Family Conflict and Stress Disrupt Emotion Regulation in Youth

A recent study led by Karim Ibrahim, PsyD, at Yale Child Study Center (YCSC) found that difficulties managing emotions in childhood are linked to attention problems, aggression, anxiety, and depression. The study examined more than 9,000 children and adolescents and found that difficulties managing emotions are common among youth with mental health symptoms.

Differences between boys and girls emerged at different times during development, researchers found. The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry: Open, also suggests that family conflict and stressful life events may be linked to mental health symptoms through how children manage their emotions.

The researchers found that difficulty regulating emotion at ages 12 to 13 is linked to more severe mental health symptoms both earlier in childhood (ages 9 to 10) and later in adolescence (ages 13 to 14). These findings suggest that managing emotions is a stable feature linked to mental health as children grow and is an important target for early intervention.

This large-scale study examined how difficulties managing emotions are linked to common youth mental health symptoms, including attention problems, aggression and anger, and anxiety and depression, across a diverse group of children and adolescents.

The study also examined how exposure to adverse experiences, such as family conflict and negative life events, is related to the severity of different areas of mental health symptoms through emotion regulation.

“Understanding how early life stress interacts with emotion regulation difficulties can help us identify children who are at higher risk for mental health conditions and develop more precise treatments," says Ibrahim, whose work leading the Emotion and Systems Neuroscience Lab at YCSC focuses on how early life stress, environmental factors, and social media affect brain development and emotion regulation in youth mental health conditions.

The study analyzed data from the Adolescent Brain Cognitive Development (ABCD) study, the largest long-term study of brain development and child health in the United States. The ABCD study includes a diverse national sample of youth who were enrolled at ages 9 to 10 and followed into adolescence.

The researchers looked at relationships among emotion regulation, childhood adversity, and three types of mental health symptoms: attention problems (difficulty concentrating), externalizing problems (anger, aggression, and defiance), and internalizing problems (anxiety and depression).

Children with greater emotion regulation difficulties showed more severe symptoms across all three areas. They also relied on suppression, which means hiding or holding back emotional responses, researchers say. This strategy is typically associated with more severe mental health symptoms.

Exposure to family conflict, such as fighting, throwing items, criticizing, and hitting during disagreements among family members, increased behavior problems primarily by disrupting children’s ability to manage their emotions. Negative life events, such as witnessing violence or experiencing serious illness, had similar effects through emotion regulation.

For internalizing symptoms of anxiety and depression, children exposed to heightened family conflict showed more severe internalizing symptoms that were linked to greater difficulties with emotion regulation. They also relied more on hiding their emotional responses (suppression) and less on changing their perspective about a situation (reappraisal).

These findings were confirmed in follow-up analyses tracking youth as they grew. Family conflict at ages 9 to 10 predicted mental health symptoms at ages 13 to 14 through its impact on how children manage their emotions. This supports the importance of early intervention.

All children aged 12 to 13 in the study showed similar patterns overall. However, analyses over time revealed differences between boys and girls. Boys who had more trouble managing emotions showed more externalizing problems earlier than girls. In contrast, girls who hid or suppressed their emotions were more likely to develop attention problems later.

This may reflect different ways that symptoms appear in boys and girls, or possible “masking” of attention-related behaviors in girls, researchers say. The study’s large, diverse sample, with relatively equal numbers of boys and girls, provides strong evidence for these patterns.

The researchers used advanced statistical methods to examine the effects of emotion regulation and accounted for factors such as cognitive ability and pubertal development. They found that youth who were further along in puberty had higher symptom levels, particularly in girls.

“These findings support the development of treatments that address emotion regulation across different mental health conditions,” says James Gross, PhD, a professor at Stanford University and a co-author of the study. “By targeting emotion regulation broadly, we may reduce risk for several types of symptoms or behavioral problems.”

“For the first time, this study shows emotion regulation is related to adversity and mental health symptoms in adolescents, with consistent relationships at different points in time,” says Ilanit Gordon, PhD, associate professor at Bar-Ilan University and a study co-author.

"The transition to adolescence is a critical window for child brain development. During this time, executive functioning skills are also developing—such as attention, cognitive flexibility, and inhibition—that support emotion regulation abilities,” says Ibrahim. “Understanding how stress affects the developing brain and risk of mental health symptoms is vital. Early interventions that teach emotion regulation skills and provide support for families could help reduce severity of mental health problems in youth.”