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Prior research suggests sex differences may shift across development, yet findings have been inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from 600 children (ages 6\u201317; 53.2% male) referred to a pediatric anxiety specialty clinic in the Northeastern United States between 2013 and 2021. Parents completed the Child Behavior Checklist (CBCL\/6\u201318). Ordinary least squares regression models with an interaction term (sex\u2009\u00d7\u2009age) were estimated using Hayes\u2019 PROCESS macro (Model 1). The Johnson\u2013Neyman technique was applied to identify developmental periods where sex differences were significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sex significantly moderated the association between age and CBCL scores. Boys displayed higher externalizing scores than girls between ages 6 and 9.7\u00a0years, whereas girls showed higher internalizing scores from age 10.4\u00a0years onward. Effect sizes for the interactions were modest (\u0394R2 range\u2009=\u2009.03\u2013.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings indicate that the expression of behavioral problems among anxiety-referred youth differs by both sex and developmental stage. Early externalizing difficulties in boys and later-emerging internalizing difficulties in girls suggest that findings may inform age- and sex-sensitive approaches to assessment and intervention to age- and sex-specific trajectories in pediatric anxiety populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40359-025-03529-8","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T10:09:08Z","timestamp":1762164548000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Sex and age as moderators in the expression of internalizing and externalizing behaviors: insights from the Child Behavior Checklist (CBCL)"],"prefix":"10.1186","volume":"13","author":[{"given":"Roald A.","family":"\u00d8ien","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Cogo-Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Nordahl-Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K.","family":"Juel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy K.","family":"Silverman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli R.","family":"Lebowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"3529_CR1","volume-title":"Manual for the ASEBA school-age forms & profiles","author":"TM Achenbach","year":"2001","unstructured":"Achenbach TM, Rescorla LA. 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Silverman should be affiliated with #1 Yale School of Medicine \u2013 Child Study Center, New Haven, CT, USA.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. The study protocol was reviewed and approved by the Yale University Institutional Review Board (IRB).IRB# 1306012298 (Silverman, 2013).IRB#: 1311013020 (Lebowitz, 2014).IRB#: 2000023649 (Lebowitz, 2018).IRB#: 2000025143 (Silverman, 2019).Informed consent was obtained from all participants. For participants under 18\u00a0years of age, consent was obtained from legal guardians, and assent was obtained from children.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable, as no identifying information of participants is included in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1211"}}