C 2005) Journal of Abnormal Child Psychology, Vol. 33, No. 2, April 2005, pp. 145–155 ( DOI: 10.1007/s10802-005-1823-1
Emotion Socialization in Families of Children With an Anxiety Disorder Cynthia Suveg,1,3 Janice Zeman,1 Ellen Flannery-Schroeder,2 and Michael Cassano1 Received May 4, 2004; revision received August 20, 2004; accepted September 14, 2004
Compared emotion socialization in 26 children with anxiety disorders ages 8–12 years and their mothers to 26 nonclinical counterparts without psychopathology. Children and their mothers participated in an emotion interaction task in which they discussed occasions when the child felt worry, sadness, and anger. Responses were coded for length of discussion, proportion of words spoken by child vs. mother, frequency of positive and negative emotion words, explanatory discussion of emotion, and maternal facilitation of emotion discussion. Children and their mothers also completed the Expressiveness and Control scales of the Family Environment Scale. Results indicated that mothers of children with an anxiety disorder spoke less frequently than their child, used significantly fewer positive emotion words, and discouraged their children’s emotion discussions more than did mothers of nonclinical children. Nonclinical children and their mothers indicated significantly more emotional expressiveness in their families than did children with an anxiety disorder and their mothers. These results highlight the potential role of truncated family emotional expressivity in the emotional development and functioning of children with an anxiety disorder. KEY WORDS: anxiety; emotion; socialization; mothers.
As evidenced by terms such as “affect revolution" (Fischer & Tangney, 1995), considerable research in the past decade has been devoted to the study of emotional development. Given the emerging evidence that emotional development is strongly related to healthy psychological functioning (Cicchetti, Ackerman, & Izard, 1995; Southam-Gerow & Kendall, 2002), research has attempted to identify the components deemed necessary for adaptive socioemotional functioning (e.g., Eisenberg & Fabes, 1992; Eisenberg, Fabes, & Losoya, 1997; Hubbard & Coie, 1994; see Saarni, 1999, for a review). Although description of the behaviors and knowledge associated with emotional competence is a necessary, fundamental step in understanding socioemotional functioning, it is important to delineate the processes and mecha-
nisms that both facilitate and impede optimal emotional development. One process thought to be crucial to the development of emotional competence is the influence of socialization agents from infancy through adolescence (Saarni, 1999). In this way, emotional competence is thought to arise through experiences with the social environment with parents exerting a strong influence on the socialization of emotional expression skills (Calkins, 1994; Kopp, 1989; Saarni, 1999). Emotion socialization can occur through direct instruction and contingent responding but also in indirect ways such as modeling, family emotional climate, imitation, social referencing, expectancy communication, and exposure to emotionally eliciting stimuli (Saarni, 1999). Although parents socialize their children’s emotion in a number of ways, research has explicated (a) the discussion of emotion experiences and (b) family emotional expressiveness as among the primary modes through which such socialization may occur (see Eisenberg, Cumberland, & Spinrad, 1998, for a review). The majority of emotion socialization research has been conducted with normative populations, primarily
1 Department
of Psychology, University of Maine, Orono, Maine. of Psychology, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania. 3 Address all correspondence to Cynthia Suveg, Child and Adolescent Anxiety Disorders Clinic, Temple University, 1701 N. 13th Street, Philadelphia, Pennsylvania 19122; e-mail:
[email protected]. 2 Department
145 C 2005 Springer Science+Business Media, Inc. 0091-0627/05/0400-0145/0
146 examining the infant and preschool age developmental periods. With a base of information now established, however, research needs to consider how familial emotion socialization practices operate within atypical populations. Consistent with the developmental psychopathology perspective, examining the socialization of emotion behaviors in atypical family contexts may serve to highlight processes within the parent–child dyad that are necessary for adaptive emotional development (Sroufe, 1990; Sroufe & Rutter, 1984). It is important, however, to consider that particular methods of managing emotional experiences (e.g., expressing, inhibiting, or exaggerating) are not in and of themselves maladaptive. Rather, the appropriateness of each method is determined by the context in which the emotional experience occurs (Cole & Kaslow, 1988). As such, an important developmental task for children is to develop models of emotional expressiveness that they can use flexibly in response to the changing demands of the social context; a rigid overreliance on a single emotion regulation strategy is one way in which maladaptive emotion management may be manifested. Of primary interest to this study are the ways in which emotion socialization practices may differ in families that have a child with an anxiety disorder versus families without an anxiety disordered child. Children with an anxiety disorder and their families present a unique opportunity in which to study emotion socialization for several reasons. First, anxious children have been shown to exhibit deficits in their emotional functioning with respect to their understanding of emotional experiences (Southam-Gerow & Kendall, 2000) and their ability to manage emotionally evocative situations (Suveg & Zeman, 2004; Suveg, Zeman, & Stegall, 2001; Zeman, Shipman, & Suveg, 2002). Second, research that has examined families of anxious children indicates that parents may exhibit behaviors that contribute to anxious children’s socioemotional difficulties (see Wood, McLeod, Sigman, Hwang, & Chu, 2003, for a review). Specifically, parents of anxious children appear to (a) encourage maladaptive patterns of responding to social and other situations through direct discussions with their children (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996), (b) model anxious behavior themselves (Whaley, Pinto, & Sigman, 1999), and (c) exhibit overcontrolling and intrusive behaviors (Dumas, LaFreniere, & Serketich, 1995; Hudson & Rapee, 2001; Krohne & Hock, 1991; Siqueland, Kendall, & Steinberg, 1996; Whaley et al., 1999). Thus, comparisons with a normative, nonclinical group provide an opportunity to examine emotion socialization practices that encourage adaptive socioemotional functioning and, in turn, can provide important informa-
Suveg, Zeman, Flannery-Schroeder, and Cassano tion on how deviant practices may impact emotional development in children with an anxiety disorder.
Discussion of Emotion A plethora of developmental research documents that parents socialize emotion through the discussion of emotional experiences (Denham, 1998; Dunn, Brown, & Beardsall, 1991; Eisenberg et al., 1998; Kuebli, Butler, & Fivush, 1995). The discussion of emotion may directly or indirectly influence a child’s developing emotion-related skills in a number of ways (Denham, 1998; Eisenberg et al., 1998; Gottman, Katz, & Hooven, 1997; Kopp, 1989; Thompson, 1990). With respect to indirect influences, emotion-related discussions have been associated with preschool children’s ability to use emotion-related language (Dunn, Bretherton, & Munn, 1987) and their overall understanding of the causes and consequences of emotion (Denham, Cook, & Zoller, 1992; Dunn et al., 1991). In turn, children who are more skilled at using emotion-related language and understanding emotional experiences may be more adept at regulating their own arousal during distressing situations (Eisenberg et al., 1998). In a more direct manner, emotion-related discussion may affect the development of emotional competence by explicitly teaching the child ways of understanding and managing emotional experiences (Barrett et al., 1996; Gottman et al., 1997). To the extent that these strategies are adaptive, they will contribute to optimal emotion skill development in the child. Studies involving families of anxious children provide preliminary evidence that through discussion, parental practices influence the development of emotion skills (Barrett et al., 1996; Dadds et al., 1996). In one study, Barrett et al. (1996) examined parental influence on 7- to 14-year-old children who were diagnosed as anxious (anxiety disorder), oppositional-defiant (ODD), or received no diagnosis. Children and their parents were presented individually with a number of situations that could be perceived as threatening, interviewed about their interpretations, and asked to generate possible solutions to these dilemmas. Children and parents then participated in a discussion in which the child provided the final solution to the situation. Results relevant to the present study indicated that children with an anxiety disorder interpreted the ambiguous situations in a more threatening manner than control children. Further, children with an anxiety disorder responded with more avoidant solutions that increased following the family discussion. A later elaboration of this study by Dadds et al. (1996) found that mothers of both anxious and aggressive
Emotion Socialization and Anxious Children children agreed with their children less than mothers of nonclinical children and that mothers of anxious children listened to their children less than mothers of aggressive children. Parents of anxious children were also more likely to respond to their child’s avoidant versus coping responses with their own avoidant responses. In contrast, parents of nonclinical children were more likely than the aggressive or anxious groups to agree with and/or listen to prosocial communication by their child. These findings suggest that through modeling and/or parental reinforcement, maladaptive patterns of responding may be learned, maintained, and/or inadvertently encouraged. Other research has similarly found support for the role of parental influences on childhood anxiety (e.g., Chorpita, Albano, & Barlow, 1996; Greco, Cadotte, & Morris, 2000). The current study adds to this growing literature by comparing emotion discussions between mothers and children with an anxiety disorder to a nonclinical control group. Rather than examining the discussions in the context of an experimenter-generated topic, this study used an unstructured emotion discussion task in which children and their mothers decided which emotionally evocative situations to discuss, thus enhancing ecological validity. Further, this type of task provided an opportunity to observe how the dyads responded to an ambiguous, potentially anxiety-invoking situation.
Family Expressiveness Perhaps one of the most indirect methods of emotion socialization is through the emotional climate in the household (Halberstadt, Fox, & Jones, 1993; Thompson, 1990). Parents transmit social signals that provide information to the child concerning the acceptability of emotional displays (Barrett & Campos, 1987). When these signals become repetitive within the family context, cultural values concerning the meaning of emotional events are communicated to the child and become internalized over time (Campos, Mumme, Kermoian, & Campos, 1994). Dunsmore and Halberstadt (1997) suggest that the “overall frequency, intensity, and duration of positive and negative emotional expressiveness in the family is important in the child’s formation of schemas about emotionality, about expressiveness, and about the world” (p. 53). For example, a child who learns that emotional expression is acceptable and valued may be more likely to openly express his or her emotions. In contrast, a family environment that discourages emotional expression might implicitly encourage the child to rely on affect-suppressing methods of managing emotional experience. Although functional in one context (i.e., the family), the same method of managing emotion
147 may be maladaptive when utilized in another context (i.e., peers; Jenkins & Oatley, 1998). The role of family emotional expression and climate in the development of emotional difficulties in children with an anxiety disorder has not been directly investigated. Related research in the area of parenting practices suggests that expressed parental overinvolvement, criticism, and control may directly and indirectly influence regulatory abilities of both anxious children and children at risk for anxiety disorders (Dadds & Roth, 2001; Donovan & Spence, 2000; Hirshfeld, Biederman, Brody, Faraone, & Rosenmaum, 1996; Siqueland et al., 1996). For example, in a meta-analysis examining the relation between anxiety, depression, and perceptions of early parenting, Gerlsma, Emmelkamp, and Arrindel (1990) concluded that various types of phobic disorders were consistently related to a parenting style characterized by low levels of affection and high levels of control. Using observational methodology, Hudson and Rapee (2001) found mothers of children with an anxiety disorder exhibited more intrusiveness and negativity than mothers of children without an anxiety disorder when asked to solve two challenging tasks. Other studies using varied methodologies (e.g., Expressed Emotion task) have likewise found a relation between parental emotional overinvolvement and childhood anxiety disorders (e.g., Hibbs et al., 1991; Stubbe, Zahner, Goldstein, & Leckman, 1993). The present study examined family expressiveness as it may occur in everyday interactions among family members, rather than assessing parenting practices per se. Consequently, mothers’ and children’s perceptions of the typical family emotional environment were assessed. The primary goal of this study was to examine emotion-related socialization behaviors in families that have a child with an anxiety disorder through an emotion discussion task and by assessing children’s and mothers’ perceptions of the family emotional environment. Although we acknowledge the important role of fathers in children’s psychological development (Phares & Compas, 1992), we only included mothers in order to establish a base of information that can then be later used to provide a comparison to fathers’ contributions. Children ages 8– 12 years were selected for this study because their development of basic emotion competence skills (e.g., decoding, understanding, vocabulary; Saarni, 1999) should be sufficiently developed that detection of emotion socialization differences between groups can be observed. Given that emotion socialization practices appear to vary by sex (Brody & Hall, 2000), we included this variable in our analyses. The emotions of worry, sadness, and anger were chosen for study because they are frequently experienced in middle childhood (Saarni, 1999) and are emotions that
148 children with an anxiety disorder have been found to have difficulty regulating (Suveg & Zeman, 2004). Hypotheses were generated based on theoretical tenets and previous empirical findings. With respect to the discussion of emotion, it was expected that, relative to mothers of control children, mothers of children with an anxiety disorder would (1) have shorter overall emotion discussions, (2) use a greater number of negative emotion words and fewer positive emotion words, (3) engage in less explanatory discussion of emotions (i.e., would spend less time discussing the causes and consequences of emotions with their children), and (4) discourage the discussion of emotions by their children. Further, it was hypothesized that relative to nonclinical children, children with an anxiety disorder would (5) engage in less explanatory discussion of emotion. Regarding the emotional expressivity factor, it was expected that (6) children with an anxiety disorder and their mothers would indicate less family expressivity and higher levels of control than would nonclinical children and their mothers. METHOD Participants Fifty-two children between the ages of 8 and 12 years and their biological mothers participated; 26 of the children were diagnosed with an anxiety disorder, whereas the remaining children did not have any form of psychopathology. The sample included in this report is the same as was utilized in the aforementioned paper by Suveg and Zeman (2004) that examined patterns of children’s emotion regulation. Children in the anxiety disorder group included 12 boys (M age = 10 years, 1 month; SD = 10 months) and 14 girls (M age = 10 years, 10 months; SD = 10 months) and the control group included 12 boys (M age = 10 years, 4 months; SD = 12 months) and 14 girls (M age = 10 years, 9 months; SD = 8 months). Mothers in the anxiety disorder group had a mean age of 37 years, 3 months (SD = 5 years, 7 months) and mothers in the control group had a mean age of 36 years (SD = 4 years, 7 months). Children were first screened for anxiety and depressive symptoms in their classroom; those that met study criteria were later administered a diagnostic interview (described more fully in the Procedures section). All children were Caucasian and families were primarily of middle socioeconomic status (e.g., skilled workers) based on the Hollingshead Four Factor Index of Social Status (Hollingshead, 1975). Based on the Anxiety Disorder Interview Schedule for Children–Fourth Edition (ADIS-IV)—Child/Parent Versions (Silverman & Albano, 1996), children with an
Suveg, Zeman, Flannery-Schroeder, and Cassano anxiety disorder had the following principal diagnoses: generalized anxiety disorder (girls = 3, boys = 5), separation anxiety disorder (girls = 4, boys = 5), social phobia (girls = 6, boys = 1), and specific phobia (girls = 1, boys = 1). The majority of children in the sample also had a comorbid anxiety disorder (girls = 10, boys = 8) and to a lesser extent, a comorbid externalizing disorder (i.e., oppositional defiant disorder, attention-deficit hyperactivity disorder; girls = 2, boys = 3). With respect to having received treatment services, 14 children with an anxiety disorder were never in treatment, 5 had been in treatment in the past, 2 were on a waitlist for services, and 3 were in some form of counseling. Treatment history for 2 of the 26 children is unknown. MEASURES Descriptive Variables The Hollingshead Four Factor Index of Social Status (Hollingshead, 1975) was used to assess educational level and occupation. The Hollingshead has been shown to have good validity (Deonandan, Campbell, Ostbye, Tummon, & Robertson, 2000). Intellectual Functioning To determine that participants had the requisite verbal ability to understand the tasks and questionnaires used in the study, and that the groups did not differ from each other in verbal skills, participants were administered the age-appropriate version of the Vocabulary subtest of the Wechsler series (i.e., Wechsler Intelligence Scale for Children—Third Edition, 1991, or Wechsler Adult Intelligence Scale—Third Edition, 1997). The Vocabulary subtest was chosen because of its high reliability and correlation with the Full Scale IQ (Wechsler, 1991, 1997). All children in this study, except for one anxious boy and one anxious girl, had at least an average-level score on this subtest (i.e., scaled score ≥ 7). Based on the mothers’ report of the children’s intellectual and academic functioning in combination with behavioral observations, it was concluded that their low scores were likely a reflection of performance anxiety; thus, they were included in the analyses. All mothers had at least average-level verbal abilities. Psychopathology The Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1997) is a 37-item questionnaire that uses a dichotomous response format
Emotion Socialization and Anxious Children to assess symptoms of anxiety in children. Although best used as a screening, rather than a diagnostic measure, examination of the psychometric properties of the RCMAS reveals adequate reliability and validity (Lonigan, Carey, & Finch, 1994; Pela & Reynolds, 1982). Internal consistency of the RMCAS in this study was high (α = .91). The Children’s Depression Inventory (CDI; Kovacs, 1992) is a 26-item questionnaire that assesses depressive symptomatology in children over the past 2 weeks using a 3-point response scale. The item assessing suicidal intent was omitted in response to schools’ requests. Similar to the RCMAS, the CDI is best used as a screening, not diagnostic, tool. The psychometric properties of the CDI are well-established (Carey, Gresham, Ruggiero, Faulstich, & Enyart, 1987; Kovacs, 1985; Smucker, Craighead, Craighead, & Green, 1986). Internal consistency for the CDI in this study was .89. Anxiety Disorders Interview Schedule for DSMIV, Child and Parent Versions (ADIS-IV; Silverman & Albano, 1996). The ADIS-IV Child and Parent versions are semi-structured interviews that assess anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). The interviews provide quantifiable data regarding anxious symptomatology, course, and functional impairment of the disorder. The ADIS-IV interviews also screen for additional, nonanxiety disorders and thus, permit the interviewer to rule out alternative diagnoses. Diagnostic impressions are formed separately for the child and parent interviews then combined to form composite diagnoses; final diagnoses are assigned if the child or parent indicated that the symptoms were causing clinically significant interference in functioning and the interviewer assigned a clinician severity rating of 4 or greater (on a scale of 0–8; see clinician’s manual; Albano & Silverman, 1996). Clinical judgment is required to distinguish between primary and comorbid disorders. Examination of the psychometric properties of the ADISIV Child and Parent versions reveal adequate reliability and validity (Silverman & Albano, 1996; Silverman & Nelles, 1988; Silverman, Saavedra, & Pina, 2001; Wood, Piacentini, Bergman, McCracken, & Barrios, 2002). Diagnostic reliability was established for this study by having an advanced graduate student unaware of diagnostic status rate approximately 1/3 of randomly selected audiotaped interviews (kappa for principal diagnosis = .89). Symptom Checklist-90—Revised (SCL-90-R; Derogatis, 1994). The SCL-90-R is a 90-item self-report questionnaire of symptoms of adult psychopathology. Participants respond on a 5-point Likert scale (0 = Not at All, 4 = Extremely) how much they were distressed by a variety of symptoms in the last week. The SCL-90-R
149 yields a total scale score and nine subscale scores; the Anxiety and Depression subscales were used for this study. Adequate reliability and validity have been established for this measure (Derogatis, 1994). In this study, internal consistency for both scales was high (Anxiety α = .91, Depression =.92) Discussion of Emotion Children participated in the Mother–Child Emotion Interaction Task in which they were asked to discuss with their mother a time when they experienced each of the following three emotions: (1) worry, (2) sadness, and (3) anger. Children chose to discuss a variety of situations across all emotions (e.g., “I felt worried when you guys were gone on your trip,” “I was sad when my Dad told me he wasn’t coming to my birthday party,” “I felt mad when you had to work on all those days of the weekend.”). This audiotaped task, which took approximately 5 minute, was modeled after previous research (e.g., see Shipman & Zeman, 1999), in order to evaluate emotion socialization as it may occur through the discussion of emotion. The discussion was coded by a research assistant who was blind to diagnostic status, for (a) the length of discussion, (b) total words spoken by the dyad and by mother and child separately, (c) the frequency of maternal and child use of negative and positive emotion words, (d) the presence of explanatory discussion of emotion (i.e., discussion of the causes and consequences of emotion), and (e) the facilitation (i.e., encouragement and discouragement) of emotion discussion. Another research assistant who was also blind to diagnostic status rated approximately 1/3 of randomly selected audiotaped emotion discussions. Kappa coefficients were computed for dichotomous categories and correlation coefficients were computed for continuous variables. Interrater reliability coefficients for both mother and child across all coding categories ranged from moderate (child presence of explanatory discussion of emotion = .63) to excellent (child and mother frequency of positive emotion words = 1.00). Family Expressiveness Children and mothers completed part of the Family Environment Scale (FES; Moos & Moos, 1994) to assess their perceptions of family socioemotional climate. Two of the FES scales relevant to the present study were used including the Expressiveness scale that measures the degree of emotional expressiveness in the family and the Control scale that reflects the degree of structure within the family. Each scale is composed of 9 items, to which
150 participants respond on a 5-point Likert scale. Examination of the reliability and validity of the Expressiveness and Control subscales of the FES reveal adequate psychometric properties (i.e., α = .69 and .67, respectively; Moos, 1990). In this study, child- and mother-completed Expressiveness and Control scales demonstrated adequate internal consistency (α = .53, .62, and .50, .61, respectively). Note that examination of the reliability coefficients for each item of the mother-reported Expressiveness scale indicated that one item (i.e., “We say anything we want to around home") did not reliably contribute to the overall scale, and thus, was eliminated from the scale composition.
PROCEDURE A multiple gating procedure as described in Suveg and Zeman (2004) was implemented to ensure that all children who participated were placed into the correct group (i.e., Anxiety Disorders, Nonclinical Controls). Children and mothers/guardians were invited to participate in Gate A through the public school system. In order to participate, children had to provide verbal assent and their parent had to provide written consent. Children who met these criteria (n = 210) were administered, in a group classroom setting, the RCMAS and CDI. Children who scored at least one standard deviation above the mean (i.e., T score ≥ 60) on the RCMAS were considered for inclusion into the anxiety disorder group and those who scored within the normative range were considered for inclusion into the nonclinical group. Although children who scored in the clinical range (girls = 7, boys = 1) on the CDI in addition to the RCMAS were considered for inclusion into the study, children who scored in the clinical range on the CDI but in the normative range on the RCMAS were excluded from the study (girls = 2, boys = 1). At Gate B, a research assistant who did not subsequently collect Gate C data determined which children met Gate A criteria and called their mothers to conduct a phone interview to screen out false positives and to invite participation in Gate C. An additional phone screening was considered necessary given that the RCMAS and CDI include vague questions (e.g., “Often I feel sick in my stomach,” “Things bother me many times”) that might reflect general distress as opposed to anxiety or depression specifically. We also wanted to screen out children who may have responded affirmatively on the questionnaires because they were experiencing temporary situational stress but not at the level that would likely qualify for a disorder. Therefore, the phone screening asked questions, using prompts from the ADIS-IV, about specific anxiety
Suveg, Zeman, Flannery-Schroeder, and Cassano disorders (e.g., “Some children always seem to be worrying. They might worry about . . . Do you think that your child has been worrying a lot about such things?”) and depression (e.g., “Depression is a feeling that some people have when . . . Has your child ever felt depressed?”). Families of children who met these criteria and were eligible to move on to Gate C but declined (n = 5) and/or who did not meet the additional screening criteria (n = 8) were offered help in securing follow-up clinical services if they so desired. Gate C data were collected by four clinical psychology graduate students who were blind to diagnostic status. At this gate, the diagnostic interview (ADIS-IV) and questionnaires were administered, and families participated in the interaction task. Families chose to complete Gate C at the research center (n = 25) or in their homes (n = 27). The diagnostic interview was administered to the child and mother by the same graduate student in a random order. Following the emotion discussion task, mothers and their children independently completed the FES with assistance as necessary. Participants were paid $25.00 for their participation in the 2-hr session.
RESULTS Participants with missing data were not included in the analyses for that measure; thus, the total number of participants in the following analyses ranges from 48 to 52. Reasons for missing data include participants’ request to not complete an instrument or technical problems with the audiotaping equipment. Measures of effect size (i.e., eta-squared) were obtained for all analyses where appropriate and interpreted according to criteria suggested by Cohen (1988): (a) .01–.05 = small effect, (b) .06–.13 = medium effect, and (c) .14 or larger = large effect. Participant Characteristics To examine potential differences between girls and boys as well as between groups, 2 (Group) × 2 (Sex) analyses of variance (ANOVA) were conducted on participant characteristics. Results revealed no differences between groups on SES, maternal age, and verbal abilities. There was a main effect for child age such that girls (M = 10 years, 10 months; SD = 9 months) were significantly older than boys (M = 10 years, 3 months; SD = 12 months), F (1, 48) = 5.79, p < .05, η2 = .11. Given these findings, child age was entered into the analyses as a covariate; however, because the results remained unchanged, the variable was not included in final analyses.
Emotion Socialization and Anxious Children With respect to measures of symptomatology, children with an anxiety disorder (M = 19.71, SD = 4.72) endorsed significantly more anxiety symptoms on the RCMAS than did nonclinical children (M = 8.96, SD = 6.07), F (1, 45) = 46.47, p < .0001, η2 = .51. Similarly, children with an anxiety disorder (M = 15.21, SD = 4.72) endorsed significantly more depressive symptoms on the CDI than did nonclinical children (M = 6.36, SD = 5.20), F (1, 45) = 18.71, p < .001, η2 = .29. A significant main effect for sex indicated that overall, girls (M = 12.57, SD = 9.79) endorsed more depressive symptoms than did boys (M = 8.19, SD = 4.76), F (1, 45) = 4.81, p < .05, η2 = .10. An independent samples t test was completed on mothers’ self-reported anxious and depressive symptoms using the Anxiety and Depression scales from the SCL90-R. Results revealed that mothers of children with an anxiety disorder reported significantly more symptoms of anxiety (M = 5.00, SD = 6.95) than did mothers of children without psychopathology (M = 1.92, SD = 3.5), t(50) = 2.02, p < .05, η2 = .08. Similarly, mothers of children with an anxiety disorder reported more symptoms of depression (M = 10.44, SD = 10.37) than did mothers of children without psychopathology (M = 4.77, SD = 4.1), t(49) = 2.54, p < .01, η2 = .12.
Discussion of Emotion A series of 2 (Group) × 2 (Sex) ANOVAs were conducted on variables coded from the Mother–Child Interaction task. Bonferroni corrections were conducted to limit the experimentwise error to p < .05 (e.g., three tests on dyad-provided data from the discussion task, .05/3 = .02; five tests on mother-provided data from the discussion task, .05/5 = .01; three tests on child-provided data from the discussion task, .05/3 = .02). With respect to length of discussion and number of words used in the discussion, no significant group or sex differences were found. A 2 (Group) × 2 (Sex) ANOVA conducted on the proportion of words spoken by mother versus child revealed a significant main effect for group, F (1, 44) = 6.18, p < .02, η2 = .12. In nonclinical dyads, mothers spoke a greater percentage of the time whereas in anxiety disorder dyads, children spoke a greater percentage of the time. Two (Group) × 2 (Sex) ANOVAs were conducted on both mothers’ and children’s frequency of negative and positive emotionrelated words. Neither the main effects nor interactions was significant for frequency of negative emotion-related words used by mothers or children during the emotion discussion. Analysis of mothers’ frequency of positive-
151 related words yielded a significant main effect for Group, F (1, 44) = 9.15, p < .01, η2 = .17, such that mothers of children with an anxiety disorder used significantly fewer positive emotion-related words during the discussion task than mothers of nonclinical children. There were no significant effects for child data. Two (Group) × 2 (Sex) ANOVAs revealed no significant differences as a function of group or sex in mothers’ or children’s use of explanatory discussion of emotion (i.e., discussion relevant to the causes and consequences of emotion). Facilitation of emotional expression included both the presence of encouragement and discouragement during the emotion discussion task and was coded for mothers only. There were no significant effects for the presence of mothers’ facilitation of discussion. A 2 (Group) × 2 (Sex) ANOVA conducted on mothers’ discouragement of emotion-related discussion, however, revealed that mothers of children with an anxiety disorder demonstrated significantly more discouragement during the emotion discussion task than mothers of nonclinical children, F (1, 44) = 7.07, p < .01, η2 = .14. See Table I for means and standard deviations. Family Expressiveness A 2 (Group) × 2 (Sex) ANOVA was conducted on mother-reported expressiveness on the FES. Results revealed a significant main effect for Group, F (1, 48) = 6.63, p < .01, η2 = .12, in which mothers of nonclinical children reported significantly more expressiveness in their families than did mothers of children with an anxiety disorder. Similarly, nonclinical children reported significantly more family expressiveness than did children with an anxiety disorder, F (1, 46) = 5.50, p < .05, η2 = .11. Main effects for Sex and interactions were nonsignificant for both mother- and child-reported expressiveness. With respect to the Control scale findings, analyses of motherand child-report yielded nonsignificant main effects and interactions. DISCUSSION Parental socialization has been identified as one of the key mechanisms through which children develop the skills necessary to function in emotionally competent ways, with the discussion of emotion and family emotional expressiveness identified as primary venues through which such emotion socialization occurs (Eisenberg et al., 1998). This study expands upon this research base by reporting interesting differences in emotion socialization in families that have a child with an anxiety disorder.
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Suveg, Zeman, Flannery-Schroeder, and Cassano Table I. Means and Standard Deviations for Anxiety Disorder and Nonclinical Groups Group Dependent measure
Anxiety disorder
Length of discussiona Number of words spoken by dyad Proportion of words spoken (mother vs. child) Mother’s use of negative words Child’s use of negative words Mother’s use of positive words Child’s use of positive words Mother’s use of explanatory discussion Child’s use of explanatory discussion Mother’s positive facilitation Mother’s discouragement Mother-reported expressiveness Child-reported expressiveness Mother-reported level of control Child-reported level of control
2 m, 49 sec (1 m, 4 sec) 196.68 (30.69) 39.13 (23.90)∗ 6.46 (6.60) 4.75 (3.31) 0.08 (0.28)∗∗ 0.13 (0.34) 0.54 (0.51) 0.58 (0.50) 0.58 (0.50) 0.67 (0.48)∗∗ 26.42 (5.22)∗∗ 23.30 (3.02)∗ 25.16 (5.31) 29.40 (3.70)
Nonclinical 3 m, 9 sec (1 m, 37 sec) 251.54 (30.59) 55.39 (20.52) 8.42 (6.34) 4.67 (2.75) 0.71 (0.96) 0.21 (0.59) 0.75 (0.44) 0.67 (0.48) 0.79 (0.41) 0.29 (.46) 29.42 (2.37) 25.68 (4.18) 24.62 (3.38) 28.08 (3.24)
Note. Means are presented followed by standard deviations in parentheses. a Measured in minutes. ∗ p < .05 . ∗∗ p < .01.
With respect to the discussion of emotion, the results indicated that mother–child emotional discussions were qualitatively different depending on the composition of the dyad. Not only did mothers of anxiety disorder children discourage the discussion of negative emotional experiences, they used fewer positive emotion words during the discussion than did mothers of control children, suggesting that the discussions overall, were not very pleasant. Further, although the total number of words spoken by the dyads did not differ, the proportion of words spoken by mothers versus children differed between the groups. Mothers of children with an anxiety disorder used fewer words during the discussion than their children in contrast to mothers of nonclinical children, who spoke the majority of the time during the discussion with their children. It may be that mothers of anxious children do not know how to respond to their children when engaging in conversation about emotions or are not comfortable talking about emotional experiences with their children. The findings should also be interpreted in the context of the mother’s level of self-reported symptoms of psychopathology. That is, mothers of anxious children reported significantly more symptoms of both anxiety and depression than did mothers of nonclinical children, which may have affected their responding and level of involvement in the task. Taken together, children with an anxiety disorder may view their mothers as poor sources of emotional assistance and/or come to anticipate negative responses from their mothers when they express or discuss their emotional experiences. This expectancy, in turn, may prompt children with an anxiety disorder to regulate their expressivity in maladap-
tive ways (e.g., suppression of expressivity or expression of emotions in culturally inappropriate ways, see Suveg & Zeman, 2004). Given that parent–child emotional discussions are one of the key venues through which children acquire emotion skills, children with an anxiety disorder are likely to be at a disadvantage relative to their nonclinical peers. Although the findings present a cohesive picture of the quality and nature of emotion discussion between children with an anxiety disorder and their mothers, the data do not provide support for all of the hypotheses. Specifically, mothers of children with an anxiety disorder did not differ from mothers of control children in their frequency of negative emotion word use or explanatory discussion of emotion. With respect to the former, it could be that discussing only negative emotional experiences (i.e., worry, sad, mad) equalized the task demands, thus rendering the task insensitive to detecting differences. Future research should ask respondents to discuss a neutral and positive type of emotional experience in order to determine whether mothers of children with anxiety disorder would incorporate more negative emotion labels into their discussions than mothers of control children. With respect to the latter, although mothers of children with an anxiety disorder did not exhibit less explanatory discussion of emotion than mothers of control children, they did discourage the discussion of emotion more than mothers of control children. Whereas mothers of nonclinical children allowed their child to discuss his or her emotion-related experiences, mothers of children with an anxiety disorder discouraged their child’s emotion-related discussion by
Emotion Socialization and Anxious Children changing the topic or ignoring the child. Although the processes involved in the parent–child interaction were not directly examined, it appears that the mothers of nonclinical children provided their children with more opportunity to discuss their experiences and had more positive interactions overall. Indeed, these findings are consistent with previous research that found anxious children and their parents to interact in generally aversive ways (e.g., Dumas & LaFreniere, 1993), and mothers of anxious children to exhibit more control and negativity during interactions with their children (e.g., Hudson & Rapee, 2001; Siqueland et al., 1996). Surprisingly, no significant findings emerged between children with an anxiety disorder and control children on any of the child-related emotion discussion variables. It appears that emotion socialization differences in this task were more readily apparent at the adult than child level. Future research is needed to explicate the reasons why child group differences did not emerge during the emotion discussion task. Family Expressiveness Family expressiveness or emotional climate is thought to be important in shaping children’s beliefs about their own and other’s emotionality (Dunsmore & Halberstadt, 1997). As expected, this study found that children with an anxiety disorder and their mothers indicated lower levels of family emotional expressivity than nonclinical children and their mothers. Importantly, the FES: Expressiveness scale assesses general expressivity (e.g., “Family members often keep their feelings to themselves,” “It’s hard to blow off steam around the house without upsetting someone”) as opposed to specific types of positive and negative emotional expressiveness. This finding of less emotional expressivity in families that have a child with an anxiety disorder is particularly noteworthy given that it was reported independently by both child and parent. Further, they are commensurate with the findings that (a) mothers of children with an anxiety disorder discouraged the discussion of emotion more than mothers of nonclinical children and (b) mothers in the anxiety disorder dyad spoke less than their children during the emotion discussion task whereas mothers in the nonclinical dyad spoke more than their children during the emotion discussion task. Collectively, these findings paint a picture of truncated emotional expressivity in families that have a child with an anxiety disorder. Dunsmore and Halberstadt (1997) suggest that family emotional expressiveness is critical in the formation of children’s schemas about “appropriate” emotional expression. Based on this assertion, it appears that children
153 with an anxiety disorder might develop a set of expression beliefs regarding the appropriateness of suppressing or minimizing emotional expressiveness within the family context. Indeed, based on the results from this study it may be adaptive for children with an anxiety disorder to dampen their emotional expressivity at home because their expressions may be met with rejection. An important developmental task is to learn how to manage emotional experiences flexibly in response to one’s social context (Campos et al., 1994; Jenkins & Oatley, 1998; Saarni, 1999). This task may be particularly challenging for children with an anxiety disorder given that their schemas for emotional expressiveness may be distorted (e.g., the belief that is always appropriate to suppress expressivity), and/or they may apply these schemas indiscriminately to all social contexts. These results contribute to the growing body of developmental research that examines components of adaptive emotional functioning in children as well as the processes involved in the development of these skills. With respect to the clinically relevant implications of these findings, Ginsburg and Schlossberg (2002) argue for more family-based models of treatment. Indeed, some treatment programs for anxious youth already include a family component that teaches parents to manage their own anxiety levels and how to coach their children on managing anxiety (e.g., Barrett, Rapee, & Dadds, 1996; Cobham, Dadds, & Spence, 1998). For whom (e.g., younger children) and under what conditions (e.g., parental psychopathology present) such family-based treatment programs might be most beneficial is still under investigation. Nonetheless, this study offers some additional, specific areas that may be targeted in family-based interventions. For instance, parent education regarding the importance of emotionrelated discussions with their children to children’s developing emotion management abilities could be included. Providing parents an opportunity to actually engage in such discussions with their child while in treatment in order to receive constructive feedback might also be helpful. Although this study yielded some provocative findings, generalizability is limited by the relatively homogenous sample in that all dyads were Caucasian and of middle-class SES. Further, the relatively small sample size may have precluded the detection of hypothesized, yet unfound, group differences. Future research should include a more ethnically diverse sample of children with anxiety disorder given that anxiety disorders in children are found across various ethnic groups (Angold et al., 2002; Costello, Farmer, Angold, Burns, & Erkanli, 1987). Given that emotional development in children occurs largely in the context of family systems (Saarni, 1999), family members other than mothers should be included in future
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