Mapping early pathways of emotional and conduct problems: Risk, adaptation and sex differences

Patterns of emotional and behavioural difficulties in early childhood are of major public health relevance, as they may mark the onset of persistent vulnerability. This study used a person-centred approach to identify sex differences in co-developmental trajectories of emotional and conduct problems and to examine multi-contextual predictors of risk or adaptation. Data came from the ELISA cohort (Galicia, Spain), a community sample of 2,467 children followed annually since 2016 (48.1% girls; M age = 4.25, SD = 0.99). A joint growth mixture model identified three trajectories from T2 to T6, with good classification quality (entropy = .852): adaptive (67.4%), co-occurring (16.9%), and predominantly emotional (15.6%). SES predicted adaptive versus co-occurring membership. Sex was associated with trajectory membership: girls were more often in predominantly emotional or adaptive pathways, whereas boys were more represented in the co-occurring risk pathway. After controlling for baseline (T1) emotional and conduct problems, T2 predictors distinguished both non-adaptive trajectories from the adaptive one and revealed distinct multi-contextual patterns. The predominantly emotional group was marked by affective vulnerability and a strained caregiving climate, reflected in parenting stress. In contrast, the co-occurring group was characterized by behavioural vulnerability, particularly higher psychopathic-like features, and punitive parenting. Both risk pathways reflected poorer social adjustment, but predominantly emotional membership was associated with peer victimization, whereas co-occurring membership involved greater engagement in bullying. Evidence for sex-specific predictor effects was limited, although socioeconomic disadvantage showed a tentative pattern of greater relevance to girls’ emotional-risk pathway. Overall, findings support sex-informed early risk stratification and prevention targets tailored to distinct developmental risk pathways.

Key messages

• Distinct trajectories and modifiable predictors may help refine early risk stratification and targeted prevention in child public mental health.

• Sex differences in early pathways highlight the need for prevention approaches sensitive to developmental heterogeneity.