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Participants included 71 children with MD and 86 typically developing (TD) children (ages 8\u201312) from Shanghai, China (32 MD, 46 TD) and Alberta, Canada (39 MD, 40 TD). Teachers rated their students\u2019 internalizing problems using the Behavior Assessment System for Children\u2013Third Edition (including anxiety, depression, somatic complaints, and social withdrawal subscales), while students self-reported on their mathematics and school anxiety. Results indicated first that children with MD experienced significantly higher levels of both internalizing problems and mathematics anxiety than their TD peers. Second, Canadian children with MD were rated as having more mathematics anxiety than their Chinese counterparts and Chinese children with MD had more somatic complaints than their Canadian counterparts. No significant interaction was found between country and difficulty group status. Taken together, these findings suggest that having MD confers emotional vulnerability in both countries, but culture may shape the form in which distress is expressed.<\/jats:p>","DOI":"10.1177\/00222194261491760","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:01:33Z","timestamp":1792656093000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Co-Occurrence Between Internalizing Problems, Academic-Related Anxieties, and Mathematics Difficulties: A Cross-Cultural Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3005-7724","authenticated-orcid":false,"given":"Dan","family":"Cai","sequence":"first","affiliation":[{"name":"Shanghai Normal University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4771-3476","authenticated-orcid":false,"given":"Ana Paula Alves","family":"Vieira","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan-Xin","family":"Huang","sequence":"additional","affiliation":[{"name":"Shanghai Normal University, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliya","family":"Kotelnikova","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9081-992X","authenticated-orcid":false,"given":"George K.","family":"Georgiou","sequence":"additional","affiliation":[{"name":"University of Alberta, Edmonton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"1","key":"e_1_3_3_2_1","first-page":"95","article-title":"International policies, identification, and services for students with learning disabilities: An exploration across 10 countries","volume":"17","author":"Agrawal J.","year":"2019","unstructured":"Agrawal J., Barrio B. 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