ASSOCIATIONS BETWEEN MALTREATMENT AND EMOTION
DYSREGULATION IN YOUNG CHILDREN
A Thesis
Presented to the faculty of the Department of Psychology
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF ARTS
in
Psychology
by
Deanna Kathryn Boys
FALL
2013
ASSOCIATIONS BETWEEN MALTREATMENT AND EMOTION
DYSREGULATION IN YOUNG CHILDREN
A Thesis
by
Deanna Kathryn Boys
Approved by:
__________________________________, Committee Chair
Marya C. Endriga, Ph.D
__________________________________, Second Reader
Susan G. Timmer, Ph.D
__________________________________, Third Reader
Kelly A Cotter, Ph.D
____________________________
Date
ii
Student: Deanna Kathryn Boys
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library and credit is to
be awarded for the thesis.
__________________________, Graduate Coordinator
Jianjian. Qin, Ph.D
Department of Psychology
iii
___________________
Date
Abstract
of
ASSOCIATIONS BETWEEN MALTREATMENT AND EMOTION
DYSREGULATION IN YOUNG CHILDREN
by
Deanna Kathryn Boys
Children exposed to violence and abuse have been found to exhibit emotional problems
such as high emotional reactivity, which is indicative of maladaptive emotional
regulation processes. Young children with dysregulated emotions have exhibited
emotional and behavioral problems that can lead to more severe problems and
psychopathology in later childhood. The present study evaluated emotional reactivity and
emotional regulation among 186 maltreated children as compared to 33 non-maltreated
children. Consistent with study hypotheses, child emotional reactivity as rated by
caregivers was significantly negatively related to observed emotion regulation during
caregiver-child interaction. Contrary to expectations, however, non-maltreated children
showed a sharper decline in emotion regulation than maltreated children in response to
increasingly aversive play situations with their caregivers, which may be due to lower
baseline levels of regulation in the maltreated group.
iv
Study results suggest that examining emotion regulatory processes during dyadic
interaction in a maltreated population is useful for developing a fuller understanding of
the construct in a relationship context.
_______________________, Committee Chair
Marya C. Endriga, Ph.D
_______________________
Date
v
ACKNOWLEDGEMENTS
This thesis would not have been possible without the support of many people. I
would first like to express my deepest gratitude to my advisor, Dr. Endriga, for her
constant encouragement, patience, gentle guidance and her ability to always be “Team
Deanna” throughout this entire process. Her dedication to helping her students succeed
has been inspirational. I would like to thank Dr. Timmer for first sparking the fire in my
research flame and also for creating an atmosphere where I could actively pursue and
research so many of my burning questions. She has a wonderful ability to always
challenge me to look closer and think harder; I am a better person because of it. I would
also like to thank Dr. Cotter, for always being so positive and encouraging, and for her
insightful and constructive comments on multiple drafts; these were very helpful. To my
entire committee: I could not have asked for a more supportive “Team Deanna,” or better
role models. I am truly grateful for everything you have done for me.
I would also like to thank everyone at the CAARE Center for offering me this
opportunity to be a part of something important for the community. Also, without all of
the hard work of the research assistants, this project would not have been possible.
Lastly, (but not least), I would like to thank my family and friends for enduring
this process with me. To my parents who are always so proud of me every step of the
way; my sisters for being my partners in crime and to my brother for being my big
brother. And to Lee Klemens for always being there for me no matter what. And to
Rosie, who with her puppy dog eyes always let me know when it was time for bed.
vi
TABLE OF CONTENTS
Page
Acknowledegments ............................................................................................................ vi
List of Tables .................................................................................................................... ix
List of Figures ..................................................................................................................... x
Chapter
1. INTRODUCTION ........................................................................................................ 1
2. LITERATURE REVIEW ............................................................................................. 5
Emotion Regulation and Dysregulation .................................................................. 5
Theoretical Framework: Developmental Psychopathology .................................. 12
Effects of Maltreatment and Violence Exposure on Children .............................. 13
Effects of Maltreatment and Violence Exposure on Children’s Emotional
Dysregulation ........................................................................................................ 14
3. METHOD ................................................................................................................... 20
4. RESULTS ................................................................................................................... 27
Preliminary Analyses: Demographic Differences in Emotional Reactivity. ........ 27
Hypothesis 1.1: Child Emotional Reactivity and its Relation to Emotion
Dysregulation ........................................................................................................ 29
Hypothesis 1.2: Child Emotional Reactivity and Change in Child Emotion
Dysregulation Across Play Situations ................................................................... 31
Hypothesis 2.1: Child Emotional Reactivity and Abuse and Violence Exposure 32
vii
Hypothesis 2.2: Maltreatment History and Change in Responsiveness ............... 33
5. DISCUSSION ............................................................................................................. 37
Summary ............................................................................................................... 37
Emotional Reactivity and Emotion Regulation .................................................... 38
Emotion Regulation and Abuse and Violence History ......................................... 39
Limitations ............................................................................................................ 44
Conclusion ........................................................................................................... 44
Appendix A. Emotional Availability Coding Sheet ......................................................... 46
Appendix B. Child Behavior Checklist 1 ½ to 5 .............................................................. 49
References ......................................................................................................................... 50
viii
LIST OF TABLES
Tables
Page
1.
Demographics for Sample …………………….……………………………….28
2.
Mean and Standard Deviations of Child Responsiveness in its relation to
Emotional Reactivity…………………………………………………………..30
3.
Mean Scores and Standard Deviations for Child Responsiveness as a Function of
Emotional Reactivity…………………….…………………………………….32
4.
Mean Scores and Standard Deviations for Child Responsiveness as a Function of
Abuse History and Violence Exposure ……………………………………. …34
ix
LIST OF FIGURES
Figures
1.
Page
Child responsiveness across three behavioral analogs as a function
of their abuse and violence exposure history. . .……………………………….36
x
1
Chapter 1
INTRODUCTION
The ability to regulate one’s emotions is an essential part of the socio-emotional
developmental process (Cicchetti & Toth, 1995). During infancy and early childhood,
infants and young children are still developing the ability to modulate and control how
they react emotionally and behaviorally to stressful situations. Young children depend on
caregivers to help them learn how to manage the intensity and expression of their
emotions (Cole, Michel, & Teti , 2004; Eisenberg & Morris, 2002; Morris, Silk,
Steinberg, Myers, & Robinson 2007; Thompson, 1994). In order to provide comfort and
security, caregivers respond to crying infants by soothing and holding (Thompson, 1994)
or by diverting children’s attention away from the distressing situation (Gross &
Thompson, 2001). Parents also reinforce their children’s positive emotional strivings by
responding with praise and sensitivity to pro-social behaviors (Eisenberg & Morris, 2002;
Morris et al., 2007). Caregivers serve as models by demonstrating appropriate expression
of emotions, especially in taxing and ambiguous situations, by reinforcing appropriate
emotional responses and instructing them about the meaning of the responses. (Carson &
Parke, 1996; Eisenberg, Valiente, Morris et al., 2003). As children age, extrinsic
regulations by others eventually internalize and children are increasingly able to use these
learned strategies on their own (Eisenberg & Morris, 2002; Gross & Thompson, 2004).
Thus, young children’s ability to regulate their own emotions is contingent upon parents’
2
ability to recognize potentially difficult situations, children’s emotional states, and to help
soothe them when they become dysregulated (Eisenberg & Morris, 2002; Eisenberg et
al., 2003).
For caregivers to be able to address and facilitate this social learning of
appropriate expression and managing of emotions, they must be able to understand their
children’s emotional cues (Eisenberg & Morris, 2002) and make themselves emotionally
available (Robinson, Emde, & Korfmacher, 1999). When parents are unable to make
themselves emotionally available or are possibly emotionally negative in their
interactions with their children, this can hinder their children’s emotional self-regulation
development (Martins, Soares, Martins, Tereno, & Osorio, 2012) . Children who have
been abused or have witnessed inter-parental violence are more likely to engage in
negative emotional interactions, making the chances of developing successful emotion
regulation strategies less likely when their emotional experiences with their caregivers
are filled with anxiety and emotional unpredictability (Carson & Parke, 1996; Maughan
& Cicchetti, 2002; Sroufe, 1996). Additionally, compared to non-maltreated children,
maltreated children have been found to exhibit higher negative emotional reactivity
(Sturge-Apple, Davies, Cicchetti, & Manning, 2012). We know from other research that
the more severe the emotional reaction, the harder it is for children to regulate their
emotions (e.g., Little & Carter, 2005), and the greater the likelihood that they will use
maladaptive emotion regulation strategies (Morris et al., 2007), putting them at greater
risk for later psychopathology (Cicchetti & Toth, 2000; Keenan, 2000).
3
The present study evaluated how emotional reactivity and emotional regulation in
the context of parent-child interactions are related to one another in a maltreated
population. First, the relationship between caregiver report of their child’s emotional
reactivity and the child’s observed responsiveness to the parent was examined. Children’s
responsiveness to their parents was observed in three increasingly aversive behavioral
observations as a dyadic measure of the child’s emotional regulation and the parent’s
effectiveness in helping the child to cope with these distressing situations. Second, the
relationships between children’s maltreatment history, their emotional reactivity, and
their emotional responsiveness to their parents were examined.
Statement of the Problem
Adaptive and appropriate emotion regulation is a core component of healthy
development (Cicchetti, 2006; Gross & Thompson, 2004; John & Gross, 2004), and
emotional reactivity is a key indicator of children’s ability to self-regulate (Morris et al.,
2007). When children are highly emotionally reactive, they show high vigilance to threat
and have difficulty containing their anxiety, anger, and frustration (Achenbach, 2000).
They show by their emotional reactivity to environmental triggers that they have
difficulty regulating their emotions. Problems with emotion regulation are closely
associated with psychopathology (Mennin, Holoway, Fresco, Moore, & Heimburg, 2007;
Nolen-Hokesema, Stice, Wade, Bohon, 2007) such as anxiety-based disorders (Kasdan &
Breen, 2008; Mennin et al., 2007), major depressive disorder (Nolen-Hokesema et al.,
2008), borderline personality disorder (Linehan, 1993; Putnam & Silk, 1995), alcohol and
4
substance abuse issues (Gratz & Tull, 2009) and eating disorders (Nolen-Hoeksema et al.,
2007). During early childhood, the inability to regulate emotions appropriately or the use
of maladaptive ways to control emotional expression can occur as an adaptation to poor,
abusive or neglectful parenting (Cicchetti, 2006). Children who have experienced trauma
or have been maltreated may have developed emotion regulation strategies that were
adaptive in a dysfunctional family setting, but maladaptive when used in other contexts,
contributing to difficulties in their socio-emotional development (Cicchetti & Lynch,
1995). With emotion regulatory problems often a function of high emotional reactivity
(Little & Carter, 2005) and being at the forefront of problems that can persist in to
adulthood, it is important to gain understanding into the ways maltreatment and violence
exposure affect children’s emotional self-regulation.
5
Chapter 2
LITERATURE REVIEW
Emotion Regulation and Dysregulation
Emotion regulation has been described as the ability to respond to the ongoing
requirements of experience with a pattern of emotions that is socially acceptable and
reasonably flexible enough to allow variation in reactions as well as the ability to delay
these reactions when necessary (Cole et al., 1994). Individuals vary significantly in how
they manage and express their emotions. It is the norm for individuals to vary in their
expression of their emotional patterns, either by type or intensity; however, in some
settings emotional patterns can affect functioning and become associated with
psychopathology (e.g., Cole et al., 1994). Emotion dysregulation can occur when
management of emotional patterns operates in a dysfunctional way so that functioning is
compromised (Cole et al., 1994). Dysregulated emotions in children might present as
over-controlled or under-controlled depending on the situation in which they are viewed
(Cole, Martin & Dennis, 2004; Cole et al., 1994). With under-controlled emotions,
children exhibit an amplified negative reaction (Martin, et al., 2012). For example, undercontrolled emotions might be evident in children who present with an initial exaggerated
negative emotional response to a disappointment (Liew, Eisenberg, & Riser, 2003) or an
unpredictable fluctuation between calm and negativity with little provocation (e.g., Cole
et al., 2003).
6
The construct of emotion regulation and dysregulation is complex and difficult to
measure. As such, different paradigms exist to evaluate emotion dysregulation that
depend on the age of the child and the exact variables under study. Most paradigms are
observational, involving a series of shifts in conditions to elicit changes in emotions. For
example, the “still-face” paradigm (Tronick, Als, Adamson, Wise, & Brazelton, 1978)
uses a dyadic interaction between mothers and their very young infants in three separate
situations to measure changes in the infant’s emotions in relation to changes in the
mother’s emotional availability. In the first phase of the task, mothers engage with their
infants in a free play interaction. Next, the caregiver assumes a neutral expression and
remains unresponsive, keeping her face completely still, although oriented toward the
infant. The infant usually responds to this change by trying to reengage by vocalizing and
gesturing to the caregiver. Typically, the infant becomes distressed when the mother fails
to respond, which provides an opportunity to observe emotion regulation and the infant’s
attempts to regulate negative affect. In the last phase, mothers are instructed to provide
comfort if necessary and resume face-to-face play. Infants’ emotional responses to the
mother are used to evaluate their regulation (Weinbug & Tronick, 1996).
Little and Carter (2005) used play situations to stimulate emotional reactivity in
infants while measuring the infants’ emotion regulation. Caregivers were told to engage
in a free play situation with their infants. After completion of this situation infants were
then evaluated during a challenge condition that should elicit infant emotional reactivity
by restricting their ability to move their arms and legs. Next, infants were placed in a
7
condition that would prompt the infant to engage in emotional self-regulatory behaviors
(i.e., self-soothing), by removing the restraints, but not allowing the child to have any
social contact. Lastly, infants were then allowed to be soothed by an experimenter and
then a caregiver. This paradigm was designed to provoke emotionally reactive responses
from the infants, but then provide them with opportunities to self-regulate, comfort
themselves and also receive comfort their caregiver. The researchers measured how
infants reacted emotionally (negatively), whether they attempted to regulate their
reactions (fuss or immediate intense cry), and used the Emotional Availability Scales
(Biringen, 2000) to evaluate infants’ emotional responsiveness. A significant relationship
was found between infant emotional reactivity responsiveness and regulation attempts.
Infants who presented with more negative initial reactions to a challenge and less
emotional responsiveness towards their caregiver took longer than other infants to calm
themselves during those distressing situations. This research demonstrated that more
severe emotional reactions predicted more trouble regulating emotions. Furthermore
these preliminary findings outline the importance of assessing emotional regulation
within the caregiver-child relationship (Little & Carter, 2005).
Emotional expression after infancy has been measured using a task to elicit
disappointment (Cole, Zahn-Waxler, & Smith, 1994; Saarni, 1984). In the
“disappointment task” paradigm, children are told that they will receive a desired prize
after completing some tasks. Instead, children receive a broken item (e.g., a broken
pencil). Researchers code children’s responses to this disappointment for discreet
8
displays of affect, other behavioral responses and active engagement in regulation
strategies. Children who were able to effectively regulate their emotional reactions during
this task were able to “mask” their disappointment when in the presence of an
experimenter, i.e., socially acceptable emotion regulation. However, some children
displayed dysregulated emotions, such as disappointment, anger and frustration, i.e.,
socially unacceptable emotion regulation (Cole, Zahn-Waxler, & Smith, 1994).
Parent report measures of children’s emotion regulation such as the Emotion
Regulation Checklist (ERC: Shields & Cicchetti, 1997) have also been previously used
and validated. On the ERC, parents rate how often children are able to regulate emotions
appropriately and how often they show lability and dysregulated negativity. The ERC has
demonstrated validity with observed emotion regulation. However, reliance on caregiver
report measures of behavioral and emotional problems can be problematic. When using
caregivers’ observations and ratings of their children’s behavior, it is important to
remember that caregivers can often have their own motivations and biases for providing a
rating of their children’s behavior especially in regards to what represents abnormal
behavior (De Los Reyes & Kazdin, 2005). Even when including additional reporters such
as the children themselves or teachers, ratings of children’s behavioral problems can still
be discrepant (De Los Reyes & Kazdin, 2005). In an extensive literature review of 119
studies, Achenbach, McConaughy and Howell (1987) found that when rating the same
child’s behavioral problems, different informants (e.g., parent, teacher, etc.) had
significantly discrepant ratings. These findings have been replicated in clinical samples
9
(Grills & Ollendick, 2002) and have also been found when measuring emotion regulation
(Hourigan, Goodman, & Southam-Gerow, 2011). Hourigan and colleagues (2011) found
inconsistencies between both the parent’s view and the child’s view of the child’s
emotional regulation in relation to the children’s internalizing and externalizing behavior
problems. School-age children were asked to evaluate their own emotion regulation and
then their reports were compared to parent’s reports of the child’s emotion regulation
using the Children’s Emotional Management Scales (CEMS) and the Child Behavior
Checklist (CBCL). Children who presented with more internalizing behavior problems
were more likely to report more discordant expression of sadness and anger when
compared to their parents’ reports of their emotional regulation. However, when children
had externalizing behavior problems and high emotional reactivity, parents reported them
as exhibiting more dysregulated anger than what their child reported. The authors
concluded that children act differently and express different emotional patterns within
differing contexts and with different people. They posited that their findings
demonstrated the complex nature of emotion regulation, and suggest using parent report
in addition to observational assessments when examining emotion regulation (Hourigan
et al., 2011).
Infants and young children are highly reliant on their caregivers to provide
appropriate emotional socialization and regulatory support (Eisenberg, Cumberland, &
Spinrad, 1998). Infants are quite limited in their behavioral repertoire (Gross &
Thompson, 2004; Little & Carter, 2005), especially in response to their need to maintain
10
optimal levels of arousal, calming, soothing and reassurance (van der Kolk & Fisler,
1994). In a typically developing child, a small disappointment or distressing situation
might elicit a small display of negative affect, but the child is able to either be redirected
by a caregiver or may redirect her or his own attention to a new stimulus. When the
emotion regulatory system fails to develop or becomes overwhelmed, emotional
dysregulation can be an inevitable consequence. During negative emotional experiences,
children feel emotions like fear, anger, or frustration that push them away from a neutral
state of emotions. Once the child becomes overwhelmed with emotion, he or she may not
be able to self-soothe, redirect themselves or otherwise respond to the situation
effectively (Cole et al., 1994; Little & Carter, 2005). Children who demonstrate
emotional dysregulation might also exhibit a high amount of under-controlled, negative
emotional reactivity, e.g., displaying an initial negative response to a stimulus (Little &
Carter, 2005), or show an inappropriate or incongruous emotional responses relative to
the stimuli (Kim & Cicchetti, 2010). In emotionally charged and stressful situations,
children who exhibit high amounts of emotional reactivity have a difficult time being
able to return to a calm state (Eisenberg et al., 1998). Furthermore, this difficulty
returning to a calm state may be exacerbated by insensitive and detrimental parenting
practices caused by the caregivers’ own inability to manage their emotions (Carrere &
Bowie, 2012).
11
Emotional Reactivity and Emotional Regulation
While emotional reactivity and emotional regulation are separate, they are
inherently intertwined. “Emotional reactivity” is the term that describes the sensitivity
and intensity of emotional reactions to situations or events, while “emotional regulation”
describes the process of attempting to manage or reduce the intensity of initial and
subsequent emotional reactions. Stifter and Jain (1996) point out that emotional reactivity
and emotion regulation are interdependent. In a longitudinal study of infant emotion
reactivity and regulation, they examined infants in a frustration task (i.e., toy removal).
At 5 months, emotional reactivity during the frustration task predicted the presence of
regulatory behaviors such as self-soothing at 10 months and at 18 months during the
same task. The authors posited that in infants, alertness and reactive emotional awareness
is a trait during infancy that is adaptive and helps infants try to engage in behaviors to
remove aversive stimuli from their environments. However as children age, emotional
reactivity, especially negative emotional reactivity, becomes less appropriate and
maladaptive especially within social interactions (Cole et al., 2004). Additionally,
children’s emotion regulation is often occupied with the modulation of negative
emotional expressivity and helping children return to a calm state after an initial reaction
(Little & Carter, 2005). As a result, the magnitude of the reaction, whether it be
appropriate or inappropriate, is indicative of the effectiveness of the emotional regulatory
system. When there is a highly negative emotionally reactive response, there are still
emotion regulation processes at work (Cole et al., 1994). Learning and developing an
12
appropriate strategy for how to react to emotion-eliciting experiences and successfully
maneuvering toward an appropriate and adaptive response is especially important for
children’s development (Eisenberg et al., 2002) as it affects later social and behavioral
functioning (Calkins & Fox, 2002).
Theoretical Framework: Developmental Psychopathology
In order to understand the diverse and complex pathways of children’s emotional
development, it is advantageous to take a developmental psychopathology perspective.
Developmental psychopathology draws from multiple disciplines including neurology,
embryology, psychiatry and psychology (Cicchetti, 1990). The integration of these fields
provides a more thorough understanding of multiple developmental processes and
domains (Chaffin, 2006). Furthermore, developmental psychopathology focuses on how
behaviors can become maladaptive when they diverge from their optimal developmental
trajectories or pathways (Cicchetti & Toth, 1994; Sroufe & Rutter, 1984), which is
important for understanding emotional dysregulation (Maughan & Cicchetti, 2002). The
concepts of equifinality and multifinality are useful for understanding trajectories in child
development and explaining how emotional regulation develops differently (Shields &
Cicchetti, 1998). Equifinality assumes the same developmental problems or disorders can
stem from different factors (Cicchetti & Toth, 2008; Cicchetti & Rogosch, 1996; Sroufe,
1989). For example, both physical and sexual abuse have been linked to depression in
children (Cicchetti & Valentino, 2006). Conversely, multifinality proposes that risks and
protective factors will combine to create different outcomes for different children
13
(Cicchetti & Toth, 2008). To illustrate, children who have been sexually abused may go
on to develop social and emotional disorders of different types or may not develop a
disorder at all (Kendall-Tackett, Williams & Finkelhor, 1993). This may also be true for
psychological phenomena outside of specific disorders, such as emotional dysregulation.
Equifinality would propose that many different circumstances, including violence
exposure and abuse, could result in a child who has difficulty understanding and
managing their own emotions when stressed (Shields & Cicchetti, 1998). Children’s prior
negative experiences would make it difficult to return back to an emotional state of
equilibrium. As a result, children might drift away from a healthy developmental
trajectory. Their early difficulty managing their emotional reactions could affect how
they deal with later stressful social interactions (Shields & Cicchetti, 1998). However,
multifinality would suggest that at least some children with histories of violence exposure
or abuse will not develop difficulties with emotion regulation.
Effects of Maltreatment and Violence Exposure on Children
Research has consistently documented the wide ranging effects that exposure to
abuse and violence has on children (for review see Kitzman et al., 2003). After the child
has left the stressful or traumatic environment, the effects of the trauma manifest
themselves in many different ways and do not always develop in the same ways for each
child (Cicchetti & Valentino, 2006). Links have been found between maltreatment and
problems with children’s neurological functioning (Heim et al., 2008), biological and
physiological developmental processes (Alink, Cicchetti, Kim, & Rogosch, 2012;
14
Cicchetti, Rogosch, Gunnar, & Toth, 2010; Zalewski et al. 2012), cognitive functioning
(Shonk & Cicchetti, 2001) emotional issues (Alink et al. 2009; Toth et al. 1992) and
internalizing and externalizing behavior problems (Manly et al., 2001; Rogosch &
Cicchetti, 1994). Additionally, research has documented that children exposed to
violence exhibit similar social and emotional problems to children who were directly
abused (Timmer, Thompson, Culver, Urquiza, & Altenhoffen, 2012 & Martin, 2012). For
example, abused and violence-exposed children have exhibited physical aggression,
negative affect and noncompliant behaviors (Chaffin, 2006; Cicchetti & Rogosch, 1994;
Shields & Cicchetti, 1998; Urquiza & McNeil, 1996). Furthermore, as children mature,
research has shown that both groups of children also tend to exhibit more withdrawn
behaviors (Haskett & Kistner, 1991) and more disorganized and labile emotions than
children who had not been maltreated (Maughan & Cicchetti, 2002; Davies et al., 2012).
Effects of Maltreatment and Violence Exposure on Children’s Emotional
Dysregulation
Families from violence-ridden or abusive environments have been shown to
experience more stress than typical non-maltreating families (Fantuzzo, Boruch, Beriama,
Atkins, & Marcus, 1997). For example, exchanges between parents and children who
have experienced abuse or violence tend to be less positive and more negative than their
non-abusing counterparts (Bousha & Twentyman, 1984). Small stressors, such as
disappointments or disagreements serve as triggers to larger conflicts which, in turn,
provide children poor models of emotional and behavioral responses (Carrere & Bowie,
15
2012). In a comprehensive review of the development of emotion regulation, Morris and
colleagues (2007) argued that children’s development of emotion regulation occurs as a
result of children’s observations of their close family. These include observations of
parenting practices, emotional climates, and the emotional reactions of the caregivers.
When the caregiving environment is impoverished or harmful, such as with physical
abuse or in households with domestic violence, children’s emotional regulation capacities
are more likely to be non-optimal (Davies et al., 2012; Manly et al, 2001). In these cases,
children are unlikely to observe appropriate emotional responses (Carson & Parke, 1996)
or experience healthy and positive parenting practices (Cerezo, D’Ocon, & Dolz, 1996;
Shipman & Zeman, 1999). Previous research has documented how some young
maltreated children demonstrate more anger and reactivity (Alessandri, 1991; Shields &
Cicchetti, 1998), blunted emotional expression (Gaensbauer, 1980) and the inability to
properly recognize emotions (Pollak, Cicchetti, Hornung, & Reed, 2000) as compared
with non-maltreated children. Furthermore, studies have examined how in response to
conflict, abused children and children exposed to violence in the home exhibit
dysregulated emotion patterns (Maughan & Cicchetti, 2002) and more emotional
reactivity (Davies et al., 2012).
Taken together, these findings display a pattern that demonstrates how children
are emotionally and behaviorally impaired by abuse and violence exposure. These
findings also reveal the importance of the caregiver-child relationship in relation to young
children’s emotion regulation within the context of a maltreating environment.
16
Maltreated children are often exposed to these harsh and detrimental experiences by their
caregivers (Chaffin 2006). If children are exposed to harmful events and experience
negative unpredictable caregiving (Morris et al., 2007), one might expect that children’s
emotional difficulties would be most apparent in observations with the caregiver. Just as
caregivers who are maltreating have difficulty being emotionally available (Martins et al.,
2012) and emotionally responsive (Eisenberg, Fabes, Shepard, Guthrie, Murphy, &
Reiser, 1999), children might also demonstrate less emotional responsiveness towards
their caregivers. A previous study (Little & Carter, 2005), found that child responsiveness
was related to infants’ reactive emotions and their emotional self-regulation attempts in
distressing situations, such that infants who were less emotionally responsive to their
caregivers and more emotionally reactive took longer to regulate their emotions and
return to a calm state after a distressing situation. Based on this evidence, young
children’s responsiveness towards their caregivers in an aversive situation might be
related to young children’s emotional reactivity. Additionally, even when children
respond in a highly emotionally reactive manner, there are still emotional regulatory
processes that occur, even if they appear dysregulated (Cole et al., 2003). If there is a
relationship between children’s emotional reactivity and their responsiveness to their
parents, then based on previous research (e.g., Little & Carter, 2005), one might expect
that when children experience changing situations that increase in aversion, the change in
how they emotionally react and respond to their caregivers might reflect children’s
emotion regulation attempts. Given that maltreated children are products of such an
17
impoverished caregiving environment (Carson & Parke, 1996; Maughan & Cicchetti,
2002; Morris et al., 2007; Sroufe, 1996), it would be important to gain understanding of
how these children change the way they interact emotionally with their caregivers and
how children are able to emotionally navigate aversive or distressing situations.
Purpose of the Current Study
Previous research has pointed out the deleterious effect of child maltreatment on
their social and emotional development; in particular,. abusive and violent environments
may lead to emotional regulation difficulties in the young child. To examine young
children’s emotional regulation, past research methodologies have used both caregiver
report and observations of children, but few have looked at children that have been
exposed to abusive and violent environments (Shields & Cicchetti, 1998; Little & Carter,
2005), with even fewer that have evaluated how maltreated children are able to regulate
their emotions within a caregiver-child observation (e.g., Maughan & Cicchetti, 2002).
By observing the caregiver-child relationship, we can gain further understanding of the
mechanisms by which abuse and a violent home environment can affect young children’s
emotion regulation.
Based on previous methodology and construct conceptualization, if children’s
emotion regulation attempts are evident in a caregiver-child observation, it could be
observable two possible ways: A single aversive situation or the change from a nonaversive to an aversive situation. In a single aversive situation with their caregivers,
young children might present with an emotional response to the caregiver that will be
18
representative of underlying emotion regulatory processes. Alternately, it might require a
change in aversive situations to be able to observe emotion regulation in a caregiver-child
observation. Evaluating the quality of children’s responses to their caregivers in
situations varying in stressfulness to the child, and measuring the degree of the shift in
child’s responsiveness might be an effective way of measuring children’s emotional
regulation. The present study seeks to evaluate these claims using observational and
caregiver report assessments.
The current study examined the relationship between emotional reactivity and
emotional regulation in young children. Additionally, the study evaluated the effect of
violence and abuse on a child’s observed emotional regulation. Children’s emotional
reactivity, as reported by their caregiver was compared to observed responsiveness in
specific aversive play scenarios with their caregivers. Children’s observed responsiveness
to their parents in increasingly aversive play situations, as well as the change in
responsiveness to the parent from situation to situation was used as a measure of
children’s emotion regulation. Secondly the study compared how abused and/or exposed
to violence children differed from non-abused and/or exposed to violence children in
emotional reactivity and regulation.
Hypotheses
Aim 1: To investigate the connection between emotional reactivity and emotion
regulation and assess how parent ratings of their children’s emotional reactivity are
19
related to observations of children’s responsiveness in an increasingly aversive semistructured play situation.
Hypothesis 1.1: Children who are rated by their caregivers as more emotionally
reactive will demonstrate more emotional dysregulation as measured by low children’s
responsiveness to their caregivers.
Hypothesis 1.2: Compared with children with low to moderate emotional
reactivity,, children who are rated as having high emotional reactivity will demonstrate
more emotional dysregulation as measured by a significant decrease in children’s
responsiveness to their caregivers across increasingly aversive play situations.
Aim 2: To investigate the connection between emotional dysregulation, emotional
reactivity and exposure to violence and abuse history of children in observations of
increasingly aversive play situations with their caregivers.
Hypothesis 2.1: Children who have experienced abuse or have been exposed to
violence will be rated as more emotionally reactive by their caregivers.
Hypothesis 2.2: Compared to children with no violence exposure or abuse
history, children exposed to violence or with an abuse history will demonstrate more
emotional dysregulation as measured by a significant decrease in children’s
responsiveness to their caregivers in increasingly aversive play situations.
20
Chapter 3
METHOD
Participants
Participants were 219 children and their biological mothers who are part of an
research database from a larger, ongoing study of the effectiveness of Parent Child
Interaction Therapy (PCIT) for maltreated children: Thirty two had no abuse or violence
exposure history and 186 had a suspected or documented history or violence exposure
through inter-parental violence or physical abuse. Participants were referrals to a
Northern California university-based medical center and child abuse treatment clinic
from February 2003 to October 2012. In particular, most of the children were referred
because of their disruptive behaviors and the caregiver’s inability to effectively parent
and to reduce the risk of child abuse and neglect. Only children eligible to receive MediCal insurance and were treated at this clinic. Participants were included in this study if
they were between 3 to 5 years of age (mean age = 4.00, SD = 1.14), participating with
their biological mothers in PCIT, and consented to participate in research. Almost 60% of
the sample children were male (59.8%). Approximately 48.9% of the mothers 42.4% of
the children were White/Non-Hispanic, 20.1% of mothers and 28.6% of children were
African American, 19.6% of mothers and 24.1% of children were Latino and 11.4% of
mothers and 4.9% of children categorize themselves as “Other.” The mother’s average
age was 28.17 (SD = 5.86). Mother’s had an average of 11.51 years of education (SD =
1.95). Additionally, 73.9% of the mothers considered themselves single mothers. Risk
21
history for the children was also evaluated. Around 71.2% of children had been placed in
foster care and 85.4% having experienced at least one type of maltreatment (e.g., physical
abuse, sexual abuse, inter-parental violence).
Procedure
If a participant was eligible for PCIT, therapists obtained a signed consent form
(as approved from the UC Davis’ Internal Review Board) from the clients’ legal
guardian. In a pre-treatment assessment, parents received a battery of standardized
measures and a demographic questionnaire; these standardized measures address issues
with the child as well as measures that are focused on stress and issues faced by the
parent. These measures were given to the mother at the community clinic, who filled
them after the first appointment and returned them before beginning treatment.
Observational Assessment. Before PCIT began, a pre-treatment observational
assessment was conducted. The assessment consisted of three 5 minute semi-structured
interaction, which were analogs of typical parent-child interactions and designed to elicit
differing amounts of parental control and child compliance. The first 5 minutes (Child
Directed Interaction; CDI) was devoted to allowing the child to pick a toy to play with
their caregiver and for the caregiver to follow the child’s lead in play. The second 5
(Parent Directed Interaction; PDI) minutes was structured so that the caregiver has to
change the current game or activity and have the child follow their lead in play. The
transition between CDI and PDI required the parent to move from no control over the
play to exercising control and try to get the child to play along with their game and their
22
rules. The third 5 minutes (Clean Up; CU) was arranged so that the caregiver had to have
the child clean up without their help. The caregiver had to get the child to comply with
their commands as well as end the play. As each observation section progressed, the
caregiver had to assert more control over the child. Additionally as each observation
section progressed, this offered an opportunity to observe how the child reacted to
escalating control from the parent. These recorded observations were then coded by the
undergraduate and graduate level reliable coders.
Measures
Observational Coding: Emotional Availability Scales (EAS; 3rd Ed.). The
Emotional Availability Scales (EAS; Biringen, 2000) (See Appendix A) were used to
assess children’s emotional regulation capabilities and thus their emotional dysregulation
during a semi-structured observational assessment of mother-child interaction .
Emotional dysregulation has been measured by assessing the intensity of children’s
positive and negative affect in response to a changing situation with an aversive stimulus
and also noting how long it takes them to recover to a neutral emotional state (e.g., Ellis,
Beavers, Wells, 2009; Gratz, Rosenthal, Tull, Lejuez & Gunderson 2010). The changes in
the intensity of children’s affective responses to their parents in play situations is one way
to measure their emotional dysregulation. Additionally, due to the fact that this study
used archival data, many of the assessments of emotion regulation and dysregulation
were not available or feasible to use retroactively, so the Emotional Availability Scales
(EAS) will serve as a way to measure of emotional dysregulation.
23
The EAS is an observational coding system that evaluates the quality of the parent
child relationship. There are four parent scales: sensitivity, non-hostility, nonintrusiveness and structuring. For the child, there are only two: responsiveness and
involvement. For this particular study only on the child responsiveness scale was used as
an indicator of the child’s emotional dysregulation in an observational setting. Child
responsiveness reflects the child’s ability to be responsive to their parent in an
“affectively available way.” (Biringen, 1999, pg.107) including their emotional
responsiveness to the caregiver’s bids and their emotional connection to the caregiver
(Biringen, 1999) ( Scores on the child-responsiveness of the EAS range in 1-unit
increments from 7 to 1.) For this study, scores will be examined as individual discrete
scores in each analog. Higher scores will indicate that the child is more positive and
emotionally available to the parent; lower scores will indicate a child who is observed to
be more negative and less emotionally available.
Coders were doctoral level researchers, undergraduate and graduate level students
in psychology or human development who have received extensive training in Emotional
Availability coding and procedures. Two coders coded each tape and agreed on 85% of
their codes; any disagreements in codes were resolved through a discussion, and if
needed, a third coder was brought in to resolve any discrepancy. Additionally, 13 of the
tapes were recoded and evaluated using intra-class coefficients to determine sufficient
reliability and address any coder-drift. Reliability coefficients for each category are as
follows: Parental Sensitivity, r = .97, Parental Sensitivity, r = .92, Parental Intrusiveness,
24
r = .88, Parental Structuring, r = .88, Child Responsiveness, r = .93 and Child
Involvement, r = .91. Each analog (i.e., CDI, PDI & CU) of the pre-observation
assessment was coded separately, allowing the examination of change in EA from analog
to analog.
Emotional Reactivity. The child’s emotional reactivity as rated by the caregiver
was measured using Child Behavior Checklist (CBCL 11/2 – 5; Achenbach, 2000).
Emotional Reactivity is a between subjects variable that represents parent reports of
children’s emotional reactive behaviors on the Emotionally Reactive Syndrome Scale on
the CBCL 1 ½ - 5 (Achenbach, 2000). The CBCL (Achenbach, 2000) (See Appendix B)
is a standardized parent report measure that lists 100 child behavior problems. Caregivers
as asked to rate the frequency of their child’s behavior on a 3 point scale (0= never,
2=often). On the CBCL, there are multiple smaller subscales addressing specific child
behavior problem groups; these are called syndrome scales. For this particular study, the
Emotionally Reactive Syndrome Scale will be used as a measure of the child’s emotion
dysregulation. The scale examines parent’s report of their child’s emotionally reactive
behaviors and questions about whether the child is disturbed by change, has sudden mood
changes and other internalizing issues. For the purposes of this study, this variable will be
examined both as a continuous indictor of children’s overall emotional reactivity and also
categorically. To increase the clinical relevance of these analyses, the participants were
divided into three levels of emotional reactivity: The Low category includes those with
T-scores 54 and below, the Medium category includes those with T-scores 55 to 64 and
25
the High category includes those with T-scores of 65 or higher representing borderline
and clinical levels of emotional reactivity symptoms. This three-level categorization
allows easy comparison of children scoring in the Borderline and Clinical range (High
scores) and those well within the normal range (Low scores).
Abuse and Violence Exposure History. Information about each child’s history of abuse
and violence exposure was obtained from therapist, social worker and court reports that
were present in the client files. For purposes of this study, abuse and violence exposure
signifies a child experiencing physical abuse or exposure to violence. When there was
information suggesting that a child may have been abused or exposed to violence, the
research staff coded “suspected abuse or violence.” When there is a substantiated report
of abuse or exposure to violence, the research staff coded “documented abuse or
violence.” If there was no evidence in any of the client file of abuse or violence exposure,
we coded “no abuse or violence history.” For the purposes of this study, a dichotomous
indicator of child abuse and/or violence history was created with categories of No Abuse
and/or Violence History (zero reports of suspected or documented abuse and/or violence)
and Abuse and/or Violence History (one or more reports of suspected or documented
abuse and/or violence history). The two groups of suspected and documented were
combined to guard against any possibility that a child in the No Abuse and/or Violence
History group would have had some exposure, which could confound the variable.
Previous research has documented the effectiveness of combining both suspected and
documented into one group (Timmer et al., 2012).
26
Demographics Information. All participants filled out forms addressing demographic
information assessing parent and child gender, age, racial/ethnic background, as well as
parent marital status and education.
27
Chapter 4
RESULTS
Preliminary Analyses: Demographic Differences in Emotional Reactivity
To determine if significant demographic differences existed among the three
emotional reactivity groups (low, medium, high), analysis of variance tests were
conducted with continuous variables and chi-square tests of independence were
conducted with categorical variables. Results are presented in Table 1 and show that no
significant differences in children’s age, sex, and ethnicity existed between the three
groups. Table 1 also shows that mothers’ age, ethnicity, educational attainment, and
marital status does not differ significantly by emotional reactivity group.
Chi-square tests of independence were performed to determine if any
demographic differences existed among the three emotional reactivity groups with regard
to their maltreatment and violence exposure history. There were no significant
differences between the presence/absence of maltreatment and violence exposure across
the three reactivity groups, χ² (6, N= 219) =7.82, p = .25. All emotional reactivity groups
had similarly high percentages of children who had experienced abuse or violence:
81.8%, 86.5% and 89.5%, for the low, medium, and high emotional reactivity groups,
respectively.
28
Table 1
Demographics for Sample
Characteristic
Child
Mean Age (SD)
Percent Male
Low
Emotional
Reactivity
(n=88)
Medium
Emotional
Reactivity
(n=74)
High
Emotional
Reactivity
(n=57)
4.04 (1.26)
3.92 (1.07)
4.07 (1.00)
F (2, 218) .35,
p = .70
60.2%
58.1%
61.4%
χ² (2, N= 219) =.16, p
= .92
Ethnicity
Effects
χ² (6, N= 203) = 5.78,
p = .45
Caucasian
Latino/a
African American
Other
Mother
Mean Age (SD)
41.7%
37.9%
49.1%
25.0%
24.2%
22.6%
25.0%
34.8%
26.4%
8.3%
3.0%
1.9%
28.84 (6.68)
28.16 (5.09)
27.13 (5.36)
F (2, 217) 1.46,
p = .23
χ² (6, N= 219) = 2.75,
p = .83
Ethnicity
Caucasian
Latino/a
African American
Other
Education
Mean Years (SD)
Marital Status
(% single)
50.0%
43.2%
54.4%
18.2%
21.6%
21.1%
19.3%
21.6%
17.5%
12.5%
13.5%
7.0%
11.47 (1.87)
11.56 (1.94)
11.52 (2.14)
72.7%
71.6%
78.6%
F (2, 213) .04,
p = .96
χ² (2, N= 218) = .89, p
= .64
Note. Emotional Reactivity= Emotional Reactivity Syndrome Scale scores. Low Emotional Reactivity = TScore 54 and below, Some Emotional Reactivity = T-Score 55 to 64, High Emotional Reactivity = T-Score
65 and above.
29
Hypothesis 1.1: Child Emotional Reactivity and its Relation to Emotion
Dysregulation
To see if children’s emotional reactivity was related to children’s emotion
dysregulation as measured by their observed responsiveness to their mothers in the three
separate analogs (i.e., CDI, PDI, CU), a multivariate analysis of variance was conducted
using overall emotional reactivity (as measured by the CBCL) as a covariate on child
responsiveness (as measured by the EAS) in the three separate play situations of CDI,
PDI and CU. All 219 participants were included with no missing data on the outcome
measures. Results of evaluations of assumptions of normality, homogeneity of variancecovariance matrices, linearity and multicollinearity were satisfactory. With the use of
Wilks’s Lambda, results showed that there was a statistically significant overall
multivariate main effect, F (2, 214) = 3.44, p = .018, partial η2 = .046 of emotional
reactivity on the observed child responsiveness. When results for the dependent variables
were considered separately, two statistically significant differences were observed.
Univariate ANOVAs demonstrated that there was a significant effect of emotional
reactivity on observed child responsiveness in Parent Directed Interaction, F (2, 214) =
5.99, p = .02, and in Clean up, F (2, 214) = 7.50, p = .00. No statistically significant
effect was found for observed child responsiveness in Child Directed Interaction, F (2,
214) = .13, p = .72. Means and standard deviations are presented in Table 2.
30
Table 2
Mean and Standard Deviations of Child Responsiveness in its relation to Emotional
Reactivity
Emotional Reactivity
Observational Analog
CDI
PDI
CU
M
SD
4.50
3.83*
3.25*
1.04
1.04
1.09
Note. CDI= Child Directed Interaction, PDI = Parent Directed Interaction, CU= Clean Up, Child Responsiveness =
Child Responsiveness scales of Emotional Availability Scales (Biringen, 2000).
*p< .05
In order to detect the direction of the relationship between reactivity and
responsiveness in each of the analogs separately, Pearson product-moment correlation
coefficients were computed for overall caregiver-reported emotional reactivity and
observed child responsiveness in CDI, PDI and CU. Results showed a significant
negative relationship between emotional reactivity and child responsiveness in Parent
Directed Interaction and, (r = -.16, n = 22, p = .02) and in Clean up (r = -.18, n = 22, p =
.00). However, there was no correlation between emotional reactivity and responsiveness
during Child Directed Interaction (r = -.02, n = 22, p = .76). Taken together, the results
suggest that as children who were rated as more reactive were likely to less responsive to
their parents in more aversive situations. These findings lend some validity to parents’
ratings of children’s emotional reactivity. This also lends some support to using Child
Responsiveness as a proxy for emotional reactivity, and variation across the three play
situations as an indicator of emotional regulation.
31
Hypothesis 1.2: Child Emotional Reactivity and Change in Child Emotion Dysregulation Across Play Situations
In order to assess whether change in children’s responsiveness from non-aversive to more
aversive play situations is an indicator of emotional regulation, the differences across
analogs in children’s responsiveness to their parents was examined by levels of emotional
reactivity. A 3 (Emotional Reactivity Level; Low, Medium, High) X 3 (Observational
Analog; CDI, PDI, CU) repeated measures multivariate analysis of variance (MANOVA)
was conducted with the dependent variable of emotional dysregulation (as measured by
Child Responsiveness). There was a total N of 219, with no cases missing. Additionally,
results of evaluations of assumptions of normality, homogeneity of variance-covariance
matrices, linearity and multicollinearity were satisfactory. With the use of Wilks’s
Lambda, results showed that there was a significant overall multivariate main effect, F (2,
213) = 35.78, p = .00, partial η2 = .25, of observational analog on child responsiveness
and a non-significant multivariate interaction of observational analog and emotional
reactivity on child responsiveness, F (4, 426) = 1.50, p = .20. Means and standard
deviations are presented in Table 3. ) Results showed that children’s responsiveness to
their parents decreased as the aversiveness of the task increased, and that the more
emotionally reactive parents judged their children to be, the less responsiveness they
were to their parents, but that all groups showed similar decreases across analogs.
32
Table 3
Mean Scores and Standard Deviations for Child Responsiveness as a Function of
Emotional Reactivity
Low Emotional
Medium Emotional
High Emotional
Reactivity
Reactivity
Reactivity
(n=88)
(n=74)
(n=57)
M
SD
M
4.56
.89
4.46
1.15
4.48
1.09
PDI
4.05
.95
3.77
1.13
3.59
.93
CU
3.56
1.06
3.05
1.03
3.04
1.11
Observational
Analog
CDI
SD
M
SD
Note. Emotional Reactivity = Scores Emotional Reactive Syndrome Scale on Child Behavior Checklist
(CBCL; Achenbach, 2000), CDI= Child Directed Interaction, PDI = Parent Directed Interaction, CU=
Clean Up, Child Responsiveness = Child Responsiveness scales of Emotional Availability Scales
(Biringen, 2000).
Hypothesis 2.1: Child Emotional Reactivity and Abuse and Violence Exposure
In order to test the hypothesis that children exposed to more abuse and violence
would demonstrate more emotional reactivity when rated by their caregivers, an Analysis
of Variance was computed, with emotional reactivity as the dependent variable and
exposure to violence (Violence/Abuse History; 0 counts or 1 or more counts). as the
between-subjects independent variable. The results of this analysis showed a nonsignificant trend for non-abused or violence exposed children to be rated as less reactive
(Mean = 56.03, SD = 6.90) than abused and violence exposed children (Mean = 58.77,
SD = 8.80; F(1, 217) = 2.78, p = .10). The results of this analysis demonstrates that
children who have experienced abuse and had been exposed to violence were not rated as
significantly more emotionally reactive by their caregivers.
33
Hypothesis 2.2: Abuse History and Violence Exposure and Change in
Responsiveness
To test the hypothesis that children who have experienced abuse and been
exposed to violence would demonstrate a greater magnitude of change in child
responsiveness from CDI to PDI to Clean UP, possibly indicating more emotional
dysregulation, a repeated measures multivariate analysis of variance was conducted.
Child Responsiveness was the repeated measure across the three behavioral analogs
(Observational Analog; CDI, PDI, CU), and Exposure to violence was the Between
Subjects factor (Violence/Abuse History; 0 counts or 1 or more counts) repeated
measures multivariate analysis of variance was conducted on child responsiveness across
the three play analogs (CDI to PDI to CU). There was a total N of 218, with one case
missing. Additionally, results of evaluations of assumptions of normality, homogeneity of
variance-covariance matrices, linearity and multicollinearity were satisfactory. With the
use of Wilks’s Lambda, results indicated there was a significant main effect of behavioral
analog on children’s responsiveness to their parents F (2, 212) = 41.13, p = .00, partial η2
= .28, and a statistically significant interaction between analog and exposure to violence
on children’s responsiveness F (2, 212) = 7.12, p = .00, partial η2 = .06, suggesting that
the magnitude of the slopes indicating change in Child Responsiveness across the three
analogs differed by violence exposure (See Table 4). To isolate specific abuse/violence
group differences in the change in responsiveness across the three observational analogs,
I performed two separate repeated
34
Table 4
Mean Scores and Standard Deviations for Child Responsiveness as a Function of Abuse
History and Violence Exposure
No Abuse or Violence
Exposure
(n=32)
Abuse and Violence
Exposure History
(n=186)
M
SD
M
SD
CDI
4.91*
.92
4.44
1.03
PDI
3.66
.93
4.05
.95
CU
3.09
1.11
3.28
1.08
Observation Analog
Note. CDI= Child Directed Interaction, PDI = Parent Directed Interaction, CU= Clean Up, Child
Responsiveness = Child Responsiveness scales of Emotional Availability Scales (Biringen, 2000).
*p < .01
measures multivariate analysis of variance: first from CDI to PDI and then from PDI to
CU.
For the first analysis I performed a 2 (Observational Analog; CDI, PDI) X 2
(Violence/Abuse History; 0 counts or 1 or more counts) repeated measures multivariate
analysis of variance. With the use of Wilks’s Lambda, results indicated there was a
significant main multivariate effect of violence exposure and abuse history on the overall
change in child responsiveness from CDI to PDI, F (2, 215) = 5.50, p = .00, partial η2 =
.049. Univariate F tests indicated that there was a significant univariate effect of violence
exposure and abuse history on child responsiveness in CDI, F (2, 215) = 5.77, p = .02,
and a non-significant univariate effect of violence exposure and abuse history on child
responsiveness in PDI, F (2, 215) = 1.14, p = .29. Children who had been exposed to
35
violence had significantly lower responsiveness in CDI compared to children who had
not been exposed to violence.
For the second analysis, I performed a 2 (Observational Analog; PDI, CU) X 2
(Violence/Abuse History; 0 counts or 1 or more counts) repeated measures multivariate
analysis of variance. With the use of Wilks’s Lambda, results indicated there was a nonsignificant main multivariate effect of violence exposure and abuse history, F (2, 215) =
.68, p = .50, partial η2 = .006 on the overall change in child responsiveness from PDI to
CU. Univariate F tests indicated that there was a non-significant univariate effect of
violence exposure and abuse history on child responsiveness in PDI, F (2, 215) = 5.77, p
= .01, and a non-significant univariate effect of violence exposure and abuse history on
child responsiveness in CU, F (2, 215) = 1.14, p = .29.
These findings demonstrate an overall significant change in child responsiveness
from CDI to CU based on abuse history and violence exposure. I examined group means
to determine where the group differences in child responsiveness lay in relation to abuse
and violence history. This result is presented graphically in Figure 1. Figure 1 shows the
decline in child responsiveness over the three behavioral situations of CDI, PDI and CU
as a function of abuse or violence exposure history. The results revealed a pattern
contrary to my proposed hypothesis that children with abuse histories and previous
violence exposure would demonstrate a significantly greater decline in emotion
regulation (i.e., dys-regulation) over the three observational analogs as compared with
children with no abuse history or violence exposure. Children who had never experienced
36
abuse or witnessed violence actually demonstrated a significant change in responsiveness
(i.e., more dysregulation) from CDI to PDI but children with abuse histories and violence
exposure did not.
Emotional Responsivness Scale Scores
5
No Abuse or
Violence Exposure
Abuse and/or
Violence Exposure
4.5
4
3.5
3
2.5
CDI
PDI
CU
Behavioral Analog
Figure 1. Child Responsiveness across three behavioral analogs as a function of their
abuse and violence exposure history.
37
Chapter 5
DISCUSSION
Summary
The current study examined the relationship between emotional reactivity and
emotional regulation in young children. Additionally, the study evaluated group
differences in the presence or absence of child abuse and exposure to violence on a
child’s observed emotional regulation. Children’s emotional reactivity, as reported by
their caregivers was compared to observed child responsiveness in three increasingly
aversive play scenarios with their caregivers. Children’s observed responsiveness as a
result of the change in play situations was used as a measure of their emotion regulation
in the face of a distressing situation. Based on the present findings, emotional reactivity
did appear to be related to children’s responsiveness to their parents in the more aversive
play situations, but was not related to the change in responsiveness from situation to
situation. Developmental psychopathology posits that children may be adversely affected
by an event such as witnessing violence and experiencing abuse, which may present in
various ways such as high emotional reactivity and difficulties regulating their emotions.
Contrary to hypothesis 2, which stated that children exposed to violence would exhibit a
significant decrease in child responsiveness across the play situations, children exposed
to violence did exhibit a decrease in responsiveness across the three play situations;
however, since these children were significantly less responsive to their caregiver in the
38
first situation, these children did not exhibit a significant overall decrease in child
responsiveness across the three play situations. However, children who had not
experienced abuse or witnessed violence did actually demonstrate a significant change
across the three behavioral analogs. Both larger results taken together provide a complex
and unique picture of how emotional reactivity and emotion regulation are observable in
a caregiver-child relationship.
Emotional Reactivity and Emotion Regulation
The first goal of this study was to evaluate how emotional reactivity and emotion
regulation are related to each other in young children. Specifically, Hypothesis 1.1 stated
that children reported as more emotionally reactive by their caregivers would
demonstrate more situational emotional dysregulation as represented by lower
responsiveness to their caregivers in more aversive play situations than children who
were rated less emotionally reactive. This hypothesis was supported in that children
reported as more emotionally reactive by their caregivers demonstrated lower
responsiveness in the more aversive play situations of PDI and CU. These findings also
support the validity of parents’ ratings of children’s emotional reactivity. They also
support the use of the Child Responsiveness scale from the EAS as a measure of
emotional regulation in the context of parent-child interaction in increasingly aversive
situations.
The next step was to address whether children’s emotional reactivity was related
to the change in child responsiveness across the three play situations in a sequence from
39
CDI to PDI to CU and address whether this would be representative of children’s
emotional regulatory processes within the caregiver-child observation. Hypothesis 1.2
posited that across the three increasingly aversive play situations, children rated as more
emotionally reactive by their caregivers would demonstrate significantly lower
responsiveness toward their caregivers, thus indicating the presence of emotional
dysregulation. This hypothesis was not supported. Results indicated that in the caregiverchild observation, children did show a significant decrease in their responsiveness across
the three play situations, but it did not differ significantly based how emotionally reactive
they were when rated by their caregivers.
Overall, the findings indicate that emotional reactivity was related to children’s
responsiveness to their parents in the individual observations of PDI and CU, but not
related to the overall change across the three observations. These findings suggest that
responsiveness in aversive situations might actually reflect emotional regulation. It is
during the more stressful situations of PDI and CU where it would be critical for
caregivers to help their child manage the distress. The current study adds to previous
research in that few studies have used observations of parent-child interactions to assess
emotion dysregulation and also as a supplement to caregivers’ ratings of their children’s
negative emotional reactivity.
Emotion Regulation and Abuse and Violence History
To examine the second goal that compared how abused and/or exposed to
violence children differed from non-abused and/or violence exposed children in
40
emotional regulation in observations with their caregivers, I hypothesized that children
who have experienced abuse and have been exposed to violence would be rated as more
emotionally reactive by their caregivers. Results demonstrated that abused and violence
exposed children showed a non-significant trend to be rated as more emotionally reactive
by their caregivers when compared to children who did not have an abuse history or
violence exposure past. Previous research has found stronger differences between stressexposed groups. A recent study found that in response to a stressful and negative home
life, children exhibited high levels of emotional reactivity which then predicted higher
levels of emotional problems in adolescence (Shapero & Steinburg, 2013). Additionally,
since children are very much influenced emotionally by the environmental stress of the
surrounding home life, one might expect that children exposed to an unpredictable and
negative family environment (Morris et al., 2007) would demonstrate more emotional
reactivity.
Hypothesis 2.2 addressed the supposition that compared to children with no
violence exposure or abuse history, children exposed to violence and with an abuse
history will demonstrate more observed emotional dysregulation as measured by a
significant decrease in responsiveness in the caregiver-child relationship across
increasingly aversive play situations. This particular hypothesis was concerned with
looking at the change in child responsiveness in response to the increasingly aversive
situation with their caregivers and seeing if children with histories of abuse and violence
exposure would exhibit emotional dysregulation. Developmental psychopathology
41
provided a supportive frame to address this hypothesis: in response to harsh events such
as abuse, children might be driven off their optimal behavioral trajectory, thus they
develop maladaptive behaviors that are evident in emotional dysregulation (Maughan &
Cicchetti, 2002). However Hypothesis 2.1 was not supported: Both groups demonstrated
a decrease in responsiveness as interactions became more aversive and distressing for the
child. However, when faced with increasingly aversive situations, children with no
violence exposure or abuse history demonstrated a significant decrease in responsiveness,
and thus, contrary to what was expected, presented with an overall dysregulated
emotional response. To understand what was driving his result, two additional analyses
were performed examining the change in responsiveness from CDI to PDI and from PDI
to CU. Results indicated that the significant group difference occurred in the change from
CDI to PDI but not from PDI to CU. As graphically depicted in Figure 1, this interaction
effect is best explained by the fact that child responsiveness in the abuse and/or violence
exposure group was lower in CDI compared to the no-abuse and/or violence group. In
other words, the maltreatment group showed less of a decline from CDI to PDI because
they were less responsive (i.e., more dysregulated) to begin with.
To interpret these results further, it is advantageous to look within the separate
play situations and address what might have led to unexpected results. Child Directed
Interaction is designed to provide the child with an opportunity to play with new toys and
the ability to decide how they would like to play. Within this study, CDI provided the
child with the ability to be in control and not face any aversive problems and acted as an
42
emotional baseline. However, for children with abuse and violence exposure histories, the
parent-child relationship can already be fairly negative. Bousha and Twentyman (1984)
documented how maltreating parent child relationships are less positive and more
negative, with children that exhibit more negative affect towards their caregivers
(Cicchetti & Rogosch, 1994). Additionally parents tend to engage in unhealthy parenting
practices (Cerezo et al., 1996) and home environments are all around more negative and
stressful (Fantuzzo et al., 1997). Essentially, these children’s non-optimal responsiveness
to their parents might have been influenced by their previous negative experiences with
their caregiver and home environment. This might have carried over into the semistructured observational assessment creating aversion within CDI, which was supposed to
have been a non-aversive baseline analog. Thus, even in the less aversive situation these
children were still having difficulty regulating their emotions during interaction with their
caregivers. In contrast, children in the group who had not been abuse or exposed to
violence may experience somewhat more optimal parent-child relationships (although
they were still clinic-referred) such that CDI was a more positive experience for them.
This difference in baseline responsiveness created a sharper decline during the change to
PDI, which children not abused or violence exposed were more likely to experience as
more aversive and more dysregulating. While the results are not consistent with the
hypothesis, the change in children’s responsiveness to parents from CDI to PDI does
seem to in some way to reflect children’s emotion regulation in caregiver-child
observations in children who have not been exposed to violence or experienced abuse.
43
In this study, I used the Emotional Availability Scales, more specifically the Child
Responsiveness Scale in an attempt to measure emotional dysregulation in the context of
the parent-child relationship, which is an innovative contribution of the study. Studying
emotion dysregulation in the context of parent-child interaction may be especially
relevant for the child maltreatment population because excessive dysregulation may place
a child at greater risk for future abuse, which makes it a potentially important target for
clinical intervention.
While a strength of the EAS is that it is a dyadic assessment, it is also a more
global evaluation of responsiveness toward caregivers than more conventional measures
of emotion regulation. Past researchers have measured emotion regulation and
dysregulation focusing on more discreet displays of children’s emotions and behaviors
independent of parent behavior. For example, Cole and colleagues (1994) used the
“disappointment task” to elicit emotion regulation behaviors and coded specific
emotional displays in response to a disappointment. This is a more widely accepted
approach to assessment of emotion regulation because it is looking at small distinct
emotional changes and how children are able to manage them. Based on my findings, the
EAS Child Responsiveness scale appeared to reflect children’s emotional regulation, but
may not have been sufficient to fully understand these processes in abused and violenceexposed children.
44
Limitations
Using data from a larger clinical study presented several challenges. For example,
I was limited to variables within the parameters of what had already been collected or
approved as part of the research and clinical protocols. Thus, the variables used in this
study may not be completely representative of the larger constructs of emotion regulation
and dysregulation which presents a major limitation in measurement. Another limitation
of the study stems from the coding of maltreatment through retroactive chart review.
Information regarding abuse history and violence exposure from client charts can often
be limited to what is pertinent to how the child is being treated.. There is typically very
little information regarding the chronicity or timing of when the abuse or violence
occurred, which, if present, could have created opportunities for finer grained and more
accurate analysis of the associations between maltreatment and children’s emotion
regulation capabilities (Shipman & Zehman, 1999).
Conclusion
The overarching purpose of this research was to evaluate how caregiver-reported
emotional reactivity and observed emotional regulation in children were related to one
another in an at-risk population. Emotional reactivity appeared to be related to children’s
responsiveness, but not related to the change in responsiveness in the face of an aversive
situation. Children exposed to violence and with abuse histories did present with low
emotional responsiveness in aversive interactions with their caregivers. However, the
findings here indicate that when presented with an aversive situation, abused and
45
violence-exposed children started with lower responsiveness, and maintained low
responsiveness, possibly providing an attenuated picture of emotional regulation and
dysregulation. A key concept of developmental psychopathology is that when exposed to
an aversive experience, children may be affected emotionally and behaviorally such that
their behaviors become maladaptive which may affect later functioning. Based on the
findings, children who were not abused or violence-exposed actually demonstrated an
emotional pattern that might be indicative of dysregulation. This difference appeared to
work as a function of the observational paradigm in which both the caregiver and child
were involved.
Only a few studies have looked at how caregiver rated emotional reactivity are
related with observed emotion regulation and very few studies have attempted to look at
children with their caregivers in an observational assessment. Furthermore, this study
also attempted to use a global assessment of emotional responsiveness to see if it were
related to emotional reactivity and possibly emotion regulation, which had not been
typically measured this way. Study findings, while not as expected, left the impression
that the caregiver-child relationship is an important element in the developmental task for
children to learn how to regulate their own emotions. Future studies should address how
to measure and evaluate emotion regulation in the caregiver-child relationship.
46
Appendix A. Emotional Availability Coding Sheet
47
48
49
Appendix B. Child Behavior Checklist 1 ½ to 5
50
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