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Internalising and externalising problems among adolescents in Malaysia’s children institutions

  • June 25, 2019
The research team consists of five social science lecturers – Amna Md Noor (PhD), Senior Lecturer in Social Work, Hanina Halimatussaadiah Hamsan (PhD), Associate Professor in Community Psychology, Zainal Madon (PhD), Associate Professor in Guidance And Counseling, Mariani Mansor (PhD), Associate Professor in Child And Adolescent Developmental Psychology and Zaid Ahmad (PhD), Professor of Philosophy And Civilisational Studies. This study was assisted by Tang Sui Sam as a research assistant who is also a UPM graduate student and officers from the Institute Social Malaysia (ISM) comprising Al-Azmi Bakar (PhD), Nurul Hidayah Abd. Khalid, Dana Zulkeefly, Khor Siew Yee and Loh Siew Lik who involved directly throughout the research process.

Several studies have identified that post-institutionalised children are significantly correlated with behavioural problems. This study emphasises on internalising and externalising problems among adolescents in Malaysia’s adolescent children institutions. A stratified sampling method was utilised to determine the response among adolescents from four different regions across Malaysia. Through the sampling method, a total of 220 adolescents were selected to be the respondents of this study. The Youth Self-Report (YSR) measurement was used as a tool to measure the behavioural and emotional problems of these adolescents. The results showed that 54.5% and 24.1% of the respondents obtained internalising scores at clinical and borderline levels respectively. In terms of externalising problems, 41.4% and 20.9% of the respondents obtained scores at clinical and borderline levels. Therefore, relevant agencies should pay extra attention to the behavioural and emotional development of institutionalised adolescents in order to prevent internalising and externalising problems among institutionalised adolescents.

The behavioural problems among adolescents can be in various forms and the indicators used to measure these problems may vary with different studies. These indicators include internalising and externalising behavioural problems, academic failure, anti-social behaviour, substance abuse, risky sexual behaviour and delinquency. Development of behavioural problems can increase the risk of an adolescent getting involved in criminal activities, violence and illegal drug usage during his or her adulthood. The wellbeing and development of a child in terms of mental, behavioural and cognitive development will be negatively influenced if the child is exposed to elements of behavioural problems.

An adolescent is an individual who is undergoing a period of transition from childhood to adulthood, where the individual is prepared to face future challenges in life. During this specific period, the adolescent experiences biological, cognitive, social and economic transitions. Adolescents can possibly get involved in risk-taking situations, conflicts and troubles which can lead to behavioural problems. It is found that behavioural problems among adolescents are highly associated with improper or inadequate prevention and intervention of caretakers. These problematic behaviours may eventually escalate and manifest in adulthood.

The situation is more acute for adolescents who stay in children’s institutions where they are more likely to be exposed to the risk of manifesting behavioural problems. Adolescents who stay in children’s institutions usually have a history of physical abuse, neglect by family members or abandonment by parents. Most of them come from extreme poverty and broken familybackgrounds. Disabilities and serious illnesses are also some of the reasons some adolescents are sent to a children’s institution. The negativities around them may have contributed to the formation of behavioural problems among them. Much research have shown that adolescents in children’s institutions have a greater tendency to get involved in crimes during adulthood. Besides that, previous studies have shown that adolescents who leave children’s institutions when they are above 18 years old, are often confronted with several challenges and hardships. These include homelessness, criminal activities (which lead to incarceration), mental health problems, early sexual activities (which result in teenage pregnancies), low educational attainment, unemployment and drug abuse. In addition, a study in Russia reported that adolescents who leave children’s institutions are exposed to high risks of involvement in crimes, prostitution and suicide.

Nonetheless, it has been pointed out that the issue of behavioural problems among adolescents in children’s institutions is due to the poor conditions there. The support and services provided in these institutions are found to be improper and inadequate in ensuring the positive development of adolescents who reside there. Therefore, failure to provide a suitable environment for the adolescents together with the conditions of children’s institutions have adverse effects on the growth of these adolescents which may directly lead to behavioural problems.

In Malaysia, only a few studies have been carried out concerning the well-being of adolescents who reside in children’s institutions. The seriousness of behavioural problems among children who reside in children’s institutions is still unknown in Malaysia. As stated above, adolescents who have no alternative but to reside in children’s institutions have encountered difficult situations and bad experiences with their family members in the past. Therefore, children’s institutions should provide the necessary intervention and proper aid to the adolescents to help them to recover from the bad experiences and lead them to positive development. Thus, it is essential to consider this aspect in order to identify the seriousness of behavioural problems among adolescents who reside in children’s institutions. It is a crucial step in determining the effectiveness of strategy planning for children’s institutions in Malaysia.

Youth Self-Report (YSR)

Youth Self-Report (YSR) was developed and established by ASEBA to measure the emotional and behavioural problems of adolescents. YSR is an instrument that consists of 112 items to be completed by the adolescents themselves. The respondents are instructed to evaluate themselves on how true each = item describes themselves now or within the past 6 months. This instrument can be used to assess internalising (anxiety, depression, over-controlled) and externalising (aggressiveness, hyperactivity, noncompliant, under- controlled) behaviours. It contains eight subscale symptoms which are withdrawn, somatic complaints, anxiety and depression, social problems, thought problems, attention problems, aggressive and delinquent behaviours. The summation of subscale anxious/depressed and withdrawn/depressed scores is equivalent to the scores for internalising behaviours. On the other hand, the summation of rule-breaking and aggressive behaviour scores are the scores of externalising behaviours. Total problem scores are the sum of all eight symptoms’ scores. Higher scores indicate greater problematic behaviours whereas lower scores indicate otherwise. The reliability of the instrument is .92. Prior to the study, a pilot study was conducted with a sample size of 15 adolescents from two children institutions in Pulau Pinang. The Cronbach Alpha test has shown that the reliability of the measurement is .94, which exceeds the value recommended by Nunnally (1978).

The Findings

There are five main anxiety disorders that occur in internalising behaviours: namely separation, social, general, post-traumatic stress and obsessive compulsive disorders. It was found that committing suicide stemmed from internalising behaviours (Chen, Lewis & Liu, 2011). The result of this research shows that more than half (54.5%) of the respondents faced a clinical level of internalising behaviours. The results for each sub-symptom shows that different respondents have different internalising problems. This was evidenced by the different distribution of respondent percentage under clinical stage for each sub-symptom ie 23.6% for anxious, 21.4% for withdrawn and somatic complaints (12.3%).

For externalising problem scores, the results indicate that 62.3% of the respondents were abnormal in externalising problems and have the obvious symptoms of such behavioural problems. An individual with the symptom of externalising behaviours may manifest aggression, violence, harassment, disruptiveness and defiance. Therefore, it can increase the likelihood of getting involved in adult crimes and violence. The consequences the child may face is ending up dead, in jail, or engaging in substance abuse resulting in making it nowhere in life. However, for the sub-symptom of rulebreaking behaviours and aggression, 68.2% and 58.6% of the respondents have obtained normal level score. Only a minority of adolescents (7.3%) exhibit the symptom of rule-breaking behaviours. This somehow indicates that the adolescents in children’s institutions are obedient to the rules. The overall results show that more than half of the respondents have obtained a clinical level for total problem scores. A large number of adolescents have indicated that the environment, conditions and services provided by the children’s institutions are inadequate to instil good behaviours in the children who reside there. It is reported that children who reside in children’s institutions have significantly higher behavioural problems than children who are living with their parents in Kuala Lumpur. Thus, more efforts should be invested on children’s institutions in order to improve the overall condition to instil positive development of the children.

Conclusion

This study thus proves to relevant agencies, especially the Department of Social Welfare and schools, that they should pay extra attention to the behaviours and emotional development of institutionalised adolescents. To prevent internalising and externalising problems among institutionalised adolescents, more attention should be focused on adolescents identified with such behavioural problems so that professional counselling services in both schools and institutions can be provided. Besides that, relevant agencies should promote activities that can enable adolescents to participate in positive youth development programs and engage themselves with the environment so as to minimise the onset of depression, feeling withdrawn and somatic problems. This will benefit youths residing in children’s institutions and thus prepare them to be responsible citizens in the future.

References:
1. Achenbach, T., & Rescorla, L. (2001). Manual for the ASEBA School-age Forms and Profiles.Child Behaviour checklist for ages 6-18, teacher’s report forms, youth self-report and integrated system of multi-informant assessment: Burlington, VT: University of Vermont.
2. Chen X., Lewis G., Liu J., (2011). Childhood Internalizing Behaviour: Analysis and Implications, Journal of Psychiatric and Mental Health Nursing, 2011, 18, 884-894.
3. Jianghong L., PhD, RN (2004). Childhood Externalizing Behaviour: Theory and Implications, J Child Adolescent Psychiatry Nurse. 2004; 17(3): 93-103.
4. Larson, R. W., Wilson, S., & Rickman, A. (2009). Globalization, societal change, and adolescence across the world. Handbook of Adolescent Psychology.
5. Lumos (2015). Supporting Deinstitutionalisation in Moldova, Retrived 10 October,2015, From: https://wearelimos.org/stories/supportingdeinstitutionalisationmoldova.
6. Nunnally, J. C. (1978). Psychometric Theory. New York: McGraw-Hill.
7. Pantin, H., Schwartz, S. J., Coatsworth, J. D., Sullivan, S.,Briones, E., & Szapocznik, J. (2007). FamiliasUnidas: A systemic, parent-centered approach to preventing problem behaviur in Hispanic adolescents.
8. Pashkina (2001). Sotsial’noe Obespechenie, 11:42–45. Cited in Holm-Hansen J, Kristofersen LB, Myrvold TM eds. Orphans in Russia. Oslo, Norwegian Institute for Urban and Regional
Research (NIBR- rapport 2003:1).
9. Rahman, A., Nazri, F., Daud, M., Iryani, T., Nik Jaafar, N. R., Shah, S. A., … & Salwina, W (2013). Behavioural and Emotional Problems in a Children’s Home in Kuala Lumpur. PediatricsInternational, 55(4), 422-427.
10. Schlegel, A. (2009). Cross-Cultural Issues in the Study of Adolescent Development. Handbook of Adolescent Psychology.
11. WI, W. S., CG, N., MR, R. S., & HH, A. (2015). Prevalence of Depression in Adolescents Living in Residential Homes in Perak, Malaysia and Its Association with Socio-Demographic and Personal Factors. Malaysian Journal of Psychiatry, 23(2), 40- 51.

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