Internalizing and Externalizing Problems and Their Associations with Social and Learning Difficulties: Evidence from Vietnamese Primary School Children

Objective: Guided by the adjustment erosion model, this study examined whether parent-rated hyperactivity/inattention and anxiety were differentially associated with children's self-reported social and learning difficulties, and whether anxiety moderated the associations of hyperactivity/inattention with these outcomes. Methods and Materials: A cross-informant, cross-sectional design was used with 588 parent-child pairs (M age = 9.59 years, SD = 0.51; 54.4% boys) recruited by convenience sampling from urban, semi-urban, and rural areas of northern Vietnam. Parents completed 13 items assessing hyperactivity/inattention (8 items, alpha = .83) and anxiety (5 items, alpha = .71). Children completed measures of social difficulties (10 items, alpha = .75) and learning difficulties (10 items, alpha = .86). Hierarchical regression and PROCESS moderation analyses were conducted after adjustment for demographic covariates. Findings: Hyperactivity/inattention was positively associated with both learning difficulties (beta = .14, p < .001) and social difficulties (beta = .19, p < .001). Anxiety was positively associated with social difficulties (beta = .12, p = .003) but not learning difficulties (beta = -.07, p = .102). Anxiety significantly moderated the associations between hyperactivity/inattention and learning difficulties (interaction beta = .08, p = .035) and social difficulties (interaction beta = .11, p = .003). Explained variance remained modest. Conclusion: Co-occurring anxiety may strengthen the concurrent associations between hyperactivity/inattention and children's perceived school-adjustment difficulties. Because the design was cross-sectional and based on convenience sampling, the findings should be interpreted as conditional associations rather than causal or developmental effects.