Risk and resistance factors in the adaptation of mothers of children with cystic fibrosis.

Examined 35 mothers of children with cystic fibrosis (CF) to assess the relationship of risk and resistance factors to level of psychological adjustment. Dimensions of maternal adaptation, disease severity, family adaptability and cohesion, family life stress, and intrapersonal coping style were assessed. As a group, mothers evidenced significant levels of general psychological distress, and appear to constitute an at-risk population. Multiple regression analyses indicated higher levels of maternal distress were associated with increased levels of stressful family life events and an escape-avoidance coping style. Disease severity, family financial resources, and family adaptability and cohesion did not significantly contribute to the regression model.     

Impact on maternal parenting stress of receipt of genetic information regarding risk of diabetes in newborn infants.

Our objective was to investigate whether notification of high-risk status for type 1 diabetes in newborn infants results in an increased maternal-parenting stress level when compared with notification of low-risk status for type 1 diabetes. Maternal parenting stress level was assessed at 5-7 weeks postpartum (baseline) and was reassessed 4-5 months after parents were informed of their newborn infants' genetic screening results (follow-up). Parenting stress level was measured using the total stress score (TSS) of the Parenting Stress Index/Short Form. The outcome variable, change in TSS, was calculated by subtracting the baseline TSS from the follow-up TSS. Demographic variables such as maternal race, maternal age, maternal education level, maternal marital status, child's birth order, and total family income were assessed through a structured phone interview at the time of baseline assessment. The risk factor of interest was the child's human leukocyte antigen (HLA) status for type 1 diabetes, i.e., whether child was at a high or moderate (combined into "high") genetic risk or at a low genetic risk for type 1 diabetes. A sample of 88 mothers (23 with a high-risk child and 65 with a low-risk child) was evaluated. Baseline median TSSs were 65 and 74 for mothers of low-risk infants and mothers of high-risk infants, respectively. Both groups' median TSS decreased between baseline and follow-up. No significant differences were found between change in TSS and maternal age, race, education level, marital status, total family income, or child's birth order. Although the median decrease in TSS was smaller in mothers with a high-risk child when compared with mothers of a low-risk child, this difference was not statistically significant. We did not find an association between newborn's HLA status and change in maternal TSS. The results of this study suggest that notification of high-risk status for type 1 diabetes in newborn infants may not result in an increased level of parenting stress among mothers.     

Parenting stress in mothers of very-low-birth-weight (VLBW) and full-term infants: a function of infant behavioral characteristics and child-rearing attitudes

OBJECTIVE: To examine the moderating effects of child-rearing attitudes on the relation between parenting stress and infant behavioral characteristics for mothers of very-low-birth-weight (VLBW) and full-term infants. METHODS: Fifty-six 9-month-old infants (23 VLBW and 33 full-term) and their mothers were the participants. Mothers completed measures of parenting stress, child-rearing attitudes, infant temperament, and infant behavioral problems. RESULTS: The VLBW infants had a higher frequency of behavioral problems, and their mothers reported more child health concerns than the mothers of the full-term infants. Regression analyses showed that the relation between parenting stress and infant distress was moderated at medium and high levels of parental strictness for only the VLBW infants. CONCLUSIONS: The amount of stress the mothers of the VLBW infants experienced was a result of the congruence between their infant's behavioral characteristics and their own child-rearing attitudes.     

Impact on maternal parenting stress of receipt of genetic information regarding risk of diabetes in newborn infants

Our objective was to investigate whether notification of high-risk status for type 1 diabetes in newborn infants results in an increased maternal-parenting stress level when compared with notification of low-risk status for type 1 diabetes. Maternal parenting stress level was assessed at 5–7 weeks postpartum (baseline) and was reassessed 4–5 months after parents were informed of their newborn infants' genetic screening results (follow-up). Parenting stress level was measured using the total stress score (TSS) of the Parenting Stress Index/Short Form. The outcome variable, change in TSS, was calculated by subtracting the baseline TSS from the follow-up TSS. Demographic variables such as maternal race, maternal age, maternal education level, maternal marital status, child's birth order, and total family income were assessed through a structured phone interview at the time of baseline assessment. The risk factor of interest was the child's human leukocyte antigen (HLA) status for type 1 diabetes, i.e., whether child was at a high or moderate (combined into “high”) genetic risk or at a low genetic risk for type 1 diabetes. A sample of 88 mothers (23 with a high-risk child and 65 with a low-risk child) was evaluated. Baseline median TSSs were 65 and 74 for mothers of low-risk infants and mothers of high-risk infants, respectively. Both groups' median TSS decreased between baseline and follow-up. No significant differences were found between change in TSS and maternal age, race, education level, marital status, total family income, or child's birth order. Although the median decrease in TSS was smaller in mothers with a high-risk child when compared with mothers of a low-risk child, this difference was not statistically significant. We did not find an association between newborn's HLA status and change in maternal TSS. The results of this study suggest that notification of high-risk status for type 1 diabetes in newborn infants may not result in an increased level of parenting stress among mothers. Am. J. Med. Genet. 86:219–226, 1999. © 1999 Wiley-Liss, Inc.     

Interactions between maternal characteristics and neonatal behavior in the prediction of parenting stress and perception of infant temperament

BACKGROUND: Prenatal cocaine exposure is a marker of developmental risk. Social environmental risk factors may include maternal stress and maternal perceptions of difficult infant temperament. OBJECTIVES: To examine factors that may predict or moderate maternal ratings of parenting stress and difficult temperament in cocaine-exposed (CE) infants. METHOD: Neonatal behavior, infant temperament, parenting stress, and maternal psychopathology were measured in a large sample of infant-mother dyads with prenatal CE and a nonexposed comparison sample. Participants were drawn from an existing longitudinal data set (Maternal Lifestyle Study). RESULT: Relations between neonatal behavior and infant temperament ratings were moderated by mothers' ratings of parenting stress. Relations between neonatal cry and parenting stress were moderated by maternal psychopathology ratings. Results were unrelated to drug exposure history. CONCLUSIONS: For mothers of at risk infants (with or without prenatal CE), psychological distress affects the degree to which infant behavioral characteristics are experienced as stressful or difficult. Implications for treatment and outcome are discussed.     

Maternal HIV Infection: Parenting and Early Child Development

Examined whether support could offset the potential stress ofmaternal HIV infection with regard to parenting and early childdevelopment in two studies of low income, urban, drug-usingmothers of infants and toddlers. In one study, support was providedthrough home intervention; in the other, support was measuredthrough self-report. There were few differences in parentingand early child development related to maternal HIV infection.HIV+ mothers reported less child-related stress among theirtoddlers, more normative levels of child abuse potential following18 months of home intervention, and displayed more positiveinvolvement with their children. Results, interpreted from ecologicaltheory, suggest that although the early stages of maternal HIVinfection may have been too distal to influence the lives ofhigh-risk mothers of infants and toddlers, when differencesexisted, HIV+ mothers demonstrated more positive attitudes andbehaviors toward parenting and were more able to benefit fromhome intervention than HIV– mothers.     

Early Problem Behavior Among Children From Low-Income,Mother-Headed Families: A Multiple Risk Perspective

Examined proximal and contextual factors most strongly related to externalizing behavior among young children growing up in low-income, mother-headed families. Participants were 50 low-income single mothers and their preschool-age children who were visited twice in the home setting. Measures of proximal (low levels of supportive parenting, high levels of punitive disciplinary practices, low levels of maternal emotional well-being) and contextual (low maternal support, high levels of family stress) risk were assessed in relation to maternal reports of child externalizing behavior and an index of negative child behavior during a clean-up task. Child defiance during the clean-up task was highly associated with punitive maternal control in the same situation but had no other direct correlates. However, multiple risk factors representing both proximal and contextual variables were associated with variations in children's behavior problem scores. Mothers of children with high behavior problem scores reported lower feelings of self-efficacy in handling child care and emotional stressors, more frequent use of punitive child disciplinary practices, and lower feelings of satisfaction with the quality of their supportive resources than others. Maternal self-evaluations of coping efficacy mediated the relation between perceived support and child behavior problems, suggesting that constructs of personal control are important to represent in future studies of highly stressed parents.     

Longitudinal study of observed and perceived family influences on problem-focused coping behaviors of preadolescents with spina bifida

OBJECTIVE: To study coping socialization longitudinally by examining reported and observed family environment and parenting variables in relation to children's problem-focused coping in a sample of 68 families of preadolescents with spina bifida and 68 matched able-bodied comparison families. METHODS: Family environment and parenting variables were assessed with mother and father reports and observational measures. Children's problem-focused coping was self-reported. RESULTS: Prospective analyses revealed that maternal responsiveness, paternal responsiveness, and family cohesion predicted an increase in children's use of problem-focused coping strategies, while change in paternal responsiveness and maternal responsiveness and demandingness was related concurrently to change in coping. Few group (spina bifida vs. able-bodied) or gender differences with respect to parenting and family influences on children's coping behaviors were found. CONCLUSIONS: Multimethod findings suggest that the quality of parenting and family environment is associated with children's problem-focused coping behaviors. We discuss clinical implications.     

Maternal care patterns and behavioral development of rhesus macaque abused infants in the first 6 months of life

We investigated the maternal care patterns of rhesus macaque mothers who physically abuse their infants, and compared their infants' behavior to that of nonabused infants. Parametric and multidimensional scaling analyses indicated that abusive mothers have a distinct parenting style characterized by high rates of rejection and contact-breaking from their infants. Compared to control infants, abused infants exhibited signs of delayed independence from their mothers including higher rates of distress calls and anxiety, lower rates of contact-breaking, and differences in play. Several aspects of the abused infants' behavior were correlated with rates of abuse received during the first month, or with other maternal behaviors. These findings provide a more comprehensive characterization of the parenting styles of abusive mothers and the early behavioral development of their infants than previously available. Detailed knowledge of the early experience of abused infants is crucial for understanding possible pathological alterations in behavior and neuroendocrine function later in life.     

Changes in maternal distress and child-rearing strategies across treatment for pediatric cancer

OBJECTIVES: To examine longitudinal changes in perceived stress, affective distress, and self-reported parenting strategies among mothers of children with cancer over the initial 6 months of diagnosis and treatment, and to examine relationships between changes in distress and subsequent parenting strategies. METHOD: Questionnaire data were gathered regarding parental perceived stress, caregiver burden, affective distress, and parenting strategies from 65 mothers of children (mean age = 8.3 years) with cancer at 2-5, 12-14, and 22-24 weeks postdiagnosis. RESULTS: Consistent with other studies in the literature, maternal affective distress decreased over the time course of the study. Perceived stress also decreased, while caregiver burden remained relatively stable. Parental consistency fluctuated over the study period, while other parenting strategies (i.e., control, nurturance, and responsiveness) remained stable. CONCLUSIONS: Although maternal affective distress decreased following the initial diagnosis of cancer, sources of stress (e.g., caregiver burden) may remain stable, indicating the need for interventions to bolster parental coping resources.     

Behavioral family intervention for children with developmental disabilities and behavioral problems.

The outcomes of a randomized clinical trial of a new behavioral family intervention, Stepping Stones Triple P, for preschoolers with developmental and behavior problems are presented. Forty-eight children with developmental disabilities participated, 27 randomly allocated to an intervention group and 20 to a wait-list control group. Parents completed measures of parenting style and stress, and independent observers assessed parent-child interactions. The intervention was associated with fewer child behavior problems reported by mothers and independent observers, improved maternal and paternal parenting style, and decreased maternal stress. All effects were maintained at 6-month follow-up.     

Maternal depression and infant daytime cortisol

The effect of maternal depressive disorder on infant daytime cortisol production was studied in three groups of infants; one group with mothers with comorbid depression and anxiety (n = 19), a second group with mothers with depression only (n = 7), and a third group with non‐depressed mothers (n = 24). The infants' cortisol production pattern was measured when they were 6, 12, and 18 months old in combination with repeated measures of parenting stress and depression symptoms. Multilevel modeling analyses showed that infants of mothers with comorbid depression and anxiety had relatively higher cortisol production from morning to bedtime and higher bedtime values as compared to infants of non‐depressed mothers and infants of depressed only mothers when they were 6 and 12 months old, but not when 18 months old. The results were interpreted in light of possible changes in the infants' stress regulatory capacities or changes in maternal coping strategies at infant age 18 months. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 334–351, 2013     

Effect of Maternal Anxiety on Parenting Stress of Fathers of Children With ADHD

BackgroundHyperactivity, inattention, and impulsivity of children with attention deficit hyperactivity disorder (ADHD) increase parenting stress and familial conflict. Among parent-related factors, maternal mental health has been studied in-depth, but studies on paternal factors in this context are scarce. This cross-sectional study was conducted of children with ADHD and their parents in South Korea. We investigated the relationships between ADHD symptom severity of children and the mental health of their mothers and fathers.MethodsThe study included 70 children with ADHD and their 140 married heterosexual parents (70 fathers and 70 mothers). Children completed the Child Depression Inventory and State-Anxiety Inventory for children, and their parents completed the Korean ADHD rating scale-IV, Adult ADHD self-report scale, State-Anxiety Inventory, Patient Health Questionnaire-9, and Parental Stress Scale.ResultsThere was a significant positive correlation between children’s ADHD symptoms and maternal anxiety symptom severity, whereby more severe ADHD symptoms were associated with more severe maternal anxiety symptoms. There was also a significant positive correlation between maternal anxiety symptom severity and paternal parenting stress severity, whereby more severe maternal anxiety was associated with more severe paternal parenting stress. A mediation model showed that paternal parenting stress severity was not directly related to children’s ADHD symptoms, but the severity of maternal anxiety mediated this relationship.ConclusionThe present study found the importance of mental health in mothers of children with ADHD and the interrelatedness of mental health within families. Future assessments and treatment of children with ADHD should include both the children and their parents.     

Stress, appraisal, and coping in mothers of disabled and nondisabled children.

The cognitive-behavioral model of stress and coping provided the framework for this study of mothers of physically disabled children (n = 69) and mothers of nondisabled children (n = 63). The first aim was to test for differences between groups in responses to stressful parenting events. As hypothesized, mothers of disabled children reported higher levels of depressive symptomatology. Differences in psychological distress and health status approached significance. The second aim was to explore the mediating influences of coping strategies and cognitive appraisals. As predicted, emotion-focused coping was related to increased psychological distress in mothers of disabled children whereas problem-focused coping was associated with decreased distress. Both relationships were significant even after controlling for differences in type of parenting stressor. Hierarchical regressions showed that 58 and 25% of the variance in psychological distress was explained by the independent variables; however, the predictors were different for the two groups of mothers. Factors that may explain the differential effectiveness of coping and appraisal, and clinical implications of this study are discussed.     

Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.     

Parental management of fear in chronically ill and healthy children

This study was undertaken to determine the impact of children's health status on parental management of fear and avoidance, as well as the relationship between parenting strategies and children's fear and anxiety levels. Thirty-one children with a chronic life-threatening illness, 30 children with chronic non-life-threatening conditions, and 28 healthy children, and their mothers, were studied. Children's health status, by diagnosis, was not a significant determinant of maternal fear-management strategies. For chronically ill children, clinical health status, in terms of illness course, prognosis, physical impairment, and time since diagnosis were related to maternal parenting strategies and to children's levels of medically related fears. For the sample as a whole, maternal fear-management strategies were related to child sex, socioeconomic status, and mothers' trait anxiety. These results are discussed in terms the interactive effects of child characteristics, health status, fear/anxiety, and parenting strategies.     

Consistency and change in the behavior of rhesus macaque abusive mothers with successive infants

This study investigated the abusive behavior and parenting styles of 7 rhesus macaque mothers with infants born in 2 consecutive years. All subjects lived in captive social groups and were observed during the first 12 weeks of infant life. With the exception of 1 individual, mothers were generally consistent in the frequency with which they abused their successive infants. Similarities were also found in the temporal course of infant abuse, the use of the most common pattern of abuse, and some measures of parenting style, notably those reflecting maternal protectiveness. The findings of this study are discussed in relation to different hypothesized relationships between infant abuse and parenting style in macaques. © 1999 John Wiley & Sons, Inc. Dev Psychobiol 34: 29–35, 1999     

Concerns and coping of African-American mothers after youth assault requiring emergency medical treatment

OBJECTIVE: To explore maternal experience following youth assault occurring in the community. METHODS: A semistructured interview was used to elicit concerns and coping strategies among 35 African-American mothers whose children received emergency department (ED) treatment for assault-related injuries. Mothers also completed measures of violence exposure, trauma symptoms, social support, and youth functioning. RESULTS: The most common concerns involved family safety, maternal mental health, and youth externalizing behavior. Faith and social support were the most common coping strategies. High levels of distress were found, which were directly related to maternal violence exposure, relationships that required mothers to nurture others, and youth functioning. Distress was inversely related to relationships that provided guidance from others. CONCLUSION: Distress is common among low-income African-American mothers of youth assault victims. To bolster youth recovery and to reduce the risk of future injury, ED staff should be knowledgeable regarding culturally sensitive resources to address maternal distress.     

The Parents' Solution Book: Your Child From Five to Twelve (Book)

Measured the frequency of socioeconomically disadvantaged preschool children's aggressive, assertive, and submissive behaviors in play interaction with their mothers. Boys were significantly more assertive but not more aggressive or submissive than girls. Sociofamilial predictors including maternal depression, maternal anger, parenting stress, family life stress, and maternal perceptions of children's aggressive behavior were examined. Sex of the child interacted with (a) maternal depression to predict aggressive and assertive behavior and (b) maternal anger to predict submissive behavior. In all cases where child's sex exerted a significant moderating influence, boys' behavior was more vulnerable to differences in levels of maternal depression and anger, with lower rates of boys' behavior associated with higher levels of maternal distress.     

Childhood chronic illness as a family stressor.

Investigated the impact of childhood chronic illness within a family context. We interviewed 30 mothers of 6- to 14-year-old children with asthma or diabetes and 30 mothers of healthy children of the same age and sex. Family functioning, extrafamilial social support available to mothers, and child life stress events were examined in relation to the children's psychological adjustment and illness events. The mothers of asthmatic children reported a greater number of internalizing behavior problems in their children, perceived their own social support as less adequate, and reported a greater number of stressful events. Regression analyses demonstrated that family functioning, maternal social support, and chronic illness were significantly related to the psychological adjustment of the child. The importance of family functioning and resources available to the family, such as social support, are discussed as protective influences in coping with childhood chronic illness.