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Purpose <p>Children with neurofibromatosis type 1 (NF1) frequently experience internalizing and externalizing problems, yet their developmental patterns remain poorly understood. This study examined age-related trends and subgroup differences in these symptoms.</p> Methods <p>Integrative data analysis combined 1,841 observations from 1,194 children with NF1 (ages 3–18) across nine institutions. Internalizing/externalizing problems were assessed using parent-rated Child Behavior Checklist (CBCL sample; <i>n</i> = 1,087 observations) or Behavior Assessment System for Children (BASC sample; <i>n</i> = 754 observations). The two samples were analyzed separately. Time-varying effect modeling characterized age-related symptom patterns overall and across subgroups defined by sex, NF1 inheritance mode, the presence of plexiform neurofibromas, and attention-deficit/hyperactivity disorder (ADHD) diagnosis.</p> Results <p>Across both assessments, children with NF1 exhibited greater internalizing and externalizing problems relative to normative means, although mean scores generally remained below clinical thresholds. Deviations were greater in older than younger children for internalizing problems, whereas deviations in externalizing symptoms remained relatively similar across age. Age patterns for both problems were largely consistent across subgroups except that children with ADHD showed higher symptom levels and distinct age patterns.</p> Conclusions <p>Findings highlight age-related differences in behavioral symptoms in NF1 relative to population norms, with greater internalizing deviations and relatively consistent externalizing deviations across age, as well as more pronounced deviations among children with co-occurring ADHD. Although interpretation is limited by reliance on parent reports, cross-sectional data, and normative rather than control comparisons, findings underscore the importance of ongoing monitoring and future longitudinal, multi-informant research to clarify developmental trajectories and clinical needs in NF1.</p>

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Age trends of internalizing and externalizing problems in children with neurofibromatosis type 1: a multicenter study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Dan Liu,
  • Xiaoli Zong,
  • Jonathan M. Payne,
  • Peter L. Stavinoha,
  • Pamela L. Wolters,
  • Karin S. Walsh,
  • Jennifer Janusz,
  • Bonita P. Klein-Tasman,
  • Stephanie M. Morris,
  • Carrie E. Bearden,
  • Natalie Pride,
  • Yang Hou

摘要

Purpose

Children with neurofibromatosis type 1 (NF1) frequently experience internalizing and externalizing problems, yet their developmental patterns remain poorly understood. This study examined age-related trends and subgroup differences in these symptoms.

Methods

Integrative data analysis combined 1,841 observations from 1,194 children with NF1 (ages 3–18) across nine institutions. Internalizing/externalizing problems were assessed using parent-rated Child Behavior Checklist (CBCL sample; n = 1,087 observations) or Behavior Assessment System for Children (BASC sample; n = 754 observations). The two samples were analyzed separately. Time-varying effect modeling characterized age-related symptom patterns overall and across subgroups defined by sex, NF1 inheritance mode, the presence of plexiform neurofibromas, and attention-deficit/hyperactivity disorder (ADHD) diagnosis.

Results

Across both assessments, children with NF1 exhibited greater internalizing and externalizing problems relative to normative means, although mean scores generally remained below clinical thresholds. Deviations were greater in older than younger children for internalizing problems, whereas deviations in externalizing symptoms remained relatively similar across age. Age patterns for both problems were largely consistent across subgroups except that children with ADHD showed higher symptom levels and distinct age patterns.

Conclusions

Findings highlight age-related differences in behavioral symptoms in NF1 relative to population norms, with greater internalizing deviations and relatively consistent externalizing deviations across age, as well as more pronounced deviations among children with co-occurring ADHD. Although interpretation is limited by reliance on parent reports, cross-sectional data, and normative rather than control comparisons, findings underscore the importance of ongoing monitoring and future longitudinal, multi-informant research to clarify developmental trajectories and clinical needs in NF1.