The Influence of Negative Feedback and Social Rank on Feelings of Shame and Guilt: A Vignette Study in 8- to 13-Year-Old Non-Clinical Children.

This experimental study examined the role of negative feedback and social rank in the experience of self-conscious emotions, shame and guilt, in typically developing children aged 8 to 13 years. Participants were tested by means of a vignette paradigm in which feedback and social rank were systematically manipulated and levels of shame and guilt were assessed after listening to each of the vignettes. In addition, children completed a set of questionnaires for measuring individual differences in shame and guilt proneness, social comparison, submissive behavior, and external shame. The results showed that children presented with negative feedback reported higher ratings of shame and guilt than when presented with positive feedback, implying that the provision of negative feedback has a significant impact on children's experience of self-conscious emotions. Social rank had less effect on children's report of these self-conscious emotions. Furthermore, the individual difference variables of guilt proneness, and to a lesser extent shame proneness and submissive behavior, appeared to be positively related to self-conscious emotions as reported during the vignette task.

Shame on Me! Self-Conscious Emotions and Big Five Personality Traits and Their Relations to Anxiety Disorders Symptoms in Young, Non-Clinical Adolescents.

This study explored the relations between self-conscious emotions, personality traits, and anxiety disorders symptoms in non-clinical youths. One-hundred-and-eighteen adolescents aged 12-15 years completed the brief shame and guilt questionnaire for children (BSGQ-C) and items of the youth self-report (YSR) to measure shame and guilt, the big five personality questionnaire for children, and the youth anxiety measure for DSM-5. Results for shame indicated that this self-conscious emotion-either measured by the BSGQ-C or the YSR-was uniquely and positively associated with a broad range of anxiety disorders symptoms, and correlated positively with neuroticism and negatively with extraversion. Guilt did not show significant associations with anxiety disorders symptoms once controlling for the influence of shame, and links with personality traits varied dependent on the assessment instrument that was used (BSGQ-C or YSR). Finally, when controlling for neuroticism and extraversion, shame consistently remained a significant correlate of anxiety disorders symptoms. Altogether, these results add to the growing body of evidence indicating that high levels of shame are clearly associated with anxiety pathology.

Lack of guilt, guilt, and shame: a multi-informant study on the relations between self-conscious emotions and psychopathology in clinically referred children and adolescents.

The present study examined the relationships between dysregulations in self-conscious emotions and psychopathology in clinically referred children and adolescents. For this purpose, parent-, teacher-, and self-report Achenbach System of Empirically Based Assessment data of 1000 youth aged 4-18 years was analyzed as this instrument not only provides information on the intensity levels of lack of guilt, guilt, and shame, but also on the severity of various types of psychopathology. The results first of all indicated that dysregulations of self-conscious emotions were more common in this clinical sample than in the general population. Further, a consistent pattern was found with regard to the relationships between self-conscious emotions and childhood psychopathology. That is, lack of guilt was predominantly associated with oppositional defiant and conduct (i.e., externalizing) problems, while guilt and shame were primarily linked with affective and anxiety (i.e., internalizing) problems. By and large, these findings confirm what has been found in non-clinical youth, and suggest that self-conscious emotions play a small but significant role in the psychopathology of children and adolescents.

The Association Between Callous-Unemotional Traits, Externalizing Problems, and Gender in Predicting Cognitive and Affective Morality Judgments in Adolescence.

Morality deficits have been linked to callous-unemotional traits and externalizing problems in response to moral dilemmas, but these associations are still obscure in response to antisocial acts in adolescence. Limited evidence on young boys suggested that callous-unemotional traits and externalizing problems were associated with affective but not cognitive morality judgments. The present study investigated these associations in a community sample of 277 adolescents (M age  = 15.35, 64 % females). Adolescents with high callous-unemotional traits showed deficits in affective but not cognitive morality, indicating that they can identify the appropriate moral emotions in others, but experience deviant moral emotions when imagining themselves committing antisocial acts. Externalizing problems and male gender were also strongly related to deficits in affective morality, but they had smaller associations with deficits in cognitive morality too. Implications for treatment and the justice system are discussed.

Fear-related confirmation bias in children: a comparison between neutral- and dangerous-looking animals.

The purpose of this study was to examine confirmation bias in children without explicitly inducing fear. Eighty non-clinical children (7-13 years) were shown pictures of a neutral animal (quokka) and two dangerous-looking animals (aye aye and possum). For each animal, levels of perceived fear, threat and request for additional threatening or non-threatening information were obtained. A behavioral approach test (BAT) was included as behavioral measure of fear. The results indicated that the aye aye and possum were rated as more threatening and fearful than the quokka. For the aye aye and possum higher fear levels coincided with search for more threatening than non-threatening information. This pattern was absent in non-fearful children and for the non-threatening quokka. During the BAT the quokka was more often approached first compared to the aye aye and possum. Our findings suggest that confirmation bias in children can be observed without using verbal fear induction.

Relations among behavioral inhibition, shame- and guilt-proneness, and anxiety disorders symptoms in non-clinical children.

This study examined relationships between the self-conscious emotions of shame and guilt, behavioral inhibition (as an index of anxiety proneness), and anxiety disorder symptoms in non-clinical children aged 8-13 years (N = 126), using children's self-report data. Results showed that there were positive and significant correlations between shame and guilt, behavioral inhibition, and anxiety disorders symptoms. When controlling for the overlap between shame and guilt, it was found that shame (but not guilt) remained significantly associated with higher levels of anxiety proneness and anxiety symptoms. Further, when controlling for the effect of behavioral inhibition, shame still accounted for a significant proportion of the variance of total anxiety and generalized anxiety scores. For these anxiety problems, support emerged for a model in which shame acted as a partial mediator in the relation between behavioral inhibition and anxiety. These results indicate that the self-conscious emotion of shame is a robust correlate of anxiety pathology in children.

Validation of the Dutch Reactive Proactive Questionnaire (RPQ): differential Correlates of Reactive and Proactive Aggression from childhood to adulthood.

This study reports reliability and validity of the Dutch Reactive-Proactive Aggression Questionnaire (RPQ). In total, 845 participants completed the RPQ along with other measures of aggression. Groups consisted of non-offender participants, criminal offenders, youngsters (age 6-18), and adults (age above 18). Test-retest stability in a subsample of 324 childhood arrestees was good (all ICC's > 0.41). A confirmatory factor analysis supported the same two-factor structure as in the original RPQ. Convergent validity was adequate (all r's > 0.16). Moreover, results demonstrated that the proactive and reactive subscales were differentially related to measurements of callousness and impulsiveness, respectively. Criterion validity was shown in that non-offender subjects demonstrated significantly lower RPQ scores than offender samples. Finally, construct validity was demonstrated in that violent offenders showed higher aggression scores than non-violent offenders. Proactive aggression showed different developmental trajectories within non-offender versus criminal samples, indicating that this form of aggression may be more pathological.

Some youths have a gloomy side: correlates of the dark triad personality traits in non-clinical adolescents.

This cross-sectional study examined the Dark Triad personality traits and their correlates in non-clinical youths aged 12-18 years (N = 117). Child- and parent-report data were obtained on Machiavellianism, narcissism, and psychopathy as well as on Big Five personality factors and symptoms of aggression and delinquency. Results indicated that especially Machiavellianism and psychopathy were in a theoretically meaningful way related to Big Five factors: that is, both traits were associated with lower levels of agreeableness, conscientiousness, and openness/intellect, and higher levels of emotional instability. Further, Machiavellianism and psychopathy also emerged as significant and unique correlates of symptoms of aggression and delinquency, which further underlines the importance of these Dark Triad traits in the pathogenesis of disruptive behavior problems in youths.

Screening for hearing loss versus parental concern regarding hearing problems: Subsequent referral and treatment for otitis media in the Netherlands.

OBJECTIVE: The present study investigates whether general practitioner (GP) consultation initiated by failing the population hearing screening at age nine months or GP consultation because of parental concern over ear/hearing problems was more important in deciding on referral and/or surgical treatment of otitis media (OM). DESIGN: A questionnaire covering the history between birth and 21 months of age was used to obtain information on referral after failing the hearing screening, GP consultations for ear/hearing problems, and subsequent referral to a specialist and possible surgical treatment at an ENT department. SETTING: The province of Limburg, the Netherlands. SUBJECTS: Healthy infants invited for the hearing screening at age nine months, who responded in an earlier study called PEPPER (Persistent Ear Problems, Providing Evidence for Referral, response rate 58%). MAIN OUTCOME MEASURES: The odds of a child being surgically treated for OM. RESULTS: The response rate for the present questionnaire was 72%. Of all children tested, 3.9% failed the hearing screening and were referred to their GP. Of all 2619 children in this study, 18.6% visited their GP with ear/hearing problems. Children failing the hearing screening without GP consultation for ear/hearing problems were significantly more often treated surgically for OM than children passing the hearing screening but with GP consultation for ear/hearing problems. CONCLUSION: Objectified hearing loss, i.e. failing the hearing screening, was important in the decision for surgical treatment in infants in the Netherlands.

Risk factors for failing the hearing screen due to otitis media in Dutch infants.

Hearing loss from otitis media (OM) can affect young children's development. Some children with persistent OM-related hearing loss and associated problems can benefit from treatment, but researchers and clinicians are still unclear on how to identify them best. The present study aims to determine which factors are most related to the hearing loss in OM, as a first step towards an effective case-finding instrument for detecting infants with persistent OM-related hearing loss. The full PEPPER ('Persistent Ear Problems, Providing Evidence for Referral') item pool includes a wide range of risk factors for OM in a single questionnaire, and is easily completed by parents or guardians. The questionnaire was sent to all children invited for the universal hearing screen at age 9 months in Limburg, The Netherlands. Repeatedly failing of the hearing screen was used as outcome marker indicative of OM-related chronic hearing loss. Univariate analyses were conducted to determine statistically significant risk factors predicting 'fail' cases at this hearing screen. Five items were found as individually predictive of hearing screen failure and subsequent referral: 'having severe cold symptoms', 'attending day care with >4 children', 'having siblings', 'severe nasal congestion' and 'male gender'. Suitably worded parental questions document risk factors for OM-related hearing loss in infants, broadly consistent with past general literature on OM risk factors, but more focused. The findings justify further optimising and evaluation of an additive or multiplicative combination of these questions as a means for selecting and routing an infant with diagnosed or suspected OM to further care.

Stress-reactive rumination, negative cognitive style, and stressors in relationship to depressive symptoms in non-clinical youth.

The role of cognitive vulnerability in the development of depressive symptoms in youth might depend on age and gender. The current study examined cognitive vulnerability models in relationship to depressive symptoms from a developmental perspective. For that purpose, 805 youth (aged 10-18, 59.9% female) completed self-report measures. Stress-reactive rumination was strongly related to depressive symptoms. Negative cognitive style (i.e., tendency to make negative inferences) in the domains of achievement and appearance was more strongly and consistently related to depressive symptoms in girls compared to boys. Negative cognitive style in the interpersonal domain was positively related to depressive symptoms in both girls and boys, except in early adolescent girls reporting few stressors. To conclude, the cognitive vulnerability-stress interaction may be moderated by the combination of age and gender in youth, which may explain inconsistent findings so far. Current findings highlight the importance of taking into account domain specifity when examining models of depression in youth.

Childhood Disorder: Dysregulated Self-Conscious Emotions? Psychopathological Correlates of Implicit and Explicit Shame and Guilt in Clinical and Non-clinical Children and Adolescents.

This study examined psychopathological correlates of implicit and explicit shame and guilt in 30 clinical and 129 non-clinical youths aged 8-17 years. Shame and guilt were measured explicitly via two self-reports and a parent report, and implicitly by means of an Implicit Association Test (IAT), while a wide range of psychopathological symptoms were assessed with questionnaires completed by children, parents, and teachers. The results showed no differences of implicit and explicit shame and guilt between the clinical and non-clinical group, implying that dysregulation of these self-conscious emotions is not per definition associated with psychopathology. Correlational analyses indicated that self-reported explicit shame was positively associated with a broad range of internalizing psychopathology, while self-reported explicit guilt was associated with higher levels of anxiety and to some extent lower levels of externalizing psychopathology. Correlations with parent-rated shame and guilt revealed the same pattern of results but were in general weaker. Furthermore, implicit shame and guilt did not show significant correlations with the various measures of psychopathology. It can be concluded that the link between shame and guilt and psychopathology is complex, and partly dependent on the disorder under study and context-related factors defining the maladaptive nature of these self-conscious emotions.

Self-Compassion Correlates of Anxiety and Depression Symptoms in Youth: A Comparison of Two Self-Compassion Measures.

BACKGROUND AND PURPOSE: Self-compassion is considered as a protective psychological construct that would shield against the development of emotional problems. The aim of the present study was to compare the 'protective nature' of two measures of self-compassion: the Self-Compassion Scale for Youth (SCS-Y) and the Sussex-Oxford Compassion for the Self Scale (SOCS-S). METHODS: Eighty-seven adolescents aged 12 to 18 years completed both self-compassion measures as well as scales of anxiety and depression symptoms. RESULTS: SCS-Y and SOCS-S scores were positively correlated, and for both measures it was generally found that higher levels of self-compassion were associated with lower levels of emotional symptoms. However, the uncompassionate self-responding scales of the SCS-Y correlated positively with anxiety and depression symptoms and hence can better be seen as indices of vulnerability. Regression analyses suggested that a positive attitude toward oneself, as measured by the self-kindness scale of the SCS or its SOCS-S equivalent 'feeling for the person suffering' is particularly relevant as a buffer against emotional problems. CONCLUSION: The protective nature of self-compassion can be established by both measures. Caution is advised with the use of the uncompassionate self-responding scales included in the SCS-Y as they appear to measure vulnerability rather than protection.

The role of subclinical psychopathic traits on experimentally induced self- and other-compassion.

Psychopathic traits come with high levels of anger and aggression. Since previous studies showed that compassion can mitigate both anger and aggression, the current research puts compassion forward as a possible target to alleviate psychopathy's destructive patterns. Specifically, the present study explored the influence of subclinical psychopathic traits-as well as their three subcomponents egocentricity, callousness, and antisociality-on the efficacy of experimentally induced self-compassion (SC) and other-compassion (OC). This manuscript is part of a larger study in which student and community participants (N = 230, M age = 27.41, 65.2% female) completed a psychopathic trait questionnaire to assess their dimensional level of psychopathy, filled out state SC and OC questionnaires, and were randomized to participate in an experimental self- or other-compassion induction. It was expected that psychopathic traits would positively relate to increases in SC but negatively relate to increases in OC. Baseline levels of both SC and OC negatively related to psychopathy. Overall, as expected, the results on change scores show that subclinical psychopathic traits positively related to a stronger increase in SC, irrespective of the type of compassion induction. This positive relation between a stronger increase in SC and psychopathy total and callousness was more pronounced after the SC induction, rather than after the OC induction. Psychopathic traits did not differentially influence changes in OC. One implication of this study is that high psychopathic and callousness traits predispose to profit extra from targeting SC. Furthermore, psychopathic traits do not hinder increasing compassion for others. These findings suggest that compassion is a promising intervention to improve the wellbeing of people with elevated subclinical psychopathic traits and those around them. Although further research is needed to assess the impact of compassion on anger and aggression specifically, and on clinical psychopathy, the current study suggests that both SC and OC may be useful intervention targets in case of elevated psychopathic traits.

Narcissistic traits and compassion: Embracing oneself while devoiding others.

Grandiose narcissistic traits refer to exploitative and arrogant attitudes, while vulnerable narcissistic traits entail hypersensitivity to judgment and low self-esteem. Little is known about how individuals with narcissistic traits can improve their attitudes toward themselves and others. The current research puts self- and other compassion forward as possible targets to alleviate some of destructive patterns of narcissism. Generally, self-compassion (SC) has previously been associated with beneficial effects on psychological wellbeing, while other compassion (OC) is advantageous for interpersonal relationships. This study explored the relationship between narcissistic traits and the efficacy of experimental compassion inductions. Student and community participants (N = 230, M age = 27.41, 65.2% female) completed grandiose and vulnerable narcissistic trait, SC and OC state questionnaires, and either an SC or OC induction. It was expected that individuals with higher narcissistic traits (particularly grandiose traits) would benefit from the inductions and show higher SC after but would have greater difficulty showing meaningful increases in OC (especially OC directed at the general population). The results indicated that individual differences in grandiose and vulnerable narcissistic traits are related to the magnitude of improvements following the inductions: the theorized lack of SC in individuals with vulnerable oversensitivity to judgment traits seems possible to be counteracted through different types of compassion exercises. Moreover, higher grandiose exploitativeness-entitlement and global vulnerable narcissistic traits related to less increases than others. However, directly inducing OC in individuals with these traits was linked to greater OC improvements than improvements after inducing SC. Overall, the present findings suggest that self-compassionate behavior can be improved in individuals with high oversensitivity and that other compassionate behavior could potentially be increased if, specifically, other compassion exercises are utilized when higher levels of certain narcissistic traits are present.

The influence of rumination and distraction on depressed and anxious mood: a prospective examination of the response styles theory in children and adolescents.

The present study sought to test predictions of the response styles theory in a sample of children and adolescents. More specifically, a ratio approach to response styles was utilized to examine the effects on residual change scores in depression and anxiety. Participants completed a battery of questionnaires including measures of rumination, distraction, depression, and anxiety at baseline (Time 1) and 8-10 weeks follow-up (Time 2). Results showed that the ratio score of rumination and distraction was significantly associated with depressed and anxious symptoms over time. More specifically, individuals who have a greater tendency to ruminate compared to distracting themselves have increases in depression and anxiety scores over time, whereas those who have a greater tendency to engage in distraction compared to rumination have decreases in depression and anxiety symptoms over time. These findings indicate that a ratio approach can be used to examine the relation between response styles and symptoms of depression and anxiety in non-clinical children and adolescents. Implications of the results may be that engaging in distractive activities should be promoted and that ruminative thinking should be targeted in juvenile depression treatment.

Brief report: Direct and indirect relations of risk factors with eating behavior problems in late adolescent females.

This study explored correlations between risk factors and eating behavior problems in late adolescent, non-clinical females (N=301). Participants completed questionnaires for assessing eating problems, the closely associated factors of Body Mass Index (BMI) and body dissatisfaction, and a number of other risk variables that are thought to be involved in psychopathology in general, namely insecure attachment, low self-esteem, and negative affect (i.e., social anxiety and depression). Results indicated that high levels of eating problems were associated with high levels of insecure attachment, social anxiety, and depression, and with low levels of self-esteem. Further, regression analyses suggested that depression and self-esteem had a unique, direct relationship with eating problems, whereas insecure attachment and social anxiety only seemed to have indirect relations. The links between these general risk variables and eating behavior problems were independent from the specific eating problem correlates of BMI and body dissatisfaction.

Psychometric properties of the aggression questionnaire in Dutch violent forensic psychiatric patients and secondary vocational students.

The psychometric properties of a Dutch version of Buss and Perry's Aggression Questionnaire (AQ) were examined in a sample of violent forensic psychiatric inpatients and outpatients and a sample of secondary vocational students. The internal consistency, interitem correlations, and item-scale correlations of the subscales Physical Aggression, Anger, and Hostility were good but turned out to be unsatisfactory for the subscale Verbal Aggression. The four-factor structure of the AQ could not be confirmed, but the four-factor structure of a 12-item version (short form) of the AQ, the AQ-SF, produced an acceptable fit. The test-retest reliability of the AQ and AQ-SF total scores was good, although the test-retest reliability of the AQ-SF subscale Physical Aggression was not satisfactory. The validity of both the AQ and AQ-SF could be demonstrated by meaningful correlations with alternative measures of aggression and personality, but inpatients were not found to display higher scores on the AQ or AQ-SF than the students.

Attention control in middle childhood: relations to psychopathological symptoms and threat perception distortions.

The present study examined the construct of attention control, which is an important aspect of effortful control, in a sample of non-clinical children aged between 9 and 13 years. Results demonstrated that attention control was associated with a broad range of psychopathological complaints, including symptoms of anxiety, aggression, depression, and ADHD. As predicted, lower levels of attention control were accompanied by higher levels of these symptoms. Further, attention control was also negatively related to threat perception distortions, which indicates that children who display low levels of this regulative temperament factor are more prone to such cognitive biases. Third, when controlling for neuroticism, attention control remained significantly (negatively) associated with symptoms of anxiety, depression (child report only), and ADHD. The correlations between attention control and threat perception distortions largely disappeared when the influence of neuroticism was partialled out. Only the link between attention control and anxious interpretations of ambiguous vignettes survived this correction. Finally, no evidence was found for the hypothesised mediating role of cognitive distortions on the relation between temperament factors and psychopathological symptoms.

Level of psychosocial adaptation in young school children with otitis media.

OBJECTIVE: Assessment of the level of psychosocial adaptation in Dutch young school children with persistent and/or recurrent otitis media compared to a U.S. community sample. The goal of this study was to determine the presence of behavioural effects related to a history of hearing loss resulting from recurrent or persistent otitis media. METHODS: Caregivers of 160 children, age range 4-7 years, suffering from either upper respiratory tract infections (URTI) and/or otitis media with effusion (OME), completed the generic Strengths and Difficulties Questionnaire (SDQ) and impact supplement before consulting the ENT physician. RESULTS: In the ENT sample significant differences were found for the SDQ subscales hyperactivity-inattention and emotional symptoms, as well as for the total difficulties score and impact rating, compared to the U.S. community sample (p<.0005). Classification of severity (low, medium, high difficulties) for SDQ symptom scores, according to U.S. normative scoring bands, showed significantly more children in higher severity bands for SDQ total difficulties (p<.0005), emotional symptoms (p<.005), hyperactivity-inattention (p<.001) and prosocial behaviour (p<.005). This is expressed in a larger percentage of scores in the high difficulties (>90% of scores) than in the medium difficulties (80-90% of scores) band for most ENT SDQ scores, except for SDQ prosocial behaviour (18.1%) and total difficulties (17.5%). CONCLUSION: The level of psychosocial adaptation seems to be compromised in the Dutch ENT sample for both internalising (emotional symptoms) and externalising (hyperactivity-inattention) behaviour dimensions, which indirectly supports the cumulative effects of a disease history with chronic otitis media, resulting in poorer attention skills and fewer social interactions present. The classification of SDQ symptom severity, indicates that any behavioural effect of otitis media and resulting hearing loss is within the borderline score range, asking for vigilance regarding possible developmental and educational sequelae during childhood.