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(p. 18) The Relation of Self-Regulation to Children’s Externalizing and Internalizing Problems 

(p. 18) The Relation of Self-Regulation to Children’s Externalizing and Internalizing Problems
(p. 18) The Relation of Self-Regulation to Children’s Externalizing and Internalizing Problems

Nancy Eisenberg

, Maciel M. Hernández

, and Tracy L. Spinrad

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date: 19 May 2019

Self-regulation in children

The lack of emotional or behavioral regulation is often viewed as a component of psychopathology; indeed, some types of problems are defined in part by the lack of self-regulation (e.g., some externalizing problems and depression/anxiety; American Psychiatric Association, 2013). However, empirically, agreement has not been reached regarding what capacities are included in the construct of “regulation” or “self-regulation” (e.g., see Eisenberg, Hofer, Sulik, & Spinrad, 2014). In this chapter, we consider some useful conceptual distinctions in the domain of control, briefly present heuristic hypotheses regarding the relations between regulation-relevant constructs and externalizing and internalizing behaviors, and review representative empirical findings.

Conceptual issues

Eisenberg, Hofer, Sulik, and Spinrad (2014) defined emotion-related self-regulation as a process used to “manage and change whether, when and how (e.g., how intensely) one experiences emotions and emotional-related motivational and physiological states, as well as how emotions are expressed behaviorally. Thus, it includes processes used to change one’s own emotional state, to prevent or initiate emotion responding (e.g., by selecting or changing situations), to modify the significance of an event for the self, and to modulate the behavioral expression of emotion (e.g., through verbal or nonverbal cues)” (p. 157). The term “emotion-related” self-regulation is used because many of the processes/abilities that are part of emotion-related regulation can be involved in regulating multiple aspects of functioning, which include not only the expression and experience of emotion, but also aspects of cognition, attention, and behavior that do not involve (or secondarily or minimally involve) modulating the expression and experience of emotion. Thus, emotion regulation, defined by Gross (2014) as “shaping which emotions one has, when one has them, and how one experiences or expresses these emotions” (p. 6), can be viewed as occurring when emotion-related self-regulatory skills are applied directly to the experience or expression of emotion. Of course, external influences such as parents or providers of social support can contribute to the modulation of emotion and its expression, but for clarity, we have argued it is clearer to differentiate such external controlling factors from self-regulation (Eisenberg & Spinrad, 2004).

Regardless of the specific terminology, we have suggested it is useful to distinguish between self-regulatory processes that can readily become volitional when required to adapt or achieve (p. 19) a goal and those “regulating” or controlling processes that affect emotion and behavior but are harder to control volitionally. As has been discussed by researchers from multiple subdisciplines of psychology (see Carver, 2005), many non-volitional processes have important modulating (in a sense, regulating) effects on attention, behavior, cognition, and physiological responding. Eisenberg et al. (2014) used the term “self-regulation” to refer to “potentially volitional, self-regulatory processes.”

The interconnectedness of these constructs makes it difficult to differentiate emotion from its self-regulation; someone who expresses little emotion in a potentially evocative context may be regulating his or her emotion or simply may not be responding emotionally. Thus, it is beneficial to focus on the processes used to manage emotion, cognition, and associated behavior, rather than to measure the amount of emotion experienced or expressed. Consequently, when studying the regulation of emotion, rather than look for possible self-regulation of emotional displays, there are advantages to focusing on and measuring aspects of executive functioning that contribute to self-regulation (e.g., executive attention) and dispositional differences in self-regulation that employ the skills used for the regulation of emotion and related cognitive, physiological, and behavioral responses.

Effortful self-regulatory processes

The temperamental underpinnings of self-regulation are known as effortful control, defined by Rothbart and Bates (2006, p. 129) as “the efficiency of executive attention, including the ability to inhibit a dominant response and/or to activate a subdominant response, to plan, and to detect errors.” Effortful control includes the capacities to effortfully (i.e., willfully) deploy attention (e.g., to focus and shift attention as needed) and to willfully inhibit or activate behavior, especially when doing so is a non-preferred (subdominant) response (i.e., inhibitory control and activational control, respectively). Effortful control is often measured with parents’ and teachers’ ratings and with a variety of behavioral measures, including those assessing the ability to delay gratification (e.g., wait until a bell rings to pick up a snack), inhibiting and activating similar behaviors based on different commands (games like Simon says), and executive-functioning skills involving the management of attention and inhibiting behavior.

Although effortful control is believed to be the temperamental core of self-regulation, emerging self-regulation can be conceptualized broadly, including more than the basic executive functioning-related skills involved in effortful control (e.g., the abilities to effortfully shift and focus attention and to effortfully activate and inhibit behavior as needed for adaptation). For instance, complex cognitive strategies (e.g., cognitive restructuring), seeking social support, persistence, and motivational components, such as the desire to act in ways consistent with norms or expectations, may also be viewed as aspects of self-regulation.

Eisenberg and colleagues (Eisenberg et al., 2014) have argued that although effortful control is defined as effortful or willful, individuals may not always be aware that they are modulating emotion, attention, or behavior. Some aspects of effortful control undoubtedly become automatic and executed without substantial conscious awareness in contexts with relevant triggering cues (Mischel & Ayduk, 2011); however, an effortful control-related process can shift into a volitional and more conscious mode of functioning when it is adaptive to move from an automatic to effortful status (analogous to automobile driving becoming much more effortful and less automatic when on ice).

Self-regulatory abilities are not necessarily inherently good or bad in terms of their outcomes. People can use self-regulation to achieve goals that are maladaptive or adaptive, and whether a consequence is positive or negative (socially, morally, or in normative terms) can differ in the short-term versus long-term. Nonetheless, effortful self-regulatory processes are probably more (p. 20) likely than some less volitional aspects of control (see below) to result in adaptive outcomes, or at least in desired goals (regardless of whether or not they are actually socially or functionally adaptive) because they can be flexibly applied when needed to accommodate contextual demands rather than being applied in a rigid manner.

Reactive control processes

As previously noted, there are many processes that are controlling or regulating in the sense that they modulate another system but which are also relatively non-volitional, nearly always automatic, and less flexible than effortful control. Because both the volitional nature and the flexibility of “regulatory” processes likely affect their effectiveness and outcomes, it can be argued that it is useful to differentiate volitional self-regulation from less volitional processes involved in control of emotion, physiological responding, and behavior.

Rothbart and Bates (2006) differentiated between temperamental regulation and reactivity. They defined reactivity as “responsiveness to change in the external and internal environment” (p. 100), including emotional reactivity and action tendencies. We use the term “reactive control” to refer to the action tendencies, rather than the emotion, that are part of reactivity. Rothbart and Bates (2006) defined self-regulation as “processes such as effortful control and orienting that function to modulate reactivity” (p. 100). Although Rothbart and colleagues (e.g., Derryberry & Rothbart, 1997) view emotional reactivity and behavioral reactivity as strongly linked processes, it seems likely that reactive behaviors sometimes occur without being evoked by emotion because they are part of a child’s characteristic way of responding in particular contexts.

In our view, overcontrolled and undercontrolled behaviors reflect two types of reactive control at the extremes of a heuristic continuum. In regard to overcontrol, children’s inhibited behavior in certain contexts often is relatively involuntary and difficult to modulate willfully (Eisenberg & Morris, 2002). For example, children labeled as “behaviorally inhibited” by Kagan (1998) tend to be wary and overly constrained in novel and/or stressful situations and appear to have difficulty willfully modulating their inhibition. On the other extreme, undercontrol—the impulse to approach people or inanimate objects in the environment (often quickly) without much thought—often appears to be relatively involuntary. Such behavior is clearly reflected in at least some types of impulsive behavior. Undercontrol and overcontrol map onto Gray’s (Pickering & Gray, 1999) behavioral activation (BAS; which involves sensitivity to cues of reward or cessation of punishment) and behavioral inhibition (BIS; activated in situations involving novelty and stimuli signaling punishment or frustrative nonreward) systems. Both these systems are believed to be centered in subcortical regions of the brain. In contrast, effortful control appears to be centered primarily in cortical regions of the brain such as the anterior cingulate gyrus and prefrontal areas for the “cool” executive functioning components (Cohen & Lieberman, 2010; Rothbart & Bates, 2006) and perhaps the ventromedial prefrontal cortex and orbitofrontal cortex for “hot” tasks involving rewards/delays (Happaney, Zelazo, & Stuss, 2004). However, there undoubtedly are many connections between these cortical areas and the subcortical systems involved in reactive control and emotion (Goldsmith, Pollak, & Davidson, 2008).

The distinction between volitional and non-volitional regulatory or controlling processes has been discussed in diverse literatures, including work on coping (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001), and in the personality, clinical, social psychological, and cognitive literatures (see Carver, 2005, for a review of similar perspectives, including dual processing models). Supporting this distinction, Eisenberg and her colleagues (Eisenberg et al., 2004, 2013; Valiente et al., 2003), with modeling procedures, found that they could differentiate empirically between effortful and reactive control when assessed with a variety of adult-report and/or behavioral measures of effortful and reactive control from 30 months to pre/early adolescence. Thus, prediction of maladjustment is likely to be enhanced by considering both effortful and reactive processes used in regulation/control.

(p. 21) Relations of regulatory processes to maladjustment: A framework

In 1992, Eisenberg and Fabes developed a heuristic model to guide predictions regarding the relations of regulation (and emotional intensity) to an array of developmental outcomes, including some problem behaviors. The regulation aspect of this model was updated by Eisenberg and Morris (2002). Briefly, they hypothesized that externalizing problems tend to be related to low levels of effortful control/self-regulation, including attentional, activational, and inhibitory control, and high levels of reactive undercontrol (impulsivity). In contrast, internalizing problems were predicted to be associated with high reactive overcontrol, low attentional control (used to modulate emotions associated with internalizing problems), and low activational control in some contexts (e.g., when used to counter tendencies to withdraw socially); internalizing problems were not expected to be associated with sizable deficits in effortful inhibitory control. Optimally regulated children—those without internalizing or externalizing problems—were hypothesized to be high in all types of effortful control (attentional, activational, inhibitory) and to be neither overly controlled nor highly undercontrolled.

Nigg (2006) argued that there are at least two temperamental pathways to conduct disorders. One is based on a low fear response and low affiliation (resulting in low empathy and sympathy), often accompanied by high impulsivity (low reactive control), and sometimes involving psychopathy. Low physiological arousal to potential punishment in these individuals makes efforts to socialize the child difficult and often unsuccessful. Nigg’s second pathway leading to impulsive conduct problems involves extreme levels of approach (e.g., to incentives), especially if combined with average to high negative emotionality (also see Eisenberg & Fabes, 1992), and average or low levels of reactive overcontrol and effortful control. Similarly, Nigg (2006) further suggested that attention deficit hyperactivity disorder has at least two temperamental pathways, one involving very low effortful control (often co-occurring with high emotionality) and another involving strong approach tendencies.

It is important to note that investigators vary somewhat in what they conceptualize as impulsivity and this might affect theoretical predictions. For example, Johnson, Carver, and Joormann (2013) measured impulsive responses to emotions versus non-emotion-relevant impulsivity. They argued that people with sensitive incentive-approach temperament (what many others call impulsivity) and high reactivity to emotions may be overwhelmed by strong desires and hence prone to sensation seeking or antisocial impulses. They further suggested that those with low approach temperament along with high reactivity to emotions might be overly affected by sadness and fatigue, resulting in lethargy and inaction that generally characterizes depression. In contrast, those with sensitive threat-avoidance temperament and high reactivity to emotions may be especially prone to anxiety. This focus on control over emotion reactions differs from that of Eisenberg and colleagues (e.g., 2002), who focused more on the approach/incentive behavioral component of impulsivity, which led to different predictions. We would argue that Johnson et al.’s (2013) measure of emotion-relevant impulsivity reflects both a lack of effortful control of emotions and impulsivity when emotionally aroused.

Frick and Morris (2004) proposed that although deficits in self-regulation contribute to reactive, emotionally driven conduct problems (e.g., reactive aggression), they are unlikely to be involved in covert externalizing problems (e.g., stealing) and proactive externalizing problems (e.g., unprovoked, unemotional aggression that is used for personal gain or to influence and coerce others). They also suggested that children with reactive, emotionally driven externalizing problems are prone to negative emotion and have difficulties regulating emotion and inhibiting behavior when emotionally aroused. They further argued that these children’s emotion dysregulation can impair the development and use of sociocognitive skills involved (p. 22) in information processing and undermine the quality of socializing interactions. Similar to Nigg (2006), Frick and Morris (2004) hypothesized that children prone to proactive aggression, including those with psychopathic (callous-unemotional) traits, are low in inhibition due to fear, which undermines the development of the conscience, but are not consistently low in self-regulation.

The role of self-regulation in internalizing problem behaviors also likely varies with the type of problem. For example, social withdrawal is often a component of internalizing symptoms; however, socially withdrawn behavior can stem from social anxiety and/or fearfulness, social rejection (perhaps due to lack of self-regulation), and the mere preference of being alone (Coplan & Armer, 2007). Attentional control may be particularly important for modulating the experience of social anxiety and fearfulness, and effortful activational control may help fearful/anxious children overcome their withdrawn behavior. Lack of effortful inhibitory control may be especially related to social withdrawal due to peer rejection for inappropriate behavior (because of its role in externalizing behaviors that elicit peer rejection). In contrast, various components of effortful control may be irrelevant for social withdrawal due to the preference to be alone (which may not reflect an internalizing problem). Moreover, the attentional component of effortful control may be more highly related to depressive and anxious symptoms than is inhibitory or activational control. Unfortunately, there are few studies in which various aspects of effortful control/self-regulation have been examined as separate predictors of psychological symptoms, both broadband (externalizing or internalizing more generally) or specific types of internalizing or externalizing problems.

Externalizing problems

Externalizing behaviors—“behaviors that violate the rights of others (e.g., aggression, destruction of property) and/or that bring the individual into significant conflict with societal norms or authority figures” (American Psychiatric Association, 2013)—are associated with adjustment problems in the academic, social, and emotional domains across the lifespan. Externalizing problem behaviors, unified by a common theme of outward behaviors, constitute a variety of behaviors: Aggression, delinquency, hyperactivity, defiance (American Psychiatric Association, 2013), and subtypes of reactive aggression (e.g., emotionally-driven aggression), covert externalizing (e.g., stealing, lying), proactive externalizing (e.g., aggression for self-gain), and callous-unemotional trait conduct problems (e.g., unprovoked and unemotional aggression; Frick, Ray, Thornton, & Kahn, 2014). Growing empirical evidence supports the premise that emotion regulation is negatively associated—and impulsivity is positively associated—with externalizing problem behaviors across development (Eisenberg, Spinrad, & Eggum, 2010).

Self-regulation and externalizing problems

Diverse measures of effortful emotion-related self-regulation have been negatively associated with externalizing behaviors, especially emotionally-driven reactive externalizing (Eisenberg, Spinrad, & Eggum, 2010; e.g., Valiente et al., 2006). For example, attention refocusing (i.e., shifting attention from an emotion-eliciting stimulus) during a disappointment task was negatively associated with externalizing two years later, particularly for children who expressed higher anger than other children (assessed in preschool/kindergarten; Morris, Silk, Steinberg, Terranova, & Kithakye, 2010). Also, performance on executive control (i.e., inhibition and attention) and delay tasks at 36 to 40 months has predicted lower hyperactivity and externalizing problems at 63 to 67 months (Lengua et al., 2015). Similarly, from ages four to seven, emotion regulation (assessed with a (p. 23) combined measure of emotionality and regulation) was consistently negatively associated with externalizing across time, but not vice versa (Blandon, Calkins, Grimm, Keane, & O’Brien, 2010).

Associations between effortful control and externalizing behaviors have also held across longer spans of time and/or for older children (e.g., Eisenberg, Zhou, et al., 2005; Lengua, 2008). Effortful control (i.e., attention control, inhibitory control, low activity levels) at four-and-a-half years old was associated with lower externalizing and risk-taking behaviors at 15 years old (Honomichl & Donnellan, 2011). Similarly, Belsky, Pasco Fearon, and Bell (2007) found that at 54 months, first grade, and fifth grade, attention problems (measured with a continuous performance test) were positively associated with externalizing behaviors even when controlling for their prior levels. Wang, Brinkworth, and Eccles (2013) observed that misconduct behaviors decreased substantially from 13 to 18 years of age for adolescents with higher effortful control (i.e., attention shifting, activation control) at age 13. Relatedly, among nine-and-a-half-year-olds, individual growth in effortful control (but not growth in impulsivity) predicted lower externalizing problems three years later (King, Lengua, & Monahan, 2013).

In a recent study, among 36-month-olds assessed four times until 90 months of age in a cross-lagged panel design, executive functioning (assessed with a set of behavioral tasks closely related to effortful control) consistently predicted lower externalizing behaviors (Sulik et al., 2015). In one instance, however, externalizing behaviors also predicted lower executive functioning from 48 to 60 months of age. In contrast, Eisenberg, Spinrad, Eggum, et al. (2010) found that externalizing (and internalizing) at 30 months old significantly and negatively predicted effortful control at 42 months old (measured with a delay task and parent/caregiver reports). However, effortful control (although correlated with) did not significantly predict externalizing across time while controlling for the stability of all measures (also see Eisenberg, Taylor, Widaman, & Spinrad, 2015, with the same sample at 30 to 54 months). Thus, although executive functioning/effortful control frequently predicts low levels of later externalizing problems, there may be age- or context-dependent periods (e.g., in the transition to formal schooling) when externalizing behaviors and executive functioning abilities form a reciprocal process or, perhaps, when externalizing problems have a stronger effect on self-regulation.

Indeed, although effortful control frequently has been associated with subsequent externalizing problems, the relation of self-regulatory abilities to concurrent and later externalizing problems varies across studies and samples, especially when controlling for initial levels (e.g., Eisenberg, Spinrad, Eggum et al., 2010; Spinrad et al., 2012). Among children of Chinese immigrant parents in the United States, effortful control (i.e., parent- and teacher-reported inhibitory control, attention focusing) measured among first and second graders was positively associated with social competence but not with externalizing behaviors in fifth and sixth grade (Zhou, Main, & Wang, 2010). Also, among Dutch children, effortful control (i.e., parent-reported inhibitory control and attention focusing) and delayed gratification among preschoolers (36-month-olds) were negatively associated with concurrent hyperactivity and conduct problems but did not significantly predict later measures of maladjustment in kindergarten when controlling for initial levels at 36 months old (Gusdorf, Karreman, van Aken, Dekovic, & van Tuijl, 2011). Similarly, Lengua (2003) found that difficulty in delay of gratification was positively associated with externalizing symptoms concurrently, but not one year later, among third through fifth graders; however, inhibitory control did predict lower levels of later externalizing symptoms (Lengua, 2003). These results echo findings from a meta-analysis showing that inhibitory control, compared to executive functioning, was more strongly associated with externalizing behaviors among preschoolers (Schoemaker, Mulder, Deković, & Matthys, 2013).

In examining effortful control, some researchers have also distinguished “hot” and “cool” aspects based on the emotional and cognitive demands of the different tasks used to assess (p. 24) effortful control (“cool” tasks often are executive functioning tasks). Di Norcia, Pecora, Bombi, Baumgartner, and Laghi (2014) found that hot (i.e., delayed gratification), but not cool (e.g., slow down, reverse categorization) effortful control, was negatively associated with concurrent aggression and anger among Italian preschoolers. Similarly, Kim, Nordling, Yoon, Boldt, and Kochanska (2013) found that only “hot” effortful control (i.e., delayed gratification) was negatively associated with behavioral problems at 67–100 months of age. Effortful control measured with “cool” tasks (e.g., day/night, motor inhibition) did not significantly predict behavioral problems unless estimated together with delayed gratification (Kim et al., 2013). Thus, although most research has examined effortful control as one construct given conceptual concordance and measurement properties (Eisenberg et al., 2013), continued examination of the aspects of different effortful control measures is warranted given that in some studies not all components of effortful self-regulation have significantly predicted maladjustment (Di Norcia et al., 2014; Kim et al., 2013).

Callous-unemotional, covert, and proactive externalizing

Most of the studies cited thus far have evaluated models predicting reactive externalizing (aggressive emotional responses to blocked goal/provocation; Frick et al., 2014) or undifferentiated externalizing problems. Less is known about the extent to which regulatory processes are associated with covert (i.e., secretive externalizing such as lying, cheating, stealing) and proactive (i.e., aggression for self-gain) externalizing across development. Verbal ability may differentially predict reactive and proactive aggressive tendencies, suggesting a social-cognitive pathway; Arsenio, Adams, and Gold (2009) found that among adolescents, verbal ability was negatively associated with reactive aggression and positively associated with proactive aggression. Also, in that study, attention problems (an indicator of low effortful control) were more strongly and positively associated with reactive than with proactive aggressive tendencies. In another study, impulsivity and inattention measures were also positively associated with overt antisocial behaviors and positively associated with covert behaviors particularly for children with higher verbal ability (McEachern & Snyder, 2012). Relatedly, White, Jarrett, and Ollendick (2012) found that behavioral regulation was associated with reactive but not proactive aggression among children and adolescents. These studies suggest that proactive and reactive aggression have different correlates and that emotion regulation may be most associated with reactive externalizing difficulties. Furthermore, these studies imply that impulsivity and verbal ability are different risk factors for covert versus overt externalizing behaviors in childhood.

However, some findings are inconsistent with those just reviewed. Evidence regarding the relation of reactive and proactive aggression to self-regulation is not very clear. Marsee and Frick (2007) reported that reactive aggression was uniquely associated with poor emotion regulation when controlling for proactive aggression but not in the zero-order correlation. Moreover, other researchers (de Castro, Merk, Koops, Veerman, & Bosch, 2005; Xu, Farver, & Zhang, 2009) found that reactive and proactive aggression were both inversely associated with effortful control. Perhaps different domains of self-regulation (e.g., regulation of emotional experience versus behavior) are associated with reactive and proactive aggression. Alternatively, deficits in “cool” executive functioning skills, which could undermine integration and decision making, may contribute to proactive aggression, whereas self-regulation of more emotionally tinged behavior may be particularly related to problem behaviors that are impulsive and appear to be emotionally driven. Consistent with that view, the tendency to experience negative emotions (e.g., anger) has been more consistently associated with reactive than proactive aggression (e.g., Hubbard et al., 2002). In any case, the research suggests that attention to the type of externalizing problem may be important when examining associations with self-regulation (and emotionality).

(p. 25) A type of externalizing problem that is generally proactive is conduct problems with callous unemotional traits (i.e., unprovoked/unemotional aggression, lack of guilt and concern for others; Frick et al., 2014). Temperamental fearlessness (assessed with parent-report measures) has been positively associated with conduct problems or callous-unemotional traits among older children and adolescents (Barker, Oliver, Viding, Salekin, & Maughan, 2011; Lengua, 2003); however, compared to children without conduct problems, first graders with conduct problems and callous-unemotional behaviors exhibited more intense fear reactions (during a mask task) and higher baseline cortisol levels at the age of two (Mills-Koonce et al., 2015). Perhaps intense fear observed in toddlers, a sign of emotion dysregulation and heightened sensitivity, is a precursor to or marker of conduct problems with callous-unemotional traits, and fearlessness develops later. Alternatively, relations of fearfulness (and its regulation) may vary as a function of method of assessing fear (e.g., observations versus parents’ reports; Mills-Koonce et al., 2015).

Impulsivity and externalizing problems

Impulsivity—characterized by unplanned and sudden reactions without concern for negative consequences—also confers a risk for deviant behaviors, is related to temperamental surgency (Rothbart & Bates, 2006) and, as previously argued, has been viewed as a distinct element of emotion dysregulation separate from effortful control (Eisenberg et al., 2013; Spinrad et al., 2012). Marmorstein (2013) identified five types of impulsive behavior: Sensation seeking, lack of planning, lack of perseverance, negative urgency, and positive urgency; however, it could be argued that some of the forementioned actually tap effortful control as much or more than impulsivity.

Impulsivity is concurrently and prospectively associated with externalizing in childhood and adolescence. Youths who report more impulsive behaviors (e.g., act without thinking, need a lot of self-control to stay out of trouble) also report more risky behavior, including externalizing problems (e.g., Johnson et al., 2013; Romer et al., 2011). Among middle school students, negative urgency (i.e., impulsive behavior when distressed or in a negative mood) was positively associated with attention deficit/hyperactivity disorder and conduct disorder symptoms (Marmorstein, 2013). Also, impulsivity predicted rank-order change in adolescents’ alcohol use, conduct problems, and hyperactive/inattention behaviors, and sensation seeking predicted higher alcohol problems one year later (Wang, Chassin, Geiser, & Lemery-Chalfant, 2016). However, Lengua (2003) found that mother-reported impulsivity was positively correlated with, but did not significantly predict, children’s externalizing symptoms among third through fifth graders one year later. Similarly, impulsivity may not be uniquely associated with externalizing problems in older children once the predictive effects of effortful control are taken into account (Eisenberg, Spinrad et al., 2004; Valiente et al., 2006; Wang, Chassin, Eisenberg, & Spinrad, 2015). Such findings suggest that impulsivity may not always be uniquely associated with externalizing and that prospective associations vary with age and/or context.

Other work suggests that different aspects of impulsivity predict externalizing problems, although this work is difficult to interpret because some measures of impulsivity may actually tap effortful control. Based on a cross-sectional study, Settles et al. (2012) found that among fifth grade students, negative urgency (but not lack of planning) positively predicted alcohol use and smoking status (behaviors that often are considered to be externalizing problems). Furthermore, lack of perseverance (which might assess low effortful control) positively predicted smoking status among boys, but not among girls (Settles et al., 2012). Associations between components of impulsivity and types of externalizing may vary by age. For instance, lack of planning (which might reflect low effortful control or high impulsivity) and negative urgency both positively predicted alcohol and drug use among college students, whereas lack of planning positively predicted (p. 26) delinquent behavior, and negative urgency positively predicted aggression (Settles et al., 2012). Continued examination of the predictive validity of impulsivity subscales and combined measures of emotion self-regulation will help inform various pathways to externalizing across development (e.g., Eisenberg, Spinrad et al., 2004). For example, Morales, Beekman, Blandon, Stifter, and Buss (2015) found that exuberance (i.e., combined measures of impulsivity and activity) was positively associated with later externalizing in kindergarten, particularly for children with high physiological dysregulation (e.g., low baseline respiratory sinus arrhythmia [RSA], higher RSA suppression during an emotion stimulus).

The role of culture

Researchers have found that effortful control is negatively associated with externalizing difficulties in children from Indonesia (Eisenberg, Liew, & Pidada, 2004), China (Zhou, Eisenberg, Wang, & Reiser, 2004; Zhou, Lengua, & Wang, 2009), Portugal (Conceição & Carvalho, 2013), and Latino and African American backgrounds in the United States (Loukas & Roalson, 2006). However, a limited number of studies have found concurrent but not longitudinal empirical support for the association between effortful control and externalizing difficulties across children of Chinese immigrant parents (Zhou et al., 2010) and Dutch children (Gusdorf et al., 2011). What cultural processes inform the association between self-regulation and externalizing problems across time are less clear.

Research and praxis: Targeting regulation

Given the empirical support that emotion self-regulation predicts lower externalizing problems, interventions targeting self-regulation to prevent the development of externalizing behaviors have been designed and increasingly implemented (Eisenberg, Spinrad, & Eggum, 2010). Research of this sort can be a stringent test of causal relations between self-regulatory skills and externalizing problems, although often more than self-regulation is targeted by these interventions. Moreover, the results from school-based interventions intended to improve children’s behavioral regulation and reduce subsequent problem behaviors are promising, although some show mixed results, sometimes as a function of participant background characteristics (Morris et al., 2014).

Among preschoolers from low-income backgrounds, children participating in The Incredible Years intervention (which includes curriculum on regulation and emotion knowledge) had higher emotion knowledge post-intervention, but they showed similar executive functioning and problem behaviors compared to children in the control group (Morris et al., 2014). However, among children who had higher levels of behavioral problems at baseline, fewer problems were reported after the intervention compared to children in the control condition. Children participating in Tools of the Mind, a similar intervention, showed increased levels of executive functioning, particularly for those from high-poverty schools (Blair & Raver, 2014).

Programs that integrate parent- and child-focused components in the implementation of interventions are also likely to increase the prospect of favorable outcomes. Parents likely help children develop self-regulation skills through their parenting strategies and modeling of self-regulation (Belsky et al., 2007). Moreover, some researchers have found that self-regulation mediates the association between environmental factors (e.g., parenting, socioeconomic status) and externalizing behaviors (e.g., Lengua et al., 2015). Thus, targeting parenting may have downstream effects on problem behaviors. For example, the Parents and Children Making Connections—Highlighting Attention (PCMC-A) program includes parenting-focused (i.e., stress management, parent discipline, language use, and child attention exercises) and child-specific (i.e., modifying attention regulation and emotion states curriculum for children) (p. 27) training components for low-income parents and their preschool children attending Head Start (Neville et al., 2013). Compared to no-preschool/Head Start-only control participants, PCMC-A children showed increased attention regulation (measured with event-related potentials [ERP] during attention tasks) and decreased problem behaviors after the eight week intervention. Parents in PCMC-A also showed decreased parenting stress. Physiological measures, such as those assessed with ERP, provide additional support for the regulatory mechanisms modified by intervention. Similarly, among homeless youth participating in an intervention with emotional self-regulation and parenting guidance components, intervention effects on reduced conduct problems were mediated by improvements in children’s executive functioning (Piehler et al., 2014).

Some interventions have addressed specific needs of children. For example, Fast Track Promoting Alternative Thinking Strategies (PATHS) integrated the classroom-based socio-emotional curriculum from Fast Track and additional intervention components (i.e., parenting support classes, home visits) for children identified by teachers at higher risk for aggression (Conduct Problems Prevention Research Group, 2010). Compared to controls, participants in Fast Track PATHS showed lower aggression and higher prosocial behavior from first to third grade, with some effects strongest for boys and children originally high in aggression (Conduct Problems Prevention Research Group, 2010). Thus, programs addressing socio-emotional learning through curriculum in the classroom and home (especially for children identified at higher risk for behavior problems) show promising results.

Across development, children increase in their regulatory capabilities but also encounter different sets of challenges that may require varied skills and support; for example, risk taking and problem behaviors often show increases in the transition to adolescence (Duckworth, Gendler, & Gross, 2014). Family-based interventions intended to address system-level factors (e.g., family, peers, school) have found reduced problem behaviors among children and adolescents (e.g., Chang, Shaw, Dishion, Gardner, & Wilson, 2014; Prado et al., 2013). Together, empirical results suggest that interventions that target different levels of the child’s system (e.g., child-, parent-, peer-, and/or school-level factors) modify emotion self-regulation and adjustment.

Internalizing problems

Effortful control (particularly attentional control) is expected to reduce the internalizing symptoms of depression, anxiety, and social withdrawal. In contrast, children who are rigid, constrained, and behaviorally inhibited (i.e., discomfort with novel stimuli, including people; Kagan & Fox, 2006) may be prone to internalizing problems. Thus, as discussed previously, it may be hypothesized that children with internalizing symptoms are somewhat low in effortful control (particularly attentional control) and reactive undercontrol (i.e., impulsivity), but high in reactive overcontrol (i.e., behavioral inhibition).

Self-regulation and internalizing problems

In fact, the empirical findings regarding the relations of effortful control and reactive control to children’s internalizing problems are somewhat mixed. For the most part, investigators have found the predicted negative relation between effortful control and internalizing problems, anxiety, and/or depression (Buckner, Mezzacappa, & Beardslee, 2009; Eisenberg et al., 2001; Eisenberg et al., 2007; Emerson, Mollet, & Harrison, 2005; Hopkins, Lavigne, Gouze, LeBailly, & Bryant, 2013; McCoy & Raver, 2011; Morris et al., 2013; Muris, 2006; Muris, de Jong, & Engelen, 2004; Oldehinkel, Hartman, De Winter, Veenstra, & Ormel, 2004; Verstraeten, Vasey, Raes, & Bijttebier, 2009; Zalewski, Lengua, Wilson, Trancik, & Bazinet, 2011). Longitudinal (p. 28) data also support the negative relation (Eisenberg et al., 2005; 2009; Kiff, Lengua & Bush, 2011; King, Lengua, & Monohan, 2013; Lengua, 2006; Oldehinkel, Hartman, Ferdinand, Verhulst, & Ormel, 2007; Valiente, Eisenberg, Spinrad et al., 2006). Nonetheless, in a sample of toddlers, effortful control was negatively related to toddlers’ separation distress at both 18 and 30 months of age. However, the relations became nonsignificant once stability in separation distress was controlled (Spinrad et al., 2007; see Eisenberg, Spinrad et al., 2010, for similar findings at 42 months of age).

Moreover, some investigators have found a positive relation between self-regulation and internalizing problems. For example, Murray and Kochanska (2002) reported that children with high effortful control exhibited higher internalizing symptoms than did those with moderate effortful control, although very few children in the study had severe internalizing problems. Other researchers have reported no relations (see Lengua, 2008).

In most research, investigators have used continuous measures of internalizing and externalizing and have not dealt with the reality of frequent co-occurrence of the externalizing and internalizing symptoms. Thus, relations of low regulation to internalizing symptoms could be due to the co-occurrence of externalizing symptoms. In research that examined pure internalizing problems, Eisenberg and colleagues (2001, 2005; Eisenberg, Valiente, et al., 2009; Wang, Eisenberg, Valiente, & Spinrad, 2016) found little evidence of relations of effortful control to pure (non-co-occurring) internalizing problems except in the early school years. Oldehinkel et al. (2004) found that preadolescents with pure internalizing symptoms were lower in effortful control than nondisordered children, but that difference was not nearly as great as for youths with co-occurring problems. In a more at-risk adolescent sample, low effortful control predicted higher pure (non-co-occurring) depression (Wang et al., 2015). Thus, co-occurrence and age may affect the strength of relations between indices of self-regulation and internalizing symptoms.

It is important to differentiate between aspects of effortful control in understanding the relations. It is likely that some aspects of effortful control, such as attentional control, may be particularly important for children with internalizing problems. Specifically, attentional control is thought to reduce bias toward negative emotions such as sadness and anxiety and may serve to move attention from negative to neutral or positive thoughts (Derryberry & Rothbart, 1997). On the other hand, other components of effortful control, such as inhibitory control, may be related to internalizing problems due only to its negative associations with externalizing problems; that is, relations of inhibitory control to internalizing problems may be inflated because of co-occurring externalizing problems (see Eisenberg, Spinrad, & Eggum, 2010).

Indeed, children with pure internalizing symptoms, compared to non-disordered children, exhibited deficits in attentional control at 55 to 97 months (Eisenberg et al., 2001), although not two or four years later (Eisenberg, Sadovsky, et al., 2005; Eisenberg, Valiente, et al., 2009). Attentional control also has been negatively associated with anxiety disorder symptoms (Muris et al., 2004) and with boys’ anxiety and depression (Emerson et al., 2005). In longitudinal research, low attentional control has been associated with more internalizing problems from four-and-a-half to eleven years (or consistently high internalizing problems; Kim & Deater-Deckard, 2011) and with withdrawal that was high and declined over six years (Eggum et al., 2009).

Another aspect of effortful control, inhibitory control, has been examined in relation to internalizing problems, although it is conceptually less related to internalizing than attentional control. Findings have been somewhat mixed. Some researchers have reported a negative relation between the two constructs, but potential co-occurring externalizing problems were not controlled in these studies (Lengua, 2003; Rhoades, Greenberg, & Domitrovich, 2009; Riggs, Blair, & (p. 29) Greenberg, 2003). On the other hand, Eisenberg and colleagues (2001) found that internalizing children (without externalizing symptoms), compared to nondisordered children, had similar levels of inhibitory control.

As previously noted, children’s age may moderate the relations between effortful control/reactive control and internalizing problems. In a series of studies, Eisenberg and colleagues (Eisenberg et al., 2001; Eisenberg, Sadovsky, et al., 2005; Eisenberg, Valiente, et al., 2009) found that whereas the relation between effortful control and pure internalizing problems was evident in young children, it was not found in mid- to late-elementary school. Effortful control may be linked to children’s internalizing in younger age groups because effortful control at younger ages may be particularly important when effortful control is rapidly developing. Further, effortful control may be particularly important in early development when internalizing problems may require the regulation of negative emotions of sadness and anxiety as opposed to more cognitive processes. As further evidence for moderation by age, Dennis, Brotman, Huang, and Gouley (2007) reported that children’s observed effortful control was negatively related to internalizing problems at age four but not at ages five and six. However, it is clear that internalizing problems are associated with deficits in executive functioning—including overlapping self-regulatory capacities—in adulthood (see Snyder, 2013, for a meta-analysis). Continued research on age-related changes in the relations of effortful control to internalizing problems is needed.

Other emotion regulation strategies, such as cognitive reappraisal or suppression of emotion, have been studied in association with internalizing symptoms. Lougheed and Hollenstein (2012) found that adolescents who had a range of emotion regulation strategies were lower in internalizing problems than those with limited emotion regulation strategies. In addition, adolescents’ cognitive reappraisal has been found to predict lower levels of depression, whereas suppressing emotional expressions has been related to higher social anxiety (Eastabrook, Flynn, & Hollenstein, 2014). Similarly, rumination, defined as “the process of thinking perseveratively about one’s feelings and problems rather than in terms of the specific content of thoughts” (p. 400), often has been viewed as reflective of the lack of effective coping or self-regulation (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008), is thought to be related to maladaptive suppression, and has been related to a variety of internalizing problems (Nolen-Hoeksema, Stice, Wade, & Bohon, 2007; Nolen-Hoeksema et al., 2008). Thus, it appears that internalizing problems are associated with specific maladaptive methods of regulating emotion.

Reactive control and internalizing problems

Researchers have less frequently examined the associations of impulsivity (i.e., reactive undercontrol) to internalizing problems. Eisenberg et al. (2001) found that exclusively internalizing children (i.e., those without externalizing problems) were characterized by low levels of impulsivity (also see Eisenberg et al., 2007; Eisenberg, Valiente, et al., 2009). However, Lengua et al. (1998) found a positive relation between impulsivity and depression after removing overlapping items among the constructs, but not before removing overlapping items (note, however, that they did not differentiate children with pure from co-occurring internalizing symptoms). Similarly, Stifter and colleagues (2008) reported that exuberant children (i.e., those high on approach and positive affect) were rated by their parents as higher in internalizing behaviors, as well as externalizing problems, than were low-reactive children. Given that exuberant children were differentiated from inhibited children, it is likely that the exuberant children’s impulsivity was related to their high level of externalizing problems.

On the other hand, reactive overcontrol (i.e., behavioral inhibition) tends to show consistent positive relations to internalizing symptoms (Caspi, Henry, McGee, Moffitt, & Silva, 1995; Degnan, Almas, & Fox, 2010; Kagan & Snidman, 1999; Schwartz, Snidman, & Kagan, 1999). Eggum and (p. 30) colleagues (2012) reported that children’s shyness (a construct highly related to behavioral inhibition) was positively related to internalizing problems, even after controlling for earlier levels of internalizing symptoms. Further, Spinrad et al. (2007) found that toddlers’ inhibition to novelty was positively correlated with separation distress at both 18 and 30 months, controlling for the effect of effortful control.

Culture and the self-regulation of internalizing problems

It is likely that cultural norms play a role in how temperamentally based self-regulation capacities impact children’s outcomes because certain traits may be more acceptable in certain cultures. For example, in collectivist cultures, such as China, where group harmony is emphasized and the expression of negative emotion is discouraged, children’s characteristics such as regulation and attention may be highly valued and reinforced. Further, it is possible that shyness and social withdrawal have been viewed as less problematic in Asian, compared to Western cultures (Chen, Cen, Li, & He, 2005).

Although more cross-cultural work in the area needs to be conducted, it appears that the relations between effortful control and internalizing problems in current day China are similar to findings in the US (Eisenberg et al., 2007; Muhtadie, Zhou, Eisenberg, & Wang, 2013; Zhou et al., 2004). In a within-culture study of Chinese children, first and second graders with low effortful control were found to have relatively high levels of pure internalizing problems (Eisenberg et al., 2007); these children were also low in impulsivity. In another study, childhood delay ability at age two negatively predicted Chinese children’s loneliness and depression (Chen, Zhang, Chen, & Li, 2012). In a cross-cultural study, Zhou et al. (2009) found that country of origin (China versus US) did not moderate the findings when predicting children’s membership in an internalizing (versus nondisordered) group.

Similar findings have been obtained in Western European countries. In a series of studies, Muris and colleagues found that in the Netherlands, children’s effortful control was negatively related to anxiety or more global internalizing symptoms (Muris et al., 2004; Muris, Meesters, & Blijlevens, 2007; Muris, Meesters, & Rompelberg, 2007; Muris, van der Pennen, Sigmond, & Mayer, 2008; see Oldehinkel et al., 2004, for similar findings). Further, as found in the US, behavioral inhibition was positively correlated with internalizing problems (Muris, Meesters, de Kanter, & Timmerman, 2005). Rydell and colleagues (2003) reported that poorly regulated fear was associated with internalizing problems in a sample of Swedish children. Finally, in a multi-ethnic sample of adolescents from the Netherlands, de Boo and Kolk (2007) found that the inverse relations between effortful control and depressive mood were consistent across Dutch, Turkish, Moroccan, and mixed ethnic participants. Thus, findings for Western European samples appear quite consistent with US samples.

Cross-cultural differences between the US and Russia were found in one study examining the role of infant temperament to toddlers’ behavior problems. Gartstein and colleagues (2013) found that infants’ falling reactivity (i.e., the ability to calm following arousal) predicted lower internalizing problems in the US but not in Russia. It should be noted that there were also mean-level differences in internalizing problems in the Russian sample, such that Russian toddlers were significantly lower than US toddlers on internalizing problems, regardless of regulatory skills in infancy. Thus, these findings may be attributed to the fact that internalizing symptoms were quite rare in the Russian sample.

Of course, there may be cultural differences in relations within the United States. Because most studies have focused on White, non-Hispanic children in the US, it is important to (p. 31) understand whether relations of effortful and reactive control to internalizing problems differ across ethnic groups. In one of the few studies to examine such relations, Loukas and Roalson (2006) reported that effortful control was negatively related to depression in both European American and Latino adolescents. Consistent with these findings, in a sample of Head Start preschoolers, the negative relation between regulation and internalizing problems was not moderated by ethnicity/race (Hispanic versus African American; McCoy & Raver, 2011). Thus, the evidence thus far suggests that the relations of effortful and reactive control to children’s internalizing problem behaviors are quite similar across countries and cultural groups.

Moderating processes

Perhaps some of the inconsistencies in the relations of effortful control and reactive control to internalizing problems are due to interactions between effortful control (or impulsivity) and other aspects of temperament (i.e., negative emotionality, shyness) when predicting internalizing problems. Indeed, there is evidence that effortful control moderates the positive relations between negative affect and depression/internalizing problems (Muris, 2006; Oldehinkel et al., 2007; Verstraeten et al., 2009; Yap et al., 2011). Specifically, the positive relations between negative emotionality and internalizing problems appear to be stronger for children low in effortful control. In contrast, Eisenberg and colleagues (2004) found no evidence of an interaction between negative emotionality and effortful control when predicting internalizing problems.

Relations between reactive control and children’s internalizing problems also may be moderated by effortful control. White, McDermott, Degnan, Henderson and Fox (2011) found that behavioral inhibition (reactive overcontrol) at 24 months predicted parent-reported anxiety during preschool, but only for children with poor attention shifting. Similarly, in a study conducted with adolescents in the Netherlands, behavioral inhibition predicted higher internalizing problems, particularly for children with low attentional control (Sportel, Nauta, de Hullu, de Jong, & Hartman, 2011). Contrary to the findings for attentional control, the positive relations between behavioral inhibition and anxiety have been found for children high in inhibitory control but not for those with low inhibitory control, suggesting that children who are high in both inhibitory control and behavioral inhibition may be somewhat overcontrolled and anxious (White et al., 2011).

Mediating processes

The relation between effortful control and internalizing symptoms may also be mediated by dispositional factors such as ego-resiliency. That is, effortful control may allow for flexible and adaptive behavior in the face of challenge, and this flexibility may counter the development of internalizing problems. In a number of studies, ego-resiliency mediated the relations of effortful control to low levels of internalizing (but usually not externalizing) problems (e.g., Eisenberg, Spinrad, et al., 2004; Valiente et al., 2006). This mediated relation also has been found in Chinese (Eisenberg, Chang, Ma, & Huang, 2009) and French (Hofer, Eisenberg, & Reiser, 2010) samples.

In sum, the relations of effortful control and reactive control to children’s internalizing problems are somewhat complex. Although most literature supports a negative relation between effortful control and internalizing problems, findings are somewhat mixed. A more nuanced approach indicates that perhaps attentional components of effortful control are more strongly related to internalizing problems than are behavioral components (i.e., inhibitory control). Further attention (p. 32) to moderating and mediating processes might help to clarify the relation between self-regulation and internalizing problems.

Self-regulation and co-occurring problems

Internalizing and externalizing behaviors are positively associated (Bornstein, Hahn, & Haynes, 2010) and comorbidity can develop concurrently and/or sequentially (Boylan, Vaillancourt, Boyle, & Szatmari, 2007). However, we know less about the underlying regulatory mechanisms involved in the development and maintenance of their co-occurrence. Unfortunately, most researchers have used measures of internalizing and externalizing problems without differentiating children with pure problems of either type from those with co-occurring problems.

In early work in which children with co-occurring symptoms (at a borderline clinical level or higher) were differentiated from those with pure externalizing or internalizing problems, findings for children with pure externalizing problems and co-occurring problems were combined when looking at relations with effortful control and impulsivity (Eisenberg et al., 2001, 2005). In one longitudinal study (Eisenberg et al., 2001, 2005), children in the early and mid-elementary school years with both pure externalizing and co-occurring problems (teacher- and parent-reported) were low in adult-reported effortful control (inhibitory control, attention focusing, and attention shifting) and high in impulsivity. When Eisenberg and colleagues followed up the children at, on average, mid- to late-elementary school (or middle school) age, they separated pure externalizing from co-occurring externalizing and internalizing (Eisenberg, Valiente, et al., 2009). Children with co-occurring problems were still low in attentional and inhibitory control and high in impulsivity compared to nondisordered children (as were children with pure externalizing problems). These researchers did not directly compare youth with pure symptoms versus co-occurring ones. However, Oldehinkel et al. (2004) constructed similar groups and found that preadolescents with co-occurring symptoms were lower in effortful control than children with pure internalizing or pure externalizing symptoms or non-disordered children.

In the aforementioned studies, children were assigned to one maladjustment group or another and the relations of effortful control/impulsivity to maladjustment were examined in relation to a control group and, sometimes, another maladjustment group; the relations of effortful control/impulsivity to the various maladjustment groups were not necessarily unique. In a recent study, Wang et al. (2015) examined the unique prediction of levels of pure internalizing (depressive symptoms), pure externalizing (antisocial/aggressive behaviors), and co-occurring internalizing and externalizing (depressive and antisocial/aggressive behaviors) in adolescence from effortful control and impulsivity (simultaneously) five to six years earlier. Using the bi-factor modeling technique, they first computed factors for pure externalizing, pure internalizing, and co-occurring symptoms that were orthogonal from each other (e.g., variance unique to pure externalizing after covarying out variance attributable to pure internalizing or co-occurring symptoms). Then they predicted three symptom factors from both effortful control and impulsivity. Low effortful control uniquely predicted pure externalizing problems and both low effortful control and low impulsivity uniquely predicted pure internalizing and co-occurring problems. According to an interaction among effortful control, impulsivity, and age, for older adolescents only, lower effortful control predicted more pure externalizing and co-occurring symptoms at average and high levels of impulsivity. Controlling for the relation of effortful control to maladjustment likely eliminated the expected positive relation of impulsivity to co-occurring problems; indeed, in zero-order correlation, impulsivity was positively related to externalizing problems (but was not related to depression).

(p. 33) Other research suggests that children and adolescents with co-occurring internalizing and externalizing symptoms, like those with pure externalizing problems, have difficulties with self-regulation. For example, in research with a behavioral measure of inhibitory control administered to aggressive children, eight- to 12-year-olds with pure externalizing problems, had somewhat greater problems with slowing down and monitoring responding when needed than those with co-occurring internalizing problems, although the latter group still exhibited marginally less response slowing than did nondisordered children (Stieben et al., 2007). In a study of adolescents, Garnefski, Kraaij, and van Etten (2005) found that those with co-occurring symptoms or pure internalizing were higher on the maladaptive emotion regulation strategies of self-blame and rumination than those with pure externalizing or no symptoms.

Moreover, Pang and Beauchaine (2013) found that eight- to 12-year-old children with co-occurring internalizing (diagnosed depression) and externalizing (conduct disorder) problems exhibited lower resting RSA and greater RSA withdrawal to emotion evocation beyond compromised RSA responding for pure diagnoses. Baseline RSA is often viewed as reflecting physiological self-regulation and excessive RSA withdrawal is viewed as an index of emotional lability. However, results on RSA and co-occurring internalizing and externalizing problems vary across studies (e.g., see Hinnant & El-Sheikh, 2013). In contrast, in research with eight- to 12-year-old aggressive children (Stieben et al., 2007), ERP responding to an emotional induction supported the conclusion that children with pure externalizing problems had greater regulatory difficulties. Results in regard to regulatory deficits may differ depending on whether the measure of regulation taps inhibition of behavior (which may be worse to pure externalizers) or modulation of emotion and related attention (which may be exacerbated by co-occurring internalizing problems).


In summary, investigators have frequently found that children’s self-regulation is related to their externalizing and internalizing symptoms. However, research on co-morbidity is limited, and relatively little is known about differential relations with self-regulatory processes for various types of internalizing problems (e.g., anxiety, depression, and social withdrawal) and externalizing problems (e.g., overt versus covert, behaviors that vary in destructiveness to others). Similarly, more research is needed to determine if some aspects of self-regulation (e.g., delay skills versus “cooler” executive attention abilities) relate to externalizing and/or internalizing symptoms more than others (Kim et al., 2013).

In addition, it would be useful to examine additional moderators (besides negative emotionality) of the association between self-regulation and children’s externalizing and internalizing symptoms. For example, impulsivity may interact with self-regulatory skills to predict maladjustment, perhaps more at periods of development when individual differences in impulsivity are relatively marked (e.g., in the early years and in adolescence; see Wang et al., 2015). More attention to the mediators of the relation between self-regulation and children’s symptoms would also be useful; coping efficacy or self-efficacy come to mind as potential mediators.

Moreover, there is limited research examining potential causal relations between self-regulation and maladjustment, either in experimental designs or in longitudinal research that controls for prior levels of maladjustment. The research suggests that relations are bi-directional and may vary in causal predominance at different ages (Sulik et al., 2015).

The results from interventions suggest that children, especially those high in baseline levels of maladjustment or other risk factors, improve more in regulation/lower externalizing than (p. 34) do children with lesser levels of risk. However, there is less work on which aspects of interventions (e.g., training in self-regulation, teaching an understanding of emotions) have the obtained effects on reducing maladjustment. In addition, factors in children’s ecologies that might moderate the association between maladjustment and effortful control, such as stress from poverty, poor schools, or neighborhood violence, merit attention. Moreover, such contextual factors, if they affect self-regulation and/or maladjustment, could play a role in mediated relations (e.g., from poverty to self-regulation to maladjustment; see Lengua et al., 2015).

Finally, although there seem to be more similarities than differences across cultural groups in the relations of self-regulation to problem symptoms, researchers have emphasized the need to understand the cultural processes (e.g., acculturation, cultural values) associated with child development and demographic heterogeneity within cultural groups (García Coll et al., 1996; Li-Grining, 2012). For example, Telzer and colleagues (2011) found that adolescents of European- and Latino-American origin who endorsed strong familism values (e.g., cultural attitudes of family respect and obligation) showed more neural activation of regions involved with self-control (i.e., ventral striatum regions associated with reward processing) when making costly contributions to family in a “family assistance task” in early adulthood. That is, cultural processes (rather than cultural group differences) were associated with self-regulatory processes in the context of a culturally relevant reward task. Moreover, cultural values may affect the degree to which self-regulation is valued and the degree to which externalizing or internalizing symptoms are deemed problematic, with the consequence that acceptance of these values affects the relation between self-regulation and problem behaviors. Future research examining the cultural processes associated with the development of self-regulation, as well as the relation between self-regulation to externalizing and internalizing symptoms, could contribute to an understanding of the role of cultural factors in self-regulation and maladjustment.


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