Journal of Pediatric Psychology, Vol. 26, No. 6, 2001, pp. 375-384
© 2001 Society of Pediatric Psychology
Mothers' Representations of Relationships With Their Children: Relations With Mother Characteristics and Feeding Sensitivity
University of Virginia
All correspondence should be sent to Robert C. Pianta, University of Virginia, P.O. Box 9051, Charlottesville, Virginia 22906-9051. E-mail: rcp4p{at}virginia.edu .
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Abstract |
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Objective: To examine parenting representations and feeding interactions of mothers and their children with cerebral palsy (CP) and the extent to which mothers' representations predict their feeding behavior beyond other mother and child characteristics.
Methods: Fifty-eight mothers of children with mild to severe CP ages 16 to 52 months were interviewed with an adapted form of the Parent Development Interview (PDI). Correlation and regression analyses examined relations between representations (compliance with parental requests, achievement, secure base, enmeshment, worry about the child's future, and emotional pain), demographic characteristics, diagnostic severity, and developmental status.
Results: Mothers with more compliance-related concerns showed less sensitivity, acceptance, and delight during feeding. Mothers experiencing more emotional pain displayed more hostility. Mothers reporting worries about the child displayed sensitivity and delight. Representations of compliance-related experiences and worry about the child's future accounted for significant increments in explained variance in mothers' feeding behavior, after we controlled for children's skills and abilities.
Conclusions: Findings suggest maternal representations of relationships are associated with caregiving behavior for mothers of children with CP apart from other child and maternal characteristics and may be a useful focus for research and practice related to parenting children with special needs.
Key words: child disability; maternal representations; parenting; feeding; cerebral palsy.
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Introduction |
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That representational models of relationships—beliefs and expectations about others derived from aggregated experiences (Bowlby, 1982
;
Craik, 1943;
Epstein, 1991;
Stern, 1995)—guide
behavior in relationships is an increasingly widespread finding in the
literature on parenting. Representational models of attachment with one's
primary caregiver have been successfully measured in older children and adults
and related to behavior in parenting (e.g.,
George & Solomon, 1996;
Main, Kaplan, & Cassidy,
1985; Nelson,
1986,
1993;
Rubin, 1986;
Van IJzendoorn & Bakermans-Kranenberg,
1996) and marital (Pianta,
Marvin, & Morog, 1999) relationships. Furthermore, mothers'
parenting behavior is predicted not only by representations of their primary
childhood attachments (Main & Goldwyn,
1984; Van IJzendoorn,
1992) but also by the content and emotions associated with a range
of caregiving interactions with the child
(Button, Pianta, Marvin, & Saft,
2000; Slade, Belsky, Aber,
& Phelps, 1999). Mothers who behave sensitively also adapt
their representations of caregiving to meet their child's changing
developmental needs (Slade et al.,
1999).
This study extends this work on mothers' representations and parenting
interactions, which has heretofore relied exclusively on studies of typically
developing healthy children, to focus on the relation between parenting
representations and feeding interactions between mothers and their children
with a serious disability—cerebral palsy (CP). More specifically, we
examine the extent to which representations of the caregiving relationship
predict mothers' feeding behavior with their children with CP beyond the
contribution of other mother and child characteristics. Given the large
contribution of child skills and abilities to feeding interactions between
mothers and their children with CP (Welch,
Pianta, Marvin, & Saft, 2000), demonstrating connections
between behavior and representations in these groups would provide unique
support for the role of representations in mother-child relationships for this
group of children. Because of the prominence of feeding as a stressor and
concern to parents for children with CP, the study focuses only on children
with CP and on understanding relations between individual differences in
feeding behavior and representations for mothers of these children. Such an
approach provides different, and potentially more helpful, information than
would comparisons with contrast groups. Thus, the study is designed to advance
understanding of parenting processes for parents of children with CP.
Studying the way that a mother thinks about and describes her interactions
with her child is one way to better understand the correlates of individual
differences in parenting behavior (Baden
& Howe, 1992; Stern,
1991; Teti & Gelfand,
1991). Yet some attempts to identify direct links between mothers'
reported ideas and their parenting behavior have found only modest relations,
suggesting that mothers' cognitions have variable degrees of association with
their behavior (George & Solomon,
1989; Goodnow,
1988). Recent work suggests that a focus on mothers' narrative
responses to interviews concerning subjective recall and experience of
relationships may lead to a better understanding of a mother's behavior with
her child (e.g., Button et al.,
2000; Slade et al.,
1999; Zeanah, Benoit,
Hirshberg, & Barton, 1993).
Several investigators have adapted the style and focus of the
semistructured interview of adult attachment (the Adult Attachment Interview
[AAI]; George, Kaplan, & Main,
1985) to assess mothers' representations of multiple features of
the parent-child relationship. In these interviews about care-giving, mothers'
descriptions of their relationships with their children are rated globally for
aspects of the internalized relationship like those assessed in the AAI:
levels of insight/sensitivity (Bretherton,
Biringen, Ridgeway, Maslin, & Sherman, 1989), narrative style,
exhibited affect, modulation of affect, and content
(Slade et al., 1999;
Zeanah et al., 1993), or the
presence or absence of security, rejection, uncertainty, and helplessness
(George & Solomon,
1996).
One of these instruments, the Parent Development Interview (PDI), was
developed by Aber, Slade, Berger, Bresgi, and Kaplan
(1985) to assess a parent's
representational model of her relationship with a specific child. The
interview focuses on three central domains: the parent's view of her
experience in the parent-child relationship, the parent's view of the child's
experience in the relationship, and the parent's overall awareness of the
relationship. Like the AAI, the PDI probes for specific experiences and
associated emotions across a number of relationship issues. Because the PDI
taps a variety of interactive themes, information it yields illuminates the
multidimensional nature of parenting representations, not solely the
attachment function of the child-mother relationship.
For this study, we used the PDI to elicit mothers' representations of six
dimensions of their relationship with the child: compliance (the extent to
which interactions involving the child's response to maternal requests or
demands are a focus), achievement (responses that involve discussions of the
child's developmental progress), comfort/safety (a focus on the mother as a
source of comfort and security for the child), enmeshment (indications of
boundary confusion between mother and child), worry about the child's future
(e.g., whether the child will live independently), and emotional pain
associated with parenting the child (e.g., sadness, grief). In comparisons
with parents of typically developing children, these dimensions have proven
particularly salient for parents of children with disabilities (see
Button et al., 2000). In
previous studies using this instrument, mothers' representations of worry and
anxieties about their child's future, as well as concerns related to
parent-child boundaries, predicted their sensitive interactions with their
child in teaching situations. In addition, representations of mothers of
children with CP, unlike those of mothers raising typically developing
children, are dominated by concerns about compliance with parental requests
and are marked by worry for the child's future and a sense of pain and burden
associated with parenting the child
(Button et al., 2000). In this
study, we extend this work to focus exclusively on associations between
mothers' representations and their feeding behaviors with their child who has
CP.
Cerebral palsy is a heterogeneous group of permanent motor disorders,
resulting from an injury to the brain, that affects approximately 1.5 in every
2,000 infants born in the United States
(Healy, 1990). Depending on
the type and severity of brain injury, CP may include a number of functional
problems that vary widely in severity. Children with CP typically need some
level of physical assistance during feeding, problem solving, and play.
Furthermore, while these children may have increased physical needs, their
impairments also may make their cues more difficult to read
(Reilly & Skuse,
1992).
Of particular interest for this study were the relations between mothers'
representations of their relationship with a child who has a chronic disabling
condition (CP) and the mother's sensitivity during feeding, an often difficult
interaction for children with motor disorders
(Reilly & Skuse, 1992;
Satter, 1990). As children
with disabilities can make different, and often greater, demands upon their
caregivers, particularly in feeding situations
(Cox & Lambrenos, 1992;
Kazak & Marvin, 1984;
Parmelee, 1989;
Satter, 1990), child
attributes may overwhelm the relation between representations and behavior for
children with CP that has been reported for teaching and play situations.
Although the maternal behaviors important for parenting nonimpaired
children are also important for mothers whose child has CP (i.e., sensitivity,
support for autonomy, acceptance), a child's disability may complicate the
interaction. For example, we recently reported that maternal sensitivity was
not as strong a predictor of feeding success for mothers of children with CP
as was the degree of a child's oral-motor impairment
(Welch et al., 2000), and
representations of parenting for mothers of children with CP are marked by
more worry, emotional pain, and other concerns than those of mothers of
children without a diagnosis (Button et
al., 2000). Therefore, it is important to consider the possibility
that level of child impairment may moderate the relation between mothers'
representations and their parenting behavior. In this study, we examined the
extent to which mother-child feeding behaviors with a child with CP were
predicted by the child's developmental status, mother's education, maternal
representations of caregiving, and the interaction between representations and
the child's developmental status.
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Method |
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Participants
This sample of 58 mothers of children diagnosed with CP was part of a larger study of families who participated in a study of parent-child attachment and family functioning in families raising children with a range of developmental disabilities and chronic medical conditions. The study had institutional review board (IRB) approval and informed consent was obtained from parents. Families were recruited from clinics at university medical centers, community hospitals, and early intervention programs and came from rural (58.6%), suburban (19%), and urban (22.4%) areas. The mean age of mothers in this sample was 29.81 years (SD = 5.87, range = 19-50). On average, mothers had 12.74 years of education (range = 8 to 18, SD = 2.09). The annual family income for the sample ranged from $6,000 to $84,000 (M = $27,619, SD = $19,825).
All 58 children of these mothers had received a diagnosis of CP from a physician at least 12 months before data collection. The children involved in the study ranged in age from 16 to 52 months at the time of data collection (M = 32.34 months, SD = 10.81). Female children comprised 39.7% of the children about whom mothers were interviewed (n = 23); 60.3% (n = 35) were male.
Thirty-one (53.4%) of these mothers were raising children with moderate to
severe cerebral palsy. These children were not functionally locomotor,
requiring adults to carry them in order to move from place to place.
Twenty-seven (46.6%) mothers were raising children who had been diagnosed with
mild CP and were able to ambulate independently, by walking, crawling,
rolling, and so on. This distinction, based largely on gross motor
functioning, is related to the children's status in cognitive, language, fine
motor, and social development as well (see
Pianta, Marvin, Britner, & Borowitz,
1996).
All children met a minimum criterion of an 8-to 10-month developmental
level as assessed by the Bayley Scales of Infant Development
(Bayley, 1969), the Vineland
Adaptive Behavior Scales (Sparrow, Balla,
& Cicchetti, 1984), and clinic staff and parent reports of
functional levels. All children demonstrated minimal competencies in
communicating with their mothers such that mothers (and observers and clinic
staff) indicated the child regularly displayed cues that the mother
understood. The clarity of these cues and the confidence with which they could
be understood varied, but there was agreement among parents and observers that
the child was an active participant in interactions. These steps were taken to
ensure that observations of feeding behaviors were face valid for these
children. All of the mothers responded to the Vineland Adaptive Behavior
Scales, a parent report of child developmental level. The mean Composite Score
for the entire sample was 64.04 (SD = 13.22, range = 36-99).
Procedures
Families in the study participated in a day of data collection. The adapted
version of the Parent Development Interview and the Vineland Adaptive Behavior
Scales were administered to mothers, and mother and child were observed during
a lunchtime feeding interaction. The children completed a variety of
videotaped assessment procedures. Families were also given a set of
self-report questionnaires to complete at home.
Measures
The Vineland Adaptive Behavior Scales. Children were assessed with
the Vineland Adaptive Behavior Scales Survey Form
(Sparrow et al., 1984), in an
interview administered to the primary caregiver. The Vineland is a
well-validated, reliable, and widely used measure of "personal and
social sufficiency of individuals from birth to adulthood" (p. 1). It
surveys four areas of functioning—communication, daily living skills,
socialization, and motor skills—producing domain scores in each area as
well as an overall composite score. Within each domain are three subdomains,
which do not produce standard scores, but do produce age equivalents.
Test-retest reliability coefficients for the domain and composite scores are
in the.80s to.90s. Interrater reliabilities are in the.70s for all scales
except for socialization, which has an r of.62. The Vineland was
validated on a large national sample. The Adaptive Behavior Composite score
from the Vineland was used in this study as an index of the child's general
developmental status.
Parent Development Interview. The PDI administered in this study
was adapted from Aber et al.'s
(1985) longer version to assess
a parent's representation of herself as a parent and her relationship with her
child (Pianta, O'Connor, & Marvin,
1993). The adaptation involved shortening the interview slightly
in consultation with the interview's authors. Interview questions ask parents
to recall specific interactions with their child and to describe their own and
their child's emotional responses to the incidents discussed. All interviews
were videotaped and administered by an interviewer trained in standardized
administration. In 75% of the interviews, interviewer and interviewee were
matched on gender, and there were no differences in PDI responses of
gender-matched and nonmatched mothers.
Mothers' responses to the 13 adapted PDI questions were coded one question
at a time from detailed notes using a standard procedure. They were coded on a
set of six 4-point rating scales developed to reflect what parents say about
caregiving, how they say it, and what emotion they express or exhibit as they
discuss caregiving themes (Pianta et al.,
1995).
Scales include compliance (the extent to which the content of the response involves the mother's role as a socialization agent and the child's compliance with expectations and requests); achievement (the response describes the parent as teacher and monitor of developmental progress); comfort/safety (how the parent comforts and provides a secure base), enmeshment (scored when the parent's report reveals a lack of appropriate parent-child boundaries due either to role reversal or the parent's needs taking precedence over the needs of the child [e.g., "I go to him for a hug when I am down;" "He's my best friend"]), and the emotions pain and worry about the future. The scale for pain involves the mother expressing emotional pain concerning her child or her role as parent; this might include sadness or grief, or indication that raising this child is an emotional burden for her. Worry refers to the mother's concerns about the child's future: whether the child will live independently, what the child's ultimate developmental status will be.
These six constructs are coded separately for each of the 13 PDI questions
on a 4-point scale: 0 = no evidence of construct in parent's response; 1 =
vague or minimal evidence of construct; 2 = clear evidence of construct; 3 =
detailed, elaborate, or episodic description of the construct assessed
(Pianta et al., 1995). For
instance, a response is scored 1 on the compliance scale if the mother alluded
to her child's compliance or noncompliance in an oblique fashion (e.g.,
"He fussed all day," or "He was very good that day");
responses were scored 2 if they clearly articulated an aspect of behavior
management but did not elaborate with detail (e.g., "She tested limits
all night"); and responses were scored 3 on the compliance scale if a
detailed example was given of an episode of coping with behavior management of
the child.
All interviews were coded by more than one coder from a group of six coders. Twenty-eight percent of the interviews were coded by the entire working group (independently) in order to maintain reliability across all members of the group and different coding subgroups. Seventy-two percent of the interviews were coded (independently) by teams of two individuals from the working group. Team coders watched, took notes, and coded responses independently and met to establish consensus on disagreements after the entire interview had been coded independently. Consensus was established by review of the videotaped interview question, the coding manual, and by discussion.
Because extensive preliminary analyses indicated that scores for these six
constructs based only on responses to the seven most open-ended questions were
highly related (r <.80) to scores based on all 13 questions and
also produced greater variability among subjects
(Button, 1997), this
investigation is based on responses to the seven most open-ended questions in
the PDI. Thus, scores (i.e., 0, 1, 2, and 3) were assigned for each question
(n = 7) for each construct (n = 6). This scoring is
hereafter referred to as cell-level.
There was 83% exact overall agreement at the cell level. Due to a high base
rate of zero codes, agreement also was calculated for nonzero cell-level codes
and for presence versus absence of a construct. There was a rate of 68.1%
exact agreement on nonzero codes and 90.3% on presence versus absence of
constructs, again, at the cell level. In cells in which each of the 4-scale
points was represented in the sample (78.5% of all cells), these levels of
agreement were tested against chance using chisquare tests (with 
) and
exceeded levels of agreement expected by chance at the p <.05
level or better.
Distributions of the PDI scores tended to be positively skewed and kurtotic. Hence, we used the square root transformation procedure, which produced the most normal distributions. For the purposes of analysis, transformed cell scores were standardized, summed across questions, and averaged to produce composite mean scores for each construct, (e.g., a mean compliance score). Interrater agreement for construct means was calculated using the intraclass correlation, ICC (2,i). Raters were treated as classes in this analysis. Intraclass correlations for the six constructs ranged from.73 to.83, with SEMs ranging from.10 to.17. Thus, reliability analysis indicates adequate agreement for the purposes of using codes for specific constructs for individual questions (e.g., cells), as well as support for reliability of construct means across the entire set of questions. Thus, we averaged the responses to the seven open-ended questions to derive scores for each of the six constructs under investigation. For the remainder of the article, we will use these composite indices.
Maternal Behavior During a Feeding Interaction. Two different
procedures were used to code mothers' behavior with their children in a
feeding situation (Welch et al.,
2000). The first approach uses global rating scales to evaluate
the emotional quality of maternal behavior, and the other codes discrete
behaviors reflecting a mother's technical skill in feeding.
The five scales assessing emotional quality—sensitivity, acceptance,
interference, maternal delight, and maternal hostility—are scored on
7-point global-judgment scales. They are adapted from previously published
maternal rating scales (Ainsworth, Blehar, Waters, & Wall, 1978;
Matas, Arend, & Sroufe,
1978). All of these scales required overall judgments about the
quality of the mother's responses, attitudes, feelings, and actions toward her
child while feeding. Reliability was calculated based on percent agreement
within one point for 55% of the cases. Overall, interrater agreement on the
rating scales was 81% (within one point for each of the 7-point scales).
Agreement for the individual scales ranged from 67% to 100% (within one point)
with a mean of 83%.
Codes for discrete maternal behaviors were drawn from the maternal behavior
subscale of the Nursing Child Assessment Training: Feeding Scale (NCAFS,
Barnard, 1978), which was
modified for use with this CP sample. A mother's technical skill in feeding
was assessed by rating dichotomously 27 discrete behaviors (present or absent)
that are in turn summed to reflect two subscales: sensitivity and
intrusiveness. Interrater reliability was assessed via two coders, who coded
10 tapes each for comparison with a primary coder's ratings. The average
percentage of interrater agreement across all items for these 20 subjects
was.83 (exact agreement). The alpha reliability coefficient for the
sensitivity subscale was.63; for intrusiveness, it was.71.
Data Analysis
We first present descriptive statistics and correlations for child and
mother characteristics, maternal representations, and feeding behaviors. To
examine the relations between maternal report and maternal behavior, we
performed a series of regression analyses. The Maternal Feeding Behavior Scale
sensitivity and intrusiveness scores, as well as the five global ratings of
mothers' feeding interactions, were the dependent variable in each analysis.
In each regression, three blocks of variables were entered. The first block
included the child's Vineland Adaptive Behavior Composite Standard score to
account for variation in children's abilities. In previous studies
(Button et al., 2000), child
age was not correlated with PDI scores and hence was not included in these
analyses. Similarly, the Vineland proved to be a better indicator of the child
attributes related to mothers' representations and behavior than did severity
of CP (Button et al., 2000;
Welch et al., 2000). Because
of the wide age range in the sample of children, we examined child age and
time since diagnosis as potential covariates and moderators. Neither was
related to any of the parenting or interview variables, so both were dropped
from further analyses.
The second block added the six PDI scores: compliance, achievement, safety, pain, enmeshment, and worry. The third block consisted of interaction terms for combinations of the representation codes and the Vineland (e.g., PDI x Vineland) to examine the extent to which associations between the child's developmental status and mother's feeding interactions were moderated by mother's representations of the child. Interactions were evaluated one at time and retained when significant.
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Results |
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Less severe CP diagnostic status was associated with older age of child (r = -.31, p <.05), and higher ability on the Vineland (r = -.38, p <.05). Male children in the study tended to be younger (r =.28, p <.05). Older child age was associated with higher Vineland scores (r =.50, p <.05) and maternal age (r =.27, p <.05). Higher maternal education was associated with higher family income(r =.43, p <.05) and maternal age (r =.27, p <.05).
For correlations between background variables and PDI scales, mothers described relationships with their child in terms of secure base behavior when children had higher Vineland scores (r =.401, p <.01). There were no other significant correlations between PDI variables and diagnostic status, child gender, child age, maternal age or education, or family income. Table I presents correlations between background variables and feeding variables. Higher quality feeding interactions were correlated with higher maternal levels of education and higher Vineland scores. Global feeding sensitivity was related to milder CP status. Maternal intrusiveness during feeding was also related to higher maternal age and higher family income.
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Table II presents correlations among PDI and feeding variables. Mothers who described more compliance-related content in their representations showed less sensitivity, less acceptance, and less maternal delight during feeding. Mothers' concerns related to the child's achievement were associated with less intrusiveness during feeding. Mothers reporting more pain in the mother-child relationship displayed more hostility in feeding the child. Finally, when mothers reported more feelings of worry about their child's future, they also displayed more sensitivity and delight during feeding.
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We used multiple regression analyses to examine the extent to which maternal representations of relationships accounted for explained variance in the mother's behavior with their child in feeding. Initially, the Vineland composite score and maternal education were entered first, and PDI scales were entered as the second block, followed by a block in which PDI x Vineland interaction terms were evaluated. Because maternal education did not account for significant amounts of explained variance when the Vineland was in the model, it was dropped and the models were re-run with only the Vineland as a covariate. Similarly, because no interaction terms accounted for significant increments in explained variance (either individually or as a block), the interactions were dropped from the analyses and two-block models were analyzed and reported in Table III. Results for the representational variables are reported and interpreted only when the overall model was significant and the representational variables, as a block, accounted for a significant increment in explained variance.
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Mothers' representations accounted for significant variance, beyond that accounted for by the child's developmental status, for two of the global ratings of the emotional quality of their behaviors: sensitivity, F(7, 47) = 3.65, p <.003, R2 =.35, and maternal delight, F(7, 47) = 4.96, p <.001, R2 =.43. When mothers' representations were marked by less compliance-related content and a higher degree of worry about the child's future, they were observed to be more sensitive when feeding their child with CP. When maternal representations were marked by less compliance-related content, higher levels of concern about the child's achievement, and again more worry about the child's future, mothers also displayed more delight in feeding their children.
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Discussion |
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In this sample of children with fairly serious developmental disabilities that disturb feeding interactions with their mothers, maternal representations accounted for significant increments in explained variance, even after accounting for mothers' reports of their children's developmental status and skills. Thus, the association of relationship representations and behavior was unique and independent of the extent to which feeding interactions were influenced by the child's skills and abilities. These findings affirm other work establishing an association between a mother's mental representations of her relationship with her child and her interactions with the child (e.g., Belsky, Youngblade, & Pensky, 1989
; Button et al.
2000; Haft & Slade,
1989; Zeanah et al.,
1993) and extend this association for children with serious
developmental disabilities.
Mothers' representations of compliance-related experiences with their
children and the extent to which they describe concerns about the child's
future predict the quality of their interactions with their children,
independent of the influence of the child's developmental status on feeding
interactions. For this sample of children with CP, in which developmental
status has proven to be a very strong predictor of mothers' feeding behaviors
(Welch et al., 2000), this
provides considerable support for the extent to which representations play a
role in the system of behaviors, beliefs, and affects that constitute
caregiving for children. That mothers' representations account for individual
differences in feeding behaviors within this sample of mothers of children
with CP suggests that assessing and understanding these representations may
help to improve parent-child interactions for children with CP.
The finding that content about compliance with parental expectations and
demands is related to less sensitive feeding interactions is consistent with
other work indicating relations between parents' regulation of negative
emotions and experience in relationships with children and their parenting
behaviors (Belsky et al.,
1989). This likely correlation reflects a truly reciprocal or
transactional relation between representation and behavior. The finding that
mothers who described more worry and concern about the child's future were
also more sensitive may reflect a less reciprocal and more directed relation.
Responses that would receive high scores for worry about the child's future
invariably reflect an aspect of perspective taking and affective attunement to
the child's needs that likely is a precursor to, or condition supporting,
sensitive behavior toward the child.
Within a relationship, although mothers may play a larger role in
establishing relationship patterns than their toddlers, child variables are
also relevant (Stern-Bruschwiller & Stern, 1989), a particularly important
point for this study, which included a sample of motorically impaired
children. Given the significant association between mother-reported Vineland
scores and her feeding interactions with the child, the child's developmental
status apparently contributes significantly to the quality of the mother-child
relationship and can make it difficult to fully assess the role of the
mother's mental model as an influence (e.g.,
Welch et al., 2000).
Interestingly, the child's developmental status, while a significant
covariate, did not moderate the relation between maternal representations and
behavior, indicating that, unlike representations of loss or grief concerning
the child's diagnosis per se (Welch et
al., 2000), representations of normative parenting dimensions such
as compliance are associated with parenting behavior at all levels of the
child's skills or abilities.
Previous attempts to identify direct links between parents' reported ideas
and parenting behaviors have found modest relations
(George & Solomon, 1989).
Though this study is an important first step in extending this work to
children with disabilities, certain limitations of the study need to be
considered. Results based on this fairly small convenience sample (albeit
rather large for studies of developmental processes in children with
disabilities) require replication and extension. In addition, CP is a
heterogeneous disability not only defined by severity: the type of CP, and its
specific effects on a child, might affect parent-child interactions, and this
study was not designed to examine such effects. However, the inclusion of the
Vineland as an index of general impairment was one attempt to address effects
due to disability. Replicating this study with a larger sample of nonimpaired
children, or extending the work to a sample of children with other disabling
conditions or illnesses, would allow for a more in-depth analysis of the
relations between mental models and maternal behavior across the full range of
parenting circumstances and thus allow for more powerful inferences concerning
relations between representations and behavior. The null findings concerning
moderating influences of the child's disability status may be overly
influenced by the small sample size and the fact that all children in the
sample had a disability and therefore should be reexamined in larger samples.
Finally, we emphasize that the results pertaining to mothers' representations
and behavior are correlational and not directional. Further work in
longitudinal designs can begin to address issues of causality and effect.
In sum, the findings of this study indicate that mothers' representations
of child-mother relationships are related to their behavior with their child
with CP, independent of the child's skills and abilities. When representations
are dominated by compliance-related content, mothers' behaviors are less
sensitive; when representations reflect concern about the child's development
in the future, mothers behave more sensitively. These findings provide
evidence linking psychological and behavioral aspects of parenting and suggest
that professionals working with parents of children with developmental
disabilities should integrate these two important aspects of parenting in
their assessment and interventions related to caring for children with
disabilities. Thus, assessment of mothers' representations in the practice of
pediatric psychology may provide better understanding of their perspective
about the child and emotional experience of the child. This knowledge can be
used in tailoring interventions designed to support the mother's sensitive
interactions with the child during feeding and other situations. This type of
interplay between assessment of representations and parent-child interaction
interventions has been used in practice with other populations (e.g.,
Stern, 1995) and this study
suggests the potential for use in samples of children with CP.
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Acknowledgments |
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This research was supported by NICHD grant R01HD26911 and by NIDRR grant H133G20118 to Drs. Pianta and Marvin.
Received July 7, 2000; revision received October 16, 2000; revision received December 18, 2000; accepted January 9, 2001
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References |
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