Child Development, xxxx 2019, Volume 00, Number 0, Pages 1–22

Emotion Reactivity and Regulation in Maltreated Children: A Meta-Analysis

Iris Lavi Lynn Fainsilber Katz
University of Haifa University of Washington

Emily J. Ozer James J. Gross

University of California, Berkeley Stanford University

The many adverse effects of child maltreatment make the scientific investigation of this phenomenon a matter
of vital importance. Although the relationship between maltreatment and problematic emotion reactivity and
regulation has been studied, the strength and specificity of these associations are not yet clear. We examine
the magnitude of the maltreatment—child-emotion reactivity/regulation link. Studies with substantiated mal-
treatment involving children aged up to 18 were included, along with a smaller number of longitudinal stud-
ies (58 papers reviewed, encompassing more than 11,900 children). In comparison to nonmaltreated children,
maltreated children experience more negative emotions, behave in a manner indicative of more negative emo-
tion, and display emotion dysregulation. We outline several theoretical implications of our results.

The topic of child maltreatment has occupied
researchers in the past 6 decades, since the term
“battered child syndrome” gained currency
(Kempe, Silverman, Steele, Droegemueller, & Silver,
1962). Interest in this complex, significant issue
remains high, with more than 300 publications with
the term “child maltreatment” in the title in 2017
alone (Google Scholar database, retrieved on
August 9, 2018). Child maltreatment includes acts
or omission of acts by a parent or other caregiver
that result in harm, potential for harm, or threat of
harm to a child (Leeb, Paulozzzi, Melanson, Simon,
& Arias, 2008). Acts of child maltreatment are fre-
quently divided into four subtypes: physical abuse,
neglect, emotional maltreatment, and sexual abuse
(Barnett, Manly, & Cicchetti, 1993; Cicchetti & Toth,
2005). Most studies addressing maltreatment
addressed several subtypes of maltreatment while
excluding sexual abuse (e.g., Schofield, Conger, &
Conger, 2017; Teisl & Cicchetti, 2008; Young &
Widom, 2014), recognizing that, in the literature,
sexual abuse frequently incorporates acts commit-
ted by other persons close to the child and not
exclusively by the parents (e.g., Paolucci, Genuis, &
This research was supported in part by the Haruv Institute
Postdoctoral Fellowship and by the Marie Curie International
Outgoing Fellowship awarded to Iris Lavi. The funding source
did not influence the findings or the report and the authors
report no conflict of interest.
Correspondence concerning this article should be addressed to
Iris Lavi, University of Haifa, 199 Aba Khoushy Ave. Mount Car-
mel, Haifa 3498838, Israel. Electronic mail may be sent to
iris.lavi.01@gmail.com.
Violato, 2001). In this review, we will follow the
classic distinction between sexual abuse and other
forms of maltreatment (Belsky, 1993) and address
outcomes related to physical abuse, neglect, and
emotional maltreatment.
One central focus in research on child maltreat-
ment has been emotional processes of maltreated
children, including emotion reactivity and regula-
tion (e.g., Kim & Cicchetti, 2010; Shields & Cicchetti,
2001; Skowron, Cipriano-Essel, Gatzke-Kopp, Teti,
& Ammerman, 2014). Emotion reactivity is the reac-
tion when an emotion arises—the subjective feeling,
behavioral manifestation, and bodily response. Emo-
tion reactivity varies in its valence (negative or posi-
tive) and intensity (strong or weak; Gross & Jazaieri,
2014; Gross & Thompson, 2007). Emotion regulation
is the way individuals influence which emotions
they have, when they have them, and how they
experience and express them (Gross, 1998).
In this study, we examine the reactivity–maltreatment
and regulation–maltreatment relationships sepa-
rately, and compare the magnitudes of both connec-
tions. We also investigate the relationships between
maltreatment and individual subprocesses within
reactivity and regulation, such as intensity of anger,
and compare magnitudes of the connections. These
comparisons shed light on which specific emotional
processes are most closely linked to maltreatment,
© 2019 Society for Research in Child Development
All rights reserved. 0009-3920/2019/xxxx-xxxx
DOI: 10.1111/cdev.13272
2 Lavi, Katz, Ozer, and Gross
which has several potential benefits, namely: (a)
better understanding of long-term effects of child
maltreatment, (b) clearer theoretical understanding
of emotional processes in complex social conditions,
and (c) more effective programs to help victims of
maltreatment that target specific areas of difficulties
to which they are vulnerable.
Child Maltreatment and Children's Emotion Reactivity
and Regulation
Multiple theoretical models have sought to
define and explain the development of child emo-
tion reactivity and regulation following experiences
of maltreatment. The first model, focusing on
attachment, addresses the impact of shortfalls of the
parent–child emotional bond on emotion reactivity
and regulation of children (Bowlby, 1988; Cicchetti
& Lynch, 1995; Cyr, Euser, Bakermans-Kranenburg,
& Van Ijzendoorn, 2010; Main & Hesse, 1990;
Mikulincer & Shaver, 2007; Mikulincer, Shaver, &
Pereg, 2003). Next, the social information process-
ing theory suggests that maltreatment leads to the
development of dysfunctional encoding of external
cues, resulting in high levels of child hostility,
anger, and aggression (Crick & Dodge, 1994; Cum-
mings, Pellegrini, Notarius, & Cummings, 1989;
Grych & Fincham, 1990). A third model suggests
that maltreated children learn dysfunctional reactiv-
ity and regulation from their parents (Eisenberg
et al., 2001); this learning process is enhanced by
the fact that maltreating parents show a rigid and
restricted repertoire of emotional processes, and by
the social isolation that is characteristic of maltreat-
ing families and which limits other available role
models (summary of models and predictions is pre-
sented in Supporting Information).
Attachment-Focused Theories
Attachment is the inborn tendency of infants to
seek proximity to a caring individual in times of
stress and/or discomfort (Bakermans-Kranenburg
& van IJzendoorn, 2016). It is the emotional bond
that connects a child to his/her caregivers (Ains-
worth, 1973; Bowlby, 1951, 1969). These early bonds
are immensely important for the development of
the child and have an impact on physical, cognitive,
emotional, and social well-being (Ainsworth, 1973;
Bowlby, 1951, 1969). A sensitive and caring attach-
ment figure is regarded a safe haven and as a
secure base for the child, and this function is a key
component of a well-functioning attachment bond
(Bowlby, 1988). The development of attachment
during the early years influences many adjustment
outcomes, including the future ability to self-regu-
late emotions (Mikulincer et al., 2003). In the first
year of life, the child uses proximityseeking to care-
givers, the primary and innate attachment strategy
(Bowlby, 1988). When caregivers respond posi-
tively, successful proximity-seeking leads to a
secure attachment: the feeling that the world is safe,
and that one can explore it and other humans
safely (Mikulincer et al., 2003). A securely attached
child has a secure base script (Waters, Rodrigues, &
Ridgeway, 1998)—a regulation strategy that
includes acknowledgment and display of distress,
support seeking, and engagement in instrumental
problem solving.
It has been proposed that maltreatment increases
the probability of insecure attachment via two
paths (Mikulincer et al., 2003, figure 3): parental
rejection and parental intrusiveness. These parental
behaviors are characteristic of many, if not most,
maltreatment subtypes (e.g., Belsky & Jaffee, 2006).
Maltreating-rejecting parents punish the child for
proximity seeking and emphasize self-reliance,
encouraging the child to refrain from exhibiting
needs and emotions. The child thus distances her-
self from her own emotions in an attempt to avoid
painful experience of negative affect, that is, she
develops hyporeactivity to both negative and posi-
tive emotions, coupled with an inability to regulate
emotions when these are activated. Maltreating-in-
truding parents compulsively interfere with child’s
exploration and emphasize a sense of helplessness
and deficits in self-regulation. Children react with
hyperactivating strategies of anxiety and fear, and
experience fewer opportunities to develop adequate
abilities to self-soothe, such that they are character-
ized by hyper-reactivity to negative emotions and
hyporeactivity to positive emotions (Mikulincer
et al., 2003).
Further research has indicated the relationship
between experiences of maltreatment and the devel-
opment of insecure attachment is specifically rele-
vant to the emergence of disorganized attachment
(Baer & Martinez, 2006; Cyr et al., 2010). Disorga-
nized attachment is characterized by a condition of
"fright without solution" for the child, indicating an
absence of a strategy to deal with stress (Main &
Hesse, 1990). A child displaying disorganized
attachment is nervous and anxious, and is unre-
sponsive when rejoining the parent after separation
(Main, Kaplan, & Cassidy, 1985). Maltreatment has
been found to be strongly related to the develop-
ment of disorganized attachment in children (Cyr
et al., 2010). In a meta-analysis, Cyr et al. (2010)

reported that maltreated children were less secure
and more disorganized than other high-risk chil-
dren. Maltreatment leads the child to experience a
paradox: The parent is the only source of comfort
and at the same time is abusive and frightening
(Van Ijzendoorn, Schuengel, & Bakermans-Kranen-
burg, 1999). Patterns of disturbances in attachment
lead to elevated sensitivity to stress, dysregulation
of emotions, and difficulties in self-regulation of
emotions (Cook et al., 2017; Lyons-Ruth & Jacob-
vitz, 2016).
Social Information Processing
The second major theoretical framework linking
maltreatment to the development of emotion reac-
tivity and regulation focuses on problems in cogni-
tive processing. In the social information processing
model (Crick & Dodge, 1994), processing of social
information begins with encoding and interpreta-
tion of cues; accurate execution of these two initial
steps is mandatory for later stages of the informa-
tion processing. Maltreatment in the early years can
lead to alterations in this initial stage (Crick &
Dodge, 1994), for instance, greater accuracy in per-
ception of anger in adults’ faces (Pollak, Messner,
Kistler, & Cohn, 2009). That is, we would expect to
see hyper-reactivity to negative emotions in mal-
treated children, specifically, anger, fear, and
aggression.
Social Learning
According to social learning perspectives, children
observe their parents as models, including patterns
of reactivity and regulation (Bandura, 1997). In non-
maltreating families, parents aid the child in devel-
oping skills such as inhibiting negative emotions,
self-soothing, and directing attention in social con-
texts (Eisenberg et al., 1999; Gottman, Katz, & Hoo-
ven, 1996). In maltreating families, parents who are
hostile toward their children and exhibit negative
emotions model dysregulated behavior for their
children (Eisenberg et al., 2001). These learned neg-
ative affect and poor regulation strategies are trans-
ferred to the child’s interactions with peers (Parke,
Cassidy, Burks, Carson, & Boyum, 1992). The ten-
dency to react aggressively may cause further diffi-
culties in learning emotion regulation techniques
(Repetti, Taylor, & Seeman, 2002). In addition, mal-
treated children often live in chaotic and disorga-
nized homes with little social support in or outside
the family (Cicchetti, 1996; Stith et al., 2009). This
social isolation further reduces their opportunity to
Emotion in Maltreated Children 3
develop sufficient social interaction skills through
trial and practice (Cicchetti, 1996). This constellation
of factors may contribute further to the develop-
ment of insufficient skills in the regulation of emo-
tions.
The three theories presented show the different
facets of a process by which maltreated -children
develop a distinct pattern of emotion reactivity and
regulation. Attachment theory -stresses the prob-
lematic emotional bond between child and parent,
a bond that would result in difficulties developing
self-regulation, learning theory addresses -the lack
of models for such behaviors, and the social-infor-
mation theory addresses biases in -encoding and
interpretation of external cues. The theories con-
verge in the prediction that -maltreated children
would be highly reactive to negative emotions. For
example, we would -expect these children to show
high levels of sadness and anger. We would also
predict that these -children would show high levels
of behaviors indicative of such emotions. Indeed,
according to -attachment theory, when children are
faced with consistent rejection from their parents,
hypo-sensitivity to positive and negative emotions
might develop. In addition, the models also predict
dysregulation: -difficulty in self-management of
emotions, coping, and problem solving.
Importantly, the theoretical models suggest a
causal link between parental behaviors -and chil-
dren’s emotional processing. It is also likely that
there are reverse causal or bi-directional links—
from child to parent and from parent to child (Avi-
nun & Knafo, 2014).
Research Questions and Hypotheses
Multiple models indicate that children exposed
to maltreatment are likely to develop dysfunctions
in emotion reactivity and regulation. The models
described suggest three distinct paths linking mal-
treatment and child reactivity and regulation: (a)
dysregulation via insecure attachment with the mal-
treating parent; (b) dysfunctions in interpretation of
cues, which result in hyper-reactivity to negative
emotions; and (c) social learning of dysfunctional
reactivity and regulation by observing these pat-
terns in the maltreating parent. The fact that many
maltreating families are socially isolated potentially
enhances all of these patterns, as the children have
few other role models and are highly dependent on
their (maltreating) parents. Although existing mod-
els distinguish among various parental behaviors,
these theories do not articulate the relationship of
these parenting behaviors to the major subtypes of
4 Lavi, Katz, Ozer, and Gross
maltreatment such as physical abuse and neglect.
Rather, extant theories focus on the consequences of
specific parental behaviors that cut across the vari-
ous maltreatment subtypes (e.g., rejection). To our
knowledge, hypothesized links between subtypes of
maltreatment and various emotion reactivity/regu-
lation processes have not yet been tested.
We present the following two primary hypothe-
ses, based on the theoretical models described. Our
first primary hypothesis is that in comparison to
nonmaltreated children, maltreated children will
show hyperreactivity to negative emotions and
hyporeactivity to positive emotions. In secondary
analyses, we explore the link between child mal-
treatment and specific constructs within child emo-
tion reactivity and examine differences in emotion
reactivity between neglected and abused children.
Our second primary hypothesis is that in compar-
ison to nonmaltreated children, maltreated children
will show dysregulation of emotion. We also
explore the strength of the link between child mal-
treatment and specific constructs within child emo-
tion regulation and examine differences in emotion
regulation between neglected and abused children.
Method
Identification of Articles in Sample
Articles were located using the search host Pro-
Quest to conduct computerized searches of four
databases (conducted in October 2017): PsycINFO,
ERIC, Social Work, and PubMed. The search focused
on three major constructs: reactivity, emotion regu-
lation/emotion dysregulation, and child maltreat-
ment; list of search terms appears in Supporting
Information. We chose highly inclusive search
terms in order not to miss relevant papers, did not
have a publication date limit, and included pub-
lished and unpublished manuscripts. Given
resource limitations, only studies published in Eng-
lish were included. The initial search resulted in a
pool of 6,003 papers. We also used the reference
lists of papers in the meta-analysis to create a list of
prominent authors and then conducted a focused
search for relevant articles by these authors. We
found 59 papers during this search, including dis-
sertations and reports. We then excluded dupli-
cates, resulting in a pool of 5,566 papers. A flow
diagram for location of papers appears in Figure S1
in Supporting Information.
The research team screened the pool of papers to
determine which were relevant to this meta-analy-
sis. This was done in two stages. First, the first
author and two research assistants examined titles
and abstracts independently and 10% in duplicate.
Papers were excluded for three reasons: (a) did not
include relevant predictor variable of child mal-
treatment and relevant outcome variables of either
emotion reactivity or emotion (dys)regulation; (b)
included only sexual abuse, not other subtypes of
child maltreatment; or (c) did not examine the rela-
tionship between child maltreatment and emotion
reactivity and regulation. This stage resulted in
exclusion of 4,920 papers, leaving 646. In the sec-
ond stage, the research team examined remaining
papers in their entirety independently and 10% in
duplicate. To ensure articles were relevant to our
study, we used the following inclusion/exclusion
criteria: (a) included if examined maltreatment
directed toward children aged 0–18; (b) included if
examined the relationship between emotion regula-
tion (of the maltreating parent) and child maltreat-
ment—316 papers excluded. Last, because cross-
sectional and longitudinal studies constitute the lit-
erature (as there are no randomized controlled trials
given ethical considerations), we chose to include
studies of any design that either (c1) used a
prospective design and/or (c2) used a cross-sec-
tional design and relied on official records of his-
tory of child maltreatment—240 papers were
excluded (of which 170 addressed reactivity/regula-
tion of children and 70 addressed reactivity/regula-
tion of parents); further details regarding search
strategies and criteria appears in Supporting Infor-
mation; (d) excluded if was qualitative with no sta-
tistical data—16 papers excluded; (e) excluded if
the same sample, variables and results were pre-
sented in more than one article—6 papers excluded;
in most cases, effect sizes were identical in the two
articles, when this was not the case, the more recent
article was included; (f) excluded if emotion regula-
tion was of the maltreating parent and not the child
—10 papers excluded. An outline of the exclusion
criteria used at this stage is provided in Supporting
Information. At this stage, 588 papers were
excluded. The remaining 58 papers were included
in the meta-analysis.
To test reliability of the screening process, a sub-
set of independent second screening and coding
was conducted. Two master’s students screened
and coded a sample that included 10% of the
papers. The master’s students included 100% of the
papers that the research team included in the first
stage and included additional papers as well. At
the second stage—the full-text eligibility screening—
there was 65.34% agreement, with higher rates of
overinclusion by the students. Reliability of coding

was between 0.61 and 1.00, with 54% of reliability
equaling 1.00. Coding reliability of statistical data
was between 0.97 and 1.00 (Cohen’s kappa was cal-
culated for nominal measures and interclass correla-
tion for continuous measures). All disagreements
were resolved in subsequent coding meetings.
Sample of Studies
Majority of studies included reported multiple
analyses, for a total of 131 separate effect sizes.
However, as described below, each meta-analysis
included just one effect size per independent sam-
ple, to ensure the statistical independence of all
effect sizes. Studies are listed in Table 1, with char-
acteristics of each study. Variables coded from each
study appears in Supporting Information.
Measures of Maltreatment
Most of the studies included in the meta-analysis
used official records of maltreatment or observa-
tional data taken by child welfare professionals as
an indication of past maltreatment, either as an
indication that the child had been maltreated or as
an indication that the parent was maltreating. Of
the 58 studies, four utilized scales to measure mal-
treatment, and these were the only studies that did
not utilize official records to establish child mal-
treatment. These studies used prospective designs,
and the maltreatment was measured in the first
wave of the longitudinal design. The maltreatment
scales used in these four studies were the Abusive
Behavior Cluster that uses home observation and
the family problem-solving task, the Conflict Tactics
Scales (CTS-child report on parent; Straus, 1979),
the CTS (CTSPC-parent self-report; Straus, Hamby,
& Warren, 2003), and the Child Abuse and Neglect
Risk Evaluation—Short version (Schatz & Burke-
Lefever, 2003).
Measures of Emotion Reactivity and Emotion
Regulation
In our examination of the child maltreatment lit-
erature, we considered a range of variables relevant
to the categories of emotion reactivity and regula-
tion. Although there is considerable -debate regard-
ing the distinctness of emotions, and the
differentiation between reactivity and -regulation
(Gross & Feldman Barrett, 2011), we make use of
the general distinction between -the process of reac-
tivity and the process of regulation. -Within the
general category of reactivity, we follow the well-
Emotion in Maltreated Children 5
established distinction -among experience, behavior,
and physiology, while addressing the valence of the
emotion and, -where indicated, the specific emotion
addressed (Gross & Jazaieri, 2014; Gross & Thomp-
son, 2007). Thus, for example, we coded indications
of behaviors of anger and experiences of anger as
two distinguishable manifestations of emotions
(both in the category of reactivity, the first under
the major construct of behavior and the second
under major construct of experience); within these
major constructs, these emotions are under the
minor construct of anger. Another set of examples
pertain to the valence of emotion. Such coding
entails, for instance, -positive emotions (e.g., experi-
ence low level of happiness, under the major con-
struct of -experience), or negative emotions
(behaving in a way indicative of high levels of
anger, under the -major construct of behavior). -
These categories and constructs appear in Table 2,
along with justifications regarding allocation of
minor constructs to the various major constructs;
the scales used appear in Supporting Information.
Emotion Reactivity Category
This category includes three major constructs:
experience, physiology, and behavior. Experience
was determined using scales measuring for nega-
tive emotions, such as anger, sadness, and guilt,
and positive emotions, such as happiness. The
physiology construct was examined by looking at
physiological reactions such as skin conductance
and respiratory sinus arrhythmia (RSA). The behav-
ior indicators construct was examined using scales
measuring the behavioral manifestations of emo-
tions; specifically, the intensity and frequency of
aggression, anger, antisocial behavior, low positive
effect, and high negative effect.
Emotion Dysregulation Category
Dysregulation was measured directly, with scales
designed for this purpose, and indirectly, with
scales designed to measure use of dysfunctional
problem solving.
Calculation of Effect Sizes
Given that most outcomes reported were based
on group differences in means (Johnson & Eagly,
2000), we calculated standardized mean difference
(SMD) effect sizes (Cohen’s d) to index differences
in mean levels of emotion reactivity and regulation
for children who were or were not maltreated. All
 6
Table 1
Studies in Meta-Analysis

Cs versus Parents’ Child's Child age in Total Maltreatment Reactivity/reg-

Study Location long gender gender yearsa n sub-type ulation ES (95% CI)

Bank and Burraston (2001) USA L Both Boys 10 182 PA Beh. Agg. 0.56 (0.33, 0.79)
N Beh. Agg. 0.32 ( 0.02, 0.66)
Bennett, Sullivan, and Lewis (2005) USA CS Mots Both 5 (0.8) 177 PA Beh. Neg. 0.18 ( 0.22, 0.57)
PA Beh. Ang. 0.09 ( 0.65, 0.48)
N Beh. Neg. 0.20 ( 0.14, 0.53)
N Beh. Ang. 0.04 ( 0.51, 0.43)
Lavi, Katz, Ozer, and Gross

PA, N Beh. Neg. 0.20 ( 0.23, 0.62)

PA, N Beh. Ang. 0.34 ( 0.2, 0.88)
Bennett, Sullivan, and Lewis (2010) USA L Mots Both 5 111 N Exp. Neg. 0.33 (0.06, 0.59)
Bousha and Twentyman (1984) USA CS Mots N/A 4.4 36 PA Beh. Agg. 1.4 (0.47, 2.33)
N Beh. Agg. 1.07 (0.33, 1.8)
Chavez (2006) USA L Both Both 11 or less 1,196 PA, N, SA Dys. 0.06 ( 0.01, 0.14)
Cipriano (2010) USA CS Mots Both 3.75 (0.74) 85 PA, N Beh. Ang. 0.29 ( 0.74, 0.16)
PA, N Beh. Neg. < 0.01 ( 0.45, 0.45)
PA, N RSA 0.24 ( 0.24, 0.72)
PA, N Dys. 0.07 ( 0.37, 0.52)
Connor, Doerfler, Volungis, Steingard, and USA CS Both Both 12.76 (3.24) 58 PA, SA Beh. Agg. 1.18 (0.92, 1.45)
Melloni (2003) PA, SA Beh. Neg. 0.54 (0.02, 1.07)
Dadds, Mullins, McAllister, and Atkinson Australia CS Mots Both 3.3 (1.33) 60 PA Beh. Pos. 1.92 (1.29, 2.56)
(2003) PA Beh. Neg. 0.59 (0.04, 1.14)
PA Exp. Neg. 0.44 ( 0.11, 0.98)
Darwish (1999) USA CS Both Both 4 (0.44) 30 PA, PN, EM, SA Beh. Agg. 0.54 ( 0.19, 1.27)
PA, PN, EM, SA Dys. 0.84 (0.1, 1.59)
de Pa
ul and Arruabarrena (1995) Spain CS Both Both 5–11 66 PA Beh. Agg. 0.59 ( 0.16, 1.34)
N Beh. Agg. 0.67 ( 0.03, 1.37)
Delker, Noll, Kim, and Fisher (2014) USA L Mots Both 3 240 PA, EA Dys. 0.26 (0.01, 0.52)
Dileo, Brewer, Northam, Yucel, and Australia CS N/A Both 8.48 (1.75) 50 PA, N, AE, SA Beh. Agg. 0.51 ( 0.07, 1.08)
Anderson (2017) PA, N, AE, SA Beh. Neg. 0.91 (0.32, 1.5)
PA, N, AE, SA Dys. 0.66 (0.08, 1.24)
Ewing-Cobbs, Prasad, Kramer, and Landry USA CS Both Both 3.5 or less 56 PA Dys. 1.09 ( 0.47, 2.65)
(2000)
Finzi, Har-Even, and Weizman (2003) Israel CS Both Both 9.77 (1.8) 114 PA Exp. Neg. 2.94 (2.17, 3.72)
PA Dys. 1.26 (0.65, 1.86)
N Exp. Neg. 1.71 (1.06, 2.36)
N Dys. 0.09 ( 0.48, 0.66)
Finzi et al. (2002) Israel CS Both Both 9.77 (1.8) 114 PA Beh. Agg. 1.93 (1.26, 2.6)
N Beh. Agg. 0.46 (0.17, 0.75)
Ghirmay (2015) USA L N/A Both 0–11 807 PA, N, SA Dys. 0.20 (0.06, 0.34)
Continued

Cs versus Parents’ Child's Child age in Total Maltreatment Reactivity/reg-

Study Location long gender gender yearsa n sub-type ulation ES (95% CI)

Gordis, Feres, Olezeski, Rabkin, and USA CS Both Boys 12.1 (1.21) 187 PA, PN, EM, SA Beh. Agg. (B) 0.29 (0, 0.59)
Trickett (2009) PA, PN, EM, SA Beh. Agg. (G) 0.66 (0.34, 0.99)
PA, PN, EM, SA Phy. (B) 0.02 ( 0.28, 0.31)
PA, PN, EM, SA Phy. (G) 0.16 ( 0.48, 0.17)
PA, PN, EM, SA RSA (B) 0.15 ( 0.14, 0.45)
PA, PN, EM, SA RSA (G) 0.11 ( 0.21, 0.44)
Harris (2010) USA CS Both Both 12.63 (2.2) 80 PA Exp. Ang. 0.66 (0.21, 1.11)
Haskett, Allaire, Kreig, and Hart (2008) USA CS Both Both 7.2 (1.4) 153 PA Beh. Agg. 0.34 (0.02, 0.66)
Haskett (1990) USA CS Both Both 4.86 (0.51) 18 PA Dys. 1.32 (0.36, 2.29)
Hennessy et al. (1994) USA CS Both Both 8.73 (1.47) 88 PA Exp. Neg. 0.47 ( 0.04, 0.97)
Herrenkohl, Klika, Herrenkohl, Russo, and USA L Both Both 1.5–6 357 PA Beh. Ang. 0.43 (0.22, 0.64)
Dee (2012) N Beh. Ang. 0.18 ( 0.03, 0.39)
Hjorth and Ostrov (1982) USA CS Both Both 12–16 49 PA Dys. 0.70 (0.12, 1.28)
Houck and King (1993) USA CS Both Both 6–11 225 PA, N, SA Beh. Agg. 0.41 ( 0.01, 0.83)
PA, N, SA Dys. 0.58 ( 0.29, 1.44)
Jaffee, Caspi, Moffitt, and Taylor (2004) USA L Both Both 5 1,116 PA Beh. Agg. 0.32 (0.21, 0.44)
Keil and Price (2009) USA CS Both Both 6.5 188 N Beh. Agg. 0.34 ( 0.11, 0.79)
PA, N Beh. Agg. 0.57 (0.11, 1.03)
Kim and Cicchetti (2010) USA CS Both Both 8.11 (1.77) 421 PA, PN, EM, SA Dys. 0.44 (0.25, 0.63)
Kinard (1980) USA CS Both Both 5–12 60 PA Beh. Agg. 0.34 ( 0.02, 0.7)
Klorman, Cicchetti, Thatcher, and Ison USA CS Both Both 6.65 (2.37) 212 PA, N, EM, SA Phy. 0.10 ( 0.29, 0.09)
(2003)
Koenig, Cicchetti, and Rogosch (2000) USA CS Mots Both 3.61 (0.11) 89 PA Beh. Neg. 0.20 ( 0.23, 0.63)
PA Beh. Pos. 0.59 ( 0.03, 1.22)
N Beh. Neg. 0.39 ( 0.09, 0.87)
N Beh. Neg. 0.28 ( 0.3, 0.85)
Lansford et al. (2002) USA L Mots Both 5 444 PA Beh. Agg. 0.77 (0.48, 1.06)
Ma & Li, 2014) Hong CS Both Both 9–15 283 PA, SA Dys. 0.46 (0.26, 0.65)
Kong
Main and George (1985) USA CS Both N/A 1–3 20 PA Beh. Agg. 1.79 (0.76, 2.83)
Manly, Kim, Rogosch, and Cicchetti (2001) USA CS Both Both 7.51 (1.45) 814 PA Beh. Agg. 0.56 (0.29, 0.84)
N Beh. Agg. 0.47 (0.17, 0.76)
EM Beh. Agg. 0.65 (0.27, 1.03)
N EM Beh. Agg. 0.43 (0.13, 0.73)
PA Dys. 0.62 (0.42, 0.81)
N Dys. 0.41 (0.08, 0.73)
EM Dys. 0.48 (0.22, 0.75)
Emotion in Maltreated Children

N EM Dys. 0.39 ( 0.37, 1.15)

7
 8
Continued

Cs versus Parents’ Child's Child age in Total Maltreatment Reactivity/reg-

Study Location long gender gender yearsa n sub-type ulation ES (95% CI)

Maughan and Cicchetti (2002) USA CS Mots Both 5.31 (1.04) 139 PA Beh. Agg. 0.60 (0.25, 0.95)
N Beh. Agg. 0.45 (0.11, 0.80)
McGinn (2014) Canada CS Fats Both 9.26 (2.45) 31 PA Dys. 1.28 (0.19, 2.36)
McLaughlin, Peverill, Gold, Alves, and USA CS N/A Both 16.58 (1.39) 42 PA, SA Dys. 0.51 ( 1.04, 2.05)
Sheridan (2015)
Milojevich (2016) USA CS N/A Both 12.51 (3.27) 395 PA, N. SA Beh. Agg. 0.35 (0.14, 0.56)
Lavi, Katz, Ozer, and Gross

PA, N. SA Dys. 0.22 ( 0.02, 0.47)

Moretti and Craig (2013) Canada L Both Both 15.34 (1.53) 179 PA, EA Dys. (Mthr) 0.35 (0.05, 0.64)
PA, EA Dys. (Fthr) 0.12 ( 0.42, 0.18)
Reidy (1977) USA CS Both Both 6.61 (1.05) 58 PA Beh. Agg. 0.89 (0.44, 1.33)
N Beh. Agg. 0.27 ( 0.39, 0.93)
Robinson et al. (2009) USA CS Mots Both 2.73 (0.89) 123 PA, PN, EM, SA Beh. Ang. 1.95 (1.52, 2.38)
PA, PN, EM, SA Beh. Pos. 1.06 (0.68, 1.43)
PA, PN, EM, SA Dys. 0.29 ( 0.07, 0.65)
Schatz, Smith, Borkowski, Whitman, and USA L Mots Both 3 126 CM Dys. 0.22 ( 0.03, 0.47)
Keogh (2008)
Schofield et al. (2017) USA L Both Both About 18 290 PA, EM Dys. 0.37 (0.08, 0.66)
Shenk, Noll, and Cassarly (2010) USA CS Both Girls 15.75 (1.11) 211 PA, PN, SA Dys. 0.54 (0.26, 0.82)
Shenk, Putnam, Rausch, Peugh, and Noll USA CS Both Girls 17 (1.16) 110 PA, PN, SA RSA 0.3 ( 0.08, 0.69)
(2014)
Shenk, Griffin, and O'Donnell (2015) USA L N/A Girls 17 (1.17) 110 PA, N, SA Exp. Neg. 0.43 (0.05, 0.81)
PA, N, SA Dys. 0.61 (0.22, 0.99)
Shields and Cicchetti (1998) USA CS Both Both 8.97 (1.87) 228 PA Beh. Agg. 0.45 (0.06, 0.84)
PA Beh. Neg. 0.52 (0.13, 0.91)
PA Dys. 0.53 (0.14, 0.92)
N Beh. Agg. 0.06 ( 0.33, 0.46)
N Beh. Neg. 0.26 ( 0.14, 0.65)
N Dys. 0.24 ( 0.16, 0.63)
Shields and Cicchetti (2001) USA CS Both Both 8.98 267 PA, N, EM, SA Dys. 0.42 (0.17, 0.67)
Shipman and Zeman (2001) USA CS Mots Both 9.07 (2.03) 50 PA Beh. Neg. 0.83 (0.25, 1.41)
PA Dys. 0.74 (0.40, 1.07)
Shipman, Edwards, Brown, Swisher, and USA CS Mots Both 9.17 (2.09) 48 N Beh. Neg. 0.52 ( 0.18, 1.23)
Jennings (2005) N Dys. 0.63 (0.22, 1.04)
Shipman (1990) USA CS Mots Both 8.79 (2.04) 40 PA Exp. Ang. 0.07 ( 0.55, 0.69)
PA Exp. Neg. 0.57 (0.33, 0.81)
PA Beh. Agg. 0.91 (0.25, 1.56)
PA Beh. Neg. 0.96 (0.31, 1.62)
PA Dys. 0.86 (0.40, 1.32)
Continued

Cs versus Parents’ Child's Child age in Total Maltreatment Reactivity/reg-

Study Location long gender gender yearsa n sub-type ulation ES (95% CI)

Skowron et al. (2014) USA CS Mots Both 3.71 (0.72) 161 PA, PN, EM RSA 0.08 ( 0.26, 0.1)
Smith and Walden (1999) USA CS Mots Both 4.55 (0.67) 30 PA, N Exp. Neg. 0.22 ( 1.13, 1.56)
PA, N Beh. Agg. 0.10 ( 0.41, 0.61)
PA, N Phy. 0.14 ( 0.38, 0.66)
PA, N Dys. 0.25 ( 0.02, 0.51)
Stoddart (1993) USA CS Both Both 4.9 34 PA Exp. Neg. 0.93 (0.19, 1.66)
PA Beh. Agg. 0.73 (0.01, 1.46)
Teisl and Cicchetti (2008) USA CS Both Both 8.04 (1.63) 267 PA Beh. Agg. 0.40 (0.15, 0.66)
PA Dys. 0.49 (0.13, 0.85)
CM Beh. Agg. 0.16 ( 0.11, 0.43)
CM Dys. 0.31 ( 0.03, 0.66)
Veloz (2005) USA CS Mots Both 8.56 (1.97) 44 PA, N Dys. 0.61 (< 0.01, 1.22)
Vorderstrasse (2013) USA CS Both Both 10.54 (0.96) 200 PA Beh. Agg. 0.34 ( 0.08, 0.76)
Young and Widom (2014) USA L Both Both 0–11 547 PA Exp. Neg. 0.27 ( 0.08, 0.62)
N Exp. Neg. 0.29 (0.07, 0.51)

Note. CI = confidence interval; L = longitudinal; CS = cross-sectional; B = boys; G = girls; Mots = mothers; Fats = fathers; PA = physical abuse; N = neglect, EM = emotional mal-
treatment; SA = sexual abuse; CM = child maltreatment (not further detailed); Beh. = behavioral; Exp. = experience; Agg. = aggression; Ang. = Anger; Neg. = high negative affect;
Pos. = low positive affect; Dys. = dysregulation; RSA = respiratory sinus arrhythmia; Phy. = physiological reactivity; ES = effect size.
a
Mage (SD) or range.
Emotion in Maltreated Children
9
10 Lavi, Katz, Ozer, and Gross
Table 2
Categories, Major and Minor Constructs of Emotion Reactivity, and Emotion Regulation
Major construct Minor construct
Category: emotion reactivity
Experience Anger
High negative affect
Low positive affect
Behavior Aggression and antisocial behavior
Anger
High negative affect
Low positive affect
Physiology Physiological reactivity
Respiratory sinus arrhythmia (RSA)
Description
Category: emotion dysregulation
Emotion dysregulation, dysfunctional coping, and problem solving
Attempts to change emotions and/or regulate emotions in a constructive way
Difficulty controlling emotions
effect sizes were coded in a unified direction such
that positive values (> 0) indicated that maltreat-
ment was associated with worse child outcomes,
for example, higher negative emotion reactivity,
lower positive emotion reactivity, and higher emo-
tion dysregulation (i.e., lower emotion regulation).
Where possible, we included a substantive transfor-
mation of the effect sizes, based on the measures
utilized. Ten studies reported correlational data;
sensitivity analysis, presented in Supporting Infor-
mation, was conducted to examine aggregated
effect sizes while excluding these studies. In cases
where a study was relevant to the meta-analysis
but the data given were insufficient for our statisti-
cal analysis, the authors were contacted and asked
to provide the missing data. The authors of five
papers were contacted; only in one case was the
data provided by the author (Finzi, Har-Even,
Shnit, & Weizman, 2002).
Effect size calculations were derived using
STATA (StataCorp., 2017). The studies included in
the analysis used a wide range of constructs and
research designs. In order to use conventional
meta-analytic techniques, which assume the statisti-
cal independence of effect sizes (Rosenthal, 1994),
we composed a set of decision principles to ensure
Description of minor construct
Subjective feeling of annoyance and irritation
Subjective feelings such as hostility, sadness, and disappointment
Subjective feelings such as joy, happiness, satisfaction
Behaviors indicative of verbal and/or physical hostility and violence toward
others (not the child; Aggression has been described as an indicator to
emotion reactivity, Averill, 1983)
Behaviors indicative of annoyance and irritation
Behaviors indicative of emotions such as hostility, sadness, and
disappointment
Behaviors indicative of emotions such as joy, happiness, satisfaction
Bodily responses indicative of changes in arousal
An index of parasympathetic activity that addresses the vagal nerve influences
on the heart; achieved by measuring periodic fluctuations in heart rate that
are linked to breathing (Literature indicates RSA is an indicator of emotion
reactivity, Butler, Wilhelm, & Gross, 2006)
the statistical independence of effect sizes. When
studies reported outcomes for multiple, highly simi-
lar contexts, we calculated a weighted average
effect size (weighting for dfs) and used this average
as a single, overall effect size for the construct for
the study (using formulas in Borenstein, Hedges,
Higgins, & Rothstein, 2009, pp. 227–228). This was
done for all minor constructs, except reactivity-be-
havior-anger (in which there were no studies
reporting similar variables). Thus, we ensured that
for each meta-analysis, each unique sample con-
tributed only one effect size to the synthesis, mean-
ing that all effect sizes in the synthesis were
statistically independent. As there were too few
studies to enable a multilevel meta-analysis, we
elected to structure major constructs conceptually
and to ensure that each unique sample only con-
tributed one effect size to an outcome.
In addition, although we considered using a
multilevel approach to average across all the reac-
tivity outcomes and create one larger reactivity
pooled effect (to directly compare to dysregulation
outcomes), the results from the individual models
indicated substantial heterogeneity in some models
and a mix of both significant and nonsignificant
findings. Thus, we anticipated that any multilevel

model across all these reactivity outcomes would
also show significant variability and thus be some-
what unstable for a discussion comparing dysregu-
lation to reactivity (without explaining the
particular subtypes). Following this, we address the
differences between reactivity and dysregulation
descriptively and as ranges in the interpretation of
the results.
We estimated pooled effect sizes using a ran-
dom-effects model, based on the assumption that
variability in effect sizes was due to sampling
error in addition to true variability (Lipsey & Wil-
son, 2001) because of the likely heterogeneity of
the populations, samples, and constructs appearing
in the included studies (Hedges & Vevea, 1998).
We examined heterogeneity in effect sizes by esti-
mating Q (used to test the null hypothesis of effect
sizes homogeneity), s2 (an estimate of the variance
of the distribution of effect sizes), and I2 (the pro-
portion of observed variability that is due to true
heterogeneity rather than chance). Although we
had not prespecified moderator analyses, some of
our models had enough studies, and enough vari-
ability, to allow us to conduct -bivariate meta-re-
gressions for up to five variables, depending on
model (percent female, geography of study
[USA = 1 vs. Non-US = 0], child mean age, study
design [Correlational = 0 vs. Longitudinal = 1],
and maltreatment type [Neglect = 1, Abuse = 0]).
Given the way some of these moderators were
reported in primary studies, the moderator analy-
ses is somewhat crude. For instance, although we
have conducted moderator analysis for percent
gender, these outcomes represent the proportion of
a group in a study—that is, any analysis that indi-
cates this is a significant moderator suggests that
studies with a certain proportion of that gender
are more (or less) likely to demonstrate the out-
comes rather than the ability to say something
about maltreatment outcomes by gender more
specifically.
Results
Prior to presenting the main sections of the results,
descriptive data of the studies included in the
meta-analysis are described in Supporting Informa-
tion and will be addressed. More than 11,900 chil-
dren were assessed in studies included in our meta-
analysis, with a mean number of children in each
study being 205.45 (SD = 247.65, range = 18–1,196).
Across studies, the mean age of parent-participants
was 33.36 years (MSD = 6.00) and of child-
Emotion in Maltreated Children 11
participants was 8.12 years (MSD = 1.48). Most
studies were conducted in the United States, with
77.6% of the studies being cross-sectional (k = 45).
Of the 58 papers located, one was published during
the 1970s (Reidy, 1977), four were published during
the 1980s (Bousha & Twentyman, 1984; Hjorth &
Ostrov, 1982; Kinard, 1980; Main & George, 1985),
nine during the 1990s (Darwish, 1999; de Pa ul &
Arruabarrena, 1995; Haskett, 1990; Hennessy, Rabi-
deau, Cicchetti, & Cummings, 1994; Houck & King,
1993; Shields & Cicchetti, 1998; Shipman, 1990;
Smith & Walden, 1999; Stoddart, 1993), and the rest
of the reviewed papers (k = 44) during the 2000s.
This marked increase in the number of studies dur-
ing the 2000s suggests a growing interest in emo-
tion reactivity and regulation of maltreated
children, as well as growing specificity in the theo-
rizing of emotion reactivity, emotion regulation,
and child maltreatment. Descriptive data of
reviewed studies appear in Table 1. Forest plots
appear in Supporting Information.
Reactivity-Experience-Anger
Only two studies reported anger experience and
the weighted mean effect size for the relationship
between child maltreatment and child’s experience
of anger was nonsignificant: SMD = .41 (95% CI
[ 0.16, 0.98)]. This model had no remaining hetero-
geneity, and thus, possible moderators were not
examined.
Reactivity-Experience-Negative Affect
The weighted mean effect size for the relationship
between child maltreatment and child’s experiences
of negative affect, averaged over 11 effect sizes, was
significant: SMD = .71 (95% CI [0.41, 1.01]). This
model had a significant amount of heterogeneity
(Q = 60.43, p < .001, s2 = .193, I2 = 83.5%); however,
this heterogeneity appeared largely driven by a sin-
gle study, which when removed resulted in a signif-
icant effect size (SMD = .40, 95% CI [0.29, 0.51]) and
no remaining heterogeneity.
Reactivity-Behavior-Aggression
As shown in Table 3, the weighted mean effect
size for the relationship between child maltreatment
and child’s aggressive behavior, averaged over 38
effect sizes, was 0.53 (95% CI [0.43, 0.62]). This indi-
cates that maltreated children were significantly
more likely to display aggression in comparison to
nonmaltreated children. This model also had a
12 Lavi, Katz, Ozer, and Gross

Table 3
Meta-Analysis Results: ESs by Category and by Major and Minor Constructs

K (n) ES LL UL v2(df) p I2 s2

Reactivity
Experience
Experience—anger 2 (120) 0.41 0.16 0.98 2.25 (1) .13 55.70 .10
Experience—high neg. affect 11 (1,795) 0.71 0.41 1.01 60.43 (10) < .01 83.50 .19
Behavior
Behavior—aggression 38 (9.029) 0.53 0.43 0.62 95.48 (37) < .01 61.20 .05
Behavior—anger 7 (1,453) 0.36 0.09 0.82 69.15 (6) < .01 91.30 .33
Behavior—high neg. affect 14 (1,556) 0.38 0.24 0.53 16.70 (13) .21 22.20 .02
Behavior—low pos. affect 4 (361) 0.96 0.34 1.58 15.78 (3) < .01 81.00 .32
Physiology
Physiological reactivity 4 (604) 0.07 0.21 0.07 1.32 (3) .72 0.00 .00
Physiological—RSA 5 (718) 0.08 0.07 0.22 4.90 (4) .30 18.30 .01
Dysregulation 38 (10,099) 0.42 0.32 0.51 118.92 (37) < .01 68.90 .04

Note. ES is standard difference in means. Effects reported are under random model. Negative affect = Reactivity to other negative affect
(e.g., shame, guilt, disgust, sadness, hostility); Q (Cochran’s Q) = squared deviations of each study’s estimate from the overall meta-ana-
lytic estimate, weighting each study’s contribution (Higgins, Thompson, Deeks, & Altman, 2003). RSA = respiratory sinus arrhythmia;
ES = effect size.

significant amount of heterogeneity (Q = 95.48,

p < .001, s2 = .05, I2 = 61.2%) and so potential mod-
erators were examined. Across the five bivariate
meta-regression models, none of the moderators
explained any of the variability in outcomes (see
Table 4), indicating that this effect may not be stable
for certain children with certain characteristics.
Reactivity-Behavior-Anger
As shown in Table 3, the weighted mean effect
size for the relationship between child maltreatment
and child’s angry behavior, averaged over seven
effect sizes, was nonsignificant: SMD = .36 (95% CI
[ 0.09, 0.82]). This model also had a significant

Table 4
Moderator Analysis: Effect Sizes by Category and by Major and Minor Constructs

Effect modifier k b [95% CI] Constant s2 Residual I2 (%) Adjusted R2

Reactivity-behavior-aggression
Gender (% female) 17 0.05 [ 2.12, 2.02] 0.48 [ 0.41, 1.37] .01 50.1 64.57
Geography (USA = 1) 38 0.24 [ 0.61, 0.12] 0.74 [0.40, 1.09] .04 61.18 0.54
Child age (mean of sample) 38 0.00 [ 0.05, 0.04] 0.55 [0.17, 0.93] .05 61.22 8.21
Design: cross-sectional versus longitudinal 38 0.05 [ 0.35, 0.26] 0.53 [0.42, 0.65] .05 61.32 8.13
(longitudinal = 1)
Maltreatment type (abuse = 0, neglect = 1) 28 0.24 [ 0.54, 0.05] 0.66 [0.50, 0.82] .06 67.4 9.67
Reactivity-behavior-anger
Child age (mean of sample) 7 0.58 [ 1.30, 0.14] 2.75 [ 0.27, 5.77] .31 87.61 39.36
Design: cross-sectional versus longitudinal 7 0.08 [ 1.80, 1.65] 0.38 [ 0.57, 1.33] .62 92.63 22.62
(longitudinal = 1)
Dysregulation
Gender (% female) 14 0.12 [ 0.71, 0.73] 0.49 [0.16, 0.83] 0 21.59 0
Geography (USA = 1) 38 0.01 [ 0.23, 0.25] 0.40 [0.18, 0.61] .03 69.25 5.31
Child age (mean of sample) 38 0.01 [ 0.01, 0.03] 0.34 [0.13, 0.54] .03 64.66 1.13
Design: cross-sectional versus longitudinal 38 0.29 [ 0.44, 0.15] 0.44 [0.39, 0.55] .01 34.27 71.11
(longitudinal = 1)
Maltreatment type (abuse = 0, neglect = 1) 20 0.18 [ 0.55, 0.20] 0.54 [0.37, 0.71] .05 56.94 13.05

Note. Effect size is standard difference in means. Effects reported are under random model. Negative affect = reactivity to other nega-
tive affect (e.g., shame, guilt, disgust, sadness, hostility); Q (Cochran’s Q) = squared deviations of each study’s estimate from the overall
meta-analytic estimate, weighting each study’s contribution (Higgins et al., 2003).

amount of heterogeneity (Q = 69.15, p < .001,
s2 = .33, I2 = 91.3%), and so potential moderators
were examined. One study appeared to be a poten-
tial outlier so the model was rerun with this study
removed. The overall mean effect did not substan-
tially change, and there was still a large amount of
remaining heterogeneity so we used the original
model to conduct moderator analysis. Only child
age and study design (cross-sectional vs. longitudi-
nal) had sufficient number of studies reporting data
on moderators, and both variables were not a sig-
nificant moderators of the relationship between
maltreatment and child angry behavior (see
Table 4).
Reactivity-Behavior-Negative Affect and Positive Affect
As shown in Table 3, the relationship for child
maltreatment and affect was significant for both
high negative affect (.38, 95% CI [0.241, 0.53],
k = 14) and low positive affect (.96, 95% CI [0.34,
1.58]). This indicated that, in comparison to non-
maltreated children, children experiencing maltreat-
ment were significantly likely to display both high
negative and low positive affect. Tests for homo-
geneity indicated that there was no significant
heterogeneity among high negative affect outcomes,
and although there was heterogeneity for low posi-
tive affect, there were too few studies to explore it.
Reactivity-Physiological Reactivity
Only a few studies reported physiological out-
comes including reactivity and RSA; neither of the
models for these outcomes were significant, and
there was no heterogeneity to explore (see Table 3).
Dysregulation
As shown in Table 3, the weighted mean effect
size for the relationship between child maltreatment
and child’s dysregulation, averaged over 38 effect
sizes, was 0.42 (95% CI [0.32, 0.51]). This indicates
that, in comparison to children who were not mal-
treated, children who were maltreated were signifi-
cantly more likely to display emotion dysregulation.
This model also had a significant amount of hetero-
geneity (Q = 118.92, p < .001, s2 = .04, I2 = 68.9%),
and so potential moderators were examined. Across
the five bivariate meta-regression models, only the
study design was a significant moderator
(b = 0.29, 95% CI [ 0.44, 0.15]), indicating that
longitudinal studies were more likely to demon-
strate smaller effects than cross-sectional studies.
Emotion in Maltreated Children 13
This moderator explained a large portion of the vari-
ability (residual I2 = 33.27%, adj R2 = 71.11%; see
Table 4).
Substantive transformation of the effect sizes was
possible for only a small portion of the effect sizes
due to the high variability in measures used (see
Supporting Information). Analyzing the measure
used most prominently as an indication of negative
emotion reactivity and of dysregulation, the Emo-
tion Regulation Checklist (Shields & Cicchetti, 1995,
1997), scored on a scale of 1–4, reveals that mal-
treated children scored 1.42 points higher on the
negative affect behavior scale and 0.57 points
higher on the dysregulation scale, in comparison to
nonmaltreated children. This result is in accordance
with results indicating that reactivity effect sizes are
higher than dysregulation effect sizes.
Summary Across Constructs
Results indicate that, in comparison to nonmal-
treated children, maltreated children are signifi-
cantly more likely to have negative effects on
regulation, aggression, high negative affect behav-
iors and experience, and low positive affect behav-
iors with effect sizes ranging from 0.41 to 0.96;
most of the reactivity effect sizes are slightly higher
in comparison to the dysregulation outcomes. Of
note, the physiological outcomes did not appear to
be significantly affected for maltreated children and
these effect sizes were less than half those for
behavior and experience outcomes. Overall, there is
a great degree of variability in child outcomes
across the various constructs of interest.
Publication Bias Analysis
Three methods were used to examine the possi-
bility of small study bias, or bias due to the omis-
sion of studies with negative results or small
sample sizes: a funnel plot, the Egger test for funnel
plot asymmetry, and a trim and fill analysis. These
were only conducted for the analyses with more
than 20 studies (dysregulation and aggression). The
funnel plot was asymmetrical (i.e., there were few
included studies with small sample sizes and nega-
tive findings) and Egger’s test was significant
(Egger b = 2.02, 95% CI [1.27, 2.77], p < .01 for dys-
regulation and Egger b = 1.45, 95% CI [0.33, 2.56],
p = .012), indicating possible small study bias. In
the trim and fill analysis, the dysregulation out-
comes remained significant but were smaller (.24,
95% CI [0.15, 0.34]), and the aggression outcomes
remained similar to the original analysis (.41, 95%
14 Lavi, Katz, Ozer, and Gross
CI [0.29, 0.52]). Thus, these results suggest the
potential for small study bias in the effect sizes
included in the synthesis, such that the magnitude
of this mean effect size may be upwardly biased;
although the gaps in the funnel plot may simply be
due to a lack of studies indicating a reverse rela-
tionship than would be expected (i.e., maltreated
children have more positive outcomes compared to
their nonmaltreated peers). Additionally, these tests
could be driven to some extent by existing hetero-
geneity in the included studies or other factors not
related to publication bias (e.g., Lau, Ioannidis, Ter-
rin, Schmid, & Olkin, 2006). Given that we could
not test for potential publication bias across all the
outcomes, it seems possible that there will be
reporting bias or small study bias in this field. The
relevant funnel plots appears in Supporting Infor-
mation.
Discussion
This study addressed the question of which emo-
tional processes are the most vulnerable to the
experience of growing up in a family challenged by
maltreatment. Our goal was to address this ques-
tion via a theoretically informed synthesis of the
extant empirical literature on emotion reactivity
and regulation of maltreated children. Our meta-
analysis is the first to our knowledge to examine
this relationship between children’s experience of
maltreatment and the development of emotion reac-
tivity and emotion regulation. Our emotion reactiv-
ity findings indicate that, in comparison to
nonmaltreated children, maltreated children show
aggressive behaviors, high levels of negative emo-
tions, and low levels of positive emotion and expe-
rience high levels of negative emotions. Examining
emotion regulation reveals that maltreated children
have dysfunctional coping and problem-solving
abilities and are emotionally dysregulated. Our
results indicate that, for maltreated children, dys-
functions in the various emotion reactivity con-
structs examined are stronger than dysfunctions in
emotion regulation.
Emotion Reactivity in Maltreated Children
Addressing the components of emotions (experi-
ence, behavior, and physiology, Gross & Jazaieri,
2014; Gross & Thompson, 2007), we note that more
studies examined the behavioral indicators of emo-
tion (e.g., crying as indicative of sadness, clenching
your jaws as indicative of anger) than experiences
of emotion or of physiology. Below, we review
results of behavioral manifestations of emotions,
followed by subjective reports on emotions, and
finally review bodily responses.
Results of the behavioral indicators of affect
show that, in comparison to nonmaltreated chil-
dren, maltreated children exhibit much higher
levels of aggression. Maltreated children might
react in a violent and destructive manner to their
environment. Interestingly, results regarding anger
were nonsignificant. Our findings are aligned with
prior research demonstrating the link between mal-
treatment and conduct disorder and violent tenden-
cies (Andreou, Comasco, Aslund,  Nilsson, &
Hodgins, 2018; Docherty, Kubik, Herrera, & Boxer,
2018). In comparison to nonmaltreated children,
maltreated children also show higher levels of
behavioral manifestations of negative affect. None
of the reviewed studies addressed experiences of
positive emotions. This neglect of positive emotions
might represent a focus on the negative conse-
quences of exposure to maltreatment.
Turning to experiences of emotions, in compar-
ison to nonmaltreated children, children who have
been maltreated experience higher levels of sadness,
hostility, and fear. Most of the effect sizes for this
analysis are based on informant-report measures
(e.g., parent, teacher; only 3 of the 11 effects are
self-report). We further examined here whether, in
comparison to nonmaltreated children, children
who have been maltreated exhibit higher levels of
physiological representations of emotion. Physiolog-
ical data were presented in nine effect sizes from
six studies included in this meta-analysis. The
aggregated average effect size for the physiological
data was not statistically significant.
To summarize, we found that maltreated chil-
dren tend to be aggressive, show high levels of
negative affect, and experience high levels of sad-
ness, fear and hostility. Our results are aligned
with key theoretical models discussed previously.
Specifically, attachment theories (Bowlby, 1988;
Cicchetti & Lynch, 1995; Main & Hesse, 1990;
Mikulincer & Shaver, 2007), social information the-
ories (Crick & Dodge, 1994; Cummings et al., 1989;
Grych & Fincham, 1990) and learning theories
(Eisenberg et al., 2001) are consistent in predicting
that maltreated children will have higher levels of
negative affect. Our results further demonstrate
that low levels of positive emotion is the construct
that shows the greatest divergence between non-
maltreated and maltreated children. That is,
although aggressive behaviors of children have
been studied extensively, the greatest difference

between maltreated children and nonmaltreated
children is in the levels of behavioral manifesta-
tions of positive emotion.
These results support the outlined hypotheses.
All three reviewed theories converge in -predicting
hyper-reactivity to negative affect, describing how
experiences of maltreatment result -in the child
experiencing and expressing negative emotions.
Attachment -theory (Mikulincer et al., 2003) also
describes specific patterns that indicate high levels
of hyporeactivity to positive emotions: this pattern
is described as resulting from continuous -intrusive-
ness on the part of the parents. The results of this
study indicate that indeed, low -levels of behaviors
indicating positive emotions are characteristic of
maltreated children. Thus, -not only do maltreated
children show high levels of sadness, anger, and
hostility; these children -also show low levels of joy
and happiness.
Emotion Regulation in Maltreated Children
Our second set of meta-analyses focused on emo-
tion regulation of maltreated and nonmaltreated
children. Examining the different manifestations of
emotion regulation, our results indicate that mal-
treated children exhibit dysregulation more than
nonmaltreated children. These children find it hard
to control their emotions—as reported by the child
and others in his/her environment. In addition,
these children have difficulties with coping and
with finding solutions to problems.
Our results for emotion regulation of maltreated
and nonmaltreated children are consistent with the
theoretical frameworks discussed earlier. These
theories converge in predicting dysregulation for
maltreated children. Attachment theories predict
that dysregulation would result from child mal-
treatment (Bowlby, 1988; Cicchetti & Lynch, 1995;
Main & Hesse, 1990; Mikulincer & Shaver, 2007;
Mikulincer et al., 2003) because maltreating parents
fail to form a secure base for the child. This ren-
ders the child unable to develop beneficial emotion
regulatory capabilities. In addition, the prediction
made by learning theories, specifically addressing
difficulties in problem solving (Eisenberg et al.,
2001), was also supported. According to Eisenberg
et al. (2001), the child learns poor problem-solving
techniques from his/her maltreating parents, who
resort to a very narrow set of disciplinary strate-
gies. Furthermore, many if not most maltreating
families are socially isolated (Cicchetti, 1996; Stith
et al., 2009). This isolation can prevent the child
from establishing other role models that would
Emotion in Maltreated Children 15
exhibit more flexible and varied social behavior
(Cicchetti, 1996).
Interestingly, for this outcome study design (con-
trasting cross-sectional to longitudinal studies) was
a significant moderator. That is, effect sizes for
cross-sectional studies were significantly higher
than effect sizes for longitudinal data, with this
moderator explaining a significant portion of the
variance in dysregulation. We can compare this
result to the nonsignificant moderation of study
design for behavioral indicators of aggression. This
might lead us to postulate that the relationship
between maltreatment and behavioral aggression is
long lasting, whereas the relationship between mal-
treatment and child dysregulation decreases with
time. It is possible that maltreated children adapt
more regulatory techniques with time/age, and this
is represents the impact of maturation with age.
Reactivity and Regulation of Abused Versus Neglected
Children
Our last set of findings concerning maltreated
children focused on the question of whether abused
and neglected children differ in levels of reactivity
and regulation. Only partial comparisons between
the groups were possible, due to the small number
of studies comparing these groups. The low num-
ber of studies reflects the high comorbidity between
abuse and neglect. It also represents the under-
standing that there might be differences between
abuse that is accompanied by neglect and abuse
that is not accompanied by neglect (and similarly
regarding neglect)—and thus many studies do not
compare between the two subtypes. With this con-
sideration, below we review studies that have
examined groups of families that were reported to
demonstrate only abuse or only neglect.
In all constructs examined, fewer studies exam-
ined neglected children, in comparison to abused
children. This reflects the “neglect of neglect” that
has been reported when addressing child maltreat-
ment (Hobbs & Wynne, 2002). In two cases, com-
parisons between abuse and neglect were possible,
that is, in heterogeneous constructs and when the -
number of studies was sufficient: reactivity-behav-
ior-aggression and dysregulation. In both cases,
maltreatment subtype (abuse vs. neglect) was non-
significant. However, the results show a trend
toward effect sizes being lower in cases of neglect,
in comparison to cases of abuse.
Our results demonstrate the relationship between
exposure to maltreatment and alterations in the
emotional processes of reactivity and regulation.
16 Lavi, Katz, Ozer, and Gross
The theories of attachment, social information -pro-
cessing, and learning all converge in their
description of the outcomes of maltreatment—
hypernegativity and dysregulation. Although all
theories predict similar outcomes, they indicate dif-
ferent pathways for these outcomes. The theories
reviewed stress the main role of the parent as a
model for the child: thus, these theoretical frame-
works -indicate that the child is not only exposed
to a violent, abusive, and neglecting relationship,
but is -also exposed to a distorted role model.
Neglect of the basic relational needs of the child
results in a significant vulnerability: results of our
analyses indicate that this vulnerability is expressed
in greater negative emotions, lower positive emo-
tions, and difficulty controlling and managing these
emotions. Our results further indicate that these
alterations in reactivity are, in most cases, stronger
than alterations in regulation. Last, our results sug-
gest that, with time, regulation abilities might
improve while reactivity patterns remain stable.
These results have consequences for our under-
standing of the development and maturation of
emotional processes in children.
Implications for Future Practice and Research
Our results underscore the strong link between
maltreatment and children’s difficulties in the emo-
tional processes of reactivity and regulation. These
results could inform treatment of maltreated chil-
dren. Therapists should be informed regarding the
consequences of maltreatment of children and set
treatment goals accordingly. Understanding emo-
tion reactivity/regulation developmental phases
and the relationship between emotion processes
and attachment (Shaver & Mikulincer, 2014) could
guide therapists in setting therapeutic goals for
maltreated children. For instance, the fact that low
levels of positive affect is a characteristic of mal-
treated children should be taken into account
when setting therapeutic goals. Indeed, savoring
positive affect has been reported to be a therapeu-
tic strategy in family therapy (Lunkenheimer,
Shields, & Cortina, 2007) and could be used to
increase positive affect in maltreated children. Last,
it is known that certain characteristics of the child
(e.g., difficult temperament) are risk factors for
maltreatment (Stith et al., 2009). Thus, maltreat-
ment at a young age could lead to the develop-
ment of aggressive and negative behavior of the
child, leading to further maltreatment. Such poten-
tially escalating interaction patterns between the
parent and child could be taken into account
together with understanding that families undergo
developmental stages that are more conflictprone
and in which escalating influences may become
even more salient.
Our results indicate a possible path for intergen-
erational transmission of maltreatment, a process
that has been under study in recent decades, with
studies indicating such transmission in various cir-
cumstances (e.g., Berlin, Appleyard, & Dodge,
2011). Our results suggest a possible mediator for
this link: It is possible that when maltreatment
results in difficulties in emotion reactivity and reg-
ulation, these difficulties characterize the child as
s/he grows into an adult. These difficulties and
biases could be a risk factor when this child
becomes a parent (Lavi, Ozer, Katz, & Gross, in
submission).
Limitations and Directions for Further Research
We note that the literature itself is characterized
by design limitations such as a relatively low pro-
portion of longitudinal designs and lack of speci-
ficity in the assessment of subcategories of
maltreatment and subcategories of emotional pro-
cesses. For example, only 13 of the 58 papers in the
meta-analysis employed a longitudinal design,
likely owing to challenges in following populations
of highly stressed families and children over time.
It is also possible that although these families are
already registered within the child welfare system,
they are difficult to approach or it is challenging to
gain their trust or cooperation due to the multiple
problems they are facing. The significant differences
in emotion reactivity/regulation found in our
results underscore the need to examine these rela-
tionships while utilizing prospective designs. A
prospective design could help establish which cau-
sal direction has more empirical support: Is it that
maltreated children develop difficulties in emotion
reactivity and regulation, or is it that children who
are highly emotionally reactive and are emotionally
dysregulated are difficult to raise, and hence are at
greater risk of maltreatment? It is likely that both
scenarios co-occur, as it has been noted that chil-
dren’s difficult behavior is a strong risk factor for
maltreatment (Black, Slep, & Heyman, 2001; Stith
et al., 2009). Carefully designed prospective studies
could help advance our knowledge regarding this
issue.
Further, more attention should be given to the
subcategories within child maltreatment—as our
results indicate that the different subtypes could be
related to differential child outcomes. The

understudied nature of emotional maltreatment (ne-
glect and abuse) is especially apparent (see also
Lavi et al., 2019). More nuanced examination of the
emotional processes is also necessary: Many studies
examined factors that pertain to emotional reactiv-
ity and emotion regulation as a single dimension,
whereas others did not differentiate between the
various processes within regulation. Last, there was
little use of up-to-date measurement approaches of
emotion reactivity and regulation (i.e., RSA).
A second set of limitations concerns under-at-
tention to questions of psychological resilience in
the context of maltreatment. The reviewed studies
explored a variety of demographic and resilience
factors (e.g., gender, peer relationship, e.g., Kim &
Cicchetti, 2010; Moretti & Craig, 2013). However,
the great variability in these resilience factors and
their measurement precludes the possibility of
generating a unified effect size for these moder-
ated relations. We were only able to address a
narrow range of moderators. Further studies are
needed in order to be able to address the impact
of such factors on the maltreatment-reactivity/reg-
ulation link.
Furthermore, it would be illuminating- to exam-
ine the moderating role of protective factors in the -
maltreatment-reactivity/regulation link while using
the differential susceptibility (Belsky, 2005) and bio-
logical sensitivity to context (Boyce & Ellis, 2005)
frameworks. According to these -frameworks, out-
comes for children such as well-being and psycho-
logical distress are determined by the -interplay
between environmental stress (here, maltreatment
vs. -benevolent parenting) and children’s sensitivity
(here, reactivity/regulation). For a relationship -to
match patterns of differential susceptibility, the
environmental stressor and the sensitivity -should
not be related. To pursue this line of investigation,
in future studies it will be important to explore
whether children -who are sensitive (here, highly
reactive and dysregulated) would gain greater ben-
efit from -parental interventions, in comparison to
less sensitive children. Initial findings point in that -
direction (Scott & O’Connor, 2012).
Our results indicate that there is a significant
relationship between exposure to child maltreat-
ment and development of hyper-reactivity to nega-
tive emotions, hyporeactivity to positive emotions
and dysregulation. Emotion reactivity and regula-
tion are crucial for the social, psychological, and
behavioral development of children. Our study
underscores the need to consider the consequences
of maltreatment for the basic, core emotional pro-
cesses of children.
Emotion in Maltreated Children 17
References
References marked with an asterisk indicate studies
included in the meta-analysis.
Ainsworth, M. D. S. (1973). The development of infant–
mother attachment. In B. Cardwell & H. Ricciuti (Eds.),
Review of child development research (Vol. 3, pp. 1–94).
Chicago, IL: University of Chicago.

Andreou, D., Comasco, E., Aslund, C., Nilsson, K. W., &
Hodgins, S. (2018). Maltreatment, the oxytocin receptor
gene, and conduct problems among male and female
teenagers. Frontiers in Human Neuroscience, 12, 112.
https://doi.org/10.3389/fnhum.2018.00112
Averill, J. R. (1983). Studies on anger and aggression:
Implications for theories of emotion. American Psycholo-
gist, 38, 1145–1160. https://doi.org/10.1037/0003-066X.
38.11.1145
Avinun, R., & Knafo, A. (2014). Parenting as a reaction
evoked by children's genotype: A meta-analysis of chil-
dren-as-twins studies. Personality and Social Psychology
Review, 18, 87–102. https://doi.org/10.1177/10888683
13498308
Baer, J. C., & Martinez, C. D. (2006). Child maltreatment
and insecure attachment: A meta-analysis. Journal of
Reproductive and Infant Psychology, 24, 187–197.
https://doi.org/10.1080/02646830600821231
Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H.
(2016). Attachment, parenting, and genetics. In J. Cas-
sidy & P. R. Shaver (Eds.), Handbook of attachment: The-
ory, research, and clinical applications (pp. 155–179). New
York, NY: Guilford.
Bandura, A. (1997). Self-efficacy: The exercise of control.
New York, NY: W. H. Freeman.
*Bank, L., & Burraston, B. (2001). Abusive home environ-
ments as predictors of poor adjustment during adoles-
cence and early adulthood. Journal of Community
Psychology, 29, 195–217. https://doi.org/10.1002/jcop.
1014
Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining
child maltreatment: The interface between policy
and research. In D. Cicchetti & J. T. Manly (Eds.),
Child abuse, child development, and social policy (Vol. 8,
pp. 7–73). Norwood, NJ: Ablex.
Belsky, J. (1993). Etiology of child maltreatment: A
developmental-ecological analysis. Psychological Bulletin,
114, 413–434. https://doi.org/10.1037/0033-2909.114.3.
413
Belsky, J. (2005). Differential susceptibility to rearing
influence. In B. Ellis & D. Bjoklund (Eds.), Origins of the
social mind: Evolutionary psychology and child development
(pp. 139–163). Now York, NY: Guilford.
Belsky, J., & Jaffee, S. R. (2006). The multiple determi-
nants of parenting. In D. Cicchetti & D. J. Cohen (Eds.),
Developmental psychopathology. Vol. 3: Risk, disorder and
adaptation (pp. 38–85). New York, NY: Wiley.
*Bennett, D. S., Sullivan, M. W., & Lewis, M. (2005).
Young children's adjustment as a function of
18 Lavi, Katz, Ozer, and Gross
maltreatment, shame, and anger. Child Maltreatment, 10,
311–323. https://doi.org/10.1177/1077559505278619
*Bennett, D. S., Sullivan, M. W., & Lewis, M. (2010).
Neglected children, shame-proneness, and depressive
symptoms. Child Maltreatment, 15, 305–314. https://doi.
org/10.1177/1077559510379634
Berlin, L. J., Appleyard, K., & Dodge, K. A. (2011). Inter-
generational continuity in child maltreatment: Mediat-
ing mechanisms and implications for prevention. Child
Development, 82, 162–176. https://doi.org/10.1111/j.
1467-8624.2010.01547.x
Black, D. A., Slep, A. M. S., & Heyman, R. E. (2001). Risk
factors for child psychological abuse. Aggression and
Violent Behavior, 6, 189–201. https://doi.org/10.1016/
S1359-1789(00)00022-7
Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Roth-
stein, H. R. (2009). Introduction to meta-analysis. West
Sussex, UK: Wiley. https://doi.org/10.1002/
9780470743386
*Bousha, D. M., & Twentyman, C. T. (1984). Mother-child
interactional style in abuse, neglect, and control groups:
Naturalistic observations in the home. Journal of Abnor-
mal Psychology, 93, 106–114. https://doi.org/10.1037/
0021-843X.93.1.106
Bowlby, J. (1951). Maternal care and mental health (Vol. 2).
Geneva, Switzerland-: World Health Organization.
Bowlby, J. (1969). Attachment and loss: Attachment. Vol. 1:
Loss. New York, NY: Basic.
Bowlby, J. (1988). A secure base: Clinical applications of
attachment theory. London, UK: Routledge.
Boyce, W. T., & Ellis, B. J. (2005). Biological sensitivity to
context: I. An evolutionary–developmental theory of
the origins and functions of stress reactivity. Develop-
ment and Psychopathology, 17, 271–301. https://doi.org/
10.1017/S0954579405050145
Butler, E. A., Wilhelm, F. H., & Gross, J. J. (2006). Respi-
ratory sinus arrhythmia, emotion, and emotion regula-
tion during social interaction. Psychophysiology, 43,
612–622. https://doi.org/10.1111/j.1469-8986.2006.
00467.x
* Chavez, J. M.( 2006). An examination of race/ethnicity
differences in depression and violence as conse-
quences of childhood maltreatment. Doctoral disserta-
tion. University at Albany, State University of New
York.
Cicchetti, D. (1996). Child maltreatment: Implications for
developmental theory and research. Human Develop-
ment, 39, 18–39. https://doi.org/10.1159/000278377
Cicchetti, D., & Lynch, M. (1995). Failures in the expect-
able environment and their impact on individual devel-
opment: The case of child maltreatment. In D. C. D. J.
Cohen (Ed.), Developmental psychopathology: Risk, disor-
der, and adaptation (Vol. 2, 2nd ed., pp. 32–71). New
York, NY: Wiley.
Cicchetti, D., & Toth, S. L. (2005). Child maltreatment.
Annual Review of Clinical Psychology, 1, 409–438.
https://doi.org/10.1146/annurev.clinpsy.1.102803.
144029
* Cipriano, E. A.( 2010). Emotion regulation in children
exposed to maltreatment: The interplay between mal-
treatment status, parenting quality, and temperament.
Doctoral dissertation. The Pennsylvania State Univer-
sity.
*Connor, D. F., Doerfler, L. A., Volungis, A. M., Stein-
gard, R. J., & Melloni, R. H. (2003). Aggressive behav-
ior in abused children. Annals of the New York Academy
of Sciences, 1008, 79–90. https://doi.org/10.1196/anna
ls.1301.009
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein,
M., Cloitre, M., & Liautaud, J. (2017). Complex trauma
in children and adolescents. Psychiatric Annals, 35, 390–
398.
Crick, N. R., & Dodge, K. A. (1994). A review and refor-
mulation of social information-processing mechanisms
in children's social adjustment. Psychological Bulletin,
115, 74–101. https://doi.org/10.1037/0033-2909.115.1.
74
Cummings, J. S., Pellegrini, D. S., Notarius, C. I., & Cum-
mings, E. M. (1989). Children's responses to angry
adult behavior as a function of marital distress and his-
tory of interparent hostility. Child Development, 60,
1035–1043. https://doi.org/10.2307/1130777
Cyr, C., Euser, E. M., Bakermans-Kranenburg, M. J., & Van
Ijzendoorn, M. H. (2010). Attachment security and disor-
ganization in maltreating and high-risk families: A series
of meta-analyses. Development and Psychopathology, 22,
87–108. https://doi.org/10.1017/S0954579409990289
*Dadds, M. R., Mullins, M. J., McAllister, R. A., & Atkin-
son, E. (2003). Attributions, affect, and behavior in
abuse-risk mothers: A laboratory study. Child Abuse and
Neglect, 27, 21–45. https://doi.org/10.1016/S0145-2134
(02)00510-0
* Darwish, D.( 1999). A comparison of maltreated and
non-maltreated preschoolers’ social skills and play in
peer interactions. Doctoral dissertation. Fordham
University, New York, NY.
*de Pa ul, J., & Arruabarrena, M. I. (1995). Behavior prob-
lems in school-aged physically abused and neglected
children in Spain. Child Abuse and Neglect, 19, 409–418.
https://doi.org/10.1016/0145-2134(95)00009-W
*Delker, B. C., Noll, L. K., Kim, H. K., & Fisher, P. A.
(2014). Maternal abuse history and self-regulation diffi-
culties in preadolescence. Child Abuse and Neglect, 38,
2033–2043. https://doi.org/10.1016/j.chiabu.2014.10.
014
*Dileo, J. F., Brewer, W., Northam, E., Yucel, M., &
Anderson, V. (2017). Investigating the neurodevelop-
mental mediators of aggression in children with a his-
tory of child maltreatment: An exploratory field study.
Child Neuropsychology, 23, 655–677. https://doi.org/10.
1080/09297049.2016.1186159
Docherty, M., Kubik, J., Herrera, C. M., & Boxer, P.
(2018). Early maltreatment is associated with greater
risk of conduct problems and lack of guilt in adoles-
cence. Child Abuse and Neglect, 79, 173–182. https://doi.
org/10.1016/j.chiabu.2018.01.032

Eisenberg, N., Fabes, R. A., Shepard, S. A., Guthrie, I. K.,
Murphy, B. C., & Reiser, M. (1999). Parental reactions
to children's negative emotions: Longitudinal relations
to quality of children's social functioning. Child Develop-
ment, 70, 513–534. https://doi.org/10.1111/1467-8624.
00037
Eisenberg, N., Gershoff, E. T., Fabes, R. A., Shepard, S. A.,
Cumberland, A. J., Losoya, S. H., & Murphy, B. C.
(2001). Mother's emotional expressivity and children's
behavior problems and social competence: Mediation
through children's regulation. Developmental Psychology,
37, 475–490. https://doi.org/10.1037/0012-1649.37.4.475
*Ewing-Cobbs, L., Prasad, M., Kramer, L., & Landry, S.
(2000). Inflicted traumatic brain injury: Relationship of
developmental outcome to severity of injury. Pediatric
Neurosurgery, 31, 251–258. https://doi.org/10.1159/
000028872
*Finzi, R., Har-Even, D., Shnit, D., & Weizman, A. (2002).
Psychosocial characterization of physically abused chil-
dren from low socioeconomic households in compar-
ison to neglected and nonmaltreated children. Journal of
Child and Family Studies, 11, 441–453. https://doi.org/
10.1023/A:1020983308496
*Finzi, R., Har-Even, D., & Weizman, A. (2003). Compar-
ison of ego defenses among physically abused children,
neglected, and non-maltreated children. Comprehensive
Psychiatry, 44, 388–395. https://doi.org/10.1016/S0010-
440X(03)00106-8
*Ghirmay, M.( 2015). Three potential mediators of the
effects of child abuse and neglect on smoking in middle
adulthood. Doctoral dissertation, The City University of
New York.
*Gordis, E. B., Feres, N., Olezeski, C. L., Rabkin, A. N., &
Trickett, P. K. (2009). Skin conductance reactivity and
respiratory sinus arrhythmia among maltreated and
comparison youth: Relations with aggressive behavior.
Journal of Pediatric Psychology, 35, 547–558.
Gottman, J. M., Katz, L. F., & Hooven, C. (1996). Parental
meta-emotion philosophy and the emotional life of
families: Theoretical models and preliminary data. Jour-
nal of Family Psychology, 10, 243–268. https://doi.org/
10.1037/0893-3200.10.3.243
Gross, J. J. (1998). The emerging field of emotion regula-
tion: An integrative review. Review of General Psychol-
ogy, 2, 271–299. https://doi.org/10.1037/1089-2680.2.3.
271
Gross, J. J., & Feldman Barrett, L. (2011). Emotion genera-
tion and emotion regulation: One or two depends on
your point of view. Emotion Review, 3, 8–16. https://d
oi.org/10.1177/1754073910380974
Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion regu-
lation, and psychopathology: An affective perspective.
Psychological Science, 2, 387–410. https://doi.org/10.
1177/2167702614536164
Gross, J. J., & Thompson, R. A. (2007). Emotion regula-
tion: Conceptual foundations. In J. J. Gross (Ed.), Hand-
book of emotion regulation (pp. 3–24). New York, NY:
Guilford.
Emotion in Maltreated Children 19
Grych, J. H., & Fincham, F. D. (1990). Marital conflict and
children's adjustment: A cognitive-contextual frame-
work. Psychological Bulletin, 108, 267–290. https://doi.
org/10.1037/0033-2909.108.2.267
* Harris, L. S.( 2010). Influence of maltreatment on execu-
tive functions that underlie problem solving. Doctoral
dissertation. University of California, Davis.
*Haskett, M. E. (1990). Social problem-solving skills of
young physically abused children. Child Psychiatry and
Human Development, 21, 109–118. https://doi.org/10.
1007/BF00706119
*Haskett, M. E., Allaire, J. C., Kreig, S., & Hart, K. C.
(2008). Protective and vulnerability factors for physi-
cally abused children: Effects of ethnicity and parenting
context. Child Abuse and Neglect, 32, 567–576. https://d
oi.org/10.1016/j.chiabu.2007.06.009
Hedges, L. V., & Vevea, J. L. (1998). Fixed-and random-
effects models in meta-analysis. Psychological Methods,
3, 486–504. https://doi.org/10.1037/1082-989X.3.4.486
*Hennessy, K. D., Rabideau, G. J., Cicchetti, D., & Cum-
mings, E. M. (1994). Responses of physically abused
and nonabused children to different forms of interadult
anger. Child Development, 65, 815–828. https://doi.org/
10.2307/1131420
*Herrenkohl, T. I., Klika, J. B., Herrenkohl, R. C., Russo,
M. J., & Dee, T. (2012). A prospective investigation of
the relationship between child maltreatment and indi-
cators of adult psychological well-being. Violence and
Victims, 27, 764776. https://doi.org/10.1891/0886-6708.
27.5.764
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman,
D. G. (2003). Measuring inconsistency in meta-analyses.
British Medical Journal, 327, 557–560. https://doi.org/
10.1136/bmj.327.7414.557
*Hjorth, C. W., & Ostrov, E. (1982). The self-image of
physically abused adolescents. Journal of Youth and Ado-
lescence, 11, 71–76. https://doi.org/10.1007/BF01834704
Hobbs, C. J., & Wynne, J. M. (2002). Neglect of neglect.
Current Paediatrics, 12, 144–150. https://doi.org/10.
1054/cupe.2001.0266
*Houck, G. M., & King, M. C. (1993). Cognitive function-
ing, and behavioral and emotional adjustment in mal-
treated children post-intervention. Journal of Child and
Adolescent Psychiatric Nursing, 6, 5–17. https://doi.org/
10.1111/j.1744-6171.1993.tb00154.x
*Jaffee, S. R., Caspi, A., Moffitt, T. E., & Taylor, A. (2004).
Physical maltreatment victim to antisocial child: Evi-
dence of an environmentally mediated process. Journal
of Abnormal Psychology, 113, 44–55. https://doi.org/10.
1037/0021-843X.113.1.44
Johnson, B. T., & Eagly, A. H. (2000). Quantitative synthe-
sis of social psychological research. CHIP Documents.
Retrieved from http://digitalcommons.uconn.edu/
chip_docs/13
*Keil, V., & Price, J. M. (2009). Social information-process-
ing patterns of maltreated children in two social
domains. Journal of Applied Developmental Psychology, 30,
43–52. https://doi.org/10.1016/j.appdev.2008.10.003
20 Lavi, Katz, Ozer, and Gross
Kempe, C. H., Silverman, F. N., Steele, B. F., Droege-
mueller, W., & Silver, H. K. (1962). The battered
child syndrome. Journal of the American Medical Associa-
tion, 181, 17–24. https://doi.org/10.1001/jama.1962.
03050270019004
*Kim, J., & Cicchetti, D. (2010). Longitudinal pathways
linking child maltreatment, emotion regulation, peer
relations, and psychopathology. Journal of Child Psychol-
ogy and Psychiatry, 51, 706–716. https://doi.org/10.
1111/j.1469-7610.2009.02202.x
*Kinard, E. (1980). Emotional development in physically
abused children. American Journal of Orthopsychiatry, 50,
686–696. https://doi.org/10.1111/j.1939-0025.1980.tb
03332.x
*Klorman, R., Cicchetti, D., Thatcher, J. E., & Ison, J. R.
(2003). Acoustic startle in maltreated children. Journal of
Abnormal Child Psychology, 31, 359–370. https://doi.
org/10.1023/A:1023835417070
*Koenig, A. L., Cicchetti, D., & Rogosch, F. A. (2000).
Child compliance/noncompliance and maternal con-
tributors to internalization in maltreating and nonmal-
treating dyads. Child Development, 71, 1018–1032.
https://doi.org/10.1111/1467-8624.00206
*Lansford, J. E., Dodge, K. A., Pettit, G. S., Bates, J. E.,
Crozier, J., & Kaplow, J. (2002). Long-term effects of
early child physical maltreatment on psychological,
behavioral, and academic problems in adolescence: A
12-year prospective study. Archives of Pediatrics and
Adolescent Medicine, 156, 824–830. https://doi.org/10.
1001/archpedi.156.8.824
Lau, J., Ioannidis, J. P. A., Terrin, N., Schmid, C. H., &
Olkin, I. (2006). Evidence based medicine: The case of
the misleading funnel plot. British Medical Journal,
333, 597–600. https://doi.org/10.1136/bmj.333.7568.
597
Lavi, I., Manor-Binyamini, I., Seibert, E., Katz, L. F., Ozer,
E. J., & Gross, J. J. (2019). Broken bonds: A meta-analy-
sis of emotion reactivity and regulation in emotionally
maltreating parents. Child Abuse and Neglect, 88, 376–
388. https://doi.org/10.1016/j.chiabu.2018.11.016
Lavi, I., Ozer, E. J., Katz, L. F., & Gross, J. J. (in submis-
sion). The role of parental emotion reactivity and regu-
lation in child maltreatment: A meta-analytic review.
Leeb, R. T., Paulozzzi, L., Melanson, C., Simon, T., &
Arias, I. (2008). Child maltreatment surveillance: Uniform
definitions for public health and recommended data elements.
Atlanta, GA: Centers for Disease Control and Preven-
tion, National Center for Injury Prevention and Con-
trol.
Lipsey, M. W., & Wilson, D. B. (2001). Applied social
research methods series: Practical meta-analysis (Vol. 49).
Thousand Oaks, CA: Sage.
Lunkenheimer, E. S., Shields, A. M., & Cortina, K. S.
(2007). Parental emotion coaching and dismissing in
family interaction. Social Development, 16, 232–248.
https://doi.org/10.1111/j.1467-9507.2007.00382.x
Lyons-Ruth, K., & Jacobvitz, D. (2016). Attachment disor-
ganization from infancy to adulthood: Neurobiological
correlates, parenting contexts, and pathways to disor-
der. In J. Cassidy & P. R. Shaver (Eds.), Handbook of
attachment: Theory, research, and clinical applications (Vol.
3, pp. 667–695). New York, NY: Guilford.
*Ma, E. Y. M., & Li, F. W. S. (2014). Developmental
trauma and its correlates: A study of Chinese children
with repeated familial physical and sexual abuse in
Hong Kong. Journal of Traumatic Stress, 27, 454–460.
https://doi.org/10.1002/jts.21944
*Main, M., & George, C. (1985). Responses of abused and
disadvantaged toddlers to distress in agemates: A
study in the day care setting. Developmental Psychology,
21, 407–412. https://doi.org/10.1037/0012-1649.21.3.
407
Main, M., & Hesse, E. (1990). Parents’ unresolved trau-
matic experiences are related to infant disorganized
attachment status: Is frightened and/or frightening par-
ental behavior the linking mechanism? In M. T. Green-
berg, D. Cicchetti, & E. M. Cummings (Eds.),
Attachment in the preschool years: Theory, research, and
intervention (pp. 161–182). Chicago, IL: University of
Chicago.
Main, M., Kaplan, N., & Cassidy, J.( 1985). Security in
infancy, childhood, and adulthood: A move to the level
of representation. Monographs of the Society for Research
in Child Development, 50(1-2), 66 – 104. https://doi.org/
10.2307/3333827
*Manly, J. T., Kim, J. E., Rogosch, F. A., & Cicchetti, D.
(2001). Dimensions of child maltreatment and chil-
dren's adjustment: Contributions of developmental
timing and subtype. Development and Psychopathology,
13, 759–782.
*Maughan, A., & Cicchetti, D. (2002). Impact of child mal-
treatment and interadult violence on children's emotion
regulation abilities and socioemotional adjustment.
Child Development, 73, 1525–1542. https://doi.org/10.
1111/1467-8624.00488
* McGinn, H. C.( 2014). The role of paternal emotion
socialization in the development of children's emotion
regulation in the context of physical maltreatment. Doc-
toral disertation. Ontario Institute for Studies in Educa-
tion of the University of Toronto.
*McLaughlin, K. A., Peverill, M., Gold, A. L., Alves, S., &
Sheridan, M. A. (2015). Child maltreatment and neural
systems underlying emotion regulation. Journal of the
American Academy of Child & Adolescent Psychiatry, 54,
753–762. https://doi.org/10.1016/j.jaac.2015.06.010
Mikulincer, M., & Shaver, P. R. (2007). Attachment in
adulthood: Structure, dynamics, and change. New York,
NY: Guilford.
Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attach-
ment theory and affect regulation: The dynamics,
development, and cognitive consequences of attach-
ment-related strategies. Motivation and Emotion, 27, 77–
102. https://doi.org/10.1023/A:1024515519160
* Milojevich, H. M.( 2016). The role of maltreatment in
the development of emotion regulation. Doctoral dis-
sertation. University of California, Irvine, Irvine, CA.

*Moretti, M. M., & Craig, S. G. (2013). Maternal versus
paternal physical and emotional abuse, affect regulation
and risk for depression from adolescence to early adult-
hood. Child Abuse and Neglect, 37, 4–13. https://doi.
org/10.1016/j.chiabu.2012.09.015
Paolucci, E. O., Genuis, M. L., & Violato, C.( 2001). A
meta-analysis of the published research on the effects
of child sexual abuse. Journal of Psychology , 135 , 17–36.
https://doi.org/10.1080/00223980109603677
Parke, R. D., Cassidy, J., Burks, V. M., Carson, J. L., &
Boyum, L. (1992). Familial contribution to peer compe-
tence among young children: The role of interactive
and affective processes. In R. D. Parke & G. W. Ladd
(Eds.), Family-peer relationships: Modes of linkage (pp.
107–134). Hillsdale, NJ: Erlbaum.
Pollak, S. D., Messner, M., Kistler, D. J., & Cohn, J. F.
(2009). Development of perceptual expertise in emotion
recognition. Cognition, 110, 242–247. https://doi.org/
10.1016/j.cognition.2008.10.010
*Reidy, T. J. (1977). The aggressive characteristics of
abused and neglected children. Journal of Clinical Psychol-
ogy, 33, 1140–1145. https://doi.org/10.1002/1097-4679
(197710)33:4<1140:AID-JCLP2270330449>3.0.CO;2-G
Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky
families: Family social environments and the mental
and physical health of offspring. Psychological Bulletin,
128, 330–366. https://doi.org/10.1037/0033-2909.128.2.
330
*Robinson, L. R., Morris, A. S., Heller, S. S., Scheeringa,
M. S., Boris, N. W., & Smyke, A. T. (2009). Relations
between emotion regulation, parenting, and psy-
chopathology in young maltreated children in out of
home care. Journal of Child and Family Studies, 18, 421–
434. https://doi.org/10.1007/s10826-008-9246-6
Rosenthal, R. (1994). Parametric measures of effect size.
In H. Cooper & L. V. Hedges (Eds.), The handbook of
research synthesis (pp. 231–244). New York, NY: Russell
Sage Foundation.
Schatz, J. N., & Burke-Lefever, J. (2003). Understanding
maltreatment: The interplay between mothers’ parent-
ing orientations and children's vulnerability. Paper pre-
sented at the Gatlinburg Conference on Research and
Theory in Intellectual and Developmental Disabilities,
Annapolis, MD.
*Schatz, J. N., Smith, L. E., Borkowski, J. G., Whitman, T.
L., & Keogh, D. A. (2008). Maltreatment risk, self-regu-
lation, and maladjustment in at-risk children. Child
Abuse and Neglect, 32, 972–982. https://doi.org/10.
1016/j.chiabu.2008.09.001
*Schofield, T. J., Conger, R. D., & Conger, K. J. (2017).
Disrupting intergenerational continuity in harsh parent-
ing: Self-control and a supportive partner. Development
and Psychopathology, 29, 1279–1287. https://doi.org/10.
1017/S0954579416001309
Scott, S., & O'Connor, T. G. (2012). An experimental test
of differential susceptibility to parenting among emo-
tionally-dysregulated children in a randomized con-
trolled trial for oppositional behavior. Journal of Child
Emotion in Maltreated Children 21
Psychology and Psychiatry, 53, 1184–1193. https://doi.
org/10.1111/j.1469-7610.2012.02586.x
Shaver, P. R., & Mikulincer, M. (2014). Adult attachment
and emotion regulation. In J. J. Gross (Ed.), Handbook of
emotion regulation (pp. 237–250). New York, NY: Gil-
ford.
*Shenk, C. E., Griffin, A. M., & O'Donnell, K. J. (2015).
Symptoms of major depressive disorder subsequent to
child maltreatment: Examining change across multiple
levels of analysis to identify transdiagnostic risk path-
ways. Development and Psychopathology, 27, 1503–1514.
https://doi.org/10.1017/S0954579415000905
*Shenk, C. E., Noll, J. G., & Cassarly, J. A. (2010). A mul-
tiple mediational test of the relationship between child-
hood maltreatment and non-suicidal self-injury. Journal
of Youth and Adolescence, 39, 335–342. https://doi.org/
10.1007/s10964-009-9456-2
*Shenk, C. E., Putnam, F. W., Rausch, J. R., Peugh, J. L.,
& Noll, J. G. (2014). A longitudinal study of several
potential mediators of the relationship between child
maltreatment and posttraumatic stress disorder symp-
toms. Development and Psychopathology, 26, 81–91.
https://doi.org/10.1017/S0954579413000916
Shields, A. M., & Cicchetti, D. (1995). The development of
an emotion regulation assessment battery: Reliability
and validity among at-risk grade-school children. Paper
presented at the Society for Research in Child Develop-
ment, Indianapolis, IN.
Shields, A. M., & Cicchetti, D. (1997). Emotion regulation
among school-age children: The development and vali-
dation of a new criterion Q-sort scale. Developmental
Psychology, 33, 906–916. https://doi.org/10.1037/0012-
1649.33.6.906
*Shields, A. M., & Cicchetti, D. (1998). Reactive aggres-
sion among maltreated children: The contributions of
attention and emotion dysregulation. Journal of Clinical
Child Psychology, 27, 381–395. https://doi.org/10.1207/
s15374424jccp2704_2
*Shields, A. M., & Cicchetti, D. (2001). Parental maltreat-
ment and emotion dysregulation as risk factors for bul-
lying and victimization in middle childhood. Journal of
Clinical Child Psychology, 30, 349–363. https://doi.org/
10.1207/s15374424jccp1801_9
* Shipman, K. L.( 1990). The socialization of affect man-
agement skills: A developmental psychopathology per-
spective. Doctoral dissertation. University of Maine.
*Shipman, K. L., Edwards, A., Brown, A., Swisher, L., &
Jennings, E. (2005). Managing emotion in a maltreating
context: A pilot study examining child neglect. Child
Abuse and Neglect, 29, 1015–1029. https://doi.org/10.
1016/j.chiabu.2005.01.006
*Shipman, K. L., & Zeman, J. (2001). Socialization of chil-
dren's emotion regulation in mother–child dyads: A
developmental psychopathology perspective. Develop-
ment and Psychopathology, 13, 317–336. https://doi.org/
10.1017/S0954579401002073
*Skowron, E. A., Cipriano-Essel, E., Gatzke-Kopp, L. M.,
Teti, D. M., & Ammerman, R. T. (2014). Early
22 Lavi, Katz, Ozer, and Gross
adversity, RSA, and inhibitory control: Evidence of chil-
dren's neurobiological sensitivity to social context.
Developmental Psychobiology, 56, 964–978. https://doi.
org/10.1002/dev.21175
*Smith, M., & Walden, T. (1999). Understanding feelings
and coping with emotional situations: A comparison of
maltreated and nonmaltreated preschoolers. Social
Development, 8, 93–116. https://doi.org/10.1111/1467-
9507.00082
StataCorp. (2017). Stata statistical software: Release 15. Col-
lege Station, TX: StataCorp LLC.
Stith, S. M., Liu, T., Davies, L. C., Boykin, E. L., Alder, M.
C., Harris, J. M., & Dees, J. (2009). Risk factors in child
maltreatment: A meta-analytic review of the literature.
Aggression and Violent Behavior, 14, 13–29. https://doi.
org/10.1016/j.avb.2006.03.006
Stoddart, R. M. (1993). Social cognitive skills, social
adjustment and perceived competence in maltreated
preschoolers. Paper presented at the Biennial Meeting
of the Society for Research in Child Development, New
Orleans, LA.
Straus, M. A. (1979). Measuring intrafamily conflict and
violence: The conflict tactics (CT) scales. Journal of Mar-
riage and the Family, 41, 75–88. https://doi.org/10.
2307/351733
Straus, M. A., Hamby, S. L., & Warren, W. L. (2003). The
conflict tactics scales handbook. Los Angeles, CA: Western
Psychological Services.
*Teisl, M., & Cicchetti, D. (2008). Physical abuse, cognitive
and emotional processes, and aggressive/disruptive
behavior problems. Social Development, 17, 1–23.
https://doi.org/10.1111/j.1467-9507.2007.00412.x
Van Ijzendoorn, M. H., Schuengel, C., & Bakermans-
Kranenburg, M. J. (1999). Disorganized attachment in
early childhood: Meta-analysis of precursors,
concomitants, and sequelae. Development and Psy-
chopathology, 11, 225–250. https://doi.org/10.1017/
S0954579499002035
* Veloz, C. Y.( 2005). Play behaviors and social skills
among maltreated foster children. Doctoral dissertation.
Fordham University, New York. NY.
* Vorderstrasse, V. M.( 2013). Hostile attribution biases
and problematic peer relationships in physically abused
school-age children. Doctoral dissertation. Department
of Psychology, Roosevelt University.
Waters, H. S., Rodrigues, L. M., & Ridgeway, D. (1998).
Cognitive underpinnings of narrative attachment
assessment. Journal of Experimental Child Psychology, 71,
211–234. https://doi.org/10.1006/jecp.1998.2473
*Young, J. C., & Widom, C. S. (2014). Long-term effects of
child abuse and neglect on emotion processing in adult-
hood. Child Abuse and Neglect, 38, 1369–1381. https://d
oi.org/10.1016/j.chiabu.2014.03.008
Supporting Information
Additional supporting information may be found in
the online version of this article at the publisher’s
website:
Appendix S1. Summary of Theories of Emotion
Regulation and Maltreatment
Appendix S2. Search Phrases, Details Regarding
Search and Criteria, and Variables Coded From
Each Study
Appendix S3. Emotion Reactivity and Emotion
Regulation Scales
Appendix S4. Sensitivity Analysis
Appendix S5. Flow Diagram
Appendix S6. Descriptive Data of Studies
Included
Appendix S7. Forest Plots of Meta-Analysis
Results
Appendix S8. Funnel Plot of Effect Sizes of
Meta-Analysis