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1.  Anxiety/Stress among Mothers Living with HIV: Effects on Parenting Skills & Child Outcomes 
AIDS care  2010;22(12):1449-1458.
Parental HIV infection has been associated with negative outcomes for children, and parenting skills appear to be one mechanism operating in that association. The present study focuses on the relations between maternal stress, parenting, and child functioning among families where the mother is living with HIV. Sixty-nine mothers with at least one child between 6 and 12 years old completed questionnaires at the baseline assessment of an intervention designed to facilitate maternal disclosure of HIV status. Respondents were assessed using multiple measures of stress/anxiety, and parenting skills and child outcomes, including the Parenting Stress Index, the RAND Mental Health Inventory, the Family Routines Questionnaire, and the Child Behavior Checklist. Covariance structural modeling was used to assess the variable relationships, with latent constructs created for maternal anxiety/stress, parenting skills, and child problem behaviors (both direct and indirect effects were evaluated, with a model-based bootstrap used to verify model stability). Results demonstrated that maternal stress was negatively associated with a broad range of parenting skills, and that parenting skills were negatively associated with child problem behaviors. Mothers living with HIV who are anxious about their own health and functioning, and who were more stressed in their parental role, were more likely to exhibit poorer parenting skills—specifically to engage children less frequently in family routines (e.g., eating meals together, having a bedtime routine), poorer parent-child communication, and poorer and less consistent parenting discipline. Not uncommonly, mothers living with HIV experience a range of stressors above and beyond those related to their illness (e.g., poverty, residence in high risk and low resource communities, discrimination). Results demonstrate the need for interventions designed to decrease maternal stress and enhance parenting skills for families affected by HIV.
PMCID: PMC3000905  PMID: 20824552
HIV; maternal stress; parenting; child functioning
2.  Stress among Fathers of Young Children with Type 1 Diabetes 
Although fathers’ stress has been shown to have important implications for children’s health and well-being, few studies of children with type 1 diabetes have considered paternal parenting stress. The current study contributes to the literature by exploring correlates of fathers’ pediatric parenting stress in a sample of young children with type 1 diabetes. Forty-three fathers of children 2–6 years old with type 1 diabetes completed self-report questionnaires examining pediatric parenting stress, child behavior, participation in diabetes management tasks, and parental psychological resources. Results of multiple regression show that fathers’ pediatric parenting stress is positively associated with state anxiety and mother-reported difficult child behavior. These findings suggest that fathers may experience parenting stress differently than mothers, and that their experiences may have implications not only for their own level of anxiety, but also for their children’s behavior.
PMCID: PMC2853761  PMID: 20047355
fathers; parenting stress; type 1 diabetes; early childhood
3.  Maternal Employment and Parent-Child Relationships in Single-Parent Families of Low-Birth-Weight Preschoolers 
Nursing research  1998;47(2):114-121.
The influence of premature birth of an infant in female-headed, single-parent families together or in conjunction with family environment factors, such as employment of the mother, on the mother-premature child relationship has not been considered in past studies.
To explore differences in parent-child and family relationships for employed and nonemployed single mothers of low–birth-weight (LBW) and full-term preschool children and to describe the relationships of the mothers employment status, employment history, and employment attitude-behavior consistency to parent-child and family relationships.
Single mothers with LBW (n = 60) and full-term (n = 61) preschool children provided data on their employment situation, the Parenting Stress Index, the Feetham Family Functioning Survey, and the Home Observation for Measurement of the Environment.
Employed mothers had more positive perceptions and provided more enriching home environments for their children. Greater attitude-behavior consistency was associated with more positive perceptions of the parental role.
Thus, in single-parent families, employment and consistency are positive influences on the mother-child relationship.
PMCID: PMC2792580  PMID: 9536195
maternal-child; low-birth-weight infants; single-parent families; maternal employment
4.  Stress in Adolescents with a Chronically Ill Parent: Inspiration from Rolland’s Family Systems-Illness Model 
This article was inspired by Rolland’s Family Systems-Illness (FSI) model, aiming to predict adolescent stress as a function of parental illness type. Ninety-nine parents with a chronic medical condition, 82 partners, and 158 adolescent children (51 % girls; mean age = 15.1 years) participated in this Dutch study. The Dutch Stress Questionnaire for Children was used to measure child report of stress. Ill parents completed the Beck Depression Inventory. Children filled in a scale of the Inventory of Parent and Peer Attachment measuring the quality of parent attachment. Both parents filled in the Parent-Child-Interaction Questionnaire-Revised. We conducted multilevel regression analyses including illness type, the ill parent’s depressive symptoms, family functioning (quality of marital relationship, parent-child interaction, and parent attachment), and adolescents’ gender and age. Four regression analyses were performed separately for each illness type as defined by disability (Model 1), and onset (Model 2), course (Model 3), and outcome of illness (Model 4). In all models, higher adolescent stress scores were linked to lower quality of parent-child interaction and parent attachment, and adolescents’ female gender. The four models explained approximately 37 % of the variance in adolescent stress between individuals and 43-44 % of the variance in adolescent stress between families. Adolescent stress was not related to parental illness type. Our results partially supported the FSI model stating that family functioning is essential in point of child adjustment to parental illness. In the chronic stage of parental illness, adolescent stress does not seem to vary depending on illness type.
PMCID: PMC3484274  PMID: 23125518
Chronic medical condition; Adolescent; Stress; Family-systems illness model
5.  Maternal feeding practices, child eating behaviour and body mass index in preschool-aged children: a prospective analysis 
Previous research has found associations between parental feeding practices and children's eating behaviour and weight status. Prospective research is needed to elucidate these relationships.
One hundred and fifty-six mothers of 2- to 4-year-old children completed questionnaires including measures of maternal feeding practices (pressure to eat, restriction, monitoring and modelling of healthy eating), child eating behaviour (food responsiveness, food fussiness and interest in food), and mother reported child height and weight. The questionnaire was repeated 12 months later. Regression analyses were used to find longitudinal associations between maternal feeding practices, child eating behaviour and child body mass index (BMI).
Modelling of healthy eating predicted lower child food fussiness and higher interest in food one year later, and pressure to eat predicted lower child interest in food. Restriction did not predict changes in child eating behaviour. Maternal feeding practices did not prospectively predict child food responsiveness or child BMI.
Maternal feeding practices appear to influence young children's eating behaviour but not weight status in the short term.
PMCID: PMC2907299  PMID: 20579397
6.  Preliminary Evaluation of Maternal Caregiver Stress in Pediatric Eosinophilic Gastrointestinal Disorders 
Journal of Pediatric Psychology  2012;37(5):523-532.
Objective To characterize caregiver stress (CS) in parents of children with Eosinophilic Gastrointestinal Disorders (EGIDs) and understand relationships with psychological functioning and child behavior. Methods Caregivers with a child (0–17 years) with EGID completed questionnaires for demographics, EGID severity, treatments, CS, psychological distress, self-efficacy, and child behaviors. Results A total of 163 caregivers (98% mother, 94% Caucasian) participated. CS correlated with psychological distress, income, child behavioral problems, treatments, and disease severity. Children were rated higher than age-specific norms for emotional difficulties. Behavioral difficulties associated with gender, age, EGID severity, and duration. Parent psychological distress was most strongly associated with CS. Parental self-efficacy, dietary treatments, and child emotional difficulties were also related to stress. Conclusions Mothers reported stress and psychological distress from caring for a child with EGID. The relationship between these variables suggests these parents may benefit from supportive psychotherapy interventions. Evaluation of parental self-efficacy and child behavior is also warranted.
PMCID: PMC3356561  PMID: 22271793
child behavior; eosinophilic gastrointestinal disorders; parental caregiver stress; psychological functioning
7.  Effects of massage therapy of asthmatic children on the anxiety level of mothers 
Asthma is the most common chronic disease of childhood and its prevalence is increasing all over the world. Asthma influences on many aspects of family daily life. Health care of children with chronic asthma can have deep impact on health and welfare of the family members. Studies showed a relation between the life quality of children suffering from asthma and the anxiety level of parents. These parents are looking for ways to confront with their stress, to reduce their anxiety in encountering with their asthmatic children, and to improve their performance. This research was accomplished with the aim of determining the influence of massage therapy on anxiety level of mothers with asthmatic children.
This was a quasi-experimental study with two groups and a pretest and posttest design. The samples of research were 60 mothers of 5-14 year-old asthmatic children who were under treatment in medical centers of Isfahan. They were randomly divided into two groups of control and massage therapy by convenience sampling method. The data were collected by standard Spielberger questionnaire. Mothers of massage group were trained to massage head, neck, face, shoulder, hand, leg, and back of their children every night before bedtime for one month while there was no intervention for the control group during this month except the standard treatment. In both groups, the Spielberger standard questionnaire was filled by mothers. The data were analyzed by descriptive analysis, independent t-test, paired-t test, and chi-square test.
The results showed no significant difference in mean anxiety level between the two groups before the intervention but there was a significant difference between them after intervention (p < 0.03). Also, there was a significant difference in mean level of anxiety score of mothers before and after the intervention in massage group (p < 0.001).
The anxiety level of mothers can be reduced by effective utilization of daily child massage therapy and giving an active role to the mothers in caring and treating the child. Daily massage helped mothers to have more sense of participation in caring their children and as a non-pharmacological method can be accompanied with pharmacological methods.
PMCID: PMC3093168  PMID: 21589776
Asthma; anxiety; children; massage therapy; mothers
8.  Predictors of parental perceptions and concerns about child weight 
Appetite  2012;62:96-102.
Appropriate levels of parental perception and concern about child weight are important components of successful obesity treatment, but the factors that contribute to these attitudes need clarification. The aim of this study was to identify child and parent characteristics that best predict parental perceptions and concerns about child weight. A cross-sectional design was used to assess characteristics of parents (e.g. age, income, and feeding attitudes) and children (e.g. body composition, ad libitum intake, and reported physical activity). Results are reported for 75, 4–6 year-olds from diverse ethnicities. Perceived child weight and concern were measured with the Child Feeding Questionnaire (CFQ). Multiple linear regression was used to identify the best models for perceived child weight and concern. For perceived child weight, the best model included parent age, children’s laboratory intake of sugar-sweetened beverages (SSB) and palatable buffet items, and two measures of child body composition (ratio of trunk fat-to-total fat and ratio of leg fat-to-total fat). For concern, child android/gynoid fat ratio explained the largest amount of variance, followed by restrictive feeding and SSB intake. Parental perceptions and concerns about child weight are best explained by models that account for children’s eating behavior and body fat distribution.
PMCID: PMC3552072  PMID: 23207190
obesity; body weight; parental perceptions; eating behavior
9.  The Relationship Between Sources and Functions of Social Support and Dimensions of Child- and Parent-Related Stress 
In this longitudinal study, we examined the relationship between the sources and functions of social support and dimensions of child- and parent-related stress for mothers of young children with mild developmental delays.
Sixty-three mothers completed assessments of stress and support at two time points.
Multiple regression analyses revealed that parenting support during the early childhood period (i.e., advice on problems specific to their child and assistance with child care responsibilities), irrespective of source, consistently predicted most dimensions of parent stress assessed during the early elementary years and contributed unique variance. General support (i.e., primarily emotional support and validation) from various sources had other, less widespread effects on parental stress.
The multi-dimensional perspective of the construct of social support that emerged suggested mechanisms mediating the relationship between support and stress and provided a framework for intervention.
PMCID: PMC2585608  PMID: 18507703
parent stress; social support; developmental delay
10.  Parental attitudes and opinions on the use of psychotropic medication in mental disorders of childhood 
The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication.
A 20-item questionnaire was distributed to 140 parents during their first contact with an outpatient child psychiatric service. The questionnaire comprised of questions regarding the opinions, knowledge and attitudes of parents towards children's psychotropic medication. Sociodemographic data concerning parents and children were also recorded. Frequency tables were created and the chi-square test and Fisher's exact tests were used for the comparison of the participants' responses according to sex, educational level, age and gender of the child and use of medication.
Respondents were mostly mothers aged 25–45 years. Children for whom they asked for help with were mostly boys, aged between 6 and 12 years old. A total of 83% of the subjects stated that they knew psychotropic drugs are classified into categories, each having a distinct mechanism of action and effectiveness. A total of 40% believe that there is a proper use of psychotropic medication, while 20% believe that psychiatrists unnecessarily use high doses of psychotropic medication. A total of 80% fear psychotropic agents more than other types of medication. Most parents are afraid to administer psychotropic medication to their child when compared to any other medication, and believe that psychotherapy is the most effective method of dealing with every kind of mental disorders, including childhood schizophrenia (65%). The belief that children who take psychotropic medication from early childhood are more likely to develop drug addiction later is correlated with the parental level of education.
Parents' opinions and beliefs are not in line with scientific facts. This suggests a need to further inform the parents on the safety and efficacy of psychotropic medication in order to improve treatment compliance.
PMCID: PMC2206023  PMID: 18005445
11.  Informant Discrepancies in Assessing Child Dysfunction Relate to Dysfunction Within Mother-Child Interactions 
Examined whether mother-child discrepancies in perceived child behavior problems relate to dysfunctional interactions between mother and child and stress in the mother. Participants included 239 children (6–16 years old; 58 girls, 181 boys) referred for oppositional, aggressive, and antisocial behavior, and their mothers. Mother-child discrepancies in perceived child behavior problems were related to mother-child conflict. Moreover, maternal stress mediated this relationship. The findings suggest that discrepancies among mother and child evaluations of child functioning are not merely reflections of different perspectives or artifacts of the assessment process, but can form components of conceptual models that can be developed and tested to examine the interrelations among critical domains of child, parent, and family functioning.
PMCID: PMC3020626  PMID: 21243074
attribution bias context; disagreement; discrepancies; stress; conflict
12.  Stability, Continuity, and Similarity of Parenting Stress in European American Mothers and Fathers across their Child’s Transition to Adolescence 
Experiencing some degree of parenting stress is virtually unavoidable, particularly as children enter early adolescence and assert their independence. In this study, we examined how parenting stress attributed to the parent, the child, or the dyad changed in mean level and relative standing across their child’s transition to adolescence. We also compared mothers and fathers from the same families in terms of parenting stress and explored how one parent’s stress affected the other parent’s stress.
Participants included 222 European American parents (111 mothers and 111 fathers), assessed when their children were 10 and 14 years old.
Parenting stress was highly stable from 10 to 14 years. Total parenting stress increased across time, and was attributable to stress due to increased parent-child dysfunctional interaction, not parental distress or stress due to child behavior. Mothers and fathers agreed moderately in their relative standing and in the average levels of parenting stress in the three different domains of parenting stress at each time point. Mothers’ and fathers’ stress across domains were sometimes related.
Mothers’ and fathers’ increased parenting stress across their child’s transition to adolescence seems to derive from parent-child interaction rather than qualities of the parent or the child per se. Finding ways to maintain parent-child communication and closeness may protect parents and families from increased stress during this vulnerable time.
PMCID: PMC2827850  PMID: 20191083
13.  Spectrum of Asthma in Children—III, Psychological and Social Components 
British Medical Journal  1973;4(5883):16-20.
Behavioural disturbances in the child, the mother-child and family relationships, and the family social structure were studied in a representative sample of the whole range of asthmatic children and compared with a control group of normal children. Behavioural disturbances occurred more often and at a statistically significant level only in the small group of children with severe and continuing asthma. These children were those with severe chronic airways obstruction as assessed physiologically and also with the most severe allergic manifestations.
Predominant in the mother-child relations was an over-concern to protect the child's health in those children with continuing asthma at 14 years of age. The families of the very severely affected group of children showed evidence of more stress than other families. Socioeconomic conditions were not significantly different in any group of asthmatic children compared with the control group.
PMCID: PMC1587077  PMID: 4755207
14.  Maternal Coping Strategies in Response to a Child’s Chronic and Oncological Disease: a Cross-Cultural Study in Italy and Portugal 
Pediatric Reports  2013;5(2):43-47.
A child’s oncological or chronic disease is a stressful situation for parents. This stress may make it difficult for appropriate management strategies aimed at promoting the child’s wellbeing and helping him or her cope with a disease to be adopted. In particular, this study focuses on the possible connections between the variable national cultural influences and the parental strategies used to cope with a child’s severe disease by comparing the experiences of Italian and Portuguese mothers. The study investigates differences and cross-cultural elements among the coping strategies used by Italian and Portuguese mothers of children with oncological or chronic disease. Two groups of mothers took part: 59 Italian mothers (average age 37.7 years; SD=4.5) and 36 Portuguese mothers (average age 39.3 years; SD=4.6). The tool used was the Italian and the Portuguese versions of the COPE inventory that measures five coping strategies: Social Support, Avoidance Coping, Positive Aptitude, Religious Faith and Humor, Active Coping. There were statistically significant differences between Portuguese and Italian mothers regarding Social Support (F(3, 94)=6.32, P=0.014, ɳ2=0.065), Religious Faith and Humor (F(3, 94)=20.06, P=0.001, ɳ2=0.18, higher values for Portuguese mothers) and Avoidance Coping (F(3, 94)=3.30, P=0.06, ɳ2=0.035, higher values for Italian mothers). Regarding child’s disease, the only statistically significant difference was in Religious Faith and Humor (F(3, 94)=7.49, P=0.007, ɳ2=0.076, higher values for mothers of children with chronic disease). The findings of specific cultural transversalities provide the basis for reflection on important factors emerging on the relationship between physicians and parents. In fact, mothers’ coping abilities may allow health workers involved in a child’s care not only to understand how parents face a distressful event, but also to provide them with professional support.
PMCID: PMC3718229  PMID: 23904966
maternal coping; chronic disease; oncological disease; emotional distress
15.  Validation of a maternal questionnaire on correlates of physical activity in preschool children 
Valid measures of physical activity correlates in preschool children are lacking. This study aimed to assess the validity, factor structure and internal consistency of a maternal questionnaire on potential correlates of four-year-old children's physical activity.
The questionnaire was designed to measure the following constructs: child personal factors; parental support and self-efficacy for providing support; parental rules and restrictions; maternal attitudes and perceptions; maternal behaviour; barriers to physical activity; and the home and local environments. Two separate studies were conducted. Study I included 24 mothers of four-year-old children who completed the questionnaire then participated in a telephone interview covering similar items to the questionnaire. To assess validity, the agreement between interview and questionnaire responses was assessed using Cohen's kappa and percentage agreement. Study II involved 398 mothers of four-year-old children participating in the Southampton Women's Survey. In this study, principal components analysis was used to explore the factor structure of the questionnaire to aid future analyses with these data. The internal consistency of the factors identified was assessed using Cronbach's alpha.
Kappa scores showed 30% of items to have moderate agreement or above, 23% to have fair agreement and 47% to have slight or poor agreement. However, 89% of items had fair agreement as assessed by percentage agreement (≥ 66%). Limited variation in responses to variables is likely to have contributed to some of the low kappa values. Six questions had a low kappa and low percentage agreement (defined as poor validity); these included questions from the child personal factors, maternal self-efficacy, rules and restrictions, and local environment domains. The principal components analysis identified eleven factors and found several variables to stand alone. Eight of the composite factors identified had acceptable internal consistency (α ≥ 0.60) and three fell just short of achieving this (0.60 > α > 0.50).
Overall, this maternal questionnaire had reasonable validity and internal consistency for assessing potential correlates of physical activity in young children. With minor revision, this could be a useful tool for future research in this area. This, in turn, will aid the development of interventions to promote physical activity in this age group.
PMCID: PMC2791748  PMID: 19954524
16.  Associations between parent and child pain and functioning in a pediatric chronic pain sample: A mixed methods approach 
This study employed a mixed-method design to test sex-specific parent-child pain associations. Subjects were 179 chronic pain patients aged 11–19 years (mean = 14.34; 72% female) presenting for treatment at a multidisciplinary, tertiary clinic. Mothers and children completed questionnaires prior to their clinic visit, including measures of children’s pain, functioning and psychological characteristics. Mothers also reported on their own pain and psychological functioning. Interviews were conducted with a sub-sample of 34 mothers and children prior to the clinic visit and analyzed using a grounded theory approach. The quantitative data suggest stronger mother-daughter than mother-son pain relationships. The qualitative data suggest that girls’ pain and pain-related disability is related to an overly enmeshed mother-daughter relationship and the presence of maternal models of pain, while boys’ pain and disability is linked to male pain models and criticism and to maternal worry and solicitousness. Boys and girls appear to have developmentally incongruous levels of autonomy and conformity to maternal expectations. The mixed-method data suggest distinct trajectories through which mother and father involvement may be linked to chronic pain in adolescent boys and girls.
PMCID: PMC3105525  PMID: 21643522
Sex differences; parent-child relationships; chronic pain
17.  Attitudes of Saudi parents toward separation from their children during dental treatment 
The Saudi Dental Journal  2009;21(2):63-67.
The purpose of this study was to investigate the attitudes of Saudi parents to being separated or not separated from their children in the dental office and to assess the factors affecting such attitudes.
Five hundred and five parents participated in the study by completing a questionnaire which included questions related to their sex, marital status, job, family income and reasons for seeking dental treatment for the child. Questions were also designed to determine the responses and attitudes of the parents regarding their presence in the dental clinic.
Ninety-seven percent of the respondents preferred to stay with their children during dental treatment of their children. The main reason given by 83% of the parents was that the child would feel safe. More than 72% of the parents reported that they would reduce their child’s fear and comfort him/her during the dental treatment.
From the parent’s point of view, the most threatening dental procedure undergone by their children was dental anesthesia (87.7%) followed by the use of dental drills (55.4%). It can be concluded from the results that majority of Saudi parents studied preferred to stay with their children during treatment. Dentists should consider this when treating children.
PMCID: PMC3722991  PMID: 23960461
18.  Syndrome specificity and mother-child interactions: Examining positive and negative parenting across contexts and time 
This study examined the extent to which child syndromes and observation context related to mothers’ parenting behaviors. Longitudinal observations were conducted of parenting behavior across ages 3, 4, and 5 years during structured and unstructured activities. The 183 participants included mothers of children with autism spectrum disorders, cerebral palsy, Down syndrome, undifferentiated developmental delay, or typical cognitive development. Negative parenting behaviors were higher in structured activities and higher in mothers of children in all developmentally delayed groups. Positive parenting was higher in unstructured activities and especially high for mothers of children with Down syndrome. Despite differences found through direct observation of parenting children in different diagnostic groups, they are not as strong as syndrome-group differences found through more commonly used self-report questionnaires assessing domains like parenting stress.
PMCID: PMC3548024  PMID: 22829243
developmental disabilities; parenting behaviors; autism
19.  Stress in mothers of young children with eczema 
Archives of Disease in Childhood  2007;92(8):683-686.
To assess parental stress levels of mothers of children less than 6 years old with eczema and compare these levels with those reported for other chronic childhood illnesses.
Mothers were recruited from hospital‐based out‐patient clinics (55%) or while their child was an in‐patient (45%) for management of eczema. Maternal stress was measured utilising the Parenting Stress Index‐Long Form (PSI) in 33 mothers. The severity of the eczema at the time of interview was documented by the Eczema Area and Severity Index (EASI) score and the Investigators' Global Assessment (IGA) score.
The children with eczema had a mean age of 2.8 years. Mothers of children aged 5 years or less with eczema exhibited significantly higher total stress scores (mean PSI 259.6, 95% CI 244.9 to 274.3) as compared to mothers of normal children (PSI 222.8, 95% CI 221.4 to 224.2) and children with other chronic disorders such as insulin‐dependent diabetes (PSI 218.1, 95% CI 204.7 to 231.6) and profound deafness (PSI 221.7, 95% CI 206.4 to 237.0). Stress scores in the parental domain (138.2, 95% CI 128.9 to 147.6) did not differ significantly from the scores of parents of children with severe disabilities such as those requiring home enteral feeding (135.2, 95% CI 129.3 to 141.1) and those with Rett syndrome (132.8, 95% CI 125.0 to 140.6).
Moderate to severe childhood eczema should be regarded as a significant illness in which maternal stress is equivalent to that associated with the care of children with severe developmental and physical problems.
PMCID: PMC2083902  PMID: 17412743
eczema; mothers; preschool; psychological stress
20.  Parental Responses to Positive and Negative Emotions in Anxious and Nonanxious Children 
This study examined the role of multiple children's emotions and parental anxiety during parent–child interactions of anxiety disordered (AD) and nonanxious (NA) children ages 7 to 13 years. Families (mother, father, child) each discussed three recent and real separate situations in which the child experienced anxiety, anger, and happiness. Results revealed significant differences in behavior between parents of AD and NA children. Maternal behavior, but not paternal behavior, was related to the emotion the child was experiencing. Mothers of AD children displayed greater intrusive involvement than mothers of NA children in those situations in which the child was experiencing negative affect. A significant interaction was evident between maternal anxiety disorder and emotion, whereby anxious mothers were more intrusive in situations involving anxiety and anger (compared to positive emotion situations), whereas nonanxious mothers were more intrusive only during situations involving anger.
PMCID: PMC2677179  PMID: 18470768
21.  Impact of Prior Traumatic Life Events on Parental Early Stage Reactions following a Child's Cancer 
PLoS ONE  2013;8(3):e57556.
In pediatric oncology, effective clinic–based management of acute and long–term distress in families calls for investigation of determinants of parents' psychological response to the child's cancer. We examined the relationship between parents' prior exposure to traumatic life events (TLE) and the occurrence of posttraumatic stress symptoms (PTSS) following their child's cancer diagnosis. Factors mediating the TLE–PTSS relationship were analyzed.
The study comprised 169 parents (97 mothers, 72 fathers) of 103 cancer diagnosed children (median age: 5,9 years; range 0.1–19.7 years). Thirty five parents were of immigrant origin (20.7%). Prior TLE were collated using a standardized questionnaire, PTSS was assessed using the Impact of Events–Revised (IES–R) questionnaire covering intrusion, avoidance and hyperarousal symptoms. The predictive significance of prior TLE on PTSS was tested in adjusted regression models.
Mothers demonstrated more severe PTSS across all symptom dimensions. TLE were associated with significantly increased hyperarousal symptoms. Parents' gender, age and immigrant status did not significantly influence the TLE–PTSS relationship.
Prior traumatic life–events aggravate posttraumatic hyperarousal symptoms. In clinic–based psychological care of parents of high–risk pediatric patients, attention needs to be paid to life history, and to heightened vulnerability to PTSS associated with female gender.
PMCID: PMC3597714  PMID: 23516408
22.  Parental stress when caring for a child with cancer in Jordan: a cross-sectional survey 
Most studies report that being parents of a child with cancer is a stressful experience, but these have tended to focus on mothers and few have included both parents. Moreover, studies have focussed on families in Western countries and none have been published examining the psychological outcomes for parents living in an Arabic country.
This research explores the stress levels of Jordanian parents caring for a child with cancer in order to identify the psychological needs of parents in this environment and to explore how mothers and fathers stress levels might differ.
The study was carried out in Jordan using the Perceived Stress Scale 10-items (PSS10). The questionnaire was completed by 300 couples with a child who has cancer and a comparison group of 528 couples where the children do not have any serious illness. Multivariate backward regression analysis was carried out.
Analysis adjusting for spousal stress and sociodemographic predictors revealed that stress levels of mothers with a child who had cancer remained significantly higher than mothers whose children did not have any serious illness (p < 0.001). However, having a child with cancer did not show a significant association with the fathers’ reported stress scores (p = 0.476) when spousal stress was in the model, but was highly significant once that was removed (p < 0.001).
Parental stress was analysed for those with a child who has cancer and in models which included spouse’s stress scores, sociodemographic and cancer-related predictors 64 % of the variance was explained for mothers (adjusted R2 = 0.64, p < 0.001) and fathers (adjusted R2 = 0.64, p < 0.001). Models excluding spousal stress scores explained just 26 % of the variance for fathers and 22 % for mothers.
This is the first study into the psychological outcomes for parents living in an Arabic country who care for a child with cancer. Both mothers and fathers with a child diagnosed with cancer reported higher stress levels than those from the normal Jordanian parent population. Mothers and fathers of children with cancer reported significantly different levels of stress to each other but models reveal significant contributions of the stress score of fathers upon mothers, and vice versa. The findings provide evidence of the need for psychological support to be developed for families caring for a child with cancer in Jordan.
PMCID: PMC3416682  PMID: 22838940
Parents; Children; Cancer; Stress; Caregivers; Mothers; Fathers
23.  Resilience and the course of daily parenting stress in families of young children with intellectual disabilities 
Parenting stresses have consistently been found to be higher in parents of children with intellectual disabilities (ID); yet, some families are able to be resilient and thrive in the face of these challenges. Despite the considerable research on stress in families of ID, there is still little known about the stability and compensatory factors associated with everyday parenting stresses.
Trajectories of daily parenting stress were studied for both mothers and fathers of children with ID across child ages 36–60 months, as were specific familial risk and resilience factors that affect these trajectories, including psychological well-being of each parent, marital adjustment and positive parent–child relationships.
Mothers’ daily parenting stress significantly increased over time, while fathers’ daily parenting stress remained more constant. Decreases in mothers’ daily parenting stress trajectory were associated with both mother and father’s well-being and perceived marital adjustment, as well as a positive father–child relationship. However, decreases in fathers’ daily parenting stress trajectory were only affected by mother’s well-being and both parents’ perceived marital adjustment.
Parenting stress processes are not shared entirely across the preschool period in parents of children with ID. Although individual parent characteristics and high-quality dyadic relationships contribute to emerging resilience in parents of children with ID, parents also affect each others’ more resilient adaptations in ways that have not been previously considered.
PMCID: PMC2796238  PMID: 19874449
fathers; intellectual disability; mothers; parenting stress; resilience
24.  The Feeding Demands Questionnaire: Assessment of Parental Demand Cognitions Concerning Parent–Child Feeding Relations 
There are few validated instruments measuring parental beliefs about parent–child feeding relations and child compliance during meals.
To test the validity of the Feeding Demands Questionnaire, a parent-report instrument designed to measure parents’ beliefs about how their child should eat.
Participants were 85 mothers of 3- to 7-year-old same-sex twin pairs or sibling pairs, and their children. Mothers completed the eight-item Feeding Demands Questionnaire and the Child Feeding Questionnaire, plus measures of depression and fear of fat.
Statistical analyses
Psychometric evaluations of the Feeding Demands Questionnaire included principal components analysis, Cronbach’s α for internal consistency, tests for convergent and discriminant validities, and Flesh-Kincaid for readability.
The Feeding Demands Questionnaire had three underlying factors: anger/frustration, food amount demandingness, and food type demandingness, for which subscales were computed. The Feeding Demands Questionnaire showed acceptable internal consistency (α ranging from .70 to .86) and was written at the 4.8th grade level. Mothers reporting greater anger/frustration during feeding were more likely to pressure their children to eat, while those reporting greater demands about the type of foods their children eat were more likely to monitor child fat intake. Mothers reporting greater demands about the amount of food their children eat were more likely to restrict eating, pressure children to eat, and monitor their fat intake.
The Feeding Demands Questionnaire appears valid for assessing maternal beliefs that children should comply with rules for eating and frustration during feeding. Different demand beliefs can underlie different feeding practices.
PMCID: PMC2917044  PMID: 18375218
25.  Effects of Stress on Mothers of Hospitalized Children in a Hospital in Iran 
Hospitalization of a child can cause severe anxiety and stress in the parents, especially for the mother. This stress consequently affects the treatment course of the child. Hereby, we investigate the impact of different stressors in mothers of hospitalized children.
Materials & Methods
In this cross-sectional study, 225 mothers of hospitalized children in the pediatric ward of Besat hospital were randomly selected and studied. Data collection tool was a two-part questionnaire gathered by interviewing the mother. The first part included demographic information of the patients.
The second part included questions regarding stressors in four different categories; child-related factors, environmental factors, socioeconomic factors and health professional factors. SPSS 16.5 was used for statistical analysis and data were analyzed by one way ANOVA and T test.
In the child-related factor category, fear of child death (84%); in the socioeconomic factor category, fear of disease in the other siblings (84%); in the environmental factor category, unpleasant odors in the ward (56%); and in the health professional category, not enough explanation about inserting IV lines, (54.2%) constituted the most important factors.
There was a meaningful correlation between the stressors and the mothers’ age and occupation, child age, days of hospitalization, types of admission and health insurance coverage, but there was no meaningful correlation between stressors and other factors.
Professional and in depth training programs should be provided for health care providers and nursing staff regarding dealing with mothers of hospitalized children.
PMCID: PMC3943023
Stressors; Mothers; Hospitalized children

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