FACULTEIT DER MAATSCHAPPIJ- EN GEDRAGSWETENSCHAPPEN Graduate School of Child Development and Education
Orthopedagogiek Masterthesis
The Association Between Internalizing Problems and Shame in Children Aged 2 to 5 Years
De Associatie Tussen Internaliserende Problemen en Schaamte in Kinderen van 2 tot 5 Jaar
Name student: Kelly Veenstra Address: Makassarstraat 130E City: Amsterdam Phone number: 06-44653617 Student number: 10891781 E-mail: Kelly.veenstra@live.nl Group: OOP
Supervisor: Milica Nikolić
Second reviewer: Wieke de Vente
Subject: The Association Between Shame and Internalizing Problems in Children Aged 2-5. Date of submission: 15-10-2018
Abstract
Internalizing problems are common in children and gradually increase in early
childhood, with serious consequences such as numerous disorders. Shame has been related to internalizing problems and might be a maintaining mechanism. This study investigated the association between internalizing problems and the expressions of shame in children between the age of 2 to 5 years (N = 69, 55.1% girls). It was also investigated whether this relation was moderated by age, since it is expected that the distress in internalizing problems is
strengthened by shame, leading to more internalizing problems over time. Participants were led to believe that they broke the researcher’s favourite toy, called Teddy, in order to elicit shame. Two indicators of shame were observed, namely the latency to talk/show about Teddy and gaze, head, and body aversions. Parents filled in the CBCL, a questionnaire to assess child’s internalizing problems. No correlation was found between internalizing problems and the indicators of shame; however, for the children around the age of 2.5 years, internalizing problems were significantly associated with more latency to talk/show about Teddy to the parent or test leader, indicating that shame might be related to internalizing problems around the age of 2.5 years.
Abstract
Internaliserende problemen komen regelmatig voor en stijgen in de vroege kindertijd, met ernstige gevolgen zoals de ontwikkeling van stoornissen. Eerder onderzoek laat zien dat schaamte gerelateerd is aan internaliserende problemen en eventueel internaliserende
problemen in stand houdt. In deze studie is de relatie internaliserende problemen en de expressies van schaamte onderzocht bij kinderen tussen 2 en 5 jaar (N = 69, 55.1% meisjes). Ook werd onderzocht of deze relatie gemodereerd werd door leeftijd, omdat verwacht wordt dat het leed bij internaliserende problemen versterkt wordt door schaamte, wat leidt tot meer internaliserende problemen. Participanten werd voorgehouden dat zij de onderzoekers favoriete beer kapot hadden gemaakt, om schaamte uit te lokken. Twee indicatoren van schaamte werden geobserveerd. Ouders vulden de CBCL, een vragenlijst over
internaliserende problemen bij hun kinderen, in. Het onderzoek toont geen correlatie tussen internaliserende problemen en de indicatoren van schaamte; echter, voor de jongste kinderen, die rond de leeftijd van 2.5 jaar waren, was de relatie tussen internaliserende problemen significant geassocieerd met een langere tijd voor het kind begon met praten of laten zien van de beer aan de ouder of testleider. Dit kan duiden op een relatie tussen schaamte en
The Association Between the Expressions of Shame and Internalizing Problems in Children Aged 2-5
Problem behaviours in toddlers can be roughly divided into different categories, one of which is internalizing problems, such as depression, anxiety, withdrawal and somatization (Baillargeon et al., 2007). Since this kind of problem behaviours are, in contrast to
externalizing problems, not overt but more internal, it makes them difficult to recognize in younger, less verbally developed children (Tandon, Cardeli, & Luby, 2009). Internalizing problems tend to gradually increase with age in early childhood (Gilliom & Shaw, 2004). Predictors of higher internalizing symptoms are for instance inadaptability, negative emotionality and behavioral inhibition of the child due to temperament traits (Keiley, Lofthouse, Bates, Dodge, & Pettit, 2003). Internalizing problems can have serious
consequences, such as rejection by peers (Keiley et al., 2003) and development of mental disorders, such as depression and different types of anxiety disorders (Bittner et al., 2007). Côté et al. (2009) identified a group of one-and-a-half-year-olds with high frequency of depressive and anxiety symptoms. This group consisted of 14.7% of their sample and the depression and anxiety symptoms in this group increased sharper between the age of one-and-a-half to 5 years compared to their peers in the moderate and low frequency depression and anxiety groups (Côté et al., 2009). Thus, it is important as well as relevant to study
internalizing symptoms in preschool aged children, because children in this age group are at high risk for the development of mental disorders at a later age.
Up until this day, not much is known about the development of depression during the preschool period (Luby, Belden, Pautsch, Si, & Spitznagel, 2009). Until recently, the theory that children even as young as preschool age could experience depression was not relevant (Whalen, Sylvester, & Luby, 2017). However, research by Luby and Belden (2012) showed that children as young as 24 months can show signs and symptoms of depression. The most frequently found symptoms at this age were irritability, lack of joy and looking unhappy. Other examples of depressive symptoms in toddlers consist of withdrawal and being tearful often (Luby & Belden, 2012). It is, therefore, relevant to investigate factors that are related to depression already early in childhood. In this way, depression later in childhood may be prevented so children do not experience problems related to depression, such as a decrease in academic achievement and problems in interpersonal functioning (Kapornai & Vetró, 2008).
Anxiety symptoms, on the other hand, have long been acknowledged in preschool-aged children (Tandon et al., 2009). Symptoms of anxiety in toddlers are extreme worry, restlessness, irritability and muscle tension among other things. Anxiety in younger children
can lead to less optimal socio-emotional functioning, less academically skilled children and maladaptive ways of coping with negative feelings (Weeks, Coplan, & Kingsbury, 2009). Because of its serious consequences already in early childhood, more research should also focus on the factors that may influence anxiety in young children. This knowledge may lead to better understanding of the development of internalizing psychopathology in early
childhood, its prevention and its treatment.
Many factors in the individual and in the environment can contribute to the onset of internalizing problems in early childhood, of which insecure attachment and temperamental traits are examples (Zahn–Waxler, Klimes–Dougan, & Slattery, 2000). Most of these factors have been extensively investigated before (e.g., Côté et al., 2009; Keiley et al., 2003;
McLeod, Wood, & Weisz, 2007). Disturbances in self-conscious emotions, such as shame, have also been related to internalizing problems in past research, but mostly in older children and adolescents (Muris & Meester, 2014). It was found that children and adolescents who show more symptoms of depression and/or anxiety, also show more shame (e,g., Hughes, Gullone, & Watson, 2011; Mills et al., 2015; Muris, Meesters, Bouwman, & Notermans, 2014). Nevertheless, not much research exists on shame and internalizing psychopathology in early childhood. However, both shame and internalizing problems occur in early childhood and may influence each other in this early life period. For this reason, it is important to investigate the role of shame in internalizing problems in early childhood.
Lewis (1998) defined shame as an extreme negative emotion that is evoked when one feels failure related to a standard, feels accountable for the failure, and thinks that the failure reflects an impaired self. Shame is a self-conscious emotion that affects the whole self and is oriented towards the self (Teroni & Deonna, 2008). In shame, the self is the focus of negative evaluation, causing the individual to evaluate the self as incompetent or bad (Lewis, 1971). It is a negative and painful state, which has different mental and physical consequences (Lewis, 1997). A mental consequence, for instance, is the inability to speak. Mostly when
experiencing shame, the wish to hide or disappear arises (Lewis, 1995). Physical consequences may consequently consist of shrinking the body in order to ‘disappear’, according to (Lewis, 1995), or avoid the situation or the social stimuli such as averting the body away from the ones that were present in the situation that elicited shame (Drummond, Hammond, Satlof-Bedrick, Waugh, & Brownell, 2017) Research on shame specifically in toddlers is infrequently done, therefore knowledge about shame-related behaviour in
toddlerhood is sparse (Drummond et al., 2017). However, it is known that the expressions of shame in toddlers consist of avoidance, withdrawal, hiding, being slow to repair the damage,
and being slow to inform the one they hurt about what has happened (Barrett, Zahn-Waxler, & Cole, 1993). Aside from the earlier mentioned markers of shame, Darwin (1872) stated that shame can be marked by blushing. He stated that various self-conscious states, including shame, can be accompanied by blushing. According to Castelfranchi and Poggi (1990) blushing has a communicative purpose in the mental state of shame. They proposed that blushing shows the individual’s sensitiveness to the judgement of others. Next to that, blushing shows that the individual is conscious about the evaluation of others and it shows that they fear the evaluation of others (Castelfranchi & Poggi, 1990). Blushing can be a sign of awareness of the possibility that an individual has made a mistake. Since blushing is involuntarily and cannot be showed if not genuine, it can be seen as the sincerest sign of shame. However, blushing as a sign of shame has not been investigated in toddlers yet. Lewis (1997) also assumed that the emotion of shame first emerges around the age of 2.5 to 3 years. In order to feel shame, several capacities need to be present in an individual. First of all, a stable self-representation has to be formed. Next to that, there has to be awareness of the self, in a way that one is different from other people (Tracy, Robin, & Tagney, 2007). These capacities usually occur between the age of 15 and 30 months and 18 to 24 months,
respectively (Lewis & Carmody, 2008; Tracy et al., 2007). Lastly, one has to be able to be aware that one’s behaviour does not follow social standards or rules (Tracy et al., 2007). Studies showed that children between the age of 2 and 3 already have basic understandings of social norms (Rakoczy & Schmidt, 2012). From the occurrence of the needed capacities in order to feel shame, it can be concluded that shame would be likely to occur around the age of 2 years. Although it has been assumed that shame appears later than at the age of two in past studies, Drummond et al. (2017) found evidence even 2-year-old toddlers may show signs of shame during a broken toy mishap task. In this task, the child is led to believe that he/she broke an adult’s favourite toy. According to Drummond et al. (2017), shame-prone children behave in a certain way that is assumed to express the experience of shame: They avert their gaze and body and are slow to tell about the mishap and to repair the toy.
Although experiencing shame may sometimes be socially functional and important for social interactions, it can be maladaptive when an individual has a tendency to respond with intense shame in various situations (Mills et al., 2015). As mentioned before, experience of intense shame has been previously related to internalizing problems, such as depression and anxiety in children and adolescents (Muris & Meester, 2014). For instance, previous research in clinical and non-clinical samples of children from 6 to 13 years showed that shame
situations, was linked to internalizing problems, such as depression, state anxiety and trait anxiety (Ferguson, Stegge, Eyre, Vollmer, & Ashbaker, 2000). Research of Taihara and Malik (2016) showed that self-reported proneness to shame in different situations of transgression was positively linked to internalizing problems in adolescents and young adults.
Previous studies also showed that shame is significantly correlated with depression. For instance, Thompson and Berenbaum (2006) assessed 195 adults to examine if the
emotional responses to measured dilemmas, resembling everyday life dilemmas, were linked to depression. Results showed that participants, with a history of depression or a current depression showed more shame after being exposed to the dilemmas. Kim, Thibodeau, and Jorgensen (2011) performed a meta-analysis of the association of shame and guilt with depressive symptoms from 108 studies with a total of 22411 participants between the age of 10 and 88 years. Results indicated that the association between shame and depressive symptoms were as high as r = .43. This relation was also investigated in older children and adolescents. For instance, Hughes et al. (2011) investigated emotional functioning in 170 9- to 15-year-olds with high levels of depressive symptoms compared to 170 children and
adolescents in the same age category with low levels of depressive symptoms. Their results suggested that children and adolescents with a high number of depressive symptoms reported significantly more shame compared to their peers with low levels of depressive symptoms. Shame was measured using a questionnaire with different everyday-life dilemma’s, namely the Test of Self-Conscious Affect (TOSCA) for children. Another study that investigated this relation in older children and used the TOSCA, is the longitudinal study of Mills et al. (2015), assessing the relation between shame and internalizing problems in 174 children between the age of 7 and 13. Results showed significant positive correlations between shame and
depressive symptoms. The results of this study also showed that shame was predictive of subsequent problems in late childhood. Next to that, this study found that shame specifically predicted depressive disorders in early adolescence. Shame was associated with, and
predicted, boys’ depressive symptoms directly and their general internalizing problems indirectly. In sum, past research has showed that shame is related and contributes to the development of depression in late childhood, adolescence, and adulthood.
However, not many studies have investigated how shame relates to depression in early childhood. One study that did investigate this, was a study from Luby et al. (2009) in which they investigated if preschool children between the age of 3 and 5 years old with a depression showed higher levels of shame than their healthy peers. To measure shame in children, parents reports of children’s shame and a Story Stam Battery in which the 305 participating
children were asked about their attribution and representation of shame were used. Results of this study indicated that depression predicted shame, in a way that participants with higher severity of depression symptoms, also showed higher levels of shame. From this, it can be concluded that shame is related to depressive symptoms already in early childhood, however, more evidence is needed considering that only one study investigated this and only using self- and parent-reports of shame.
The relation between shame and anxiety has also been studied in different age groups. In adults, two studies found that shame was related to social anxiety, and social anxiety could also be predicted from shame (Hedman, Ström, Stünkel, & Mörtberg, 2013; Levinson, Byrne, & Rodebaugh, 2016). Shame was assessed trough self-reports in both studies. Hedman et al. (2013) used the TOSCA and Levinson et al. (2016) used a questionnaire with shame items to measure shame-proneness in adults. Arkin, Detchon, and Maruyama (1982) found that anxiety can also elicit shame in adults with test-anxiety, based on self-reported measures of shame. Furthermore, Fergus, Valentiner, McGrath, and Jencius (2010) examined the role of shame with the TOSCA in anxiety disorders in a sample with adolescents and adults, aged 13 to 77, with an anxiety disorder diagnoses. Results indicated that shame-proneness was only linked to symptoms of social anxiety disorder and generalized anxiety disorder. Muris et al. (2014) examined the relationship between shame and anxiety disorder symptoms in 126 children aged 8 to 13. Shame was assessed using self-reported feelings of shame after reading vignettes. Results indicated that there was a positive and significant correlation between shame and anxiety disorders symptoms, symptoms of panic/somatic, generalized anxiety and social phobia. The previously mentioned study of Mills et al. (2015) in children between the age of 7 and 13, also assessed anxiety in relation to shame, next to investigating depression. Shame was measured using the children’s version of the TOSCA. Results suggested that shame indirectly predicted social anxiety for girls.
The only study that also assessed younger children concerning the relation between anxiety and shame was a study of Muris et al. (2015). This study assessed the relation between the unbalance in self-conscious emotions and psychopathology in a clinical sample consisting of children and adolescents between the age of four and 18. Most participants were diagnosed with ADHD and pervasive developmental disorders, amongst other disorders, such as anxiety disorder, depressive disorder and disruptive behaviour disorders. Self-reports, parent reports and teacher reports of shame were used. Results showed that shame was related to anxiety problems in this study. Thus, previous studies showed that a relation between shame and anxiety can be found in adults, adolescents and older children. Nevertheless, this
relation has not been examined extensively in younger children. Furthermore, the majority of past research relied heavily on self-reports of shame experience, whereas studies that
measured shame in more objective ways, for example, by using observations or physiological measures, are lacking.
In sum, there has been extensive research on the relation between shame and internalizing symptoms in adolescents and adults, but research on how shame manifests in preschool aged children and whether there is an association between shame and internalizing problems in these young children is limited. Furthermore, it has not been investigated whether the relation between shame and internalizing symptoms strengthens with age. Based on the tripartite model (Clark & Watson, 1991), that assumes that the general distress that is a
consequence of depression and anxiety, is strengthened by shame, which in turn leads to more anxiety and depressive symptoms over time, it may be expected that the relation between internalizing problems and shame strengthens over time, highlighting shame as a maintaining mechanism of internalizing problems. This in turn leads to more anxiety and depressive symptoms. However, no research has focussed on this model in preschool aged children so far. Since the relation between psychopathology and shame is assumed to strengthen over time in adults, it is expected that this may also be the case with children, especially in early childhood, after the first symptoms of shame and internalizing symptoms appear.
Present Study
In this study, the association between shame and internalizing symptoms was
investigated in children aged 2 to 5. It was expected that children who had more internalizing problems, also showed more shame in a situation of transgression. Next to that, it was
examined whether this relation strengthens with age. Based on the tripartite model (Clark & Watson, 1991), it was expected that the relation between age and internalizing problems became stronger with age.
Since previous research showed that children as young as the age of two can express shame in a situation of transgression (Drummond et al., 2017), this research focussed on children starting at the age of two years, to detect whether expressions of shame in a situation of transgression were related to internalizing symptoms and to investigate how this relation evolved across early childhood years. Until now, a limited amount of research has focussed on the relation between internalizing problems and shame in children this young. This study can, therefore, contribute to the knowledge in the area of internalizing symptomatology and factors related to it in early childhood.
Next to that, if shame is already related to internalizing psychopathology at an early age, and if the relation becomes stronger with age, it might be possible to recommend targeting shame in early childhood with the aim to reduce it, which may be a way to prevent internalizing symptoms and thereby possibly the development of disorders such as anxiety disorders and depression.
Method Participants
A total of 69 children, of which 31 (44.9%) were boys and 38 were girls (55.1%), and their mother (87%) or father (13%) participated. The age of the participating children was between 24 and 71 months (M = 50.25, SD = 13.19) and the age of their parents. Most children were Caucasian (n = 60) and born in the Netherlands (n = 65). All children could speak fluent Dutch or English and parents spoke either Dutch or English. Parents education level was relatively high, M = 6.37, SD = 1.69, on a scale ranging from 1 = primary
education, to 9 = doctorate.
Children and their parent were recruited through kindergartens and elementary schools in and around Amsterdam. If a school agreed to participate, a researcher brought the
information letters with consent forms and the schools handed them out to the parents. Next to that, parents were recruited by online advertisements on social media and by advertisements in front of museums, libraries and public places like parks and museums. After active
informed consent, a researcher contacted the parent and arranged the visit to the Family lab of University of Amsterdam. The parent and researcher then agreed on a date to conduct the measurement. The study was approved by the Ethics Review Board of the University of Amsterdam.
Design and Procedure
This study is part of a cross-sectional study in which self-conscious emotions are measured in children aged 2 to 5. These emotions were measured during different tasks in the UvA Family Lab, which the child visited with their father or mother. Next to that, data was also collected using questionnaires for parents. The tasks and observations took place in a test-room where four cameras were placed, and the measurements were recorded. The whole procedure took around 90 minutes.
When the child and parent arrived at the UvA Family Lab, they were seated in a waiting room, where the test-leader introduced the study and gave information about the measurement. After this, the child, parent and test-leader went to the test-room where the measurement was taking place. The test-leader showed the child and parent the room, gave
the parent a laptop with questionnaires that the parent had to fill in and played with the child, so the child got accustomed to the room and to the test-leader. Parents filled in different questionnaires while the test-leader engaged the child in a series of tasks. Subjects of the questionnaires were problem behaviour of the child and social development and
psychopathology of the parent and child amongst other things. When all the tasks were done, and the parent was done with the questionnaires, the child, parent and the test-leader went back to the waiting room, where the researcher debriefed the parent and the child. Also, the child received a small present and a diploma for participation.
To elicit shame, the child was engaged in the Broken Toy mishap task in which they were led to believe that they broke the researcher’s favourite toy called Teddy (Barrett et al., 1993; Cole, Barrett, & Zahn-Waxler, 1992; Kochanska, Casey, & Fukumoto, 1995). Before the task, the test-leader gave the parent an instruction card with additional information about the Broken Toy Mishap Task and asked for their permission before proceeding. The parent was also instructed to stay as much neutral as possible in this task and was informed that the toy would break so as the child believes it was his/her fault. To measure blushing, a
thermometer and a photoplethysmograph were attached to the left cheekbone. Blushing was first measured in a 2-minute baseline, during which the child was asked to sit down and was given a comic picture book. After this, blushing was measured in the task in two episodes. The first episode consisted of the period in which Teddy broke while the test-leader was out of the room, which was approximately 90 seconds. The second episode began when the test-leader came in and talked to the child, which was also approximately 60 seconds. After the task, a 2-minute recovery was measured.
The task begun with the test-leader showing the children a teddy-bear called Teddy and telling them that this was her favourite toy from when she was a child. The test-leader then told them that she had to get something from another room and that the child could play with the Teddy while she was gone. The test-leader emphasized that the child had to be careful with it. The test-leader then hung Teddy on the wall with velcro and left the room. The teddy was altered, so that its arm and/or leg would fall off, while the child was playing with it. The test-leader waited around 90 seconds to go back in or went in when the child stopped playing with Teddy. The test-leader then gave five cues in total. The first que was done outside the experiment room, but loud enough for the child to know that the test-leader was going to enter the room again. For this cue, the test-leader said, “Thank you and see you soon”, to make it look like she was talking to a colleague. The second que consisted of looking at the Teddy for 15 seconds. Then, the test-leader asked the child what had happened
with Teddy in a neutral tone. Then, after waiting for 15 seconds, the test-leader asked what had happened with Teddy that made his arm and/or leg fell off with a slightly concerned tone. Lastly, the test-leader told the child that Teddy was her favourite toy with a concerned tone. After these ques, the test-leader debriefed the child according to the standardized procedure of this task, which consisted of telling the child that the test-leader had forgotten that the teddy was already broken and that she could fix it. The test-leader then went to the other room and came back with (another) intact teddy showing that Teddy was fixed again and saying that, since the Teddy was happy again, as well as the test-leader, the child could also be happy again. If the child showed signs of distress such as crying, the debriefing procedure immediately started, and the cues were skipped.
Measures
Observations of Shame. Videos of the Broken Toy mishap were micro-coded using the Observer XT 13 (Zimmerman, Bolhuis, Willemsen, Meyer, & Noldus, 2009). The task consisted of different episodes and began when the child realised that the teddy was broken and ended when the test-leader left the room to “repair” the teddy, after the debriefing. The coding system that was used to code shame was based on previous coding systems from studies from Drummond et al. (2017) and Barrett et al. (1993). Following behaviours reflecting shame were coded and then combined: lip corners, the latency to talk/show about Teddy to the parent and to the test-leader and gaze, head, and body aversions. For descriptions and examples of the coded behaviour, see Table 1. The latency to talk/show about Teddy to the test-leader or to the parent was also coded in seconds and reflected the amount of time it took the child to start talking about Teddy and/or showing broken Teddy to the parent (episode 1) and to the test-leader (episode 2). Gaze, head, and body aversions were coded when the child moved their eyes, head, or body away from the test-leader without focussing on something relevant as the parent or the Teddy during episode 2 and was coded as duration in seconds. Lip corners were also coded to detect smiles (lip corners up), in order to exclude aversions during a smile because they reflect shyness/embarrassment rather than shame (Colonnesi, Napoleone, & Bögels, 2014). Latency to talk and avoidance are assumed to be indicators of shame according to Barrett et al. (1993) and Drummond et al. (2017). Therefore, it is expected that the longer the latency to talk/show about Teddy to the parent and test-leader and the longer the gaze, head, and body aversions, which represent avoidance, the more shame is showed. The mean length of the Broken Toy mishap in seconds was 149.75 (SD = 48,94), counted from when Teddy broke. Two students were trained extensively to reliably code shame on videos of pilot measurements and real measurements, until interrater reliability
(Cohen’s kappa) of .80 or higher was reached in individual coding categories. Interrater reliability was calculated by correcting Cohen’s kappa for kappa max, which was κ = .72 for the latency to talk/show about Teddy and κ = .91 for gaze, head, and body aversions and based on 20% of the double-coded videos.
Blushing. Additionally, electrodes were attached to the child’s cheek. With this, physiological blushing, as a physiological marker of shame was measured during the Teddy Task. Blushing was measured with a photoplethysmograph sensor, that was attached to the child’ cheek to measure the facial blood flow. Blood volume and blood volume pulse was measured with an infrared-reflective photoplethysmograph transducer. Since this was AC coupled it was able to measure fast-changing signals, as well as slow-changing signals, due to it also being DC coupled. Next to that, cheek temperature was measured with a thermometer that measures skin temperature. This was measured unilaterally with a platinum PT1000 sensor. The measured signals were sampled at 200 Hz by a National Instruments NI6224 data acquisition system. The signals were analysed with Vsrrp98 software (Molenkamp, 2011). Blushing was indexed as the increase in blood pulse amplitude (AC), blood volume (DC) and temperature reactivity from 2-minutes baseline to the first 2-minutes of the broken Toy task.
Children’s Internalizing Problems. Parents reported on children’s internalizing problems with the Child Behaviour Checklist for Ages 1.5-5 (Achenbach & Rescorla, 2000). The parent that was present in the lab filled in this questionnaire, among other questionnaires. The Child Behaviour Checklist for Ages 1.5-5 obtains parent’s ratings on social, emotional and behavioral problems (Ivanova et al., 2010). The questionnaire contains 99 questions on a scale of 0 to 2, in which 0 = not true, 1 = somewhat or sometimes true and 2 = very true or often true. Answers should be based on a description of the child now, or in the past two months. The Child Behaviour Checklist for Ages 1.5-5 is an instrument which can assess seven syndromes in diverse societies. The scale Internalizing was used for the current study. This scale contains 4 subscales, namely emotionally reactive (M = 2.40, SD = 2.20),
anxious/depressed (M = 2.90, SD = 2.30), somatic complaints (M = 1.80, SD = 1.90) and withdrawn (M = 1.50, SD = 1.70) and has a total of 36 items. Example items are ‘Gets too upset when separated from parents’ and ‘Looks unhappy without a good reason’ (Achenbach & Rescorla, 2000; Pandolfi, Magyar, & Dill, 2009). As well as in the validation study of Achenbach and Rescorla (2000), the Chronbach’s α for this subscale was .89 in the current study, indicating good reliability of the instrument.
Table 1
Coded Behaviour with Description and Example
Data Analyses
Data was checked for outliers (± 3 SD), skewness and kurtosis. Found outliers were Winsorized by changing their value to the next highest observed value in the range of ± 3 SD. Pearson’s moment product correlations were performed to check the associations between study variables. The first research question, concerning the association between shame and internalizing problems, was answered with a correlation analyses. The second research
Behaviour Description Example
Gaze aversion Moving the gaze away from the test-leader.
Coded when the child averts the gaze from the test-leader, for instance when the child looks at the floor.
Head aversion Moving the head away from the test-leader.
Coded when the child averts the head away from the test-leader, for example head tilt to the side or head down.
Body aversion Moving the body away from the test-leader.
Coded when the child averts the body from the test-leader, for example when the child turns away from the test-leader or runs under the table.
Lips
Corners neutral Outer parts of the lips are straight with the inner parts
of the lips.
Coded when the lips are not curved.
Corners up
Corner of the lips are up relative to the inner parts of the lips.
Coded when the outer parts of the lips are higher than the inner parts of the lips, for example when the child is smiling. Corners
down
Corner of the lips are down relative to the inner part of the lips.
Coded when the outer parts of the lips are lower than the inner parts of the lips, for example, as part of the sad/crying face. The latency to
talk/show about Teddy
The latency to
talk/show about Teddy
Coded when the child is talking about and/or showing Teddy to parent and/or test-leader
question, concerning the role of age as a moderator in this relation, was answered with a moderation regression analyses. The independent variable was internalizing problems and the dependent variables were the latency to talk/show about Teddy to the test-leader and with the parent and gaze, head and body aversions. Because there was no significant correlation between the two indicators of shame, namely the latency to talk/show about Teddy and gaze, head, and body aversions, r (46) = -.10, p = .513, these variables were used separately in two different models as two different indicators of shame. Next to this, age as a moderator was included to test whether the relation between internalizing problems and shame becomes stronger with age. This question was answered using model 1 from PROCESS (Hayes, 2013) with bootstrapping based on 5000 replications. Data from aversions, the latency to talk/show about Teddy and internalizing problems were standardized before the analyses. Analyses were performed using SPSS version 24 (IBM corp., 2016).
Results Preliminary Analyses
Of the 69 participants in total, data of 21 participants was missing due to several reasons. First, in three cases the parent did not give permission for the task. Second, in 12 cases the child did not touch or break the Teddy. Next to that, in three cases Teddy broke while the test-leader was still in the room. Lastly, in one case the task was skipped, due to the child being sick. For these reasons, data of 48 participants (69.57%) could be coded for expressions of shame. Data about the age was missing for one child. Thus, data of the age of the participant was available for 98.55% of the participants. Data of internalizing problems was available for all the participants. Lastly, data of blushing was only available for 28 participants (40.58%) due to many participants refusing the electrodes and failing of the equipment. Because much of the data was missing in combination with a small sample size, it was decided to not include physiological blushing in further analyses.
Shame was measured by several non-verbal behaviours, namely the latency to
talk/show about Teddy and gaze, head, and body aversions. All data were checked for outliers (± 3 SD), skewness and kurtosis. In the data of the latency to talk/show about Teddy to the test-leader and the parent three outliers were found. However, they were not removed or Winsorized because they constituted around 5% of the data and we could check back the videos and confirm that they were valid, since extreme values can also be a case of errors in coding. The latency to talk/show about Teddy to the parent and to talk to the test-leader were averaged into the total the latency to talk/show about Teddy. The variable was not normally distributed, with skewness of 2.48 (SE = 0.35). Therefore, it was log transformed. This
improved the distribution, with a skewness of 0.56 (SE = 0.35), thus, the transformed variable was used in the following analyses.
Next to that, percentage of gaze, head, and body aversions were calculated taking into account the total duration of the Teddy task. No outliers were found, and the data were normally distributed (skewness for head aversion was -0.12, SE = 0.35 and kurtosis -0.41, SE = 0.68 for body aversion 0.61, SE = 0.35 and kurtosis -1.03, SE = 0.681 and for gaze aversion -0.09, SE = 0.35 and kurtosis -0.67, SE = 0.68). One variable for total percentage of aversion was computed based on a mean score of body aversion, head aversion and gaze aversion.
Furthermore, internalizing problems were measured with the CBCL Internalizing scale, and these scores were computed to a mean score. One outlier was found for
internalizing problems, which was changed to the next highest value which was not an outlier plus 0.01. Because it had a skewness of 1.26 (SE = 0.29) it was log transformed. After the transformation, skewness improved to 0.94 (SE = 0.29). Thus, the transformed variable was used in the following analyses. The variables talk about/show Teddy and gaze, head, and body aversions and internalizing problems were checked for sex differences, but no
significant differences were found on any of the variables (p > .050), so sex was not included in the analyses.
The missing data was analysed, and this showed that there was 16,30% missing values in total. The Little’s MCAR test was used to detect whether the missing data was completely at random. Results were not significant, which indicated that the missing data was completely at random, χ2(1)= 0.095, p = .758. Missing values were imputed using expectation
maximization method to achieve more power for the analyses. Table 2 reports descriptive statistics for age, internalizing problems, gaze, head, and body aversions and talk about/show Teddy.
Table 2
N, Mean, SD and Range of Children’s Age in Months, Internalizing Problems, Aversions and Talk About/Show Teddy After Imputing Data
N M (SD) Range
Age 68 50.25 (13.19) 24-71
Internalizing problems 69 0.91 (0.40) 0.21-2.01
Aversions 69 46.32 (18.37) 3.91-97.44
The Relation Between the Expressions of Shame and Internalizing Problems
To investigate the association between talk about/show Teddy and gaze, head, and body aversions, internalizing problems and age, Pearson Correlation analysis two-tailed were performed. The results showed no significant correlations between study variables. Table 3 shows the results of the Pearson Correlation analysis.
Table 3
Pearson’s Correlations of Latency to talk, Aversions, Internalizing Problems and Age in Months Latency to talk/show Aversions Internalizing problems Age r p r p r p r p Latency to talk/show .06 .619 .14 .265 -.05 .714 Aversions .06 .619 -.10 .438 .01 .970 Internalizing problems .14 .265 -.10 .438 .01 .924 Age -.05 .714 .01 .970 .01 .924
Age as a Moderator in the Relation Between the Expressions of Shame and Internalizing Problems
To investigate the hypothesis that age strengthens the relation between internalizing problems and the expressions of shame, a moderation analysis was executed using model 1 of PROCESS v3.1 (Hayes, 2013) in SPSS. This analysis was executed for both indicators of shame as outcomes separately.
The analysis of the moderation of age in the relation between internalizing problems and talk about/show Teddy showed that the overall model, R2 = .07, F
(3, 64) = 1.54, p = .214,
was not significant in explaining the variance in talk about/show Teddy. However, the analysis showed that there was a trend toward a significant interaction effect, β = -0.30, t(64) = -1.99, p = .051, which was expected. Thus, the relation between internalizing problems and talk about/show Teddy showed a trend to change with age. For the youngest children (M – 1 SD), higher score on internalizing problems was significantly associated with longer latency to talk about/show Teddy β = .46, bootstrapped 95% CI [0.01, 0.90], t = 2.06, p = .043. For the relation between internalizing problems and shame in medium-aged children (M +/- 1 SD), there was no significant relation between talk about/show Teddy and internalizing
problems, β = 0.06, bootstrapped 95% CI [-0.17, 0.29], t = 0.53, p = .599, indicating that internalizing problems were not significantly associated with more latency to talk about/show Teddy. For the relation between internalizing problems and shame in older children (M + 1 SD), it was found that the relation between talk about/show Teddy and internalizing problems was not significant, β = -0.22, bootstrapped 95% CI [-0.60, 0.16] t = -1.15, p = .255,
indicating that internalizing problems were not significantly associated with more latency to talk about/show Teddy. Figure 1 shows the moderating effect of age on the relation between talk about/show Teddy and internalizing problems.
Figure 1. The moderating trend effect of age on the relation between internalizing problems and latency to talk about/show Teddy.
The analysis of the moderation of age in the relation between gaze, head, and body aversions and internalizing problems showed that the overall model, R2 = .04, F
(3, 64) = 1.00, p
= .400, was not significant in explaining the variance in aversion. Analysis showed that there was no significant interaction effect, β = 0.25, t(64) = 1.59, p = .117. Thus, the relation between gaze, head, and body aversions and internalizing problems did not strengthen over time (see Table 4 for the outcomes of the analyses).
Table 4
Moderation Effect of Age in the Relation Between Expressions of Shame and Internalizing Problems
Variables β SE t p 95 % confidence interval for B
Lower bound Upper bound Model 1 Talk about/show Teddy -0.03 0.11 -0.29 .770 -0.26 0.19 Internalizing problems 0.09 0.12 0.77 .443 -0.14 0.32 Age -0.12 0.12 -0.99 .326 -0.36 0.12 Internalizing problems x age -0.30 0.15 -1.99 .051 -0.59 0.00 Model 2 Aversions 0.00 0.12 0.03 .975 -0.24 0.25 Internalizing problems -0.09 0.12 -0.74 .463 -0.34 0.16 Age 0.07 0.13 0.54 .589 -0.19 0.33 Internalizing problems x age 0.25 0.16 1.59 .117 -0.07 0.57 Discussion
The purpose of this study was to investigate whether there was an association between the expressions of shame and internalizing problems in children aged 2 to 5. Next to that, it was investigated whether this relation was moderated by age. It was expected that children who had more internalizing problems also showed more shame in a situation of transgression and that the relation between internalizing problems and shame would strengthen over time. Results showed that there was no significant relation between the indices of shame and internalizing problems. Next to that, results showed that age did not significantly moderate the relation between shame and internalizing problems, however, there was a trend toward age moderating the relation between internalizing problems and shame indexed as child’s latency to talk about Teddy or show Teddy to the parent and to the experimenter after
breaking it. Contrary to the expectations, this finding showed that the relation between internalizing problems and shame exists for the youngest children, who were around the age of 2.5 years. This relation was not found for older children from around the age of 4 to 5 years.
The findings of the present study that internalizing problems are not related to shame overall, across different ages is surprising. Results were not consistent with previous studies, which showed that children and adolescents who showed more symptoms of depression and/or anxiety, also showed more shame (e,g.. Hughes et al., 2011; Mills et al., 2015; Muris et al., 2014). Contradicting results can possibly be explained by the way shame was measured. The previously mentioned studies used self-reports to measure shame, in which participants responded to different everyday-life dilemma’s or self-reported on feelings of shame after reading vignettes, while the current study elicited shame in a real situation and used observations to measure shame. Possibly the children with internalizing symptoms do internally feel shame in the present study, but they do not show it in the behaviours that we expected, namely latency to talk/show and aversion. The results of this research are also not consistent with previous research from Luby et al. (2009), which found that toddlers with depression showed higher levels of shame. This might also be explained by the way shame was measured. Luby et al. (2009) used reports from parents and asked children about their attribution and representation of shame. As mentioned before, in the present study shame was observed during a task that elicits shame. Observations are believed to be a more accurate and objective way to measure behaviour, since social desirability, amongst other things, does not play a role (Altmann, 1974). Social desirability is the tendency to choose answers that are believed to be more acceptable, instead of choosing the answer that is the best fit to the question (Grimm, 2011). Social desirability mainly occurs when collecting data on socially sensitive, personal subjects or social norms. Taking this into account, it might be that participants in the study done by Luby et al. (2009) provided answers based on what they believe is acceptable, instead of based on their feelings. In this way the measured amount of shame in the previous study, could be higher, but more biased when compared to this study. Another explanation for discrepant results may be that the observations from the current study reflect the state of shame in one situation of transgression, whereas self- and parent-reports may represent more stable dispositions toward experiencing shame in different situations. Next to that, differences in results can be a consequence of the difference in participants. The study by Luby et al. (2009) was conducted using a clinical sample, which consisted mainly of pre-schoolers diagnosed with a depression, while the current research had a community,
non-clinical sample. Possibly shame is not related to some internalizing problems in healthy children, but only in children with a clinical diagnosis.
Contrary to what was expected, no correlations were found between age and
internalizing problems and age and shame. A possible explanation for the unexpected result of no correlation between age and internalizing problems is that, although Gilliom and Shaw (2004) found that internalizing problems increase gradually in early childhood, the current study used a non-clinical sample, in contrast to the research done by Gilliom and Shaw (2004). Côté et al. (2009) found that 1.5-year-olds with high frequency of depressive and anxiety symptoms had a sharper increase of these symptoms between the age of 1.5 to 5 years than their peers with less symptoms. However, in their study results also showed that the group with low frequency of depressive and anxiety symptoms had relatively stable levels of these symptoms during early childhood. In the sample of the current study, consisting of healthy participants, it could be that the symptoms in children of all ages were low to start with, accounting for no significant increase with age.
A possible explanation that there was no correlation between age and shame, is that it is believed that shame is relatively stable during the preschool period (Bafunno & Camodeca, 2013). Also, Mills (2005) offered an explanation why shame may not increase with age in early childhood. He stated that, as a results of the development of self-regulation in early childhood, children might be able to regulate their distress and shame reactions more over time. Therefore, expressions of shame may not increase due to increasingly good
self-regulation. As self-regulation increases in early childhood, in the period which we assessed in the current study, it could be that with age children become increasingly better at regulating emotions, thus, experiencing and expressing no more shame than younger children.
Another unexpected result was that there was no correlation found between the two indices of shame, namely talk about/show Teddy and gaze, head, and body aversions. Based on previous research (Barrett et al., 1993; Drummond et al., 2017), it was expected that talk about/show Teddy and gaze, head, and body aversions were correlated, but unexpected results were found. As mentioned earlier, the coding scheme in this study was based on research of Barrett et al. (1993) and Drummond et al. (2017). In the study from Drummond et al. (2017), it was found that toddlers that avoided the test-leader more (more frequent gaze and body aversions from the experimenter), also took more time to confess to breaking the toy (longer latency to talk or show the toy). However, Drummond et al. (2017) also used latency of gaze and body aversions and frequencies, rather than duration of gaze/body aversions, into
body aversion, and did not take frequencies and latency of aversions into account, this could account for the difference. Another explanation could be that latency to talk is a verbal behaviour, while aversion of gaze, head and body are verbal behaviours. Verbal and non-verbal behaviours may not always show correlations. Lastly, it is possible that one of the two indices of shame used in this study do not represent shame at this early age. For instance, it could be that latency to talk about/show Teddy is not a sign of avoidance, but rather that children these young take more time to think through what they will say.
Lastly, the result that internalizing problems are related to shame in young, but not older children are not in line with the tripartite model (Clark & Watson, 1991). Following this model, it was expected that the relation between internalizing problems and shame would strengthen over time. The tripartite model states that the general distress that is normal to depression and anxiety, is strengthened by shame, which in turn leads to more anxiety and depressive symptoms over time. Taking this into account, together with the fact that the first symptoms of shame and internalizing problems appear in early childhood, it was expected that the older the child would be, the stronger the effect would be.
A possible explanation for these unexpected results could be the secondary appraisal process, described by Lazarus (1991a,b). This process consists of a cognitive component, in which the child either blames the self or blames others, and a behavioral component as a consequent of the cognitive component, in which the child chooses and performs an
interpersonal action (Muris & Meester, 2014). In shame, the same cognitive component can lead to different behaviours. For instance, self-blame can lead to too much submissive and avoidant behaviour, in turn leading to depression and anxiety. However, it is known that normal amounts of submissive and avoidant behaviour have the important social function of atonement, and therefore do not have to be maladaptive in cases of a serious transgression, which is the case in the current study. Only when this reaction is excessively dominant, the unfavourable cognitions and behaviour patterns that are typical for anxiety and depression will be prevailed. It could be that the children in this study did experience shame as a result of the serious transgression in the Teddy task, but normally not show dominant reactions of shame and therefore do not experience internalizing problems as a result. Self-blame can lead not only to avoidance, but occasionally also to prosocial behaviour, especially in individuals with non-dominant reactions of shame, which in turn leads to no psychopathology. Thus, children who experience shame do not necessarily also experience internalizing problem as a consequence, it could also be that healthy, prosocial children experience shame. Therefore, it
could be concluded that next to children with internalizing problems other children, who are prosocial and healthy also experience shame.
Another possible explanation for the unexpected results can be that older children had more understanding of the Broken Toy situation, so it was possible that they were more likely to think that Teddy was already broken, in which case they may not feel responsible and blamed others for breaking Teddy. It could be possible that when these children did not feel responsible, it could be that they did not feel ashamed, no matter their internalizing problems. Unlike the older children, the younger children likely thought that they were responsible for breaking Teddy and the ones who are prone to depression and anxiety likely showed more shame because of breaking Teddy.
This present study contains some strengths, of which the most important one is the age range of the participants, namely 2 to 5 years. Not only did this allow us to test how the relation between shame and internalizing problems was across time and to detect differences or similarities between different ages, it also made it possible to study shame in relation to internalizing symptoms in the period in which shame is expected to develop (Lewis, 1997). In developmental research, often participants from different age groups are taken together as one group for analytic purposes. As a result of this, the results cannot be generalized, causing a limitation of the utility of the finding (Zahn–Waxler et al., 2000). However, taking the age of the participants into account in the analyses, allowed us to look at the relation between internalizing problems and shame across early age. Also, research on this subject in such young children is sparse, which makes it important to study shame and internalizing problems in this age group. Next to that, observations of the Teddy task were reliably coded by trained students, and this data was used to measure shame. Since observations are a more objective way to measure behaviour than for instance questionnaires, the data is expected to be without a reporter bias (Altmann, 1974).
This research also has some limitations. First, despite of the test-leader requesting the present parent to act as neutral as possible, this was not always the case. Some parents’ behaviour affected the task, for instance when parents started laughing or instructed the child to behave in a certain way, when they for instance told the child to repair the Teddy. This might have affected the children’s response and therefore the data. However, this was not reported during the coding of the video’s and therefore no data is available on how often this was the case. Second, to measure internalizing problems, parents filled in the CBCL
questionnaire. Research of Najman et al. (2001) showed that mothers are likely to report on their child’s behaviour using the CBCL in a biased way. This makes it possible that the
reported internalizing problems were underestimated in this study. In response to this limitation, a suggestion for future research arises. To counteract the effect of the possible underestimation by parental report, in future research internalizing problems of the child could be determined through clinical interviews with the parent.
Another limitation of the present study was the sample size, which was fairly small. This decreased the statistical power. Future research should aim for a bigger sample size, resulting in more statistical power. Next to that, although this research focussed mainly on anxiety and depression within the category of internalizing problems, the subscale
‘internalizing problems’ was used from the CBCL instead of the ‘anxiety/depression’ scale. Retrospectively it was found that the ‘anxiety/depression’ scale was somewhat too narrow for the purpose of this research. That is why the ‘internalizing’ scale was used instead, since this scale is broader. However, this scale also takes problems into account that were not as relevant for shame as depression and anxiety, such as some items in the category of ‘somatic complaints’ and ‘emotionally reactive’. For future research on this subject, it is recommended to use a questionnaire/interview that focusses specifically on anxiety and depression.
Moreover, future research should include measures of the child’s understanding of the situation. In this way, it can be explored whether the child really assumed that Teddy broke due to their behaviour. Lastly, the current research did not code a baseline for expressions, behaviours and verbal expressions, prior to the Broken Toy task. As a result of this, it was not possible to control for natural and common children’s behaviour. Research of Bafunno and Camodeca (2013) coded these behaviours during the last minute of the period before the Teddy task. Research of Barrett et al. (1993) determined a baseline for averting gaze during the period in which the researcher told the child about the toy. For future research is it recommended to determine a baseline before the task, therefore making it able to rule out individual differences in the coded behaviours.
The present study showed that shame might be related to internalizing problems in very early childhood around the age of 2.5 years. If this is the case, the findings of this study might also have practical implications. For instance, clinicians can target shame in early childhood and try to reduce it, which may be a way to prevent internalizing symptoms and thereby possibly the development of disorders such as anxiety disorders and depression. Interventions could also rely on the secondary appraisal process, discussed by Lazarus (1991a,b). Clinicians could focus on navigating self-blame after shame to activate more pro-social behaviour with no psychopathology as an outcome, instead of letting it elicit
negative outcome of self-blame could be altered to a non-disruptive outcome, namely no psychopathology.
In conclusion, this study found that there was no significant relation between the indicators of shame and internalizing problems overall. Findings also showed that the relation between internalizing problems and shame seems to exist for the youngest children, who were around the age of two-and-a-half years. Research on the relation between internalizing
problems and shame in very early childhood is sparse, although this age group is at high risk for the development of mental disorders at a later age. For this reason, more research should focus on this relation, since this knowledge may lead to better understanding of the
development of internalizing psychopathology in early childhood, its prevention and its treatment.
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