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BACKGROUND: The authors conducted a randomized controlled trial to determine whether parental presence during induction of anesthesia (PPIA) is associated with parental physiologic and behavioral manifestations of stress. METHODS: Children and their parents (N = 80) were randomly assigned to one of three groups: (1) PPIA; (2) PPIA plus 0.5 mg/kg oral midazolam; and (3) control (no PPIA or midazolam). The effect of the group assignment on parental heart rate (HR), parental blood pressure, and parental skin conductance level (SCL) were assessed. Both parental HR and parental SCL were monitored continually. Anxiety of the parent and child was also assessed. RESULTS: Parental HR increased from baseline until the induction of anesthesia (P = 0.001). A group-by-time effect ( P= 0.005) was also found. That is, throughout the induction period there were several time points at which parents in the two PPIA groups had a significantly higher HR than did parents in the control group (P < 0.05). Similarly, SCL was found to increase in all parents from baseline until induction of anesthesia (P = 0.001). Significant group differences in SCL changes over time were found as well (P = 0.009). State anxiety and blood pressure following induction of anesthesia did not differ significantly between groups ( P= nonsignificant). Examination of parental Holter data revealed no rhythm abnormalities and no electrocardiogram changes indicating ischemia. CONCLUSIONS: The authors found that PPIA is associated with increased parental HR and SCL. However, no increased incidence of electrocardiogram abnormalities were found in parents present during induction of anesthesia.
The parental role can be an enduring one for many people with sons or daughters with learning disabilities. Despite this, there has been little research on parents' experiences during their offspring's adult years. The present paper examines the different dimensions of work undertaken by parents in the care of their adult offspring and how they felt these had changed over the years. The paper also explores how parents seek to combine parental work with other aspects of their lives. Data for this study were derived from a qualitative, in-depth study of the experiences of parents of 33 co-resident adult offspring with learning disabilities. The data suggest that the long-term nature of parenting involves both stability and change. For example, some parents had experienced a depletion of physical resources and enthusiasm that made it difficult for them to carry out some aspects of parental work. Parents had also met new difficulties, such as the handling of the disclosure of learning disability to their offspring, as well as to members of the public. For all parents, parenting had remained an extensive involvement, so that they still found it difficult to meet the demands of parenting, and their own non-parental tasks and interests. The data also indicate that service intervention needs to be based on an appreciation of the temporal and personal difficulties in parents' lives, and that service intervention can add to the perceived burden of carers without such an appreciation.
In order to examine the extent to which parents' levels of education, financial resources, self-esteem, and their mastery-orientation versus task-avoidance are associated with their parenting styles and parental stress, data from two studies were analyzed. In Study I, parents of 105 6 to 7-year old children were asked to fill in scales measuring their parenting styles and parental stress, mastery-orientation, financial resources, and their level of education. In Study II, 235 parents were asked to fill in the same scales. An identical pattern of results was found in the two studies. Parents' self-esteem and their use of mastery-oriented strategy were found to be associated with authoritative parenting and low parental stress, whereas parents' low level of education was related to an authoritarian parenting style. The results further showed that the impact of parents' self-esteem on authoritative parenting and parental stress was partly mediated by their use of a mastery-oriented strategy.
STUDY OBJECTIVES: To describe the prevalence of parental prompting to smoke (eg, parent requests that their child light the parent's cigarette in his/her own mouth) in a sample of families, and to assess the agreement between child and parent reports of the prompting behaviors. DESIGN, SETTING, AND PARTICIPANTS: A total of 3,624 adolescents from 10 middle/junior high schools completed baseline surveys. Parents identified as smokers in these surveys were contacted to complete a telephone survey. These analyses included 270 parent/child pairs. Fifty-one percent of parents were Latino American, 51% had the equivalent of a high-school diploma, 83% were employed when surveyed, and the median household monthly income was between $2,200 and $2,599. MEASUREMENTS AND RESULTS: Students completed a paper-and-pencil survey assessing demographic characteristics, seven parental prompts to smoke, past month smoking, parental smoking, acculturation, and familism. A similar questionnaire was developed to collect information by telephone from smoking parents. Concordance between child- and parent-reported prompting was > 85% for five of seven prompts. However, the reported prevalence of six of the seven prompts was lower among parents than children. Thirty-two percent of mothers and 17% of fathers reported prompting their children to bring cigarettes to parents (the most common prompt). Students reported that 62% of their mothers and 54% of their fathers prompted them to bring their cigarettes, a substantial discrepancy in both cases. CONCLUSIONS: Child-reported prompting prevalence was consistently higher than parents' reports, with the biggest discrepancies between requests to clean ashtrays and bring cigarettes, the two most common prompts. In subsequent studies of parental prompting, it is advisable to collect data from both children and parents and to validate the accuracy of the sources.
PURPOSE: To examine if parental smoking modifies the association between parent-child connectedness and parental disapproval of youth smoking with smoking behavior among minority youth. METHODS: Baseline data from an urban Seattle, Washington neighborhood-based intervention trial to reduce risk behaviors among minority males and females aged 11-15 years were used to identify 428 minority youth-parent/guardian pairs. Parental smoking status, assessed by telephone interview, and youth reports of connectedness and parental disapproval, assessed by questionnaire, were tested in Chi-squared stratified analysis and logistic regression to predict youth smoking. RESULTS: The majority (86%) of the parents/guardians were the natural parent of the surveyed child (67% mother; 19% father). Parental mean age was 41 years, 54% reported household incomes less than $30K, and 26% were current smokers. Youth had a mean age of 13 years, 28% self-identified as African-American, 37% as Asian, and 35% as "Multiethnic"; 41% reported ever smoking, and 9% reported smoking within the past 30 days. Perceived parental disapproval of smoking was not associated with youth smoking behavior. Among youth whose parent did not smoke, those who reported low level of parent-child connectedness were two times more likely to report ever having smoked than those who reported high levels of connectedness. Among youth whose parent smoked, connectedness was not associated with youth smoking. The interaction between connectedness and parental smoking status and its relationship to youth smoking remained significant after controlling for covariates. CONCLUSION: Overall, high levels of parent-child connectedness are protective against youth smoking. However, family connectedness may not protect children from becoming smokers when parents smoke.
The needs of parents of hospitalized children have received some attention in the health literature, but few studies have compared parents' perceptions of needs with staff's ideas about parents' needs. The aim of this study was to examine differences between the perceptions of the needs of parents of hospitalized children held by staff - nurses, doctors and allied health staff, and parents in a 150-bed paediatric hospital in Sweden. The convenience sample comprised 132 staff - nurses, doctors and allied health staff and 115 parents of children admitted to all the wards except intensive care. Kristjánsdóttir's "needs of parents of hospitalized children" questionnaire (NPQ) was the instrument of choice and was modified slightly for use with staff. Results indicated significant differences in perceptions of the importance of different needs of parents, of how well they were being met in the hospital and how much help the parents needed to have them filled. Differences between parents' and staff's perceptions of the importance of parental needs were found in areas relating to psychosocial needs, but in general, in that hospital, the needs were being adequately met. The main differences between staff's and parents' results were in the degree of independence shown by parents in requiring help to have their needs met. This demonstrates either that parents are much more independent than appraised by staff, or, that parents are sometimes unaware of the level of assistance available.
Early research suggested that the loss of a parent during childhood can lead to depression and other psychopathology in children and adults. More recent research has differentiated between loss due to death and separation from parents and has questioned the link between early parental death and psychopathology. We examined the hypothesis that separation from parents has a more detrimental effect than the death of a parent on the mental health of adolescents in the community. Israeli adolescents (N = 844) with a mean age of 16.7 +/- 1.0 years (mean +/- SD) participated in this study. Seventy reported that a parent did not live at home during one of three 5-year periods until they reached the age of 15; 37 reported the death of a parent and 777 were from intact families. All participants completed the Brief Symptom Inventory (BSI), General Well Being Schedule (GWB), Parental Bonding Instrument (PBI), and Perceived Social Support Family/ Friends Scales (PSS-Fam and PSS-Fr). Adolescents who had experienced separation from parents had more psychiatric symptoms (BSI), expressed a lower sense of well-being (GWB), experienced less support from their family (PSS-Fam), and felt less cared for and more controlled by their parents (PBI) compared with those belonging to intact families. The death of a parent was not associated with significantly different scores on these variables. When we controlled for parental bonding (PBI) and perceived social support from family (PSS-Fam), the differences between the separation group and the intact family group were no longer significant. The psychological impact of separation from parents involves a greater risk for psychopathology than the death of a parent. The quality of the relationship with the parents moderates the negative impact of separation from them.
The purpose of this research was to explore parenting stress and parents' willingness to accept treatment in relation to the behavioral problems of children with Attention-Deficit Hyperactive Disorder (ADHD). A total of 100 subjects, either fathers or mothers of children with ADHD, were recruited by convenience sampling from southern Taiwan. The results of this research were: (1) the standardized score for parents' perception of the behavioral problems of their ADHD children was 67.09. (2) The standardized score for parents perception of parenting stress was 62.00. (3) The parents who were most willing to accept treatment were those in the parent training group. (4) The behavioral problems of ADHD children were significantly related to parenting stress (p .001). (5) ADHD children's behavioral problems and parental self-awareness of psychological and emotional problems were the two variables most influential on parenting stress, and recognition of the pathological cause was the most influential factor in willingness to accept treatment. Through this research we also found that the parents hoped that a parent training group would be established. Therefore, nursing personnel can try to develop parent training groups in order to relieve parents' parenting stress.
BACKGROUND: Recent years have seen new challenges to laws protecting minors' confidential access to reproductive health services. Little research has explored parental views on the issue. OBJECTIVE: To examine parents' views about laws requiring parental notification (PNLs) when minor children seek to obtain prescription contraceptives, the exceptions parents would endorse, and the consequences they would expect. DESIGN: Fifteen-minute telephone surveys conducted in 2002. SETTING: Minnesota and Wisconsin. PARTICIPANTS: Population-based sample of 1069 parents of adolescents aged 13 to 17 years with a working telephone number. An additional 1095 eligible parents declined and 360 were not available to participate. MAIN OUTCOME MEASURES: Views about PNLs ("Do you think a law requiring notification of parents when a teen requests birth control from a clinic is a good idea, a bad idea, or neither a good nor a bad idea?"). RESULTS: Of the eligible parents, 42.4% completed the survey. More than half (55.1%) of participants thought PNLs were a good idea. However, 96.1% of parents expected at least 1 negative consequence and 47.6% expected 5 or more negative consequences to result with the enactment of PNLs. For exceptions to PNLs, 85.5% of parents endorsed at least 1, and 29.7% endorsed 5 to 6. Each additional anticipated positive consequence of enacting PNLs was significantly associated with more than twice the odds of favoring PNLs (odds ratio [OR], 2.28), and each additional negative consequence was associated with lower odds of supporting PNLs (OR, 0.87). Likewise, each additional exception endorsed was associated with lower odds of supporting PNLs (OR, 0.71). CONCLUSIONS: Many parents hold complex views on the need for confidentiality and the appropriate involvement of parents in adolescent health care services. Educating parents about the potential negative consequences of parental notification could change their support of PNLs.
BACKGROUND: The prevalence of mental health problems in women is 1:3 and such problems tend to be persistent. There is evidence from a range of studies to suggest that a number of factors relating to maternal psychosocial health can have a significant effect on the mother-infant relationship, and that this can have consequences for the psychological health of the child. It is now thought that parenting programmes may have an important role to play in the improvement of maternal psychosocial health. OBJECTIVES: The objective of this review is to address whether group-based parenting programmes are effective in improving maternal psychosocial health including anxiety, depression and self-esteem. SEARCH STRATEGY: A range of biomedical, social science, educational and general reference electronic databases were searched including MEDLINE, EMBASE CINAHL, PsychLIT, ERIC, ASSIA, Sociofile and the Social Science Citation Index. Other sources of information included the Cochrane Library (SPECTR, CENTRAL), and the National Research Register (NRR). SELECTION CRITERIA: Only randomised controlled trials were included in which participants had been randomly allocated to an experimental and a control group, the latter being either a waiting-list, no-treatment or a placebo control group. Studies had to include at least one group-based parenting programme, and one standardised instrument measuring maternal psychosocial health. DATA COLLECTION AND ANALYSIS: A systematic critical appraisal of all included studies was undertaken using the Journal of the American Medical Association (JAMA) published criteria. The data were summarised using effect sizes but were not combined in a meta-analysis due to the small number of studies within each group and the presence of significant heterogeneity. MAIN RESULTS: A total of 22 studies were included in the review but only 17 provided sufficient data to calculate effect sizes. These 17 studies reported on a total of 59 outcomes including depression, anxiety, stress, self-esteem, social competence, social support, guilt, mood, automatic thoughts, dyadic adjustment, psychiatric morbidity, irrationality, anger and aggression, mood, attitude, personality, and beliefs. Approximately 22% of the outcomes measured suggested significant differences favouring the intervention group. A further 40% showed differences favouring the intervention group but which failed to achieve conventional levels of statistical significance, in some cases due to the small numbers that were used. Approximately 38% of outcomes suggested no evidence of effectiveness. REVIEWER'S CONCLUSIONS: It is suggested that parenting programmes can make a significant contribution to the improvement of psychosocial health in mothers. While the critical appraisal suggests some variability in the quality of the included studies, it is concluded that there is sufficient evidence to support their use with diverse groups of parents. However, it is also suggested that some caution should be exercised before the results are generalised to parents irrespective of the level of pathology present, and that further research is still required.
Reports of parenting styles were assessed in 110 primarily white, middle-class sixth, eighth, and tenth graders (M = 11.98, 13.84, and 16.18 years of age) and their parents (108 mothers and 92 fathers). Parents judged the legitimacy of parental authority and rated family conflict and rules regarding 24 hypothetical moral, conventional, personal, multifaceted (containing conventional and personal components), prudential, and friendship issues. Adolescents viewed their parents as more permissive and more authoritarian than parents viewed themselves, whereas parents viewed themselves as more authoritative than did adolescents. Parents' parenting styles differentiated their conceptions of parental authority, but adolescents' perceptions did not. Differences were primarily over the boundaries of adolescents' personal jurisdiction. Furthermore, conceptions of parental authority and parenting styles both contributed significantly to emotional autonomy and adolescent-parent conflict. The implications of the findings for typological models of parenting and distinct domain views of social-cognitive development are discussed.
The purposes of this study were (1) to explore differences in maternal and paternal parenting style and parental involvement, (2) to examine the differences between parents' and adolescents' perceptions of parenting style and parental involvement, and (3) to explore the changes in parenting style and parental involvement between the adolescents' ninth and twelfth grade years. Subjects were 244 ninth graders recruited from several school districts in the Southeast and Midwest. Thirty-one subjects participated in a small longitudinal study three years later when they were in the twelfth grade. Measures of maternal and parental demandingness, responsiveness, values toward achievement, involvement in schoolwork, and involvement in school functions, designed for this program of research, were obtained from both adolescents and their parents. Results showed that both adolescents and parents perceived mothers to be more involved in parenting than were fathers during both ninth and twelfth grades. Mothers and fathers were not found to be different regarding their values toward achievement. Additionally, both mothers and fathers perceived themselves to be higher on all aspects of parenting than their adolescents perceived them to be during both ninth and twelfth grades. In the longitudinal study, both adolescents and parents perceived levels of parenting to drop between ninth and twelfth grades, except values toward achievement which did not change. Implications for interpretation of existing research and for considerations of future research are discussed.
OBJECTIVE: Parents of children with type 1 diabetes are crucial to promoting positive disease adaptation and health outcomes among these youngsters, yet this success may come at some consequence to parents' own well-being. Little research has examined the stress faced by parents, or explored the psychological and behavioral correlates of their stress. METHODS: One hundred and thirty-four parents of children with type 1 diabetes completed measures of diabetes self-efficacy, responsibility for diabetes management, fear of hypoglycemia, and a recently developed measure of pediatric parenting stress (the Pediatric Inventory for Parents [PIP]; R. Streisand, S. Braniecki, K. P. Tercyak, & A. E. Kazak, 2001). RESULTS: Bivariate analyses suggest that pediatric parenting stress is multifaceted; the frequency of parenting stress is negatively related to child age and family socioeconomic status and positively related to single parent status and regimen status (injections vs. insulin pump). Difficulty of parenting stress is negatively related to child age and positively related to regimen status. In multivariate analyses, a significant portion of the variance in stress frequency (32%) and difficulty (19%) are associated with parent psychological and behavioral functioning, including lower self-efficacy, greater responsibility for diabetes management, and greater fear of hypoglycemia. CONCLUSIONS: Each area of parent functioning associated with pediatric parenting stress is amenable to behavioral intervention aimed at stress reduction or control and improvement of parent psychological and child-health outcomes.
OBJECTIVE: To evaluate whether disagreements in reporting child behavior problems between biological parents and foster parents and teachers are related to depressive symptoms in the biological parent. METHOD: Child Behavior Checklists and Teacher's Report Forms were completed by parents, foster parents, and teachers on 95 foster children between ages 5 and 16 during 1990-1991. Depressive symptoms in biological parents were assessed using the Center for Epidemiologic Studies Depression Scale. Structural equation modeling was used to estimate the relation between parental depressive symptoms and the discrepancies between their reports and those of two other informants. RESULTS: In both the internalizing and externalizing behavior models, a significant relation was found between parents' depressive symptoms and their discrepancies in reporting, but not with child behavior. This relation was stronger for internalizing than externalizing models. CONCLUSIONS: Using foster parents (and teachers) as informants offered a unique opportunity to view the reports of biological parents in comparison to two independent reports. Foster parents have a similar observational situation as biological parents but bring a less emotionally invested perspective to behavior observation, even when they are relatives. It is likely that depressive symptoms in parents distort their reports of their children's behavior. Clinicians would be wise to supplement parental with other informant reports.
An outline of the evolution of parental care among the vertebrates is presented, leading to a characterization of critical features of parental care among the mammals and birds. Among the lower vertebrates (fishes, amphibia) and reptiles there are a variety of patterns of parental care. These can be divided into those that involve parental behavior and those that are nonbehavioral. Among extant species, parental behavior is not the predominant form of parental care, although it is present in many species of fish, frog and reptile. Nonbehavioral patterns of parental care predominate and are equally effective as parental behavior. Parental behavior is based on reciprocal stimulus interaction (trophallaxis) between the parent and the offspring and includes behavior directed at the nest, eggs, and developing young. Among lower vertebrates and reptiles there are increases in the complexity and completeness of parental behaviors but only among the mammals and birds has parental behavior been elaborated as the only form of parental care. Critical characteristics of mammalian parental behavior are: simultaneous onset of birth, lactation, and maternal care, rapid formation of an attachment of the mother to her offspring, synchrony in the behavioral interaction between mother and young during their development until weaning, and the significance of the mother-offspring unit as the basis of social organization. Among birds there is the period of egg incubation in the nest preceding hatching of the young, in addition to the above characteristics of mammals, but the mother-offspring unit is not the basis for social organization.
OBJECTIVE: To examine adjustment in children of a parent with multiple sclerosis within a stress and coping framework and compare them with those who have 'healthy' parents. SUBJECTS: A total of 193 participants between 10 and 25 years completed questionnaires; 48 youngsters who had a parent with multiple sclerosis and 145 youngsters who reported that they did not have a parent with an illness or disability. METHOD: A questionnaire survey methodology was used. Variable sets included caregiving context (e.g. additional parental illness, family responsibilities, parental functional impairment, choice in helping), social support (network size, satisfaction), stress appraisal, coping (problem solving, seeking support, acceptance, wishful thinking, denial), and positive (life satisfaction, positive affect, benefits) and negative (distress, health) adjustment outcomes. RESULTS: Caregiving context variables significantly correlated with poorer adjustment in children of a parent with multiple sclerosis included additional parental illness, higher family responsibilities, parental functional impairment and unpredictability of the parent's multiple sclerosis, and less choice in helping. As predicted, better adjustment in children of a parent with multiple sclerosis was related to higher levels of social support, lower stress appraisals, greater reliance on approach coping strategies (problem solving, seeking support and acceptance) and less reliance on avoidant coping (wishful thinking and denial). Compared with children of 'healthy' parents, children of a parent with multiple sclerosis reported greater family responsibilities, less reliance on problem solving and seeking social support coping, higher somatization and lower life satisfaction and positive affect. CONCLUSIONS: Findings delineate the key impacts of young caregiving and support a stress and coping model of adjustment in children of a parent with multiple sclerosis.
When infants are admitted to a neonatal intensive care unit, the parents are immediately confronted with the crisis surrounding a critically ill newborn and often require additional support. Parents experience feelings of anxiety, fear, anger, and guilt over this unanticipated event. In addition, parents often describe the withdrawal of friends and the denial responses of well-meaning family members during their infant's illness. In an effort to address the NICU parents' need for support, Butterworth Hospital in collaboration with Michigan State University initiated a demonstration and research project focused on parent-to-parent support. The primary goal of the program is to improve parenting outcomes by providing emotional, informational, and role modeling support to parents of high-risk infants utilizing experienced volunteer parents. The program model includes professional program coordinators who recruit and train volunteer parents with past NICU experience. Volunteers are then matched to new NICU families based on infant's diagnosis, similar geographic location, and other characteristics. Volunteers provide support through hospital visits, phone contact, and home visits during the infant's hospitalization and throughout the infant's first year of life. The program was evaluated by analyzing the differences between a treatment group and a comparison group of parents. Significant differences between groups were found on measures of maternal mood states, maternal-infant relationships, and home environment. Services to over 900 families by 110 volunteer parents have convinced staff that the volunteer parents are a valuable and indispensable component of the services at Butterworth Hospital and that families of high-risk infants benefit from past experiences and ongoing support of volunteer parents.