Journal of Clinical Child and Adolescent Psychology

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Anger and Sadness Regulation: Predictions to

Internalizing and Externalizing Symptoms in
Children

Janice Zeman , Kimberly Shipman & Cynthia Suveg

To cite this article: Janice Zeman , Kimberly Shipman & Cynthia Suveg (2002) Anger and
Sadness Regulation: Predictions to Internalizing and Externalizing Symptoms in Children, Journal
of Clinical Child and Adolescent Psychology, 31:3, 393-398

To link to this article: https://doi.org/10.1207/S15374424JCCP3103_11

Published online: 07 Jun 2010.

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Journal of Clinical Child and Adolescent Psychology Copyright © 2002 by
2002, Vol. 31, No. 3, 393–398 Lawrence Erlbaum Associates, Inc.

BRIEF REPORT

Anger and Sadness Regulation: Predictions to Internalizing

and Externalizing Symptoms in Children
Janice Zeman
Department of Psychology, University of Maine
Kimberly Shipman
Department of Psychology, University of Georgia
Cynthia Suveg
Department of Psychology, University of Maine

Examined the relation between children’s self-reported anger and sadness regulation
and the presence of internalizing and externalizing symptoms. Participants were 121
boys and 106 girls in the fourth and fifth grades who completed the Children’s De-
pression Inventory (CDI), State–Trait Anxiety Inventory for Children (STAIC), Emo-
tion Expression Scale for Children (EESC), and Children’s Emotion Management
Scales (CSMS, CAMS) and rated each other on aggressive behavior. Results of multi-
ple regression analyses indicated that the inability to identify emotional states, the in-
hibition of anger, the dysregulation of anger and sadness, and the constructive coping
with anger predicted internalizing symptoms. The dysregulated expression of sadness
and constructive coping with anger were inversely related to externalizing symptoms.

Emotion regulation has been defined as the “extrin-
sic and intrinsic processes responsible for monitoring,
evaluating, and modifying emotional reactions … to
accomplish one’s goals” (Thompson, 1994, pp. 27–28).
Poor emotion regulation skills have been posited to be
involved in most forms of childhood psychopathology
(Cicchetti, Ackerman, & Izard, 1995) and have been
linked to many negative outcomes, including poor so-
cial functioning (Hubbard & Coie, 1994), low aca-
demic achievement (Greenberg, Kusche, Cook, &
Quamma, 1995), psychological maladjustment (Casey,
1996; Garber, Braafladt, & Zeman, 1991), and poor
physical health (Salovey, Rothman, Detweiler, &
Steward, 2000). Given the importance of emotional
functioning to psychosocial adjustment, it is surprising
that there is little research that has investigated the
links between emotion regulation and childhood psy-
chopathology. Thus, the goal of this study was to deter-
mine whether children’s self-reported regulation of an-
We would like to thank Susan Penza-Clyve for her help with data
collection as well as the following schools who assisted in this re-
search: Leroy H. Smith School, Riverton Elementary School, and
State Street School.
Requests for reprints should be sent to Janice Zeman, Depart-
ment of Psychology, 5742 Little Hall, University of Maine, Orono,
ME 04469–5742. E-mail: Zeman@maine.edu
ger and sadness would predict internalizing and ex-
ternalizing symptoms.
Three aspects central to effective emotion regula-
tion were examined: (a) emotional awareness, the abil-
ity to identify one’s internal emotional experience; (b)
expression management, the inhibition and exagger-
ated displays of emotion; and (c) emotion coping, the
strategies used to manage negative emotional experi-
ence in a constructive manner. Although there has been
little empirical research linking these aspects of emo-
tion regulation with child psychopathology, deficits in
these areas have been hypothesized to underlie chil-
dren’s risk for both internalizing (e.g., anxiety, depres-
sion) and externalizing (e.g., oppositional defiance, ag-
gression) problems (Cole, Michel, & O’Donnell-Teti,
1994).
Emotional awareness has been identified as an es-
sential component of emotionally competent function-
ing (Saarni, 1999). To date, most research has ex-
amined children’s awareness of others’ emotions
(Cassidy, Parke, Butkovsky, & Braungart, 1992; Hub-
bard & Coie, 1994) while neglecting to study chil-
dren’s awareness of their own emotional states and
its relation to psychopathology. One study, however,
does provide empirical support of the link between
emotional awareness and psychopathology (Casey &

393
 ZEMAN, SHIPMAN, SUVEG
Schlosser, 1994). A goal of this study was to examine
the relation between children’s emotional awareness
and symptoms of psychopathology.
Children also must learn how to manage their emo-
tional expression in an adaptive manner that is sen-
sitive to the demands of the social context (Saarni,
1999). According to Plutchik (1993), the overcontrol
of emotion may underlie internalizing difficulties giv-
en that behavioral inhibition is frequently associated
with childhood anxiety and depression. Conversely,
children who exhibit externalizing behavioral prob-
lems are likely to display difficulties in the under-
control of emotion. Although limited in scope, avail-
able research does suggest that children with inter-
nalizing disorders are less emotionally expressive than
healthy controls, whereas children with externalizing
disorders display higher levels of dysregulated emo-
tional expression (e.g., frequent negative emotion,
emotion inappropriate to the situation; Casey, 1996;
Eisenberg et al., 1996). A second goal of this study was
to examine two aspects of expression management,
namely, self-reports of the inhibition or suppression of
emotional expression and the dysregulated or exagger-
ated displays of emotion.
Finally, children must learn effective strategies for
coping with negative emotional experience (Compas,
Connor-Smith, Saltzmann, Thomsen, & Wadsworth,
2001). Research suggests that children’s internalizing
and externalizing symptomatology may be related to
coping skill. For example, when asked about strategies
for altering negative emotional states, depressed chil-
dren produced fewer and lower quality coping strategies
than healthy controls (Garber et al., 1991). Further,
children with externalizing symptomatology reported
greater use of inappropriate coping strategies than chil-
dren without externalizing difficulties (Barrett, Rapee,
Dadds, & Ryan, 1996; Zahn-Waxler et al., 1994). A
third goal of this study was to examine the relation be-
tween children’s self-reported coping with emotional ex-
perience and internalizing and externalizing symptoms.
The studies reviewed here contribute to the litera-
ture by demonstrating the presence of links between
emotional functioning and symptoms of psychopa-
thology. The purpose of this study was to help delin-
eate the specific types of emotion regulation deficien-
cies (i.e., awareness, management, coping) that may be
present in children experiencing internalizing and ex-
ternalizing symptoms. Research indicates that by the
middle childhood years, children have learned basic
emotion management skills (Saarni, 1999), thus, fourth-
and fifth-grade children were chosen as it was expected
that their responses would reflect enduring methods of
emotion regulation. Internalizing and externalizing
symptoms were chosen for study because these two
broadband dimensions characterize child psychopa-
thology (Eisenberg et al., 1996). Indexes of depression
and anxiety were based on children’s self-report given
394
some research that suggests that children are reliable
reporters of their internalizing symptoms (Achenbach,
McConaughy, & Howell, 1987). Conversely, research
indicates that peers are the most accurate reporters of
each other’s externalizing behaviors (Crick & Grot-
peter, 1995). Thus, peer ratings of aggressive behavior
were utilized as an indicator of externalizing symp-
toms. The emotions of anger and sadness were chosen
for examination because of empirical research that
identifies these emotions as central components in ex-
ternalizing and internalizing disorders.
Based on the theoretical and empirical literature ex-
amining children’s socioemotional development, the
following hypotheses were generated. With regard to
internalizing symptoms, given that both anger (e.g., ir-
ritability) and sadness are emotional experiences asso-
ciated with childhood depression (Zahn-Waxler,
Klimes-Dougan, & Slattery, 2000), it was hypothe-
sized that the inhibition of anger and the dysregulated
expression of anger and sadness would predict inter-
nalizing symptoms. Further, it was anticipated that
poor emotional awareness would be positively related
to internalizing symptoms and that effective coping
with both anger and sadness would be negatively re-
lated to internalizing symptoms. We expected a differ-
ent pattern of emotion skill deficits with regard to
externalizing symptoms. Given that anger is a predom-
inant emotion experienced in children with external-
izing disorders, it was expected that the dysregulated
expression of anger and nonconstructive coping with
anger would be related to externalizing symptoms and
that a lack of emotional awareness would also predict
externalizing symptoms.
Method
Participants
Participants were 121 boys (M age = 10 years, 9
months, SD = 9 months, range: 110–153 months) and
106 girls (M age = 10 years, 8 months, SD = 16 months,
range: 108–147 months) in the fourth (n = 85) and fifth
grades (n = 142) attending public schools serving a
predominantly Caucasian (95.6%), middle-class pop-
ulation. Children lived with both parents (58.5%),
mother alone (22.8%), mother and stepfather (10.3%),
father alone (2.2%), grandparents (1.3%), father and
stepmother (0.9%), and other family constellation
(4.0%). Peers (N = 227) rated each other on specific
sets of behaviors described later.
Measures
Emotion Measures
Emotion Expression Scale for Children (EESC).
The EESC (Penza-Clyve & Zeman, in press) is a 16-
item questionnaire that uses a 5-point Likert scale—1
 ANGER AND SADNESS REGULATION
(not at all true), 3 (somewhat true), and 5 (extremely
true)—and comprises two subscales. This study used
the Poor Awareness subscale that assesses children’s
difficulty identifying emotions (e.g., “I often do not
know how I am feeling,” “I have feelings that I can’t fig-
ure out”). Based on a normative sample of elementary
school age children, this EESC scale has strong internal
consistency (α = .83) and test–retest reliability (r = .59;
Penza-Clyve & Zeman, in press). Construct validity has
been established with other measures of emotion man-
agement (Penza-Clyve & Zeman, in press).
Children’s Sadness and Anger Management
Scales (CSMS, CAMS). The CSMS (Zeman, Ship-
man, & Penza-Clyve, 2001) consists of a 12-item Sad-
ness scale and an 11-item Anger scale (CAMS) that
children respond to on a 3-point Likert scale: 1 (hardly
ever), 2 (sometimes), 3 (often). Factor analysis yielded
three factors. The first scale, Inhibition, assesses
self-report of masking or suppressing emotional ex-
pression (e.g., “I get mad inside but I don’t show it”).
The second scale, Dysregulated Expression, measures
culturally inappropriate expression of anger and sad-
ness (e.g., “I cry and carry on when I am sad”). The
third scale, Emotion Regulation Coping, examines per-
ceptions of the ability to cope with anger and sadness
through constructive control over emotional behaviors
(e.g., “I try to calmly deal with what is making me feel
mad”). Coefficient alphas ranged from .62 to .77, and
test–retest reliability ranged from .61 to .80 for the six
scales. Research has demonstrated construct validity
for each of the factors using primarily Caucasian, mid-
dle-class samples (Zeman et al., 2001).
Internalizing Symptoms
Child Depression Inventory (CDI; Kovacs,
1985). The CDI is a 27-item questionnaire that as-
sesses depressive symptomatology in children over the
past 2 weeks. Items are scored on a 3-point scale. Per
school administration request, the item assessing sui-
cidality was not administered. Reliability and validity
have been established (Kovacs, 1985). The sample
mean was 7.72 (SD = 7.26; range = 0–35) with no sig-
nificant sex differences. For this study, the coefficient
alpha was .94.
State–Trait Anxiety Inventory for Children
(STAIC). The Trait scale of the STAIC (Spielberger,
1973) consists of twenty 3-point Likert-format items
that assess children’s tendency to experience anxiety
states. Reliability and validity have been established
(Spielberger, 1973). The sample mean was 32.79 (SD =
6.80; range = 20–53) with no significant sex differ-
ences. The coefficient alpha was .87.
Given the high comorbidity between anxiety and
depression (Brady & Kendall, 1992), the content over-
lap between the CDI and STAIC, and the significant
correlation between the measures in this study (r = .48,
p < .001), a composite measure of depression and anxi-
ety was created. Mean responses to five content-over-
lapping items were derived.1 To keep the scaling units
for each questionnaire consistent, CDI items were re-
coded to score 1, 2, or 3. The internalizing total score
was created by adding the five composite items to the
remaining CDI and STAIC questions, resulting in a to-
tal of 41 items (M = 58.95; SD = 10.68), with an overall
mean per item of 1.44 (SD = 0.26). There were no sig-
nificant sex differences. Internal consistency was .91.
Externalizing Symptoms
Aggressive behavior. Using the aggression beha-
vior rating scale developed by Cassidy and Asher (1992),
children rated their classroom peers on four aggressive
behaviors using a 5-point Likert scale ranging from 1
(not at all) to 5 (a whole lot). The items included: starts
fights, is mean, gets mad easily, and hits, pushes, or
kicks. An aggression score for each child was calculated
by summing the ratings for each item and then summing
all four items and dividing by the number of raters.
There was a significant sex difference with peers rating
boys (M = 7.65, SD = 2.67, range = 4.3–15.1) higher than
girls (M = 6.13, SD = 1.78, range = 4.0–11.9) on pres-
ence of aggressive behavior, t(225) = 4.97, p < .001.
Procedure
Children with parental permission to participate
were administered the questionnaires in small groups
within their classroom. Emotion measures (i.e., EESC,
CSMS, CAMS) and internalizing (i.e., CDI, STAIC)
and externalizing (i.e., aggressive behavior ratings)
symptom questionnaires were administered over two
sessions.
Results
Data were analyzed using two simultaneous multiple
regression analyses. Children’s self-report of internaliz-
ing symptoms and peer ratings of aggressive behavior
were the dependent variables, and the emotion measures
(i.e., EESC, CSMS, CAMS) were entered as predictor
variables. Predictor variables were entered simulta-
neously because there was no a priori, theoretical basis
from which to establish causal priority among the emo-
tion scales (Cohen & Cohen, 1983). Initial analyses in-
1Five items had overlapping content: (a) CDI 1 (“I am sad many
times”) and STAIC 3 (“I feel unhappy”); (b) CDI 6 (“I worry that bad
things will happen to me”) and STAIC 17 (“I worry about things that
may happen”); (c) CDI 10 (“I feel like crying many times”) and
STAIC 2 (“I feel like crying”); (d) CDI 13 (“It is hard to make up my
mind about things”) and STAIC 4 (“I have trouble making up my
mind”); and (e) CDI 16 (“I have trouble sleeping many nights”) and
STAIC 18 (“It is hard for me to fall asleep at night”).
395
 ZEMAN, SHIPMAN, SUVEG

dicated that the regression coefficients did not differ as a lar, children’s report of their dysregulated expression of
function of sex. sadness and the constructive control over angry behaviors
were both inversely related to externalizing symptoms.
Internalizing Symptoms See Table 2 for beta and significance values.
The regression equation describing the relation be-
tween the emotion measures and internalizing symp-
toms was significant, F(7, 204) = 28.05, p < .0001, and Discussion
explained 49% of the variance. The results of the EESC
Poor Awareness scale indicated that children’s self-re- Emotional Awareness
ported difficulty identifying their negative emotional The results of this study indicate that poor emo-
states significantly predicted the presence of internal- tional awareness predicted internalizing symptoms.
izing symptoms. Further, based on the CSMS and This lack of awareness or avoidance of acknowledging
CAMS, the inhibition of anger and the inappropriate one’s emotions is likely to result in an impoverished
expression of anger and sadness predicted higher lev- ability to manage emotional experiences in a construc-
els of internalizing symptoms. Conversely, construc- tive way (Saarni, 1999). Without being aware of the na-
tive coping with angry behaviors was inversely related ture of one’s emotional state, children will be less able
to internalizing symptoms. See Table 1 for beta and to access social support or change the situation to alter
significance values. the emotional experience. Consequently, the experi-
ence of a negative emotional state is likely to persist or
Externalizing Symptoms result in more adverse outcomes, such as depression
The regression equation examining child-reported and anxiety. It is interesting to note that emotional
emotion regulation and peer report of aggressive behav- awareness was not related to the presence of external-
ior was significant, F(7, 204) = 5.01, p < .0001. This izing problems in this study.
equation accounted for 15% of the variance. In particu-
Expression Management
Table 1. Multiple Regression Analyses for Emotion
The results from this study indicate that the inhibi-
Regulation Findings Predicting Internalizing Symptoms
tion of anger predicted internalizing symptoms. Not
B SE B β surprisingly, the suppression of sadness was not related
EESC: Poor awareness .64 .10 .39***
to internalizing symptoms given that many children
CEMS: Anger express their depression and anxiety. In addition, the
Inhibition .74 .34 .14* results from this study indicate that children with inter-
Dysregulated expression 1.03 .37 .17** nalizing symptoms also express their sad and angry
Emotion regulation coping –.87 .32 –.17** emotions in nonconstructive, excessive ways (e.g.,
CEMS: Sadness
Inhibition .35 .30 .08
whine/fuss, cry and carry on, slam doors). Either
Dysregulated expression .90 .38 .13* method of emotional dysregulation (i.e., under- and
Emotion regulation coping –.31 .27 –.07 overcontrol) is likely to result in poor quality relation-
ships with the social environment that, in turn, exacer-
Note: EESC = Emotion Expression Scale for Children; CEMS:
Children’s Emotion Management Scales. bate feelings of distress and anxiety. It is interesting
*p < .05. **p < .01. ***p < .001. that these styles of regulating emotion held for experi-
ences of both anger and sadness. This finding lends
Table 2. Multiple Regression Analyses for Emotion
support to the notion that although sadness is thought
Regulation Findings Predicting Externalizing Symptoms to be a central emotion in internalizing symptoms,
other emotions play equally important roles and com-
B SE B β prise part of the depressive experience (Zahn-Waxler et
EESC: Poor Awareness –.02 .03 –.05 al., 2000).
CEMS: Anger In regard to the relation between expression man-
Inhibition .02 .10 .02 agement and externalizing symptoms, the findings that
Dysregulated expression .18 .11 .13+ emerged differed from those obtained with internaliz-
Emotion regulation coping –.29 .09 –.26***
CEMS: Sadness
ing symptoms. This is consistent with past research
Inhibition .00 .08 .00 that has found that patterns of emotion regulation differ
Dysregulated expression –.35 .11 –.23** for children reporting internalizing versus external-
Emotion regulation coping –.04 .08 –.04 izing symptoms (Barrett et al., 1996; Casey, 1996).
Note: EESC = Emotion Expression Scale for Children; CEMS = Specifically, based on the CEMS scales, the inhibition
Children’s Emotion Management Scales of anger or sadness did not predict externalizing symp-
*p < .05. **p < .01. ***p < .001. toms. The dysregulated expression of sadness was in-

396
 ANGER AND SADNESS REGULATION
versely related to aggressive ratings with a trend for the
dysregulated expression of anger (i.e., slamming doors,
saying mean things) to predict externalizing symp-
toms. As hypothesized, we did not find inhibition of
emotion experience to be a salient emotional marker
for aggressive behavior given that externalizing diffi-
culties are thought to be characterized by the under-
control of emotion (Plutchik, 1993). Further, the types
of sadness behaviors included on the Dysregulated
scale (i.e., crying, moping, whining) were not likely to
be endorsed as the emotional communication style
used by aggressive children. The finding that anger
dysregulation (i.e., slamming doors, losing temper)
predicted aggression, however, is consistent with the
notion that externalizing behavior problems are char-
acterized by the undercontrol of emotion (Plutchik,
1993).
Emotion Coping
Healthy psychological functioning requires that
children learn to cope with aversive emotions in adap-
tive ways (Saarni, 1999). The results of this study lend
partial support to this theoretical tenet. Specifically,
coping adaptively with anger was inversely related to
the presence of internalizing and externalizing symp-
toms. No significant relations were found for coping
with sadness. Studies examining depressed, anxious,
and aggressive children and adolescents indicate that
their coping strategies are of lower quality and less
adaptive than their psychologically healthy counter-
parts (Compas et al., 2001; Garber et al., 1991; Green-
berg et al., 1995). It appears that one of the central chal-
lenges facing children with both internalizing and
externalizing symptoms is to learn constructive ways
of controlling feelings of anger. It is surprising that
coping effectively with sadness did not predict inter-
nalizing or externalizing symptoms. Future research
should examine coping with sadness in more detail to
determine if children are better able to cope with sad-
ness than anger. In addition, research needs to examine
whether poor emotion coping places a child at risk for
developing psychopathology or if the experience of
having internalizing or externalizing psychopathology
compromises one’s ability to cope effectively with
negative emotional experience.
It is interesting to note the general pattern of results
that emerged in which more variance was accounted
for by emotion regulation variables when predicting
internalizing versus externalizing symptoms (49% vs.
15%). This finding may be due to the effects of shared
method variance. That is, it is likely that stronger rela-
tions between self-reported internalizing symptoms
and self-reported emotion regulation variables would
be expected than for peer-rated externalizing symp-
toms and self-reported emotion regulation functioning.
The results should also be interpreted with a degree of
caution given the predominantly Caucasian, middle-
class population that places limits on generalizability.
Further, the sample was drawn from the community
and does not represent a clinical population. Future re-
search should investigate issues related to emotion reg-
ulation using clinic samples of psychiatrically dis-
turbed children, multiple informants of children’s
behavior, a balance between self-report and observa-
tional methodology, and a wider array of sociocultural
groups.
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Received April 25, 2001
Accepted March 1, 2002