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Emotion Regulation in Children With Anxiety Disorders

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Journal of Clinical Child and Adolescent Psychology Copyright © 2004 by
2004, Vol. 33, No. 4, 750–759 Lawrence Erlbaum Associates, Inc.

Emotion Regulation in Children With Anxiety Disorders

Cynthia Suveg and Janice Zeman
Department of Psychology, University of Maine

This study examined emotion management skills in addition to the role of emotional
intensity and self-efficacy in emotion regulation in 26 children with anxiety disorders
(ADs) ages 8 to 12 years and their counterparts without any form of psychopathology.
Children completed the Children’s Emotion Management Scales (CEMS) and Emo-
tion Regulation Interview (ERI), and mothers reported on their children’s emotion
regulation using the Emotion Regulation Checklist (ERC). Results indicated that chil-
dren who met Diagnostic and Statistical Manual for Mental Disorders (4th ed., Amer-
ican Psychiatric Association, 1994) criteria for an anxiety disorder had difficulty
managing worried, sad, and anger experiences, potentially due to their report of ex-
periencing emotions with high intensity and having little confidence in their ability to
regulate this arousal. These findings indicate that emotion regulation needs to be con-
sidered centrally in research with anxious populations.

A considerable body of research has identified
emotional competence, the ability to act efficaciously
in emotionally arousing situations, as a crucial com-
ponent in children’s adaptive social functioning and
psychological adjustment (Cicchetti, Ackerman, &
Izard, 1995; Eisenberg & Fabes, 1992; Eisenberg,
Fabes, & Losoya, 1997; Hubbard & Coie, 1994;
Saarni, 1999). From a functionalist theoretical per-
spective, one skill posited to underlie emotionally
competent functioning is the ability to regulate emo-
tion in flexible and adaptive ways in response to the
demands of the social context (Campos, Mumme,
Kermoian, & Campos, 1994).
Despite the growing body of empirical research that
has investigated emotion-regulation skills in normative
populations (for a review, see Saarni, 1999), relatively
little research has examined these abilities in atypical
populations. In their review of emotion understanding
and regulation, Southam-Gerow and Kendall (2002)
highlighted that only a few studies have examined
emotion understanding and regulation in children with
psychopathology. This is surprising given that aspects
of emotion regulation have been posited to play a role
in most forms of psychopathology (Casey, 1996;
Cicchetti et al., 1995; Cole, Michel, & O’Donnell-Teti,
1994).
Cynthia Suveg is now at the Department of Psychology, Temple
University.
This article is part of the first author’s doctoral dissertation. We
would like to thank Philip Kendall for his helpful comments on an
earlier draft of the article.
Requests for reprints should be sent to Cynthia Suveg, Child
and Adolescent Anxiety Disorders Clinic, Temple University,
Weiss Hall, 1701 N. 13th Street, Philadelphia, PA 19122. E-mail:
csuveg@temple.edu
Although the literature examining emotion regula-
tion in children with psychopathology is scant, a few
findings are beginning to emerge (e.g., Casey, 1996;
Suveg, Zeman, & Stegall, 2001; Southam-Gerow &
Kendall, 2000; Zeman, Shipman, & Suveg, 2002). For
example, using self-report questionnaires and peer rat-
ings, Zeman et al. examined the predictive relation be-
tween anger and sadness regulation and internalizing
and externalizing symptoms in a community sample of
elementary school age children. Results of regression
analyses indicated that the inability to identify emo-
tional states, the inhibition of anger, the dysregulated
expression of anger and sadness, and maladaptive an-
ger coping were significant predictors of internalizing
symptoms. In contrast, dysregulated sadness expres-
sion and maladaptive coping with anger were related to
externalizing symptoms. Suveg et al. assessed fourth-
and fifth-grade children’s self-report of anxious symp-
toms and methods of emotion regulation across fear-,
sadness-, and anger-invoking situations. Results re-
vealed that children who reported experiencing anx-
ious symptoms relied mostly on inhibited and dys-
regulated methods to manage their scared, sad, and
angry feelings to the neglect of adaptive regulation
strategies. Furthermore, Southam-Gerow and Kendall
found that children with anxiety disorders (ADs) dem-
onstrated less understanding of emotional dissem-
blance and fluctuating emotional experiences com-
pared to youth with no anxiety disorders.
Two additional components of emotion regulation
that have been investigated, albeit mostly with norma-
tive populations, are intensity of emotional experience
and self-efficacy. Although an optimal level of arousal is
believed to facilitate performance in a situation, re-
search suggests that high arousal may lead to over- or

750
 EMOTION REGULATION IN ANXIOUS CHILDREN
under-control of emotional experience, both of which
have been inversely associated with social and emo-
tional competence (Bradley, 1990; Cole et al., 1994;
Eisenberg, Cumberland, & Spinrad, 1998). Although
both positive and negative emotional overarousal is as-
sociated with less adaptive responding, negative emo-
tions tend to produce greater levels of arousal than posi-
tive emotions (Bradley, 2000; Cacioppo, Berntson,
Larsen, Poehlmann, & Ito, 2000). The preponderance of
negative emotional experience that is a central compo-
nent of childhood anxiety (Blumberg & Izard, 1986;
Laurent et al., 1999) and the physiological hyperarousal
that is a distinguishing feature of anxiety (Clark & Wat-
son, 1991) place anxious children at significant risk for
emotion-regulation difficulties that extend beyond the
ability to manage anxious experiences.
Self-efficacy is another factor that is likely to affect
children’s emotion regulation in that children who
have a greater sense of self-efficacy are likely to perse-
vere (Bradley, 2000). When applied to emotion regula-
tion in particular, children with low self-efficacy may
not be likely to try different strategies to manage emo-
tionally arousing situations. Research has found trait
anxiety in children to be associated with low levels
of self-efficacy (Muris, 2002). Furthermore, research
with anxious children indicates that they tend to with-
draw from or avoid emotionally arousing situations,
suggesting that they may have low self-efficacy in
those situations (Barrett, Rapee, Dadds, & Ryan, 1996;
Suveg et al., 2001).
The aforementioned literature suggests that chil-
dren with ADs may be a particularly useful population
in which to study certain facets of emotion regulation
(for further discussion of emotion regulation and child-
hood anxiety, see Thompson, 2001). Indeed, examina-
tion of emotion-regulation skills in anxious children
may help identify emotion-related processes that con-
tribute to the ontology or maintenance of childhood
anxiety. Thus, the goal of this study was to examine
methods of emotion regulation (i.e., dysregulated ex-
pression, inhibition, coping) and components thereof
(i.e., self-efficacy, degrees of intensity) in children
with ADs. To address limitations of previous studies,
we used rigorous diagnostic procedures, investigated
specific emotions (i.e., worry, sadness, anger) instead
of studying global negative emotional states, obtained
mother report of children’s emotion regulation, consid-
ered the influence of maternal psychopathology on
maternal report of children’s behavior given that this
variable may influence parents’ reports of children’s
behavior (cf. Richters, 1992; Schaughency & Lahey,
1985), and established that participants had the requi-
site verbal ability to respond to the study questions.
Consistent with the functionalist perspective, the in-
dividual emotions of worry, sadness, and anger were
chosen for study because much of the research with
anxious children has examined anxiety-provoking situ-
ations or emotions along more global dimensions (e.g.,
tripartite model of anxiety and depression; Chorpita,
2002; Chorpita, Albano, & Barlow, 1998; Lonigan,
Hooe, David, & Kistner, 1999). Child sex was included
as a variable because the emotional development litera-
ture suggests that children’s emotion-regulation deci-
sions vary according to the child’s sex (Brody & Hall,
2000; Saarni, 1999; Zeman & Garber, 1996). Given
that children develop stylized ways of managing emo-
tional experiences in middle childhood, children in the
third through fifth grades were selected (Cole &
Kaslow, 1988). The vignettes developed for this study
included the mother as the audience figure, because
children of this age group report being most comfort-
able expressing emotions to their mothers compared to
fathers and peers (Saarni, 1999; Zeman & Garber,
1996).
Based on the literature, it was hypothesized that, in
contrast to their peers without an anxiety disorder
(NADs), children with an AD would (a) display more
maladaptive patterns (i.e., more inhibition and
dysregulated expression and less adaptive coping) of
worry, sadness, and anger; (b) report experiencing
higher levels of emotional intensity; and (c) perceive
themselves as less efficacious in emotionally arousing
situations. Lastly, it was hypothesized that emotional
intensity would be negatively related to children’s re-
ported emotion-regulation decisions.
Method
Participants
Participants were 52 Caucasian children between
the ages of 8 and 12 years and their biological mothers
who were primarily of middle-class socioeconomic
status (SES). The AD group included 12 boys (M age =
10 years, 1 month, SD = 10 months) and 14 girls (M
age = 10 years, 10 months, SD = 10 months) who were
recruited from public elementary schools. Psychologi-
cal diagnoses were made using mother and child report
of symptoms on the Anxiety Disorder Interview
Schedule for Children–Fourth Edition (ADIS–IV), re-
sulting in the following principal diagnoses: separation
anxiety disorder (4 girls, 5 boys), social phobia (6 girls,
1 boy), generalized anxiety disorder (3 girls, 5 boys),
and specific phobia (1 girl, 1 boy). Given the high
comorbidity among the anxiety disorders (Albano,
Chorpita, & Barlow, 1996; Brady & Kendall, 1992),
children with multiple anxiety disorders were included.
Eight boys and 10 girls in the AD group had a comorbid
anxiety diagnosis, and 3 boys and 2 girls had a comorbid
externalizing disorder (i.e., oppositional defiant disor-
der, attention deficit hyperactivity disorder).
The NAD group included 12 boys (M age = 10
years, 4 months, SD = 12 months) and 14 girls (M age =
751
 SUVEG AND ZEMAN
10 years, 9 months, SD = 8 months). Children in the
control group scored within the normative range on
both the Children’s Depression Inventory (CDI) and
Revised Children’s Manifest Anxiety Scale (RCMAS)
and did not meet diagnostic criteria for a psychological
disorder based on the ADIS–IV. Analyses of variance
(ANOVAs) examining group and sex effects on age re-
vealed a significant sex main effect indicating that girls
(M = 10 years, 10 months, SD = 9 months) were signifi-
cantly older than boys (M = 10 years, 3 months, SD = 1
year, 0 months), F(1, 48) = 5.79, p < .05, η2 = .11.
Measures
Psychopathology
ADIS–IV. The ADIS–IV (Silverman & Albano,
1996) consists of child and parent semistructured inter-
views that assess a broad range of anxiety, mood, and
behavior disorders according to the Diagnostic and
Statistical Manual of Mental Disorders (4th ed.
[DSM–IV], American Psychiatric Association, 1994)
criteria. Children were assigned a diagnosis if either
the child or the parent indicated that the symptoms
were causing significant interference in functioning
and the clinician subsequently assigned a severity rat-
ing of 4 or greater (as suggested in the clinician’s man-
ual of the ADIS–IV, Child and Parent Versions; Albano
& Silverman, 1996). The psychometric properties of
the ADIS–IV indicate acceptable reliability and valid-
ity (Silverman & Albano, 1996; Silverman & Nelles,
1988; Silverman, Saavedra, & Pina, 2001; Wood,
Piacentini, Bergman, McCracken, & Barrios, 2002).
An advanced graduate student blind to diagnostic
status rated approximately one third of randomly se-
lected audiotaped interviews to establish diagnostic re-
liability. The kappa value for principal diagnosis
was .89. Disagreements on diagnosis were resolved
through discussion.
RCMAS. The RCMAS (Reynolds & Richmond,
1997) is a 37-item questionnaire designed to assess
symptoms of anxiety in children and adolescents. The
psychometric properties of the RCMAS have been ex-
tensively studied with adequate internal consistency
established (Lonigan, Carey, & Finch, 1994; Pela &
Reynolds, 1982). A 2 (group) × 2 (sex) ANOVA indi-
cated that children in the AD group (M = 19.71, SD =
4.72) scored significantly higher on the RCMAS than
did children in the NAD group (M = 8.96, SD = 6.07),
F(1, 45) = 46.47, p < .0001, η2 = .51, with no signifi-
cant sex differences or interaction effects.
CDI. The CDI (Kovacs, 1992) is a 26-item ques-
tionnaire that assesses depressive symptomatology in
children over the past 2 weeks. Items are scored on a
752
3-point scale and summed to yield a total depression
score. The psychometric properties of the CDI have
been established (Carey, Gresham, Ruggiero, Faul-
stich, & Enyart, 1987; Kovacs, 1985). A 2 (group) × 2
(sex) ANOVA indicated children in the AD group (M =
15.21, SD = 8.50) scored significantly higher on the
CDI than did children in the NAD group (M = 6.36, SD
= 5.20), F(1, 45) = 18.71, p < .001, η2 = .29. A main ef-
fect for sex emerged such that girls (M = 12.57, SD =
9.79) endorsed more depressive symptoms than did
boys (M = 8.19, SD = 4.76), F(1, 45) = 4.81, p < .05, η2
= .10. There were no interaction effects.
Emotion Regulation
Children’s Emotion Management Scales (CEMS):
Anger and sadness. The CEMS (Zeman, Shipman,
& Penza-Clyve, 2001) assesses self-report of chil-
dren’s sadness (11 items) and anger (12 items) man-
agement. Using a Likert scale of 1 (hardly ever), 2
(sometimes), or 3 (often), children respond to items
that comprise three subscales: (a) Inhibition, suppres-
sion of emotional expression (e.g., “I get sad inside but
I don’t show it”); (b) Dysregulated Expression, chil-
dren’s culturally inappropriate emotional expression
(e.g., “I say mean things to others when I am mad”);
and (c) Emotion Regulation Coping, children’s adap-
tive methods of emotion management (e.g., “When I
am feeling sad, I do something totally different until I
calm down”). A Worry Management scale that has a
similar three-factor structure was developed for use in
this study. Preliminary validity has been established in
other research (Stegall, 2003) such that a total worry
score (Emotion Regulation Coping scale was inversely
scored) was found to be positively related with parent
and child report of internalizing and externalizing
symptomatology. Examination of the psychometric
properties of the CEMS indicate coefficient alphas that
range from .62 to .77 and test–retest reliability ranging
from .61 to .80 for the individual scales (Zeman et al.,
2001).
Emotion Regulation Checklist (ERC). The ERC
(Shields & Cicchetti, 1997) consists of 24 items that
assess parents’ perceptions of their child’s typical
methods of managing emotional experiences on a scale
of 1 (never) to 4 (always). The ERC yields two sub-
scales: (a) Lability/Negativity, which assesses inflexi-
bility, lability, and dysregulated negative affect (e.g.,
“Exhibits wide mood swings”) and (b) Emotion Regu-
lation, which measures appropriate emotional expres-
sion, empathy, and emotional self-awareness (e.g.,
“Can modulate excitement in emotionally arousing sit-
uations”). Reliability coefficients are high for the over-
all scale (.89) and for the two subscales (Lability/
Negativity = .96, Regulation = .83; Shields & Cicchet-
ti, 1997). Validity has been established through posi-
 EMOTION REGULATION IN ANXIOUS CHILDREN

tive correlations with observers’ ratings of children’s
regulatory abilities and the proportion of expressed
positive and negative affect (Shields & Cicchetti,
1997). Discriminant validity demonstrates that the
ERC can reliably be differentiated from other emo-
tion-related constructs (Shields & Cicchetti, 1997).
Emotion Regulation Interview (ERI). The ERI
was designed for use in this study to assess children’s
report of their emotional intensity and self-efficacy and
was modeled after previous research (e.g., Zeman &
Garber, 1996). Children were read six vignettes that
were designed through pilot testing to elicit worry, sad-
ness, and anger in the presence of their mother. Follow-
ing each vignette, children were asked three questions
that assessed their (a) decisions regarding emotional
expression (i.e., “Would you show how worried, sad,
or mad you feel to your mother?”), (b) emotional inten-
sity (i.e., “How worried, sad, or mad would you feel in
this situation?”), and (c) self-efficacy (i.e., “How much
would you be able to make yourself feel better in this
situation?”). Children responded to the questions using
a 4-point Likert scale. Their decision to show their
emotion was rated from 1 (definitely would) to 4 (defi-
nitely would not), and their perceived self-efficacy was
rated from 1 (a little) to 4 (a lot). For the intensity ques-
tion, children were shown a picture of a thermometer
and asked to indicate how worried, sad, or mad they
would feel (1 = not at all, 10 = very). Refer to the Ap-
pendix for the vignettes.
Descriptive Variables
SES. Mothers’ reported on their own and their
spouse’s (when applicable) level of education and cur-
rent occupation. Responses were coded using the Hol-
lingshead Four-Factor Index of Social Status (Hol-
lingshead, 1975) that yields five social status
categories. Higher numbers indicate higher level of
SES. The Hollingshead has been shown to have good
validity (Deonandan, Campbell, Ostbye, Tummon, &
Robertson, 2000).
Intellectual functioning. Children and their moth-
ers were administered the Vocabulary subtest of the
Wechsler Intelligence Scale for Children–Third Edition
(Wechsler, 1991) and the Wechsler Adult Intelligence
Scale–Third Edition (Wechsler, 1997), respectively.
These measures were included to determine that partici-
pants had sufficient verbal ability to understand the
questionnaire items and to ensure that there were no
group differences in verbal ability that could potentially
influence the validity of the findings. The Vocabulary
subtest has high reliability, provides the best measure of
general intelligence of the scale, and has the highest cor-
relation with the Full Scale IQ score of all subtests
(Wechsler, 1991, 1997). All children in this study, ex-
cept for 1 anxious boy and 1 anxious girl, had at least an
average-level score on this subtest (i.e., scaled score ≥
7). The low score for these children was attributed to per-
formance anxiety rather than below-average intelli-
gence. All mothers had at least an average-level score.
There were no significant group or sex main effects
or interactions on the descriptive variables of maternal
age, SES, or children’s and mothers’ verbal abilities.
See Table 1 for means and standard deviations for de-
scriptive variables.
Maternal psychopathology. The Symptom Check-
list–90–Revised (SCL–90–R; Derogatis, 1994) is a 90-
item questionnaire that assesses symptoms of adult
psychopathology using a 5-point Likert response scale
ranging from 0 (not at all) to 4 (extremely). Adequate re-
liability and validity have been established (Derogatis,
1994). Research has suggested that parental emotional
distress may impact parents’reports of child behavior in
terms of overall adjustment and symptoms of
psychopathology (cf. Richters, 1992; Schaughency &
Lahey, 1985). Thus, the SCL–90–R was administered to
determine whether mothers of children with an AD dif-

Table 1. Variables as a Function of Diagnostic Group and Sex

Anxiety Disorder Group Non-Anxiety-Disorder Group

Girls Boys Girls Boys

Variable M SD Range M SD Range M SD Range M SD Range

Child vocabulary 10.29 3.67 5–18 11.33 3.55 3–16 12.07 2.53 7–16 12.33 3.42 7–17
scorea
Mother vocabulary 10.92 3.45 6–17 11.27 3.44 7–17 11.14 3.51 5–16 11.25 1.54 9–14
scoreb
Family incomec 3.18 1.25 1–5 3.80 1.55 1–5 3.83 .94 2–5 3.64 .92 2–5
SCL–90–Rd 65.59 66.16 2–240 43.92 40.06 7–134 31.02 27.70 6–112 26.42 20.50 4–82

Note: SCL–90–R = Symptom Checklist–90–Revised. AD = anxiety disorder; NAD = no anxiety disorder.

aAssessed with the Vocabulary subtest of the Wechsler Adult Intelligence Scale–Third Edition; n = 26 for both groups. bAssessed with the Vocab-

ulary subtest of the Wechsler Adult Intelligence Scale–Third Edition; n = 23 for the AD group and n = 26 for the NAD group. cIndicating that, on
average, families in this study were of middle socioeconomic status; n = 21 for the AD group and n = 23 for the NAD group. n = 26 for both
groups.

753
 SUVEG AND ZEMAN
fered from mothers of children without an AD with re-
spect to their level of psychological distress. Results of a
one-way ANOVA revealed that mothers of children with
an AD (M = 55.59, SD = 55.71) reported a significantly
greater number of total symptoms of psychopathology
than mothers of children without an AD (M = 28.89, SD
= 24.28), F(1, 50) = 5.02, p < .05, η2 = .09.
Procedure
The study implemented a multiple gating procedure
to ensure that all children who participated were placed
into the correct diagnostic group (i.e., AD, NAD).
Gate A
Within the public school system, children and
mothers or guardians were invited to participate in the
first stage of this project. A total of 210 children pro-
vided verbal assent and had parental consent to partici-
pate. All of these children participated in a 30-min ses-
sion in their classrooms where they completed the
RCMAS and CDI in a group format. Two research as-
sistants attended each school screening. Children with
a T score ≥ 60 on the RCMAS were considered for in-
clusion in the AD group and those who scored within
the normative range were considered for inclusion in
the NAD group. Given the high correlation between
anxiety and depressive disorders (Brady & Kendall,
1992; Lonigan et al., 1994), children who scored in the
clinical range (7 girls, 1 boy) on the CDI in addition to
the RCMAS were considered for inclusion in the study.
However, children who scored in the clinical range on
the CDI but in the normative range on the RCMAS
were excluded from the study (2 girls, 1 boy).
Gate B
A research assistant who did not subsequently col-
lect Gate C data determined which children met these
initial screening requirements based on the RCMAS
and CDI results and called their mothers to solicit par-
ticipation in Gate C. Given that the RCMAS and CDI
are measures of distress and not necessarily indicative
of diagnostic status, an additional screening was con-
ducted over the phone to exclude children with a false
positive score on the anxiety and depression measures.
Families of children who met criteria to move on to
Gate C but declined (n = 5) were offered help in secur-
ing follow-up services if they so wished. Children who
did not meet the additional screening criteria (n = 8)
were not included in the study.
Gate C
Four graduate students who were blind to group sta-
tus and trained to administer the diagnostic interview
and questionnaires collected all data. The 2-hr data col-
754
Table 2. Dysregulation Scores by Group and Emotion Type
as Assessed by the Children’s Emotion Management Scales
Anxious Nonanxious
Emotion M SD M SD
Worry 1.60 .50 1.44 .46
Sadness 1.67 .57 1.45 .39
Anger 1.70 .46 1.44 .44
Note: Higher scores indicate more dysregulated expression of emo-
tion. n = 26 for each group across all emotions.
lection was conducted either at the participant’s home
(AD = 15, NAD = 12) or in the research laboratory (AD
= 11, NAD = 14), depending on the family’s prefer-
ence. Maternal and child interviews were conducted in
random order, and questionnaires were placed in pack-
ets in random order. Children and their mothers com-
pleted their questionnaires autonomously and received
assistance by a graduate student as needed.
Results
Data Analytic Strategy
Repeated-measures ANOVAs were conducted to
examine group, sex, and emotion differences on the
CEMS and ERI with ANOVAs utilized to examine
group and sex differences on the ERC. All F tests re-
ported represent Wilks’s lambda values. Bonferroni
corrections were applied when conducting all subse-
quent within-subjects contrasts to limit the experi-
ment-wise error rate to p < .05 (e.g., three tests compar-
ing the different emotions; .05/3 = .016). Measures of
effect size (i.e., eta-squared) were obtained for all anal-
yses where appropriate and interpreted according to
criteria suggested by Cohen (1988): (a) .01 to .05 =
small effect, (b) .06 to .13 = medium effect, and (c) .14
or larger = large effect.
Emotion Regulation Strategies1
Child-reported emotion regulation. Using the
Children’s CEMS, a significant group main effect
emerged for the Dysregulated scale, F(1, 48) = 5.35, p
< .05, η2 = .10, such that children with an AD reported
more dysregulated expression across all emotions than
did children in the NAD group. See Table 2 for means
and standard deviations.
A significant Emotion × Group interaction emerged
for the Inhibition scale, F(2, 47) = 1.30, p < .05, η2 =
.12. When the interaction was broken down, however,
1To determine that results on the CEMS, ERC, and ERI were not
driven by the comorbid externalizing disorders, analyses were rerun
without these participants’ data included and the results remained
statistically significant.
 EMOTION REGULATION IN ANXIOUS CHILDREN

the only finding to approach significance (p < .08) re-
vealed that children with an AD reported more inhibi-
tion of worry than did children with no AD.
Analyses examining the Emotion Regulation Cop-
ing scale revealed significant main effects for group,
F(1, 48) = 23.08, p < .0001, η2 = .33, and sex, F(1, 48) =
17.53, p < .0001, η2 = .27. Children with an AD and girls
reported less adaptive coping than did children without
an AD and boys. A significant main effect was also
found for Emotion, F(2, 47) = 4.11, p < .05, η2 = .15.
Subsequent within-subjects contrasts indicated that all
children indicated more adaptive coping with sadness
(M = 2.25, SD = .42) than with worry (M = 2.12, SD =
.36). Anger was not significantly different than either.
See Table 3 for means and standard deviations.
Mother report of child emotion regulation.
For analyses of the ERC data, the SCL–90–R total score
was entered as a covariate because correlational analy-
ses revealed significant relations between the
SCL–90–R Total score and the Negativity/Lability
scale (r = .40, p < .01) and the Regulation scale (r = –.42,
p < .01). A significant group main effect for the
Negativity/Lability subscale emerged, F(1, 46) = 14.90,
p < .0001, η2 = .25, such that mothers of ADs perceived
their children as more inflexible, labile, and emotionally
negative (adjusted M = 2.18, SD = .51) than mothers of
control children (adjusted M = 1.65, SD = .31). A group
main effect approached significance for the Regulation
subscale, F(1, 46) = 3.56, p = .07, η2 = .07. Mothers of
children with an AD rated their children significantly
lower on appropriate emotion expression and
self-awareness (adjusted M = 3.04, SD = .43) than did
mothers of children without an AD (adjusted M = 3.31,
SD = .27). No sex or interaction effects were found.
Emotional Intensity
To examine the hypothesis that children with an AD
would report experiencing higher levels of emotional
intensity than children without an AD in response to
emotionally arousing situations, global intensity scores
were computed for each of three emotions on the ERI by
obtaining a mean intensity score for the camp and sports
scenarios. A significant Group × Emotion interaction
emerged, F(2, 44) = 3.13, p < .05, η2 = .13, which was ex-
plicated by examining group differences within emo-
tion type. The results indicated that children with an AD
reported experiencing worry and anger more intensely
than control children with no differences for sadness.
See Table 4 for means and standard deviations.
The relation between emotional intensity and chil-
dren’s reported emotion-regulation decisions was ex-
amined by correlating the responses to the questions
from the ERI assessing intensity (i.e., “How worried,
sad, or mad would you feel if this really happened to
you?”) and regulation decisions (i.e., “Would you show
how worried, sad, or mad you feel to your mother?”).
Analyses were conducted separately by group status
only as there were no specific hypotheses by sex. For
the AD group, significant correlations were found for
the sadness and anger scenarios, whereas for the NAD
group, all three scenarios yielded significant correla-
tions (see Table 5). To examine whether the strength of
relation differed among the anxious and control
groups, Fisher’s r to z transformations were first calcu-
lated followed by two sample Z tests of correlation.
None of the transformations for any of the emotions
were significant.
Emotional Self-Efficacy
Global self-efficacy scores were computed by ob-
taining a mean score for the camp and sports scenarios
separately by emotion type (i.e.,“How much do you
Table 4. Children’s Self-Report of Intensity by Emotion
Type as Assessed by the ERI
Anxiousa Nonanxiousb
ERI Intensity
Question M SD M SD F Value η2
Worry 6.33 1.73 4.85 1.99 8.90** .15
Sadness 6.41 2.34 5.71 1.92 2.35 —
Anger 7.48 2.06 5.19 1.98 16.11*** .25
Note: ERI = Emotion Regulation Interview. Maximum score =
10.00 (1 = not at all, 10 = very). Dashes indicate that eta squared was
not computed as the differences between groups was not significant.
an = 23 for all emotions. bn = 26 for all emotions.

**p < .01. ***p < .0001.

Table 3. Coping Scores by Group, Sex, and Emotion Type

Table 5. Correlations Between Self-Reported Emotional
as Assessed by the Children’s Emotion Management Scales
Intensity Scores and Emotion Regulation Decisions by
Worry Sadness Anger Group
M SD M SD M SD Group Emotion r

Anxious 1.97a .29 2.08a .40 2.03 .44 Anxious Worry –.22
Nonanxious 2.26a .38 2.43a .35 2.39 .38 Sadness –.63**
Boys 2.26a .37 2.48a .41 1.99 .31 Anger –.43*
Girls 2.06a .32 2.32a .42 2.12 .49 Nonanxious Worry –.45*
Sadness –.55**
Note: Higher scores indicate more adaptive coping with emotion. n Anger –.59**
= 26 for each group across all emotions. Means in the same row that
share superscripts differ significantly at p < .05. *p < .05. **p < .01.

755
 SUVEG AND ZEMAN
think you would be able to make yourself feel better in
this situation?”). Analyses revealed a significant main
effect for group, F(1, 46) = 9.92, p < .01, η2 = .17.
Across all emotions, children with an AD perceived
themselves as less efficacious than did children with-
out an AD. A significant main effect also emerged for
emotion type, F(2, 46) = 3.55, p < .05, η2 = .13. Subse-
quent within-subjects contrasts indicated that all chil-
dren perceived themselves as significantly less effica-
cious in the worried scenario (M = 2.89, SD = .67) than
in sadness (M = 3.09, SD = .65) scenarios. Anger was
not significantly different than either. No significant
sex differences or interactions were found. See Table 6
for means and standard deviations.
Discussion
The functionalist approach underscores the impor-
tance of learning how to manage emotions in flexible
and adaptive ways in response to the demands of the
social context (Campos et al., 1994). This ability is
considered a central component of emotional compe-
tence (Saarni, 1999). Not surprisingly, difficulties with
emotion regulation have been posited to play a role in
most forms of psychopathology (Bradley, 1990, 2000;
Casey, 1996; Cicchetti et al., 1995). The results from
this study provide strong support for this theoretical as-
sertion with regard to childhood anxiety disorders.
Specifically, children with an AD indicated more
dysregulated expression of worry, sadness, and anger
than did children without an AD. Interestingly, how-
ever, no group differences emerged for inhibition of
emotion. This pattern of findings initially appears
counterintuitive as anxious children are typically char-
acterized by shy and withdrawn behaviors rather than
externalizing types of behaviors (similar to those on
the Dysregulation scale). It could be, however, that
children with an AD strive to contain their negative
emotions, but when the strain of inhibiting their emo-
tions becomes too uncomfortable, these “bottled up”
emotions are unleashed in dysregulated ways.
Children with an AD also reported coping less adap-
tively with worry, sadness, and anger than did children
Table 6. Children’s Self-Efficacy Scores by Emotion Type
as Assessed on the Emotion Regulation Interview
Anxiousa Nonanxiousb
Emotion M SD M SD
Worry 2.72 .66c 3.06
Sadness 2.82 .66c 3.33
Anger 2.86 .73d 3.33
Note: Higher scores indicate greater self-efficacy. Means in the
same column with the same superscripts differ significantly at p <
.05.
an = 25 for all emotions. bn = 26 for all emotions.
756
without an AD. This finding is consistent with previous
research that found that children experiencing anxious
symptomatology reported using less constructive ways
of managing their negative emotions than nonanxious
children (Suveg et al., 2001) and that poor coping with
anger predicted internalizing symptomatology (Zeman
et al., 2002). Convergent evidence for the finding that
children with an AD experience difficulties with emo-
tion regulation comes from maternal report. Mothers of
children with an AD perceived their children as signifi-
cantly more negative and labile than did mothers of chil-
dren without an AD. Given these findings, deficits in
emotion regulation should be considered a potential cor-
relate of the difficulties that children with an AD experi-
ence in their psychological functioning (Strauss, Frame,
& Forehand, 1987).
An interesting, albeit unexpected, finding was that
all children indicated more adaptive coping with sad-
ness than with worry. Although the emotional develop-
ment literature suggests that by the age of 3 years chil-
dren experience the full repertoire of emotions (Lewis,
2000), children’s ability to identify and label such
emotions follows a developmental course that is highly
interconnected with their cognitive development. Be-
cause worry involves a certain cognitive sophistica-
tion, children become better able to identify and ar-
ticulate their worries with increasing age (Muris,
Merckelbach, Meesters, & van den Brand, 2002). In
addition, sadness expression is more readily observ-
able (e.g., tears, facial expression) than worry expres-
sion, and, thus, children may have received more direct
socialization to help them learn how to cope with this
experience. Consequently, it could be that children of
the age group used in this study (i.e., 8 to 12 years) are
likely to have had less experience and practice in cop-
ing with worry than sadness.
It is not clear why, in this study, both girls with and
without anxiety disorders reported less adaptive emo-
tion coping than did boys. One explanation could be that
this study used a forced-choice questionnaire, as op-
posed to observational or open-ended methodologies
that may yield different results. It could also be that girls
were more willing than boys to admit to having difficul-
ties coping with negative emotions partly because they
have received more encouragement to express vulnera-
ble feelings than have boys.2 Lastly, from a functionalist
perspective, endorsement of certain coping items in the
CEMS (i.e., “When I am feeling sad, I control my crying
and carrying on”) actually may reflect a nonadaptive re-
sponse for girls if their goal is to obtain support or assis-
.64c
tance from their social context.
.55c The hypothesis that children with an AD would ex-
.66d perience their emotions more intensely than children
without an AD was supported for the worry and anger
2We thank one of the reviewers for this explanation for the find-
ing that all girls reported less adaptive coping than did boys.
 EMOTION REGULATION IN ANXIOUS CHILDREN
scenarios and was in the expected direction for the sad-
ness scenario, although it did not reach significance.
These findings nicely dovetail research indicating that
hyperarousal is a distinguishing feature of anxiety
(Clark & Watson, 1991), and, as such, children with an
AD may be overly sensitive to emotional cues in their
environment.
It was further hypothesized that intensity of emo-
tional experience would relate to the decision to ex-
press emotion. For the AD group, intensity of emo-
tional experience was positively related to the decision
to express sad and angry feelings to their mothers,
whereas for the NAD group, emotional intensity was
positively correlated to the decision to display all three
emotions. Indeed, this is consistent with normative re-
search, which has found that children endorse high
emotional intensity as an appropriate reason to express
emotions (Saarni, 1999).
Interestingly, for the AD group, the relation be-
tween worry intensity and the decision to express the
emotion was nonsignificant. It could be that the rules
for expressing worry, or other anxiety-like emotions,
are more complicated in families with an anxious
child. Indeed, there is a growing body of both theoreti-
cal and empirical literature implicating familial pro-
cesses in the development and maintenance of child-
hood anxiety (e.g., Barrett, et al., 1996; Dadds & Roth,
2001; Gruner, Muris, & Merckelbach, 1999; Rapee,
1997, 2001; Woodruff-Borden, Morrow, Bourland, &
Cambron, 2002).
The hypothesis that children with an AD would per-
ceive themselves as significantly less emotionally
self-efficacious than children without an AD was sup-
ported across the worry, sadness, and anger scenarios.
This finding provides a potential contributing explana-
tion for research that has found that anxious children
tend to withdraw from or avoid emotionally arousing
situations (Barrett et al., 1996; Suveg et al., 2001).
Children who have greater self-efficacy are likely to
persevere in difficult situations and develop more
adaptive coping skills (Bradley, 2000). Furthermore,
regardless of diagnostic status, all children perceived
themselves as significantly less efficacious in the
worry versus the sadness and anger scenarios, which is
consistent with the previous finding that children re-
ported less adaptive coping with worry than sadness
and anger. As was the case with coping, it could be that
children of this age group have had less opportunity to
practice managing worry versus sadness experiences.
Thus, their self-efficacy in worry situations is less de-
veloped than in sadness and anger situations because
of their lack of experience, success, or both.
Although this study reveals a coherent set of find-
ings, there are some potential limitations. First, the
sample was homogenous with respect to ethnicity (i.e.,
Caucasian) and SES (i.e., middle class). Second, the
sample did not include youth across the developmental
span. Third, only mothers participated. Given that fa-
thers play a role in children’s emotional development
(Goodman, Brogan, Lynch, & Fielding, 1993), it will
be important to include father data in future research.
Fourth, much of the emotion-regulation data was based
on self-report with its inherent limitations. Finally, the
sample size was small, which may have decreased the
power needed to detect sex differences.
These findings provide evidence for the argument
that emotion regulation needs to be considered in re-
search with atypical populations. Children with an AD
and their mothers reported difficulties with adaptive
emotion regulation, potentially due to their report of
experiencing emotions intensely and having little con-
fidence in their regulation ability. Further, children
with an AD not only reported difficulty managing anx-
iety-related experiences, but also sadness- and an-
ger-provoking experiences. From a functionalist per-
spective, it would be important to determine how the
demands of the social context impact the emotion-reg-
ulation goals and strategies chosen by children with an
AD. It may be that the expressive difficulties docu-
mented in this study actually reflect the adoption of
adaptive management strategies in response to a long
history of socialization pressures to express emotion in
nonnormative ways. Future research needs to examine
the role of emotion socialization in children with ADs.
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Appendix
Sports–Worried Scenario. You really want to be on the
soccer team so you decide to try out. Your mother goes
with you to the try-outs. During the try-outs, you think
View publication stats
that there are a lot of kids who are really good at soccer.
You are not sure if you are good enough to make the
team. This makes you feel WORRIED.
Sports–Sad Scenario. You really want to be on the soc-
cer team so you decide to try out. The next day your
mother goes with you to check the bulletin board
where the names of kids who made the team are listed.
When you get there you find out that you didn’t make
the team but that your friends did. This makes you feel
SAD.
Sports–Mad Scenario. You really want to be on the
soccer team so you decide to try out. Your mother goes
with you to the try-outs. During the try-outs you prac-
tice kicking the ball back and forth with another child
who purposely kicks the ball away from you so that
you cannot kick the ball back. This makes you feel
MAD.
Camp–Worried Scenario. You take your child to meet
the bus on the first day of summer camp. Your child is
planning to share a seat on the bus and a cabin at camp
with his/her best friend who is supposed to meet
him/her there. When you arrive at the bus stop, your
child finds out that his/her best friend is unable to go to
camp. Your child doesn’t know ANY of the other chil-
dren who are going but they all seem to know each
other. This makes your child feel WORRIED.
Camp–Sad Scenario. You take your child to meet the
bus on the first day of summer camp. When you arrive,
your child finds out that some of his/her friends are go-
ing but that his/her best friend got sick at the last min-
ute and can’t go. This makes your child feel SAD.
Camp–Mad Scenario. You take your child to meet the
bus on the first day of summer camp. Your child is glad
that he/she gets to be third in line because he/she will
get a good seat on the bus. All of a sudden, another
child purposely pushes him/her out of line, which
causes your child to have to move to the end of the line.
This makes your child feel MAD.
Received November 18, 2003
Accepted June 2, 2004
759