Children with disruptive behavior disorders (DBDs) experience high rates of comorbid psychopathology, including internalizing disorders. According to the dual pathway model, comorbid internalizing symptoms may be associated with less (buffer hypothesis) or more (multiple problems) severe clinical presentations among children with DBDs. We examined whether the presence of comorbid internalizing symptoms is associated with differences in the severity of clinic-referred children’s (N = 284, age 6 to 12) disruptive behavior, as measured by parent ratings of their oppositionality-defiance, impairment, and callous-unemotional traits. Potential gender effects were also examined. Children with DBD and clinically elevated internalizing symptoms showed significantly higher levels of oppositionality-defiance and overall behavioral impairment and, unexpectedly, callous-unemotional traits, than children with DBD and sub-clinical internalizing symptoms. There were no significant main effects of gender or interactions between internalizing symptoms and gender. Results are consistent with the multiple problems hypothesis and suggest that children with DBDs should be assessed for internalizing symptoms. Moreover, children with comorbid DBD and internalizing disorders may require specific clinical attention, such as sequenced or modular interventions, or interventions targeting relevant transdiagnostic processes, in order to meet their treatment needs.

患有破坏性行为障碍（DBD）的儿童经历了包括内在性疾病在内的多种合并症。根据双途径模型，合并症的内在症状可能与DBD患儿较少（严重假说）或较多（多重问题）严重的临床表现有关。我们检查是否内向因子症状的存在与在诊所被称为儿童的严重程度差异有关（ñ = 284，年龄在6到12岁之间）的破坏性行为，通过父母对他们的对立，抵制，损伤和无情的性格特征的评估来衡量。还检查了潜在的性别影响。与患有DBD和亚临床内在症状的儿童相比，患有DBD并在临床上具有内在症状升高的儿童表现出更高的对立防御和总体行为障碍水平，以及出乎意料的无情的性格特征。性别或内在症状与性别之间的相互作用没有明显的主要影响。结果与多种问题假说相符，并建议应评估患有DBD的儿童的内在症状。此外，患有DBD合并症和内在性疾病的儿童可能需要特殊的临床注意，