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Increasing evidence suggests that exposure to childhood adversity can cause powerful and long-lasting consequences on a child’s development (McLaughlin et al., 2019a). It may affect the neurodevelopment of cognitive, social, and emotional skills, causing cognitive biases and modified patterns of emotional reactivity and emotion regulation (McLaughlin et al., 2019b). Childhood adversity comprises negative environmental experiences that demand great adaptation from an average child (McLaughlin, 2016), such as parental absence and exposure to violence, and is associated with many forms of psychopathology in all stages of life (McLaughlin et al., 2019b). Adversity is a multi-dimensional construct frequently represented by two dimensions, such as threat, which involves harm or threat of harm to the child's physical integrity or well-being, as in the case of violence exposure; or deprivation of expected inputs in development, such as the absence of a primary caregiver and support, as well as inadequate levels of education, cognitive and social stimuli (McLaughlin et al., 2019b).
Studies suggest that deprivation is frequently present in situations of neglect, institutional upbringing, and other forms of parental absence. Moreover, it occurs more frequently in families with low socioeconomic status (SES) (McLaughlin et al., 2019b). Research in cognitive neuroscience indicates that poverty affects brain development in a way that compromises future learning, stating that children with developmental disorders raised in poverty are doubly disadvantaged (Lipina & Posner, 2012; Sheridan & McLaughlin, 2016). Thus, adverse experiences, as well as toxic stress in childhood, are risk factors for the development of behavior problems and psychopathology, furthermore, often impair socioemotional functions, such as emotion knowledge (EK) and emotion regulation (ER) (McLaughlin et al., 2019a; McLaughlin et al., 2019b; O'Malley et al., 2015).
EK refers to the ability to understand emotions in facial expressions, behavioral cues, and social contexts (Izard et al., 2008; Trentacosta & Fine, 2010). It enables one’s development to understand emotions in different contexts, to label and name emotions, to observe the causes of emotions, as well as to identify the relationship between emotion, motivation, and behavior (Izard et al., 2001). EK develops from early stages in childhood and is substantially increased throughout development to provide one’s ability to manage and adaptively utilize emotions (Trentacosta & Fine, 2010). In turn, ER refers to one’s ability to modelate the emotional experience depending on their goal (Gross, 2014). It comprises attempts to influence emotions in oneself and others (McRae & Gross, 2020). The model proposed by Gross (1998) divides ER into 5 families of ER strategies (e.g. situation selection, situation modification, attentional deployment, cognitive change, and response modulation), which are defined depending on the moment that they impact the process of emotion generation.
Evidence suggests that both skills predict positive outcomes in childhood and are fundamental to one’s adaptive and healthy relationship with their context, as well as to the opportunities and challenges they face during life. Accordingly, they favor the development of emotional competence, and greatly impact academic success, social relationships, and general development (Izard et al., 2001; Morgan et al., 2009; Morris et al. 2017; Trentacosta & Fine, 2010). EK enables a child to anticipate emotions and behaviors in themselves and others (Mecca et al., 2016). Children who successfully understand their peers’ emotions and express their affection appropriately tend to be more successful in their social interactions than children with impairments in the emotion domain (Diamond et al., 2008). Also, children with greater EK present better social skills, inhibitory control, school achievement, and prosocial behavior, as well as lower levels of aggressivity, negative interactions with peers, and behavior problems (Mecca et al., 2016). Moreover, EK development during preschool years has been hypothesized as a protective factor in the prevention of developmental problems and psychopathology (Machado, 2012).
Public Health understands vulnerability as a condition that comprises one’s possibility of a sickening process due to individual, collective, and contextual variables. According to Ayres et al. (2009), a person or a group is vulnerable not only because of their idiosyncrasy but also because their context increases their susceptibility to becoming ill. Thus, vulnerability emphasizes the idea that an individual’s social and economic condition will decrease or increase their access to basic and necessary resources for disease-protection, and, therefore, influence their health outcome (Ayres et al., 2009). A poverty-environment, stress and little positive emotional interaction opportunities, may lead to an increase in negative emotional experiences and fewer opportunities to engage in emotion discourse, which promotes EK and ER (Izard et al., 2008). Thus, contexts of vulnerability may be risk factors for the development of children’s, with repercussions on the prevalence of behavior problems.
Behavior problems in childhood refer to persistent and repetitive behavior patterns that suggest future risk for a child's development, even though they do not fulfill the criteria for psychopathology (Santos et al., 2016). They are defined as deviations from social behavior that may be divided into two major categories: internalizing and externalizing problems. The latter refers to negative behaviors directed outwards, such as impulsivity and hyperactivity, whereas the first one comprises patterns such as social withdrawal, anxiety, and sadness. Studies suggest that preschool children with behavior problems have more difficulties in adjustment throughout their lives and are at risk of developing psychopathologies in the future (Santos et al., 2016).
EK impairments contribute to increasing social deficits, negative affect, and emotional dysregulation, which favors the development of internalizing and externalizing problems (Trentacosta & Fine, 2010). Difficulties in EK and ER can favor anger/frustration dysregulation, as well as the development of negative emotional patterns and social difficulties (Trentacosta & Fine, 2010). Indeed, in their mediation study, Di Maggio et al. (2016) reported that EK was positively associated with social competence and negatively associated with internalizing problems among preschoolers. Moreover, the authors described that children’s ER mediated the effects of EK on social competence and anxious-avoidant behavior. Such results suggest that ER may be considered the mechanism in which EK affects social adjustment, highlighting these skills as protective factors for social competence and the prevention of behavior problems (Di Maggio et al., 2016).
Increasing evidence is showing the relationship between adversity, poverty, SES, and behavior problems in childhood (Kaiser et al., 2017; Shelleby et al., 2014). Some studies found that the mediated effects of poverty on children’s behavior problems are mediated by parental and contextual variables, such as parents’ mental health, parenting style, and domestic chaos (Kaiser et al., 2017; Shelleby et al., 2014). However, few studies address how exposure to childhood adversity influences the emotional mechanisms involved in the etiology and maintenance of many forms of psychopathology (McLaughlin et al., 2019b).
Whereas previous research has described the relationships between contexts of adversity and behavioral problems (Di Maggio et al., 2016; Kaiser et al., 2017; Shelleby et al., 2014; Trentacosta & Fine, 2010) and the importance of socioemotional skills in the prevention of psychopathology (Machado, 2012), the present study aims to investigate the effects of socio-emotional skills mediation, such as EK and ER, in the relationships between developmental contexts and behavior problems.
Method
Participants
The project used a convenience sample of 373 children between 3 and 6 years (M = 4.55; SD = 1.52) from three Brazilian states, Bahia (48.7%), Minas Gerais (27.7%), and São Paulo (23, 7%). Over half the sample (52.4%) was female, 44.9% studied in public schools, and 53.5% belonged to the B2, C1, C2, D, and E classes, according to the Brazilian Economic Classification Criteria. Children with a history of neurological or psychiatric disorders and children with very low birth weight (<1500g) were not included in the study. Most mothers had an undergraduate degree (40.1%), 24.4% had finished high school, and 13.3% completed a technical course.
Table 1: Descriptive Statistics for Sociodemographic Data (N = 373)
| % | ||
|---|---|---|
| Sex (female) | 52 | |
| Type of school (%) | ||
| Public | 44.4 | |
| Private | 55.6 | |
| State of residence (%) | ||
| Bahia | 48.8 | |
| Minas Gerais | 27.3 | |
| São Paulo | 23.9 | |
| Socioeconomic Status (%) | ||
| A | 22.6 | |
| B1 | 18.2 | |
| B2 | 19.3 | |
| C1 | 12.5 | |
| C2 | 14.0 | |
| D | 12.2 | |
| E | 1.2 | |
| Maternal schooling (years of formal schooling) | ||
| 0-3 | 5.4 | |
| 4-9 | 22.2 | |
| 10-13 | 27.1 | |
| More than 13 years | 45.3 | |
Measures
Prospective data was collected based on using recognized scientific tools, such as validated psychological tests for children and standardized questionnaires answered by parents and teachers.
Sociodemographic and Health Questionnaires
This questionnaire sought to analyze children’s health conditions, as well as the family sociodemographic and economic informations. Answered by participants’ parents or legal guardians, the questionnaire was also used for screening purposes since it addressed questions regarding the children's neurological and psychiatric background. The family’s SES was assessed using the Brazilian Economic Classification Criterion (Associação Brasileira de Empresas de Pesquisa [ABEP], 2022).
Emotion Knowledge
The Brazilian version (Andrade et al., 2014) of the Emotion Matching Task (EMT, Izard et al., 2003) was administered to the children. The EMT is a comprehensive measure of EK designed for children aged 3 to 6 years. It consists of four tasks of 12 items each that assess, respectively, emotion expression matching, emotion situation knowledge (ESK), expressive EK (emotion labeling), and receptive EK. Operationally, the EMT consists of a photo presentation of children of different ethnicities performing facial expressions of the basic emotions: sadness, happiness, surprise, anger, fear, and neutrality.
Emotion Regulation
The Brazilian version (Reis et al., 2016) of the Emotion Regulation Checklist (ERC) (Shields & Cicchetti, 1997) was administered to the children’s teachers. ERC is a 24-item Likert scale that assesses children’s ER. It is divided into two subscales: ER and emotional lability/negativity. The first one is related to emotional expressions, empathy, and emotional self-awareness, whilst the latter is related to inflexibility, anger dysregulation, and mood instability. Its items address behavior frequency and range from 1 (never) to 4 (almost always).
Behavior Problems
The Brazillian Version (Bordin et al., 1995) of the first version of the Child Behavior Checklist (CBCL) was administered to the children’s parents or caregivers. CBCL is a questionnaire that assesses behavior problems in childhood and has two versions, one aimed at children aged between 1-5 years and another for children between 4-18 years. Considering that the first version of the CBCL provides its use for children up to 5 years and 4 months and that the use of both versions would induce an item equivalence process, which may cause methodological bias, we used this version for our research.
Verbal Ability
The USP Auditory Vocabulary Test (TVAud-A33r) assesses verbal ability in children aged 18 months to 6 years and consists of 33 items, arranged in order of difficulty, in which children must identify, among five images, the one that was enumerated by the researcher. This instrument was validated and standardized in Brazil by Capovilla and Prudêncio (2006).
Procedure
The project’s principal investigators in each state contacted public and private schools of BA state, MG state, and SP state and presented the project to their board. After schools’ adhesion, an invitation letter was sent to parents and/or legal guardians, containing the project’s objectives, justification, and methodology. Along with this letter, the Informed Consent Form (ICF) was sent. Children who participated in this study were duly authorized by their parents or guardians. A team at each research group was trained to apply the instruments. The instruments were applied in a controlled situation, conducted individually, in a silent room, and previously structured for the investigation. The interview was conducted primarily in a single session lasting approximately 40 minutes, held at the school, at a time previously agreed with the board to interfere as little as possible in school activities.
Data Analysis
Firstly, descriptive statistics were conducted for each study variable. Secondly, we examined which variables had direct effects over the total of behavior problems, the internalizing problems, and the externalizing problems. Later, a simple mediation analysis was conducted for each significant variable found in the first step. The mediation analysis used is described by Sharma (2015) as a Simple Mediation Model, in which a single mediator variable is considered during the process.
Results
Descriptive Analysis
The EMT total mean score was 32.17 (SD = 9.7, Md = 35). The EK dimension with a higher mean score was the receptive EK, which was assessed through the first (M = 8.4, SD =2.8, Md = 8) and fourth (M = 8.9, SD = 2.6, Md = 10) tasks. The second EK dimension with a higher mean was the expressive EK (third task: M = 8.0, SD = 3.4, Md = 9). Lastly, the EK dimension with lower scores was the ESK (second task: M = 7.5, SD = 2.5, Md = 8). CBCL total mean score was 36.0 (SD = 24.0), with externalizing problems mean score being 11.8 (SD = 8.4) and the internalizing mean score 10.6 (SD = 8.4).
As shown in Table 2, no statistically significant differences were found between states for most EK subdomains. However, children living in the state of São Paulo (SP) performed better in Expressive EK. The reported prevalence of behavior problems was higher in the states of Minas Gerais and Bahia.
Table 2: Descriptive Analysis for Emotion Knowledge (EK), Emotion Regulation (ER), Verbal Ability and Behavior Problems by State of Residence
| Bahia | Minas | São Paulo | |||||
| M (SD) | 95% CL | M (SD) | 95% CL | M (SD) | 95% CL | ||
| Verbal ability | 28.51 (5.10) | 28.00-29.00 | 29.19 (3.58) | 28.00-30.00 | 28.97 (3.68) | 28.00-30.00 | |
| EK | 32.01 (10.30) | 30.50-33.52 | 31.23 (8.88) | 29.48-32.97 | 33.82 (8.97) | 31.93-35.71 | |
| Receptive EK | 17.01 (5.25) | 16.24-17.78 | 16.78 (4.33) | 15.93-17.76 | 17.76 (4.59) | 16.80-18.73 | |
| Expressive EK | 7.65 (3.62)* | 7.12-8.18 | 7.47 (3.48)* | 6.79-8.15 | 8.81 (2.96)* | 8.19-9.43 | |
| ESK | 7.40 (2.56) | 7.02-7.77 | 6.97 (2.35) | 6.51-7.43 | 7.25 (2.67) | 6.68-7.81 | |
| ER | 24.74 (3.13)* | 24.00-25.00 | 25.35 (3.84)* | 24.00-26.00 | 26.81 (4.47)* | 26.00-28.00 | |
| Lability/ Negativity | 26.44 (7.74)* | 25.00-28.00 | 25.19 (7.40) | 24.00-27.00 | 23.88 (7.68)* | 22.00-26.00 | |
| Behavior problems | 40.29 (20.63)** | 37.00-43.00 | 40.71 (22.95)** | 36.00-46.00 | 23.47 (22.62)** | 18.00-29.00 | |
| Internalizing BP | 11.55 (7.47)** | 10.00-13.00 | 12.36 (8.67)** | 11.00-14.00 | 7.16 (7.39)** | 6.00-8.00 | |
| Externalizing BP | 13.25 (7.44)** | 12.00-14.00 | 13.14 (8.09)** | 11.00-15.00 | 8.10 (8.28)** | 6.00-10.00 | |
| * p < 0.05; **p < 0.01 | |||||||
Mediation Analysis
Total Behavior Problems
Regarding the study’s variables, five of them had significant results over behavior problems. Three of them were exogenous: the SES, which decreased the number of behavior problems (β = -0.65, p < 0.01), as well as to live in the MG state (β = 14.2, p < 0.05) and in the BA state (β = 18.1 p < 0.05), which tended to increase the number of such problems. The endogenous variables that had direct effects on the number of behavior problems were: ESK, which decreased the number of these problems (β = -1,8, p < 0.01), and emotional lability, which suggested an increasing effect (β = 0,43, p < 0.05).
Concerning the mediated effects, the ESK suffered a positive effect from three variables: children’s age, SES, and maternal schooling. Emotional lability suffered a negative effect from children’s age, and a positive effect from children’s sex, suggesting a higher emotional lability in boys. Additionally, to live in the BA state also had a positive effect in emotional lability.
Accordingly, of the socioeconomic variables, the SES had both direct and mediated effects (β = 0.06, p < 0.05) over behavior problems, with ESK being the mediating variable in this relationship. Also, to live in the BA state had both direct and mediated effects (β = 0.87, p < 0.05) over such problems, with emotional lability being the mediating variable. Maternal schooling had an effect over behavior problems only when mediated by ESK (β = -0.87, p < 0.05).
Of the child’s variables, sex had a mediated effect (β = 1.23, p <.0.01) on behavior problems, with emotional lability being the mediating variable. Moreover, children’s age had their effects mediated by emotional lability (β = -0.40 p <.0.05) and ESK (β = -2.22, p < 0.01).
Internalizing Behavior Problems
Maternal schooling (β = -2.63, p < 0.01), to live in the MG state (β = 4.34, p < 0.05), and to live in the BA state (β = 3.84 p < 0.05) were the exogenous variables that had direct effects over internalizing problems. The endogenous variables to cause this outcome were ESK (β = -0.59, p < 0.01) and ER (β = -0.25, p < 0.05). The SES (β = 0.02), type of school (β = 0.45, p < 0.05, public being higher), to live in the MG state (β = 0.58, p < 0.05) or in the BA state (β = 0.61, p < 0.05) had their effects over behavior problems mediated by ER. Children's age (β = -0.71, p < 0.01), SES (β = -0.02, p < 0.05), and maternal schooling (β = -0.28, p < 0.05) had their effects mediated by ESK.
Externalizing Behavior Problems
Maternal schooling (β = -1.37, p < 0.01), to live in the MG state (β = 4.43, p < 0.05), and to live in the BA state (β = 4.59, p < 0.05) were the exogenous variables that had direct effects over externalizing problems. The endogenous variables to cause this outcome were ESK (β = -0.57, p < 0.05) and emotional lability (β = 0.24, p < 0.01). Children’s age (β = -0.22, p < 0.05) and sex (β = 0.66; boys higher), as well as to live in the BA state (β = 0.47, p < 0.05) had their effects over behavior problems mediated by emotional lability. Lastly, children’s age (β = -0.97, p < 0.01), SES (β = -0.02, p < 0.05), and maternal schooling (β = -0.25, p < 0.05) had their effects over externalizing problems mediated by ESK (Figure 1).
Figure 1: Graphical Representation of Mediation Analyses Performed for Internalizing and Externalizing Behavior Problems
Notes. (A) mediation analyses performed for internalizing behavior problems (B) mediation analyses performed for externalizing behavior problems. Lines represent statistically significant associations (* p < 0.05; **p < 0.01). Solid line represents the endogenous variables pathway and dashed lines represents exogenous variables one´s. SES= socioeconomic status; REK = receptive emotion knowledge; EEK = expressive motion knowledge ESK= emotion situation knowledge ER= Emotion Regulation; ELN= emotional lability/negativity.
Discussion
Understanding neurodevelopmental protective factors is relevant, especially in contexts of adversity and vulnerability. Studies suggest that socioemotional skills favor positive outcomes in childhood, with repercussions on children’s mental health and social life (Izard et al., 2001; McLaughlin et al., 2019b; Morgan et al., 2009; Morris et al., 2017; Trentacosta & Fine, 2010). Therefore, this study aimed to investigate the mediating role of ER and EK in the relationship between developmental contexts and behavior problems.
ESK mediated the effects of SES and maternal schooling on the outcome of both internalizing and externalizing problems. ESK is an EK dimension that refers to the ability to understand emotion-eliciting events, enabling one’s understanding of emotions in themselves and others (Denham, 1998). Studies show that contexts of adversity favor social and emotional information processing biases, such as attention bias to threat (ABT) (Krugers et al., 2017; McLaughlin et al., 2019b; Pollack et al., 2000). Accordingly, misunderstanding emotional cues and the context-emotion relationship can lead to hostile attributions and biases, as well as aggressive reactions, which, if persistent, favor the development of behavior problems in children (Krugers et al., 2017; McLaughlin et al., 2019b; Trentacosta & Fine, 2010). Although the type of adversity the child experiences influences the type of attentional bias and emotional processing to be learned (McLaughlin et al., 2019b), studies show that, in general, adverse experiences in childhood influence children's perceptual preferences and emotional discrimination skills (Pollack et al., 2000), which contributes to the development of psychopathologies throughout life (McLaughlin et al., 2019b).
ER mediated the effects of SES and type of school on the prevalence of internalizing problems. ER impairments have been associated with the development of internalizing problems in childhood and adolescence (Aldao et al., 2016). Furthermore, studies show that contexts of adversity are risk factors for the development of internalizing problems (Raver et al., 2016) and affect self-regulation skills (Krugers et al., 2017). Indeed, in Raver et al.’s (2016) study, chronic exposure to poverty-related adversity during childhood and ER characteristics, such as ABT, the accuracy of facial emotion appraisal, and negative affect, predicted higher levels of internalizing symptoms in children in a six-years-follow-up. Thus, an adverse context favors emotional dysregulation, which, in turn, hinders one’s learning of healthy behavioral and emotional patterns, favoring the development of behavior problems (Raver et al., 2016; Trentacosta & Fine, 2010).
The results regarding the direct effect of emotional lability and SES on the increase of behavior problems, as well as the direct effect of ESK on the reduction of these problems, corroborate previous studies about this issue (Izard et al., 2001; McLaughlin et al., 2019b; Morgan et al., 2009; Morris et al., 2017; Trentacosta & Fine, 2010). Moreover, they contribute to the understanding of which emotional mechanisms are involved in the risk and protection of the development of behavior problems and psychopathologies in the future.
Children in the São Paulo (SP) state obtained better results in the study’s measurements compared to the rest of the sample. Another interesting result indicates that two Brazilian states, Bahia (BA) and Minas Gerais (MG) had direct effects on behavior problems, tending to increase them. Brazil is a country with a continental dimension that has great regional differences, both in cultural and socio-economic terms. Socioeconomic inequalities among Brazilian regions contribute to different outcomes on childhood development according to recent studies (Hazin et al., 2016). SP and MG states are located in the country's most economically rich region, the Southeast, with SP state being the state with the highest economic and social investment, infrastructure, and human capital in Brazil. Thus, the present study points to the relevance of the place of residence in the outcome of behavior problems in Brazilian children, since states with lower socioeconomic conditions than SP had direct effects on the risk of developing these problems.
Another relevant result indicates that living in BA state had effects mediated by emotional lability on the outcome of behavior problems. Emotional lability is an ER dimension related to reactivity or sensitivity to emotion-eliciting events, and, when increased in childhood, is associated with negative outcomes on behavior problems (Oattes et al., 2018). Studies suggest that both ER and emotional lability are influenced by environmental factors, such as parenting styles (Morris et al., 2017) and early exposure to adversity (Krugers et al., 2017). Therefore, it seems that BA state impacts the development of this ER dimension, which, in turn, influences children’s outcomes on behavior problems, reinforcing the argument that a child’s macro-social context also impacts the risks children have on developing both emotional skills and mental health problems.
Knowledge about the emotional mechanisms involved in the impact of adversity on children's mental health is relevant as it enables the development of more specific and effective interventions (McLaughlin et al., 2019b). Thus, this study contributes to the scope of investigations that seek to understand the relationship between adversity, poverty, SES, and behavior problems in childhood. Additionally, it points to the importance of socioemotional, more specifically ESK and emotional lability, as protective and risk factors to neurodevelopment. Finally, this study supports the relevance of socioemotional stimulation curricula in early childhood, especially for children in situations of social vulnerability, as a way to prevent negative mental health outcomes and to develop emotional and social health in childhood.
This study has some limitations. First, the multifactorial nature of adversity and vulnerability was not fully encompassed by the study variables, since only SES, maternal schooling, type of school, and place of residence were considered as context variables. Thus, future studies should include in their measures diversified instruments that include more references of the impact of the context and the different types of adversity on emotional development. Furthermore, our analysis did not differentiate children from urban and rural areas in all three Brazilian states, a condition that appears to have an important influence on cognitive and emotional outcomes in this country. Another limitation comprises the lack of specificity in measuring the types of ER strategies, which have different developmental trajectories and can be differently affected by the context. Thus, future studies should consider these dimensions in their analysis, to obtain more specific results on such relationships.
