J. Child Psychol. Psychiat. Vol. 41, No. 7, pp.

907–915, 2000
Cambridge University Press
' 2000 Association for Child Psychology and Psychiatry
Printed in Great Britain. All rights reserved
0021–9630\00 $15n00j0n00

Expressed Emotion, Parenting Stress, and Adjustment in Mothers of

Young Children with Behavior Problems
Bruce L. Baker
UCLA, Los Angeles, U.S.A.

Tracy L. Heller
California School of Professional Psychology, Los Angeles, U.S.A.

Barbara Henker
UCLA, Los Angeles, U.S.A.

Expressed Emotion (EE), a measure of the emotional climate of the family, predicts
subsequent adjustment of adults with mental disorder (Leff & Vaughn, 1985). Despite the
acknowledged importance of the family in childhood disorders, there have been relatively
few studies of expressed emotion with adolescents and school-aged children and virtually
none focused on preschoolers. The present study utilized the Five Minute Speech Sample
(FMSS) to examine how Expressed Emotion relates concurrently and longitudinally to child
problem status in a community sample of 112 preschool-aged children. At preschool, the
proportion of high EE increased significantly across three child groups : Comparison (8n1 %),
Borderline Problem (15n8 %), and High Problem (41n2 %) ; however, preschool EE was not
predictive of subsequent child status at 1st grade. Expanded FMSS codes, tapping positive
affect and worry about the child, were also related to child problem group at preschool and
were predictive of subsequent child status at 1st grade. Because parents’ stress and
adjustment were also highly related to child problem group status, we examined whether the
FMSS codes were essentially a proxy for these or whether they explained unique variance.
In two stepwise regressions on preschool child group status (divided by total problems and
by externalizing problems), maternal stress was the only variable to enter. Also, in predicting
to 1st grade externalizing child group status, only maternal stress entered. Discussion
focused on the extension of the EE construct and other FMSS coding to young children, and
the need to recognize that to some extent these variables may reflect maternal stress and
adjustment.

Keywords : Behavior problems, Expressed Emotion, externalizing disorder, parent–child

relations, preschool children, stress.

Abbreviations : BDI : Beck Depression Inventory ; CBCL : Child Behavior Checklist ; DAS :
Dyadic Adjustment Scale ; EE : expressed emotion ; EOI : emotional overinvolvement ; FIQ :
Family Impact Questionnaire ; FMSS : Five Minute Speech Sample ; SCL-90 : Symptom
Checklist-90 ; TRF : Teacher Report Form.

There is increasing evidence that children with behavior
problems in the preschool years are at higher risk for
adjustment problems in later childhood (Campbell, 1994 ;
Heller, Baker, Henker, & Hinshaw, 1996 ; Richman,
Stevenson, & Graham, 1982). These findings of con-
tinuity have focused attention on family adjustment and
parenting practices in early childhood. Studies with
preschoolers have shown that in families with child
behavior problems there is greater parental stress (Baker
& Heller, 1996), less spousal support (Suarez & Baker,
1997), more authoritarian child-rearing beliefs (Heller
et al., 1996), and greater maternal negativity and less
Requests for reprints to : Dr Bruce L. Baker, Department of
Psychology, 405 Hilgard Avenue, UCLA, Los Angeles, CA
90095, U.S.A. (E-mail : Baker!psych.ucla.edu).
warmth in parent–child interactions (Campbell, Ewing,
Breaux, & Szumowski, 1986 ; Richman et al., 1982).
Although these may be as much the effects as the causes
of childhood behavior problems (Bell & Harper, 1977),
these family characteristics are proving to be predictive of
subsequent child adjustment (Campbell, 1994 ; Egeland,
Kalkoske, Gottesman, & Farrell-Erickson, 1990 ; Heller
et al., 1996).
Expressed Emotion (EE) is a measure of the emotional
climate of the home ; it has shown high predictive value in
families of adult members with mental disorder. Families
are characterized as high EE or low EE, based upon
evidence of critical and\or emotionally overinvolved
attitudes expressed by parents toward the son or daughter
during an interview. In families of adult offspring with
mental disorder, EE has proven to be a strong predictor
of the son or daughter’s relapse after returning home
from hospitalization (Leff & Vaughn, 1985). Presumably

907
908 B. L. BAKER, T. L. HELLER, and B. HENKER
the attitudes expressed during the interview are reflective
of unsupportive behaviors expressed on daily family
interactions that have a negative impact on the patient.
Despite the acknowledged importance of parent–child
interactions in childhood disorders, there have been
relatively few studies of expressed emotion with adoles-
cents and school-aged children and we know of none
focused on preschoolers.
The present study examines expressed emotion in
parents of preschool aged children ; we have included a
community sample of children rather than those in
psychiatric treatment and have followed them longitu-
dinally. As with many recent studies of EE, we utilized a
brief, recorded Five Minute Speech Sample (FMSS ;
Magana et al., 1986) rather than the original Camberwell
Family Interview (Brown, Birley & Wing, 1972 ; Vaughn
& Leff, 1976).
The primary question of interest is whether high EE
characterizes families of preschool-aged children with
behavior problems and predicts future behavior prob-
lems. Studies of older children and adolescents have
suggested that the EE construct is a useful discriminator.
Hibbs et al. (1991), studying children (mean age 12n9
years) with obsessive compulsive disorder and disruptive
behavior disorders, found more high EE families in these
clinical groups than in a nonpsychiatric comparison
group. Asarnow and her colleagues, studying children
aged 7–14 with depressive disorders, found more high EE
parents than in a comparison group (Asarnow, Thomp-
son, Hamilton, Goldstein, & Guthrie, 1994). Moreover,
the recovery rates 1 year after hospital discharge were
much worse in high EE homes than in low EE ones
(Asarnow, Goldstein, Tompson, & Guthrie, 1993).
Schwartz, Dorer, Beardslee, Lavori, and Keller (1990)
also found more high maternal EE in families of school-
aged children with attention deficit-hyperactivity dis-
order, conduct disorder, depression, or substance abuse.
Marshall, Longwell, Goldstein, and Swanson (1990),
studying boys aged 6–15 with ADD-H, found a re-
lationship between EE status and parent–child inter-
actions ; interactions with parents previously rated high
EE by the FMSS were characterized by greater verbal
coercion and more negative affective style.
The present study extends the investigation of EE to
families of preschool and kindergarten children, an age
group in which others have found similar family charac-
teristics, such as hostility, related to problem behaviors
(Richman et al., 1982). We thus hypothesized that the EE
component critical remarks would be higher in families
where a child has significant behavior problems. The
other component, emotional overinvolvement (EOI), may
not be applicable for families of very young children, in
that the components would have a different meaning at
this age. For example, a high degree of protectiveness and
positive remarks would characterize normative parenting
behaviors with a preschooler. We therefore did not expect
a relationship between EOI and child behavior problems.
A second question of interest is whether the com-
ponents of high EE (critical remarks and EOI) relate to
particular types of childhood disorder. Stubbe, Zahner,
Goldstein, and Leckman (1993) found higher levels of
criticism in parents of children with disruptive behavior
diagnoses and higher levels of EOI in parents of children
with anxiety disorders. In a three-group study of children
with conduct disorder, emotional disturbance, and com-
parisons, high maternal criticism was significantly related
to externalizing symptoms (Vostanis, Nicholls, &
Harrington, 1994). In the present study, we examine the
relationship of EE and its components to preschool
children’s externalizing and internalizing problem scores.
A third question is whether the clinically rich FMSS
could yield useful information beyond the coding of EE
and its components. Most authors who score EE from the
FMSS report only family EE status, scored as a binary
variable (high vs. low) ; some report the critical and EOI
scores that comprise EE. Although this simplicity is
attractive, there may be value in scoring for other
dimensions. We note that the EE score reflects negative
attitudes, but that parents also vary greatly in positive
expression and this may be an important protective
factor. Vostanis and Nicholls (1995), citing findings by
Richman et al. (1982) that low maternal warmth is
associated with child behavior disturbance in pre-
schoolers, argue that this variable (which is scored from
the longer Camberwell Family Interview) should be
included in FMSS scoring. In the present study, we
derived additional codes for the FMSS to assess positive
affect (including warmth) and concern or worry about the
child.
A fourth question is whether EE is a unique dimension
of family environment, or is essentially another way of
reflecting parents’ stress, adjustment difficulties, and\or
socioeconomic disadvantage. Hibbs et al. (1991) found
that high EE was associated with a parental history of
psychiatric disorder in families of children with obsessive
compulsive disorders, disruptive behavior disorders, and
normal comparisons. Goldstein (1987) found that parents
of young adults with schizophrenia who were rated as
high EE had higher lifetime rates of psychiatric disorder
than did parents rated low EE. Asarnow et al. (1993)
suggest the need for further research to clarify the
relationship between parent EE and psychiatric disorder,
in order to understand better the association between EE
and child outcome. In the present study, we included
young children who did not have major psychiatric
disorders but the much more common behavior problems
of childhood. We did not assess presence or history of
parental psychiatric disorder, which would have been low
in this community sample ; rather, we assessed levels of
stress and adjustment, individually and in the marriage.
As we have noted, these have been associated with child
problems ; we sought to determine whether EE would
have an independent association.
The present study, then, addressed four questions : (1)
Is parental EE associated with child behavior problems in
families with very young children, concurrently and
longitudinally ? (2) Is EE a unitary construct, or do its
components relate to childhood behavior problems dif-
ferently ? (3) Can FMSS coding be expanded mean-
ingfully to include other characteristics of the parental
disclosure ? (4) Is EE a unitary and separate characteristic
of families, or is it better viewed as a reflection of parental
stress and adjustment ?
Method
Subjects
Subjects were 112 families with young children who were
participating in a longitudinal study of the cognitive, emotional,
and social development from preschool to grade 3. Families
were recruited through local preschools, kindergartens, and
day-care centers. Flyers given to directors invited participation
of families with children demonstrating (1) externalizing be-
havior problems (e.g. disruptive, overly active, disobedient) ; (2)
 EXPRESSED EMOTION AND CHILDREN WITH BEHAVIOR PROBLEMS 909

Table 1
Child and Family Demographics : Mean (Standard Deviation) or Percentage by Child
Behavior Problem Group (N l 100)
Child group

Comparison Moderate High

Variable N l 40 N l 42 N l 18 F χ#
Child age (months) 54n2 (7n3) 54n6 (7n4) 55n5 (6n4) 0n21
Sex (% boys) 52n5 42n9 72n2 3n13
Race (% Caucasian) 72n5 73n8 77n8 0n18
Birth position (%)
Only child 32n5 31n0 38n9 0n70
First-born 40n0 35n7 33n3
Later-born 27n5 33n3 27n8
MPC (IQ) 111n6a (11n5) 109n5a (13n0) 100n0b (11n8) 5n80**
Mother’s age 38n6 (5n0) 36n5 (4n7) 36n3 (6n4) 2n26
Mother’s education 6n3 (0n7) 6n1 (0n8) 5n8 (1n1) 2n56
SES score 54n8a (10n2) 55n0a (10n1) 47n0b (15n4) 3n63*
% married 87n5 81n0 77n8 1n05
Mother’s Total CBCL 48n6a (7n4) 60n3b (7n0) 67n2c (4n3) 55n46***
Teacher’s Total CBCL 47n7a (7n9) 58n2b (9n9) 68n8c (4n7) 42n03***
Means were contrasted with Tukey HSD post hoc tests ; those with different superscripts differed
by p n05.
* p n05 ; ** p n01 ; ***p n001.

internalizing behavior problems (e.g. withdrawn, shy, anxious) ;
or (3) no significant behavior problems. The study focused on
the continuity and prediction of behavior problems and, as
such, recruited a disproportionate number of children meeting
criteria (1) and (2) above. Children were parent- and usually
teacher-identified and ranged widely in the number and type of
problem behaviors. Exclusionary criteria included a score of 75
or below on the KABC intelligence test (Kaufman & Kaufman,
1983), mental retardation, autism, or other significant de-
velopmental delays.
Children averaged 4n6 years of age (range 3n5 to 5n9 years),
were 56 % male, and were primarily Caucasian (75 %). In 70 %
of families this child was the only or the eldest child. Mothers
averaged 37n3 years of age. Parents were generally well-educated
and middle to upper socioeconomic status (see below).
Diagnostic Groups
For behavior problem analyses, children were classified as
comparison (N l 40), moderate behavior problem (N l 42), or
high behavior problem (N l 18) by a set of decision rules.
Twelve children were not classified, because of missing data
from mother (1) or teacher (11). We contrasted the 12 families
with missing data to the 100 families with complete behavior
problem data on 25 variables assessing expressed emotion,
demographics, stress, or adjustment. There were three signifi-
cant differences : families with missing data reported signifi-
cantly less negative impact of the child, greater parenting sense
of competence, and more spousal support. These family
differences may have been due to chance, especially because
these families were unclassified, in all but one case, because of
the teacher’s, not the mother’s, failure to comply with measure-
ment.
Comparison children were those referred to us as not having
problems, and both mother and teacher Child Behavior
Checklist (CBCL, Achenbach, 1991) total T scores were below
60 (see below for description of CBCL). High behavior problem
children were referred to us as having behavior problems ;
mother’s and\or teacher’s CBCL total T score was 64 or greater
(in the clinical range) and the other was at least 60 or above (in
the borderline range). Moderate behavior problem children had
either a mother’s or a teacher’s CBCL total T score of at least 60
(borderline range), but scores did not meet the above criteria for
high behavior problems. Table 1 shows demographic charac-
teristics and CBCL T scores by child groups. The groups
differed significantly on child IQ, with the high problem group
scoring lower than the other two groups. The groups also
differed significantly on the Hollingshead score (Hollingshead,
1975), a socioeconomic status indicator, with the high problem
group scoring lower. For subsequent analyses, IQ and\or SES
were covaried if they related significantly to the dependent
variable.
Procedures
Families were recruited in three annual cohorts of similar
size. Parents initiated contact with the center, at which time a
telephone screening elicited the primary child-related concerns.
Only one child participated per family. Exclusionary criteria
included mental retardation, autism, or other significant de-
velopmental delays. Parents were sent consent and release
forms, measures to be completed by both parents, and measures
for the child’s teacher. Families then participated in two 2-hour
assessment sessions at the research center. The measures
described below were among those obtained. Families were
followed up for one 2-hour assessment when the child was in
first grade.
Five Minute Speech Sample : Expressed Emotion
(EE ) and Expanded EE
The Five Minute Speech Sample (FMSS ; Magana et al.,
1986) is tape-recorded and scored for EE and Expanded EE.
Instructions to the parent for the FMSS are : ‘‘ I’d like to hear
your thoughts about your child … Tell me what kind of person
he\she is, and how you get along together. ’’ The interviewer
remains in the room, but the parent is to speak without
interruption for 5 minutes. The FMSS was scored by raters who
were uninformed about the child and the family. Scoring
criteria were developed by Magana et al. (1986 ; Magana-
Amato, 1993) and are based upon the affective quality of the
total 5-minute monologue. EE status is dichotomous, with
respondents considered low EE unless criteria for high EE are
met. High EE is defined based on a high score on either of two
dimensions : criticism and EOI. An FMSS is scored as high on
the criticism dimension if any of the following criteria is met :
negative initial statement, negative relationship rating, or one
910 B. L. BAKER, T. L. HELLER, and B. HENKER
or more criticisms as defined on the Camberwell Family
Interview (Leff & Vaughn, 1985) EE coding scheme. A high EOI
rating is assigned if the parent : (1) reports self-sacrificing
overprotective behavior (e.g. not allowing the child to go to
school for fear that his or her feelings will be hurt), (2) breaks
down in tears during the FMSS ; or (3) shows a combination of
any of the following : excessive detail about the past, excessive
statements of positive attitude and\or excessive praise (five or
more positive remarks). Our coding supervisor was trained by
staff of the Goldstein Family Project at UCLA, and she further
trained the coders.
Expanded EE codes were developed for this study, and
scored by a separate team of coders. Coders were undergraduate
research interns, uninformed about the child and family. They
received approximately 20 hours of training with pilot tapes ;
subsequently, each tape was scored by two or three coders and
these scores were averaged. We began with a large exploratory
pool of 36 dimensions, each coded on a 4- or 5-point scale.
Three coders scored 32 tapes for reliability, distributed through-
out data collection. Many of the dimensions occurred in-
frequently and\or could not be scored reliably. We retained the
11 codes where inter-rater reliability averaged above r l n60,
and subsequently used only 6 of these because the others were
correlated highly with the 6 chosen.
We combined six codes into composite variables when they
were highly intercorrelated and the combination made con-
ceptual sense. Four positive parent descriptors (warmth, en-
joying being a parent, encouraging, and positive tone) were
highly intercorrelated (r l n77 to n86) and were combined into a
Positive Affect score. Two items indicating confusion and worry
(confused about what to do ; concerned or worried about the
child’s behavior) were highly related (r l n80) and were com-
bined into a Worry score.
Measures of Child Behavior Problems
Child Behavior Checklist. The CBCL (Achenbach, 1991) is
a widely-used and well-standardized parent rating scale for
child behavior problems, with separate forms for ages 2–3 and
4–16 years ; we used the 2–3 year form for 19 children. The two
forms yield comparable scores. Parents indicate the degree or
frequency of occurrence of 113 behaviors on a scale of 0–2. Raw
scores are converted to T scores, based on separate norms by
gender and age ; scoring yields a total problem T score, broad-
band T scores for Internalizing and Externalizing dimensions,
and a series of narrow-band clinical scale scores.
CBCL-Teacher Report Form. The teacher version of the
CBCL (the TRF) is similar in format, with 118 items. Although
the TRF is widely used, well-established norms are not available
for the preschool version. In the present sample, there was a
high correlation (r l n80) between externalizing scores on the
TRF and the Preschool Behavior Questionnaire (Behar, 1977),
another commonly used measure.
We note that CBCL derived scores were analyzed as a three-
level variable (comparison, moderate, or high behavior prob-
lems) rather than as continuous variables for two reasons. First,
the CBCL has a high range of scores within the ‘‘ normal ’’ range
and a narrower range within the clinical domains of interest ;
when continuous scores are used in correlational analyses,
effects related to the relatively small group of high scorers are
apt to get overshadowed by the large and, for our purposes,
irrelevant variability in ‘‘ normal ’’ scores. Second, the groups
employed have clinical meaning and are consistent with
Achenbach’s (1991) recommendations for cutoff points.
Measures of Mother Stress and Adjustment
Family Impact Questionnaire. The FIQ (Donenberg &
Baker, 1993) is a 50-item questionnaire that asks about the
‘‘ child’s impact on the family compared to the impact other
children his\her age have on their families ’’ (e.g. Item 1 : ‘‘ My
child is more stressful ’’). Parents endorse items on a 4-point
scale ranging from ‘‘ not at all ’’ to ‘‘ very much. ’’ The scales of
interest here are negative impact (combining negative impact on
feelings about parenting and on social relationships) and
positive impact (on feelings about parenting). We have found
the negative impact score had a test–retest reliability of r(93) l
n67 from preschool to first grade, and it correlated highly with
the child-related stress factor of the Parenting Stress Index
(Abidin, 1990), a well-standardized, 101-item measure of
parenting stress, r(129) l n69.
Parenting Daily Hassles Scales. This measure (Crnic &
Greenberg, 1990) lists 20 problems that parents might ex-
perience in the daily care of their children (e.g. cleaning up after
him\her). Parents indicate the frequency of each problem and
the intensity (how much of a hassle it is), each on a 4-point scale
(‘‘ Not at all ’’ to ‘‘ Very much ’’). Crnic and Greenberg report
high internal reliability for the intensity scale (alpha l n90), and
high correlation between the two scales (r l n78). We analyzed
only the intensity (hassles) scale.
Beck Depression Inventory. The BDI (Beck, Ward, Mendel-
son, Mock, & Erbaugh, 1961) is a 21-item self-report measure of
the cognitive, affective, and somatic dimensions of depression.
Each item contains four statements, ranging from no indication
of depression (I do not feel sad) to high indication (I am so sad
or unhappy that I can’t stand it). Items sum to a total score that
can range from 0 to 63.
Symptom Checklist-90. The SCL-90 (Derogatis, 1986) is a
90-item self-report measure of symptoms of psychopathology ;
the respondent rates the extent of distress from 0 (not at all) to
4 (extremely). Items sum to a total score that can range from 0
to 360.
Dyadic Adjustment Scale. The DAS (Spanier, 1976) is a 32-
item self-report measure of marital adjustment and sums to a
total score that can range from 0 to 151.
Results
Expressed Emotion and Child Problem Groups
For mothers, 102 tapes were scorable for EE ; of these,
18 (18 %) met criteria for high EE. For fathers, only 37
tapes were available for scoring ; 2 (5 %) met criteria for
high EE. Because we had speech samples from so few
fathers, we did not combine mother and father data to
create family scores ; rather, we based all analyses on
mothers’ scores.
Our primary question was whether high EE charac-
terizes families of young children with behavior problems.
When children were classified into problem groups,
mothers’ EE differed significantly across child groups.
For the comparison group, 3 of 37 mothers (8n1 %) were
classified high EE. For the borderline problem group, 6 of
38 (15n8 %) were classified high EE. For the high problem
group, 7 of 17 (41n2 %) were classified high EE, χ# (2, 92)
l 8n98, p l n01 (see Table 2 A).
Table 2 A also shows the mean scores across child
groups for EE components. A MANCOVA was con-
ducted, including critical remarks and EOI and covarying
child IQ score. Using Wilks’ Lambda, groups differed
significantly, approximate F(4,174) l 3n53, p n01. The
individual ANCOVA, covarying child IQ, was significant
for critical remarks. Parents of high problem children
scored more than five times as high on critical remarks as
did parents of comparison children. EOI scores were low
and did not differ by child group.
Relationship of EE to Externalizing vs.
Internalizing Dimensions
Our second question was whether the components of
EE (critical remarks and EOI) related differentially to
children’s CBCL broad-band externalizing vs. internal-
 EXPRESSED EMOTION AND CHILDREN WITH BEHAVIOR PROBLEMS 911

Table 2
EE and Expanded EE. Mean Scores (and SD) by Child Behavior Problem Group, and F
for ANCOVA, with Child Intelligence Covaried
Child group

Variable Comparison Moderate High F χ#

A. Expressed Emotion N l 37 N l 38 N l 17
EE Status (% high) 8n1a 15n8ab 41n2b 8n98**
Critical 0n19a (0n46) 0n45a (0n69) 1n00b (0n87) 6n77**
EOI 0n27 (0n56) 0n37 (0n59) 0n35 (0n70) 0n20

B. Expanded EE N l 39 N l 42 N l 17
Positive affect 11n84a (2n84) 11n34a (2n51) 9n07b (2n83) 4n07*
Worry 5n87a (2n28) 6n36a (2n27) 8n53b (1n66) 6n18**
Means with different superscripts differ by p n05. The difference in Ns is attributable to
differences between the EE and Expanded EE coding teams as to whether a tape was considered
clear enough to code.
** p n01 ; *** p n001.

Table 3
Correlations between FMSS Codes and Maternal Stress\Adjustment
EE codes Expanded EE codes

Criticism EOI Positive affect Worry

Family impact
(negative) (N l 110) n46*** n07 kn43*** n49***
Family impact
(positive) (N l 110) n01 kn26** n32** kn32**
Daily hassles
(N l 106) n19 n16 kn44*** n27**
Parenting sense
of competence (N l 109) kn33** n02 n37*** kn28**
BDI (N l 104) n45*** kn02 kn19 n09
SCL-90 (N l 106) n38*** kn06 kn22* n13
Parenting Agreement
& Support Scale (N l 81) kn44*** n17 n12 kn26*
DAS (N l 90) kn11 kn09 kn09 kn03
*p n05 ; ** p n01 ; *** p n001.

izing scores. Critical remarks had a modest but significant
relationship to CBCL externalizing score, for mothers,
r(99) l n22, p n05, and for teachers, r(91) l n24,
p n05. Critical remarks were unrelated to CBCL inter-
nalizing scores, for mothers (r l n08) and teachers (r l
n07). Emotional overinvolvement was not related to either
CBCL broad-band score, for mothers or teachers (range
of r lkn06 to n07). Hence, the relationship between EE
and behavior problems is accounted for almost entirely
by the relationship between critical remarks and external-
izing behavior problems.
Expanded EE Codes
Our third question was whether the FMSS could be
coded meaningfully for domains beyond those included
in EE. The expanded EE codes were moderately cor-
related with critical remarks : positive affect, r(100) l
kn47, p n001 ; worry, r(98) l n41, p n001 ; neither
was correlated with EOI. Table 2B shows the mean
scores across child groups for the expanded EE codes. A
MANCOVA was conducted including positive affect and
worry, and covarying child intelligence. Using Wilkes’
Lambda, groups differed significantly, approximate
F(4, 186) l 2n46, p n05. Individual ANCOVAs, covary-
ing child IQ, revealed significant group differences on
each expanded EE code. The high problem group mothers
scored significantly lower on the positive affect domain,
and higher on worry, than the other two child groups.
We also examined the relationship between the ex-
panded EE codes and CBCL externalizing and internal-
izing dimensions. For mothers, the externalizing score
was significantly related to positive affect, r(107) lkn26,
p n05, and worry, r(107) l n40, p n001 ; the internal-
izing score did not relate to either expanded EE code.
For teachers, the externalizing score was significantly
related to positive affect, r(97) lkn20, p n05, and
worry, r(97) l n37, p n001. However, teachers’ inter-
nalizing scores also related to positive affect, r(97) l
kn34, p n01, and worry, r(97) l n32, p n01.
FMSS Codes and Other Measures of Maternal
Stress and Adjustment
Table 3 shows correlations between FMSS codes and
measures of mothers’ stress and adjustment. Mothers’ EE
criticism and expanded FMSS codes were moderately
related to scores on questionnaires assessing stress and
coping (negative impact of the child, perceived daily child
hassles, parenting sense of competence). EE criticism was
912 B. L. BAKER, T. L. HELLER, and B. HENKER
Table 4
Mother Stress and Adjustment Mean (SD) Scores by Child Behavior Problem Groups
and F for ANCOVA with Child Intelligence and Family Socioeconomic Status Covaried
as Appropriate
Comparison
Variable N l 40
Family impact (negative) 16n7a (8n7)
Family impact (positive) 14n1 (5n5)
Daily hassles 46n1a (6n9)
Parenting sense of 51n6 (7n7)
competence
BDI 6n1a (5n2)
SCL-90 30n0a (24n9)
Parenting Agreement 44n6 (8n1)
& Support Scale
DAS 109n6 (16n0)
Means with different superscripts differed by p n05. Child IQ was covaried for daily hassles and
FIQ negative. SES was covaried for daily hassles, parenting sense of competence, DAS, BDI, and
SCL-90.
* p n05 ; ** p n01 ; *** p n001.
also moderately related to measures of maternal ad-
justment and spousal support. No FMSS code related to
marital adjustment.
We further explored how these questionnaire measures
related to child behavior problems. Table 4 shows mean
scores across child groups. Two measures of parenting
stress, daily hassles and the FIQ Negative Impact Scale,
differentiated the child groups as well as the FMSS codes
did. Two measures of adjustment, the BDI and SCL-90,
also significantly differentiated the child groups.
To test the unique contribution to child group status of
maternal EE, expanded EE, and the parent stress and
adjustment measures, we conducted a stepwise regression
analysis on child group score (0, 1, 2). We considered
those variables with significant univariate relationships to
child group. We first entered SES and child IQ as a block,
and then allowed the remaining variables to enter
stepwise, with p to enter l n05. Following SES and child
IQ, R# l n09, F l 4n17, p n05, the FIQ’s negative
impact scale was the only variable to enter, R# change l
n22, F(1,80) l 26n3, p n001. The only EE variable that
came close to entering was critical remarks (p l n08). The
model accounted for 32 % of the variance in child
problem group status, with only FIQ negative impact
entering significantly.
Child Groups Based on CBCL Externalizing T
Scores
Our child grouping was based upon the total CBCL
problem score. However, parental EE was related con-
sistently to the CBCL externalizing T score but not to the
internalizing T score. Therefore, grouping the children on
the externalizing dimensions would probably show
stronger relationships with EE and our expanded codes.
We further analyzed the data with the children reclassified
into three externalizing groups, using comparable cri-
teria, as follows. Comparison children had both mother
and teacher Child Behavior Checklist (CBCL, Achen-
bach, 1991) broad-band externalizing and internalizing T
scores below 60. High externalizing children had mothers
and\or teacher’s CBCL externalizing score of 64 or
greater (in the clinical range) and the other was at least 60
Child group
Moderate High
N l 42 N l 18 F
22n1b (9n9) 35n7c (17n5) 12n8***
13n7 (5n1) 10n9 (5n2) 2n37
52n6b (9n4) 54n4b (10n6) 5n67**
48n0 (10n3) 46n2 (10n6) 1n88
7n2a (4n9) 11n8b (9n2) 4n00*
46n3b (32n5) 66n8b (61n9) 4n74*
42n2 (6n4) 40n4 (8n0) 1n61
103n6 (16n2) 100n9 (23n6) 1n21
(in the borderline range). Moderate externalizing children
had either a mother’s or teacher’s CBCL externalizing
score of at least 60 (borderline range), but scores did not
meet the above criteria for high externalizing.
The three externalizing child groups differed signifi-
cantly on child IQ, so this was covaried in further
analyses. The externalizing groups differed significantly
on the EE and expanded EE variables of critical remarks,
F(2,91) l 6n16, p n01, and worry, F(2,98) l 9n74,
p n001. Positive affect approached significance, F l
2n55, p l n08. We conducted a hierarchical regression
analysis to determine whether the expanded EE scores
had additional explanatory power. IQ was entered in
block 1, accounting for 8n2 % of the variance, F(1,91) l
8n09, p n01. EE criticism was entered in block 2 and
accounted for an additional 8n2 % of variance, F R#
change (1,90) l 8n81, p n01. Expanded EE scores were
entered in block 3 and accounted for an additional 9n1 %
of the variance, F R# (2,88) l 5n39, p n01.
The externalizing child groups also differed signifi-
cantly on the mother stress measures of negative impact
and daily hassles, and on depression. A linear regression
was conducted, with child IQ entered in step 1, the FMSS,
stress, and adjustment variables then considered stepwise,
and p to enter l n05. The model accounted for 38 % of
the variance in externalizing group status. In addition to
child IQ, only the FIQ negative impact entered, R# l n28,
F(1,84) l 38n16, p n001. The only EE variable that
came close to entering was worry ( p l n08).
Prediction to Child Status at First Grade
Further analyses were conducted to determine the
relationship of measures taken at preschool to the child’s
subsequent externalizing behavior problem status 2 years
later (mean l 25n5 months), at first grade. There were 20
families who had a preschool externalizing score but not
a first-grade one. We compared these families to the
remaining families on 26 demographic, EE, CBCL, and
stress and adjustment measures that have been referred to
in this report. There were no significant differences.
The first-grade sample (N l 85) was classified as
follows : comparison (N l 45), borderline externalizing
 EXPRESSED EMOTION AND CHILDREN WITH BEHAVIOR PROBLEMS
(N l 26) and high externalizing (N l 14). For these
children, there was high continuity between their pre-
school and first-grade externalizing group classifications,
Phi l n78, p n001.
We examined demographic variables by first-grade
problem group in one-way ANOVAs. The groups differed
significantly on child gender, χ# (2,85) l 7n32, p n05,
with more boys in the high externalizing group. The
groups also differed on mothers education, F(2,82) l
4n22, p n05, with more educated mothers in the com-
parison group than in the two externalizing groups. We
covaried these two variables in subsequent analyses. One-
way ANCOVAS by problem groups did not approach
significance for EE, criticism, and EOI. The groups were
differentiated, however, by the expanded FMSS codes for
worry, F(2,77) l 5n37, p n01, with positive affect ap-
proaching significance, F(2,77) l 2n82, p l n07. Problem
groups also differed on two measures of mothers’ stress
and adjustment : FIQ negative impact, F(2,80) l 11n51,
p n001, and spousal support, F(2,67) l 3n80, p n05.
A regression analysis was run with child gender and
mother education entered in step 1, and the four variables
with significant univariate relationships entered stepwise
in step 2. Only FIQ negative impact score entered in step
2, R# change l n14, F Change (1,66), l 13n65, p n001.
The accounted for 31 % of the variance, with two
variables, child gender and mother negative impact,
entering significantly.
Discussion
We first asked whether expressed emotion charac-
terized families of children in preschool or kindergarten
with behavior problems. The percentage of families who
met criteria for high EE in this community sample (18 %),
drawn broadly from schools, was considerably lower
than other authors have found with older samples drawn
more selectively from clinics (Kershner, Cohen, & Coyne,
1996). The proportion of high EE families in the high
child behavior problem group (41 %) was more com-
parable to findings by investigators with clinical samples.
Upon further examination, the relationship between
EE and child behavior disorders was attributable to one
EE component, critical remarks ; the other component,
emotional overinvolvement, did not differ across child
problem groups. We had anticipated EOI being unrelated
to child behavior problems, but we had expected that
high EOI would be normative at this age. However,
contrary to our expectations, EOI was scored rarely.
The relationship between high EE and child behavior
problems was attributable to one CBCL broad-band
score, that for externalizing problems ; the other broad-
band score, internalizing problems, did not relate to the
EE variables. This finding is consistent with previous
work by Stubbe et al. (1993) and Hirshfeld, Biederman,
Brody, and Faraone (1997), who found higher criticism
in parents of children with disruptive behavior diagnoses.
Their finding of a relationship between emotional over-
involvement and anxiety disorders did not emerge here
for the broad-band internalizing dimension, although it
was precluded by the low incidence of EOI.
We explored expanding the FMSS codes for two
primary reasons. First, these speech samples contain
much information beyond that reflected in the limited EE
categories. Much clinically rich content cannot be re-
flected in scoring schemes because without standard
prompts topical coverage is not consistent. One mother
913
might talk, for example, about how supportive her
husband is, but others will not mention their spouses.
Nevertheless, indicators that cut across content cate-
gories, such as positive affect (e.g. warmth, encour-
agement, positive tone) and worry or concern, are
scorable from all tapes. These variables, particularly
those reflecting positive emotions, expand upon the EE
summary scores from the FMSS, which denote negative
emotions (criticism and overinvolvement).
Second, coding EE, even from a 5-minute speech
sample, is an arduous process that requires expert
supervision and high standards of reliability. Indeed, the
coding for much of the research utilizing the FMSS has
been done either by the staff of the Family Project at
UCLA or with some involvement from that staff. Our
expanded FMSS variables were coded by separate raters,
who were unfamiliar with EE codes. The coding was
reliable. The expanded EE categories differentiated child
groups at preschool and at first grade as well as, or better
than, the EE score. However, when maternal stress was
accounted for, neither EE nor expanded EE scores
entered the regression equation predicting child group
status.
Following Asarnow et al. (1993), we asked whether EE
is a unique dimension of the family environment or
whether mothers’ verbal behavior (scored for EE) is a
reflection of socioeconomic status or of stress and
adjustment difficulties. In the present sample, the EE and
expanded EE scores were unrelated to socioeconomic
status. Our sample was generally high in SES, so the
limited range may have precluded finding this relation-
ship ; however, our results are consistent with other
studies that have not found a relationship between
socioeconomic status and EE (Hibbs et al., 1991 ; Stubbe
et al., 1993). The FMSS codes were moderately related,
however, to measures of mothers’ wellbeing. Moreover,
stress and adjustment measures differentiated child
groups as well as, or better than, the EE scores. When
child problem group status at preschool, determined
from total CBCL T-scores, was regressed on all of these
indicators of maternal wellbeing, our maternal stress
measure (negative impact) was the only variable that
entered. Moreover, when child problem status at pre-
school or 2 years later, each determined from CBCL
externalizing T scores, was regressed on preschool pre-
dictors, maternal stress was again the only variable to
enter. None of the FMSS codes explained variance
beyond mother’s self-report of stress, although there were
several trends. As predictors, then, the FMSS codes do
not seem to contribute a great deal that is unique, beyond
self-reports of mothers’ child-related stress. However, the
FMSS codes are behavioral measures, and may more
directly reflect how mothers’ experiences of child-related
stress translate into attitudes and expression that can
influence the child.
These findings offer some support for employing the
EE construct with families of preschool-aged children.
The EE status score (high vs. low) differentiated families
by the degree of child behavior problems, with the
relationship almost entirely accounted for by the critical
remarks component. The emotional overinvolvement
component was rarely scored and may have less utility
with this age group. Expanding the FMSS codes to
include other dimensions, such as positive affect and
worry, may be fruitful. These expanded EE scores also
differentiated families by the degree of child behavior
problems. It appears, however, that the FMSS variables
914 B. L. BAKER, T. L. HELLER, and B. HENKER
may be a reflection of parent stress, which is itself a
stronger correlate of child behavior problems.
We are hopeful that future studies with young children
will explore additional ways of gleaning information
from the FMSS, and will further examine the relationship
of EE sub-scores with the type of child disorder (internal-
izing or externalizing). One limitation of the present
study is the potential problem of shared method variance.
Our measures of EE and stress were derived from
mothers, and our measure of child behavior problems
was derived partly from mothers (and also from teachers).
This reliance on the same reporter may have increased
some of the relationships found among these domains.
This problem would be mitigated somewhat if one were
able to obtain independent child diagnoses and\or
complete measures from fathers. We also encourage
further study of the critical questions of whether the
expressed emotion construct relates to parenting be-
haviors and has independent explanatory power beyond
measures of family stress and adjustment. EE scoring
requires considerable training and is a time-consuming
process. If a quickly scored self-report measure of
parenting stress has as much predictive power, then it
would have much greater utility for service providers
seeking to understand families of young children with
problem behaviors.
Acknowledgements—This investigation received support
from the Fernald Child Study Center at the University of
California, Los Angeles. It is part of the Preschool Project, Co-
Pls Bruce L. Baker and Barbara Henker. We gratefully
acknowledge the considerable assistance provided by Michael
Goldstein and Sybil Zaden for training in EE coding, and by
Terry Webster in developing the expanded EE coding, and by
the Fernald Research Interns in coding the tapes.
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Manuscript accepted 9 March 2000