Youth Parasympathetic Functioning Moderates Relations between Cumulative Family Risk and Internalizing Behaviors

  • Marta Benito-GomezEmail author
  • Anne C. Fletcher
  • Cheryl Buehler
Empirical Research


Problematic family functioning places young adolescents at risk for internalizing behaviors. However, not all adolescents who experience family risk develop internalizing behaviors during early adolescence. Informed by a cumulative risk perspective, the current study examined whether associations between cumulative family risk, as well as particular family risk domains, and youth internalizing behaviors are moderated by youth parasympathetic reactivity. Participants include 68 young adolescents in 6th grade. Youth were 56% female, 41% African American, and 54% European American. For young adolescents who experienced higher change in respiratory sinus arrhythmia during a challenge/stressor task, greater cumulative family risk, exposure to more family risk domains, and several particular risk factors (maternal psychological well-being, marital/family system risk), were associated with higher levels of internalizing behaviors. The findings from this study demonstrate that the extent to which both particular family risk factors and cumulative family risk place youth at increased risk for internalizing behaviors depends on youth’s parasympathetic functioning.


Early adolescence Delta RSA Parasympathetic nervous system Internalizing behaviors Cumulative family risk 



The authors thank the study participants and research assistants who helped collect data for the analyses presented in the current study.

Authors’ Contributions

A.C.F. and C.B. designed the study and supervised data collection; A.C.F., C.B., and M.B.G. participated in the conceptualization of this manuscript and the development of the cumulative family risk measure; M.B.G. performed the statistical analysis, wrote the literature review, methods, results, and discussion. All three authors participated in preparation of revised versions and approved the final version of this manuscript.


This research was supported by grants to C.B. and A.C.F. from the University of North Carolina Greensboro.

Data Sharing and Declaration

This manuscript's data will not be deposited.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board at the University of North Carolina in Greensboro and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants that participated in the current study.


  1. Achenbach, T. M. (1991). Manual for the child behavior checklist/4–18 and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.Google Scholar
  2. Achenbach, T. M., & Edelbrock, C. S. (1978). The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin, 85, 1275–1301.CrossRefGoogle Scholar
  3. Amato, P. R., & Hohmann-Mariott, B. (2007). A comparison of high and low-distress marriages that end in divorce. Journal of Marriage and Family, 6, 621–638. Scholar
  4. Appleyard, K., Egeland, B., van Dulmen, M. H., & Alan Sroufe, L. (2005). When more is not better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry, 46, 235–245.CrossRefGoogle Scholar
  5. Barber, B. K. (1996). Parental psychological control: revisiting a neglected construct. Child Development, 67, 3296–3319.CrossRefGoogle Scholar
  6. Barber, B. K., Stolz, H. E., & Olsen, J. A. (2005). Parental support, psychological control, and behavioral control: assessing relevance across time, culture, and method: V. Assessing relevance across culture: cross-national replications. Monographs of the Society for Research in Child Development, 70, 58–72.CrossRefGoogle Scholar
  7. Beauchaine, T. P. (2015). Future directions in emotion dysregulation and youth psychopathology. Journal of Clinical Child & Adolescent Psychology, 44, 875–896. Scholar
  8. Bender, H. L., Allen, J. P., McElhaney, K. B., Antonishak, J., Moore, C. M., Kelly, H. O., & Davis, S. M. (2007). Use of harsh physical discipline and developmental outcomes in adolescence. Development and Psychopathology, 19, 227–242.CrossRefGoogle Scholar
  9. Benson, M. J., Buehler, C., & Gerard, J. M. (2008). Interparental hostility and early adolescent problem behavior: spillover via maternal acceptance, harshness, inconsistency, and intrusiveness. The Journal of Early Adolescence, 28, 428–454.CrossRefGoogle Scholar
  10. Boucsein, W. (2012). Electrodermal activity. New York: Springer Science.CrossRefGoogle Scholar
  11. Buske-Kirschbaum, A., Jobst, S., Wustmans, A., Kirschbaum, C., Rauh, W., & Hellhammer, D. (1997). Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosomatic Medicine, 59, 419–426. Scholar
  12. Buss, K. A., Davis, E. L., & Kiel, E. J. (2011). Allostatic and environmental load in toddlers predicts anxiety in preschool and kindergarten. Development and Psychopathology, 23, 1069–1087.CrossRefGoogle Scholar
  13. Bradford, K., Barber, B. K., Olsen, J. A., Maughan, S. L., Erickson, L. D., & Ward, D. et al. (2004). A multi-national study of interparental conflict, parenting, and adolescent functioning: South Africa, Bangladesh, China, India, Bosnia, Germany, Palestine, Colombia, and the United States. Marriage & Family Review, 35, 107–137. Scholar
  14. Buehler, C., & Gerard, J. M. (2013). Cumulative family risk predicts increases in adjustment difficulties across early adolescence. Journal of Youth and Adolescence, 42, 905–920. Scholar
  15. Buehler, C., Krishnakumar, A., Stone, G., Anthony, C., Pemberton, S., Gerard, J., & Barber, B. K. (1998). Interparental conflict styles and youth problem behaviors: a two-sample replication study. Journal of Marriage and Family, 60, 119–132.CrossRefGoogle Scholar
  16. Buske-Kirschbaum, A., Jobst, S., Wustmans, A., Kirschbaum, C., Rauh, W., & Hellhammer, D. (1997). Attenuated free cortisol response to psychosocial stress in children with atopic dermatitis. Psychosomatic Medicine, 59, 419–426. Scholar
  17. Byrne, B. M. (2001). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Mahwah, New Jersey: Lawrence Erlbaum Associates.Google Scholar
  18. Calkins, S. D., Propper, C., & Mills‐Koonce, W. R. (2013). A biopsychosocial perspective on parenting and developmental psychopathology. Development and Psychopathology, 25, 139–414. Scholar
  19. Conger, R. D., & Elder, G. H. (1994). Families in troubled times: adapting to change in rural america. New York: Aldine de Gruyter.Google Scholar
  20. Cook, E. C., Wilkinson, K., & Stroud, L. R. (2018). The role of stress response in the association between autonomy and adjustment in adolescents. Physiology & Behavior, 189, 40–49. Scholar
  21. Copeland, W., Shanahan, L., Jane Costello, E., & Angold, A. (2009). Configurations of common childhood psychosocial risk factors. Journal of Child psychology and Psychiatry, 50, 451–459.CrossRefGoogle Scholar
  22. Cummings, E. M., Cheung, R. Y. M., Koss, K., & Davies, P. T. (2014). Parental depressive symptoms and adolescent adjustment: a prospective test of an explanatory model for the role of marital conflict. Journal of Abnormal Child Psychology, 42, 1153–1166. Scholar
  23. Cummings, E. M., Koss, K. J., & Davies, P. T. (2015). Prospective relations between family conflict and adolescent maladjustment: security in the family system as a mediating process. Journal of Abnormal Child Psychology, 43, 503–515. Scholar
  24. Diamond, L. M., Fagundes, C. P., & Cribbet, M. R. (2012). Individual differences in adolescents' sympathetic and parasympathetic functioning moderate associations between family environment and psychosocial adjustment. Developmental Psychology, 48, 918–931. Scholar
  25. Doyle, A. B., & Markiewicz, D. (2005). Parenting, marital conflict and adjustment from early-to mid-adolescence: mediated by adolescent attachment style? Journal of youth and adolescence, 34, 97–110.CrossRefGoogle Scholar
  26. Duggal, S., Carlson, E. A., Sroufe, L. A., & Egeland, B. (2001). Depressive symptomatology in childhood and adolescence. Development and Psychopathology, 13, 143–164.CrossRefGoogle Scholar
  27. El‐Sheikh, M. (2005). Stability of respiratory sinus arrhythmia in children and young adolescents: a longitudinal examination. Developmental Psychobiology, 46, 66–74. Scholar
  28. El-Sheikh, M., & Erath, S. A. (2011). Family conflict, autonomic nervous system functioning, and child adaptation: state of the science and future directions. Development and Psychopathology, 23, 703–721. Scholar
  29. El-Sheikh, M., Harger, J., & Whitson, S. M. (2001). Exposure to interparental conflict and children’s adjustment and physical health: The moderating role of vagal tone. Child Development, 72, 1617–1636. Scholar
  30. El-Sheikh, M., & Whitson, S. A. (2006). Longitudinal relations between marital conflict and child adjustment: vagal regulation as a protective factor. Journal of Family Psychology, 20, 30–39. Scholar
  31. Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural equation modeling, 8, 430–457.CrossRefGoogle Scholar
  32. Evans, G. W., Li, D., & Whipple, S. S. (2013). Cumulative risk and child development. Psychological bulletin, 139, 1342.CrossRefGoogle Scholar
  33. Fletcher, A. C., Buehler, C., Buchanan, C. M., & Weymouth, B. B. (2017). Parenting stressors and young adolescents' depressive symptoms: does high vagal suppression offer protection? Physiology & Behavior, 17, 78–87. Scholar
  34. Gerard, J. M., & Buehler, C. (2004). Cumulative environmental risk and youth maladjustment: the role of youth attributes. Child Development, 75, 1832–1849. Scholar
  35. Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: a meta-analytic review. Clinical Child and Family Psychology Review, 14, 1–27. Scholar
  36. Graziano, P., & Derefinko, K. (2013). Cardiac vagal control and children’s adaptive functioning: a meta-analysis. Biological Psychology, 94, 22–37. Scholar
  37. Greaves-Lord, K., Tulen, J., Dietrich, A., Sondeijker, F., van Roon, A., Oldehinkel, A., & Huizink, A. (2010). Reduced autonomic flexibility as a predictor for future anxiety in girls from the general population: the TRAILS study. Psychiatry Research, 179, 187–193.CrossRefGoogle Scholar
  38. Haltigan, J. D., Roisman, G. I., Cauffman, E., & Booth-LaForce, C. (2017). Correlates of childhood vs. adolescence internalizing symptomatology from infancy to young adulthood. Journal of Youth and Adolescence, 46, 197–212.CrossRefGoogle Scholar
  39. Hammen, C., & Brennan, P. A. (2003). Severity, chronicity, and timing of maternal depression and risk for adolescent offspring diagnoses in a community sample. Archives of general psychiatry, 60, 253–258.CrossRefGoogle Scholar
  40. Hastings, P. D., Klimes-Dougan, B., Kendziora, K. T., Brand, A., & Zahn-Waxler, C. (2014). Regulating sadness and fear from outside and within: mothers’ emotion socialization and adolescents' parasympathetic regulation predict the development of internalizing difficulties. Development and Psychopathology, 26, 1369–1384. Scholar
  41. Hayes, A. F. (2012). PROCESS: a versatile computational tool for observed variable mediation, moderation, and conditional process modeling. [White paper].
  42. Hinnant, J. B., Elmore-Staton, L., & El-Sheikh, M. (2011). Developmental trajectories of respiratory sinus arrhythmia and preejection period in middle childhood. Developmental psychobiology, 53, 59–68.CrossRefGoogle Scholar
  43. Hinnant, J. B., Erath, S. A., Tu, K. M., & El-Sheikh, M. (2015). Permissive parenting, deviant peer affiliations, and delinquent behavior in adolescence: the moderating role of sympathetic nervous system reactivity. Journal of Abnormal Child Psychology, 44, 1–11. Scholar
  44. Holder, M. K., & Blaustein, J. D. (2014). Puberty and adolescence as a time of vulnerability to stressors that alter neurobehavioral processes. Frontiers in Neuroendocrinology, 35, 89–110.CrossRefGoogle Scholar
  45. Jessor, R. (1998). New perspectives on adolescent risk behavior. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  46. Karavidas, M. K., Lehrer, P. M., Vaschillo, E., Vaschillo, B., Marin, H., Buyske, S., & Hassett, A. (2007). Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression. Applied psychophysiology and biofeedback, 32, 19–30.CrossRefGoogle Scholar
  47. Kirschbaum, C., Pirke, K. M., & Hellhammer, D. H. (1993). The ‘Trier Social Stress Test’–a tool for investigating psychobiological stress responses in a laboratory setting. Neuropsychobiology, 28, 76–81.CrossRefGoogle Scholar
  48. Lengua, L. J., & Kovacs, E. A. (2005). Bidirectional associations between temperament and parenting and the prediction of adjustment problems in middle childhood. Journal of Applied Developmental Psychology, 26, 21–38.CrossRefGoogle Scholar
  49. Lopez-Duran, N. L., Kovacs, M., & George, C. J. (2009). Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: A meta-analysis. Psychoneuroendocrinology, 34, 1272–1283.CrossRefGoogle Scholar
  50. McLaughlin, K. A., Alves, S., & Sheridan, M. A. (2014). Vagal regulation and internalizing psychopathology among adolescents exposed to childhood adversity. Developmental Psychobiology, 56, 1036–1051. Scholar
  51. Moos, R. H., & Moos, B. S. (1986). The Family Environment Scale: the manual. Palo Alto CA: Consulting Psychologists Press.Google Scholar
  52. Muthén, L. K., & Muthén, B. O. (2018). Mplus: Statistical Analysis with Latent Variables: User’s Guide (Version 8). Los Angeles, CA: Authors.Google Scholar
  53. Parra, G. R., DuBois, D. L., & Sher, K. J. (2006). Investigation of profiles of risk factors for adolescent psychopathology: a person-centered approach. Journal of Clinical Child and Adolescent Psychology, 35, 386–402. Scholar
  54. Petersen, A. C., Crockett, L., Richards, M., & Boxer, A. (1988). A self-report measure of pubertal status: reliability, validity, and initial norms. Journal of Youth and Adolescence, 17, 117–133.CrossRefGoogle Scholar
  55. Pinquart, M. (2017). Associations of parenting dimensions and styles with internalizing symptoms in children and adolescents: a meta-analysis. Marriage & Family Review, 53, 613–640.CrossRefGoogle Scholar
  56. Porges, S. W. (1985). U.S. Patent no. 4,510,944. Washington, DC: U.S. Patent and Trademark Office.Google Scholar
  57. Porges, S. W. (2003). Social engagement and attachment. Annals of the New York Academy of Sciences, 1008, 31–47. Scholar
  58. Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74, 116–143. Scholar
  59. Proulx, C. M., Helms, H. M., & Buehler, C. (2007). Marital quality and personal well-being: a meta-analysis. Journal of Marriage and Family, 69, 576–593. Scholar
  60. Quintana, D. S., & Heathers, J. A. J. (2014). Considerations in the assessment of heart rate variability in biobehavioral research. Frontiers in Psychology, 5, 805. Scholar
  61. Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  62. Roisman, G. I., Newman, D., Fraley, R. C., Haltigan, J. D., Groh, A. M., & Haydon, K. C. (2012). Distinguishing differential susceptibility from diathesis‐stress: recommendations for evaluating interaction effects. Development and Psychopathology, 24, 389–409. Scholar
  63. Romeo, R. D. (2010). Pubertal maturation and programming of hypothalamic-pituitary-adrenal reactivity. Frontiers in neuroendocrinology, 31, 232–240.CrossRefGoogle Scholar
  64. Sameroff, A. J., Bartko, W. T., Baldwin, A., Baldwin, C., & Seifer, R. (1998). Family and social influences on the development of child competence. In M. Lewis, & C. Feiring (Eds.), Families, risk, and competence (pp. 161–185). Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  65. Scarpa, A., & Ollendick, T. H. (2003). Community violence exposure in a young adult sample: III. Psychophysiology and victimization interact to affect risk for aggression. Journal of Community Psychology, 31, 321–338.CrossRefGoogle Scholar
  66. Shelton, K. K., Frick, P. J., & Wootton, J. (1996). Assessment of parenting practices in families of elementary school-age children. Journal of Clinical Child Psychology, 25, 317–329.CrossRefGoogle Scholar
  67. Sroufe, L. A., & Rutter, M. (1984). The domain of developmental psychopathology. Child Development, 55, 17–29. Scholar
  68. Steinberg, L., Dahl, R., Keating, D., Kupfer, D. J., Masten, A. S., & Pine, D. S. (2006). The study of developmental psychopathology in adolescence: integrating affective neuroscience with the study of context. In D. Cicchetti, D. J. Cohen, D. Cicchetti, & D. J. Cohen (Eds.), Developmental psychopathology, vol 2: Developmental neuroscience (2nd ed.) (pp. 710–741). Hoboken, NJ, USA: John Wiley & Sons Inc.Google Scholar
  69. Stroud, L. R., Papandonatos, G. D., D'Angelo, C. M., Brush, B., & Lloyd-Richardson, E. E. (2017). Sex differences in biological response to peer rejection and performance challenge across development: a pilot study. Physiology & behavior, 169, 224–233.CrossRefGoogle Scholar
  70. van der Bruggen, C. O., Stams, G. J., & Bögels, S. M. (2008). Research review: the relation between child and parent anxiety and parental control: a meta-analytic review. Journal of Child Psychology and Psychiatry, 49, 1257–1269. Scholar
  71. Van Oort, F. V. A., Greaves‐Lord, K., Verhulst, F. C., Ormel, J., & Huizink, A. C. (2009). The developmental course of anxiety symptoms during adolescence: the TRAILS study. Journal of Child Psychology and Psychiatry, 50, 1209–1217.CrossRefGoogle Scholar
  72. Wang, M. T., & Kenny, S. (2014). Longitudinal links between fathers’ and mothers’ harsh verbal discipline and adolescents’ conduct problems and depressive symptoms. Child Development, 85, 908–923. Scholar
  73. Wang, Y. C. L., Chan, H. Y., Lin, C. W., & Li, J. R. (2015). Association of parental warmth and harsh discipline with developmental trajectories of depressive symptoms among adolescents in Chinese society. Journal of Family Psychology, 29, 895–906. Scholar
  74. Wetter, E. K., & El‐Sheikh, M. (2012). Trajectories of children’s internalizing symptoms: the role of maternal internalizing symptoms, respiratory sinus arrhythmia and child sex. Journal of Child Psychology and Psychiatry, 53, 168–177.CrossRefGoogle Scholar
  75. Yap, M. B. H., Pilkington, P. D., Ryan, S. M., & Jorm, A. F. (2014). Parental factors associated with depression and anxiety in young people: a systematic review and meta-analysis. Journal of Affective Disorders, 156, 8–23. Scholar
  76. Zahn-Waxler, C., Klimes-Dougan, B., & Slattery, M. J. (2000). Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression. Development and Psychopathology, 12, 443–466.CrossRefGoogle Scholar
  77. Zimmerman, M. A., Stoddard, S. A., Eisman, A. B., Caldwell, C. H., Aiyer, S. M., & Miller, A. (2013). Adolescent resilience: Promotive factors that inform prevention. Child Development Perspectives, 7, 215–220. Scholar

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Authors and Affiliations

  1. 1.Department of Human Development and Family StudiesThe University of North Carolina at GreensboroGreensboroUSA

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