Parental Control in the Etiology of Anxiety

Natalie Ballash,1Ovsanna Leyfer,

1Amy F. Buckley,

1and Janet Woodruff-Borden

1,2

Anxiety disorders are among the most prevalent forms of adult and childhood psychiatric

disorders, and they are highly familial. However, the mechanisms of transmission remainunclear. One familial characteristic that may promote the development of anxiety is theconstruct of parental control. This paper provides a conceptual overview of the construct ofcontrol in the parenting and anxiety literatures, reviews existing literature on control in

anxious families, and reviews current conceptual models of and developmental approaches toanxiety. Based on the current empirical literature, an elaborated model that takes childdevelopmental level into consideration is proposed in order to provide a better understanding

of the role of parental control in the development of anxiety.

KEY WORDS: anxiety; control; parenting; development.

Anxiety disorders are among the most prevalentforms of adult and childhood psychiatric disorders(Anderson et al., 1987; Bernstein and Brochardt,1991; Kashani and Orvaschel, 1990), affectingbetween 10% and 25% of the population over thecourse of an individual’s lifetime (Kessler et al., 1994;Robins et al., 1984). In addition, many anxiety dis-orders begin in childhood (Keller et al., 1992; Ost,1987; Stemberger et al., 1995) and may continue intoadulthood if left untreated (Cantwell and Baker,1989; Dadds et al., 1999). Due to this early onset,high prevalence rates, and the associated economiccosts, it is crucial to gain an understanding of thedevelopment and prevention of anxiety disorders(Spence, 2001). In order to accomplish this, researchhas largely focused on the transmission of anxietyfrom parent to child (e.g., Dumas et al., 1995;Hudson and Rapee, 2001; Whaley et al., 1999;Woodruff-Borden et al., 2002).

Research demonstrates that anxiety tends toaggregate in families (e.g., Last, Hersen, Kazdin,

Orvaschel, and Perrin, 1991; Torgersen, 1983;Weissman et al., 1984). Children of parents withanxiety disorders are 5–7 times more likely to bediagnosed with an anxiety disorder than children ofparents without an anxiety disorder (Beidel andTurner, 1997; Turner et al., 1987). However, themechanisms for the transmission of anxiety areunclear. Family and twin studies (Hettema et al.,2001; Kendler et al., 1992; Lenane et al., 1990;Torgerson, 1983) suggest only moderate heritabilityof anxiety disorders (30–40% of the overall vari-ance; Hettema et al., 2001) and thus that the role ofenvironmental factors may have been underesti-mated (Tambs and Moum, 1993). Accordingly, itappears important to identify psychosocial factorsthat put individuals at risk for developing anxietydisorders.

Research has relatively recently begun to focuson family characteristics that may promote thedevelopment of anxiety. Although the family systemis complex, research indicates that family relation-ships differ between anxious and nonanxious families(e.g., Cobham et al., 1999; Dadds et al., 1996; Starket al., 1990; Woodruff-Borden et al., 2002). Onefamilial characteristic that has consistently beenfound to differ and has been emphasized in theliterature is the construct of parental control. Despite

1Department of Psychological and Brain Sciences, University of

Louisville, Louisville, KY, 40292, USA.2To whom correspondence should be addressed; e-mail: j.woodruff-

borden@louisville.edu

Clinical Child and Family Psychology Review, Vol. 9, No. 2, June 2006 (� 2006)

DOI: 10.1007/s10567-006-0007-z

1131096-4037/06/0600-0113/0 � 2006 Springer ScienceþBusiness Media, Inc.

this emphasis, however, the current empirical litera-ture on anxiety and control lacks a unifying concep-tual framework that incorporates a developmentalanalysis of the impact of parental control on thedevelopment of child anxiety. The purpose of thecurrent review is to provide a conceptual overview ofthe construct of control in the parenting and anxietyliteratures, to review existing literature on control inanxious families, and to review current conceptualmodels of and developmental approaches to anxiety.Based on the current empirical literature, an elabo-rated model that takes child developmental level intoconsideration is proposed in order to provide a betterunderstanding of the role of parental control in thedevelopment of anxiety.

THE CONSTRUCT OF CONTROL

IN THE PARENTING LITERATURE

The parenting literature offers a rich source ofdata regarding control that could be integrated intothe anxiety literature. Specifically, the parenting lit-erature differentiates between two types of control:behavioral and psychological. Behavioral controlconsists of behaviors parents use to manage, regu-late, and supervise their children (Barber, 1996;Pettit et al., 2001). It is further broken down intotwo types: discipline and monitoring. Discipline re-fers to the specific strategies that parents use toenforce rules and foster values in their children(Cummings et al., 2000). Monitoring is the level ofawareness and supervision that parents maintain totrack their child’s activities and whereabouts(Cummings et al., 2000). Psychological control isdefined as the attempts parents make to impedetheir child’s development of independence andautonomy (Barber et al., 1994; Pettit et al., 2001).This dichotomous conceptualization enables inves-tigation of the differential effects of each type ofcontrol on children. The empirical literature exam-ining the impact of these types of control on chil-dren is reviewed next.

Behavioral Control

Discipline

Baumrind (1967) first conceptualized a typol-ogy for parenting discipline styles. These categoriesseem to consist of the dimensions of warmth andcontrol (Paquette et al., 2000). Baumrind (1967)

found evidence for three styles of discipline in herassessment of parents and their preschool children.An authoritarian style was associated with lack ofwarmth and high control. She found children ofthese parents to be discontent, withdrawn, anddistrustful. An authoritative parenting style wasassociated with being controlling and demanding,but also warm and receptive. Children of authori-tative parents were found to be content, self-reliant,explorative, and self-controlled. Finally, permissiveparents were not controlling or demanding, butwere warm. These children were found to be theleast self-reliant, explorative, and self-controlled.Evidence for a fourth category termed stimulativeparenting was recently empirically supported (Pa-quette et al., 2000). However, the generalizability ofthis finding is questionable. The study was con-ducted on French–Canadian impoverished fathers,and differences found between groups could be ac-counted for by the demographic variables. Repli-cation of this finding is needed before it isconsidered as a fourth category.

Baumrind’s (1967) original three categories ofparental discipline styles have received considerableattention in the literature. Many studies havefocused on the child outcomes associated with eachtype. As Baumrind (1967) originally found, theauthoritative style appears to be associated with themost positive outcomes. Replications of this originalstudy on preschool children using separate parentand child interviews and naturalistic observationssupported the findings that authoritative parentingis associated with stability, assertiveness, indepen-dence, achievement, and social responsibility inpreschool children (Baumrind, 1971; Baumrind andBlack, 1967).

Positive outcomes have also been found in olderchildren. These studies have all relied upon childreport of parental discipline style, therefore it isimportant to interpret these findings in terms ofperceived parental discipline. Authoritative parentinghas been associated with academic success. In highschool students, an authoritative parenting style wasrelated to higher GPAs, while authoritarian andpermissive styles were negatively associated withGPA (Dornsbusch et al., 1987). Adolescents in 6th,10th, and 12th grades with authoritative parentsdemonstrated lower test anxiety than adolescentswith nonauthoritative parents (Chapell and Overton,1998). In addition, a mediating model has been sup-ported for adolescents in a similar age range.Authoritative parenting leads to a healthy sense of

114 Ballash et al.

autonomy and orientation toward work, which thenleads to academic success (Steinberg et al., 1989).

A variety of other positive outcomes have beenfound for the authoritative discipline style. Forinstance, it has been associated with advanced moralreasoning in 6th, 10th, and 12th graders, and 1st yearcollege students (Boyes and Allen, 1993; Chapell andOverton, 1998). Using a longitudinal methodology,Baumrind (1991) assessed children at 4, 9, and15-years-old and found that adolescents of authori-tative parents were less likely to have problems withdrug use. Conversely, authoritarian parenting hasbeen related to negative outcomes, such as increasedself-consciousness and avoidance in the classroom,sports, and amongst peers, in 4th, 5th, 7th, and 8thgrade students (Yee and Flanagan, 1985).

Despite the empirical success with Baumrind’stypologies, many researchers have defined disciplinedifferently, using a wide variety of measures to assessdiscipline styles. With respect to academic success, anambitious longitudinal project was conducted.Maternal behavior was assessed during a teachingtask and a hypothetical discipline situation completedwhen the child was 4-years-old. Parenting style wasfound to impact school performance at ages 4, 5/6,and 12. Specifically, parental direct control tactics ledto lower school performance (Hess and McDevitt,1984).

The influence of discipline on aggression inchildren has been commonly studied as well. Parents’discipline style was found to impact preschool chil-dren’s behavior (Hart et al., 1992). The disciplinestyle was assessed by means of disciplinary styleinterview administered to a parent and observation ofparent–child interactions on a playground. Childrenof parents with a less power-assertive style, i.e., aparenting style characterized by less coercion to elicitcertain behaviors (e.g., less physical punishment,withdrawal of privileges), demonstrated fewer dis-ruptive behaviors during a naturalistic playgroundobservation. These children were also more preferredby their peers. Child behaviors mediated the rela-tionship between maternal discipline and peer status.In addition, a significant age difference was found.Older preschool children of less power-assertivemothers demonstrated more prosocial behavior thandid older children of more power-assertive mothers,but this difference was not found in younger children.

In a longitudinal study, using home-basedobservations of parent–child interactions, teacherand parent-reported child aggression was predictedby negative-coercive parenting style, in 5-year-old

children (Pettit et al., 1993). Finally, in a sample of4th and 5th grade boys, an interaction was foundbetween parent-reported harsh discipline and tea-cher-reported aggression. Children’s fearfulness anddepression were assessed by self-report. Harsh disci-pline was assessed using a 6-item scale, consisting ofdescriptions of physically aggressive behaviors par-ents may have used in conflicts with their children.For moderately to highly fearful children, harsh dis-cipline predicted high levels of aggression. For chil-dren having low fear, this relationship did not exist.In addition, harsh discipline was related to children’sself-reported depression in highly fearful boys(Colder et al., 1997).

Comparison is difficult among existing studiesbecause discipline is frequently defined differently.The dimensions of warmth and control are commonto each of them, but the parental categories differgreatly in these studies. Many measures have beenidentified as reliable and valid for the study of disci-pline (Locke and Prinz, 2002). One particular psy-chometrically sound measure assesses Baumrind’s(1967) typology (PPQ; Robinson et al., 1995).Empirical evidence supports the importance of par-enting discipline styles. Considering that several reli-able and valid instruments assessing parentingdiscipline have been developed, continued researchon these categories is needed.

Monitoring

Parental monitoring has been studied in relationto many psychosocial variables, such as academicachievement and adjustment, and is central tobehavior change (see Dishion and McMahon,1998, for a review). In a sample of 11–14-year-oldchildren, children and teachers rated parents’behavioral, intellectual, and personal involvement intheir children’s school (Grolnick and Slowiaczek,1994). Behavioral involvement was rated by childrenand teachers, and it included such activities as havingmet the child’s teacher, attending parent–teacherconferences, participation in school events, andattending open houses. Intellectual involvementincluded activities fostering the child’s intellectualdevelopment, such as going to libraries and museums,reading books and newspapers, and others. Personalinvolvement was rated by children only and includedthe involvement subscale items from the ParentingContext Questionnaire and the items from the ParentInvolvement Measure. The first questionnaire definedinvolvement as ‘‘the dedication of psychological

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resources in the context of positive affect’’ (p. 241)and included items such as the parent knowing whathappens to the child in school and what the childdoes in school. The second questionnaire includedsuch behaviors as knowing where the child is andkeeping track of how the child does in school. Amediating model was supported in which mother’sbehavioral and intellectual involvement led to chil-dren’s perceived competence and understanding ofcontrol, i.e., understanding of how their behaviorsaffect outcomes, which then predicted school perfor-mance. School performance was also indirectlyaffected by father’s behavioral involvement throughperceived competence. Thus, parental monitoringwas associated with positive outcomes.

For highly active 4th and 5th grade children,poor parental monitoring assessed by a parent-reportquestionnaire of parental supervision of children’sbehaviors and activities, was associated with aggres-sion. A more complicated relationship betweenmonitoring and self-reported depressive symptomswas noted. For moderately fearful children, a curvi-linear relationship was found. Both extremely highand low levels of parental involvement were associ-ated with depression. For highly fearful children,depressive symptoms increased as parental involve-ment increased (Colder et al., 1997).

Parental monitoring has received partial supportas a protective factor against adolescents’ behaviorproblems. For instance, a longitudinal study of10-year-old boys demonstrated that poor parentalmonitoring at age 10 was predictive of subsequentinvolvement with antisocial peers at age 12 (Dishionet al., 1991). Parents’ monitoring scores were basedon children’s report of how their activities andbehaviors were supervised by the parents at home, theparents’ report about the number of hours spent withthe children during the 24 h prior to the time of theassessment, as well as an interviewer’s rating of howwell a particular child was supervised by his or herparents. However, this relationship was no longersignificant when continuity of friendships was takeninto account (Dishion et al., 1991). Other researchsupported a relationship between adolescents’involvement in family decision-making, as reportedby either the adolescent or both parent and adoles-cent, and susceptibility to peer pressure and deviance.However, this relationship also became insignificantonce family structure was considered (Dornsbuschet al., 1985; Steinberg, 1987). High-school students’perceptions of parental monitoring, as measured by aself-report questionnaire assessing the degree of

parental involvement in children’s activities andbehaviors, were positively associated with academicachievement and self-reliance, and negatively relatedto drug use, which were all subsequently related topeer group association (Brown et al., 1993). A reviewof the literature indicated that co-occurring individ-uality and connectedness in family relationshipscontributed to adolescents’ identity exploration androle-taking skills (Grotevant and Cooper, 1986).

There is much less research in the area of mon-itoring, as compared to discipline. In fact, theresearch leaves many questions to be answeredregarding the relationship of parental monitoring tochild outcome. The main limitation of this literatureis that the methods of assessment of parental moni-toring have been highly inconsistent. Further,although there is clearly an established link betweenlow levels of monitoring and child externalizingbehaviors (Dishion and McMahon, 1998), the rela-tion between parental monitoring (i.e., high levels ofmonitoring) and child internalizing behaviors (viz.,anxiety) remains unclear. The extent to which sig-nificantly high levels of parental monitoring affectchild internalizing behaviors/outcome developmen-tally deserves further attention.

One important contribution of this literature isits attention to age differences. Changes in parents’and children’s views of monitoring with age havebeen studied. For instance, older children havereported more permissive parental treatment thanyounger children (Steinberg, 1987). In addition,junior high school students have described theirfamily environments as more participatory andallowing more autonomy than elementary schoolstudents (Yee and Flanagan, 1985). Finally, a longi-tudinal study indicated that between the ages of 13and 15 the beliefs that personal issues are underparental authority decreased in African Americanadolescents. These beliefs were assessed by presentingthe adolescents with a set of 24 hypothetical situa-tions and inquiring about their opinions on parentalauthority in each of these situations. The adolescentsalso changed their perception of parental authority inpractical, friendship, and personal issues, viewing itas less restrictive (Smetana, 2000). These findingsaddress important developments in both children andparents’ perceptions of monitoring.

Psychological Control

Psychological control and behavioral controlhave been empirically demonstrated to be distinct

116 Ballash et al.

constructs and to play independent roles in childoutcomes (Barber et al., 1994; Smetana and Daddis,2002). There is a great deal of research demonstratingthat behavioral control is more consistently linkedwith child externalizing outcomes, while psychologi-cal control is associated with internalizing problems(Barber, 1996; Barber et al., 1994).

Barber (1996) conducted three separate cross-sectional studies to support this finding. In 5th, 8th,and 10th grade students, parent-reported childdepression was predicted by child-reported parentalpsychological control, as measured by a 6-itemquestionnaire assessing the child’s perception ofparental behaviors and interaction patterns. Thequestionnaire included such items as [the parent]’’isalways trying to change me’’, ‘‘wants to controlwhatever I do’’, and ‘‘is less friendly with me if I donot see things his (her) way’’. Increased levels ofpsychological control were associated with increaseddepression. Conversely, parent-reported child delin-quency was predicted by child-reported parentalbehavioral control, which was measured by a 5-itemchild report scale that included questions aboutparental knowledge regarding who the child’s friendsare and how the child spends his or her free time.Higher levels of behavioral control were associatedwith lower delinquency. Psychological control wasonly found to add a small amount of additionalvariance in mother–son dyads. Barber (1996) at-tempted to replicate these findings in a subsampleusing behavioral observation of parental control andassessing child outcome one year later at 12 years ofage. He found a similar relationship between psy-chological control and depression in mother–daugh-ter dyads. Counter to previous findings, behavioralcontrol was uniquely related to depression for father–son dyads. The previous association between behav-ioral control and delinquency was replicated in mo-ther–child dyads. Barber’s third study was areplication of study 1 with 5th and 8th grade studentsonly. He supported those findings, with the exceptionthat a relationship between psychological control anddelinquency was also found (Barber, 1996). Thus, itappears that both types of control may be related toboth externalizing and internalizing child problems.Due to the inconsistency of these findings, furtherreplication is needed.

Psychological control has been found to berelated to externalizing child outcomes in preschoolage children. Parent-reported psychological control(assessed by a set of items similar to the onesdescribed by Barber, 1996) was positively related to

teacher reports of the child’s overt aggression(Hart et al., 1998). In terms of internalizing out-comes, perceived psychological control was found tobe positively related to self-reported shyness in col-lege students (Eastburg and Johnson, 1990) andnegatively related to self-esteem in 7th, 8th, and 9thgraders (Litovsky and Dusek, 1985). In addition,psychological control, as assessed by child report onitems related to parental guilt induction in an attemptto influence child behaviors and behavioral observa-tion of a 3-min parent–child interaction, was found tobe a mediating factor between family conflict andadolescents’ (11–14-years-old) internalizing problems(Fauber et al., 1990).

Another study evaluated this issue using a lon-gitudinal methodology (Pettit et al., 2001). Internal-izing and externalizing problems were assessed atages 8, 10, and 13/14 using mother, teacher, andadolescent reports. The questions on the degree ofparental involvement in children’s lives and psycho-logical control were modeled after Brown et al.(1993), Dishion et al. (1991), and Barber (1996). Atall ages, high levels of parental monitoring wereassociated with fewer delinquency problems, whilethe relationship between parental psychological con-trol and child outcome was more complicated. Ingirls and teens low in preadolescent delinquentproblems, high levels of psychological control wereassociated with increased delinquency. In girls andteens high in preadolescent anxiety and depression,increased psychological control was related toincreased anxiety and depression.

The relationship between psychological controland internalizing versus externalizing outcomes isunclear, but high levels of psychological control areconsistently associated with negative outcomes. Agemay potentially impact the link between psychologi-cal control and outcome and add to the complexity ofthis relationship. The relationship between psycho-logical control and delinquency was stronger for 5thgrade than 8th grade children. An opposite effect wasfound for depression; the relationship with psycho-logical control was stronger for 8th graders than 5thgraders (Barber, 1996).

Limitations and Conclusions

The literature on parental psychological controlappears to be better established than that of behav-ioral control. However, it shares limitations of theparenting literature in general. Many of which arerelated to measurement. For instance, reporting

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biases are important to consider. Whether theparenting style is reported by child, parent, or both orwhether it is objectively observed influences theinterpretations that can be made regarding findings.Reports by children gauge their perceptions of theirparents’ style, which may be most meaningful, butthis is limited by age. Younger children are not ableto accurately complete self-report questionnaires.Thus, there is a bias in the literature in which studieson younger children utilize parent report or obser-vation, while studies on older children more oftenrely on self-report. Parent reports may be invalidatedby the highly face-valid nature of control questionsand the strong social desirability of answers. Inaddition, research indicates that parents and adoles-cents report differently. Adolescents more oftendescribed their parents as permissive or authoritar-ian, while parents more often reported themselves asauthoritative (Smetana, 1995). Observation largelysolves these problems, but social desirability is still anissue. Naturalistic observations may best reconcilethese shortcomings.

The literatures of each type of control oftenoverlap, and studies investigate multiple types ofcontrol. While this is not necessarily problematic, thedistinct constructs often lose their individual mean-ing. This seems to be a measurement problem. Con-structs are measured differently across studies andoften become blended into one another. Discipline,monitoring, and psychological control need to befurther delineated and continue to be researched asseparate constructs, as previous findings indicate thatthey have unique effects on child outcome (Barber,1992). One approach would be to utilize measureswith strong psychometric properties consistentlyacross studies. Many have already been developed fordiscipline and psychological control (Locke andPrinz, 2002; Robinson et al., 1995; Schaefer, 1965).Work needs to continue on the development of aninstrument for monitoring. In addition, utilizing bothself-report and observational methods would allowfor validation of these constructs.

One suggested solution to the measurementproblem has been to separate parenting behaviorsand parenting style (Darling and Steinberg, 1993).Behaviors are described as more concrete variables,such as spanking, while parenting style is the attitudeand emotional climate one portrays in childrearing.Theoretically, parenting style relays to the child howthe parent feels about him or her, while parentingbehaviors communicate how the parent feels aboutthe child’s behavior. Thus, parenting style is a context

in which behaviors occur. Parenting behaviors areaffected most by a child’s changing age, while par-enting style should remain more consistent (Lockeand Prinz, 2002). This is especially relevant for dis-cipline, because as children develop, different disci-pline strategies become more or less appropriate anduseful (Baumrind, 1978; Locke and Prinz, 2002).Darling and Steinberg (1993) hypothesized that stylemoderates the influence of behaviors on the child’soutcome. Based on this model, then, it is important tomeasure both parenting behaviors and style for alltypes of control (Barber, 1996). Parenting style maybe best measured by self-report (Darling and Stein-berg, 1993), and behaviors by objective observation.

A final issue with respect to control in the par-enting literature is that there is currently a lack ofstudies that focus on cultural variations of control.For example, the only minority group given anynotable attention in the literature has been AfricanAmericans, and research in this area is quite limited.While some research indicates that discipline stylesand their impact on adolescents are similar in AfricanAmerican families (Hill, 1995), some researchers haveargued that Baumrind’s (1967) categories do notappropriately categorize African American parenting(Mason et al., 1996). In addition, a curvilinear rela-tionship was found between psychological andbehavioral control and adolescent behavior prob-lems. The authors explained that the task of deter-mining the appropriate level of control is moredifficult for African Americans parents, who oftenlive in areas more prone to peer pressure (Masonet al., 1996). Clearly, more research is needed in orderto determine whether control factors are differentiallyrelated to anxiety disorder development.

CURRENT STATE OF THE ANXIETY

LITERATURE

Overview of the Empirical Research

A multitude of studies have been conducted toassess the differences in family functioning betweenanxious and nonanxious families, including differ-ences in control. The methods for assessing thesefamilies vary between studies. There are typicallythree different approaches to the methodology. First,adults with anxiety disorders are interviewed retro-spectively regarding their childhood family environ-ment. This method is plagued by the limitations ofself-reported, retrospective data collection, such asmemory bias. Second, families with an anxious

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parent are studied concurrently. This methodologyrepresents an ‘‘at risk’’ household because of thechild’s increased chance of developing an anxietydisorder (Beidel and Turner, 1997; Turner et al.,1987). This method evaluates family functioningprior to a child developing an anxiety disorder. Thus,predisposing factors for anxiety are at work. Finally,research is conducted on families with anxious chil-dren. This method provides a measure of familyfunctioning following the development of a child-hood anxiety disorder. Consequently, differencesfound in these families could either be due to factorsthat predisposed the child to anxiety or factors thatchanged after the child became anxious, with thedirectionality of the effect indeterminable.

Research also differs with respect to how familialdifferences are measured. Some studies use self-report, while others utilize behavioral observations.Both methods have strengths and weaknesses. Self-report allows the researcher to tap into cognition andother internal processes, but it is also more likely tobe distorted by factors such as perception or socialdesirability. In addition, it must be viewed in light ofchildren’s abilities to accurately provide self-reportson complicated phenomenon. Observational studiesprovide a more objective representation of familyfunctioning. However, social desirability can stillimpact the family’s behavior in the laboratory setting.In addition, valid and reliable coding systems can bedifficult to establish. It is imperative for accurateunderstanding of the literature to interpret findingswith these caveats in mind.

Retrospective Studies

Retrospective self-report measures of anxiousadults were among the earliest type of data collectionin familial anxiety studies. The participants for thesestudies were often drawn from a clinical population.In one study, adults previously diagnosed by a mentalhealth worker completed retrospective control mea-sures for their mother and father. A sample of 60adults with panic disorder recalled their fathers asbeing high on overprotection and low on care (Leonand Leon, 1990). In another study, 80 female patientswith panic disorder with agoraphobia, diagnosedusing a structured interview, described their child-hood environments as conflictual, lacking in parentalwarmth and support, and involving parental chronicphysical illness and substance abuse in comparison to100 women with no self-reported clinical diagnosis.Mothers of the anxious group were described as more

rejecting. The construct of control was also measuredin this study. No differences were found between theanxious and control groups on measures of maternalor paternal overprotection (Laraia et al., 1994).

Studies of ‘‘at risk’’ Families

Anxious adults are often assessed with respect totheir current family functioning. The impact of thisenvironment on the child is then considered. In onesuch study, an outpatient sample of anxious adultsdiagnosed via structured interview and a recruitedcontrol group both completed self-report question-naires, and parent–child dyads were observed duringbehavioral interactions in a structured play environ-ment. Children ranged from 7 to 12-years-old. Anx-ious parents perceived their families as being low oncohesion, expressiveness, and moral–religiousemphasis, and high on conflict and achievement ori-entation. No differences were found on self-reportedcontrol between groups. Anxious parents also did notreport a difference from nonanxious parents in theactivities in which they allowed their children toparticipate, but they reported more distress whentheir children separated from them and during chil-dren’s physical activities. Anxious parents reportedmore personal distress during the structured playtask. They were also less likely to play with their childduring the task than nonanxious parents were(Turner et al., 2003).

Whaley and colleagues (1999) conducted abehavioral interaction study in which anxious moth-ers interacted with their child in mild to moderatelyanxiety-producing tasks. Mothers were recruited andadministered a structured interview about themselvesand also a semi-structured interview to obtain thechild’s diagnostic information. Children, who rangedin age from 7 to 14, were also administered the semi-structured diagnostic interview to determine diag-nostic status. The groups were created based onpresence or absence of an anxiety diagnosis in themother, and 36 families met criteria. Anxious moth-ers were found to be less warm, positive, and grantingof autonomy. In addition, they were more critical andcatastrophizing. Maternal behavior predicted childanxiety, contributing more to its development thanmaternal psychopathology or ongoing stress. Fur-ther, anxious mothers whose children were alsoanxious were significantly less likely to displaybehaviors consistent with autonomy-granting thanwere either anxious mothers with nonanxious chil-dren or the nonanxious mother–child dyads, lending

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support to the notion that control behaviors exhib-ited by anxious mothers may be reciprocally influ-enced by child anxiety.

A follow-up study to the original Whaley et al.(1999) research found a main effect for child anxietystatus on maternal granting of autonomy, indicatingthat it is anxiety in the child that contributed most tomothers’ control behaviors. Maternal displays ofwarmth toward their children were most associatedwith child anxiety status, not maternal anxiety(Moore et al., 2004).

In a similar study, 51 parents interacted withtheir children during moderately anxiety-provokingtasks. Parents were designated as either anxious ornonanxious following administration of a clinicalinterview. Children, who ranged in age from 6 to 12,were also administered a structured diagnostic inter-view to determine anxiety status. Woodruff-Bordenand colleagues (2002) observed that anxious parentswere less productively engaged, more withdrawn, andmore disengaged than control parents. A mean dif-ference in control was not found between groups.However, following a child’s display of negativeaffect, anxious parents were more likely than non-anxious parents to attempt to control the situation.

Studies with Anxious Offspring

Finally, researchers have approached the study ofcharacteristics in anxious families from the perspectiveof families with anxious children. In one study, 51children between the ages of 9 and 14 were separatedinto diagnostic groups on the basis of a semi-structuredinterview with the child. Diagnostic status of parentswas not obtained, however, mothers of the childrencompleted a self-report measure of family functioning.Anxious and depressed children perceived their fami-lies as less supportive, more conflictual, more disen-gaged from outside activities, more enmeshed, lesspromoting of independence, and less democratic thancontrol children did (Stark et al., 1990).

Messer and Beidel (1994) compared 100 childrenon their reports of family functioning. The childrenwere separated into groups on the basis of a compositediagnosis from structured interviews with the parentand child. The children had a mean age of 10, with noage range reported. Anxious children reported thattheir families promoted less independence. Results ofa child self-report measure did not reveal perceiveddifferences in terms of control. However, correlationalanalyses revealed that child anxiety was positivelyrelated to reported parental control.

The majority of studies involving anxious chil-dren are conducted using behavioral data. Often bothbehavioral and self-report data are combined. Onestudy demonstrated that children are accuratereporters of familial interactions involving themselves(Siqueland et al., 1996). Children between the ages of9 and 12 were designated to either anxious or controlgroups. Children in the anxious group were diag-nosed by structured interviews conducted with parentand child. Controls were recruited participants whodid not receive an elevated anxiety score on a parent-report measure. Diagnostic status of parents was notobtained. Objective observers rated parents withclinically anxious children as less granting of auton-omy (i.e., more controlling). Anxious children ratedtheir parents as low in acceptance. Mothers’ andfathers’ self-report ratings coincided with oneanother, but not with their children’s. Interestingly,the children’s reports, but not the parents’, correlatedwith observer ratings.

Another study, however, failed to find a rela-tionship between children’s reports and observedbehavior (Greco and Morris, 2002) in a group of highversus low socially anxious children. Groups weredefined by the highest and lowest quartile scores on achild social anxiety measure. The 48 children wereeither in elementary or middle school, but age infor-mation was not provided. Children also completedself-report measures of perceived parenting style.Children and their fathers completed a brief, chal-lenging task together, which was coded for behavioralindicators of parental overprotection and rejection.There was also no difference in socially anxious andsocially nonanxious children’s perceptions of theirfathers. However, observers rated fathers of sociallyanxious children as more controlling than fathers ofnonanxious children.

A sample of children in treatment for an anxietydisorder and a sample of children who had neversought treatment were compared on interactions witha parent during cognitively challenging tasks. Theclinical group was diagnosed via structured inter-views with parent and child. Diagnostic status of theparents was not obtained. The total sample included95 children between the ages of 7 and 15. Parents ofanxious children were rated by objective observers asbeing more negative and more intrusively involved inthe task (Hudson and Rapee, 2001).

In a similar behavioral task, only behavior wascoded as opposed to verbal interactions (Krohne andHock, 1991). Children ranged between 10 and13-years-old, and they completed a difficult

120 Ballash et al.

problem-solving task with their mothers. Maternalanxiety and child anxiety were assessed via a self-report measure of trait and state anxiety. Mothers ofhighly anxious girls were more likely than mothers ofgirls with low anxiety to intrude upon the child’sproblem-solving behaviors in a competitive manner.In addition, the mothers had a tendency to maintainthat control. This relationship was not found amongboys. However, it is important to note that in thisstudy maternal anxiety was significantly associatedwith anxiety in the female children, but not the malechildren.

In a behavioral observation study examining theeffect of parental discussions on cognition in anxiouschildren, Barrett and colleagues (1996) presented aseries of ambiguous situations, which could be con-strued as either threatening or nonthreatening, tochildren with anxiety, oppositional defiant disorder,or no diagnosis, and their parents. Results revealedthat anxious children interpreted the situations assignificantly more threatening, after discussion withtheir parents, compared to the nonanxious andaggressive children. The anxious group also reportedmore avoidant responses than the other groups.Parents of the anxious children concurred, and weresignificantly more likely to report that their childrenwould use more avoidant strategies to manage thesituations. In a follow-up paper examining the familyprocesses during discussion of these ambiguous situ-ations, parents of nonanxious children were signifi-cantly more likely to discuss the positive results ofengaging in specific behaviors, and parents of theanxious children were more likely to respond to theirchildren’s avoidance with avoidance behaviors orsuggestions (Dadds et al., 1996).

Finally, interactions between parents and theiryoung children were explored (Dumas et al., 1995). Atotal of 126 children between the ages of 2 and 6 weredivided into three groups on the basis of teacher’sreports: socially competent, aggressive, and anxious.Maternal anxiety status was not obtained. Mothersof anxious children were found to initiate morecontrol exchanges and demonstrate aversive affectmore often than other mothers. They were morecoercive and unresponsive to their children. More-over, mothers of anxious children complied with theirchildren’s control exchange behaviors significantlyless often than did mothers of aggressive or compe-tent children. There were no significant differencesamong the three maternal groups in response toaversive child behavior versus positive child behavior.Children’s behaviors also differed among the three

groups. Anxious children were more likely to benoncompliant and coercive, underscoring the impor-tance of examining the bidirectional nature of aninteraction between parent and child.

Conclusions and Limitations

Overall, these findings indicate that there is adifference in parental behavior between anxious andnonanxious families. The retrospective reports andat-risk family studies provide partial support forcontrol being more prevalent in anxious households.However, studies involving anxious children provideoverwhelming support for this notion. Both self-re-port and behavioral observation studies revealed anincreased level of control in anxious families.

Another important finding to be extracted fromthese data is the importance of parental behavior.Parental behavior was found to contribute more tochild anxiety than maternal psychopathology orstress (Whaley et al., 1999). This finding demonstratesthe importance of conducting behavioral studies andfurther exploring the impact of controlling behavioron children. Woodruff-Borden and colleagues (2002)illustrated a situation in which controlling behavior ismost likely to occur for anxious parents. Anxiousparents are more likely to become controlling whentheir child expresses negative affect. This may be theparent’s strategy for trying to alleviate perceivedanxiety in the child. Dumas and colleagues (1995)elaborated on the bidirectional nature of a controlexchange between parents and children. Data takinginto consideration both the parent and child’s con-tribution are vital. They demonstrate the effect thatone is having on another and what behaviors leadthem to behave in certain ways, such as becomingmore controlling.

Unfortunately, in all of these studies examiningcontrol in anxious families, only two assessed theimpact of child age or developmental level. In thosestudies, child age was found to influence both parentand child behavior. Hudson and Rapee (2001) foundthat child age was related to maternal involvement,but not negativity. Older children received less helpfrom their mothers. Dumas and colleagues (1995)found an impact of child age on child behavior.Younger children were more likely to express non-compliance behaviors than older children. Thus, itappears that child age could have significant conse-quences on behavioral interactions between parentand child. How these differences impact the expres-sion of control and the development of anxiety is still

121Control in Anxiety

unknown, as studies to date either have not analyzedage as a variable, or have not included a sample ofchildren with an age range large enough to investigatedifferences. Moreover, other factors directly relatedto age such as children’s emotional and social devel-opment can impact the development of anxiety andthe expression of control.

Despite findings to date, the literature on controlin anxious and nonanxious families has severalmethodological shortcomings. First, control has notbeen systematically studied. Although many positiveresults regarding control were found, control was notnecessarily identified as the main variable in thesestudies. Often, no specific results were hypothesized.Instead, researchers explored what differences mightexist between anxious and nonanxious families. Inaddition, there is a lack of consistency in the opera-tionalization of control. For example, it has beendefined as overprotection (Leon and Leon, 1990) orlack of promoting independence (Messer and Beidel,1994; Stark et al., 1990) in self-report studies andoperationalized as behavioral devices, such as com-mands (Woodruff-Borden et al., 2002) or taking overthe task (Krohne and Hock, 1991), in observationalstudies. Third, control is rarely measured by bothself-report and objective observation. Such a methodwould allow for comparison of perception of controlto actual behavioral differences. Fourth, the issue ofdiagnosis is paramount. Many studies rely upon self-report measures of anxiety to separate participantsinto groups, which precludes examination of differ-ences between clinical and nonclinical groups. Theliterature has shown an increased risk for develop-ment of an anxiety disorder in children with parentswith an anxiety diagnosis, not anxiety in general(Beidel and Turner, 1997; Turner et al., 1987).Finally, it is vital to take both the parent and child’sanxiety into consideration. If both are not known, theinferences that can be made are limited. For inter-pretation, it is important to consider whether boththe parent and child are anxious or if only one is. Thebidirectional effects of parents and children on oneanother should be considered.

Reviews

Rapee (1997) conducted a qualitative review ofempirical studies focusing on the impact of childre-aring on the development of anxiety and depression.He summarized the research as investigating twomain parental factors: acceptance and control. Basedon his review, he concluded that control is more

specifically related to anxiety than to depression. Hesurmised that anxiety is related to the children’sperception of parents as being controlling and notaccepting. He also noted that controlling behaviorsand anxiety could have a cyclical relationship be-tween parent and child, in that one increases thelikelihood of the other.

Rapee (1997) also noted many of the aforemen-tioned methodological limitations, including vagueand numerous labels of control, which made thecombination of data difficult, a lack of rationale, theuse of retrospective data, and a lack of clinicalcomparison groups. Rapee (1997) stated that therelationship found between control and anxiety wasnot necessarily related to control by one parent only.The other parent, typically the father, also needs tobe assessed. In addition, causality cannot be deter-mined by this type of research, and while it is animportant first step to determine that a relationshipexists, it is now time for the literature to move beyondthat. Studies also often have small sample sizes,which yield inadequate power to detect an effect.Finally, he noted that research has tended to focus onperceptions of child-rearing as opposed to actualobservation, and he advocated for more studies usingbehavioral observation.

A more recent qualitative review of the anxietyliterature has been conducted, building on Rapee’s(1997) earlier review (Wood et al., 2003). Wood andhis colleagues (2003) focused on literature from 1990to 2002 that assessed parenting and anxiety. Overall,they concluded that a higher level of observedparental control was related to an increased risk for achild meeting criteria for an anxiety disorder. Theysummarized this effect as medium to large and ofclinical significance.

Wood and colleagues (2003) also summarizedlimitations in the literature and made suggestions forfuture research. First, research is generally conductedon nonrepresentative samples, often excludingminority ethnic groups. Second, they cited an over-reliance on self-report measures. Third, a reliance oncross-sectional designs limits the ability to makeinferences regarding causality and development.Finally, they criticized the use of global parentingmeasures. They categorized parenting into three cat-egories: acceptance, control, and modeling of anxiousbehaviors. They also differentiated between generalparenting styles, as often assessed by global parentingof family measures, and discrete parenting behaviors.They suggested that it is important for empiricalresearch to do this as well. They described the study

122 Ballash et al.

of discrete behaviors as contributing more to theunderstanding of parent–child interactions and asbeing more clinically useful. They suggested thatresearchers study more specific hypotheses in thisarea. In addition, they suggested that researchers paymore attention to the expected time interval betweena parental behavior and development of anxiety in achild as well as the cumulative impact of thisbehavior.

Summary

Overall, the parenting literature lacks a uniformtheory with respect to the understanding of the roleof behavioral and psychological control on theexpression of anxiety. The studies often examine therelationship between control and multiple outcomevariables. This is not only a statistical problem due toinflated alpha level, but it also impedes conceptualprogress. More theoretical progress could be made bymoving beyond simple relationships and examiningthe paths among variables.

Despite these limitations, studies of control inthe parenting literature improve upon studies in theanxiety literature by more often including fathers,conducting naturalistic behavioral observations, andutilizing longitudinal methodology. Overall, this lit-erature has consistently demonstrated that high levelsof control, especially in the absence of warmth, leadto negative outcomes for children and adolescents.The division of control into three distinct types andthe conceptualization of parenting as both behaviorand style allows for investigation of the uniqueaspects of control that may contribute to childhoodproblems. However, this finer level of analysis has yetto be applied to psychopathology in children andwould enhance models of the development of anxiety.

CURRENT CONCEPTUAL MODELS RELATED

TO ANXIETY DEVELOPMENT

The construct of control is well established andaccepted as a contributor to the development ofanxiety. More conceptual models of how this trans-mission occurs and what specific processes operateare needed to further develop models of the devel-opment of anxiety.

Both Rapee (1997) and Wood et al. (2003) pro-pose mechanisms by which control may lead to thedevelopment of anxiety. Rapee (1997) suggests thatcontrolling behavior might teach children that eventsare outside of their control. Overcontrolling behavior

by the parent could contribute to the development ofanxiety in two ways. First, it relays to the child thatthere is a constant threat to them, leading to hyper-vigilance and fear. Second, it limits the child’sopportunity to learn how to cope successfully withsituations on their own, thus preventing the devel-opment of realistic expectations for themselves andthe world.

Wood and colleagues (2003) suggest a similarmechanism. Specifically, they postulate that parents’controlling behaviors prevent children from devel-oping age-appropriate behaviors, such as dressingone’s self, and age-appropriate boundaries betweenparent and child, such as decreased clinging behav-iors. This impairment in appropriate developmentthen leads to a lack of a sense of control, mastery,and autonomy for the child. The child is dependenton his parent, leading to possible separation anxiety.They argue that the specificity of this model allowsfor hypothesis-testing. For example, children belowage-appropriate norms could be compared to chil-dren above those norms in terms of anxiety symp-toms. However, no research has yet been conductedto test this model.

As a result of the emphasis on parental control,the construct of perceived control has also receivedsignificant attention in the anxiety literature as well asin the developmental literature. For example, Skinner(1996) suggests that perceived control can be under-stood in terms of a developmental process that isinfluenced by contextual factors such as the child’sinteraction with his or her parents, motivation, andcognition. Thus, changes along these dimensions willresult in changes in perceived control. Related to thisis Barlow’s (2001) model, which proposes that theperception that events are outside of one’s control is akey factor in the psychopathology of anxiety. Thus,researchers have investigated the role it plays in thedevelopment of anxiety. The rationale behind thesestudies is that overcontrolling parental behavior leadschildren to believe that events are outside of theircontrol (Davis and Phares, 1969). In order to prop-erly present theoretical models in this area, it is firstnecessary to establish that there is a difference in thefamily environments of children with different per-ceptions of control.

Empirical Studies

Like parental control, the construct of perceivedcontrol has been defined in numerous ways. One ofthe first and most often used constructs is that of locus

123Control in Anxiety

of control. There are two dimensions of locus ofcontrol. First, an internal locus of control indicatesthat individuals view events as predictable and withintheir control. Second, individuals with an externallocus of control view events as out of their control andas being unpredictable. This type of locus of controlwould be hypothesized to be related to anxiety.

An early study evaluated this construct amongundergraduate students (Davis and Phares, 1969).Comparisons involved 120 students, half of whomscored on the extreme internal end of a self-reportmeasure of locus of control, and half of whom scoredon the extreme external end. Students with an inter-nal locus of control reported their parents to be morepositive and lower in rejection, control, inconsistentdiscipline, and love withdrawal as compared to thosewith an external locus of control. Davis and Phares(1969) suggested that children might develop anexternal locus of control in order to avoid the anxietyassociated with the increased rejection and hostility.Instead of accepting the failure or deprecation thismay cause, they attribute aversive events as outside oftheir control.

Other studies have measured locus of control inyoung children and found similar results. Sixty 2ndgrade students were divided into groups based on amedian split of scores on a locus of control ques-tionnaire. The researchers observed the mother andchild while they worked on three puzzles of varyingdifficulty. They found mothers of children with aninternal locus of control to be warmer, more nur-turing, more granting of autonomy, and less critical.Mothers of children with an external locus of control,however, interfered, criticized, and took over thechild’s task more often than the mothers of internals.They also disengaged from the task more often andengaged in their own play activities (Gordon et al.,1981).

A similar methodology was utilized in a study on5th graders (Chandler et al., 1980). Fifteen childrenscoring at the extreme internal end of a locus ofcontrol measure and 11 children scoring at theextreme external end were compared. They partici-pated in challenging behavioral tasks with both par-ents. The tasks were designed so that it was necessaryfor the parents to provide assistance. Maternal self-ratings of locus of control were related to her child’s,while paternal self-ratings were not. Fathers of chil-dren with an internal locus of control perceivedthemselves to be more accepting and encouraging ofindependence and less restrictive. Their children alsoperceived them to be more nurturing and less reject-

ing than children with an external locus of controlperceived their fathers to be. Finally, objectiveobservers characterized the family environment withchildren with an internal locus of control as morearticulate, fun, relaxed, encouraging, and helpful.They also noted that parents of children with aninternal locus of control were more verbal, partici-pated more often, made more helpful suggestions,made less negative statements, and praised the childmore often than parents of children with an externallocus of control did.

Conclusions and Limitations

It is noteworthy that many of the same charac-teristics of families with anxious children were alsofound in families with children who reported anexternal locus of control. The most relevant finding tothis review is the construct of parental control, whichdiffered between families with children whose locus ofcontrol was internal versus external. Family envi-ronments of children with an external locus of controlwere perceived or observed as more controlling andhostile than family environments of children with aninternal locus of control.

The limitations of these studies are similar tothose reviewed for parental control. The samples aresmall, and there is an overreliance on self-report data.Additionally, perceived control is defined in severaldifferent ways. However, findings with behavioralobservation were similar to those based on self-re-ports. The study that utilized undergraduates (Davisand Phares, 1969) did not specify if the measure ofparental characteristics was retrospective or current.This would make a significant difference in interpre-tation. Further, it is unknown how much contact thecollege students still had with their parents. It likelyvaries widely, along with the impact that parents stillhave on their young adult children. Overall, thedirection of these effects cannot be determined. It ispossible that children with low perceived control elicitmore assistance from their parents due to a percep-tion that they are not in control of the task. Finally,there is no consideration of the impact of a child’s agein this literature. It seems of utmost importance toconsider this in regards to this cognitive variable, ascognitive abilities change rapidly in children.

Review

Schneewind (1995) reviewed literature on therelationship between family processes and perceptions

124 Ballash et al.

of control. He commented on the paucity of researchin this area. He stated that specific parenting practiceshave been associated with the development of chil-dren’s control beliefs. For instance, internal controlorientation has been associated with granting ofautonomy, less intrusiveness, less hostility, moreinductive discipline, warmth, and supportiveness.Parents of children with external orientations havebeen found to be less stimulating, less responsive, andmore authoritarian, intrusive, overprotecting, andrejecting. He also cited longitudinal evidence thatearly perceptions of a stimulating family environmentare associated with control beliefs as a young adult.Finally, Schneewind examined the correlationbetween control beliefs in parent–child dyads. Hestated that a relationship had been found betweenparents and older children and adolescents, but notwith preschool children. This suggests that childrenmay be incapable of modeling at a young age, but thatit acts as an important mechanism of transmission inlater development.

In sum, this literature suggests that a controllingenvironment may be a predisposing factor fordeveloping control-related cognitions. However, it isnot without its limitations. Schneewind (1995) dis-cussed many shortcomings of the literature. First,measuring the cognitive phenomenon of perceptionsof control in children is difficult, and the methodsthat researchers use vary widely. Second, the majorityof the research is conducted on mother–child rela-tionships, precluding consideration of the morecomplex family system. Third, longitudinal data isalmost nonexistent. Finally, analyses investigatingspecific behaviors and their impact on control beliefsare still needed.

Mediating/Moderating Models

The next step, then, in conceptualizing the rela-tionship between parental control, perceptions ofcontrol, and anxiety is to develop a model of thesequential relationship among them. Chorpita andBarlow (1998) have proposed a theoretical model toaccomplish this. It is currently the only model in theliterature to connect all of these constructs in a linearfashion. They reviewed extensive literature fromdepression, locus of control, explanatory style, ani-mal learning, biological, and attachment literature,which supported the notion that a lack of a sense ofcontrol influences the development of anxiety. Theydefined control as an individual’s capacity to influ-ence situations and outcomes in the environment, and

suggested that early childhood experiences with alack of control, perhaps due to overprotective par-enting, lead to an increased likelihood to perceivesubsequent events as outside of one’s control. Thisperception consequently acts as a psychological vul-nerability to the development of anxiety. Thus, theyplaced greater weight on childhood experiences witha lack of control, although they still acknowledgedthat later experiences can reshape that perception.

Chorpita and Barlow (1998) formulated twosequential models. First, in early childhood, theyargued that family characteristics are associatedwith the development of a lack of a sense of controlin children. If these same family characteristics areassociated with the development of anxiety, then theperceptions of control serve as a mediator in thedevelopment of anxiety. The research reviewed inthe current paper indicates that parental overcon-trol is common to both. Further, Chorpita andBarlow (1998) hypothesized that certain familialcharacteristics can put a child at risk for developingboth control-related cognitions and anxiety, sug-gesting that perceptions of control mediated therelationship between family characteristics andanxiety. In addition, they suggested that in laterdevelopment these cognitions begin to interact withnegative experiences, and it is this interaction thatleads to anxiety. This corresponds with a moretraditional diathesis-stress, or moderating model ofpsychopathology (Chorpita, Brown, and Barlow,1998).

To date, empirical support for this model islimited. Support has largely been borrowed from thedepression literature. Depression researchers havelong recognized and empirically supported the notionthat children’s increasing cognitive abilities willimpact the attributional process inherent in thesemodels (Finchman and Cain, 1986; Hammen et al.,1988; Nolen-Hoeksema, et al., 1992; Rholes et al.,1980). Nolen-Hoeksema and colleagues (1992) foundthat children’s cognitions stabilize with age and beginto contribute more to the development of depression.These developmental changes lead to differentexpectations for mediating versus moderating effectsof negative cognitions on depression. Cole andTurner (1993) found support for both mediating andmoderating models in 356 4th, 6th, and 8th gradechildren. However, the fit of the model differeddepending on the type of cognition. However, using409 children from the same age groups, Turner andCole (1994) found that a moderating model only fitfor the oldest children.

125Control in Anxiety

Chorpita and Barlow (1998) hypothesized thatprogressive stabilization of cognition represents thetransition from a mediating to a moderating model.Empirical support is needed in the anxiety literatureto support Chorpita and Barlow’s (1998) model,especially measuring perceived control as a specifictype of cognition. Chorpita and colleagues (1998)have initiated this process. They studied 93 familieswith children ranging from 6 to 15-years-old, with amean of 11.15 years. Of these children 62 were drawnfrom a clinical setting and were diagnosed with ananxiety disorder using structured interviews with theparent and child. The remaining 31 families wererecruited from the community. Their children did nothave a primary diagnosis of anxiety, as assessed by astructured interview with the parent and child. Basedon self-report and parent-report measures, theyfound support for a mediational model amongschool-age children. Locus of control mediated therelationship between control in the family environ-ment and negative affect. Negative affect was thenrelated to clinical symptoms. A controlling familyenvironment appears to contribute to a cognitivevulnerability of a lack of perceived sense of control,which then leads to anxiety. A large portion of locusof control was accounted for by control in the family(31%), and 27% of negative affect was explained bylocus of control. Thus, these relationships are notonly significant, but likely meaningful and importantfor understanding the development of anxiety. In astudy examining the role of control in the associationbetween family characteristics and anxiety in sampleof young adults, Ballash et al. (2006) found thatcontrol served to mediate the link between perceivedfamily environment and self-reported anxiety; how-ever, no moderating effects of control were found.

Chorpita and colleagues (1998) recognized aneed for further replication because of the complexityof the model. They particularly suggested replicationusing more sophisticated measures of control, longi-tudinal methodology, and more diverse samples.Chorpita and Barlow (1998) advocated for futureresearch to investigate the precise time in develop-ment that the switch occurs between these twomodels. In addition, they suggested combiningexisting theoretical models in order to expand ourunderstanding of the development of anxiety.

The developmental combination of two modelspresents a complicated picture, and research thus faris extremely limited and inconsistent within thedepression literature. Variance may be due to the waycontrol is measured and defined. Replication is

obviously vital to a better understanding and vali-dation of this model. It is the first model to so con-cisely draw these variables together, with initiallypromising results. Most importantly, however, theage at which the transition occurs from control as amediator to a moderator is unclear. There is limitedsupport for a change in cognitive effects on depres-sion between 6th and 8th grades (Turner and Cole,1994). Research needs to strive toward the elucida-tion of this transition.

The extant empirical data and theoretical con-ceptualizations of the relationship between parentalcontrol and anxiety have been presented and cri-tiqued. To summarize, there is a difference in the levelof parental control between anxious and nonanxiousfamilies, a model linking control and anxiety viaperceptions of control has been proposed, and thereare limited data to support this model. For thefurther conceptualization of the construct of control,a combination of theoretical models would be useful(Chorpita and Barlow, 1998). Chorpita and Barlow(1998) drew from varied literatures to composetheir model. Unfortunately, there has been a lack ofintegrative research across fields, resulting in thedevelopment of diverse constructs (Masia andMorris, 1998) and subsequently impeding progress asresearch is done concurrently, but separately, onsimilar constructs.

A DEVELOPMENTAL APPROACH

TO ANXIETY

One commonality between both the anxiety andparenting literatures is the lack of attention given todevelopmental changes in control. As previouslyreviewed, few studies have considered it. The par-enting literature has tended to analyze age differencesmore often than the anxiety literature has. However,neither literature has systematically studied the effectof children’s age and other developmental factors onparental control or how control impacts outcomes atdifferent ages with respect to anxiety.

Several researchers have recognized the impor-tance of a developmental analysis in understandingthe etiology of anxiety disorders in children(Manassis and Bradley, 1994; Vasey and Dadds,2001). Westenberg et al. (2004) and Warren andSroufe (2004) have proposed models suggesting thatmanifestation of anxiety symptoms changesthroughout the course of development. For example,at preschool age, children are fearful of being aloneand of darkness. Worrying about death and danger

126 Ballash et al.

may become apparent at ages 10–13, and worriesrelated to social situations at age 14–17 (Weems andCosta, 2005; Weems and Stickle, 2005). The contentof worries and fears is influenced by various devel-opmental processes. For example, it may changefrom concrete to more abstract threats (Vasey, 1993)as the child develops the capacity for abstractthinking. Worries may become more focused onevaluation as the adolescent begins developing socialunderstanding.

Empirical evidence supports the developmentalapproach. Studies consistently demonstrate thatyounger children are at great risk for developingseparation anxiety disorder, while adolescents aremore likely to develop social anxiety disorder (Weemset al., 1998; Weems and Costa, 2005). Panic attacksdo not typically begin until adolescence (Weiss andLast, 2001). Among normal children, younger chil-dren are more likely than adolescents to be afraid ofthe dark, harm coming to them, and insects, as well asendorsing greater social withdrawal (Bell-Dolanet al., 1990). Age differences are also evident in chil-dren who refuse to go to school. There appear to betwo primary anxiety diagnoses related to thisbehavior: phobias and separation anxiety. Phobicschool refusers tended to have a later age of onset anda more severe and pervasive course of school refusal(Last and Strauss, 1990).

Several studies have examined developmentalissues related to parental control and the child’sperceived control and they suggest a relationshipbetween the child’s age and child’s perceived control.Extensive research in this area has been conducted bySkinner (1990, 1991, 1996), indicating that develop-mental changes in perceived control are a reflection ofthe change in beliefs about causes. For example, atage 7–8 children’s beliefs about causes are categorizedas ‘‘known’’ and ‘‘unknown’’ (Connell, 1985). At9–10 years of age, causes are categorized as internalor external (e.g., Nowicki and Strickland, 1973).

The child’s development may also affect parentalcontrol. In children studied longitudinally at33 months and 9 years of age, parents indicated thattheir level of control increased over time (Hagekullet al., 2001). High school students reported that theirparents’ levels of monitoring decreased over thecourse of 2 years (Freeman and Newland, 2002;Smetana, 2000). In addition, older children are trea-ted more permissively (Steinberg, 1987) and describetheir families as more participatory and allowingmore autonomy than younger children (Yee andFlanagan, 1985). Thus, different patterns of change in

control occur over time for younger children versusadolescents. This indicates that a child’s age may playan important role in parents’ adjustment of control.However, method of reporting confounds these re-sults. Parents reported their own control in the studywith younger children, while the adolescents reportedon their parents’ control. In addition, parental orchild anxiety was not considered in these analyses.

Only one study including anxious familiesexamined the changes in parental control throughoutthe child’s development. In an observational study,mothers of anxious older children provided less helpthan mothers of anxious younger children (Hudsonand Rapee, 2001). Changes in parental control acrosschild age have not been directly compared betweenanxious and nonanxious parents.

The developmental changes in both perceivedcontrol and parental control may have importantimplications for child anxiety. Overall, it appearsthat, among nonanxious parents, control tends toincrease until a child is approximately 9 years of age,and then tends to decrease. These findings can guidefuture work in this area and aid in the development ofconceptual models. There is almost no research onthis trend in anxious parents.

One study examined this relationship in 5th and8th grade students. Psychological control was morestrongly related to delinquency in younger children,while depression and psychological control weremore strongly related in older children (Barber,1996). No studies have examined this issue in regardto anxiety as an outcome. The developmental changesin both perceived control and parental control mayhave important implications for child anxiety.

A PROPOSED MODEL FOR A DEVELOPMEN-

TAL APPROACH TO CONTROL IN ANXIETY

Many gaps remain in the literatures on controland anxiety. In order to progress conceptually withthese constructs, we must begin to integrate theinformation from various fields and develophypotheses regarding the missing information.Schneewind (1995) suggested a mechanism by whichthis literature becomes cohesive. He stated that it is oneof the most subtle and difficult challenges of parentingto adjust parental behavior to an age-appropriate levelfor the child. However, extensive research indicatesthat anxious parents or parents of anxious children aremore controlling than nonanxious parents at variouschild ages (2–14-years-old; Dumas et al., 1995; GrecoandMorris, 2002; Hudson and Rapee, 2001; Leon and

127Control in Anxiety

Leon, 1990; Messer and Beidel, 1994; Siqueland et al.,1996; Stark et al., 1990;Whaley et al., 1999). It could behypothesized that anxious parents are unable to adjusttheir controlling behavior appropriately to their child’sdevelopmental level.

Woodruff-Borden and colleagues (2002) sug-gested that anxious parents tend to withdraw fromtheir children until they behave negatively. Then, theparent acts in an overcontrolling manner. Theyhypothesized that the initial withdrawal is due to theparent’s preoccupation with his or her own worries orfears. Thus, it could be speculated that anxious par-ents are not as attentive to the subtle developmentalneeds of their children and act in an overcontrollingmanner, failing to appropriately consider a child’sage. This failure to properly modulate their behaviorcould prevent children from learning age-appropriatetasks and foster the belief that they are unable to dealwith events on their own, leading to a sense of inse-curity, dependence, and anxiety (Rapee, 1997; Woodet al., 2003).

The extant literature is summarized in a theo-retical model to support the hypothesis that anxiousparents differ from nonanxious parents in how theyadjust their levels of control across child age. Theimplications of this difference and other potentialimpacts of child age/developmental level are alsooutlined in Fig. 1.

It has been established in the literature (e.g.,Whaley et al., 1999) that the presence or absence ofan anxiety diagnosis will lead to a certain level of

control. Child age is hypothesized to moderate thisrelationship. Anxious parents’ levels of control willremain high and constant regardless of child’s age,whereas nonanxious parents’ control will likelyincrease until middle childhood and then decreasewith child’s age. This difference in parental modifi-cation of behavior across time results in an ordinalinteraction. However, child age is hypothesized toonly affect parenting behaviors, while parenting styleshould remain more stable regardless of child age(Locke and Prinz, 2002).

Prevalence studies of anxiety disorders havedemonstrated a higher prevalence in females thanmales (e.g., Kessler et al., 1994). This suggests thatparent gender will influence parental anxiety. Moststudies to date have only examined mother–childdyads, or have included fathers along with motherswithout consideration of the differential effects ofparent gender. However, some studies have found adifference in discipline styles between mothers andfathers (Conrad and Ho, 2001; Russell et al., 1998).In addition, mothers were found to be more influ-ential in their child’s development of perceptions ofcontrol (Chandler et al., 1980), and adolescents’ self-esteem and shyness were more closely related tomothers’ psychological control than to fathers’(Eastburg and Johnson, 1990; Litovsky and Dusek,1985).

In the current model, parental control is repre-sented as both a style and behavior. This dichotomyhas been suggested in both the anxiety and parenting

Parental Control Style

Parental Control Behaviors

Child Perceived Control

Child Age/Developmental Level

Child Anxiety

Parent Anxiety

Parent Gender

Fig. 1. Hypothesized path model with child developmental level moderating the relationship between parent anxiety, parental control,

child’s perceived control, and child’s anxiety.

128 Ballash et al.

literature (Barber, 1996; Darling and Steinberg, 1993;Wood et al., 2003). The parenting control stylesinclude self-report measures of discipline, monitor-ing, and psychological control (Barber, 1996; Darlingand Steinberg, 1993). The controlling behaviors areassessed via observed interactions with the parent andchild. The parenting style acts as a moderator on therelationship between controlling behaviors and childoutcome (Darling and Steinberg, 1993).

Child outcome is first conceptualized by thecognitive construct of perceived control. The anxietyliterature indicates that parental control leads to achild’s perceptions of control (Schneewind, 1995).The current model allows for the examination ofinfluence of each construct of control as well as styleversus behavior on these perceptions. Again, childage impacts this relationship. It could moderate therelationship between parental control and children’sperceptions of control. Research has indicated thatchild age has an impact on types of negative cogni-tions associated with anxiety (Weems et al., 2001).Child age can also moderate the impact of parentanxiety on parental control behaviors. Studies indi-cate that parental level of control changes with childage (e.g., Freeman and Newland, 2002; Hagekullet al., 2001; Smetana, 2000). Finally, the depressionliterature indicates that cognitions stabilize and con-tribute more to the development of depression as achild ages (Nolen-Hoeksema et al., 1992). Thus, childage and developmental level could serve as a mod-erator in the final path in which a lack of perceivedcontrol will lead to the development of anxiety(Chorpita and Barlow, 1998; Chorpita et al., 1998).

This model incorporates the bidirectional influ-ence of parent–child interactions. As previously sug-gested (Parker, 1993), overcontrolling parentalbehavior may be elicited by children with anxioustemperaments, or anxious children might report theirparents more negatively. For instance, a longitudinalstudy found that child manageability during their firstyear and externalizing behaviors at 2½-years-oldpredicted later parental control (Hagekull et al.,2001). In addition, anxious children between 2 and6 years of age were observed to be noncompliant andcoercive (Dumas et al., 1995). Children evidently playa role in control exchanges with their parents, andthis role likely changes across development. As indi-viduals change, so do the nature of their relationships(Collins and Russell, 1991). For instance, between theages of 13 and 15, African American adolescentsdecreased in their beliefs that personal issues wereunder parental authority (Smetana, 2000).

RECOMMENDATIONS FOR FUTURE

RESEARCH

The resulting model is complex, but providescohesion to a vast and previously disconnected bodyof literature. Empirical testing of this model willrequire several studies and replication. However,studies on individual parts of the model can be con-ducted and revisions made as necessary. In doing this,validation of other models proposed in the literatureis possible. For instance, Chorpita and Barlow’s(1998) model involving a switch from a mediating toa moderating model of development can be clarified.The proposed model will allow for explication of theage and developmental level at which cognitionschange and become more stable.

Several suggestions for improvement in meth-odology have been proposed throughout this review.To summarize, an anxiety diagnosis for both parentand child should be determined via clinical interviewsas opposed to a self-report measure of anxiety. Ayoung child’s ability to complete questionnaires mustbe determined (Alfano Hagekull et al., 2001; 2002). Inaddition, if children from a large range of ages arebeing assessed, common reporting procedures mustbe followed by all ages in order to avoid a potentialconfound. Attention to developmental level is alsocritical. Reporting of control should consist of bothself-report and observations. Naturalistic observa-tions are suggested. Control should be measured interms of discipline, monitoring, and psychologicalcontrol behaviors and styles in order to determine thespecific effects of each type. Ideally, behavioral cod-ing systems should be developed in order to corre-spond with the self-reported styles for each type ofcontrol. Children ranging from early childhood tolate adolescence should be studied. A longitudinalmethodology would provide the best test of Chorpitaand Barlow’s model; however, cross-sectionalresearch to test specific components of the model or amore elaborate structural equation model wouldprovide a useful starting point in beginning to test theproposed model.

Finally, there are two largely understudied pop-ulations in the control and anxiety literatures. First,most studies to date have only examined mother–child dyads, or have included fathers along withmothers without consideration of the differentialeffects of parent gender. However, some studies havefound a difference in discipline styles between moth-ers and fathers (Conrad and Ho, 2001; Russell et al.,1998). While mothers’ influence appears to be greater

129Control in Anxiety

on child outcomes, fathers apparently still have animportant impact. The impact of and difference inpaternal control needs to be further explored.Unfortunately, the anxiety literature has largely ig-nored this issue. Greco and Morris (2002) examinedcontrol in a sample of father–child dyads, but thesedata were not compared with mother–child dyads.

Another understudied population, as statedpreviously, is that of minority ethnic groups. It hasbeen argued that disparities between White and Blacksamples are due to socioeconomic differences. Forexample, one study compared socioeconomicallyequivalent samples of African American and Euro-pean American kindergarten children and their par-ents, and hostile control was related more stronglywith conduct problems for European Americans thanfor African Americans. Overall, however, parentswere similar in their parenting practices (Hill andBush, 2001). Research in this area is inconsistent andvery preliminary. More research needs to be con-ducted to determine if control differs in minorityfamilies, and if it does, how that difference impactsthe development of anxiety. Specifically, the currentmodel needs to be tested on these understudiedpopulations, including fathers and African Ameri-cans. This ensures generalizability of the model andallows for further investigation of differences acrossgroups.

Finally, it is important to consider the bidirec-tional influence of parent–child interactions. As pre-viously suggested (Parker, 1993), overcontrollingparental behavior may be elicited by child anxioustemperament, or anxious children might report theirparents more negatively. This transactional relation-ship and the role of the child in the elicitation ofparental control need to be explored.

In conclusion, there are many areas of parentalcontrol in the development of anxiety to be furtherstudied, and they are worthy of significant attentionin the literature. Control and anxiety are extremelycommon, they have significant consequences forchildren, and their relationship is well established.Further, the interactions between anxious parentsand their children have serious ramifications forfamilies. These behavioral strategies are likely pas-sed along with anxiety itself, causing an intergen-erational concern. A clearer understanding of therole of control in the development of anxiety wouldenable psychological treatment to target dysfunc-tional family patterns. The literature has onlyrecently begun to approach its study from a moreconceptual standpoint. This review brings together

the extant literature into a ‘‘roadmap’’ for therelationship between control and anxiety acrossdevelopment.

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