Summaries: the best scientific articles for clinical child and adolescent psychology summarized

Preface

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

What is an emotion?

The James-Lange theory

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

Emotion as a social-psychological construct

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

Why do we have emotions?

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

The evolutionary significance of emotions

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

Emotions as a social signaling system

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

Emotions provide behavioral flexibility

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

Information processing

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

Regulation and control

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

So, an emotion:

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

How are emotions elicited and how are they distinguished?

Philosophical notions

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

The Schachter-Singer theory of emotion

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

Appraisal theory

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

Cultural and individual differences in appraisal at events

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

Are there specific response patterns for different types of emotions?

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

Wat are motoric expressions?

Facial expressions

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

Vocal expressions

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

Control and strategic manipulation of an expression

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

Physiological changes

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

Subjective feelings

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

Dimensions of feeling

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

Verbal labeling of feelings

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

How can emotion components interact?

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

Catharsis

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

Proprioceptive feedback

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

Deficits in empathic abilities are thought to stem from impairments in social interaction exhibited by a person who engages in antisocial behaviour. Empathy requires social attention. When it comes to people who exhibit antisocial behaviour, no study looked into the relationship between social attention and affective and cognitive empathy.

What is the background of this study?

Some children are at high risk of (developing) antisocial behaviour, possibly resulting into receiving a criminal record. In order to help this group and prevent the negative influence on society, an early intervention is required. Other research already showed that a high-risk child comes from a more disadvantaged neighbourhood, has poorer parental guidance, exhibits alterations in brain function and structure and deals with a more problematic emotional functioning. On the other hand, studies show that a high-risk childhood does not inevitably results into a criminal adulthood, which implicates that an adequate intervention can reverse antisocial behaviour. An early intervention is also recommendable given the fact that we are especially capable of emotional and social learning during the phase between childhood and early adolescence.

Empathy and recognizing the emotions of other people are based on the gradual refinement with age of children’s recognition and production of emotional signals. They are learned through experience. A young child that can recognize other’s emotions well, has more social skills and is more popular. A child that is exposed to divergent emotional signals or is adversely treated exhibits several emotional difficulties. Engaging in inappropriate behaviour like antisocial behaviour or aggression results into issues with empathy and the recognition of emotions.

Affective empathy: the ability to experience what it feels like for someone else to experience certain emotions. Cognitive empathy: ability to understand what the thoughts or emotions of someone else might be, without being emotionally involved. Research shows that children with antisocial behaviour have unimpaired cognitive empathy but impaired affective empathy. Unimpaired cognitive empathy was also found in studies that analysed only cognitive empathy. However, empathy was examined through questionnaires. Affective empathy was not measured with psychological measures. Physiological arousal is a objective, direct and reliable measure of affective empathy and has frequently been linked to antisocial behaviour. A verbal report of the emotions someone is experiencing is not the best measure, it would be especially unreliable in case of an antisocial boy (who is likely to have issues with self-reflection and a low verbal IQ). In studies that examined affective empathy through physiological measures, measures of cognitive empathy were excluded. These studies show that children with behaviour disorders exhibited  decreased physiological responses and thus less affective empathy as a reaction to negative emotions. In this study, objective physiological measures will be used for affective empathy, combined with both affective and cognitive empathy.

Naturally, people prefer social information, also known as social attention. During social interaction, information about the emotional and mental state of the other person can be obtained by examining the face, more specific: the eyes. Social attention can be considered as a crucial precursor of empathic responses.

What methods were used?

Who participated?

Data were collected from children recruited through Amsterdam’s PIT-project (Preventive Intervention Trajectory). This program targets children at risk of developing criminal behaviour due to being related to youthful offenders (siblings) or delinquents (parents) or failing at primary school due to extreme antisocial behaviour or frequently being unauthorized absent.

The total study group consisted of 157 children (114 high-risk children, the control group included 43 children). They had an average age of 10 years and attended the same schools. The risk status of the children was confirmed by using the Dutch equivalent of the Teacher Report Form. The children in the control group scored within the normal range on the problem scales (borderline, aggression, rule-breaking behaviour, internalizing problem behaviour), while the high-risk children had high scores on the first three scales. The problem behaviour as described by the parents was identified by using the Dutch equivalent of the Child Behaviour Checklist.

What procedure was followed?

Participants were invited to take tests in accordance with the standard protocol. The children were separately assessed in a non-distracting room. 

What instruments were used?

Stimuli: four video clips were showed: a neutral one (fish in an aquarium) for obtaining baseline electrodermal and cardiovascular activity and three emotional movie clips, presenting various emotions: pain, fear and happiness.

Social attention was assessed through visual scanning patterns: the face and eyes. These patterns were measured by using an eye-tracker (fixation filter) and through hand drawings created by Tobii Studio.

Affective empathy was measured by using electrodes measuring electrodermal and cardiovascular activity. Affective arousal: the difference between baseline and the three emotional clips in electrodermal and cardiovascular activity. Heart rate was used as cardiovascular response variable and skin conductance responses and skin conductance level as electrodermal response variables.

Cognitive empathy was assessed by asking questions about the specific emotions the leading character in the video’s experienced, the intensity and causes of these emotions. 

How were the statistics analysed?

The control group and the high-risk group were compared on intellectual functioning, gender and age. Total fixation duration on the total screen was observed in order to detect possible differences in attention. Group differences were analysed by performing a two-way repeated measures assessment of variance with Dynamic Areas of Interest (eyes and face) and Emotion (pain, fear, happiness) as within-subject factors and Group as between-subjects factor. Three repeated measures assessment of variance were performed to detect differences between groups in heart rate, skin conductance response and skin conductance level as an reaction to the emotion clips with Emotion as within-subject factor and Group as between-subjects factor. MANOVA was used for a comparison between both groups regarding cognitive empathy.

What were the results?

There were no differences between the control group and the high-risk group with regard to gender and age. A significantly lower estimated full scale IQ, a significantly higher score on rule-breaking behaviour, TRF aggression, total internalizing behaviour and total externalizing behaviour were reported in the high-risk group. In comparison to the reports of the teachers, the high-risk children’s parents reported less problematic behaviour (rule breaking and aggression). IQ was excluded from further analyses, since there was no correlation found with empathy or social attention variables.

There was no difference detected between the groups regarding the total fixation duration (attention) to the total screen. The results showed no significant effect of Group on social attention, but a significant effect of Group on Emotion. The differences in fixation duration between face and eyes were biggest for the fear and pain (the negative emotions).

The groups did not differ in heart rate, skin conductance level and skin conductance responses at baseline. There was no effect of Group regarding heart rate, but there was a significant effect of fear and pain (Emotion). An increase in heart rate was observed in the control group during emotion exposure, while a decrease was observed in the high-risk group.

Regarding the skin conductance level, no significant effect of Group was observed. The results showed a significant effect of fear and pain (Emotion). In the high-risk group, a smaller increase in the skin conductance level was observed during the pain clips only.

Regarding skin conductance responses, no significant effect of Group was observed. The results showed a significant effect of fair and pain (Emotion). In the high-risk group, fewer skin conductance responses were observed during the pain clips.

The groups did not differ in cognitive empathy.

What do these results mean?

Some children are at high risk of developing antisocial behaviour and getting involved in criminal activity. A timely intervention could help those children and prevent the negative consequences for society. The study showed that high-risked children have impaired affective empathy when watching emotional video clips.

As to date, the role of social attention was in no other study assessed by using eye-tracking technology and empathy in response to various emotionally relevant events in a research group consisting children at high risk of criminal behaviour. Social attention may be a requirement for empathic response, but the high-risk group showed no impaired social attention. This implies that social attention does not account for the affective empathy deficits. The results of this study challenge the results of other studies, in which a failure in attention to the eyes was considered a cause of fear recognition issues in children with Callous-Unemotional traits. The results of this study showed no abnormality regarding social attention. This could mean that the training provided to children with CU-traits will not be helpful to high-risk children. Future research should also focus on high-risk children and examine their levels of CU-traits.

In accordance with earlier studies on affective and cognitive empathy, this study showed significant differences in affective empathy only. The results suggest that children at high risk of criminal behaviour exhibit a correct recognition and understanding of the emotions expressed in the clips, but found it problematic to experience and empathize with the negative emotions of other people. These results combined with the findings on unimpaired social attention indicate that impaired affective empathy is a crucial component that is connected to antisocial behaviour.

A child that does not understand and share the feelings of the people who suffer from his negative behaviour is expected to continue this behaviour. This study showed that the affective response to watching others in fear or pain was significantly smaller for a high risk child. Deficits in affective empathy can be indicative for other negative behaviours. It is advisable to include fMRI in future research, to examine the potential relation between affective empathy and functional brain networks. This could also provide new insights in the brain mechanisms underlying empathy.

This study shows that affective empathy deficits plays a significant role in developing antisocial behaviour, which should be taken into consideration while developing inventions. Good results have been reported after emotion awareness therapy and compassion training. Programs that focus on increasing emotion awareness could play an important role in future prevention and intervention research.

What is the conclusion?

Children at high risk of developing criminal behaviour - due to having delinquent parents, young offenders as siblings or failing at primary school because of severe antisocial behaviour or absenteeism -  exhibit unimpaired cognitive empathy and social attention but impaired affective empathy. The results of this study show the importance of emotion function (more specific: a reduced affective response) in the development of criminal behaviour and indicate that interventions should focus on affective empathy in order to create a turning point in the negative behaviour of high-risk children.

What is aggression and what does its developmental course look like?

Aggression is any form of behavior that has the goal of harming or injuring someone else. Two types of aggression based on underlying motives are:

• Reactive aggression is a defensive response to perceived provocation or threat. It is accompanied by negative affective states, such as anger and frustration.

• Proactive aggression is goal-oriented and motivated by the desire to obtain a desired outcome. It occurs in the absence of provocation and emotional arousal.

Engagement in aggression starts to emerge before the age of two and reaches a peak between the age of two and four. After that, aggression starts to gradually decrease as children learn to regulate their behavior.

How do adolescents with hearing loss differ with regards to aggression compared to adolescents without hearing loss?

Results show a higher incidence of aggression in adolescents with hearing loss. This could be due to a few reasons. Firstly, adolescents with hearing loss may be at higher risk for developing reactive aggression, because theWhaty more often attribute hostile intentions to others in benign social situations. Secondly, adolescents with hearing loss seem to infer that relationships are not always harmed by anger or aggression. Thirdly, adolescents with hearing loss may view aggressive behavior as a preferable option to obtain instrumental goals, since they don't attach the same level of negative consequences to anger and aggression.

What are shame and guilt and how do these emotions develop?

Shame focuses on the fear of being negatively evaluated by others. Guilt focuses on the responsibility for the harm caused to another. Children are not born with the ability to experience shame and guilt. These feelings usually arise after a moral transgression. The onset and development of these emotions depends on the acquisition of several cognitive skills:

• A sense of self-awareness and the capacity to reflect on the self. This develops around two years of age.

• Knowledge about social rules and the capacity to evaluate one's own behavior according to these standards. The development of this skill is highly dependent on input from the social environment, as children learn social rules via observation.

• Perspective taking abilities. Around the age of four children have developed a basic understanding of others´ intentions, beliefs and desires.

How does the development of shame and guilt differ for children with hearing loss?

The acquisition of the cognitive skills for the experience of shame and guilt relies on input from the social world. Not being able to hear the interactions in the social world has several consequences. For instance, children with hearing loss are not able to overhear interactions to learn how others´ behaviors are evaluated. This may lead them to have less awareness of social rules and standards. Also, children with hearing loss tend to have difficulties with perspective taking, as this development is highly reliant on verbal interactions.

How do the relations between shame and guilt and aggression develop during childhood and adolescence?

An important predictor of aggression is whether children and adolescents anticipate positive or negative emotions following moral transgressions. Children around the age of four know that moral transgressions are wrong, but still only attribute positive feelings to themselves. In middle childhood, children have an increased focus on others´ emotions and perspectives and they start to anticipate shame and guilt. Throughout adolescence and early adulthood, negative emotion attributes become more frequent. The expectation that one will experience negative emotions following a moral transgression turns aggression into a less desired behavioral alternative, while the expectation that one will experience positive emotions following a moral transgression is associated with higher levels of aggression.

How are feelings of shame related to aggression?

There are different results regarding the relationship between shame and aggression. In some studies, the mere anticipation of shame prevents aggressive behaviors, whereas in other studies, shame is related to higher levels of aggression. Distinguishing between reactive and proactive aggression may explain this difference. If shamed individuals feel judged and are worried about their image, they may react hostile and aggressive towards disapproving others to protect their self-esteem and increase their sense of superiority (increased reactive aggression). But, shame can also evoke a feeling of having harmed someone, and contribute to a decrease of proactive aggression.

How are feelings of guilt related to aggression?

Guilt has been found to be associated with lower levels of aggression. The anticipation that one's actions have negative consequences for others and the unpleasantness of guilt, makes it less likely that adolescents will behave aggressively. Especially, higher levels of guilt are linked to lower levels of proactive aggression.

What are the main findings of the study by Broekhof et. al. (2021) with regards to the relations between shame, guilt and the development of aggression in adolescents with and without hearing loss?

The main findings can be summarized as followed:

• Reactive and proactive aggression declined throughout adolescence.

• Higher levels of shame were related to increasing levels of reactive aggression over time.

• Higher levels of guilt were related to decreasing levels of proactive aggression.

• The developmental trend of aggression and its associations with shame and guilt apply to both adolescents with and without hearing loss.

• Adolescents with hearing loss report higher levels of proactive aggression and lower levels of shame and guilt.

• In adolescents with hearing loss, guilt peaked later in adolescence compared to adolescents without hearing loss.

What can be concluded about the level of social access of adolescents with hearing loss and their levels of aggression?

The level of social access did not seem to alter the role of shame and guilt on the development of aggression. Adolescents with hearing loss did not seem to be at risk for the development of reactive aggression, but they did show elevated levels of proactive aggression. The need for social learning is highlighted by this research, as adolescents with hearing loss reported lower levels of shame and guilt in general. Children and adolescents with hearing loss tend to be less aware of others´ perspectives and feelings, due to restricted access to the social world. They may not foresee the negative evaluations of others or negative emotional consequences as a result of aggressive behavior, making it less likely that they will experience shame and guilt.

Dynamics of affective experience and behavior in depressed adolescents

Unipolar depression disorders are an example of emotion regulation disorders. This disregulation is caused by two systems, namely the appetitive system and the aversive system. These systems determine the valence of affective states. Depression is associated with more activity and sensitivity to aversive emotional systems. These cause the appetitive emotional system to become less active and less sensitive. A person will experience more negative affect and reduced positive affect. Three factors that influence this experience are intensity, duration and frequency. Duration is associated with depression, especially when looking at maintaining positive affect and disruptive negative affect.

Depression is also associated with less activity in the left PFC. Targeted behavior is motivated by this area and this causes positive affect. The amygdala is more active in depressed adults and children. Reward related neural structures are less active.

Depressed people experience negative affect more intensely and positive affect less intensely. Depression is also associated with less intense immediate responses to positive and negative stimuli.

Adolescents are undergoing changes in affective competence and contextual challenges. This is why it is important to study development during this period. Literature focuses on disturbances in negative affect, but not on the dysregulation of positive affect. The hypothesis in this study is that depressed adolescents experience dysphoria and anger more frequently, more intensely and for a longer period of time. They will also experience less frequent, less intense and less long-term happiness. Various instruments and behavioral observations have been used to investigate this.

Methods

Participants and Measurements

Participants were 152 adolescents who do not take antidepressants, with ages between 14-18 and their parents. Participants were recruited through a school screening (CES-D) and an in-home diagnostic interview (K-SADS). Families who met the research criteria after the diagnostic interview were invited to participate in a lab assessment. During this assessment, use was made of questionnaires (AIM, PANAS-X, MEI / Child-MEI) and family interaction tasks (LIFE) that evoke happiness, anger or dysphoria.

Results

Experience

Depressed participants experience anger for longer. Depressed women experience dysphoria longer than healthy women. Depressed men experience dysphoria longer than healthy men. Healthy participants experience happiness for longer than depressed participants, according to the MEI, but not according to the observation data.

Frequency

Depressive participants experience anger more often than healthy participants. The difference between depressed and healthy adolescents is greater for women. Depressive participants experience dysphoria more often from healthy participants. Depressive participants experience happiness less often than healthy participants.

Intensity

Depressive participants experience anger more intensively than healthy participants. Depressive participants experience sadness more intensely compared to healthy participants.

Discussion

Various abnormalities were found in terms of duration, frequency and intensity of affect. Depressed participants experience anger longer. Depressed women experience dysphoria longer than healthy women. Data about happiness varies with different methods. These results are consistent with earlier work, because it is shown that depressed adolescents have difficulty retaining positive affect. Data about intensity is less solid, because observations are unreliable. Depressed women mainly experience more anger. In general, depressed adolescents experience more negative and sad affect. Experiencing less positive affect is not supported by the data found. The lack of observation data may reflect task limitations or self-report data may differ in how people remember and summarize their experiences, rather than the actual affective experience. This can cause the difference in data from observations and self-report measurements. In the future, studying the interpersonal context is also important because the family environment of depressed adolescents differs from the environment of healthy adolescents.

A limitation in this study is that relapse and recovery are not included. Affective disregulation has been studied, but this is a very broad term. The generalizability of this study is questionable because there is a lack of diversity in terms of race and ethnicity. Finally, the relationship between adolescents' responses and affective experience can be studied.