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Article Excerpt
The present study describes an examination of the relationship of parent self-focused negative attributions to specific parenting variables, namely parental overprotection, perceived child vulnerability, and parenting stress. Parents of children diagnosed with one of three chronic illnesses, Type 1 diabetes (DM1), asthma (AS), or cystic fibrosis (CF), completed self-report measures of attributions for illness-unrelated events, parental overprotection, perceived child vulnerability, and parenting stress. Results indicated that parent self-focused negative attributions were significantly associated with parenting stress among the combined and DM1-only samples. In addition, parent self-focused negative attributions were associated with perceived child vulnerability among the CF-only group, whereas self-focused negative attributions were not associated with any of the parenting variables within the AS-only group. The current results suggest that parent self-focused negative attributions may exert illness-specific influences on other cognitive processes (e.g., perceptions of child vulnerability, perceptions of stress), which have the potential to influence child adjustment outcomes.
Keywords: parents, attributions, overprotection, vulnerability, stress
THE ROLE OF ATTRIBUTIONAL STYLE IN CHILDHOOD CHRONIC ILLNESS
Given the sense of uncontrollability that children with a chronic illness and their families often experience, it is little surprise that the construct of attributional style has been examined in relation to adjustment outcomes across various childhood disease groups, including Type 1 diabetes mellitus and childhood-onset asthma (Carpentier, Mullins, Chaney, & Wagner, 2006; Chaney et al., 2004; Mullins, Chaney, Pace, & Hartman, 1997). Attributional style refers to the manner in which individuals explain the causes of events across a wide range of life domains (Abramson, Metalsky, & Alloy, 1989). It stands to reason that in contextual situations characterized by a high degree of uncontrollability, individuals are likely to initiate causal searches to explain outcomes. These causal attributions are believed to play important roles in determining emotional and behavioral responses to future situations (Abramson et al., 1989). Research has demonstrated that the manner in which individuals cognitively appraise their situation is an important component of adjustment. Specifically, more pessimistic attributional styles reliably predict a range of outcomes, including depressive symptoms, disability/pain ratings, and psychological distress (see Chancy et al., 2004; Mullins et al., 1997), while more optimistic attributional styles predict coping behavior, adjustment to major life transitions, and responses to minor stressors across various illnesses and age groups (Hasan & Power, 2002).
The types of attributions parents make about the cause(s) of their child's behavior are linked to important outcomes, such as child health and parent-child relationship satisfaction (Antshel, Brewster, & Waisbren, 2004). Notably, parents can make different types of attributions, and it is important to distinguish between self-focused and child-centered parental attributions (Joiner & Wagner, 1996). Self-focused attributions are those that occur when parents relate their children's misbehavior to something about themselves. For instance, if in response to a child hitting his or her sibling, the parent thinks "my child's behavior is such a problem, and I need to be a better parent," this would constitute a self-focused attribution. Conversely, child-centered parental attributions occur when parents relate their children's misbehavior to something about their child. Utilizing the same example above, thinking "my child is so bad," in response to the child hitting his or her sibling, would constitute a child-focused attribution. Research examining parent attributions and subsequent parental responses is fairly limited and dated, although quite consistent. These investigations have found that when parents view their children as responsible for their misbehavior (i.e., child-centered attributions), they are more likely to respond negatively than if they view themselves as responsible for it (Alexander, Waldron, Barton, & Mas, 1989; Baden & Howe, 1992; Compas, Friedland-Bandes, Bastein, & Adelman, 1981; Slep & O'Leary, 1998).
Unfortunately, there is little literature assessing self-focused attributions among parents of children with a chronic illness, with most studies focusing on the relationship of global parent attributional style to more general parent mood states (i.e., depression, psychological distress). Moreover, few researchers have examined specific or discrete parent behaviors or perceptions (i.e., parental overprotection, perceived child vulnerability, parenting stress) that may subsequently influence child behaviors (Davis et al., 2001). Given the documented transactional nature of parent-child adjustment to childhood chronic illness, it stands to reason that examination of such discrete parent variables--and their possible predictors---is necessary to determine the influence they may subsequently exert upon child adjustment outcomes.
THE RELEVANCE OF PARENTING VARIABLES
Parental Overprotection
One parenting variable that potentially influences child adjustment outcomes is parental overprotection (OP). OP involves a specific pattern of parent behaviors that are overindulgent, overanxious, overprotective, or controlling in nature and considered to be excessive given the developmental level and abilities of the child (Thomasgard & Metz, 1993, 1997). Examples of parental overprotective behavior include (a) not allowing one's child to do things on his or her own, (b) comforting one's child immediately when he or she cries, (c) using baby words to speak to one's child, and (d) not allowing one's child to make his or her own decisions. Recent studies have indicated that parents of children with a chronic illness indeed reported more controlling, overprotective, and directive behavior than parents of children without a chronic illness (Holmbeck et al., 2002; Power, Dahlquist, Thompson, & Warren, 2003). Moreover, research by Holmbeck and colleagues demonstrated that parental overprotection is associated with less behavioral autonomy that, in turn, is associated with greater externalizing problems among children with chronic illness.
Perceived Child Vulnerability
Another parenting variable that may affect chronically ill children is the parent's perception that his or her child is vulnerable (i.e., child vulnerability syndrome; Thomasgard & Metz, 1997). Although the terms parental protectiveness and child vulnerability syndrome have often been used interchangeably, it is important to note that these two constructs indeed represent distinct clinical phenomena. Unlike the concept of parental overprotection, which refers to a specific pattern of parental behaviors intended to promote the safety and security of the child (e.g., "I keep a close watch on my child"), parental perceptions of child vulnerability (PCV) reflect parental attitudes or beliefs and their resulting consequences (e.g., "My child gets more colds than other children I know"). These parental attitudes include conscious and unconscious perceptions of fear regarding their child's health and/or potential premature death (Thomasgard & Metz, 1997).
Specific risk factors have been purported to facilitate the development of child vulnerability, including having a child with a chronic illness, a life-threatening illness, or both (Thomasgard, 1998). Indeed Anthony and colleagues (2003) suggested that increased parental perceptions of child vulnerability are associated with higher levels of generalized social distress and distress in specific social situations among children with rheumatic and pulmonary disease. Similarly, Mullins and colleagues (2004) found that perceived child vulnerability, and not parental overprotection, is associated with higher levels of child depressive symptoms among a sample of school-age children with Type 1 diabetes and their parents. Collectively, these findings lend additional empirical support for the transactional relationship between discrete parenting variables and child distress, and also support the view that overprotection and child vulnerability are distinct but overlapping constructs.
Parenting Stress
In addition to parental overprotection and perceived child vulnerability, the stress of caring for a chronically ill child may be another factor that predicts child adjustment outcomes. Research clearly indicates that mothers of chronically ill children are at risk for both increased stress and psychological distress (Thompson & Gustafson, 1996). Moreover, increased parenting stress levels have been found to be associated with less optimal parent and family functioning and, thus, lower child developmental competence (Livneh & Antonak, 1997). Further, research has also documented that parenting stress appears to magnify the relationship between perceived child vulnerability and child-reported depressive symptoms (Mullins et al., 2004).
THE RATIONALE FOR EXAMINATION OF DIABETES, ASTHMA, AND CYSTIC FIBROSIS
Given the lack of research assessing the nature of the...
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