Summaries per article with Clinical Child and Adolescent Psychology at Leiden University 20/21

Preface

An emotion consists of various components, namely physical arousal, motor expressions, action tendencies and subjective feelings. These components have an effect on social cognitions, attitudes and social interactions. That is why it is important that emotions are signaled during a conversation. This is about the emotion that is being emitted, so the non-verbal communication. Emotions play a role in forming and breaking social relationships. People also like to talk to others about emotions. One of the most important areas of social psychology where emotions are important is within group dynamics. This concerns the effects of 'contagious emotions'; passing a felt emotion over to others. Examples of contagious emotions are laughter and yawning.

What is an emotion?

The James-Lange theory

The James-Lange theory takes a peripheral position (which means that it focuses more on the somatic and autonomous rather than the central nervous system). In addition, it is suggested that someone first perceives an event, after which a physical reaction occurs. Then, only after the sensation of that physical reaction, an emotion occours. The difference between the James-Lange theory and the theories before, was that in the James-Lange theory it was thought that an emotion would come only after the physical reaction and in the theories before the main idea was that that an emotion would come before a physical reaction.

Emotion as a social-psychological construct

Nowadays there is a growing consensus that 'emotion' should not be used as a synonym for 'feeling'. Instead, researchers suggest that feelings are one of the three components in the emotion construct. Other components are the neurophysiological responses and motor expressions. These 3 components together are called the 'emotional reaction triad'. Another component that belongs to this emotion construct is the action tendency, although this is also seen as a behavioral consequence rather than a component of emotion. In addition, the emotion construct includes a cognitive component, because there is always evaluative information processing when it comes to emotion-generating events. The cognitive interpretation of an event is also called an appraisal. An emotion is described as a fierce, dynamic and short process with a clear beginning and an end. This involves as a crisis response, in which the physiological and psychological components interact with each other during an emotion episode. Systems that were previously independent suddenly start working together in synchronization to ensure survival.

Why do we have emotions?

Emotions cost a lot of energy, so why do they exist?

The evolutionary significance of emotions

According to Darwin, emotions exist because they are adaptive and help regulate interactions within social living species (for example, raising eyebrows provides better vision).

Emotions as a social signaling system

Another explanation for the existence of emotions is that, because one person can express emotions, another person can respond to this more easily and this can also lead to a certain tendency towards action.

Emotions provide behavioral flexibility

Emotions are almost automatic, but are more flexible than normal stimulus-response responses. Emotions ensure 'latency time' between stimulus and action, which ensures that people are better at evaluating the situation. During that period, the chance of success and the seriousness of the consequences are examined, after which an optimal response can be chosen. If there is a negative consequence, the motivation to take action will be great. Therefore, emotions have a strong influence on motivation.

Information processing

Information processing which is done people, especially in the social field, usually consists of 'hot cognition'. These are emotional responses that help to evaluate relevant and irrelevant stimuli. The criteria used in the evaluation of stimuli are learned during conversations and are influenced by needs, preferences, goals and values.

Regulation and control

Our feelings are a constant monitor of what is happening, and thus serve as the evaluation and appraisal of the environment, physical changes in the central nervous system and action tendencies. This is a requirement when controlling or manipulating the emotion process.

So, an emotion:

• decouples stimulus and response
• ensures the (correct) action trends through a 'latency time'
• provides signals for the outside world (others)
• feelings can regulate emotional behav, which can be strateic in social interactions

How are emotions elicited and how are they distinguished?

Philosophical notions

It is clear to most philosophers that a certain situation is reacted with a certain type of emotion.

The Schachter-Singer theory of emotion

According to Schachter, two factors are important in eliciting and distinguishing emotions, namely the perception of arousal and cognitions. Arousal is always the same (non-specific) and cognition leads to a label of the emotion (for example fear). In an experiment, arousal was generated in participants by means of an adrenaline injection. This showed that cognitions labeled this arousal for events that were taking place in their environment at that time. Emotions are thus formed by felt arousal and by the cognitive interpretation of the situations that are based on the behavioral model of expression. The results have not been replicated.

Appraisal theory

The appraisal theory of Lazarus consists of primary appraisal (fun / dislike, helps / hinders achievement of the goal) and secondary appraisal (to what extent can the person deal with the consequences of an event, given his or her competences, resources and strength). Lazarus calls this model a transactional model, because the outcome of the event is not only influenced by the nature of the event, but also by the needs, goals and resources of the person. It is different for each person and often leads to a mix of emotions (emotion blend).

Cultural and individual differences in appraisal at events

Culture causes differences in appraisal, for example socialism versus individualism. In a collectivist culture, guilt and shame are seen as the result of immoral things. In an individualistic culture this only applies to guilt and this emotion also lasts longer than in collectivist cultures. So the socio-cultural value can influence someone's emotional life. Individual differences in appraisal also cause different emotional responses.

Are there specific response patterns for different types of emotions?

There is agreement about the differentiation of the emotional component of emotions, but not about the reaction patterns of the peripheral system. James uses proprioceptive feedback (sensory information from organs about physical changes) to differentiate between emotions. Schachter and Singer, on the other hand, believe that non-specific physiological arousal combined with situational factors ensure that emotions can be differentiated. Tomkins spoke about discrete emotions, where he talked about neural programs that can control a certain emotion and the associated facial expression and motor skills.

Wat are motoric expressions?

Facial expressions

Evidence has shown found that facial expressions are universal, even though small differences have been found between cultures due to cultural desirability (display rules). 

Vocal expressions

Emotions are not only recognizable by facial expressions, but also by vocal expressions. Here too there are differences between people and cultures. Emotions in voice are partly universal, even though there are language differences between cultures. This is proof of a partial biological basis of emotions.

Control and strategic manipulation of an expression

Cultural norms about appropriate expression of an emotion are called display rules. It concerns the regulation of 'congenital' systems. In addition to the fact that it is appropriate to control your emotion expression because of cultural norms, it is also important from a strategic point of view. This would allow someone to manipulate someone else. Emotion expression often only comes into being when we see other people and that is why it is seen as a communication tool. But the more an emotion overwhelms us, the harder it is to regulate it.

Physiological changes

Physiological activity is not communicative, but it provides energy. This can ensure that someone is prepared for a specific action. Studies show specific patterns for the emotions fear and anger. These are functional: in case of fear, blood flows to the heart and brain to prevent blood loss. In the case of anger, the blood flows to the muscles for action.

Subjective feelings

This involves someone's conscious experience about the processes that take place in his or her body.

Dimensions of feeling

Wundt made a three-dimensional system to display the precise nature of all complex emotional states. The three dimensions are: excitement - depression, tension - relaxation, pleasant - unpleasant. There is only evidence for the first and third dimensions and therefore, in other studies, they often use a two-dimensional model of emotions. 

Verbal labeling of feelings

Emotions are socially structured (which means that the social and cultural factors create a reality for an individual). Cultural differences in value judgment systems, social structures, communication habits and other factors influence the emotion experiences and are reflected in culturally specified states of feeling. Feelings that are verbally expressed are influenced more quickly by sociocultural variations than other components of the emotion process. This makes sense because the subjective state of feeling represents the cultural and situational context and the other components of the emotion process.

How can emotion components interact?

Research has shown that the components of emotions are all strongly interconnected.

Catharsis

Catharsis revolves around the interaction of three components of emotion, namely expression, physiology and feeling. Through an expression, a person can calm himself down, reduce his arousal and at the same time change his state of feeling.

Proprioceptive feedback

Proprioceptive feedback (or the facial feedback hypothesis) states the opposite of the catharsis hypothesis. In this case, inhibition of facial expression reduces the intensity of an emotion and emphatic facial expressions can enhance the intensity of an emotion. In an experiment, participants had to hold a pen between their lips or teeth. The participants who used their laughing muscles to hold their pen rated the cartoons they saw as funnier. The effects were even stronger when the participants saw themselves in the mirror and the effects were also stronger with participants with high self-awareness. This has the opposite effect when someone has to smile kindly, while the person is actually furious, because this only reinforces the anger.

Preface

Emotions arise as a person consciously or unconsciously evaluates an event which is relevant to his or her goals. Emotions come about, are maintained, and change or end the relationship between the person and the environment, depending on the interpretation of the meaning of the emotion for the person. In this study, two aspects of emotions and social goals are studied, namely the social goals that are expressed by the emotion and the associated social consequences that the emotion expression causes. The reason these two topics are related is that every person can react differently to different emotions because they interpret the emotion as the expression of a social goal or intention, which is different for each individual.

How emotions are distinguished from each other 

The study looked at whether children thought that anger would have a different effect on social interaction compared to fear and sadness, and whether children thought that the person who expressed the emotion had goals in social interaction that are associated with the expression of one emotion but not with another emotion. Research suggests that the appraisal (assessment) of the event determines why one particular negative emotion is experienced instead of another negative emotion. These appraisals include an analysis of our goals in relation to the event. But, the reason that one emotion is expressed faster than another can also include another aspect of goals, namely the goals of one person towards another person (the social goals). Knowledge of the effects of emotion expression on interaction can lead to revision of our expression.

Our experience of emotion may also be influenced by our analysis of our social context. For example, it is not only that someone who is regularly sad interprets the negative events in the world as his own fault (internally) and that it is impossible to change anything (stable), but also that he wants protection and comfort from other people.

Two categories of social regulation: dominance and prosocial behavior

The social-regulatory aspects of emotions have been studied through two categories, namely dominance within relationships and prosocial behavior. Children are expected to be able to distinguish between anger, sadness and anxiety.

Dominance

Anger is generated more often when a person thinks that a negative event is deliberately triggered. The cause for the event is therefore sought outside the person (external) and can be changed. Anger is associated with dominance (power) and fear and sadness with submission (powerlessness). A number of researchers have suggested that anger is an emotion that signals strength or dominance and triggers a reaction from others that reflects an attempt to deal with the dominance of the expressor. It may be that when the recipient of anger experiences the authority or dominance of the other person, the recipient can respond with his own counter-offer for dominance.

Studies also shows that aggressive behavior is more likely to be answered with anger and hostility than with depressive behavior. However, if the person against whom the aggression is being expressed feels submissive towards the other person, there is a high risk of a fearful or sad reaction. So, this depends on the person to whom the aggression is expressed (women are more likely to react anxiously or sadly than men), his or her appraisal of the event and the feelings he or she has in relation to the other person.

Prosocial behavior

In prosocial behavior, a person acts to facilitate or co-operate with another person's goals. Literature shows that even very young children offer comfort and help when they see another person in despair. Sadness and fear evoke more prosocial behavior compared to aggressive behavior. Pro-social behavior is expressed by getting closer to someone, putting them at ease and helping the other person and apologizing. However, it is interesting that respondents think that it is their own fault if they get a furious reaction compared to when the person expresses sad or fearful reactions.

Developmental changes in children's understanding of the social-regulatory aspects of emotion

Another goal of the study was to understand how the understanding of the social-regulatory aspects of emotion in children changes with age. When children become older, they become better at distinguishing between real and apparent emotions. They are also better able to mask their feelings and to show more socially acceptable emotions, even when their internal experience is negative. Research also shows that children make a distinction between the effects of positive and negative emotions on their social interactions.

Method

A total of 108 children participated in the study, with ages between 6 and 12 years. The children were randomly attributed to one of the three emotion conditions, namely sadness, fear or anger. They were read the same three vignettes in each condition, with only the words that had to do with emotion, changed. Girls were told stories in which girls played the lead and boys were told stories in which boys played the lead. The three stories include interpersonal events. In the 'Broken Toy' story, the emotion expressor shows an emotion when his or her borrowed toy is broken by the recipient (the person receiving the emotion). In the story 'Rejection', the emotion expressor shows an emotion when the receiver does not let him or her participate in a game. In the 'Harm' story, the emotion expressor shows an emotion when he / she is pushed too hard on the swing by the receiver (brother or sister) and therefore falls off the swing. The children were then asked per vignette what the receiver would feel, what action the receiver would take, how powerful or powerless the emotion expresser felt towards the receiver and what the goals of the emotion expressor were when expressing of emotion. The three vignettes were each accompanied by a cartoon illustration. The same illustration was used for every emotion condition and no facial expressions, emotional gestures, or emotional postures were used in the illustration. However, while reading the story, the experimenter pointed to the child who was the emotion expressor and asked the child about the effects of this emotion on the other child.

Results

Feelings of the recipient

The research showed that the hypothesis that the anger condition would cause more anger at the recipients than the sadness or anxiety conditions was only supported in the 'Harm' story. However, the effect was relatively weak.

The resulting measures of the recipient

In addition, it became clear that the anxiety and sadness conditions caused goal relocation and comfort rather than the anger condition. In response to anger, the recipient was more likely to respond by turning away from the emotion expressor. Results also indicate that anger, in contrast to sadness and anxiety, caused more aggression.

Dominance

Fifty percent of the children who were exposed to the anger condition therefore thought that the emotion expressor would feel stronger than the recipient, while only zero to twenty percent of the children thought that the emotion expressor would feel stronger after showing of fear or sorrow. With all stories, sadness and anxiety differ significantly from anger, but sadness and anxiety do not differ significantly from each other.

Purpose of the expressor

In showing the anger, children were also more likely to think that the goal was to let the recipient go away than when grief or fear were expressed. When showing fear or sadness, children were more likely to think that the emotion expressor was looking for comfort compared to when anger was shown.

Age differences in the concept of emotion 

The last finding was that younger children differentiated less between anger and the other two emotions than the older children.

Discussion

So, children of six years old think there are other consequences for social interaction when anger is expressed than when anxiety and sadness are expressed. They also think that the social goals of someone expressing anger are different from the social goals of someone who is expressing sadness or fear. However, even children in the age of six sometimes will not or will not express their negative emotions to avoid social consequences.

Differences in emotions on the social-regulatory aspects of emotion

It is possible that a focus on social goals and social consequences of emotional expressions will contribute to understanding the development and preservation of individual differences in emotional expressions.

Age changes in children's understanding of the social-regulatory aspects of emotion

Children between the ages of six and nine have been shown to differ in anger, sadness and fear in terms of social goals and social consequences associated with these emotions. Older children are better able to  differentiate between emotions of anger, sadness and anxiety compared to younger children.

Human psychology or real behavior

In conclusion it can be said that children think that anger, compared to sadness and fear, announces different relational goals and this results in different interpersonal consequences.

Comparison of sadness, anger and fear expressions when preschool children look at their mothers  

Research has shown that the ability of children to regulate and change their emotion expression improves with age. The purpose of this study is to show that toddlers show more grief than other emotions when they look at their mothers, and that this communicates that they need support.    

Emotion regulation and the function of expression of emotions

Younger children rely on their mother to help them with their own emotion regulation. Children look to their mother for help and adjust their behavior based on the reaction of the mother. A change in a child's facial expression reflects emotion regulation. An important aspect of the functionalist approach is that facial expressions help with relational goals. Expressions of stress serve for communication, attachment and provoking help with the caregiver. The differential emotion theory states that each emotion of stress has a separate social function and elicits specific responses from a social partner. Especially important for this study is that the expression of sadness provokes the most positive, supportive responses.      

Socialization and the development of emotion regulation

Very small children cannot intentionally change their facial expressions. Toddlers can show positive facial expressions when they get a prize that they are not happy with. However, they cannot express this reaction yet, so they do not yet understand that they are doing this. Children between 3 and 18 months do not express pain when they are in pain, but sadness. This is because it is more functional for the child, because it leads to  more support from the caregiver. Children learn to modulate their expression through interactions with their mother, who encourages certain expressions, and ignores other responses or negates them.        

Current study

The purpose of this study is to look at whether 24-year-old preschool children modulate their facial expressions with their mothers. The pattern of facial expressions is also examined in response to frustrating or threatening experiences. Four questions are considered: 1) What was the dominant stress expression in each episode? 2) Do they show sadness more often than the target emotion when they look at their mother? 3) Does the expression of sadness increase in intensity and frequency when they look at their mother? 4) Is the expression of sadness more common when they look at their mother than when they do not look at their mother?      

Method

71 children of 24 years old participated. Periods of stress were always separated by a neutral or positive episode. In the 'strange situation' (threatening episode) a male stranger entered the room and stood a few meters away from the child. He then knelt before the child and looked up without talking. The child could escape in one context, but not in the other. Second, there was a frustration episode.   

Results

The expression of sadness was compared to the expression of the target emotion (fear or anger). This happened both for the entire episode and only for the glances at the mother. ANOVAs and MANOVAs were used for the analyzes. The two 'stranger' episodes were meant to provoke a reaction of fear, and the two episodes with the toys (frustration) were meant to provoke anger. In the episode with the stranger, the expression of fear was about twice as many compared to the expression of sadness. However, when they were allowed to play freely when the stranger came in, the expression of sadness was twice as common as the expression of fear. When removing toys, anger was three times more common compared to sadness. When the toy was locked in a box, the expression of sadness was more common than anger. Expressions of sadness while watching their mother were more common in the condition when the stranger came in and they sat in a high chair and did not play freely , and in the condition in which toys were removed. The intensity of the expression of sadness increases while looking at the mother, and continues to increase afterwards. Finally, the expression of sadness when looking at the mother is compared to sadness when not looking at the mother. For the 'Stranger Highchair' condition, sadness was more common when looking at the mother than when not looking. The same applies to the 'Toy Removal' condition.           

Discussion

This study shows that preschool children express more sadness than fear or anger when they look at their mother. These expressions of sadness are also more intense than those of fear or anger. These results were most evident for the Stranger Highchair and Toy Removal condition. Moreover, the intensity and frequency of the sadness during and after the gaze to the mother, increased. These results cannot be explained by the fact that sadness occurs more often than anger and anxiety, because during the entire episode, anxiety and anger were more common in the Stranger Highchair and Toy Removal condition. Moreover, this pattern of sadness when looking at the mother was not present in the other two conditions, probably because sadness in these two conditions already occurred throughout the episode. Finally, the results show that sadness is more common when looking at the mother than when not looking at the mother. Now the question is why this is the case. A first explanation stems from the functionalistic theory, which states that sadness provokes social support and interaction. However, there is no evidence that anxiety responses are less adaptive than sadness in getting help. The fact that the children did not show any sadness before they looked at the mother indicates that they did not feel sad. Finally, it is not yet clear which mechanism plays a role in the functionalist explanation, but that is probably that of display rules. Display rules are culture-specific predictions about who can show which emotion to whom and when. This study indicates that even young children modulate their facial expressions. This is in contrast to earlier research, which suggested that cognitive development and awareness of emotions are needed for this.                   

Introduction

People with an autism spectrum disorder often experience difficulties in social behavior and communication. Often they also engage in repetitive behavior. Seventy percent of the population with ASD also experience other psychiatric disorders such as social anxiety and oppositional defiant disorder. Over time, there is a growing interest in the role of emotion control as a mediator for internalizing and externalizing behavior in these adolescents. Emotion control could be the underlying mechanism for these problems, because emotion control is very important in life. When someone is able to control his or her own emotions, it may help to keep an optimal level of arousal which is needed to achieve social and personal goals. Emotion control takes time to develop, and its development is partly dependent on social experiences and it is also modeled through social learning. People often learn from childhood on to control their emotions in a socially and culturally accepted way. Children with an autism spectrum disorder, however, often have less access to these social environments and they also show more deficits in their ability to control their emotions.

This study examines three indices which are related to emotion control: negative emotionality, emotion awareness and worry or rumination and their relationship to the development of internalizing and externalizing behavior problems in children and adolescents with autism spectrum disorder. These children and adolescents are compared to typically developing youth, so a control group.

Emotion control is the term that is used to describe several aspects of the ability to down-regulate emotions in emotion-evoking situations. When people experience problems with emotion control, these problems could be related to emotion generation and/or to the process of dealing with emotions. The different indices of emotion regulation are related to internalizing and externalizing behavior. One of the indices of emotion control is: frequently experiencing negative emotions, such as anxiety, fear and anger. This experience of negative emotions is a consequence of an inability to down regulate emotional over-arousal. Higher levels of negative emotions are associated with both internalizing and externalizing behavior problems in typically developing youth and in children and adolescents with autism spectrum disorders.

Emotion awareness is another indication of emotion control. Emotion awareness is the term for the ability to know how you feel and to link this feeling to an emotion-evoking situation. This awareness of emotions is essential for emotion regulation. A consequence of not being able to differentiate between emotions and focusing too much on bodily symptoms of an emotional experience is related to more depressive symptoms, anxiety symptoms and somatic complaints in typically developing children and children with autism spectrum disorders. Studies have also shown a relation between alexithymia (difficulties in describing and differentiating between emotions) and emotional problems in children and adolescents with autism spectrum disorder. 

The last described index of emotion control is worry or rumination. Worry and rumination are highly related processes which have to do with a chain of repetitive negative thinking. This repetitive negative thinking increases emotional over-arousal. The role of worry and rumination in youth with autism spectrum disorders has not been studied very often. This is strange, because it are especially youth with autism spectrum disorder who have a tendency to perseverate on things and therefore may be more susceptible to engage in worry and rumination. Worry and rumination is associated with developing internalizing behavior in typically developing youth. Earlier studies have shown a relationship between worry and rumination and depressive symptoms in children and adolescents with autism spectrum disorders. It has also been shown that worry and rumination are related to aggressive behavior in typically developing boys. However, it is unknown whether worry and rumination lead to disruptive behavior problems in children and adolescents with autism spectrum disorders. 

The literature on the role of emotion control on the development of internalizing and externalizing behavior is based on cross-sectional research. However, to understand the relationship between emotion control and internalizing and externalizing problems, longitudinal studies are needed. These will tell if the relations hold over time. Therefore, the authors of this article conducted a longitudinal study to test the relationship between negative emotionality, emotion awareness and worry/rumination with internalizing and externalizing behavior problems in boys in the ages of 9 to 15 with and without autism spectrum disorders. The authors chose for this age range, because it is often in adolescence that social and emotional problems increase.

The authors investigated three clusters of internalizing problems: depression, anxiety and somatic complaints. They investigated one general cluster of externalizing problems: disruptive behavior. 

The participants and their parents in this study filled in a questionnaire about different parts of emotion regulation and overall well-being at three time points, with an interval of 9 months. 

The aim of this study was: to test whether emotion control contributes to the prediction of internalizing and externalizing behavioral problems 18 months later; to examine the developmental trajectory of internalizing and externalizing behavioral problems over time; to test the co-occurrence of the developmental trajectory of emotion control with the developmental trajectory of internalizing and externalizing behavioral problems.

The expectations or hypotheses in these study were: negative emotionality, poor emotion awareness and worry/rumination are related to more internalizing problems in both boys with and without autism spectrum disorders; negative emotionality and worry and rumination will have a positive predictive value for externalizing behavior in both groups. 

Because of the fact that social environments can help to learn the skills related to emotion control and the knowledge that children and adolescents with autism spectrum disorder often are not in these environments, the authors of this article also expected that the relation between emotion control with internalizing and externalizing behavior will be stronger for boys with autism spectrum disorder compared to their typically developing peers.

Measurements

IQ

The authors used two nonverbal subtests from the Wechsler Intelligence Scale for Children-Third edition (WISC III) to calculate a general measure of intelligence. These subtests were not administered to two of the boys with autism spectrum and five typically developing boys because of time constraints.

Predictors

Negative emotionality

To assess the participants negative mood over the past four weeks, the authors used a self-report questionnaire. They used three subscales of the mood list: anger, fear and sadness. Each subscale consists of four items. The higher the score, the more negative and dysregulated the emotional experience.

Emotion awareness

Two subscales of the Emotion Awareness Questionnaire were used to differentiate between emotions and bodily awareness of emotions. The subscale for differentiating emotions consists of seven items and measured whether the children were able to differentiate between their own emotions. An example of such an item is: "I am often confused or puzzled about what I am feeling". A high score indicates a good ability to differentiate between emotions. The subscale "Bodily Awareness of Emotions" measures whether children are aware of bodily changes that are related to their emotions. This consists of five items. An example of an item is: "I don't feel anything in my body when I am scared or nervous". A high score indicates low bodily awareness.

Worry and rumination

To assess the tendency of children to dwell on a problem instead of dealing with it (by means of solving the problem or coping adaptively), the worry and rumination questionnaire for children is used. This is a self-report measure. It consists of ten items and an example of an item is: "When I have a problem, I think about it all the time". The higher the score, the higher the level of worry and rumination.

Outcome Measures

Disruptive Behavior Problem

The Child Symptom Inventory is a behavior rating-scale to assess childhood disorders. It is based on DSM-IV criteria. In this study, there was looked at whether there were problems related to attention deficit hyperactivity disorder (ADHD), oppositinal deviant disorder (ODD) and conduct disorder (CD). There were seventeen items to measure ADHD ("Is quickly distracted"), eight items to measure symptoms of ODD ("Does things to deliberately annoy others"), and fifteen items to assess symptoms of CD ("Has deliberately started fires"). The parents were asked to rate each item on a four-point scale. A higher score indicates more disruptive behavior. So, these were the measures for externalizing behavior.

For internalizing behavior, there was looked at anxiety, depression and somatic complaints.

Anxiety

The Child Symptom Inventory was also used to assess problems related to generalized anxiety. Parents rated their children's generalized anxiety symptoms in the last six months on seven items. A higher score means more anxious feelings.

Depression

To measure symptoms of depression, an adapted Dutch version of the Children's Depression Inventory (CDI) was used. This is a self-report questionnaire which includes twenty-seven items. An example of an item is: "I am sad". The higher the score, the higher the depressive mood. 

Somatic complaints

Somatic complaints were measured using the Somatic Complaint List (SCL). Children reported the frequency in which they experienced certain somatic complaints such as a headache in the past four weeks. The higher the score, the more somatic complaints.

Discussion

Many children and adolescents with autism spectrum disorder show additional emotional and behavioral problems, next to the core symptoms of their disorder. Therefore, it is important to look at the underlying mechanisms to explain this co-occurence of symptomatology. This will help in developing effective tools for prevention and interventions. In this study, three indices of emotion control that are thought to play a key role in the development of additional problems in children and adolescents with autism spectrum disorder, were examined. The main findings are: baseline levels of worry and rumination are a risk factor for developing externalizing behavior symptoms 18 months later, but only for boys with autism spectrum disorder; the developmental trajectory of internalizing and externalizing behavior symptoms did not differ between boys with and without autism spectrum disorder; increase in worry and rumination over time was related to the development of more externalizing behavior problems in boys with and without autism spectrum disorders; increase in worry and rumination and increase in negative emotionality contributed both to the development of more internalizing behavior symptoms in boy with and without autism spectrum disorders, but the relationship between worry and rumination and somatic complaints was only there for boys with autism spectrum disorders.

Developmental Trajectory of Internalizing and Externalizing Behavior in Both Groups

So, in line with previous research, the authors found that boys with autism spectrum disorder showed more internalizing and externalizing behavior problems compared to boys without autism spectrum disorders. But, the speed of development of these symptoms did not differ between the groups. Also, there was no increase in symptoms of depression and generalized anxiety found. 

The findigs also showed that there is a decrease in externalizing behavior with age for boys with and without autism spectrum disorders. This is in line with previous studies which showed that there is a negative relationship between agressive behavior and age. 

Because it is known that adolescence is a time period which is characterized by big changes in behavior and biology, the authors also looked at whether this period is an additional risk factor for boys with autism spectrum disorders. This does not seem to be the case. It seems that the heightened sensitivity that these boys show, are already evident during their childhood. And, because children with autism spectrum disorders are less able to participate in social life, this probably affects their opportunity to practice and achieve emotion control. This may explain why these symptoms emerge prior to adolescence.

Worry and Rumination as a Risk Factor for Developing Externalizing Symptomatology

This study showed that boys with autism spectrum disorders exhibit more disruptive and aggressive behavior compared to boys without autism spectrum disorders. This might be, because they experience more frustration and negative thoughts. This study showed that baseline levels of worry and rumination are indeed a risk factor for disruptive behavior eighteen months later, but only for boys with autism spectrum disorders. It is also possible that not only worrying and ruminating lead to more disruptive behavior; it may also be the case that the content of the worry and rumination differs between children with autism spectrum disorders and typically developing children. For example, high-functioning individuals with an autism spectrum disorder are often well aware of their (social) difficulties. This may be an important source for daily problems and worries, especially during adolescence, because this is a time period in which peers are important in daily life. Findings showed that adolescents with autism spectrum disorders indeed report more anger rumination compared to typically developing youth. But, it does not seem to be the case that boys with autism spectrum disorders ruminate more than boys without an autism spectrum disorder.

Emotion Control as a Risk Factor for Developing Internalizing Symptomatology

Boys with autism spectrum disorders show a higher sensitivity to develop internalizing behavior symptoms. This study shows that thinking repeatedly and negatively about daily problems increases the risk for developing internalizing behavior problems 18 months later in boys with and without autism spectrum disorders. Also, an increase in the frequency of worry and rumination also increase internalizing symptoms. So, it seems that worry and rumination and externalizing behavior symptoms are a transdiagnostic factor that underlies multiple types of psychopathology.

Regularly experiencing negative emotions also is an risk factor for internalizing problems. For example, boys with and without autism spectrum disorders who have negative emotionality, have more internalizing symptoms (anxiety, somatic complaints) eighteen months later.

Introduction

In the hearing population, moral emotions (called social emotions in class) are important influencing factors of social competence. Moral emotions such as shame, guilt, and pride, are reflected, for example, in being loved by others. Moral emotions seem to play an important role in regulating social behavior. It is unclear whether this can also be observed in early childhood. It seems that young children can already experience moral emotions, but that they do not yet have the capacity to understand the consequences of their behavior.

This research explores the moral development of children with a CI (cochlear implantation) and the relationship with this implantation and the social functioning of these children.

Function and development of moral emotions

Emotions have a social function; they motivate people to find a balance between their own interests and certain social requirements in order to optimize interpersonal relationships. Moral emotions would assume a special position in the spectrum of emotions. Moral emotions have a self-evaluating component and occur when people judge their own behavior as to whether it is morally right or wrong. Self-awareness and self-reflection will allow for correcting one's own behavior. Moral emotions discourage inappropriate behavior (morally incorrect) and reinforce appropriate behavior (morally correct).

NH (normal hearing) children know how and when to express moral emotions and will also be more socially skilled.

Moral emotions require certain insights and capacities that develop over time. Self-awareness develops during the second year of life. Parents play an important role in developing children's sense of self. During infancy, most NH children are getting better at judging their own behavior based on what they have learned from previous feedback (from their parents). At the age of three, NH children begin to develop a personal set of standards, which ultimately will guide their (emotional) behavior in the right direction, independent of external guidance.

The majority of NH children learn to understand Theory of Mind (ToM) between 2 and 5 years old. Children with CI fail in ToM during this crucial period. In the early and middle of childhood, children with CI are less able to predict the behavior of others based on the expectations and wishes of these people. They tend to use their own frame of reference more often. Children with CI are less able to express moral emotions because they do not realize that they are doing something that can be judged as reprehensible or admirable by others.

Communication and socialization

Children pick up signals from the environment to know how to behave, which emotions to experience and when and how to express these emotions. These signals are communicated in various ways, such as through body language, eye contact, facial expression, language content and pitch of voices. Children with CI are less likely to pick up these signals from the environment. Even though the CI is responsible for the perception of sound, a large amount of the children with CI still suffer from language delays. This is particularly problematic for children with CI who grow up in a 'hearing environment'.

Research goals

The first aim of this study is to study the extent to which young children with CI or normally hearing children display moral emotions in an experimental setting. The hypothesis is that children with CI are less likely to learn and internalize moral norms and show subsequent moral emotions, due to communication problems and the limited possibility of incidental learning. In addition, children with CI will have a disturbed insight into emotions and the perspective of other people, impeding the ability to draw conclusions about their own behavior from signals from the environment.

The second goal in this study is to investigate associations between moral emotions and social behavior. Young children are expected to be unable to anticipate the consequences of their behavior, regardless of whether or not they can hear. This would mean that in both groups of children there is no relationship between moral emotions and social behavior.

Third, it is studied whether communication plays an important role in the development of moral emotions. The language skills of the children will be examined as a determinant of communication. The hypothesis is that a positive relationship is found between the ability to understand and use emotion language and the extent to which moral emotions are expressed. This will be the outcome for both groups of children.

Finally, it is studied whether previous implantation stimulates the social and emotional functioning of the children in a way comparable to what was found for the spoken language skills.

Method

Participants

224 children, of which 60 with CI and 184 NH, from the Netherlands and the Dutch-speaking part of Belgium. All children are born to hearing parents and have no mental health disorder. The children with implants had all received their first implant before the age of three.

Index for moral emotions: guilt, shame, pride

There were three tasks that should provoke the feelings of shame and guilt. The Broken Car Task; children would believe they had broken the investigator's toy car. The Copy Task; the children had to draw a drawing over, after which they received negative feedback on their performance. And the Bottle Task; the children had to open a bottle on which there was a safety cap without the children knowing, so that they could not open the bottle and the researcher did. The following four behaviors were coded on a three-point scale (0 = not at all, 1 = a little, 2 = a lot): negative reaction to the situation, gaze away from the situation, collapse of the body, letting the corners of the mouth hang down / lower lip to push outside.

There were also tasks where pride was provoked. With the Copy Task, positive feedback was given and with the Bottle Task the protection was removed by the researcher, so that the child's second attempt to open the bottle was successful. Pride was scored on the same three-point scale with the following three behaviors: positive response to the situation, (smile) laughter, eye contact / upright posture.

Index for social functioning: social competence, cooperation, behavioral problems

Social competence was determined by calculating the average score for the items of the Prosocial and Peer Problems scales of the Dutch parent report version of the Strengths and Difficulties Questionairre (SDQ). Parents rate each item on a three-point scale (0 = not true, 1 = somewhat true, 2 = certainly true).

Cooperation was tested with the use of a questionnaire specially designed for this study. The scale of cooperation reflects the extent to which children were motivated to perform tasks and how they responded to the researcher's instructions. Items were assessed on a three-point scale (0 = none, 1 = sometimes, 2 = often), after which the average score of the items was calculated.

Behavioral problems were determined by calculating the average score for the hyperactivity and behavioral scales of the SDQ.

Index for language: emotional vocabulary, spoken language comprehension and production

The emotion language of children was measured with the Emotion Vocabulary Questionnaire. This is a parent reported questionnaire designed for this study. Parents assessed their children for knowing or using (through sign language or simply spoken language) mental state words or emotion words (0 = no, 1 = yes).

Spoken language comprehension and language production were obtained from children with a CI through admissions from hospitals and elsewhere. Part of the rehabilitation process after implantation supervises the language development of the children, usually through the use of the Dutch version of the Reynell Developmental Language Scales for language comprehension and the Schlichting Expressive Language Test for word and sentence production. So the spoken language skills were only measured in children with CI.

Results

It appears that children with CI express moral emotions to a lesser extent compared to normal hearing children. No major effects were found between the two groups for one of the measures of social functioning. So social competence, cooperation and behavioral problems were the same. Furthermore, it is indicated that NH children know and use more emotion words than children with CI.

Shame, guilt and pride appeared to increase with age in both groups of children. Cooperation also appeared to increase in both groups with age, while social competence only increased with age in NH children. In addition, it was striking that behavioral problems were not related to age in the NH group, while it did increase with age in children with CI.

Emotion language, indexed by emotion vocabulary, turned out not to be related to moral emotions in both groups. Emotion vocabulary turned out to be positively related to social competence in the CI group. The younger the age of insertion and the longer use of the implant, the more positively related to pride and language skills, but not to shame and guilt or other indexes of social functioning. The timing of the implantation was otherwise unrelated to emotion language.

Discussion

Moral emotions have the ability to promote positive social behavior and to protect against negative social behavior in the NH population. The majority of the group of children with CI appeared to have limited opportunities for acquiring social-emotional skills as a result of limited communication with their environment.

Young NH children may already show moral emotions, but this ability grows with age. Children with CI express shame and guilt less widely than NH children in response to emotion-provoking events. Children with CI also showed less pride. This group also appeared to be less aware of what was expected of them in terms of moral behavior in the situations. In both groups, however, a link was found between age and moral emotions. This would mean developing the moral skills along the same lines, but at a different pace. For example, the social skills of children with CI appear to develop just as well and develop at the same pace as NH children.

A relationship was found between moral emotions and positive behavior, not with negative behavior. A better developed moral sense promoted positive behavior, but did not appear to show negative behavior. Children with CI were less likely to recognize facial expressions than NH children. In addition, they were less able to detect differences in intonation in spoken language and were less likely to learn incidentally.

Introduction

An important thing for children to learn as they get older, is learning how to modulate and regulate their emotions. This is especially true for emotions such as sadness. One of the ways in which children learn to do this, is through socialization. For example, during infancy, caregivers help the children to regulate their emotional arousal. As children become older, they start to adopt individual emotion regulation strategies, which they learned from the parent-child relationship. Most of the research that studies emotion regulation in children has focused on early childhood. However, more recent research suggests that the parental influence on emotion regulation continues through middle childhood. During middle childhood, parents help their children to refine their emotion regulation skills. This is important, because as children age, they are increasingly confronted with complex social-contextual demands. Also, during middle childhood, thirteen to twenty percent of the children meet the criteria for a diagnosable mental disorder within the previous year. And, lastly, in middle childhood, children have to learn things such as the social standards of behavior (display rules: what should you express and what not), social-problem solving and recognizing and understanding emotions. All of these skills are influenced via the parent-child relationship. 

In the literature on this topic, there is a gap in how each parent influences the emotional development of their child interactively. The authors of this article state that this is important to look at. They state that, because it is unclear whether there is an optimal level of parental support needed for the development of children's emotion regulation skills, it is important to examine how mothers and fathers jointly respond to their children's expressions of sadness. By doing this, questions such as: "is it necessary that both parents provide highly supportive responses to their children's sadness, for optimal psychological well-being?". Therefore, this study looks at the individual and interactive effects of mothers' and fathers' sadness socialization responses in relation to their children's psychological and social adjustment.

Parental emotion socalization can occur through direct and indirect methods. For example, the beliefs that parents have about emotions and the acceptability of these emotions, are probably communicated during conversations with the child. These conversations or discussions are important, because these help the child in his or her socio-emotional development. The frequency and content of parental discussion of emotion have also been linked to children's emotion regulation skills and can influence the children's emotional development in a positive as well a a negative way.

Parental emotion socialization is often divided in two: supportive or unsupportive. Parents have a set of feelings and thoughts about one's emotions and their children's emotions. These are called meta-emotion philosophies. These philosophies are also often divided into two categories. To elaborate, parents who adopt a positive, supportive philosophy are more aware of their children's emotion and help their children with labeling their feelings. They see their children's experience of negative affect as a way to learn and to grow. This kind of socialization responses are linked with positive outcomes, such as adaptive emotion regulation, fewer psychological symptoms and higher levels of academic achievement and social competence.

In contrast, parents with a negative and unsupportive response, lack awareness of their child's emotions, have deficiencies in their emotion vocabulary and attempt to alter the emotion instead of viewing it as an opportunity to learn and to grow. 

Sometimes parents find the ways in which their children manage their emotions, aversive. They then try to eliminate these emotion-provoking stimuli and minimize the child's experience of negative experiences. When the child does express negativity, they react with personal distress, try to distract the child from the emotion, punish the child or ignore the child's emotions altogether. Findings from previous research have shown that when parents are unsupportive to their children's emotionality, this is linked to problem behaviors and poor social functioning in middle childhood. Also, mothers who employ unsupportive strategies, more often have adolescents with depressive symptoms.

Most studies that have been conducted have looked at maternal responses or a combination of maternal and paternal socialization practices. So, there is not much literature about how mothers and fathers socialize their children's emotional development interactively. Many studies have also not included fathers, even though they play a unique role in children's social and emotional development. However, it seems to be the case that differential maternal and paternal responses to their children's emotional expressions are associated with girls' internalizing and boys' externalizing symptomatology. Also, mothers tend to use more words in general and more words related to emotion during parent-child discussions compared to fathers. Also, compared to fathers, mothers are more likely to respond to sadness of their children with expressive encouragement. However, both parents use expressive encouragement or problem-focused responses more often with daughters than with sons.

The current study

In this study, multiple methods have been used to look at how mothers and fathers respond during discussions with their children about past events that evoked sadness. They also looked at how their responses are related to children's outcomes on things such as internalizing and externalizing symptoms and social functioning. 

The authors selected a middle childhood sample because children in this age group shift from relying on external sources for emotion regulation to more independent strategies. Parents still remain important for emotion socialization during this transitional developmental period.

The authors hypothesized that mothers' and fathers' individual responsiveness to emotions expressed by their children would be negatively related to internalizing and externalizing symptoms and positively related to social functioning. The inverse relationship was hypothesized for negative emotional responsiveness. 

When it comes to the interaction between maternal and paternal positive and negative responsiveness on boys' and girls' psycho-social functioning, the authors hypothesized that positive responses by both parents would lead to more positive psycho-social outcomes compared to two negative parental responses to sadness. But, it was unclear whether having just one positive parental response would be as effective as having two positive responses and it was also unclear whether the sex of the parent that provides the negative response would lead to different outcomes for daughters compared to sons. Based on the literature about sex differences, the authors hypothesized that having a negatively responsive father and a positively responsive mother to sadness, leads to poorer social functioning for boys, because their father is their role model. 

Methods

Participants

The participants in this study were 82 families. All of these families were 2-parent households. The children ranged from eight to eleven years old and were in the third, fourth and fifth grade. There were no significant differences between boys and girls on demographics such as age, race or socioeconomic status (SES).

Measures

Parent-child sadness discussion task

Before each session, the researcher asked the child to think of two times when he or she felt sad. After this, the children and each parent were asked to discuss  the event within 10 minutes. The topic that would be discussed with each parent was chosen at random. The discussions were video-recorded, transcribed and coded. 

Content coding

There were nine categories within the emotional discussions concerning the death or injury of a pet, interpersonal loss, or a conflict with peers/siblings/friends. There were no significant differences in content area between the topics that were discussed with mothers and fathers. 

Maternal and paternal positive responsiveness

The extent to which the mother or the father actively is engaged in the discussion, the degree to which they displayed positive responses to their child's sadness disclosure and the quality of their communication skills were used as a measure of positive responsiveness. When the score is zero, this means that there is no engagement from the father or the mother during the discussions about the sad events.

Maternal and parental negative responses

The degree to which mothers or fathers were unsupportive and displayed negative affect in response to their child's discussion of the sadness-evoking event, was used as a measure of negative responses. A score of zero means that the parent never showed any sign of negativity or unsupportive responsiveness.

Child psychopathology symptoms

Child behavior checklist

The parents rated their child's internalizing, externalizing and social functioning using the Child Behavior Checklist. The Child Behavior Checklist consists of 118 items which are rated on a 3-point scale.

Discussion

This study wanted to use the parent-child emotion discussions as a way to determine how mothers' and fathers' responses to their children's sadness would influence the child's socialization. This study is unique, because it not only looks at the separate effects of mothers' and fathers' positive and negative responses on the children's psychological and social functioning, but also at the interactive effects. The results of this study showed a complex pattern of findings. This also shows that maternal and paternal emotion socialization operate in different ways. 

To elaborate, the findings showed that the more positive mothers respond to their daughters' sadness, the fewer self-reported internalizing symptoms these girls exhibited. This is in line with previous research. So, apparently having an outlet to express sadness has beneficial effects for girls. However, this did not seem to apply to boys for either mother- or father- reports of internalizing behaviors. An explanation for this could be that support for sadness does not work the same for boys as it does for girls. For example, Rose et al. found that boys thought that expressing their personal problems to their friends would make them feel "weird" or would be a waste of time for their friends. 

When it comes down to children's externalizing symptoms, the more mothers positively respond, the lower the daughters' externalizing behaviors, as reported by fathers. There were no main effects found for boys' externalizing behaviors. An explanation could be that mothers are more "in tune" with the emotions of their daughters and therefore are more able to be salient socialization role models for their daughters, compared to their sons. 

This study also showed that there was a significant interaction between mothers' and fathers' negative responsiveness on mother-reported externalizing symptoms for boys. What is remarkable is that boys with two highly negative responsive parents showed the lowest levels of externalizing symptoms. To elaborate, boys with a negatively responsive mother and a disengaged father showed the highest externalizing symptoms, as reported by mothers.

An explanation could be that having two parents who are both consistently unsupportive of their sons' sadness, may generalize so that boys suppress outward displays of negative emotions, such as anger outbursts and aggressive behaviors. It could also be the case that these boys have learned not to rely on their parents and instead rely on their environment such as their peers and teachers. This might serve as a buffer against the development of externalizing behavior problems.

There were no significant associations found with regards to the externalizing symptoms of sons' as reported by fathers. 

Another finding was that the parent's sadness socialization processes were related to children's social competency. In contrast to internalizing and externalizing behaviors, parents were in agreement about their perception of their children's social competency. What was remarkable is that boys who have one positively responding parent and one negatively responding parent, showed the most adaptive levels of social functioning. The second interaction showed that having a supportive mother and a disengage father or having a disengaged mother and a highly negatively responsive father is related to highest level of boys' social competency. Even though it seems that having two parents who both respond positively to their children's sadness expressions would is the optimal model for parenting, it seems that having at least one parent who is responsive while the other is disengaged, also has positive outcomes.

Social anxiety disorder (SAD) is common among the population, 7.3-12.1%. The first characteristics appear in late childhood and adolescence.

A period of an age-related increase in social anxiety and fear

Adolescent changes are characterized by hormonal changes. Typical neurological developments that increase 'emotionality' during development are varied. The amygdala and the striatum are mentioned, which are involved in the basic processing of threat and reward. FMRI research revealed the differences in medial and lateral functional subdivisions of the prefrontal cortex. This is due to the response to emotionally provocative stimuli between adolescents and adults.

The involvement of the prefrontal area together with an increased reactivity of the limbic systems to threatening and rewarding stimuli may be responsible for increased emotional responses in adolescence. Typical neurological developments that increase 'sociability' during development are less divergent. A relative decrease in the anterior dorsal medial prefrontal cortex area and an increase in the posterior temporal areas when adolescents are compared with adults is found.

Changes in the brain network due to social-affective stimuli during adolescence can result in greater affective responses and greater involvement and understanding of interpersonal situations. This makes the adolescent flexible in the choice of behavior, and also makes him or her more susceptible to social fears and and anxiety.

A period of declining individual differences in social anxiety

Where the above confirms that adolescence increases the risk of social anxiety and fear, there is a small proportion of adolescents in who these symptoms are very severe and persistent. How does this type of adolescent differ from a normative developing adolescent? The answer is, there are developmental changes in both the emotional brain and the social brain. An emphasis is placed on biases during information processing (including attention bias, interpretation bias and expectation bias). Recent fMRI studies show that cognitive biases are associated with individual differences in brain activity.

Young people with an existing tendency to pay attention to (or expect) negative aspects of social cues or situations appear to experience these experiences more often and may start to behave in a mal-adaptive way, such as avoidance to avoid this situation. Because adolescents are better able to mentalize, there is an increase in the complexity and ambiguity of situations. One can explain these situations in several ways, but also with a greater chance of a negative interpretation. In future studies, it is important to look at what neurocognitive factors play a role per age group.

Introduction

Social anxiety disorder (SAD) is a very common psychiatric disorder. The lifetime prevalence, or in other words, the proportion of a population that at some point in their life has experienced symptoms of social anxiety disorder is 6,7% in Europe and 12,1% in the USA. Symptoms of social anxiety disorder can have a big impact on someone’s life and are related to outcomes such as poor social functioning, poor adjustment at work, lower levels of academic and professional achievement, lower quality of life and high levels of comorbidity with other mental disorders. Comorbidity means that someone with social anxiety disorder also often has another disorder, for example depression.

Even “subthreshold” or “subclinical” social anxiety, which means that someone experiences symptoms of social anxiety disorder, but not enough to be diagnosed with the disorder, can have a big impact on someone’s life. In the general population, 20% of the people report subclinical symptoms of social anxiety.

Social anxiety has different effects. For instance, the subjective experience of a person during social interactions is often characterized by high negative affect and low self-efficacy or feelings of inferiority. It is also often seen that social anxiety leads to increased self-focused attention and negative interpretation biases during social situations. It may also be the case that both social anxiety disorder and subclinical social anxiety symptoms go together with altered biological reactivity to stress. Some studies have suggested that the hypothalamic-pituitary-adrenal (HPA) axis, a biological stress response system, may be dysregulated in people with anxiety disorders. A dysregulated HPA axis may also cause medical health problems and could be the cause of the high comorbidity of social anxiety disorder with other medical conditions.

There is limited information about the relationship between cortisol levels and the severity of social anxiety symptoms. This study looked at multidimensional responses to social stress. Social stress was induced by means of the Trier Social Stress Test (TSST). This is a widely used procedure that triggers cortisol responses by combining elements of uncontrollability and social-evaluative threat. There was also controlled for the menstrual cycle phase and oral contraceptives, because these are known to influence the cortisol reactivity in the Trier Social Stress Test. Previous studies showed that social anxiety is linked to altered responses under stress. Therefore, in this study, there was looked at new associations between HPA axis reactivity to stress and ratings of behavioral anxiety and cognitive biases that are central to social anxiety disorder.

Materials and methods

Participants

There were 262 participants who filled in the Liebowitz Social Anxiety Scale (LSAS-SR). Only the participants who scored over 30, had no anxiety and mood disorders, were free of HPA-related medical conditions and, in the case of women, had a regular menstrual cycle, were included. Therefore, only 52 out of 262 participants were included in de final sample. These were people with increased social anxiety symptoms.

Social anxiety symptoms

The Liebowitz Social Anxiety Scale consists of 24 items or questions. It measures fear and avoidance of social situations. However, this was a self-report version of an otherwise clinical test.

State Anxiety

State anxiety can be defined as a transitory emotional state consisting of feelings of apprehension, nervousness and physiological sequelae such as an increased heart rate or respiration.

Speech Anxiety Behaviors

The participants’ speech performance during the Trier Social Stress Test was assessed by three evaluators. These evaluators made use of the Behavioral Assessment of Speech Anxiety (BASA). With the help of BASA, the speech of the participants is evaluated on six behavioral categories: voice, verbal fluency, mouth and throat, facial expression, arms and hands, and gross bodily movements. Each category contains a specific behavior. For example, for the category ‘voice’, a specific behavior could be: quivering or tense voice, talking too fast, talking too soft, and monotonous or lack of emphasis. Each evaluator watched a video of the participant and scored the BASA items on a 10-point scale which indicates the severity of anxiety. This rating is based on both the frequency and the intensity of a particular behavior. So, three independent ratings for each of the six behaviors was reached.

Cognitive biases

To assess cognitive biases, the probability and cost of negative evaluation scale was used. This means that participants were asked about how high the likelihood is that their Trier Social Stress Test performance will be evaluated negatively. So, a statement could be: “The raters will think you are incompetent”. These items would then be rated by the participant on a 5-point scale.

Discussion

Out of this study, it became clear that the intensity of social anxiety symptoms was positively associated with self-reported state anxiety and cognitive biases to negative social evaluations. Several observable anxiety behaviors as seen in the Trier Social Stress Test were also positively correlated with social anxiety symptoms, but only the correlation with facial expression was significant after adjusting for multiple comparisons. Cortisol reactivity was negatively associated with the severity of social anxiety symptoms. So, reduced cortisol may be a risk factor for socially anxious individuals. Reduced cortisol may be the result of chronic stress. In people with social anxiety, their inability to adapt to social situations could lead to allostatic load and reduced cortisol reactivity. Allostatic load is defined as the cost of chronic exposure to elevated or fluctuating endocrine or neural responses resulting from chronic or repeated challenges that the individual experiences as stressful. So, in the case of social anxiety symptoms, it could be that lower cortisol reactivity leads to an inappropriate energy supply during social situations, which lead to that socially anxious individuals are unable to adapt and are susceptible to poor performance. This can in turn lead to cognitive biases. The reduced cortisol reactivity may also lead to increases comorbidity with medical problems.

An alternative explanation for the lower cortisol reactivity is that it is a way of coping in the form of disengagement from social settings which involve possible negative evaluations or social rejection. This idea fits the recently developed model of protective inhibition: the protective inhibition of self-regulation and motivation (PRISM). The PRISM states that during social situations that lead to hyperarousal (a lot of stress) or which allow for disengagement coping, social anxiety is linked to decreased cortisol. This is then seen as a protective disengagement mechanism against extremely high emotional arousal. In this study, the participants who were hypo responders for cortisol (so, they showed a lower reactivity to cortisol), scored higher on measures of arousal.

Abstract

Empathy is associated with a reduced antisocial and increasing prosocial behavior. In this study empathy and prosocial behavior are investigated in response to sadness and distress in ODD / CD and ADHD. Six and seven year olds with ODD / CD (with / without ADHD) and with ADHD alone were compared with normally developing (NO) children. Parents and teachers indicated the degree of affective empathy of children in response to sadness and distress on a scale. Children indicated this on the basis of sad story vignettes. Compared to children with NO, children with ODD / CD and ADHD scored less highly in terms of empathy by teachers, but not by parents. Children with ODD / CD showed less prosocial behavior in response to sadness and distress compared to NO children. Children with ADHD alone did not differ from NO children. When all children with a disorder were compared with the NO children, it was found that the difference in prosocial behavior continued to exist when the ADHD symptoms were checked, but not when the ODD / CD symptoms were checked. The reduced empathy-driven prosocial behavior in response to sadness and distress in young children with ODD / CD shows that interventions should focus on increasing prosocial behavior in these children.

Introduction

Empathy is described as the ability to understand and share emotions of others with people with whom we interact. This consists of an emotional and cognitive component. Empathically related reactions are often associated with prosocial behavior and contribute to the inhibition of antisocial and aggressive behavior. The explanation for this is often sought in the central role in showing sadness and distress in the inhibition of aggressive behavior. Prosocial behavior has no direct material benefits for the person who positions himself like that. For example, when children hurt each other and see sadness and distress in the other, they also get into the same state and stop unwanted behavior to restore their own personal state.

In children and adolescents, deficiencies in empathy are known by ODD / CD. Disorders related to oppositional, distant, and antisocial behaviors. Cognitive empathy often seemed intact. It seems that a reduction in sharing feelings of sadness and distress in others is related to disruptive and aggressive behavior in children and adolescents. However, a number of things still need to be clarified:

• The study of affective empathy response patterns in response to signs of sadness and distress in others

• Research into prosocial behavior in a clinical sample of children with ODD / CD diagnoses

• Research into the influence of ADHD on emotional perception and processing in children with ODD / CS

• The investigation into whether empathy deficiencies are already visible at a younger age than school-going children and adolescents

The current study examines:

• Comparison between parent and teacher reports of affective empathy

• Measuring affective empathy in response to sad vignettes in children

• Determining empathy-induced prosocial behavior by means of a computer task with sample NO children in comparison with ODD / CD (with / without ADHD) and ADHD

It is expected that 6/7 year olds with a diagnosis score less highly on the empathy indicated by parents and teachers, show less affective empathy with the vignettes and show less prosocial behavior in comparison with NO children. In addition, the clinical group is expected to show less empathy and prosocial behavior that this difference persisted even after controlling ADHD symptoms, but not when checking for ODD / CD symptoms.

Method

Attendees

37 NO children were compared with 93 children between 6 and 7 years old with a clinical diagnosis of ODD / CD and / or ADHD.

Procedure

The interview with parents was conducted at home, as well as the CBCL. Teachers completed the TRF and the GEM. The data of the children was obtained in a quiet room with the children at school.

Measuring instruments

DISC: parent version to separate clinical group (ie: ADHD only, ODD / CD only or comorbid). GEM: both parents and teacher data. A questionnaire to clarify the empathy of children. Story Task: 8 short stories with different emotions (angry, happy, sadness or fear), each emotion has 2 stories. 2 sad stories were used here. The story was followed by an interview with the child to see if the emotion was recognized and shared. IRT: computer task that registers prosocial behavior within a social context. This was a ball throw game.

Results

Children in the clinical group were more often young and had lower SES than NO children. Teachers score children with ODD / CD and / or ADHD with less empathy in response to sadness compared to NO children. A significant negative relationship was also found between TRF aggression and affective empathy indicated by teachers. Parents did not indicate this. A significant effect of prosocial behavior was found in children's tasks. Children with ODD / CD (with / without ADHD) scored lower than NO children. Children with ADHD alone did not differ from the NO children. This difference persisted when checking for attention scores, but not for aggression scores.

Discussion

The current study differs from other studies, because attention has also been paid to empathy-induced prosocial behavior. Teachers reported deficiencies in affective empathy in response to sadness and distress in 6 and 7 year old children with ODD / CD (with / without ADHD) and in children with ADHD alone. Children with ODD / CD (with / without ADHD) failed in observed empathy-induced prosocial behavior in response to sadness and distress. Children with ADHD alone did not differ from NO children.

It seems that younger children with ADHD, the empathic response to sadness and distress of peers, is reduced, regardless of the presence of behavioral problems. This is only visible in socially challenging situations, such as school. It is therefore clear that children with disruptive and aggressive behavior genuinely have problems in sharing sadness and distress at school. The difference with the parents shows that children exhibit different behavior in different places. Perhaps a school setting is more socially challenging and there are clearer and easier shortcomings of empathy there than at home. In addition, a negative correlation was found between SES and parent-reported empathy: parents with a higher SES scored higher on their children with regard to empathy than parents with a lower SES. It seems unlikely that SES had any influence on the results of this study. For interventions it is important to pay attention to the role of empathy within the generation of prosocial behavior, not just an emphasis on reducing aggressive behavior.

Shortcomings:

• Most children with ODD / CD also had other disorders, not just ODD / CD

• There was (too) little difference between groups found in the story task, perhaps the task was not suitable for this age group

• In addition to empathy, the outcomes of the IRT can probably also be related to other relevant processes (such as monetary versus social reward)

Conclusion

Shortcomings in young children with ODD / CD regarding empathy-induced prosocial behavior have been demonstrated. As interventions have shown, empathy can be used to provoke prosocial behavior in normally developing children. This should serve as a guideline to adjust current treatments for children with ODD / CD, as they can benefit from increasing empathy-induced prosocial behavior.

Abstract

The high degree of comorbidity among mental disorders has led research to focus on finding factors associated with the development of different types of psychopathology, called transdiagnostic factors. Ruminating is involved in the etiology and maintenance of a depressive disorder and recent evidence implies that ruminating also appears to be involved in the development of anxiety disorders. Two longitudinal studies investigated whether ruminating could explain the competing and prospective associations for the above mentioned disorders. One study involves adolescents and one study involves adults. It was found that ruminating was a mediator of the unequal association between symptoms of depression and anxiety among adolescents and a shared mediator of this association among adults. In prospective analyzes among adolescents, it appeared that the baseline of depression predicted an increase in anxiety and ruminating led to a complete mediation of this association. The same was found in adults, plus that baseline anxiety was a predictor of an ncrease in depression. This study shines light on the important trans-diagnostic factor ruminating within emotional disorders.

Introduction

Various transdiagnostic factors for depression and anxiety disorders are now known: elements of affect, attention, memory, reasoning, (repeated negative) thoughts and behavior. Repeatedly negative thinking is seen as thoughts that come back, are passive or relatively uncontrolled and have a focus on negative content. A specific type of this is ruminating. A pattern of the reaction to distress in which an individual passively and pervasively thinks about the annoying symptoms and the causes and consequences of these symptoms, in which active problem-solving strategies are not given room.

Ruminating appears to be a predictor for later depressive symptoms and their future onset, number of depressive episodes and their duration. Rumination is also often reported by clients as a symptom of an anxiety disorder, PTSD and social anxiety. Rumination can lead to anxiety and depression symptoms through various mechanisms. Experimental induction of ruminating in stressed individuals leads to: more mal-adaptive, negative thoughts, less effective problem solving, uncertainty and immobility in the implementation of solutions and less willingness to participate in distracting, mood lifting activities. In addition, ruminant people experience less social support and more social friction than non-ruminant people and are considered less favored by non-ruminant people.

Within this study, the prediction is tested whether ruminating is statically responsible for the relationship between symptoms of anxiety and depression, both cross-sectionally and longitudinally. By means of two samples; adolescents (11-14 years) and adults (25-75 years). If ruminating appears to be a transdiagnostic factor, there is expected to be evidence of the role of ruminating in the overlap of such symptoms at a random moment, over time, and in individuals at different points in their lives.

Method

Adolescent participants

The participants come from two high schools. The baseline sample consisted of 51.2% boys (total N = 1065). On measurement 2, 20.8% did not participate, on measurement 3, 20.4% of the baseline sample did not participate.

Adolescent measuring instruments

Depressive symptoms: Children's Depression Inventory (CDI), based on self-report. Anxiety symptoms: Multidimensional Anxiety Scale for Children (MASC), based on self-report. Ruminating: Children's Response Styles Questionnaire (CRSQ), based on self-reporting.

Adolescents procedure

Questionnaires were filled in during mentoring, the CDI and the CRSQ were taken on T1 and T3. All three lists were taken on T2. T1 plus 4 months = T2 plus 3 months = T3.

Adult participants

Called from random phone numbers in a specific part of the US. N = 1317 participated in baseline interview, with different age groups (25-35, 45-55, 65-75). T1 plus 1 year = T2 (14.1% of T1 did not participate in T2). Participants who completed both measurement moments took part in the study (N = 1132).

Adult measuring instruments

• Depressive symptoms: Beck Depression Inventory (BDI), based on self-report and the Hamilton Rating Scale for Depression (HRSD), filled in by interviewer. The interviewer also had to pay attention to non-verbal behavior.

• Anxiety symptoms: Beck Anxiety Inventory (BAI), based on self-report.

• Ruminate: Response Styles Questionnaire (RSQ), based on self-reporting.

Adult procedure

Trained interviewers conducted the self-reports and HRSD, usually at participants' homes.

Results

Cross-sectional analyzes: Within the adolescent sample, depression was significantly associated with anxiety. A significant mediation effect was found for ruminating between the symptoms of depression and anxiety. The same was found within the adult sample, although the mediation effect there was only partial. Longitudinal analyzes: Within the adolescent sample it was found that depression on T1 predicted an increase in lumination from T1 to T2 and that this increase in turn predicted an increase in anxiety from T1 to T3. Within the adult sample a significant indirect effect was found from anxiety on T1 to depression on T3 by means of ruminating. A significant indirect effect of depression on anxiety symptoms through ruminating was found.

Discussion

Transdiagnostic factors are relevant for improving theoretical models and clinical interventions. In doing this, broad and combined treatments can be set up, with little or no taking into account specific disorders. Rumination is responsible for a significant proportion of the overlap between depression and anxiety in both adolescents and adults (more visible in adolescents). This shows that rumination is actually a trans-diagnostic factor, and certainly needs to be involved in the combined treatments. This factor is more visible in adolescents, because internalizing problems are less differentiated in adolescents than in adults. Rumination can also play a greater role in the development of anxiety symptoms in adolescents compared to in adults.

Cross-sectional findings show that rumination plays an important role in explaining the competing symptoms of depression and anxiety, but does not provide information on whether ruminating is involved in the temporal progression from depression to anxiety and vice versa. The longitudinal findings show that rumination is a complete mediator between depression and later anxiety among adolescents. This shows that depressive symptoms predict an increase in ruminating over time and that this increase in ruminating is responsible for the development in anxiety symptoms. Moreover, this shows an increased risk of anxiety disorders among adolescents with depressive symptoms. Among adults, rumination is a significant mediator in the prospective associations of anxiety and subsequent depression and vice versa. This shows that ruminative responses to negative affect are associated with increased risks of developing co-morbid symptoms of emotional disorders over time.

Shortcomings: research largely based on self-report instead of DSM diagnoses, only looking at symptoms of anxiety and depression and no other comorbid symptomatology, different measurement methods between the two sample participants and finally it cannot be demonstrated that the associations found are causal know the connection.