Wight team
did not include categories congruent with current conceptions of at-
tentional deficits or hyperactivity.
132 STEPHEN P. HINSHAW
significantly (and negatively) with Verbal IQ, Performance IQ,
and reading level, even when the other behavioral dimensions
were controlled. The main conclusion is thus that hyperactiv-
ity-inattention is specifically associated with below-average in-
telligence and with underachievement in childhood, helping to
establish the validity of this domain as a subtype of externaliz-
ing behavior (see Hinshaw, 1987).
In a closely related report, McGee, Williams, and Silva
(1984b) used cutoff scores from the two externalizing factors to
classify the 7-year-olds into hyperactive, aggressive, hyperac-
tive-aggressive, or non-behaviorally disturbed categories. The
two hyperactive groups displayed deficits in IQ and achieve-
ment, but the aggressive-only children typically did not differ
from the control population. \fet aggression played an interac-
tive role regarding specific reading delays: At both 7 and 9
years, the hyperactive-aggressive subgroup had a rate of SRR
(36%) twice as high as rates for the single-disorder groups and
five times that of the control children. Such results again point
to the value of differentiating dimensions and categories within
the externalizing domain.
When the cohort had reached the age of 9, the Rutter parent
and teacher scales were supplemented with additional items of
inattentive, impulsive, and hyperactive behavior (McGee, Wil-
liams, & Silva, 1985). Not only did a more differentiated factor
structure emerge, with inattention forming an independent di-
mension, but also only this factor correlated with IQ, reading,
spelling, and speech measures (negatively in each case). Thus,
an even finer distinction among types of externalizing behav-
ior was partially validated, in that inattention was specifically
associated with achievement and IQ.
At age 11, the cohort's externalizing and internalizing fea-
tures were appraised by means of formal diagnostic interviews
with the children, which were supplemented by parent and
teacher reports to yield categories of attention-deficit disorder,
conduct-oppositional disorders, and internalizing disorders.
Only the children with attentional deficits (whether paired with
the conduct-oppositional or internalizing categories or alone)
displayed IQ, reading, and spelling performance scores below
those of the nondiagnosed and internalizing children (Ander-
son, Williams, McGee, & Silva, 1989). Also, 62% of the 45
children classified as pervasively ADHDthat is, categorized
on the basis of at least two independent sourceshad severe
SRR, defined by scores on the Burt Reading Test that were
below the entire sample's average score at age 9 (see also McGee
& Share, 1988). Thus, the earlier findings relating attentional
problems to underachievement were replicated with a more
formal diagnostic approach; such cross-method replicability
adds to the viability of the findings.
Dimensional IQ or reading scores were more often used in
the Dunedin reports than were the categories of SRR or GRB.
Indeed, these investigations raise the issue of the viability of
categorical classifications of reading deficits, particularly for
young children. First, as noted earlier, the typical requirement
of rather severe (28-month) disparities between reading level
and either intelligence or age is quite restrictive for young chil-
dren. Indeed, it is nearly impossible for children with even
slightly subaverage IQ scores to obtain reading scores lower
than 1.5 or 2 standard errors of estimate below prediction, leav-
ing the SRR category viable only for those young children with
relatively high IQ scores. In addition, even among somewhat
older children, the distinction between SRR and GRB across
the span of 9 to 11 years is relatively unstable (Share, McGee,
McKenzie, Williams, & Silva, 1987). Given the importance of
younger age groups for discerning underlying mechanisms that
could mediate the overlap between externalizing behavior and
underachievement, these difficulties in accurately categorizing
reading problems are noteworthy.
Overall, the Dunedin reports challenge the specificity of the
linkage between antisocial behavior and SRR found in the Isle
of Wight and inner London studies. Here, the externalizing
features of hyperactivity and inattention were associated with
both subaverage IQ and reading delays.7 Note, however, that
youngsters with the combination of hyperactivity and aggres-
sion were at greatly elevated risk for SRR in the Dunedin re-
ports.
Other epidemiologic investigations. Several other studies us-
ing epidemiologic methods or population sampling merit brief
mention. First, Lambert and Sandoval (1980) used various psy-
chometric criteria to classify a community sample as either (a)
hyperactivethat is, either home, school, or physician criteria
or (b) learning disabledthat is, various discrepancy formu-
las involving Wechsler Intelligence Scale for Children-Revised
(WISC-R) IQ and Peabody Individual Achievement Test
(PIAT) achievement scores. Under lenient criteria, 53.5% of
hyperactive subjects were defined as learning disabled, but so
were 20% of controls: a greatly inflated estimation. With more
conservative definitions, lesser percentages of both hyperactive
and control youngsters met criteria for learning disability (e.g.,
16% of hyperactive children and 11% of controls meeting three
of five strict criteria).
Second, although lacking individual cognitive assessments,
the Ontario Child Health Study provided demographic data for
Canadian 4- to 16-year-olds regarding both poor school perfor-
mance, defined as the child's having failed a grade or needing
full-time remedial education, and the use of special education
services (Szatmari, Boyle, & Offord, 1989). Whereas children
with carefully defined attention deficits displayed poorer
school performance and had higher rates of special education
usage than did nondiagnosed agemates, these rates were not
significantly different from those of children with other dis-
orders (a global category of conduct disorders and emotional
disorders). Given that retention and special education place-
ment may reflect general behavioral difficulties as well as
7
The British and New Zealand epidemiologic results may not be as
discrepant as they appear. Rutter and Graham (1970) divided the Rut-
ter Scale B items into informal clusters, one of which comprised four
"motoric" items (restless/overactive, fidgety, twitches, and poor con-
centration/short attention span). Inspection of Table 7.3 (Rutter &
Graham, 1970, p. 109) reveals that for children with specific reading
retardation (SRR), teachers endorsed these items much more fre-
quently than any from the antisocial cluster; indeed, the endorsement
of poor concentration was nearly 85% for SRR youngsters, almost
double the rate for any other item on the entire scale. Yet because such
items were not consolidated into a formal dimension with early use of
the Rutter scales, inattention-hyperactivity could not be indepen-
dently examined for covariation with reading delays.
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
achievement problems per se, the lack of divergent validity
among clinical disorders is not surprising.
In an Australian epidemiologic report, Holborow and Berry
(1986) used the Conners Abbreviated Symptom Questionnaire
(Goyette, Conners, & Ulrich, 1978) to measure hyperactivity
and used four additional teacher-completed items to determine
the prevalence of learning difficulties. Among children meet-
ing the typical cutoff score for hyperactivity on the Conners,
26.5% met rating criteria for learning difficulties, compared
with 5% of the remainder of the sample. Reversing the condi-
tional probabilities, over 40% of the children rated as having
learning problems were also considered hyperactive. The chief
limitation of this report is the ad hoc, teacher-rated definition
of learning difficulties, which contributes to shared method
variance for defining both underachievement and externaliz-
ing problems.
A salient issue is the age at which associations between behav-
ioral problems and achievement difficulties first emerge. Hin-
shaw, Morrison, Carte, and Cornsweet (1987) performed a popu-
lation study of kindergarten children in several suburban
school districts, with a participation rate of over 80%. Parent
and teacher ratings from the Revised Behavior Problem Check-
list (RBPC; Quay, 1983) were examined for associations with
group tests of academic readiness and individual intellectual
assessments. For teachers, whereas the Conduct Disorder factor
displayed nearly zero correlations with cognitive and early
achievement indexes, the Attention Problem and several inter-
nalizing scales showed negative correlations ranging from -.25
to .35. No significant correlations were noted for parent-rated
factors, however, suggesting that situational specificity may ex-
ist for the correlates of behavioral problems (see also Szatmari,
Offord, Siegel, Finlayson, & Tuff, 1990).
In a companion report with additional cohorts, Morrison,
Mantzicopoulos, and Carte (1989) found that children at risk
for learning disabilitiescategorized on the basis of low per-
ceptual and prereading skillswere rated as behaviorally de-
viant across all RBPC teacher dimensions. Yet partial correla-
tions (not calculated in published study) are noteworthy: The
correlation between attention problems and prereading achieve-
ment, partialing conduct problems, was a significant .25, but
the correlation of conduct problems with prereading, partial-
ing attention problems, was .00. Thus, even before children
experience a formal academic curriculum, hyperactivity is as-
sociated with readiness problems.
Summary. The specific link between antisocial behavior
and IQ-discrepant reading deficits from the seminal reports of
Rutter et al. (1970) and Berger et al. (1975) was not replicated in
the Dunedin studies, in which attentional deficits and hyperac-
tivity comprised the externalizing scales or categories that were
associated with both subaverage IQ and reading delay. A possi-
ble explanation is that the original Rutter Scale B used in En-
gland did not yield a separate inattention-hyperactivity factor;
only through addition of pertinent items and subsequent factor
analyses did divergently valid dimensions (and distinct sub-
groups) of aggression versus hyperactivity emerge. Other epide-
miologic results essentially confirm the finding that among
kindergarten and grade school children, inattention and hyper-
activity are the most consistent correlates of underachieve-
ment.
133
Clinical Reports
Although the nonrepresentativeness of clinical samples is po-
tentially problematic for inferring estimates of comorbidity,
most of the evidence for overlap between the domains of inter-
est comes from such sources. Given increasing sophistication
in sampling and instrumentation, I highlight key clinical re-
ports from the last dozen years. Because of the volume of such
studies, I make no claims for exhaustive coverage.
Links between externalizing disorders and underachievement
in elementary grades. Most clinical reports that examine over-
lap between externalizing problems and underachievement be-
fore adolescence focus on hyperactivity-attention deficits
rather than aggression or conduct disorder. In an early report
that made use of an IQ-achievement discrepancy formula for
ascertaining specific achievement deficits, Cantwell and Satter-
field (1978) found that 39% of a clinical sample of hyperactive
children (vs. 9% of controls) were two or more grades behind
their predicted grade level in reading. The same percentage of
overlap (39%) was found by August and Garfinkel (1990), who
used a DSM-III-R definition of ADHD and a non-regression-
based discrepancy formulaWide Range Achievement Test-
Revised (WRAT-R) scores 1 standard deviation below Peabody
Picture Vocabulary Test-Revised (PPVT-R) IQ scoresto de-
fine reading disability (see also August & Garfinkel, 1989).
On the other hand, among a clinical sample of 241 hyperac-
tive children, defined by cutoffs on the Conners Teacher Rating
Scale and clinical interviews with parents, only 22 (9%) met
criteria for specific reading disability, which was indicated by a
1 standard deviation disparity between WRAT Reading and
WISC IQ (Halperin, Gittelman, Klein, & Rudel, 1984). Further-
more, in a recent investigation with rigorously defined samples
of ADHD and ADHD-aggressive boys, Forness, Youpa,
Hanna, Cantwell, and Swanson (in press) found that only 6%
met strict criteria for reading disability (i.e., a reading score at
least 1.5 standard deviations of the difference below IQ), with
no difference in prevalence of reading problems between the
subgroups. With a slightly more lenient criterion of a 1 standard
deviation discrepancy, 10% (7 of the 71 boys) were reading dis-
abled.8 In short, unless one uses estimates of underachievement
that also classify overly large numbers of comparison children
as underachieving (Lambert & Sandoval, 1980), the contention
of McGee and Share (1988) that hyperactivity-attentional defi-
cits overlap with learning disabilities at rates above 50% does
not seem warranted.
Although these and other clinical reports have yielded
meager evidence for the differential relationship of hyperactiv-
ity versus aggression with underachievement (e.g., McCon-
aughy, Achenbach, & Gent, 1988; Reeves, Werry, Elkind, & Za-
metkin, 1987), the recent investigation of Frick et al. (1991) is
8
Because children with attentional disorders often score below
norms on an empirically derived cluster of Wechsler Intelligence Scale
for Children-Revised items (Arithmetic, Coding, and Digit Span; see
Kavale & Forness, 1984), their full-scale IQ scores may be somewhat
depressed, meaning that they must attain extremely low achievement
scores to meet stringent criteria for learning disability (e.g., a 1.5 stan-
dard deviation discrepancy from IQ). Thus, a 1 standard deviation
disparity is considered more valid by some investigators (Forness,
Youpa, Hanna, Cantwell, & Swanson, in press).
134 STEPHEN P. HINSHAW
noteworthy because of its exemplary methodology. Here, exter-
nalizing children were categorized into ADHD, conduct dis-
order, or clinic control diagnoses on the basis of combined
parent, child, and teacher interview data from the Diagnostic
Interview Schedule for Children. Underachievement was deter-
mined on the basis of regression-formula discrepancies be-
tween individual IQ and achievement scores that also con-
trolled for the age of the child. Depending on the stringency of
the denning formula for underachievement, from about 6% to
20% of either conduct-disordered or attention-disordered chil-
dren showed underachievement, reflecting a modest degree of
association between each domain and learning problems. "Vet
multivariate logit analyses that controlled for the co-occurrence
of ADHD and conduct disorder revealed that only attention-
disorder status was uniquely associated with underachieve-
ment. Indeed, the apparent overlap between conduct disorder
and underachievement was related to the presence of atten-
tional problems in many conduct-disordered children. Thus,
mirroring the epidemiologic results of the Dunedin investiga-
tion, Frick et al. (1991) concluded that attentional difficulties
constitute the externalizing domain that is uniquely associated
with underachievement during childhood.
To summarize, although rates of overlap between externaliz-
ing disorders and psychometrically defined learning disabili-
ties are above chance levels, recent investigations with rigorous
formulas for defining underachievement have yielded comor-
bidity estimates that are lower than earlier figures. These rates
are still higher, however, than those reported for internalizing
youngsters. In addition, children with externalizing disorders
often have achievement-related difficulties that may not be
classifiable as formal learning disabilities, including retention
and school suspension (Barkley et al., 1990; Forness et al., in
press). Furthermore, whereas many initial clinical reports did
not find differences between hyperactive and aggressive chil-
dren in rates of underachievement, the most methodologically
sophisticated investigation in the field (Frick et al., 1991) indi-
cates that hyperactivity-inattention is the externalizing domain
most clearly associated with academic failure during the child-
hood years (for cogent discussion and provocative longitudinal
findings, see Loney, Kramer, & Milich, 1981). Furthermore,
the academic status of hyperactive children continues to be
compromised during adolescent follow-up (Fischer, Barkley,
Edelbrock, & Smallish, 1990).
Links between externalizing disorders and cognitive-verbal
deficits. Although the focus of this review is on underachieve-
ment, more basic cognitive deficits might also be associated
with externalizing behavior problems. Whereas space limita-
tions preclude a comprehensive review of this issue, I consider
two recent reports that address the link between verbal, cogni-
tive, and perceptual deficits with externalizing behavior.
First, with the intention of distinguishing among clinical
diagnostic groups regarding mechanisms of psychopathology,
Werry, Elkind, and Reeves (1987) examined hyperactive, hyper-
active plus conduct-disordered, anxiety-disordered, and com-
parison subjects on a host of laboratory measures of cognition,
attention, motor coordination, impulsivity, and reading recogni-
tion (see also Reeves et al., 1987). The most striking finding was
that when age, sex, and PPVT scores were partialed from the
analyses that compared categories, almost none of the many
initial group differences remained. For instance, once equated
for PPVT scores, the three clinical groups did not differ in
reading achievement, arguing against a higher rate of specific
reading problems in the externalizing categories. Furthermore,
only the combined hyperactive plus conduct-disordered group
differed significantly in reading from the comparison subjects
when sex and PPVT were controlled. The conclusion was that
the major deficit of youngsters with externalizing problems
(particularly attention-deficit disorders) is in the area of verbal
abilities. Indeed, long-standing verbal deficits could potentially
be a powerful third variable, mediating both externalizing be-
havior and underachievement, a point addressed subsequently.
Second, Szatmari et al. (1990) measured neurocognitive
functioning in a clinic sample of externalizing and internaliz-
ing youngsters. Their battery included measures of visual-per-
ceptual processing and problem solving. Carefully diagnosed
groups of attention-disordered versus conduct-disordered chil-
dren did not differ regarding rates of neurocognitive deficits,
whereas both categories displayed more problems (primarily of
a visual-perceptual type) than did the internalizing young-
sters. When neurocognitive scores were used to predict dimen-
sional teacher ratings of problem behavior, teacher-rated school
performance mediated the relationship, suggesting that neuro-
cognitive impairments may lead to disturbed behavior by
means of underachievement. I discuss further the possible role
of perceptual-neurodevelopmental delay in predicting both ex-
ternalizing behavior and underachievement in a later section.
Links between juvenile delinquency and cognitive-achieve-
ment problems. Because of interest in tracking the overlap
between domains into adolescence, I briefly summarize find-
ings regarding the cognitive-achievement status of delinquent
youngsters. The volume of empirical reports on links between
delinquency and underachievement requires that I rely on sev-
eral major reviews (Hawkins & Lishner, 1987; Hirschi & Hinde-
lang, 1977; Loeber & Stouthamer-Loeber, 1987; Quay, 1987;
Rutter&Giller,1983).
First, delinquent adolescents have lower IQ scores than do
their peers, particularly in the verbal domain. Although such
intelligence deficits are not typically sufficient to place delin-
quents in a mentally retarded range, they are robust (on the
order of half a standard deviation) and are particularly evident
in subgroups of delinquent youngsters with aggressive-psycho-
pathic features (Quay, 1987). Such IQ deficits are not explain-
able by socioeconomic status (SES) or racial differences be-
tween delinquent and comparison groups (Hirschi & Hinde-
lang, 1977; Wilson & Herrnstein, 1985). Furthermore, from the
reverse perspective, high IQ scores serve as a protective factor
against delinquent outcomes for aggressive boys (White, Mof-
fitt, & Silva, 1989). Note also that recent reports challenge the
differential detection hypothesis, which contends that it is not
delinquency per se but rather detection and incarceration that
are associated with lowered intelligence. Notably, Moffitt and
Silva (1988a) found that both adjudicated delinquents and a
severity-matched group of self-reported delinquents had compa-
rably depressed IQ scores.
Second, delinquent adolescents have subaverage academic
achievement, including an elevated rate of learning disabilities.
Indeed, the link between academic failure and delinquency is
claimed to be stronger than the association between lowered
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
verbal IQ and delinquency (Hawkins & Lishner, 1987). Further-
more, among several skill deficits, achievement difficulties
have the strongest concurrent associations with official and
self-reported delinquency (Dishion, Loeber, Stouthamer-
Loeber, & Patterson, 1984); poor academic performance by the
end of elementary school significantly enhances the prediction
of adolescent delinquency (Loeber & Dishion, 1983).
These findings suggest that early underachievement is
causally related to subsequent antisocial activity. Yet because
underachievement and hyperactivity are often linked during
grade school and because hyperactivity predicts later delin-
quency (Gittelman et al, 1985), support for a direct path from
low achievement to delinquent behavior is weakened (see
Loeber, 1990, for methodologic discussion). On the other hand,
delinquency rates decline when adolescents are not in school
for example, during school vacations or after school dropout
(see review of Phillips & Kelly, 1979). Furthermore, as is dis-
cussed subsequently, some reading disabled children without
externalizing features develop delinquency by late adolescence
(Maughan, Gray, & Rutter, 1985). Both of these findings sug-
gest that at least in some instances, school failure may predis-
pose to acting-out behavior. As is evident, causal paths between
domains may be variegated and complex.
To summarize, delinquency is associated with low verbal IQ
and both general and specific achievement problems, but
achievement difficulties are more strongly predictive of delin-
quent behavior than is low intellectual ability per se. Thus, by
adolescence, there is a clear link between aggressive-antisocial
acts and underachievement, whereas during childhood the
more specific relationship pertains to hyperactivity-inatten-
tion. Such findings mandate examination of the causal nature
of this complex association across development, the topic area
to which I now turn.
Causal Pathways and Underlying Mechanisms
Hypothetical Causal Models
When two variables are associated, it is often assumed that
the first caused the second or that the second caused the first.
Within such unidirectional models, additional factors can be
hypothesized to mediate paths from cause to effect, yielding
both direct and indirect causal linkages. Even simple causal
models can therefore quickly increase in complexity. Also, each
factor might cause the other, suggesting bidirectional influ-
ence. Furthermore, a third factor (or set of factors) may cause
both variables of interest, or distinctbut correlatedback-
ground factors may cause each domain, leading to a largely
spurious association between the main variables (Olweus, 1983;
Sturge, 1982).
In basic terms, several causal models might explain the co-
variation between externalizing behavior and underachieve-
ment (see Huesmann, Eron, & Yarmel, 1987; Olweus, 1983, for
cogent discussion):
1. Underachievement leads to externalizing behavior. This
model requires a history of learning failure that precedes (or
exacerbates) the emergence of externalizing features. This
causal relationship might include such additional variables as
frustration, lowered self-image, demoralization, or lack of
135
school attachment, consequences of poor achievement that
may mediate subsequent antisocial activity (e.g., Hirschi, 1969).
2. Externalizing behavior leads to underachievement. Here,
behavioral disturbance predating school entry or appearing
during early schooling would be viewed as primary; its interfer-
ence with proper classroom behavior might be the key media-
tor of underachievement. For this model to be viable, the early
externalizing features should predict subsequent underachieve-
ment independently of poor readiness skills, which might ac-
company the behavioral features.
3. Both domains lead to the other. This bidirectional model
acknowledges that both of the previous unidirectional models
occur simultaneously (see Olweus, 1983).
4. Underlying variables result in both problem domains.
Such antecedent variables could be intraindividual (e.g, temper-
ament, language difficulties) or environmental (e.g., discordant
homes, large family size). Because this model requires that they
causally precede the association, preliminary evidence for third
variables would include the joint presence of externalizing be-
haviors and cognitive difficulties in early years. More compre-
hensive investigations would require prospective, longitudinal
evaluations that include sensitive measures of the hypothesized
causal variables and their statistical control in analyses of ex-
planatory factors.
The heterogeneity of the domains under review and the prob-
able complexity of the links between them may render linear
causal models, even those with bidirectional implications,
overly simplistic. Indeed, investigators of adult psychopathol-
ogy are increasingly cognizant of the need to seek reciprocally
deterministic, multifactorial models of causation (Ohman &
Magnusson, 1987). Because of the rapid development of chil-
dren and because of the plethora of individual, familial, and
school variables that could enter into causal equations, such
complex models may be especially pertinent for developmental
psychopathology.
Much of the early literature regarding the current topic
comes from cross-sectional or retrospective research designs.
For example, Rutter and Yule (1970) compared three subgroups
of boys from the Isle of Wight investigation: (a) antisocial only
(ASB), (b) SRR only, and (c) jointly ASB and SRR (see discus-
sion in Yule & Rutter, 1985). Because the latter, mixed subgroup
had a later onset of antisocial tendencies than did the exclu-
sively antisocial boys and because they resembled the SRR-only
youngsters regarding key background variables, Rutter and
Yule (1970) concluded that either antisocial behavior results
from reading deficits or that prior variables must underlie the
association. In similar analyses with the inner-London sample,
however, Sturge (1982) did not find such a clear-cut pattern of
results. Because these designs have clear limitations in detect-
ing causal relationships, I turn to prospective, longitudinal stud-
ies, which are potentially more informative about causal infer-
ences (Loeber, 1990).
Prospective, Longitudinal Investigations
First, because of the aforementioned trend for inattention-
hyperactivity to be correlated with underachievement during
grade school and for antisocial behavior-delinquency to show
association with academic failure in adolescence, I subgroup
136 STEPHEN P. HINSHAW
the following reports on the basis of the age range (elementary
vs. secondary grades) in which follow-up data were collected.
Next, I consider only those reports with an interval of at least 1
year between initial and follow-up assessment periods, seem-
ingly a minimum time period for appraising the relationships
of interest. Third, whereas consensus is growing that meta-ana-
lytic methods are the preferred means for amalgamating find-
ings across independent investigations, the extreme differences
in measures, methods, and analytic plans across the relatively
few studies to be reviewed preclude their meaningful combina-
tion for meta-analysis. Fourth, I limit my discussion to reports
that have appeared since the review of Rutter (1974).
To yield data that would shed light on causal relationships,
investigations should include (a) assessments of both achieve-
ment-related and behavioral variables at initial as well as follow-
up periods, (b) measures of relevant antecedent variables, and
(c) statistical analyses that allow for causal inference, through
control for the effects of antecedent factors or correlated predic-
tors. Extremely few reports in the literature include all such
features; these receive the strongest weight in my discussion of
causal mechanisms. Nevertheless, because of their heuristic
value, I also include additional studies without such fully infor-
mative designs, realizing their limitations regarding explana-
tions of causal mechanisms.
Elementary grades. Table 1 contains details of the investiga-
tions in which follow-up evaluations were made during elemen-
tary school. All reports used community samples of moderate-
to-large size, a necessary feature to obtain enough children with
either deviant behavior patterns or underachievement. Even so,
those studies with categorical definitions of either poor aca-
demic performance or behavior problems often had a relatively
small number of children who were classified (e.g., McGee et al,
1986). Examination of the table reveals a diversity of methods
for assessing cognitive deficits during initial assessment periods
and for evaluating underachievement during follow-up periods;
dimensional as well as categorical indexes are used in many
reports. Indeed, only Richman et al. (1982), Jorm, Share,
Matthews, and Maclean (1986), and McGee et al. (1986) used
categories of GRB and SRR, partly because of the aforemen-
tioned difficulties in obtaining stable classifications of these
categories during early and middle childhood. Teacher ratings
predominate as the chief means of assessing behavior.
Perhaps the most salient overall finding from these reports is
that in all six instances in which relevant analyses were per-
formed, patterns of problem behavior during the initial assess-
ment were associated with early cognitive-readiness deficien-
cies (Lambert & Nicoll, 1977, did not perform relevant analy-
ses; Stott, 1981, did not include measures of cognitive
functioning during the initial assessment). Specifically, Kellam,
Branch, Agrawal, and Ensminger (1975) found that teacher rat-
ings of internalizing and externalizing items, which predicted
lowered IQ and poor reading status 2 years later, were asso-
ciated with low readiness performance in first grade. Next,
antisocial behavior in kindergarten, which predicted poor
reading 1.5 years later in the report of McMichael (1979), was
also correlated with deficient readiness skills during the initial
assessmenU-'Such associations emerged even earlier in the re-
port of Richman et al. (1982): At 3 years, general behavioral
deviance overlapped with cognitive and language delay. Further-
more, in Palfrey, Levine, Walker, and Sullivan (1985), early
measures of inattention correlated with poor reading readiness
skills in kindergarten. Finally, both Jorm, Share, Matthews,
and Maclean (1986) and McGee et al. (1986), who made classifi-
cations of GRB or SRR in grade school, showed externalizing
behavior by one or both reading-delayed groups in kindergar-
ten, before exposure to academic curricula.
Such early associations between the domains of interest
strongly suggest the influence of prior antecedent variables.
Furthermore, these associations mandate statistical control
when investigators attempt to establish causal precedence. That
is, without such techniques as multiple regression, which allow
for examination of the unique contribution of a predictor vari-
able once its correlates are partialed, the status of a predictor as
an independent cause is suspect. Unfortunately, several reports
in Table 1 failed to make use of such analyses but still went on to
posit a unidirectional influence from one domain to the other.
In those reports in which such analyses were performed, it was
found in one instance that internalizing rather than externaliz-
ing behavior uniquely predicted reading (Lambert & Nicoll,
1977) and in another that early readiness skills predicted subse-
quent underachievement more strongly than did behavioral
measures (McMichael, 1979; see also Jorm, Share, Maclean, &
Matthews, 1986). In short, associations in elementary school
between underachievement and externalizing behavior are typi-
cally predated by correlated precursors, mandating a search for
underlying variables that may be responsible for the early associ-
ation and requiring adequate statistical controls in making
causal inference. When such controls were performed in the
studies reviewed, support for unidirectional causation was
sharply mitigated.
Several additional conclusions are suggested from Table 1. In
the first place, despite the caveats just raised, some suggestive
evidence exists that the experience of reading failure may exac-
erbate initial externalizing behavior. For example, Jorm, Share,
Matthews, and Maclean (1986) found that whereas hyperac-
tive-inattentive behavior was elevated at school entry for chil-
dren later classified as GRB, antisocial behavior in these
youngsters increased after first and second grade. Also, the
careful analyses of McGee et al. (1986) demonstrated that al-
though teacher-rated externalizing behavior was elevated at
school entry for boys later categorized as reading delayed, boys
with GRB showed a relative increase in hyperactivity from age 5
to age 7, and boys with SRR displayed a relative increase in
hyperactivity from age 7 to age 9.
Second, at least in the preschool and early elementary years,
links between behavior problems and underachievement are
not always specific to the externalizing domain. For instance,
in Richman et al. (1982), behavior-problem status at 3 years was
relatively nonspecific: No consistent internalizing or external-
izing dimensions were yielded from the rating scale and inter-
view that were used. This generic behavior-problem category
was predictive of GRB 5 years later. Also, in Kellam et al.
(1975), the associations between each of six diverse behavioral
items and either concurrent or subsequent achievement status
were of nearly the same magnitude (see Tables 6 and 8; see also
Stott, 1981, for similar findings). In addition, Lambert and Ni-
coll (1977) found that internalizing rather than externalizing
ratings made independent predictions of later reading scores.
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
On the other hand, the investigations of Jorm, Share, Mat-
thews, and Maclean (1986) and McGee et al. (1986) revealed
that teacher-rated dimensions or categories of externalizing
(hyperactive, aggressive) problems were correlated with delayed
reading status but that internalizing behaviors were not. Al-
though those reports with better-validated measures of prob-
lem behavior tend to converge on the primacy of externalizing
behavior in relation to underachievement, complete specificity
cannot be presumed.
Third, the contention that behavior problems are associated
specifically with IQ-discrepant reading delay (SRR; see Berger
et al., 1975; Rutter et al., 1970) is not supported by these investi-
gations. Indeed, in many of the reports, indexes of behavioral
maladjustment were correlated with either IQ measures or with
reading scores/categories that were not adjusted for intelli-
gence. Also, in direct opposition to the early British investiga-
tions, those studies with categorizations of GRB and SRR
(Jorm, Share, Matthews, & Maclean, 1986; McGee et al., 1986;
Richman et al, 1982) typically indicated that behavior prob-
lems were related more strongly to the former than to the latter
category. Thus, little support exists for a preferential association
of specific, IQ-discrepant reading deficits to behavioral prob-
lems.
Fourth, the magnitude of association or prediction across
domains is typically modest to moderate. One perspective on
this issue is provided by McMichael (1979), who found that
although kindergarteners with antisocial problems tended to
develop reading problems by the end of the first grade, over half
of these youngsters failed to show subsequent underachieve-
ment. Thus, the relationship of interest may pertain to only a
subgroup of children with externalizing behavior.9
A final point is that in addition to failing to control for corre-
lated measures at preassessment, most reports did not analyze
for bidirectional relationships. That is, few investigators exam-
ined whether both early behavior-problem status predicted sub-
sequent underachievement and whether early cognitive-readi-
ness problems predicted later misbehavior. Unless both predic-
tive relationships are examined, however, the full set of causal
possibilities cannot be adequately appraised.
Secondary grades. Table 2 contains highlights of investiga-
tions that examined follow-up status during adolescence. Note
that none of these reports made use of categories of SRR or
GRB to define underachievement during the follow-up assess-
ment; instead, investigators used such indexes as school grades,
special classroom placement, early school withdrawal, and la-
tent variables measured by multiple indicators. The aforemen-
tioned caveats about the overlap of such variables with behavior
per se pertain here (see also Shaywitz et al, 1990). Externalizing
behavior was also assessed in diverse ways: Peer sociometric
evaluations, diagnostic interviews, examiner appraisal of ag-
gressive behavior during testing sessions, and self-reports of
delinquency were used in addition to the more typical teacher
ratings.
Two of the investigations depicted in Table 2 included (a)
measures of each domain at multiple time points, (b) assess-
ments of relevant antecedent variables, and (c) structural equa-
tion modeling to analyze datafeatures that allow more confi-
dence in causal inferences. First, in an explicit attempt to estab-
lish the credibility of unidirectional versus reciprocal versus
137
third-variable models, Olweus (1983) obtained peer assess-
ments of aggression as well as averaged school grades at both
6th and 9th grades in a Swedish sample of boys; he also ob-
tained measures of a number of familial and environmental
background variables. Cross-lagged correlations provided no
evidence for the low-grades-predict-aggression unidirectional
model, but a near-significant effect was found for the aggres-
sion-predicts-low-grades path. However, given critiques of
cross-lagged correlations as an analytic tool, Olweus also per-
formed structural equation modeling. Once the background
variables of social class, parents' ages, divorce, birth out of wed-
lock, and birth order were entered into the causal models, no
unidirectional or reciprocal causation paths remained signifi-
cant, leading to the conclusion that antecedent variables ac-
counted for the association between poor grades and aggressive
status. As mentioned earlier, however, poor grades constitute
an index of underachievement that may well be directly con-
taminated by externalizing behavior.
Second, the report of Schonfeld et al. (1988), which measured
relevant background variables and used path analyses, pro-
vided some evidence for a link between cognitive deficits in
childhood and conduct disorder 10 years later. Here, an indi-
rect path between age 7 WISC Verbal IQ and severity ratings of
conduct disorder at age 17mediated by adolescent Wechsler
Adult Intelligence Scale (WAIS) IQ scoresheld up even when
(a) early aggressive behavior and (b) the background variables of
environmental disadvantage, neurological soft signs, and paren-
tal psychopathology were controlled. Yet measurement issues
cloud the viability of these findings, in that initial aggression
was indexed by behavior ratings from the psychologists who
performed the cognitive testing. Such individualized appraisals
of externalizing behavior in the laboratory, doctor's office, or
testing room are not sensitive indicators (see, for example, Slea-
tor & Ullmann, 1981). Because more valid indexes might have
altered the paths, the unidirectional link of Schonfeld et al.
from verbal deficits to conduct disorder should be viewed
cautiously.
Several additional investigations, without such stringent anal-
yses, provided apparent support for the unidirectional model
that underachievement leads to externalizing behavior. For ex-
ample, Farrington (1979) showed that both low IQ and low
vocabulary status at 8-10 years of age predicted self-reported
and official delinquency 6 years later. Because, however,
teacher ratings of externalizing behavior at preassessment also
predicted delinquent outcomes, and because analyses control-
ling for behavior measures were not performed, the causal role
(text continues on page 140)
9
Another issue here has to do with the antisocial nature of the chil-
dren studied by McMichael (1979), who used Rutter's (1967) method
for classifying behavior-problem subgroups. In this procedure, an
overall behavior-problem score on the total scale is used to classify a
child as deviant; antisocial versus neurotic categorizations are then
made on the basis of simple numeric comparisons. Thus, if a child
received many endorsements for items pertaining to attention deficit-
hyperactivity, he or she could still be classified as antisocial if the anti-
social score were just 1 point higher than the neurotic score (e.g, 1 vs. 0;
see Jorm, Share, Matthews, & Maclean (1986). Thus, McMichael's find-
ings might pertain more to hyperactivity than to antisocial tendencies
per se.
138 STEPHEN P. HINSHAW

Table 1
Longitudinal Investigations with Follow-Up Assessments in Elementary Grades
Initial assessment
Cognitive measure Behavioral measure
Grade
Study Location N (age) Content Scale type Content Scale type
Kellam, Branch, Chicago 649 1st IQ (Kuhlman- Categorical Teacher ratings on Categorical
Agrawal, & Anderson) and 6 items,
Ensminger readiness including
(1975) (Metropolitan) concentration
tests and authority
acceptance
(externalizing),
social contact
(internalizing)
Lambert & Nicoll San Francisco b 1st Readiness battery Dimensional Teacher ratings on Dimensional
(1977) Bay Area (Let's Look at items including
Children) interpersonal
(externalizing)
and
intrapersonal
adjustment

McMichael Edinburgh, 198 Kc Readiness battery Dimensional, Teacher ratings on Dimensional,

(1979) Scotland (boys only) (Thackray) categorical Rutter Scale B categorical

Stott(1981) Guelph, 1,292 K Teacher ratings on Categorical

Ontario, 6 items: timid,
Canada distant,
lethargic
(internalizing);
hyperactive,
impulsive,
hostile
(externalizing)
Richman, Waltham 185r 3yr Language Dimensional and Parent ratings and Categorical
Stevenson, & Forest, development categorical semistructured
Graham (1982) England (Reynell), parent 8
picture interview
vocabulary,
general ability
test (Griffith)

Palfrey, Levine, Greater 285 2 wk-5 yr' Varied Parent ratings, Categorical
Walker, & Boston depending on teacher ratings,
Sullivan (1985) child's age1 psychologist
impressions on
items and on
scales
measuring
attentionj
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT 139

Follow-up assessment

Achievement measure Behavioral measure

Grade
N Content Scale type Content Scale type Key findings*
365 3rd IQ (Kuhlman-Anderson) Categorical Although teacher ratings in 1st grade
and reading predicted both IQ and reading
(Metropolitan) tests categories in 3rd grade, the ratings
were also correlated with IQ and
readiness categories in 1st grade;
further analyses were not
performed

2nd Group-administered Dimensional Teacher ratings of intrapersonal

reading test adjustment in 1st grade
(Comprehensive significantly predicted reading
Primary) scores in 2nd grade, with sex,
ethnicity, SES, and readiness level
controlled (incremental /J2 = .064);
ratings of interpersonal adjustment
did not make significant prediction
167 lstc Group-administered Dimensional, Same as initial assessment Although teacher ratings of antisocial
(boys only) reading tests categorical behavior in K predicted poor
(Southgate) reading status at the end of 1st
grade, these ratings were also
associated with poor readiness in
K. The latter were a stronger
predictor of Ist-grade reading
(incremental R2 of antisocial
scores = .024)"
1,100 2nd Group-administered Categorical Same as initial assessment All 6 behavioral items in K predicted
reading and arithmetic reading and arithmetic status in
tests 2nd grade, with largest associations
for lethargic (fi = .21 for reading)
and hyperactive (<' = .20 for
reading).' Yet no cognitive-
readiness measure was available at
initial assessment
185f 8 yr IQ (Wechsler Categorical Parent ratings on Dimensional, Behavior problem status at 3 yr
Intelligence Scale for Rutter Scale A categorical significantly predicted, for boys,
Children) and reading and teacher mild and severe GRB as well as
(Neale) tests, yielding ratings on low IQ at 8 yr (see Table 8.7). Also,
classifications of GRB Rutter Scale B low general cognitive ability at 3
and SRR yr predicted, for boys only,
behavior-problem status (antisocial
and neurotic) at 8 yr (see Tables
11.4 and 11.6)"
174 2nd Group-administered Dimensional Teacher ratings on Categorical Although attentional-problem status
reading and general and Kindergarten at or before 5 yr significantly
achievement test categorical Performance predicted low reading status in 2nd
Profile; observer grade, with 45% of the persistent
ratings of attentional concerns group vs. 12%
overall of controls in the low-reading
competence category, attention problems were
also associated with low verbal and
perceptual-motor skills in K

(table continues)
140 STEPHEN P. HINSHAW

Table 1 (continued)

Initial assessment

Cognitive measure Behavioral measure

Urade
Study Location N (age) Content Scale type Content Scale type

Jorm, Share, Geelong, 543 K Peabody Picture Dimensional Teacher ratings on Dimensional,
Matthews, & Australia Vocabulary Rutter Scale B categorical
Maclean (1986) Test plus additional
item of
inattention

McGee, Dunedin, 476 5yr Parent ratings on Dimensional

Williams, New (boys only) Rutter Scale A
Share, Zealand and teacher
Anderson, & ratings on
Silva(1986) Rutter Scale B

Note. SES = socioeconomic status; K = kindergarten; yr = year; wk = week; GRB = general reading backwardness; SRR = specific reading
' I attempt to provide quantitative indexes of the magnitude of association between domains, when they are reported or when available data allow
b
Assessments were performed in 17 classrooms in four schools; N not reported.
Primary One in Scotland is equivalent to American kindergarten; Primary Two is equivalent to American first grade.
d
Additional analyses revealed that early-readiness classifications failed to predict increments in antisocial behavior over the 1.5-year interval.
e
I calculated $ statistics from the formula in Hays (1981). Also, additional analyses revealed that overall behavioral maladjustment in kindergarten
however, reported), even when social class was controlled.
f
From a randomly selected birth cohort of 705 nonimmigrant 3-year-old children, 94 were designated as behaviorally deviant. This group, along
8
Both the rating scale (Behavior Check-list) and the interview (Behavioral Screening Questionnaire) were designed to tap general behavioral and
h
Also, at the initial assessment (3 yr), behavior-problem status was correlated with both general cognitive-developmental delay and language delay
1
Eight assessments were performed over the 5-year period constituting the initial assessment. Age-appropriate tests of cognitive functioning were
1
Four groups were distinguished: No attentional concerns at any age; early concerns that abated by age 5; late-onset concerns, which did not appear
defined.
k
Classifications of SRR and GRB were not stable from first to second grade, in part because of floor effects for reading scores in first grade.
1
These items were the three from the Hyperactivity factor of Schachar, Rutter, and Smith (1981). It was also reported that the separate teacher rating
Peabody Picture Vocabulary Scores in kindergarten were reported.
m
This report included intermediate assessments at ages 7 and 9 years as well.
Only children with stable classifications of GRB or SRR from ages 9 and 11 were included in these categories.
0
With regard to changes at the intermediate assessments, by age 7, the GRB boys had shown an increase in hyperactivity scores over the levels they
apparent for the reading-delayed and comparison boys during the initial assessment (age 5), and only the SRR group showed any subsequent
problems, defined by stability of behavior-problem status across two or more age levels.

of the cognitive variables is indeterminate. Also, Maughan et al.
(1985), who followed subjects from the Sturge (1982) investiga-
tion, found that over 40% of the 10-year-old boys with pure
SRRthat is, without concurrent antisocial behaviorhad be-
come delinquent by age 17, a proportion nearly as high as that
for initially antisocial boys. Maughan et al. added the qualifica-
tions, however, (a) that by age 17, a substantial number of sub-
jects had been lost to attrition and (b) that such results were not
apparent for the prediction of age 14 antisocial behavior, for
which initial antisocial behavior was by far the stronger predic-
tor. Furthermore, antecedent variables were not controlled in
this report.
Other reports seemed to favor the externalizing-behavior-
predicts-underachievement unidirectional model, but problem-
atic measures and insufficient analyses mandate caution. Lam-
bert et al. (1976) found that behavioral ratings from second- and
fifth-grade teachers predicted grade point average (GPA) and
achievement test scores 7 years later, even when initial IQ was
controlled. Yet the composite ratings included both internaliz-
ing and externalizing items, limiting any specificity of the pre-
diction; as well, the criterion measures of grades and group
achievement test scores may not have been free of behavioral
contamination. Also, Kupersmidt and Coie (1990) found that
peer-nominated aggression in fifth grade predicted school drop-
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT 141

Follow-up assessment

Achievement measure Behavioral measure

Grade
N (age) Content Scale type Content Scale type Key findings*

453 1st, IQ (Columbia) and Categorical Teacher ratings on Dimensional, GRB children had higher antisocial
2nd reading (Neale) tests, Rutter Scale B categorical behavior scores than did SRR or
yielding classifications control children in 1st and 2nd
ofGRBandSRR" grades (magnitude of score
differences was about 3:1, p < .01),
but no differences were apparent
in K.. Yet, for items tapping
inattention-hyperactivity, GRB
children had higher scores than
did SRR or control children in K
and 1st grade (magnitude not
reported, p<. 01)'
437 I I yr" IQ (Wechsler Categorical" Same as initial Categorical With teacher ratings, both the GRB
(boys only) Intelligence Scale for assessment; in and SRR children had higher
Children) and reading addition, antisocial and hyperactive (but not
(Burt) tests, yielding interviews were internalizing) factor scores than
classifications of GRB performed, did controls at 5 yr (magnitude of
and SRR yielding score differences not reported, p
diagnoses < .05). By 11 yr, both the GRB
and SRR children had more
diagnoses of attention-deficit
disorder and oppositional-conduct
disorder than did controls (<' =
.22 for overall diagnoses)

retardation,
their calculation.

was somewhat more predictive of low achievement in 2nd grade than was concurrent 2nd-grade maladjustment (significance tests were not,

with 91 matched comparison children, was studied more intensively.

developmental concerns; no dimensions or clusters of internalizing or externalizing behavior were yielded.
(for boys only; see Table 4.7). Thus, correlated "causes" existed for boys.
administered at each assessment (e.g., McCarthy Scales were given in kindergarten).
until kindergarten; and persistent concerns, which were evident at multiple ages. See Palfrey et al. for description of how attentional concerns were

of attentiveness, made in kindergarten, was correlated with 2nd-grade IQ (r = .52) and with 2nd-grade reading (r = .34). No analyses involving

displayed at age 5; the SRR group showed an increase in hyperactivity from age 7 to age 9. As for parent ratings, no differences in behavior were
increases (for antisocial behavior, from age 5 to age 7). Finally, both the GRB and SRR boys were quite likely to exhibit persistent behavior

out, whereas school absences in fifth grade did not predict sub-
sequent police contacts. Absences, however, are far from a per-
fect cognitive-achievement measure. Finally, Ledingham and
Schwartzman (1984) and DeBaryshe, Patterson, and Capaldi
(1991) did not include measures of cognitive functioning at
preassessment, precluding adequate tests of the alternative
causal models.
In an extremely heuristic investigation, Moffitt (1990) pre-
dicted antisocial behavior at age 11 from early childhood mea-
sures, through use of multiple regression analyses that included
interaction terms. Specifically, once age 5 aggression had been
controlled, verbal IQ, family adversity, and diagnosis of atten-
tion-deficit disorder at this early age all independently pre-
dicted subsequent antisocial behavior. In addition, however, the
significant interactions of attention-deficit disorder with intel-
ligence and family problems suggested to Moffitt (1990) that
"family adversity and verbal ability may modify the risk for
behavioral outcome that is posed by early ADD-H" (p. 904).
Also, at age 13, only the subgroup with delinquency plus a his-
tory of attentional deficits had early problems in motor develop-
ment, suggesting the addition of a neurodevelopmental risk
factor to the pattern of predictors. Furthermore, only this delin-
(text continues on page 146)
142 STEPHEN P. HINSHAW

Table 2
Longitudinal Investigations With Follow-Up Assessments in Secondary Grades
Initial assessment
Cognitive measure Behavioral measure
Grade
Study Location N Content Scale type Content Scale type
Lambert, Hartsough, San Francisco 300" 2nd,5thc IQ (Wechsler Intelligence Dimensional Teacher ratings on Dimensional
& Zimmerman Bay Area Scale for Children) 7 items tapping
(1976) and group- aggression,
administered immaturity,
achievement tests depression,
obtained from school dependency*1
records
Farrington (1979) London 411 8-10yr IQ (Progressive Matrices) Categorical Teacher and peer Categorical
(boys only) and vocabulary (Mill ratings of
Hill synonyms) tests troublesomeness,
daring,
dishonesty

Olweus(1983) Sweden 444 6th Averaged grades in (a) Dimensional Peer ratings of Dimensional
(boys only) Swedish and English, verbal and
and (b) math and other physical
subjects aggression
against peers and
verbal aggression
against teachers'

Ledingham & Montreal, 1,756 1st, 4th, Peer ratings on Categorical

Schwartzman Canda 7thk Pupil Evaluation
(1984) Inventory,
yielding
aggressive,
withdrawn, and
aggressive-
withdrawn
groups
Maughan, Gray, & Inner London 129 10 yr IQ (Wechsler Intelligence Categorical Teacher ratings on Categorical
Rutter(1985) (boys only) Scale for Children) Rutter Scale B,
and reading (Neale) yielding
tests, yielding antisocial
classification of SRR classification
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT 143

Follow-up assessment
Achievement measure Behavioral measure
Grade
N (age) Content Scale type Content Scale type Key findings*

168 9th, 12th Scholarship factor, Dimensional Adjustment, Peer Dimensional Initial teacher ratings (composite of 7
including GPA Involvement, items) predicted scholarship even when
and achievement Guidance IQ was controlled (incremental R2 =
test scores Problem factors' .31 for 9th grade and .12 for!2th grade).
Yet few significant predictions of Peer
Involvement and Guidance Problems
emerged'
409 14-16 yr Self-ratings on 38 Categorical Low IQ status at 8-10 yr predicted self-
(boys only) items assessing reported (p < .05) and official (p <
delinquency; .01) delinquency; low vocabulary status
official also predicted both types of
convictions for delinquency (p values .001; its
delinquent prediction of self-reported delinquency
offenses was significant even when SES, family
history, and family-marital conflict
were controlled). Teacher and peer
ratings at 8-10 yr also predicted
official delinquency (p < .001), even
when background factors were
controlled11
444 6th Same as initial assessment Same as initial assessment Although cross-lagged correlation
(boys only) analysis revealed a near-significant
tendency for initial aggression to
predict low grades at follow-up to a
greater degree than initial low grades
predicted subsequent aggression,
structural equation modeling indicated
only a small (standardized coefficient
= .252) link between initial aggression
and subsequent low grades.
Furthermore, the addition of
antecendent variables eliminated all
unidirectional and reciprocal causation
paths, suggesting a spurious
relationship model for the association
between domains'
753 4th, 7th, Classroom Categorical Aggressive and aggressive-withdrawn
10th placement, coded children were more likely than
as regular vs. withdrawn or comparison children to
special or below be in special classes or behind their
expected grade expected grade levels at 3-year follow-
level up (<# = .245 for omnibus chi-squared
statistic; no specific cell contrasts were
performed)
113 14 yr, 17 yr Group- Categorical Teacher ratings on Categorical Children with SRR at 10 yr were
(boys only) (only 84 administered Rutter Scale B extremely likely to display poor reading
boys at reading test at 14 yr; official status at 14 yr; antisocial status made
17yr) delinquency no incremental prediction. Also,
status at 17 yr whereas antisocial status at 10 yr was
predictive of similar status at 14 yr, with
SRR making no incremental
prediction, 41% of boys with SRR
alone at 10 yr were delinquent at 17 yr,
a rate comparable to that for boys with
initial antisocial status

(table continues)
144 STEPHEN P. HINSHAW

Table 2 (continued)
Initial assessment
Cognitive measure Behavioral measure
Grade
Study Location N (age) Content Scale type Content Scale type
Schonfeld, Shaffer, New York 126' 4yr, 7 yr IQ (Stanford-Binet at 4 Dimensional Psychologist Categorical
O'Connor, & City (boys only) yr; Wechsler ratings of
Portnoy(1988) Intelligence Scale for negativism,
Children at 7 yr) tests aggression, and
hostility, from
observations
during test
administration

Kupersmidt & Coie North 112 5th Averaged grades in Categorical Peer nominations Categorical
(1990) Carolina reading, language, and of "starting
math; excessive fights"
absences

Moffitt(1990) Dunedin, Varies" 3 yr-9 yr IQ (Wechsler Intelligence Dimensional Parent ratings on Dimensional
New Scale for Children Rutter Scale A,
Zealand Revised) and reading and teacher
(Hurt) tests ratings on Rutter
Scale B, yielding
antisocial scores"

DeBaryshe, Oregon 205 6th Latent variable of Dimensional

Patterson, & (boys only) antisocial
Capaldi(1991) behavior,
measured
through parent
and teacher
ratings, child
interviews, and
behavior
observations'
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT 145

Follow-up assessment
Achievement measure Behavioral measure
Grade
N (age) Content Scale type Content Scale type Key findings"
115 17yr IQ (Wechsler Adult Dimensional Psychiatric Categorical; First, verbal and full-scale IQ scores at
(boys only) Intelligence Scale) diagnoses Dimensional age 7 of children who later developed
and achievement (including conduct disorder were significantly
(Peabody conduct lower than those of the children who
Individual disorder) based did not develop conduct disorder. Next,
Achievement on structured path analyses revealed that effects of
Test) tests interviews with early aggression on IQ at 17 were
adolescents and eliminated when childhood IQ was also
parents;0 also, entered. In addition, childhood IQ
global severity indirectly influenced global severity
ratings of ratings at 17 through WAIS scores
psychopathology (standardized path coefficient of .50
from childhood to adolescent IQ and
.32 from adolescent IQ to global
severity rating); yet early aggression
also influenced global severity ratings
(coefficient = -.27). Finally, such third
variables as neurological soft signs,
parental psychopathology, and
environmental disadvantage did not
contribute to the concurrent
relationship between adolescent IQ and
conduct disorder0
99 12th Index of negative Categorical Police-juvenile Categorical Peer-nominated aggression in 5th grade
school outcome court contacts predicted school drop out in a stepwise
(suspensions, logistic regression, as did 5th-grade
retentions, school absences. 5th-grade school
truancy); early grades did not, however, predict police
school contact at follow-up
withdrawal (drop
outs)
435 llyr-15yr Parent ratings on Dimensional and Verbal IQ scores, family adversity, ADD
(boys only) Revised categorical classification, and the interaction of
Behavior ADD classification with verbal IQ and
Problem with family adversity predicted
Checklist; antisocial behavior at 11 yr, even after
teacher ratings antisocial behavior at 5 yr had been
on Rutter Scale controlled. Furthermore, only boys
B; self-reported with ADD histories and delinquency
delinquency; classifications at age 13 had a history
official police of motor delay at 3-5 yr. Finally, only
records the ADD plus delinquent subgroup had
persistently high levels of aggressive
acts at 15 yr
156' 7th Latent variables of Dimensional Structural equation modeling revealed
(boys only) (a) academic that the optimal fit was provided by
engagement, a model in which antisocial behavior
measured in 6th grade had a direct influence on
through parent achievement in 7th grade (/8 = -.21).
and child In this model, however, the indirect
interviews and links were stronger: Coercive discipline
teacher ratings of practices were strongly correlated with
items reflecting antisocial behavior (r = .83), and these
homework and practices predicted academic
schoolwork; and engagement (0 = -.73), which in turn
(b) academic affected academic achievement (/3 =
achievement, .61)
measured
through parent
and teacher
ratings of school
performance and
standardized
achievement tests
in four subject
areas
(table continues)
146 STEPHEN P. HINSHAW

Table 2 (continued)
Note. GPA = grade point average; yr = year; SES = socioeconomic status; SRR = specific reading retardation; ADD = attention-deficit disorder.
* I attempt to provide quantitative indexes of the magnitude of association between domains, when they are reported or when available data allow
their
b
calculation.
The 300 subjects were a random sample of 2nd and 5th graders from a population of 2,400 students in 11 schools in Northern California.
c
Initial assessments were performed in two different grade levels; 7-year follow-up assessments were performed for both groups.
d
Peer sociometric nominations and self-ratings were also included in the initial assessment.
' The factors of 9th and 12th grade cognitive and behavioral status emerged from factor analyses of archival indexes of both domains. For example,
Adjustment included counselor ratings of positive attributes, and Guidance Problems included frequency of disciplinary referrals and absences,
but Peer Involvement was not specified. Overall Status measures were composites of behavioral (delinquency) and achievement-related (e.g., honor
roll) measures; they are therefore not considered.
' Analyses of the ability of separate behavioral items to predict achievement were not performed.
*h Some predictor measures were obtained at 8 yr, but others were not collected until 10 yr.
Only the p values (and no actual <t> values) were reported. Also, no correlations between the cognitive and the behavioral predictors at 8-10 yr were
reported, nor were longitudinal predictions corrected for the influence of the alternate domain.
' The overall goal was to determine whether (a) poor grades in 6th grade predicted later aggression, (b) aggression in 6th grade predicted later poor
grades, or (c) both (a) and (b) were true (i.e., reciprocal causation). In addition, such antecedent variables as SES, parental ages, divorce, birth order,
and birth out of wedlock were added to the model, to test whether (d) common background factors could account for the association (i.e., spurious
relationship model).
' SES, parental age, and birth out of wedlock were the antecedent variables that accounted for the association between poor grades and aggression.
k
1
Initial assessments were performed at three different grade levels; 3-year follow-up assessments were performed for all groups.
Two groups of inner-city, Black boys were investigated: a group with neurological soft signs at the initial assessment and a matched comparison
group.
m
Only 94 subjects were available for path analyses.
"0 The parent interviews also yielded data regarding parental psychopatholpgy and environmental disadvantage.
Logistic regression analyses were also performed, to ascertain the predictions from early cognitive and behavioral status to the presence vs.
absence of conduct disorder. Low IQ scores scores were related only to conduct disorder; no other psychiatric diagnoses were associated. Schonfeld
et al. (1988) noted that only acquired (i.e., Verbal) and not fluid (i.e. Performance) IQ was associated with conduct disorder.
"For biennial assessments of the Dunedin cohort, Ns were 1,037 (3 yr), 991 (5 yr), 954 (7 yr), and 955 (9 yr). Analyses were restricted to boys,
however, because of the small number of girls classified as delinquent at follow-up.
" Also assessed, as background variables, were family adversity (a composite of SES, maternal mental health, maternal IQ, and family social
environment), motoric functioning (Bayley scales at age 3 and McCarthy scales at age 5), history of perinatal problems, and diagnosis of ADD.
' Also measured were parental academic achievement (e.g., IQ, years of education) and coercive discipline at home.
* Listwise deletion procedures resulted in a final sample of 156 for the structural equations. Most missing data resulted from the unavailability of
school test scores for the academic achievement variable in 7th grade.

quent plus attention-deficit disorder subgroup had significant
neuropsychological deficits (see Mofl&tt & Sirva, 1988b). Causal
paths were therefore found to span cognitive, behavioral, psy-
chosocial, and neurodevelopmental variables, interacting in
complex fashion.10
Overall, like many reports conducted during childhood (see
Table 1), investigations with adolescent follow-up often failed to
control for the alternate domain during initial assessment, and
several also failed to include adequate measures of antecedent
variables. Such issues severely constrain inferences regarding
causal precedence. Concerning the two reports with designs
that could optimally test alternative causal models, one yielded
no support for unidirectional or reciprocal causation models
once antecedent variables were partialed (Olweus, 1983).
Whereas the other appeared to support a unidirectional link
between early verbal deficits and later conduct disorder, the
domain of early aggression was inadequately measured (Schon-
feld et al., 1988). Finally, because such antecedent factors as
coercive parenting (DeBaryshe et al., 1991), family adversity,
verbal skills, and motor delay (Moffitt, 1990), as well as low
SES, birth out of wedlock, and parental age (Olweus, 1983) have
been found to influence outcomes, I examine more closely the
potential influence of third variables on the association be-
tween underachievement and externalizing behavior.
Antecedent Variables
My chief goal here is to ascertain, in brief fashion, whether
potential antecedent factors could plausibly explain the associa-
tion of interest. That is, such variables would need to correlate
with each domain and to exert their influence early in develop-
ment; furthermore, their effects should not be explainable by
other background factors. Also, in comprehensive tests of alter-
native models, the variables would need to supersede any unidi-
rectional or reciprocal causal paths when entered into predic-
tion equations (e.g., Olweus, 1983). I begin with the macro vari-
able of SES, move next to familial factors, and then cover the
intraindividual variables of IQ, language skills, and neurode-
velopmental delay. Considering such variables as separate enti-
ties ignores their probable interactions: I thus provide several
illustrations of combined effects.
10
Two additional investigations deserve mention. The study of
Huesmann, Eron, and Yarmel (1987) was not included in Table 2 be-
cause the follow-up analyses were performed in the subjects' adult-
hood, 22 years after the initial assessments at age 8. This report re-
vealed that (a) antisocial outcomes (e.g., arrest records, self-reports)
were not significantly predicted by early IQ, once initial aggression
(measured through peer sociometric methods) was controlled, but that
(b) early aggression predicted age 30 educational attainment, even
when early IQ was controlled. Next, because the report of McGee,
Share, Moflitt, Williams, & Silva (1988) was an extension into adoles-
cence of the investigation of McGee, Williams, Share, Anderson, &
Silva (1986; see Table 1), it did not constitute an independent investiga-
tion.
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
SES
In combination with other psychosocial and familial vari-
ables, SES has been implicated as a factor that could account for
the association between underachievement and externalizing
behavior (see Olweus, 1983; Sturge, 1982). Other evidence, how-
ever, suggests that SES does not alone explain the overlap. First,
regarding academic performance, although impoverished liv-
ing conditions and overcrowding are associated with such vari-
ables as lowered intellectual ability, globally low achievement,
and poor grades, there is contradictory evidence regarding the
effects of socioeconomic factors on specific or IQ-discrepant
reading delays (see Rutter & Yule, 1975; Stevenson & Fredman,
1990). A safe conclusion is that the effects of social class on
IQ-discrepant reading failure are considerably smaller than
those on unadjusted achievement or on intelligence per se. Fur-
thermore, more specific aspects of family interactionfor ex-
ample, parental attitudes toward literacy or parental listening
to the child's readingappear to mediate the relationship that
exists between SES and reading attainment (Stevenson & Fred-
man, 1990).
On the behavioral side, although inattention and hyperactiv-
ity show little or no correlation with social class (e.g., Szatmari,
Boyle, & Offord, 1989), aggressive and conduct-disordered be-
havior is associated with SES (eg., Paternite, Loney, & Lang-
horne, 1976; Szatmari, Boyle, & Offord, 1989). Yet, in adoles-
cence, links between externalizing behavior and poor academic
performance hold regardless of social strata (Hawkins &
Lishner, 1987). Furthermore, the effects of social class on anti-
social behavior are outweighed by more specific family vari-
ables, like parental hostility and parent-child conflict (Pater-
nite et al, 1976; see also Howlin & Rutter, 1987).
In summary, although lowered standards of living may set
the stage for subaverage achievement and aggression, SES is
unlikely to explain the early relationship between hyperactivity
and academic failure, particularly if the latter is separated from
IQ. Also, in older children and in adolescents, links between
delinquent behavior and underachievement are maintained
across diverse social strata. Measures of family functioning
bear examination as the specific mechanisms and processes by
which effects of social disadvantage on underachievement and
externalizing behavior may be mediated.
Familial Enables
The relationship of family factors to child psychopathology
and to underachievement constitutes an enormous topic (see
Hetherington & Martin, 1986; Stevenson & Fredman, 1990).
Concerning family history of psychopathology, there appears
to be a different aggregation of disorders in families of aggres-
sive as opposed to underachieving children. Whereas child ag-
gression is correlated with paternal psychopathy and substance
abuse (see Lahey et al., 1988) and with maternal antisocial fea-
tures and somatization (Lahey, Russo, Walker, & Piacentini,
1989), children with learning difficulties (or with pure hyperac-
tivity) often have family histories marked by underachievement
as well as speech and language delay (e^ McGee, Williams, &
147
Sirva, 1984a; Rutter et al., 1976). Siblings of learning disabled
and of purely hyperactive youngsters also tend to have achieve-
ment and language difficulties (e.g, August & Stewart, 1983).
Thus, on an aggregate level, aggressive disorders appear to have
a family configuration different from that of either under-
achievement or hyperactivity; the latter two difficulties show
intriguing similarities (see also Schachar & Wachsmuth, 1990).
Regarding intrafamilial processes, severe marital discord
and coercive parent-child exchanges are clearly related to anti-
social behavior patterns (Patterson, 1982); they may also asso-
ciate with some aspects of underachievement (see Stevenson &
Fredman, 1990). Data are sparse, however, regarding the effects
of familial functioning on the association between domains.
The seminal report of Richman et al. (1982)in which unse-
lected 3-year-olds from a birth cohort were followed for 5 years
provides a rare opportunity to examine the interactive role of
early familial variables with other risk factors in the develop-
ment of underachievement and behavioral difficulties. In this
investigation, age 3 social deprivation was measured by low
SES, use of social services, and large family size; family dys-
function was indexed by a composite variable that included
maternal depression-anxiety, marital dysfunction, overcrowd-
ing, and life stressors; and parental criticism-hostility toward
the child was appraised by research interviewers.
Amidst a series of complex relationships, language delay at 3
years of agea variable correlated with social deprivation
predicted later learning problems and behavior problems (see
subsequent section); adverse family environment at 3 years pre-
dicted the onset of new behavior problems by age 8 but did not
correlate with the persistence of extant behavior problems. In-
triguingly, early adverse family climate predicted specific (i.e.,
IQ-adjusted) reading deficits at age 8, even when early behavior-
problem status and early language delay were controlled. The
most important aspect of familial adversity in this relationship
was maternal depression-anxiety, leading Richman et al.
(1982) to speculate that a particular type of maternal unavail-
ability may be crucial, in formative years, to subsequent read-
ing difficulties that are not explainable by low IQ. The presence
of early language delays enhanced this relationship, pointing to
the combination of intraindividual and familial variables in
precipitating reading problems. In addition, the prediction was
stronger for boys than for girls and for children with age 8
behavior problems (internalizing and externalizing) than for
those without. Familial factors are thus likely to be embedded
in a network of other antecedent variables in predisposing to
underachievement and behavioral disturbance.
Such findings, which bear replication and extension (see also
Estrada, Arsenio, Hess, & Holloway, 1987), suggest the com-
plexity of interrelationships among child-related, linguistic, so-
cial, and early familial variables in the development of both
underachievement and behavioral difficulties. A key methodo-
logic concern in this area involves ascertaining whether family
variables are antecedents or consequences of child problems;
longitudinal investigations are essential to help infer causal re-
lationships. Finally, although family factors are often consid-
ered to be psychosocial, such variables contain both genetic
and environmental influences, except in adoptive families (see
Plomin, Loehlin, & DeFries, 1985). Thus, biological and envi-
ronmental factors are typically confounded with respect to fa-
148 STEPHEN P. HINSHAW
mi Hal causes of cormorbidity between underachievement and
behavior problems.
Intelligence
As noted earlier, the initial findings that antisocial behavior
was correlated specifically with IQ-discrepant underachieve-
ment have not been confirmed. Indeed, in the investigations
reviewed herein, lowered intelligence and globally low achieve-
ment are more frequent correlates of externalizing behavior
than are SRR or IQ-discrepant achievement. The possibility
remains, then, that low intellectual capacity is causally responsi-
ble for both underachievement and externalizing behavior. \fet
the relationship is not likely to be so straightforward.
First, externalizing behavior and adverse family climate cor-
relate with IQ-discrepant achievement in some investigations
(e.g., Richman et al, 1982; Rutter et al, 1970), and IQ cannot
account for such associations. Second, measurement issues are
salient. That is, because of the aforementioned tendency for
children with attentional problems to score poorly on several
subtests of the WISC-R despite otherwise "normal" intelli-
gence, IQ scores may be spuriously depressed, leading to inva-
lid presumptions of links between externalizing behavior and
subaverage intelligence. Third, on the basis of their longitu-
dinal data, Schonfeld et al. (1988) argued that verbal, or "crys-
tallized," intelligencewhich is heavily influenced by the per-
son's learning environmentis more predictive of adolescent
conduct problems than is performance IQ, which taps "fluid"
intelligence and relates to hereditary factors (see also Wilson &
Herrnstein, 1985). Fourth, more specific types of verbal media-
tion deficienciestermed social cognitive information process-
ing deficits by Dodge (1985)have been shown to relate to defi-
cient self-regulation, peer adjustment problems, and a pattern
of hyperactive plus aggressive behavior (Milich & Dodge, 1984).
Thus, externalizing behavior may be more predictable from
deficient learning environments or deficits in verbal mediation
of social stimuli than from lowered intelligence per se.
In short, intelligence is sufficiently heterogeneous as a con-
struct that it may mask more specific aspects of cognitive func-
tioning that hold stronger relationships with externalizing be-
havior. In subsequent research, it will be critical to include in-
dexes of social cognitive information processing as well as
measures of general intelligence and achievement as antecedent
variables (Schonfeld et al., 1988). Yet because of its clear status
as a correlate of both aggressive-delinquent behavior and of
poor achievement, subaverage IQ may predispose toward the
association between these two domains, particularly when fol-
low-up into adolescence is performed.
Speech and Language Difficulties
A sizable literature has emerged on the relationship between
early language problems and the development of both behav-
ioral difficulties and achievement deficits (for reviews, see
Cantwell & Baker, 1977; Howlin & Rutter, 1987; Silva, 1987;
Stevenson, 1984). Furthermore, current conceptions of reading
failure emphasize the key role of phonologic- and linguistic-
processing difficulties (Wagner & Torgeson, 1987), and lan-
guage-disordered children are prone to academic failure (Cant-
well & Baker, 1980). Thus, speech and language problems ap-
parently are excellent candidates as underlying variables: They
correlate with both domains of interest, and they predate the
emergence of the association.
In the first place, however, whereas early language delays
predict later achievement problems (Stevenson, 1984), most in-
dexes of delayed language are associated with lowered IQ. Spe-
cific (i.e., IQ-discrepant) language deficits are a weaker predic-
tor of later achievement problems than are general (non-IQ-ad-
justed) deficits, leading to the conclusion that subaverage IQ
may, in most cases, be the actual causal factor (Silva, 1987;
Stevenson & Richman, 1978). Furthermore, in grade school
children, some types of reading problems do not involve lan-
guage-processing difficulties but are more visual-perceptual in
nature (e.g., Rourke, 1985). Thus, IQ-independent language
problems are unlikely to be strong or sensitive predictors of
underachievement.
Regarding relationships with behavior problems, mild-to-
moderate language problems are associated with several types
of difficulties, and attention-deficit disorder is at or near the
top of the list (see Beitchman, Hood, Rochon, & Peterson,
1989; Cantwell, Baker, & Mattison, 1979; Cohen, McDonald,
Horodezky, & Davine, 1989). (The most prevalent behavioral
correlates of marked early language delay are severe conditions
such as autism and pervasive developmental disorders.) Al-
though replication is sorely needed, there is some evidence that
expressive, as opposed to receptive, language disorders early in
life are more specifically correlated with externalizing prob-
lems (see Beitchman, Tuckett, & Batth, 1987). Viewed as a
group, however, early language problems do not predict exter-
nalizing behavioral problems with specificity; in fact, the most
common behavioral outcome of early language delay involves
internalizing problems (Richman et al., 1982; Stevenson, Rich-
man, & Graham, 1985). Also, in contrast to the usual pattern
for externalizing behavior disorders, girls are at higher risk than
boys for behavioral consequences of language delay (Beitch-
man, Hood, & Inglis, 1990).
Overall, whereas predictive relationships are not highly spe-
cific and whereas IQ is a confounding factor, some proportion
of children with early language delays develop externalizing
problems, particularly attention deficits; and a sizable percent-
age of children with early language problems manifest subse-
quent underachievement. Additional longitudinal investiga-
tions are needed to document and explain the comorbidity of
behavioral and achievement-related difficulties following early
language delay.
Concerning putative causal chains, there are a host of ways in
which speech-language problems could predispose toward the
association of interest (see Silva, 1987). For one thing, verbal
mediation is a key factor in self-regulation, and acting-out be-
havior is negatively associated with a variety of relevant verbal
skills (Hogan & Quay, 1984). Also, the young child with diffi-
culties in producing (and processing) language might be at risk
for considerable frustration and for negative parent-child and
peer interchanges, all of which could precipitate or maintain
externalizing behavior and achievement difficulties (for ex-
tended discussion, see Howlin & Rutter, 1987). Furthermore,
because language delay is associated with lowered IQ and with
perceptual-motor deficitsfactors associated with neurode-
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
velopmental immaturitygeneral neurodevelopmental delays
might predispose both to language problems and to the subse-
quent conjoint presence of externalizing behavior and under-
achievement, a contention deserving of brief elaboration.
Neurodevelopmental Immaturity
Problems in the maturation of basic perceptual and motoric
functions, presumably reflecting neurodevelopmental delay,
have been invoked as a prior causal factor for language deficits
by Beitchman (1985). Whether, in fact, language difficulties
are preceded by more basic perceptual, precognitive deficits is a
controversial topic. In contrast to the more accepted view that
language processing proceeds from a top-down, semantically
driven model (for cogent discussion, see Yule & Rutter, 1985),
Tallal (1980) produced evidence that language dysfunction is
explainable on the basis of subtle but real perceptual dysfunc-
tions that underlie the processing of spoken sounds. Further-
more, in a provocative report with language-impaired pre-
schoolers, Tallal, Dukette, and Curtiss (1989) demonstrated
that the children's behavior profiles differed from those of con-
trols, not on the basis of patterns conforming to current con-
ceptions of emotional or behavior disorders, but solely regard-
ing items that tap attentional, motoric, and perceptual process-
ing. This finding fuels the contention that neurodevelopmental
delay rather than behavioral disturbance distinguishes children
with early language impairments from their peers.
Neurodevelopmental immaturity-delay, however, is a fuzzy
construct, badly in need of sharpening. Note, in addition, that
psychosocial variables appear critical for mediating the out-
comes of children who, with clear perinatal complications, are
at risk for neurodevelopmental delay (e.g., Werner & Smith,
1982). Despite the importance of examining neurodevelop-
mental risk, it would be quite premature to contend that in-
traindividual/biological neurodevelopmental factors are solely
responsible for producing the association between under-
achievement and externalizing behavior.
Summary
Although none of the antecedent factors discussed herein is
likely to be the sole explanatory variable for the association of
interest, each factor may predispose at least some children to-
ward overlapping patterns of externalizing behavior problems
and underachievement. Furthermore, increasing evidence
points to the potential interaction of several antecedent factors
in shaping comorbidity (see Moffitt, 1990; Olweus, 1983; Rich-
man et al, 1982). Overall, to elucidate the mechanisms that
underlie relationships between externalizing behavior and un-
derachievement, investigators must reliably assess pertinent an-
tecedent variables and must statistically control for their influ-
ence in analyses of causal models.
Conclusions and Issues
Overlap Between Domains
First, whereas externalizing behavior and formally defined
underachievement are clearly associated, recent investigations
with stringent diagnostic criteria reveal that the overlap of
149
marked, IQ-discrepant achievement deficits with either hyper-
activity or conduct disorder is less than 20%, well below esti-
mates that are often reported in the literature." This degree of
comorbidity is still far in excess of chance rates, however. Fur-
thermore, the school-related difficulties of children with exter-
nalizing problems are not limited to formal learning disabili-
ties: Such indexes as poor grades, retention, suspension, and
academic deficits that fall short of full criteria for under-
achievement are common in hyperactive and aggressive chil-
dren (e.g., Barkley et al., 1990; Fischer et al, 1990; Forness et al,
in press). Thus, the overlap between externalizing difficulties
and academic failure clearly is sizable and important.
Second, there is a crucial developmental progression with
regard to the association. In early and middle childhood, the
specific link is between hyperactivity-inattention and under-
achievement; aggression shows overlap with learning problems
during these years chiefly through its comorbidity with inat-
tention-hyperactivity (Frick et al, 1991). \et, by adolescence,
clear links have emerged between frankly antisocial behavior
and variables related to verbal deficits and underachievement.
Such a progression prompts a detailed examination of the devel-
opmental course of attentional deficits and of the aggression
that frequently co-occurs with them (cf. Barkley et al, 1990).
Underlying Mechanisms
The overriding conclusion from the investigations reviewed
above is sobering: Despite avid theoretical and empirical inter-
est in revealing the underpinnings of overlap between exter-
nalizing behavior and underachievement, alternative causal
models have rarely been tested with sufficient rigor. I have
highlighted several plausible reasons for this state of affairs,
including (a) the genuinely difficult methodologic and concep-
tual issues regarding the domains under consideration, (b) inad-
equate assessment of antecedent variables, (c) insufficient use
of statistical analyses with adequate control of correlated pre-
dictors and of antecedents, and (d) the need for costly longitu-
dinal investigations. Measurement issues are also paramount;
in fact, the two most sophisticated investigations to datein
which antecedent variables were assessed and causal models
were explicitly testedboth had limitations regarding measure-
ment of key domains during initial assessment (Olweus, 1983;
Schonfeld et al, 1988). Although definitive investigations re-
garding the processes underlying the association of interest still
remain to be performed, the field is beginning to appreciate the
quality of research efforts needed to elucidate causal mecha-
nisms (e.g, Loeber, 1990; Moffitt, 1990).
The absence of adequate designs and statistical analyses of-
11
The partial independence of underachievement and externalizing
behavior is further demonstrated by investigations of Porter and
Rourke (1985) and Fuerst, Fisk, and Rourke (1989), who used cluster
analysis to identify behavioral subtypes of learning disabled children.
The largest subgroup in each study had essentially normal behavioral
adjustment, and the biggest "problem" subgroups had internalizing
difficulties. Only 17%-18% of the total samples of learning disabled
youngsters had a behavioral profile marked by hyperactivity-aggres-
sion. Thus, attention deficits or conduct problems, on the one hand,
and learning disabilities, on the other, are not simply alternate names
for the same set of problems (Rourke, 1988; Silver, 1990).
150 STEPHEN P. HINSHAW
ten precludes inferences regarding unidirectional links. Yet sev-
eral reports suggest the possibility of at least some causation
from one domain to the other. For example, although asso-
ciated with hyperactivity and aggression in early grades, read-
ing delay-retardation may predispose to subsequent increases
in externalizing behavior (Jorm, Share, Matthews, & Mclean,
1986; McGee et al, 1986; McGee et al, 1988). Furthermore, a
subgroup of children with reading failure unaccompanied by
externalizing behavior may go on to develop formal delin-
quency by late adolescence (Maughan et al., 198S). Although
both findings are consistent with theoretical notions regarding
the role of school failure in shaping acting-out behavior (e.g,
Hawkins & Lishner, 1987; Hirschi, 1969; Rutter& Ciller, 1983),
measures of potential antecedent variables that could have ac-
counted for the increase in antisocial behavior over time were
not provided, mandating caution in inferring unidirectional
causal relationships.
Advocating the reverse unidirectional model, Patterson and
colleagues have argued strongly that early antisocial behavior-
shaped by coercive family interactionscauses academic fail-
ure once schooling begins (Patterson, DeBaryshe, & Ramsey,
1989). 'Vet the absence of measures of cognitive-readiness prob-
lems during initial assessment periods mitigates support for
this unidirectional hypothesis (DeBaryshe et al, 1991). On the
other hand, in a more rigorous test of unidirectional hypothe-
ses, Huesmann et al. (1987) demonstrated that age 8 aggression
predicted low achievement in adulthood, even when early IQ
was controlled, whereas age 8 IQ did not predict adult antiso-
cial behavior when early aggression was partialed.
The focus on overarching developmental pathways may mask
the operation of distinct causal mechanisms for different sub-
groups of children. Indeed, only some children with notewor-
thy externalizing behavior problems in kindergarten go on to
develop underachievement (e.g., McMichael, 1979). I highly rec-
ommend emphasis on assessment strategies that can uncover
subgroups with different developmental trajectories as an anti-
dote to overly broad claims for models that do not apply to all
children. Of course, research involving such subgroups will re-
quire large initial samples.
Regarding the inference of causal relationships, it is striking
that the entire database for this review comprises nonexperi-
mental investigations. Even with careful measurement strate-
gies, appropriate designs, and assiduous statistical analyses, in-
ferring causation on the basis of correlational models is prob-
lematic. Experimental intervention studies would clearly be
preferable.12 \fet the developmental and methodologic issues
that I have repeatedly mentioned render appropriate experi-
ments problematic. For example, given that for many children,
the intertwining of externalizing behavior and underachieve-
ment may emanate from complex interplays of antecedent fac-
tors that operate early in development, stratightforward inter-
ventions in behavioral versus achievement domains may be
impossible. "Vet from a clinical perspective, intervention efforts
should be delivered before problems become entrenched (see
Loeber, 1990). Another difficulty is that the probable operation
of different causal mechanisms within different subgroups
mandates examination of Subgroup X Treatment interactions
rather than main effects of treatment conditions; yet formation
of relevant subgroups requires an adequate conceptual basis on
which to categorize children as well as sizable samples. None-
theless, creatively designed interventions could begin to shed
light on the causal nature of the association under discussion.
Inattention
I have emphasized that in elementary grades, inattention-hy-
peractivity is a more consistent correlate of underachievement
than is aggression, a finding that emphasizes the importance of
defining the nature of attentional deficits. Opinion varies dra-
matically as to the essence of such problems; alternative con-
ceptions emphasize their behavioral, information-processing,
motoric response output, or motivational characteristics (e.g.,
Barkley, 1989; Douglas, 1983; Sergeant & van der Meere, 1990).
Whatever their precise nature, early attentional problems inter-
act in crucial ways with neurodevelopmental delay and with
later neuropsychological dysfunction to predispose toward aca-
demic failure and aggressive delinquency (Moffitt, 1990; Mof-
fitt & Silva, 1988b). Clarifying the construct of dysregulated
attention should have a major impact on understanding causal
mechanisms linking externalizing behavior with under-
achievement.
Final Issues
First, in several of the reports that were reviewed, the rela-
tionships between domains pertained not to extreme groups of
children, but rather to continuously distributed variables. For
example, Richman et al. (1982) found that early adverse family
environment was an independent predictor of IQ-discrepant
reading scores at age 8, across the entire distribution of such
scores. This family index did not, however, predict to the ex-
treme group of children with SRR. Also, in the 22-year longitu-
dinal data of Huesmann et al. (1987), early aggression was an
independent predictor of a continuous measure of age 30 educa-
tional attainment. Such findings have relevance for the entire
population of children, arguing for dimensional as well as cate-
gorical approaches in psychopathology research (e.g., Blash-
field, 1984).
12
Although not explicitly related to the association of interest, the
study of Bradley and Bryant (1985) provides an example of heuristic
experimental research. In investigating the relationship between pre-
school phonologic abilityexemplified by recognition of rhymes and
alliterationand subsequent reading proficiency, these investigators
first showed a predictive longitudinal relationship, suggesting a causal
link. During an experimental intervention, instruction in rhyming and
alliteration caused subsequent improvement in reading-spelling (but
not arithmetic) ability, yielding far stronger evidence for the causal
hypothesis that phonologic ability is necessary for reading. For the
problem area under review, experiments would require (a) clinical sam-
ples of either underachieving or externalizing youngsters, or groups
with documented risk for such conditions, (b) randomly assigned treat-
ment conditions directed toward either academic achievement or ex-
ternalizing behavior but not both, and (c) systematic assessment of
both achievement-related and behavioral outcomes, preferably over
lengthy time periods. Interventions related to one domain would hypo-
thetically induce improvements in the alternate problem area. Few
extant reports come close to meeting these criteria, and space does not
permit discussion of those relevant intervention studies that have been
performed.
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
Next, I have noted that reading achievement and intelligence
are complex composites of a variety of component skills. Part
of the rationale for my focus on such broad measures of cogni-
tive functioning is their direct clinical relevance for children's
success. Yet more specific cognitive variables, from subtypes of
verbal abilities to social-cognitive measures that might directly
mediate aggressive responding (e.g., Dodge, 1985), should re-
ceive increased emphasis in discussions and investigations of
cognition-behavior relationships (see Schonfeld et al, 1988).
Although important in its own right, the broad variable of un-
derachievement requires further elucidation if behavior-cogni-
tion relationships are to be fully understood.
Finally, as I have emphasized, the material covered herein
underscores the potential complexity of causal mechanisms
underlying the association of interest. Given the interactions
and transactions among social, familial, linguistic, and neuro-
behavioral variables that may culminate in the overlap between
underachievement and externalizing behavior, teasing apart
the effects of any single background factor is likely to be quite
difficult or even misguided. The challenge for the field is to
derive explanatory models with sufficient rigor and complexity
to handle the diversity of causal factors.
References
Achenbach, T. M., & Edelbrock, C. S. (1978). The classification of child
psychopathology: A review and analysis of empirical efforts. Psycho-
logical Bulletin, 85,1275-1301.
Achenbach, T. M., & Edelbrock, C. (1983). Manual for the Child Behav-
ior Checklist and Revised Child Behavior Profile. Burlington, VT:
Author.
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/
adolescent behavioral and emotional problems: Implications of
cross-informant correlations for situational specificity. Psychologi-
cal Bulletin, 707,213-232.
Aman, M. G, & Singh, N. N. (1983). Specific reading disorders: Con-
cepts of etiology reconsidered. In K. D. Gadow & I. Bialer (Eds.),
Advances in learning and behavioral disabilities (Vol. 2., pp. 1-47).
Greenwich, CT: JAI Press.
American Psychiatric Association. (1987). Diagnostic and statistical
manual of mental disorders (Sided., rev). Washington, DC: Author.
Anderson, J., Williams, S., McGee, R., & Silva, P. (1989). Cognitive and
social correlates of DSM-IH disorders in preadolescent children.
Journal of the American Academy of Child and Adolescent Psychiatry,
28, 842-846.
August, G. I, & Garfinkel, B. D. (1989). Behavioral and cognitive sub-
types of ADHD. Journal of the American Academy of Child and Ado-
lescent Psychiatry, 28, 739-748.
August, G. J., & Garfinkel, B. D. (1990). Comorbidity of ADHD and
reading disability among clinic-referred children. Journal of Abnor-
mal Child Psychology, 18, 29-45.
August, G. J., & Stewart, M. A. (1983). Familial subtypes of childhood
hyperactivity. Journal of Nervous and Mental Disease, 171, 362-368.
Barkley, R. A. (1989). The problem of stimulus control and rule-gov-
erned behavior in attention deficit disorder with hyperactivity. In
L. M. Bloomingdale & J. M. Swanson (Eds.), Attention deficit dis-
order (\o\. 4, pp. 203-228). Oxford, England: Pergamon Press.
Barkley, R. A., Fischer, M., Edelbrock, C. S, & Smallish, L. (1990). The
adolescent outcome of hyperactive children diagnosed by research
criteria: I. An 8-year prospective follow-up study. Journal of the Amer-
ican Academy of Child and Adolescent Psychiatry, 29, 546-557.
Beitchman, J. H. (1985). Speech and language impairment and psychi-
151
atric risk: Toward a model of neurodevelopmental immaturity. Psy-
chiatric Clinics of North America, 8, 721-735.
Beitchman, J. H., Hood, J., & Inglis, A. (1990). Psychiatric risk in chil-
dren with speech and language disorders. Journal of Abnormal Child
Psychology, 18, 283-296.
Beitchman, J. H., Hood, J., Rochon, J, & Peterson, M. (1989). Empiri-
cal classification of speech/language impairment in children: II.
Behavioral characteristics. Journal of the American Academy of
Child and Adolescent Psychiatry, 28,118-123.
Beitchman, J., Tuckett, M., & Batth, S. (1987). Language delay and
hyperactivity in preschoolers: Evidence for a distinct subgroup of
hyperactives. Canadian Journal of Psychiatry, 32, 683-687.
Berger, M., Yule, W, & Rutter, M. (1975). Attainment and adjustment
in two geographical areas: II. The prevalence of specific reading
retardation. British Journal of Psychiatry, 126, 510-519.
Blashfield, R. K. (1984). The classification of psychopathology: Neo-
Kraepelinian and quantitative approaches. New \brk: Plenum Press.
Bradley, L., & Bryant, P. (1985). Rhyme and reason in reading and spell-
ing. Ann Arbor: University of Michigan Press.
Brandenburg, N. A., Friedman, R. M, & Silver, S. E. (1990). The epide-
miology of childhood psychiatric disorders: Prevalence findings
from recent studies. Journal of the American Academy of Child and
Adolescent Psychiatry, 29, 76-83.
Cantwell, D. P., & Baker, L. (1977). Psychiatric disorder in children
with speech and language retardation. Archives of General Psychia-
try, 34,583-591.
Cantwell, D. P., & Baker, L. (1980). Academic failures in children with
communication disorders. Journal of the American Academy of
Child Psychiatry, 19, 579-591.
Cantwell, D. P., Baker, L., & Mattison, R. E. (1979). The prevalence of
psychiatric disorder in children with speech and language disorder:
An epidemiologic study. Journal of the American Academy of Child
Psychiatry, 18, 450-461.
Cantwell, D. P., & Satterfield, J. H. (1978). The prevalence of academic
underachievement in hyperactive children. Journal of Pediatric Psy-
chology, J, 168-171.
Cicchetti, D. (1989). Developmental psychopathology: Some thoughts
on its evolution. Development and Psychopathology, 1,1-4.
Cohen, N. J., McDonald, I, Horodezky, N., & Davine, M. (1989, Oc-
tober). Psychiatrically disturbed children with unsuspected language
disorders: Psychiatric and language characteristics. Paper presented
at the annual meeting of the American Academy of Child and Ado-
lescent Psychiatry, New York.
DeBaryshe, B., Patterson, G. R, & Capaldi, D. M. (1991). A perfor-
mance model for academic achievement. Manuscript submitted for
publication.
Dishion, T. 1, Loeber, R., Stouthamer-Loeber, M., & Patterson, G. R.
(1984). Skill deficits and male adolescent delinquency. Journal of
Abnormal Child Psychology, 12, 37-54.
Dodge, K. A. (1985). Attributional bias in aggressive children. In P. C.
Kendall (Ed.), Advances in cognitive-behavioral research and therapy
(Vol. 4, pp. 73-110). San Diego, CA: Academic Press.
Douglas, V I. (1983). Attentional and cognitive problems. In M. Rutter
(Ed.), Developmental neuropsychiatry (pp. 280-329). New "Vbrk:
Guilford Press.
Eron, L. D. (1987). The development of aggressive behavior from the
perspective of a developing behaviorism. American Psychologist, 42,
435-442.
Estrada, P., Arsenic, W F, Hess, R. D., & Holloway, S. D. (1987). Affec-
tive quality of the mother-child relationship: Longitudinal conse-
quences for children's school-relevant cognitive functioning. Develop-
mental Psychology, 23, 210-215.
Farrington, D. P. (1979). Environmental stress, delinquent behavior,
152 STEPHEN P. HINSHAW
and convictions. In I. G. Sarason & C. D. Spielberger (Eds.), Stress
and anxiety (Vol. 6, pp. 93-107). Washington, DC: Hemisphere.
Fischer, M., Barkley, R. A., Edelbrock, C. S., & Smallish, L. (1990). The
adolescent outcome of hyperactive children diagnosed by research
criteria: II. Academic, attentional, and neuropsychological status.
Journal of Consulting and Clinical Psychology, 58, 580-588.
Forness, S. R., Youpa, D., Hanna, G., Cantwell, D. P., & Swanson, J. M.
(in press). Classroom instructional characteristics in attention defi-
cit hyperactivity disorder: Comparison of pure and mixed sub-
groups. Behavioral Disorders.
Frick, P., Kamphaus, R. W, Lahey, B. B., Loeber, R., Christ, M. G.,
Hart, E., & Tannenbaum, L. E. (1991). Academic underachievement
and the disruptive behavior disorders. Journal of Consulting and
Clinical Psychology, 59, 289-294.
Fuerst, D. R., Fisk, J. L., & Rourke, B. P. (1989). Psychosocial function-
ing of learning-disabled children: Replicability of statistically de-
rived subtypes. Journal of Consulting and Clinical Psychology, 57,
275-280.
Gittelman, R., Mannuzza, S, Shenker, R., & Bonagura, N. (1985). Hy-
peractive boys almost grown up: I. Psychiatric status. Archives of
General Psychiatry, 42, 937-947.
Goyette, C. H., Conners, C. K., & Ulrich, R. F. (1978). Normative data
on revised Conners Parent and Teacher Rating Scales. Journal of
Abnormal Child Psychology, 6, 221-236.
Halperin, J. M., Gittelman, R., Klein, D. F., & Rudel, R. G. (1984).
Reading-disabled hyperactive children: A distinct subgroup of at-
tention deficit disorder with hyperactivity? Journal of Abnormal
Child Psychology, 12,1-14.
Hawkins, J. D., & Lishner, D. M. (1987). Schooling and delinquency. In
E. H. Johnson (Ed.), Handbook of crime and delinquency prevention
(pp. 179-221). New York: Guilford Press.
Hays, W L. (1981). Statistics (3rd ed.). New York: Holt, Rinehart &
Winston.
Hetherington, E. M., & Martin, B. (1986). Family interaction patterns.
In H. C. Quay & J. S. Werry (Eds.), Psychopathological disorders of
childhood (ltd ed., pp. 332-390). New York: Wiley.
Hinshaw, S. P. (1987). On the distinction between attentional deficits/
hyperactivity and conduct problems/aggression in child psychopa-
thology. Psychological Bulletin, 101, 443-463.
Hinshaw, S. P., Han, S., Erhardt, D., & Dressier, A. H. (1991). Internaliz-
ing and externalizing behavior problems in preschool children: Con-
vergence between parent and teacher ratings and behavior observa-
tions. Manuscript submitted for publication.
Hinshaw, S. P., Morrison, D. C, Carte, E. T, & Cornsweet, C. (1987).
Factorial dimensions of the Revised Behavior Problem Checklist:
Replication and validation within a kindergarten sample. Journal of
Abnormal Child Psychology, 15, 309-327.
Hirschi, T. (1969). Causes of delinquency. Berkeley: University of Cali-
fornia Press.
Hirschi, T., & Hindelang, M. J. (1977). Intelligence and delinquency: A
revisionist review. American Sociological Review, 42, 571-587.
Hogan, A. E., & Quay, H. C. (1984). Cognition in child and adolescent
behavior disorders. In B. B. Lahey & A. E. Kazdin (Eds.), Advances
in clinical child psychology (Vol. 7, pp. 1-34). New York: Plenum
Press.
Holborow, P. L., & Berry, P. S. (1986). Hyperactivity and learning dis-
abilities. Journal of Learning Disabilities, 19, 426-431.
Howlin, P., & Rutter, M. (1987). The consequences of language delay
for other aspects of development. In W Yule & M. Rutter (Eds.),
Language development and disorders (pp. 271-294). Oxford, En-
gland: MacKeith.
Huesmann, L. R., Eron, L. D., & Yarmel, P. W (1987). Intellectual
functioning and aggression. Journal of Personality and Social Psy-
chology, 52, 232-240.
Jorm, A. F, Share, D. L., Maclean, R., & Matthews, R. (1986). Cogni-
tive factors at school entry predictive of specific reading retardation
and general reading backwardness: A research note. Journal of Child
Psychology and Psychiatry, 27, 45-54.
Jorm, A. F, Share, D. L, Matthews, R., & Maclean, R. (1986). Be-
haviour problems in specific reading retarded and general reading
backward children: A longitudinal study. Journal of Child Psychol-
ogy and Psychiatry, 27, 33-43.
Kavale, K. A., & Forness, S. R. (1984). A meta-analysis assessing the
validity of Wechsler Scale profiles and recategorization: Patterns or
parodies? Learning Disability Quarterly, 7,136-156.
Kazdin, A. E. (1987). Treatment of antisocial behavior in children:
Current status and future directions. Psychological Bulletin, 102,
187-203.
Kellam, S. G., Branch, J. D, Agrawal, D. C, & Ensminger, M. E. (1975).
Mental health and going to school. Chicago: University of Chicago
Press.
Kupersmidt, J. B., & Coie, J. D. (1990). Preadolescent peer status, ag-
gression, and school adjustment as predictors of externalizing prob-
lems in adolescence. Child Development, 61,1350-1362.
Lahey, B. B., Piacentini, J. C, McBurnett, K., Stone, P., Hartdagen, S.,
& Hynd, G. (1988). Psychopathology in the parents of children with
conduct disorder and hyperactivity. Journal of the American Acad-
emy of Child and Adolescent Psychiatry, 27,163-170.
Lahey, B. B., Russo, M. F, Walker, J. L., & Piacentini, J. C. (1989).
Personality characteristics of the mothers of children with disrup-
tive behavior disorders. Journal of Consulting and Clinical Psychol-
ogy, 57,512-515.
Lambert, N. M., Hartsough, C. S., & Zimmerman, I. L. (1976). The
comparative predictive efficiency of intellectual and nonintellectual
components of high school functioning. American Journal of Ortho-
psychiatry, 46,109-122.
Lambert, N. M., & Nicoll, R. C. (1977). Conceptual model for nonin-
tellectual behavior and its relationship to early reading achievement.
Journal of Educational Psychology, 69, 481-490.
Lambert, N. M., & Sandoval, J. (1980). The prevalence of learning
disabilities in a sample of children considered hyperactive. Journal
of Abnormal Child Psychology, 8, 33-50.
Ledingham, J. E., & Schwartzman, A. E. (1984). A 3-year follow-up of
aggressive and withdrawn behavior in childhood: Preliminary find-
ings. Journal of Abnormal Child Psychology, 12,157-168.
Loeber, R. (1990). Development and risk factors of juvenile antisocial
behavior and delinquency. Clinical Psychology Review, 10,1-41.
Loeber, R., & Dishion, T. (1983). Early predictors of male delinquency:
A review. Psychological Bulletin, 94, 68-99.
Loeber, R., & Lahey, B. B. (1989). Recommendations for research on
disruptive behavior disorders of childhood and adolescence. In B. B.
Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology
(Vol. 12, pp. 221-251). New York: Plenum Press.
Loeber, R., & Stouthamer-Loeber, M. (1987). Prediction. In H. C.
Quay (Ed.), Handbook of juvenile delinquency (pp. 325-382). New
York: Wiley.
Loney, J., Kramer, J., & Milich, R. S. (1981). The hyperactive child
grows up: Predictors of symptoms, delinquency, and achievement at
follow-up. In K. D. Gadow & J. Loney (Eds.), Psychosocial aspects of
drug treatment for hyperactivity (pp. 381-415). Boulder, CO: West-
view Press.
Loney, J., & Milich, R. (1982). Hyperactivity, inattention, and aggres-
sion in clinical practice. In M. Wolraich & D. Routh (Eds.), Advances
in developmental and behavioral pediatrics (Vol. 3, pp. 113-147).
Greenwich, CT: JAI Press.
Magnusson, D. (1988). Individual development from an interactional
perspective: A longitudinal study. Hillsdale, NJ: Erlbaum.
Mann, V A., & Brady, S. (1988). Reading disability: The role of Ian-
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT
guage deficiencies. Journal of 'Consulting and Clinical Psychology, 56,
811-816.
Mantzicopoulos, P., Morrison, D. C, Hinshaw, S. P., & Carte, E. T.
(1989). Nonpromotion in kindergarten: The role of cognitive, percep-
tual, visual-motor, behavioral, achievement, socioeconomic, and
demographic characteristics. American Educational Research Jour-
nal, 26,107-121.
Maughan, B., Gray, G., & Rutter, M. (1985). Reading retardation and
antisocial behavior: A follow-up into employment. Journal of Child
Psychology and Psychiatry, 26, 741-758.
McConaughy, S. H., Achenbach, T. M., &Gent, C. L. (1988). Multiaxial
empirically based assessment: Parent, teacher, observational, cog-
nitive, and personality correlates of Child Behavior Profile types for
6- to 11-year-old boys. Journal of Abnormal Child Psychology, 16,
485-509.
McGee, R., & Share, D. L. (1988). Attention deficit disorder-hyperac-
tivity and academic failure: Which comes first and what should be
treated? Journal of the American Academy of Child and Adolescent
Psychiatry, 27, 318-325.
McGee, R., Share, D., Moffitt, T. E., Williams, S., & Silva, P. A. (1988).
Reading disability, behaviour problems, and juvenile delinquency.
In D. H. Saklofske & S. B. G. Eysenck (Eds.), Individual differences in
children and adolescents: International perspectives (pp. 158-172).
London: Hodder & Stoughton.
McGee, R., Williams, S., Bradshaw, J., Chapel, J. L., Robins, A., &
Silva, P. A. (1985). The Rutter scale for completion by teachers: Fac-
tor structure and relationships with cognitive abilities and family
adversity for a sample of New Zealand children. Journal of Child
Psychology and Psychiatry, 26, 727-739.
McGee, R., Williams, S., Share, D. L., Anderson, J., & Silva, P. A.
(1986). The relationship between specific reading retardation, gen-
eral reading backwardness, and behavioural problems in a large sam-
ple of Dunedin boys: A longitudinal study from five to eleven years.
Journal of Child Psychology and Psychiatry, 27, 597-610.
McGee, R., Williams, S., & Silva, P. A. (1984a). Background character-
istics of aggressive, hyperactive, and aggressive-hyperactive boys.
Journal of the American Academy of Child Psychiatry, 23, 280-284.
McGee, R., Williams, S., & Silva, P. A. (1984b). Behavioral and develop-
mental characteristics of aggressive, hyperactive, and aggressive-hy-
peractive boys. Journal of the American Academy of Child Psychiatry,
23, 270-279.
McGee, R., Williams, S., & Silva, P. (1985). Factor structure and corre-
lates of ratings of inattention, hyperactivity, and antisocial behavior
in a large sample of 9-year-old children from the general population.
Journal of Consulting and Clinical Psychology, 53, 480-490.
McMichael, P. (1979). The hen or the egg? Which comes firstantiso-
cial emotional disorders or reading disability? British Journal of Edu-
cational Psychology, 49, 226-238.
Milich, R., & Dodge, K. A. (1984). Social information processing in
child psychiatry populations. Journal of Abnormal Child Psychology,
72,471-489.
Milich, R., & Landau, S. (1989). The role of social status variables in
differentiating subgroups of hyperactive children. In L. M. Bloom-
ingdale & J. M. Swanson (Eds.), Attention deficit disorder (Vol. 4, pp.
1-16). Oxford, England: Pergamon Press.
Moffitt, T. E. (1990). Juvenile delinquency and attention deficit dis-
order: Boys' developmental trajectories from age 3 to age 15. Child
Development, 61, 893-910.
Moffitt, T. E., & Silva, P. A. (1988a). IQ and delinquency: A direct test
of the differential detection hypothesis. Journal of Abnormal Psy-
chology, 97, 330-333.
Moffitt, T. E., & Silva, P. A. (1988b). Self-reported delinquency, neuro-
psychological deficit, and history of attention deficit disorder. Jour-
nal of Abnormal Child Psychology, 16, 553-569.
153
Morrison, D, Mantzicopoulos, P., & Carte, E. (1989). Preacademic
screening for learning and behavior problems. Journal of the Ameri-
can Academy of Child and Adolescent Psychiatry, 28,101-106.
Offord, D. R., Alder, R. 1, & Boyle, M. H. (1986). Prevalence and
sociodemographic correlates of conduct disorder. American Journal
of Social Psychiatry, 6, 272-278.
Offord, D. R., Boyle, M. H., & Racine, Y. (1989). Ontario Child Health
Study: Correlates of disorder. Journal of the American Academy of
Child and Adolescent Psychiatry, 28, 856-860.
Ohman, A., & Magnusson, D. (1987). An interactional paradigm for
research in psychopathology. In D. Magnusson & A. Ohman (Eds.),
Psychopathology: An interactional perspective (pp. 3-21). San Diego,
CA: Academic Press.
Olweus, D. (1983). Low school achievement and aggressive behavior in
adolescent boys. In D. Magnusson (Ed.), Human development: An
interactional perspective (pp. 353-365). San Diego, CA: Academic
Press.
Palfrey, J. S., Levine, M. D., Walker, D. K., & Sullivan M. (1985). The
emergence of attention deficits in early childhood: A prospective
study. Developmental and Behavioral Pediatrics, 6, 339-348.
Paternite, C. E., Loney, J., & Langhorne, J. E. (1976). Relationships
between symptomatology and SES-related factors in hyperkinetic/
MBD boys. American Journal of Orthopsychiatry, 46, 291-301.
Patterson, G. R. (1982). Coercive family process. Eugene, OR: Castalia.
Patterson, G. R. (1990). Some comments about cognitions as causal
variables. American Psychologist, 45, 984-985.
Patterson, G. R., DeBaryshe, B. D, & Ramsey, E. (1989). A developmen-
tal perspective on antisocial behavior. American Psychologist, 44,
329-335.
Phillips, J. C., & Kelly, D. H. (1979). School failure and delinquency:
Which causes which? Criminology, 17,194-207.
Plomin, R., Loehlin, J. C, & DeFries, J. C. (1985). Genetic and environ-
mental components of "environmental" influences. Developmental
Psychology, 21, 391-402.
Porter, J., & Rourke, B. P. (1985). Socio-emotional functioning of learn-
ing disabled children: A subtypal analysis of personality patterns. In
B. P. Rourke (Ed.), Neuropsychology of learning disabilities: Essen-
tials of subtype analysis (pp. 257-279). New York: Guilford Press.
Professional Group for ADD and Related Disorders. (1991). Response
to notice of inquiry regarding special education for children with ADD.
Unpublished manuscript, Department of Pediatrics, University of
California, Irvine.
Quay, H. C. (1979). Classification. In H. C. Quay & J. S. Werry (Eds.),
Psychopathological disorders of childhood (2nd ed., pp. 1-42). New
York: Wiley.
Quay, H. C. (1983). A dimensional approach to behavior disorder: The
Revised Behavior Problem Checklist. School Psychology Review, 12,
244-249.
Quay, H. C. (1986). Classification. In H. C. Quay & J. S. Werry (Eds.),
Psychopathological disorders of childhood (3rd ed., pp. 1-34). New
York: Wiley.
Quay, H. C. (1987). Intelligence. In H. C. Quay (Ed.), Handbook of
juvenile delinquency (pp. 106-117). New \brk: Wiley.
Reeves, J. C, Werry, J. S., Elkind, G. S., & Zametkin, A. (1987). Atten-
tion deficit, conduct, oppositional, and anxiety disorders in chil-
dren: II. Clinical characteristics. Journal of the American Academy of
Child and Adolescent Psychiatry, 26,144-155.
Rey, J. M., Bashir, M. R., Schwarz, M., Richards, I. N, Plapp, J. M., &
Stewart, G. W (1988). Oppositional disorder: Fact or fiction? Journal
of the American Academy of Child and Adolescent Psychiatry, 27,
157-162.
Richman, N., Stevenson, J., & Graham, P. (1982). Preschool to school: A
behavioural study. San Diego, CA: Academic Press.
154 STEPHEN P. HINSHAW
Robins, L. N. (1970). The adult development of the antisocial child.
Seminars in Psychiatry, 6, 420-434.
Robins, L. N. (1979). Follow-up studies. In H. C. Quay & J. S. Werry
(Eds.), Psychopathological disorders of childhood (2nd ed., pp. 483-
513). New York: Wiley.
Rose, S. L., Rose, S. A., & Feldman, J. F. (1989). Stability of behavior
problems in very young children. Development and Psychopathol-
ogy, 1, 5-19.
Rourke, B. P. (1985). Overview of learning disability subtypes. In B. P.
Rourke (Ed.), Neuropsychology of learning disabilities: Essentials of
subtype analysis (pp. 3-14). New \brk: Guilford Press.
Rourke, B. P. (1988). Socioemotional disturbances of learning disabled
children. Journal of Consulting and Clinical Psychology, 56,801-810.
Rutter, M. (1967). A children's behaviour questionnaire for completion
by teachers: Preliminary findings. Journal of Child Psychology and
Psychiatry, 8,1-11.
Rutter, M. (1974). Emotional disorder and educational underachieve-
ment. Archives of Disease in Childhood, 49, 249-256.
Rutter, M. (1989). Isle of Wight revisited: Twenty-five years of child
psychiatric epidemiology. Journal of the American Academy of Child
and Adolescent Psychiatry, 28, 633-653.
Rutter, M., & Giller, H. (1983). Juvenile delinquency: Trends and per-
spectives. New \brk: Guilford Press.
Rutter, M., & Graham, P. (1970). Psychiatric aspects of intellectual and
educational retardation. In M. Rutter, J. Tizard, & K. Whitmore
(Eds.), Education, health, and behaviour (pp. 102-112). London:
Longmans.
Rutter, M., Tizard, J, & Whitmore, K. (Eds.) (1970). Education, health,
and behaviour. London: Longmans.
Rutter, M., Tizard, J., Yule, W, Graham, P., & Whitmore, K. (1976).
Research report: Isle of Wight studies, 1964-1974. Psychological
Medicine, 6, 313-332.
Rutter, M., & Yule, W (1970). Reading retardation and antisocial be-
haviourThe nature of the association. In M. Rutter, J. Tizard, & K.
Whitmore (Eds.), Education, health, and behaviour (pp. 240-255).
London: Longmans.
Rutter, M., & Yule, W (1975). The concept of specific reading retarda-
tion. Journal of Child Psychology and Psychiatry, 16,181-197.
Rutter, M., Yule, B., Quinton, D., Rowlands, O., Yule, W, & Berger, M.
(1974). Attainment and adjustment in two geographical areas: III
Some factors accounting for area differences. British Journal of Psy-
chiatry, 125, 520-533.
Saal, F. E., Downey, R. G, & Lahey, M. A. (1980). Rating the ratings:
Assessing the psychometric quality of rating data. Psychological
Bulletin, 55,413-428.
Sampson, O. C. (1966). Reading and adjustment: A review of the litera-
ture. Educational Research, 8,184-190.
Sandberg, S. T, Wieselberg, M., & Shaffer, D. (1980). Hyperkinetic and
conduct problem children in a primary school population: Some
epidemiological considerations. Journalof"ChildPsychology andPsy-
chiatry, 2.7,293-311.
Schachar, R., Rutter, M., & Smith, A. (1981). The characteristics of
situationally and pervasively hyperactive children: Implications for
syndrome definition. Journal of Child Psychology and Psychiatry, 22,
375-392.
Schachar, R., & Wachsmuth, R. (1990). Hyperactivity and parental
psychopathology. Journal of Child Psychology and Psychiatry, 31,
381-392.
Schonfeld, I. S. (1990). A developmental perspective and antisocial
behavior: Cognitive functioning. American Psychologist, 45, 983-
984.
Schonfeld, I. S., Shaffer, D., O'Connor, P., & Portnoy, S. (1988). Conduct
disorder and cognitive functioning: Testing three causal hypotheses.
Child Development, 59, 993-1007.
Sergeant, J. A. (1989). In search of processing deficits of attention in
ADD-H children. In L. M. Bloomingdale & J. M. Swanson (Eds.),
Attention deficit disorder (Vol. 4, pp. 255-272). Oxford, England:
Pergamon Press.
Sergeant, J., & van der Meere, J. (1990). Convergence of approaches in
localizing the hyperactivity deficit. In B. B. Lahey & A. E. Kazdin
(Eds.), Advances in clinical child psychology (Vol. 13, pp. 207-246).
New \ork: Plenum Press.
Share, D. L., McGee, R., McKenzie, D., Williams, S., & Silva, P A.
(1987). Further evidence relating to the distinction between specific
reading retardation and general reading backwardness. British Jour-
nal of Developmental Psychology, 5, 35-44.
Share, D. L., McGee, R., & Silva, P. A. (1989). IQ and reading progress:
A test of the capacity notion of IQ. Journal of the American Academy
of Child and Adolescent Psychiatry, 28, 97-100.
Shaywitz, S. E., Shaywitz, B. A., Fletcher, J. M., & Escobar, M. D.
(1990). Prevalence of reading disability in boys and girls: Results of
the Connecticut Longitudinal Study. Journal of the American Medi-
cal Association, 264, 998-1002.
Silva, P. A. (1987). Epidemiology, longitudinal course, and some asso-
ciated factors: An update. In W Yule & M. Rutter (Eds.), Language
development and disorders (pp. 1-15). Oxford, England: MacKeith.
Silva, P. A., McGee, R, & Williams, S. (1985). Some characteristics of
9-year-old boys with general reading backwardness or specific read-
ing retardation. Journal of Child Psychology and Psychiatry, 26,407-
421.
Silver, L. B. (1990). Attention-deficit hyperactivity disorder: Is it a
learning disability or a related disorder? Journal of Learning Disabili-
ties, 23, 394-397.
Sleator, E. K., & Ullmann, R. K. (1981). Can the physician diagnose
hyperactivity in the office? Pediatrics, 67,13-17.
Spreen, O. (1988). Prognosis of learning disability. Journal of Consult-
ing and Clinical Psychology, 56, 836-842.
Stevenson, J. (1984). Predictive value of speech and language screen-
ing. Developmental Medicine & Child Neurology, 26, 528-538.
Stevenson, J., & Fredman, G. (1990). The social environmental corre-
lates of reading ability. Journal of Child Psychology and Psychiatry,
57,681-698.
Stevenson, J., & Richman, N. (1978). Behavior, language, and develop-
ment in three-year-old children. Journal of Autism and Childhood
Schizophrenia, 8, 299-313.
Stevenson, J., Richman, N., & Graham, P. (1985). Behaviour problems
and language abilities at three years and behavioural deviance at
eight years. Journal of Child Psychology and Psychiatry, 26,215-230.
Stone, W L., & LaGreca, A. M. (1990). The social status of children
with learning disabilities: A reexamination. Journal of Learning Dis-
abilities, 23, 32-37.
Stott, D. H. (1981). Behaviour disturbance and failure to learn: A study
of cause and effect. Educational Research, 23,163-172.
Strang, J. D., & Rourke, B. P. (1985). Arithmetic disability subtypes:
The neuropsychological significance of specific arithmetic impair-
ment in childhood. In B. P. Rourke (Ed.), Neuropsychology of learn-
ing disabilities: Essentials of subtype analysis (pp. 167-183). New
York: Guilford Press.
Sturge, C. (1982). Reading retardation and antisocial behaviour. Jour-
nal of Child Psychology and Psychiatry, 23,21-31.
Sweeney, J. E., & Rourke, B. P. (1985). Spelling disability subtypes. In
B. P. Rourke (Ed.), Neuropsychology of learning disabilities: Essen-
tials of subtype analysis (pp. 147-183). New York: Guilford Press.
Szatmari, P., Boyle, M., & Offord, D. R. (1989). ADDH and conduct
disorder: Degree of diagnostic overlap and difference among corre-
lates. Journal of the American Academy of Child and Adolescent Psy-
chiatry, 28, 865-872.
Szatmari, P., Offord, D. R., & Boyle, M. H. (1989). Ontario Child
Health Study: Prevalence of attention deficit disorder with hyperac-
tivity. Journal of Child Psychology and Psychiatry, 30, 219-230.
 EXTERNALIZING BEHAVIOR AND UNDERACHIEVEMENT 155

Szatmari, P., Offord, D. R., Siegel, L. S., Finlayson, M. A. J., & Tuff, L.
(1990). The clinical significance of neurocognitive impairments
among children with psychiatric disorders: Diagnosis and situa-
tional specificity. Journal of Child Psychology and Psychiatry, 31,
287-299.
Tallal, P. (1980). Language disabilities in children: A perceptual or
linguistic deficit? Journal ofPediatric Psychology, 5, 127-140.
Tallal, P., Dukette, D., & Curtiss, S. (1989). Behavioral/emotional pro-
files of preschool language-impaired children. Development andPsy-
chopathology, 1, 51-67.
Taylor, H. G. (1988). Learning disabilities. In E. J. Mash & L. G. Terdal
(Eds.), Behavioral assessment of childhood disorders (2nd ed., pp.
402-450). New York: Guilford Press.
Wagner, R. K., & Torgeson, J. (1987). The nature of phonological pro-
cessing and its causal role in the acquisition of reading skills. Psycho-
logical Bulletin, 101,192-212.
Weiss, G., & Hechtman, L. T. (1986). Hyperactive children grown up:
Empirical findings and theoretical considerations. New York: Guil-
ford Press.
Werner, E., & Smith, P. (1982). Vulnerable but invincible: A study of
resilient children. New "Vbrk: McGraw-Hill.
Werry, J. S., Elkind, G. S., & Reeves, J. C. (1987). Attention deficit,
conduct, opposit ional, and anxiety disorders in children: III. Labora-
tory differences. Journal of Abnormal Child Psychology, 15, 409-
428.
White, J. L., Moffitt, T. E., & Silva, P. A. (1989). A prospective replica-
tion of the protective effects of IQ in subjects at high risk for juvenile
delinquency. Journal of Consulting and Clinical Psychology, 57, 719-
724.
Wilson, J. Q., & Herrnstein, R. J. (1985). Crime and human nature. New
York: Simon & Schuster.
Yule, W, & Rutter, M. (1985). Reading and other learning difficulties.
In M. Rutter & L. Hersov (Eds.), Child and adolescent psychiatry:
Modern approaches (pp. 444-464). Oxford, England: Blackwell Sci-
entific.
Received September 25,1990
Accepted May 9,1991

Instructions to Authors
Authors should prepare manuscripts according to the Publication Manual of the American
Psychological Association (3rd ed.). All manuscripts must include an abstract containing a
maximum of 960 characters and spaces (which is approximately 120 words) typed on a separate
sheet of paper. Typing instructions (all copy must be double-spaced) and instructions on pre-
paring tables, figures, references, metrics, and abstracts appear in the Manual. Also, all manu-
scripts are subject to editing for sexist language.
Authors reporting original data will be required to state in writing that they have complied
with APA ethical standards in the treatment of their sample, human or animal, or to describe
the details of treatment. (A copy of the APA Ethical Principles may be obtained from the Ethics
Office, American Psychological Association, 750 First Street, N.E., Washington, DC 20002.)
Masked review will be first an author's option. If masked review is not requested in a cover
letter, it will become the prerogative of the processing editor. Authors requesting masked
review are requested to include with each copy of the manuscript a cover sheet, which shows the
title of the manuscript, the authors' names and institutional affiliations, and the date the
manuscript is submitted. The first page of the manuscript should omit the author's name and
affiliation but should include the title of the manuscript and the date it is submitted. Footnotes
containing information pertaining to the authors' identity or affiliations should be on separate
pages. Every effort should be made to see that the manuscript itself contains no clues to the
authors' identity.
APA policy prohibits an author from submitting the same manuscript for concurrent consid-
eration by two or more publications. APA policy also prohibits duplicate publication, that is,
publication of a manuscript that has already been published in whole or in substantial part
elsewhere. Authors have an obligation to consult journal editors if there is any chance or
question that the paper might not be suitable for publication in an APA journal. Authors who
do not inform the editor of the prior publication history of previously published material will
be engaging in unethical behavior. Also, authors of manuscripts submitted to APA journals are
expected to have available their raw data throughout the editorial review process and for at least
5 years after the date of publication.
Submit five copies of each manuscript. All copies should be clear, readable, and on paper of
good quality. A dot matrix or unusual typeface is acceptable only if it is clear and legible. In
addition to addresses and phone numbers, authors should supply electronic mail addresses and
fax numbers, if available, for potential use by the editorial office and later by the production
office. Authors should keep a copy of the manuscript to guard against loss. Mail manuscripts to
the Editor, Robert J. Sternberg, Psychological Bulletin, Department of Psychology, Yale Univer-
sity, P.O. Box 11A Yale Station, New Haven, CT 06520-7447.