Journal of Child and Family Studies (2022) 31:2631–2643

https://doi.org/10.1007/s10826-022-02352-8

ORIGINAL PAPER

Perceived Strengths and Difficulties in Emotional Awareness and

Accessing Emotion Regulation Strategies in Early Adolescents
1
Caroline Cummings ●
Amy Hughes Lansing2 Christopher D. Houck3
●

Accepted: 9 June 2022 / Published online: 2 July 2022

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
Emotional awareness (EA) and access to emotion regulation strategies (ER) are often conceptualized as being on a single
continuum, yet discrepancies in these associations are found across samples. We conducted a person-centered analysis to identify
distinct profiles of adolescents’ perceived EA and ER. Secondary analyses were conducted to compare demographic variables,
distress tolerance, and parent- and teacher-report emotional functioning across profiles. Participants (N = 414) completed two
subscales of the Difficulties in Emotion Regulation Scale and a behavioral measure of distress tolerance. A parent and teacher
completed the Emotion Regulation Checklist. Adolescent mental health symptoms were measured, with responses dichotomized
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based on adolescent- and/or parent-report of clinically significant symptoms of any disorder. Exploratory two-step cluster
analysis identified three clusters: Varied EA/Low ER, Low EA/High ER, and High EA/High ER. Gender differences emerged,
with a greater proportion of girls in the Varied EA/Low ER cluster and boys in the Low EA/High ER cluster. The Varied EA/
Low ER and Low EA/High ER clusters demonstrated greater mental health symptoms, and greater parent- and teacher-reported
negativity/lability and problems with emotion regulation, than adolescents in the High EA/High ER cluster. The Low EA/High
ER cluster tolerated less distress on the behavioral task than the Varied EA/Low ER or High EA/High ER clusters, which
suggests problems with emotional awareness may contribute to inaccurate self-evaluation of one’s related emotional abilities. A
person-centered approach was useful in identifying patterns of adolescent perceptions of strengths and difficulties in emotional
development and their associations with other-report and performance on a behavioral task.
Keywords Emotion Regulation Emotional Awareness Cluster Analysis Adolescent Development Psychological
● ● ● ●

Functioning

Highlights
● Use of person-centered analyses can help us better understand how to assess and provide tailored support for emotion
development in adolescents.
● Perceived problems with emotional awareness alone, without perceived challenges with emotion regulation or perceived
problems with access to effective emotion regulation strategies, regardless of level of emotional awareness, may confer
risk of experiencing mental health symptoms and emotion regulation disturbances.
● Perceived problems with emotional awareness while perceiving few challenges with accessing emotion regulation
strategies were related to poorer distress tolerance on a behavioral task.

Adolescents’ ability to regulate emotions is associated with

* Caroline Cummings better psychosocial and physical health and is theorized to be
carolicu@ttu.edu
an important mediator of positive developmental outcomes
1
Department of Psychological Sciences, Texas Tech University, into adulthood (Campos et al., 2010; Crowell et al. 2013,
Box 42051, Lubbock, TX 79409, USA Diamond & Aspinwall, 2003; Eisenberg et al., 2005; Gar-
2
Department of Psychological Science, University of Vermont, 2 nefski et al., 2005; Vasilev et al., 2009). For successful
Colchester Avenue, Burlington, VT 05405, USA emotion regulation, that is to engage in emotion modulation
3
Rhode Island Hospital/Alpert Medical School at Brown in the pursuit of goals, the process theory of emotion reg-
University, 1 Hoppin St., Providence, RI 02903, USA ulation suggests adolescents must not only learn how to apply
2632
emotion regulation strategies, but also have awareness of
their emotional experience (Cole et al., 2004; Gratz & Roe-
mer, 2004; Gross, 2015). This is consistent with develop-
mental systems theory models of the emergence of emotion
regulation across childhood and into adolescence which
suggest that growth in self-awareness, and in particular
emotional awareness and understanding, facilitates growth in
the ability to effectively apply specific regulatory strategies
(Ciarrochi et al., 2008; Kranzler et al., 2016; Riley et al.,
2019; Roth et al., 2019; Thompson, 2011; Van Beveren et al.,
2019). At the same time, there is evidence that, while access
to effective emotion regulation strategies (i.e., the ability to
modify your emotional experience) is generally linearly
improved across adolescence—a result of shifts in neuro-
biological development that undergird self-regulation (Guyer
et al., 2016)—in many adolescents, emotional awareness (i.e.,
the ability to monitor one’s own emotional experience) may
decline before improving into emerging adulthood (Nook
et al., 2018; Rith-Najarian et al., 2014; Weissman et al.,
2020). This suggests that some adolescents may report
positive associations between use of emotion regulation skills
and level of emotional awareness, while others may experi-
ence a null or negative association between emotion regula-
tion skills and emotional awareness. Which of these patterns
are present in early adolescence and which might indicate
greater risk for challenges in emotional development and
associated outcomes remains unclear. Person-centered ana-
lytic approaches are needed to identify these potential dif-
ferential associations between emotion regulation and
emotional awareness within samples and then link those
patterns with emotional development outcomes. This manu-
script describes the use of a person-centered approach
towards identifying distinct profiles of strengths and diffi-
culties with emotional awareness and access to emotion
regulation strategies in a sample of middle school students.
Consistent with research indicating that the association
between emotional awareness and emotion regulation may
not present linearly across adolescence, the strength and
direction of the association of self-reported emotional
awareness and access to effective emotion regulation strate-
gies in adolescence differs across studies and samples. The
most common multifactorial assessment tool for these con-
structs is the Difficulties in Emotion Regulation Scale
(DERS; Gratz & Roemer, 2004). The DERS is a self-report
measure that evidences good construct validity and internal
consistency in assessing emotion regulation, including
among adolescents (Adrian et al., 2011; Neumann et al.,
2010; Perez et al., 2012). As a multifactorial measure of
emotion regulation, the DERS has six subscales, including
Lack of Emotional Awareness and Limited Access to Emo-
tion Regulation Strategies subscales. Studies of the factor
structure of the DERS highlight that emotional awareness
and access to effective emotion regulation strategies are
Journal of Child and Family Studies (2022) 31:2631–2643
distinct, yet related aspects of adolescent emotion regulation
development (Neumann et al., 2010; Perez et al., 2012). Yet,
findings from studies that utilize the DERS and variable-
centered analytic approaches (i.e., examining how two vari-
ables relate or predict another) demonstrate inconsistent
associations between emotional awareness and access to
effective emotion regulation strategies in adolescence.
Dizer aqui
For example, Neumann et al. (2010) found that greater que há
algumas
adolescent-reported problems with emotional awareness contradiçõe
were associated with fewer problems with access to emotion s, mas
que...
regulation strategies in a community-based sample of ado-
lescents attending secondary school. In contrast, Weinberg
and Klonsky (2009) found no significant correlation
between adolescent reports on the two factors in a
community-based sample of adolescents attending high
school, and Sarıtaş-Atalar et al. (2015) found a significant
but diminutive correlation in a community-based sample of
adolescents attending high school. In even further contrast,
Perez et al. (2012) found a significant and positive correla-
tion between adolescent reports on the two factors in an
inpatient psychiatric unit sample. The discrepancies among
these studies in the strength and direction of these associa-
tions for clinical inpatient and non-clinical samples support
that multiple profiles of adolescents’ perceptions of emotion
development may exist and be linked with emotional
developmental outcomes. A person-centered approach (i.e.,
how variables cluster together differently within different
types of individuals) may further broaden our understanding
of which specific profiles of strengths and difficulties in
emotion development present during early adolescence and
which adolescent characteristics (e.g., demographic vari-
ables, mental health, distress tolerance) might be most clo-
sely associated with those distinct profiles.
Moreover, discrepancies in findings across these samples
might also be attributed to the inclusion of individuals
across all stages of adolescence within study samples,
which does not account for the nonlinearity of emotion
development across adolescence (i.e., rapid gains found
during early adolescence and stagnancy then growth in the
latter stages) (Hollenstein & Lanteigne, 2018). Although
studies have used person-centered analyses to examine
emotion regulation development, these studies largely do
not consider emotional awareness and are conducted with
young adults or adolescents broadly, not during early ado-
lescence. For example, person-centered analyses were used
to better understand profiles of emotion regulation strategy
use and mental health symptoms in a sample of under-
graduate students (Dixon-Gordon et al., 2015), and distinct
profiles of emotion regulation problems and distress toler-
ance in young adults (Van Eck et al., 2017). In the context
of adolescent emotion development, defined emotion reg-
ulation profiles in adolescents based upon level of global
emotion regulation, as well as emotionality. Across all
Journal of Child and Family Studies (2022) 31:2631–2643
studies, distinct profiles of strengths and difficulties of the
studied emotion-related processes emerged, suggesting this
person-centered approach may yield unique profiles, but the
relationship between emotion regulation skills and emo-
tional awareness in early adolescents remains unclear.
Given the changes in emotional awareness and emotion
regulation systems that are theorized to occur beginning in
early adolescence, an investigation of profiles of perceived
strengths and weaknesses in emotional awareness combined
with emotion regulation strategies is warranted. For exam-
ple, it is likely that some early adolescents who perceive
challenges with emotional awareness may still have access
to strategies to regulate emotions. At the same time, other
early adolescents may perceive fewer problems in emo-
tional awareness but persistent deficits in accessing effective
emotion regulation strategies—though it is possible this
discrepancy may be in part due to biased self-evaluation
(Kruger & Dunning, 1999). Still yet, profiles with varying
levels of emotional awareness or accessing emotion reg-
ulation strategies might be similarly or differentially related
to developmental outcomes. For example, developmental
cascades theory (Masten & Cicchetti, 2010) explains that
adaptive functioning in a specific developmental process
(e.g., strengths in emotional awareness and/or access to
emotion regulation strategies) contributes to positive
downstream effects on related domains of development
(e.g., mental health functioning; distress tolerance). Con-
versely, maladaptive functioning serves as a pathway for
impairment across related facets of development. It is
unknown whether strengths in one domain (i.e., emotional
awareness only or access to emotion regulation strategies
only) may counteract the negative cascading effects of
difficulties in development of another domain (i.e., emo-
tional awareness only or access to emotion regulation
strategies only). Accordingly, identifying person-centered
profiles of perceived strengths and deficits in emotional
awareness and access to emotion regulation strategies,
along with their connections with emotion development and
mental health outcomes in early adolescence, is essential. In
doing so, researchers may generate a more nuanced
understanding of how various facets of emotion develop-
ment may contribute to adolescent psychopathology and
socioemotional functioning. Such research may ultimately
help develop more targeted interventions to support positive
developmental outcomes in adolescence.
The primary purpose of the current study was to explore
profiles of perceived strengths and difficulties in emotional
awareness and access to emotion regulation strategies in a
sample of early adolescents. Given the paucity of consistent
findings regarding the association between perceived emo-
tional awareness and access to emotion regulation strategies
in early adolescents, and lack of theory describing person-
centered profiles combining these two factors, we did not
2633
make specific hypotheses as to the number or nature of
clusters. Our secondary aim was to investigate whether
distinct profiles would capture unique groups of adoles-
cents. Specifically, exploratory analyses were conducted to
examine if differences in demographic variables between
clusters emerged. We also assessed for differences in parent
and teacher measures of emotion development (i.e., nega-
tivity/lability and emotion regulation) and a behavioral
measure of distress tolerance between clusters/profiles.
Methods
Participants
Adolescents (N = 414) were recruited from five urban public
middle schools in the northeastern United States to partici-
pate in a larger emotion regulation and sexual health pro-
motion randomized control trial intervention. All procedures
and measures described were conducted as a part of that
study (Houck et al., 2016). Briefly, recruitment occurred
between September 2009 and February 2012. Adolescents
were eligible to participate if they were aged 12–14 years, in
the 7th grade, and spoke English. Adolescents deemed at-risk
due to symptoms of emotional or behavioral problems were
targeted (see the procedures subsection below for further
details). Adolescents who had a history of being sexually
aggressive, were currently HIV-infected, had developmental
delays or were currently pregnant were excluded.
Descriptive statistics of the sample are documented in
Table 1. About half (47%) of participants self-identified as
female, and 32.6% of participants self-identified as White,
27.3% as African American/Black, 17.9% as multi-race,
3.4% as Native Hawaiian/Pacific Islander, 2.4% as Amer-
ican Indian/Alaskan Native and 1.0% as Asian. Almost half
(44%) were reported as experiencing symptoms above a
clinical cut-off for at least one psychiatric illness, including
externalizing and internalizing disorders per adolescent
(Youth Inventory-4; Gadow et al., 2002)- and/or parent-
report (Adolescent Symptom Inventory; Gadow & Sprafkin,
1997). Specifically, 18.6% of adolescents met the clinical
symptom cut-off for conduct disorder, 13.5% for opposi-
tional defiant disorder, 13.3% for attention-deficit/
Table 1 Descriptive statistics for entire sample
Lack of Emotional Awareness 3.05 (1.10)
Limited Access to Emotion Regulation Strategies 2.10 (0.83)
Age 12.96 (0.55)
Family Income (median) $25,000
Race (% White) 33%
Gender (% female) 47%
Mental Health Diagnosis Clinical Cut-off 44%
2634
hyperactivity (ADHD), hyperactive or impulsive type,
12.3% for ADHD, inattentive type, 11.6% for dysthymic
disorder, 8.7% for ADHD, combined type, 8.5% for bipolar
disorder, 5.8% for generalized anxiety disorder, and 5.8%
for major depression disorder. The primary caregivers of
participants mostly self-identified as female (79%), with an
average age of 38.74 years, and reported a median family
income of $20,000 to $29,000. Teachers of participants
were primarily English teachers, which was chosen because
most students had a consistent English class during the
study period. For more information about this sample, and
the screening process, please see Houck et al. (2016).
Procedure
All procedures were approved by the Rhode Island Hospital
institutional review board. School staff were asked to pro-
vide information on study participation to parents of stu-
dents exhibiting mental health symptoms. School staff were
encouraged to refer to a counseling referral sheet for
examples of such symptoms, such as hyperactivity or dis-
ruptive behavior, withdrawal or internalization, declining
grades, emotional lability, and concern for substance use or
sexual activity. Approximately 27% of students attending
the seventh grade during the three study years were referred,
consistent with national prevalence data for adolescent
mental health disorders (Merikangas et al., 2010). Parents of
potentially eligible adolescents were sent a consent-to-
contact form, which provided contact information for study
staff, who then called the parent to conduct eligibility
screening by phone. Adolescents who were reported by
their parents as being sexually aggressive, currently HIV-
infected, having developmental delays, or currently preg-
nant were deemed ineligible at this point. Following the
screening process, a face-to-face meeting was arranged (at
the family’s home or at a community location), during
which parental consent and adolescent assent were
obtained, and eligible adolescents began participation. This
study utilizes data from the baseline intake assessment prior
to participation in the intervention. There is one exception
to this; the behavioral distress tolerance measure was only
administered at the completion of the intervention,
approximately 8 weeks after the baseline data were col-
lected. To avoid possible intervention influences as a con-
found for distress tolerance task performance, analyses
involving this measure included only participants (n = 195)
that were randomized to the control group, which received a
health promotion only intervention without emotion reg-
ulation content. Adolescents in the control group did not
differ from the active treatment group at baseline in rates of
psychiatric symptoms meeting cut-offs for clinical disorder
(X2 = 0.40, p = 0.53), gender (X2 = 0.13, p = 0.72), ado-
lescent reports of emotional awareness (t(412) = 1.25,
Journal of Child and Family Studies (2022) 31:2631–2643
p = 0.26) and access to emotion regulation strategies
(t(412) = 2.41, p = 0.12), parent-reports of negativity/labi-
lity (t(386) = 1.07, p = 0.30) and emotion regulation
(t(386) = 0.66, p = 0.42), or teacher-reports of negativity/
lability (t(400) = 0.82, p = 0.37) and emotion regulation
(t(400) = 3.08, p = 0.08).
At baseline, adolescents completed an audio-assisted
computer self-interview on a laptop computer for all mea-
sures, in a quiet location in the school, over multiple ses-
sions if needed. Parents completed assessments on laptop
computers in the language of their choice (English, Spanish,
or Portuguese). Teachers completed paper and pencil
questionnaires. Post-intervention, adolescents completed
another computerized assessment that included a behavioral
distress tolerance measure.
Measures
Adolescent behavioral and self-report measures
Baseline measures Difficulties in Emotion Regulation
Scale (DERS): Adolescents completed two subscales of the
DERS; these assessed problems with emotional awareness
and access to emotion regulation strategies (Gratz & Roe-
mer, 2004). The other 4 subscales were not administered.
Adolescents rated statements about emotion regulation on a
5-point scale (1 = almost never to 5 = almost always). The
Lack of Emotional Awareness subscale included 6 items
about emotion awareness, e.g., “When I’m upset, I recog-
nize my emotions” and “I pay attention to how I feel.” The
Limited Access to Emotion Regulation Strategies subscale
included 8 items about accessing emotion regulation stra-
tegies, e.g., “When I’m upset, it takes me a long time to feel
better” and “When I’m upset, my emotions feel over-
whelming.” Item scores were summed and then divided by
the number of items to create an average score for each
subscale. Higher scores indicated greater problems with
emotional awareness and greater problems with accessing
emotion regulation strategies, respectively. The DERS,
including the subscale structure, has been previously vali-
dated in adolescent samples (Neumann et al., 2010; Vasilev
et al., 2009; Weinberg & Klonsky, 2009) and had strong
reliability in our sample for each subscale, Lack of Emo-
tional Awareness, α = 0.88, and Limited Access to Emotion
Regulation Strategies, α = 0.83.
Youth Inventory-4: Adolescents completed selected sub-
scales from the YI-4 (Gadow et al., 2002) to screen for
symptoms of common emotional and behavioral disorders
based on DSM-IV symptomatology. These included both
externalizing (attention deficit/hyperactivity disorder- inatten-
tive and hyperactive type, conduct disorder, and oppositional
defiant disorder) and internalizing (generalized anxiety
disorder, major depressive disorder, dysthymia, and bipolar
Journal of Child and Family Studies (2022) 31:2631–2643
disorders) psychopathology. We then generated a dichot-
omous variable where a score of 1 indicated the adolescent
met the symptom criteria based on the clinical cutoffs
(compared to normative samples) for any disorder by either
adolescent or parent-report (see below), and a score of 0
indicated the adolescent did not meet criteria for any disorder.
This approach allows for a more parsimonious approach
towards measuring adolescents’ mental health functioning
and accounts for potential discrepancies in adolescent self-
report and parent-report. The YI has been found to be reliable
across multiple samples (e.g., Gadow et al., 2002; Fanti et al.,
2018). In the current study, across all disorder scales,
reliability was good to strong (0.71 < α < 0.95).
Post-treatment measure Behavioral Indicator of Resi-
liency to Distress (BIRD): Post-intervention, adolescents
completed the BIRD, a computerized task that measures
resiliency to distress by inducing emotional distress in par-
ticipants through incrementally increasing the difficulty of a
task, then examining how long a participant persists. Parti-
cipants were asked to click on a box below a moving dot on
the computer screen in a video game like format. An ani-
mated “bird” responds to mistakes with an irritating noise,
thus increasing distress. In the third and final trial of the
BIRD, the task becomes extremely difficult and participants
can use a “quit game” button that ends the task. Participants
were informed that they could end the task early, but that the
magnitude of their prize (amount of candy) was dependent
upon how well they did on the task. The maximum time that
any participant can play in the final trial is 300 sec. In this
study, we utilized a metric of how many sec an adolescent
persisted in the final trial of the BIRD before giving up and
quitting the program, referred to as Time to Quit (from 1 to
300 sec). The BIRD has been validated as a behavioral
measure of distress tolerance in samples of adolescents
(Amstadter et al., 2012; Daughters et al., 2009; MacPherson
et al., 2010), and those studies found that around 50% of
adolescents quit the task early. Across studies, adolescents
reported varying levels of distress during the task, yet level
of distress did not predict whether adolescents quit early.
Therefore, this task likely measures how much adolescents
tolerate distress, not merely the amount of distress (i.e.,
negative affect) an adolescent experienced. In our sample of
early adolescents with mental health symptoms, 69% of the
participants quit the game early.
Parent report measures (all completed at baseline)
Emotion regulation checklist (ERC) Parents completed an
emotion regulation measure that consisted of 24 items with
two subscales designed to examine both adolescent nega-
tivity/lability (i.e., mood swings, reactivity and intensity of
emotion) and emotion regulation (i.e., adaptive regulation
2635
of emotion, emotional understanding, and empathy; Shields
& Cicchetti, 1997). Statements were rated on a 4-point scale
(1 = rarely to 4 = almost always). The negativity/lability
subscale included 16 items, e.g., “Has wide mood swings,”
“Can manage excitement,” and “Responds angrily to limit-
setting by adults.” The emotion regulation subscale inclu-
ded 8 items, e.g., “Is a cheerful child” and “Can say when
feeling sad/mad/fearful.” Item scores were summed to
generate a total score for each subscale, with higher scores
indicating more negativity/lability and better emotion reg-
ulation, respectively. The ERC has been previously vali-
dated in child and early adolescent samples (Gratz et al.,
2009; Shields & Cicchetti 1998 2001) and had moderate to
good reliability in our sample for parent-report, Negativity/
Lability, α = 0.81, and Emotion Regulation, α = 0.61.
Adolescent symptom inventory (ASI) Primary caregivers
completed subscales of the ASI (Gadow & Sprafkin, 1997)
to screen for symptoms of emotional and behavioral dis-
orders. These included both externalizing (attention deficit/
hyperactivity disorder inattentive and hyperactive type,
conduct disorder, and oppositional defiant disorder) and
internalizing (generalized anxiety disorder, major depres-
sive disorder, dysthymia, and bipolar disorders) psycho-
pathology. As noted above, scores were dichotomized,
with a score of 1 indicating the adolescent met the symp-
tom criteria based on the clinical cutoffs (compared to
normative samples) for any disorder by either adolescent
or parent-report, and a score of 0 indicated the adolescent
did not meet criteria for any disorder. The ASI has been
found to be reliable across multiple samples (e.g., Gadow
et al., 2002; Pardini et al., 2012). In the current study,
across all scales, reliability was good to strong
(0.74 < α < 0.95), apart from the parent-report scale for
symptoms of dysthymia (α = 0.66).
Teacher report measures (completed at baseline)
Emotion regulation checklist (ERC) Teachers completed
the ERC. See above for further measure details. The ERC
had strong reliability in our sample for teacher-report
(α’s = 0.95 and 0.85).
Analyses
Data were examined for normality and outliers prior to all
analyses. All statistical analyses were performed using the
Statistical Package for the Social Sciences for Windows.
Primary aim: clusters of distinct profiles
Person-centered analysis was conducted through a two-step
cluster analysis, where data are first grouped into
2636
subclusters based on the Scharz’s Bayesian Criterion, a
distance measure, and then a hierarchical process is utilized
to group subclusters into clusters (Bulger et al., 2007). The
number of clusters in the final solution is identified as the
solution with the highest ratio of distance measures between
the final number of clusters against the previous number of
clusters. This type of cluster analysis does not require pre-
specification of the number of clusters to identify nor does it
specify a latent process or structures that would underlie the
cluster structure of the data (we did not have a priori theory
for a latent structure) and therefore was best suited for the
exploratory cluster analysis of the current study. Using
visual interpretation, we identified distinct clusters of pro-
files of emotional awareness and access to emotion reg-
ulation strategies. We then ran one-way ANOVAs with
post-hoc Games-Howell corrections—due to non-
homogenous variances in cluster groups on dependent
variables—and univariate ANOVAs. Both analyses were
used to further characterize significant differences in the
associations between Lack of Emotional Awareness and
Limited Access to Emotion Regulation Strategies between
the distinct clusters. The latter analysis provides regression
parameter estimates to identify the direction and strength of
the relationship between the subscales for each cluster.
Secondary aims
Profiles associations with demographic and parent- and
teacher-report measures We conducted two secondary
analyses after completing the cluster analyses. First, we
utilized one-way ANOVAs with post-hoc corrections and
chi square analyses to examine differences in demographic
and descriptive variables for the clusters, including gender,
family income, race, age, and mental health symptoms.
Second, we utilized one-way ANOVAs with parent- and
teacher-report of emotion lability and emotion regulation as
the dependent variables in order to examine if differences in
emotion development across social domains were found
between clusters.
Profiles associations with the post-treatment behavioral
task measure The association between cluster membership
and Time to Quit on the BIRD (post-treatment) was analyzed
through a Kruskal-Wallis one-way ANOVA test, as the Time
to Quit variable had a non-normal distribution in our data.
Results
Clusters of Distinct Profiles
Exploratory two-step cluster analysis indicated that there
were three clusters of adolescent self-reported Lack of
Journal of Child and Family Studies (2022) 31:2631–2643
Emotional Awareness and Limited Access to Emotion
Regulation Strategies (Largest ratio of BIC distance mea-
sures = 2.93). We labeled these clusters based upon visual
and statistical inspection as Perceived Varied Emotional
Awareness (scores spread across rating scale) and Low
Emotion Regulation Access (Varied EA/Low ER), Per-
ceived Low Emotional Awareness and High Emotion
Regulation Access (Low EA/High ER), and Perceived High
Emotional Awareness and High Emotion Regulation
Access (High EA/High ER) clusters. It should be noted that,
for ease of interpretation and readability, the labels for
clusters describe participants’ perceived abilities in both
domains (e.g., Low EA indicates low perceived emotional
awareness, not low perceived problems with emotional
awareness as measured). The three clusters are represented
visually in Fig. 1. Average levels and standard deviations of
Lack of Emotional Awareness and Limited Access to
Emotion Regulation Strategies for each cluster are provided
in Table 2.
Further supporting the identified clusters as being distinct
profiles, one-way ANOVAs with post-hoc tests for differ-
ences by cluster indicated that each cluster was significantly
different from the others in scores on Lack of Emotional
Awareness (Welch: F (2, 185.70) = 478.75, p < 0.01, partial
η2 = 0.63) and Limited Access to Emotion Regulation
Strategies (Welch: F (2, 200.18) = 264.91, p < 0.01, partial
η2 = 0.64), with all post-hoc Games-Howell comparisons
between clusters significant (p’s < 0.03; Cohen’s d’s,
0.37 > d < 3.35). Moreover, results of a univariate ANOVA
indicated cluster membership significantly moderated the
association of Lack of Emotional Awareness and Limited
Access to Emotion Regulation Strategies (F(2, 408) = 9.84,
p < 0.001, partial η2 = 0.05; see Fig. 2). Specifically, for
adolescents in the Varied EA/Low ER cluster, the slope of
the association between Lack of Emotional Awareness and
Limited Access to Emotion Regulation Strategies was
small, but positive, and significantly different from zero
(b = 0.14, p = 0.01), such that greater perceived problems
with emotional awareness were associated with greater
perceived problems with access. Also, adolescents within
the Varied EA/Low ER cluster reported an average score on
the problems with emotional awareness (M = 2.49, SD =
1.03) and high average score on limited access to strategies
(M = 3.42, SD = 0.63) subscales. For the adolescents in the
Low EA/High ER cluster, the slope was negative and sig-
nificantly different from zero (b = −0.23, p = 0.001), such
that greater perceived problems with emotional awareness
were associated with fewer perceived problems with access.
Also, adolescents within the Low EA/High ER cluster
reported a high average score on the problems with emo-
tional awareness subscale (M = 4.03, SD = 0.52) but a low
score on the limited access to strategies subscale (M = 1.86,
SD = 0.48). For adolescents in the High EA/High ER
Journal of Child and Family Studies (2022) 31:2631–2643 2637

Fig. 1 Scatterplot of the Clusters

Varied EA/Low ER
Low EA/High ER
High EA/High ER

Table 2 Descriptive statistics for perceived problems with emotion income (X2 = 8.98, p = 0.53), or race (X2 = 4.98,
regulation clusters
p = 0.89). However, there were significant differences
Clusters M (SD) between clusters in gender (X2 = 12.70, p = 0.002) and
Varied EA/ Low EA/ High EA/ mental health symptoms (X2 = 22.77, p < 0.001). The
Low ER High ER High ER Varied EA/Low ER cluster included more females (n = 112
out of 182; 62%), whereas the Low EA/High ER cluster
Lack of EA 2.49 (1.03)a 4.03 (0.52)b 2.18 (0.58)c
a b
included more males (n = 51 out of 83; 61%). Similar rates
Limited ER 3.42 (0.63) 1.86 (0.48) 1.66 (0.44)c
of males (n = 75 out of 149; 50%) and females (n = 74 out
Age 12.98 (0.51) 12.97 (0.58) 12.94 (0.53)
of 149; 50%) were found in the High EA/High ER cluster.
Family Income $25,000 $25,000 $25,000 With regards to mental health symptoms, adolescents in
(median)
both the Varied EA/Low ER (n = 88 out of 182; 48%) and
Race (% White) 38% 40% 37%
Low EA/High ER (n = 50 out of 83; 60%) clusters were
Gender (% female) 62%a 39%b 50%a,b
more likely to include those with mental health symptoms
Mental Health 60%a 48%a 30%b
significant enough to reach a clinical cut-off for symptoms
Diagnosis Clinical
Cut-off (% at or of at least one diagnostic category assessed, in comparison
above clinical cut- to the High EA/High ER cluster (n = 45 out of 149; 30%).
off) One-way ANOVAs demonstrated that cluster member-
Means in the same row that do not share superscripts differ at a ship was significantly associated with parent-report of
p < 0.05 negativity/lability (F(2, 385) = 3.41, p = 0.03, partial
EA emotional awareness, ER access to emotion regulation strategies η2 = 0.02) and emotion regulation (Welch: F(2,
194.96) = 7.53, p = 0.001, partial η2 = 0.03), as well as
teacher-report of negativity/lability (F(2, 399) = 4.15,
cluster, the slope was positive, but not significantly different p = 0.02, partial η2 = 0.02) and emotion regulation (F(2,
from zero (b = 0.11, p = 0.07) and adolescents within the 399) = 3.42, p = 0.03, partial η2 = 0.02). Table 3 contains
cluster reported low average scores on the problems with cluster means and standard deviations for parent- and tea-
emotional awareness (M = 2.18, SD = 0.58) and limited cher- report of emotion regulation. Post-hoc t-tests found
access to strategies (M = 1.66, SD = 0.44) subscales. that adolescents in the High EA/High ER cluster were
reported as having lower Negativity/Lability compared to
Profiles Associations with Demographic and Parent- the Varied EA/Low ER Cluster (teacher: t(138.47) = 2.42,
and Teacher-Report Measures p = 0.02, Cohen’s d = 0.34) and the Low EA/High ER
Cluster (parent: t(311) = 2.49, p = 0.01, Cohen’s d = 0.29;
Demographic differences between the three clusters were teacher: t(322) = 2.50, p = 0.01, Cohen’s d = 0.28). There
also explored (see Table 2). The clusters did not differ in was one exception, such that adolescents in the High EA/
age (F(2, 410) = 0.11, p = 0.90, partial η2 < 0.001), family High ER cluster were not reported by parents as
2638 Journal of Child and Family Studies (2022) 31:2631–2643

Fig. 2 The Association of Lack

of Emotional Awareness and Varied EA/Low ER
Limited Access to Emotion
Low EA/High ER
Regulation Strategies Differed
High EA/High ER
by Cluster Membership

Table 3 Cluster membership

Clusters M (SD)
predicted differences in other
metrics of emotion regulation Varied EA/Low ER Low EA/High ER High EA/High ER

Negativity/Lability- Parent 1.93 (0.50) 1.93 (0.48) 1.80 (0.41)a

Negativity/Lability- Teacher 2.01 (0.73) 1.97 (0.72) 1.78 (0.62)a,b
Emotional Regulation-Parent 3.18 (0.44) 3.11 (0.47) 3.29 (0.36)a,b
Emotional Regulation-Teacher 2.89 (0.62) 2.91 (0.59) 3.06 (0.58)a,b
Time to Quit (median) 207.00 sec 116.50 sec 176.00 seca
EA emotional awareness, ER access to emotion regulation strategies
a
High EA/High ER cluster significantly differed from Low EA/High ER cluster
b
High EA/High ER cluster significantly differed from Varied EA/Low ER cluster

significantly different on Negativity/Lability from adoles-
cents in the Varied EA/Low ER cluster (t(127.64) = 1.86,
p = 0.07, Cohen’s d = 0.28); however, the general direction
of the effect was consistent with the other findings. Also,
adolescents in the High EA/High ER cluster were reported
as having greater Emotion Regulation compared to the
Varied EA/Low ER Cluster (parent: t(215) = −2.00,
p = 0.05, Cohen’s d = 0.27; teacher: t(220) = −2.01,
p = 0.05, Cohen’s d = 0.28) and the Low EA/High ER
Cluster (Parent: t(309.06) = −3.83, p < 0.001, Cohen’s
d = 0.43; Teacher: t(322) = −2.41, p = 0.02, Cohen’s
d = 0.26).
Profiles Associations with the Post-Treatment
Behavioral Task Measure
For the subset of adolescents in the control group (n = 195),
we found that cluster membership predicted significant
differences in adolescent Time to Quit on the hardest block
they attempted of the BIRD (Kruskal-Wallis Test = 6.06,
p = 0.05, partial η2 = 0.03). Table 3 also contains cluster
medians for Time to Quit on the BIRD. Post-hoc Mann-
Whitney U tests found that adolescents in the Low EA/High
ER cluster (mean rank = 68.55) had shorter median Time to
Quit than adolescents in the High EA/High ER cluster
(mean rank = 83.80; U = 2154.50, p = 0.03, r = 0.18),
highlighting difficulties in distress tolerance for the former
cluster. There was not a significant difference in median
Time to Quit between the Varied EA/Low ER (mean
rank = 47.60) and High EA/High ER clusters (mean
rank = 46.71; U = 927.00, p = 0.88, r = 0.02). There also
was not a significant difference in median Time to Quit
between the Low EA/High ER (mean rank = 67.87) and
Varied EA/Low ER clusters (mean rank = 55.23;
U = 1009.00, p = 0.073, r = 0.22); however, the general
direction of the effect was consistent with the other findings.
Discussion
This study explored profiles of strengths and difficulties in
self-reported emotional awareness and access to emotion
regulation strategies in early adolescents with mental health
symptoms and examined how these profiles related to
demographic variables and emotional development. Three
clusters were identified: adolescents reporting relatively
Journal of Child and Family Studies (2022) 31:2631–2643
fewer problems in awareness and access (High EA/High
ER); adolescents reporting fewer problems with accessing
emotion regulation strategies, but notable difficulties with
emotional awareness (Low EA/High ER); and adolescents
reporting problems with accessing strategies, who reported
a range of abilities related to emotional awareness (Varied
EA/Low ER). These clusters were related to demographic
variables, mental health functioning, and other facets of
emotion development (i.e., parent- and teacher-report
negativity/lability and emotion regulation; distress
tolerance).
Our findings clarified the discrepant associations
between the Lack of Emotional Awareness and Limited
Access to Emotion Regulation Strategies subscales on the
DERS as reported in the literature (Neumann et al., 2010;
Vasilev et al., 2009; Weinberg & Klonsky, 2009). There
were three distinct categories and the association between
the Lack of Emotional Awareness and Limited Access to
Emotion Regulation Strategies subscales differed for each
cluster. The positive correlation between both domains of
emotion regulation functioning, which was reported by
adolescents in the Varied EA/Low ER cluster, is con-
sistent with prior studies of clinical, adolescent samples
(e.g., Perez et al., 2012). Moreover, the inverse relation-
ship found within the Low EA/High ER cluster and the
nonsignificant association found within the High EA/High
ER cluster are consistent with studies of non-clinical,
adolescent samples (Neumann et al., 2010; Weinberg &
Klonsky, 2009, respectively). Further, these findings are
consistent with multidimensional theories of emotion
regulation purporting that there are multiple dimensions
of emotion regulation skill development that need to be
assessed separately to fully understand adolescent emo-
tional competency and psychosocial development (Cole
et al., 2004; Gratz & Roemer, 2004). Moreover, findings
support the onset of differences in patterns of strengths
and difficulties in emotional awareness and access to
emotion regulation strategies during early adolescence,
which is likely related to changes in neurobiology and
social-emotional functioning that are theorized to occur
during this key developmental period (Guyer et al., 2016;
Nook et al., 2018). For example, though it was not within
the scope of the current study, it is possible that adoles-
cents within the current sample demonstrated high varia-
bility in their neural responsiveness to emotion-related
stimuli and level of neural reactivity might have predicted
concurrent differences in emotion regulation development
(Guyer et al., 2016). Building upon current study findings,
it is imperative to explore possible mechanisms explain-
ing the emergence of different patterns of emotional
awareness and emotion regulation abilities during early
adolescence.
2639
In examining demographic differences between clusters,
there was a greater proportion of adolescent girls in the
Varied EA/Low ER cluster and adolescent boys in the Low
EA/High ER cluster. This is consistent with prior literature
(Bender et al., 2012; Neumann et al., 2010) and may be
explained by gender socialization theory, as parents often
promote emotional expressiveness (Brody & Hall, 2008)
and use more emotion-related words when interacting with
their daughters compared to sons (Adams et al., 1995;
Fivush, 1989) which yields greater emotional awareness in
girls in comparison to boys. Conversely, boys are expected
to experience more externalized emotions and parents often
shape boys to down-regulate those emotions rather than
express them (Brody, 1999; Weinberg et al., 1999), thus
boys may have reported fewer problems with access to
emotion regulation strategies because they frequently
practice downregulation of negative emotions, i.e., inhibi-
tory control of “negative” emotion. Given the findings,
there may be important psychosocial factors (e.g., sociali-
zation) to address to reduce adolescent girls’ risk for
delayed development in accessing emotion regulation stra-
tegies and boys’ risk for impaired emotion awareness.
Moreover, given that boys within our sample were just as
likely as girls to fall within the High EA/High ER cluster,
there is a need to further understand what differentiates
adolescents who experience delayed functioning in a sin-
gular domain versus those who experience healthy emotion
regulation development across both domains (e.g., differ-
ences in brain development, influence of hormones).
Our findings were also consistent with research and
theories that suggest that both emotional awareness and
ability to access various emotion regulation strategies are
necessary to guide healthier mental and behavioral func-
tioning (Cole et al., 2004; Izard, 2009; Izard et al., 2011).
Adolescents in the Varied EA/Low ER cluster and the Low
EA/High ER cluster were both more likely to have clinical
levels of mental health symptoms and were perceived by
teachers and parents as having poorer emotion regulation
compared to the High EA/High ER cluster. Therefore, while
all adolescents had some noted problems in mental health or
socioemotional functioning per school-personnel report,
having a perceived deficit in either emotional awareness or
access to emotion regulation strategies was a strong pre-
dictor of clinically significant symptoms. This is consistent
with the extended process model of emotion regulation
(Gross, 2015), which asserts that impairments with emo-
tional processing and regulation may serve as mechanisms
explaining the onset and maintenance of most psycho-
pathology. Moreover, these deficits were notable across
multiple social domains (i.e., home and school), as indi-
cated by corroborating emotion regulation data collected
from parents and teachers, thus such emotion regulation
2640
impairments might have been pervasive and affecting ado-
lescent functioning at a global level.
Exploratory analyses of performance on the BIRD task
yielded more complex findings. Adolescents in the Low
EA/High ER cluster exhibited poorer distress tolerance on
the BIRD task when compared to the High EA/High ER
cluster. Yet, those adolescents in Varied EA/Low ER cluster
did not differ significantly in performance on the BIRD
from the High EA/High ER cluster. Moreover, despite
differences in mean time-to-quit between the Varied EA/
Low ER and Low EA/High ER cluster, this difference was
not significant, which may be attributed to high variability
found in performance on the BIRD within the Low EA/
High ER cluster. Nonetheless, given that better performance
on the BIRD task has been associated with both decreased
internalizing and externalizing symptoms, including fewer
delinquent behaviors (e.g., substance use, getting in physi-
cal altercations, carrying a weapon) and alcohol use
(Cummings et al., 2013; Daughter et al., 2009), adolescents
in the Low EA/High ER cluster might be at a greater risk for
delinquent behaviors in addition to internalizing symptoms.
One hypothesis that requires further examination is that
awareness of emotions might protect adolescents with
regards to distress tolerance and engagement in risky
behaviors, even if they are experiencing elevated mental
health symptoms.
Last, although adolescents in the Low EA/High ER
cluster reported few problems with accessing emotion reg-
ulation strategies, parent, teacher, and behavioral measures
of emotion regulation suggested to the contrary. Adoles-
cents in this cluster exhibited poorer distress tolerance on
the BIRD task, greater parent and teacher reported negative
lability, and poorer parent and teacher reported emotion
regulation when compared to the High EA/High ER cluster.
While it may be that deficits in emotional awareness por-
tend less effective emotion regulation despite having access
to emotion regulation strategies, we hypothesize that ado-
lescents in the Low EA/High ER cluster were also less able
to accurately self-evaluate their emotion regulation skills.
Kruger and Dunning (1999) explain that self-assessments of
social and intellectual abilities become most biased when
people have significant deficits, as they are usually unaware
of the extent of such deficits. Lack of emotional awareness
likely limits these adolescents’ abilities to accurately rate
access to strategies to regulate emotions. In fact, develop-
mental systems theories suggest the development of self-
awareness, including emotional awareness, should precede
the development of broader self-regulatory processes, such
as the development of an emotion regulation repertoire
(Thompson, 2011). This notion is supported by this cluster
performing the worst on the BIRD distress tolerance task,
which suggested that a lack of awareness of their emotional
state may have resulted in difficulty in skillfully utilizing an
Journal of Child and Family Studies (2022) 31:2631–2643
appropriate emotion regulation strategy during the BIRD
task. Therefore, these findings highlight the importance of
assessing emotion regulation via multiple modalities (i.e.,
other-report and performance tasks), to ensure deficits are
adequately addressed and compensate for a potential bias in
self-report.
Limitations
The findings of this study need to be considered in the
context of some limitations. First, while a strength of this
sample is that our population included a heterogeneous
sample of urban youth with differing levels of socio-
emotional and/or mental health problems, it is unclear if the
findings would generalize to a general sample of adoles-
cents or to a clinical sample, i.e., additional profiles might
emerge in a true clinical, non-clinical, or population-based
sample. Moreover, school personnel referred potentially
eligible students to our research staff based on their obser-
vations or knowledge of those students who exhibited
symptoms of emotional or behavioral problems. It is pos-
sible that there are additional adolescents who may have
been eligible based on these criteria but were not referred
because school personnel did not detect their emotional or
behavioral problems. Second, since this study did not
include non-adolescent reporter measures of emotional
awareness and access to emotion regulation strategies, it
was not feasible to test questions pertaining to the con-
cordance of adolescent self-report with other reporters.
Third, the full DERS was not administered, thus the validity
of the instrument may have been affected by modification of
the item set. Fourth, the findings of this cluster analysis
would benefit from replications with larger sample sizes to
increase the reliability of the results. Although we did uti-
lize an objective indicator of distress tolerance, the BIRD
was only administered in our sample post-intervention, and
the sample size for the analyses with the BIRD was much
smaller than the sample size used for the other analyses.
Fifth, more recently, the construct validity of the awareness
subscale of the DERS has been critiqued, (e.g., Bardeen
et al., 2016). However, high internal consistency of the
items was found in our sample, thus awareness is likely to
have been reliably captured in the current study, perhaps a
benefit of the shortened measure set. Sixth, the DERS
captures trait emotion regulation abilities, thus the findings
might not generalize to adolescents who struggle with
emotional awareness or accessing effective emotion reg-
ulation strategies only within confined and specific contexts,
and therefore would fit in differing profiles depending upon
the context of interest. Last, our measure of mental health
symptoms collapsed all categories of clinical disorders. It is
unknown whether the distinct profiles may be differentially
Journal of Child and Family Studies (2022) 31:2631–2643
related to specific categories of clinical disorders (e.g.,
externalizing versus internalizing disorders).
Conclusion and Future Directions
The findings of the study allow multiple recommendations
for future research. Foremost, given the increasing number
of interventions that target emotion regulation, researchers
studying these interventions would benefit from collecting
and utilizing data on both emotional awareness and access
to effective emotion regulation strategies. These data may
help researchers understand if these skills both change in
response to intervention and if there are particular profiles
of adolescents with skills or deficits in emotional awareness
and accessing emotion regulation strategies who benefit
from emotion regulation interventions (e.g., emotion
focused coping skills, mindfulness training), including
those that utilize chain analysis to better understand the
degree to which clients have deficits in specific domains of
emotion regulation (e.g., DBT skills training). While this
study provides the framework for future studies to examine
profiles of emotion regulation, our sample consisted of
adolescents with varying levels of socioemotional and
mental health functioning, thus future studies should
explore this using both clinical and non-clinical samples to
examine whether differences exist between the two popu-
lations. Further an examination of concordance of adoles-
cent, and parent- and teacher- report on the same constructs,
as well as concordance with other more objective indicators
of emotion regulation (e.g., physiological processes), is
warranted.
Practical Implications
The findings also suggest that adolescents reporting pro-
blems with accessing effective emotion regulation strategies
and adolescents reporting problems with emotional aware-
ness may benefit from uniquely targeted interventions. For
example, it may be that adolescents reporting problems with
access to emotion regulation strategies lack self-efficacy for
utilizing available emotion regulation strategies and need
support in implementing and monitoring the success of
emotion regulation attempts. In contrast, those adolescents
reporting problems with emotional awareness were less able
to tolerate distress and may have unique emotion regulation
deficits such that interventions will need to target increasing
awareness and understanding of their emotional experience
as well as training emotion-focused regulation skills (e.g.,
tolerating distress). Interventions such as Dialectical Beha-
vior Therapy allow for such individualization based on
adolescent strengths and difficulties in emotional awareness
2641
and emotion. regulation. It is also possible that the use of a
modular approach towards treatment planning, based on
strengths and difficulties at baseline, may also be efficacious
in supporting emotion development in adolescents partici-
pating in interventions. It will also be important to
acknowledge the potential for within-person malleability in
emotional awareness and access to emotion regulation
strategies across contexts when examining how these
associations might change within interventions. By taking a
more contextualized approach we can better understand the
emotion-behavior chain and bolster treatment effects, thus
improving adolescent emotional functioning and overall
wellbeing across the lifespan.
Funding This research was supported by a grant from National
Institute of Nursing Research – R01NR011906.
Compliance with Ethical Standards
Conflict of Interest The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
References
Adams, S., Kuebli, J., Boyle, P. A., & Fivush, R. (1995). Gender
differences in parent–child conversations about past emotions: A
longitudinal investigation. Sex Roles, 33(5), 309–322.
Adrian, M., Zeman, J., & Veits, G. (2011). Methodological implica-
tions of the affect revolution: A 35-year review of emotion reg-
ulation assessment in children. Journal of Experimental Child
Psychology, 110(2), 1–27.
Amstadter, A. B., Daughters, S. B., MacPherson, L., Reynolds, E. K.,
Danielson, C. K., & Wang, F., et al. (2012). Genetic associations
with performance on a behavioral measure of distress tintoler-
ance. Journal of Psychiatric Research, 46(1), 87–94.
Bardeen, J. R., Fergus, T. A., Hannan, S. M. & Orcutt, H. K. (2016).
Addressing psychometric limitations of the Difficulties in Emo-
tion Regulation Scale through item modification. Journal of
Personality Assessment, 98(3), 298–309.
Bender, P. K., Reinholdt-Dunne, M. L., Esbjørn, B. H., & Pons, F.
(2012). Emotion dysregulation and anxiety in children and ado-
lescents: Gender differences. Personality and Individual Differ-
ences, 53(3), 284–288.
Brody, L. R. (1999). Gender, emotion, and the family. Cambridge,
MA: Harvard University Press.
Brody, L. R., & Hall, J. A. (2008). Gender and emotion in context. In
M. Lewis, J. M. Haviland-Jones & L. F. Barrett (Eds.), Handbook
of emotions. 3rd ed. (pp. 395–408). New York, NY: The Guilford
Press.
Bulger, C. A., Matthews, R. A., & Hoffman, M. E. (2007). Work and
personal life boundary management: Boundary strength, work/
personal life balance, and the segmentation-integration con-
tinuum. Journal of Occupational Health Psychology, 12(4),
365–375.
Campos, J. J., Campos, R. G., & Barrett, K. C. (2010). Emergent
themes in the study of emotional development and emotion
regulation. Developmental Psychology, 25(3), 394–402.
2642
Ciarrochi, J., Heaven, P. C., & Supavadeeprasit, S. (2008). The link
between emotion identification skills and socio-emotional func-
tioning in early adolescence: a 1-year longitudinal study. Journal
of Adolescence, 31(5), 565–582.
Cole, P., Martin, S., & Dennis, T. (2004). Emotion regulation as a
scientific construct: Methodological challenges and directions for
child development research. Child Development, 75(2), 317–333.
Crowell, S. E., Skidmore, C. R., Rau, H. K., & Williams, P. (2013).
Psychosocial Stress, Emotion Regulation, and Resilience in
Adolescence. In W. T. O’Donohue, L. T. Benuto & L. Woodward
Tolle (Eds.), Handbook of adolescent health psychology (pp.
129–141). New York, NY: Springer.
Cummings, J. R., Bornovalova, M. A., Ojanen, T., Hunt, E., Mac-
Pherson, L., & Lejuez, C. (2013). Time doesn’t change every-
thing: The longitudinal course of distress tolerance and its
relationship with externalizing and internalizing symptoms during
early adolescence. Journal of Abnormal Child Psychology, 41(5),
735–748.
Daughters, S. B., Reynolds, E. K., MacPherson, L., Kahler, C. W.,
Danielson, C. K., & Zvolensky, M., et al. (2009). Distress tol-
erance and early adolescent externalizing and internalizing
symptoms: The moderating role of gender and ethnicity. Beha-
viour Research and Therapy, 47(3), 198–205.
Diamond, L., & Aspinwall, L. (2003). Emotion regulation across the
life span: An integrative perspective emphasizing self-regulation,
positive affect, and dyadic processes. Motivation and Emotion,
27(2), 125–156.
Dixon-Gordon, K. L., Aldao, A., & De Los Reyes, A. (2015).
Repertoires of emotion regulation: A person-centered approach to
assessing emotion regulation strategies and links to psycho-
pathology. Cognition and Emotion, 29(7), 1314–1325.
Eisenberg, N., Sadovsky, A., & Spinrad, T. L. (2005). Associations of
emotion-related regulation with language skills, emotion knowl-
edge, and academic outcomes. New Directions for Child and
Adolescent Development, 109, 109–118.
Fanti, K. A., Kyranides, M. N., Lordos, A., Colins, O. F., & Ander-
shed, H. (2018). Unique and interactive associations of callous-
unemotional traits, impulsivity and grandiosity with child and
adolescent conduct disorder symptoms. Journal of Psycho-
pathology and Behavioral Assessment, 40(1), 40–49.
Fivush, R. (1989). Exploring sex differences in the emotional content
of mother–child conversations about the past. Sex Roles, 20(11),
675–691.
Gadow, K., & Sprafkin, J. (1997). Adolescent Symptom Inventory-4
(ASI-4). Stonybrook, NY: Checkmate Plus.
Gadow, K. D., Sprafkin, J., Carlson, G. A., Schneider, J., Nolan, E. E.,
& Mattison, R. E., et al. (2002). A DSM-IV-referenced, adoles-
cent self-report rating scale. Journal of the American Academy of
Child & Adolescent Psychiatry, 41(6), 671–679.
Garnefski, N., Kraaij, V., & van Etten, M. (2005). Specificity of
relations between adolescents’ cognitive emotion regulation
strategies and internalizing and externalizing psychopathology.
Journal of Adolescence, 28(5), 619–631.
Gratz, K., & Roemer, L. (2004). Multidimensional assessment of
emotion regulation and dysregulation: Development, factor
structure, and initial validation of the difficulties in emotion
regulation scale. Journal of Psychopathology and Behavioral
Assessment, 26(1), 41–54.
Gratz, K., Tull, M. T., Reynolds, E. K., Bagge, C. L., Latzman, R. D.,
& Daughters, S. B., et al. (2009). Extending extant models of
pathogenesis of borderline personality disorder to childhood
borderline personality symptoms: The roles of affective dys-
function, disinhibition, and self- and emotion-regulation deficits.
Developmental Psychopathology, 21(4), 1263–1291.
Gross, J. J. (2015). Emotion regulation: Current status and future
prospects. Psychological inquiry, 26(1), 1–26.
Journal of Child and Family Studies (2022) 31:2631–2643
Guyer, A. E., Silk, J. S., & Nelson, E. E. (2016). The neurobiology of
the emotional adolescent: From the inside out. Neuroscience &
Biobehavioral Reviews, 70, 74–85.
Hollenstein, T., & Lanteigne, D. M. (2018). Emotion regulation
dynamics in adolescence. In P. M. Cole & T. Hollenstein (Ed.),
Emotion Regulation: A Matter of Time. New York, NY:
Rutledge.
Houck, C. D., Hadley, W., Barker, D., Brown, L. K., Hancock, E., &
Almy, B. (2016). An emotion regulation intervention to reduce
risk behaviors among at-risk early adolescents. Prevention Sci-
ence, 17(1), 71–82.
Izard, C. E. (2009). Emotion theory and research: Highlights, unan-
swered questions, and emerging issues. Annual Review of Psy-
chology, 60, 1–25.
Izard, C. E., Woodburn, E. M., Finlon, K. J., Krauthamer-Ewing, E. S.,
Grossman, S. R., & Seidenfeld, A. (2011). Emotion knowledge,
emotion utilization, and emotion regulation. Emotion Review,
3(1), 44–52.
Kranzler, A., Young, J. F., Hankin, B. L., Abela, J. R., Elias, M. J., &
Selby, E. A. (2016). Emotional awareness: A transdiagnostic
predictor of depression and anxiety for children and adolescents.
Journal of Clinical Child & Adolescent Psychology, 45(3),
262–269.
Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: how
difficulties in recognizing one’s own incompetence lead to
inflated self-assessments. Journal of Personality and Social
Psychology, 77(6), 1121.
MacPherson, L., Reynolds, E. K., Cassidy, J., Daughters, S. B.,
Mayes, L. C., & Wang, F. (2010). Positive and negative rein-
forcement underlysing risk beahvior in early adolescents. Pre-
vention Science, 11(3), 331–342.
Masten, A. S., & Cicchetti, D. (2010). Developmental cascades.
Development and Psychopathology, 22(3), 491–495.
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli,
S., Cui, L., & Swendsen, J. (2010). Lifetime prevalence of mental
disorders in US adolescents: results from the National Comor-
bidity Survey Replication–Adolescent Supplement (NCS-A).
Journal of the American Academy of Child & Adolescent Psy-
chiatry, 49(10), 980–989.
Neumann, A., Van Lier, P., Gratz, K., & Koot, H. (2010). Multi-
dimensional Assessment of Emotion Regulation Difficulties in
Adolescents Using the Difficulties in Emotion Regulation Scale.
Assessment, 17(1), 138–149.
Nook, E. C., Sasse, S. F., Lambert, H. K., McLaughlin, K. A., &
Somerville, L. H. (2018). The nonlinear development of emotion
differentiation: Granular emotional experience is low in adoles-
cence. Psychological Science, 29(8), 1346–1357.
Pardini, D., Stepp, S., Hipwell, A., Stouthamer-Loeber, M., & Loeber,
R. (2012). The clinical utility of the proposed DSM-5 callous-
unemotional subtype of conduct disorder in young girls. Journal
of the American Academy of Child & Adolescent Psychiatry,
51(1), 62–73.
Perez, J., Venta, A., Garnaat, S., & Sharp, C. (2012). The difficulties in
emotion regulation scale: Factor structure and association with
nonsuicidal self-injury in adolescent inpatients. Journal of Psy-
chopathology and Behavioral Assessment, 34(3), 393–404.
Riley, T. N., Sullivan, T. N., Hinton, T. S., & Kliewer, W. (2019).
Longitudinal relations between emotional awareness and
expression, emotion regulation, and peer victimization among
urban adolescents. Journal of Adolescence, 72, 42–51.
Rith-Najarian, L. R., McLaughlin, K. A., Sheridan, M. A., & Nock, M.
K. (2014). The biopsychosocial model of stress in adolescence:
self-awareness of performance versus stress reactivity. Stress,
17(2), 193–203.
Roth, G., Vansteenkiste, M., & Ryan, R. M. (2019). Integrative
emotion regulation: Process and development from a self-
Journal of Child and Family Studies (2022) 31:2631–2643
determination theory perspective. Development and Psycho-
pathology, 31(3), 945–956.
Sarıtaş-Atalar, D., Gençöz, T., & Özen, A. (2015). Confirmatory factor
analyses of the difficulties in emotion regulation scale (DERS) in
a Turkish adolescent sample. European Journal of Psychological
Assessment, 31, 12–19.
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-
age children: The develpment and validation of a new criterion
Q-sort scale. Developmental Psychology, 33(6), 906–916.
Shields, A., & Cicchetti, D. (1998). Reactive aggression among mal-
treated children: The contributions of attention and emotion
dusregulation. Journal of Clinical Child Psychology, 27(4),
709–723.
Shields, A., & Cicchetti, D. (2001). Parental maltreatment and emotion
dysregulation as risk factors for bullying and victimization in
middle childhood. Journal of Clinical Child Psychology, 30(3),
349–363.
Thompson, R. A. (2011). Emotion and emotion regulation: Two sides
of the developing coin. Emotion Review, 3(1), 53–61.
Van Beveren, M. L., Goossens, L., Volkaert, B., Grassmann, C.,
Wante, L., Vandeweghe, L., & Braet, C. (2019). How do I feel
right now? Emotional awareness, emotion regulation, and
2643
depressive symptoms in youth. European Child & Adolescent
Psychiatry, 28(3), 389–398.
Van Eck, K., Warren, P., & Flory, K. (2017). A variable-centered and
person-centered evaluation of emotion regulation and distress
tolerance: links to emotional and behavioral concerns. Journal of
Youth and Adolescence, 46(1), 136–150.
Vasilev, C., Crowell, S., Beauchaine, T., Mead, H., & Gatzke-Kopp,
L. (2009). Correspondence between physiological and self-report
measures of emotion dysregulation: A longitudinal investigation
of youth with and without psychopathology. Journal of Child
Psychology and Psychiatry, 50(11), 1357–1364.
Weinberg, A., & Klonsky, E. (2009). Measurement of emotion dys-
regulation in adolescents. Psychological Assessment, 21(4),
616–621.
Weinberg, M. K., Tronick, E. Z., Cohn, J. F., & Olson, K. L. (1999).
Gender differences in emotional expressivity and self-regulation
during early infancy. Developmental Psychology, 35(1), 175–188.
Weissman, D. G., Nook, E. C., Dews, A. A., Miller, A. B., Lambert,
H. K., Sasse, S. F., & McLaughlin, K. A. (2020). Low emotional
awareness as a transdiagnostic mechanism underlying psycho-
pathology in adolescence. Clinical Psychological Science, 8(6),
971–988.