An examination of the interactions between mothers and children with anxiety disorders
Introduction
Aetiological models of anxiety emphasize the importance of childrearing factors in the development and maintenance of anxiety disorders in children (Chorpita and Barlow, 1998, Ginsburg and Schlossberg, 2002, Hudson and Rapee, 2004, Krohne, 1990, Manassis and Bradley, 1994, Rapee, 2001, Rubin and Mills, 1991). These theories maintain that parenting characterized by control (overinvolvement/overprotection) and rejection (negativity/criticism) are associated with anxious symptomatology in children. Parents of anxious children are likely to experience anxiety themselves (Last, Hersen, Kazdin, Francis, & Grubb, 1987) which is proposed to exacerbate an overinvolved, overprotective (Bogels and Brechman-Toussaint, 2006, Cobham, 1998, Ginsburg and Schlossberg, 2002, Hudson and Rapee, 2004, Rapee, 2001) and critical (Ginsburg, Grover, Cord, & Ialongo, 2006) parenting style with anxious children, particularly after the child exhibits negative affect (Ballash et al., 2006, Woodruff-Borden et al., 2002). In other words, dysfunctional parenting styles may reflect, in part, the manifestation of a parent's own anxiety (Hudson & Rapee, 2002). An anxious parent may be more likely to overprotect their child due to their own cognitive bias towards threat, increased perception of danger, and elevated sensitivity to their child's distress (Hudson & Rapee, 2004). Moreover, parents with high levels of anxiety may be more likely to exhibit negativity towards their child as a result of their low perceived control over their child's anxious behaviour (Wheatcroft & Creswell, 2007). As such, Ginsburg et al. (2006) have suggested that high levels of anxiety in parents may lead to “anxiety-enhancing” parenting behaviours (e.g., overinvolvement, criticism) which reinforce a child's innate vulnerability to developing an anxiety disorder. Thus, both parent and child engage in a reciprocal relationship whereby child risk factors (e.g., early temperament) interact with maladaptive parenting styles, which are theorized to be more prominent in anxious parents, increasing the likelihood that anxiety in the child will emerge.
A vast amount of research has examined childrearing patterns and childhood anxiety. Substantial findings support the association between overinvolved parenting and child anxiety disorders, while results have been somewhat less consistent regarding the relationship between parental negativity and anxiety (see Bogels and Brechman-Toussaint, 2006, McLeod et al., 2007 for recent reviews). In contrast, research investigating the association between parental anxiety and parenting practices with anxious children has been limited. Given the potential importance of parental anxiety in increasing a child's vulnerability to developing an anxiety disorder, an examination of the relationship between maternal behaviours and maternal anxiety will assist in informing and refining theoretical models with regard to the potential parent factors associated with child anxiety. Additionally, understanding the extent to which the presence of anxiety in mothers is related to maternal behaviour will allow for clinicians to better assess for and modify maladaptive parenting practices, ultimately leading to enhanced prevention and intervention strategies for child anxiety (Ginsburg et al., 1995, Hirshfeld-Becker and Biederman, 2002).
In the observational research involving clinically anxious children, self-reported maternal anxiety has not been found to be associated with increased maternal overinvolvement or negativity (Hudson & Rapee, 2001). However, questionnaire measures of mothers' anxiety may lack validity in this population. Mothers who bring their children to anxiety clinics for treatment commonly under-report or deny their own anxiety on self-report instruments (Rapee, 2000). The mean scores of mothers' anxiety in clinical child samples have often not significantly differed from the scores of mothers of nonclinical children (e.g., Bogels and Siqueland, 2006, Siqueland et al., 1996). This is incompatible with previous research which has shown that 57% of mothers presented with an anxiety disorder diagnosis at the same time that their child was being treated for anxiety (Last et al., 1987). In order to test the degree to which mothers' anxiety is associated with parenting behaviours, it would be useful to employ diagnostic interviews to assess maternal anxiety status, rather than relying solely on the self-report data used in the majority of studies. Clinical interviews allow for the development of a relationship with mothers and as a result of skilful questioning by the clinician, respondents are more likely to admit to difficulties such as anxiety (Siqueland et al., 1996). As such, structured diagnostic interviews are considered to enhance reliability and validity in making formal diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria (Kendall and Flannery-Schroeder, 1998, Silverman and Ollendick, 2005).
A handful of studies employing observational designs have used diagnostic interviews to assess anxiety in parents in order to investigate the association between parenting behaviours and parental anxiety, although findings have not been consistent. One study showed that anxious mothers were more critical and less likely to encourage psychological autonomy during interactions with their children than were nonanxious mothers (Whaley, Pinto, & Sigman, 1999). On the other hand, a number of studies have found no differences in parental control/autonomy granting or negativity/criticism between anxious and nonanxious parents (Ginsburg et al., 2004, Moore et al., 2004, Turner et al., 2003, Woodruff-Borden et al., 2002). One possible explanation for the variation of findings in the empirical literature may be related to the fact that some studies have investigated the behaviour of anxious parents without assessing the child's diagnostic status (or not considering it in the analyses), while others have explored the parenting styles in parents of anxious children without taking into account the parent's anxiety diagnosis. Given the mutual dyadic influences inherent in the parent–child relationship, the interaction style is likely to be influenced by both the mother's and the child's diagnostic status. Only one previous study (Moore et al., 2004) has examined whether maladaptive parenting behaviours were more closely related to the child's anxiety diagnosis, the mother's anxiety diagnosis, or a combination of the two. The latter study was limited, however, as it used a relatively small sample size (N = 68 dyads) which allowed for very few dyads in each group, particularly the group in which mothers were anxious and children were not (N = 8 dyads).
The aim of the current study was to investigate the association between parenting styles as they relate to both mother and child anxiety status. This study examined maternal overinvolvement and negativity/criticism, two key parenting styles associated with child anxiety, in a speech preparation task and a Five Minute Speech Sample (FMSS) from mothers. Four groups were compared: nonanxious children with nonanxious mothers, anxious children with nonanxious mothers, nonanxious children with anxious mothers, and anxious children with anxious mothers. Based on aetiological models of anxiety (e.g., Ginsburg and Schlossberg, 2002, Hudson and Rapee, 2004), it was expected that these parenting behaviours would be associated with the child's anxiety status as well as an interaction between the mother's and child's anxiety status, and would thus be highest in the group in which both mother and child were anxious.
Section snippets
Sample 1: speech task
The sample consisted of 135 children and their mothers. There were 32 dyads in which neither children nor mothers were anxious, 28 dyads in which children were anxious and mothers were not (14 clinic-referred, and 14 nonclinic-referred), 37 dyads in which both children and mothers were anxious (12 clinic-referred, and 25 nonclinic-referred), and 38 dyads in which children were nonanxious and mothers were anxious (all nonclinic-referred). Children were aged 4–16 years, with a mean age of 8.89
Demographics
There were no significant differences in age, gender, family income, ethnic background (the sample was predominantly Caucasian), or family composition between the four groups (see Table 2). Maternal involvement and negativity of the interactions did not differ between boys and girls
Discussion
The current study used two tasks to investigate maternal overinvolvement and negativity/criticism as they relate to mother and child anxiety diagnoses. Data from the speech task demonstrated that mothers of anxious children were more overinvolved than mothers of nonanxious children, regardless of maternal anxiety status. These findings were consistent for younger (4–11 years) and older (12–16 years) children. Similar results from the FMSS showed that mothers of anxious children were more
Acknowledgements
This research was funded by the Australian Research Council Discovery Project Grant Project ID DP0342793 (Chief Investigator – Dr. Jennifer L. Hudson).
References (54)
- et al.
Family issues in child anxiety: attachment, family functioning, parental rearing and beliefs
Clinical Psychology Review
(2006) - et al.
Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples
Behaviour Research and Therapy
(1997) - et al.
Family involvement in treating children with phobic and anxiety disorders: a look ahead
Clinical Psychology Review
(1995) - et al.
The relationship between anxious rearing behaviours and anxiety disorders symptomatology in normal children
Journal of Behavior Therapy and Experimental Psychiatry
(1999) - et al.
Parent–child interactions and anxiety disorders: an observational study
Behaviour Research and Therapy
(2001) - et al.
Maternal expectations and attributions about coping in anxious children
Journal of Anxiety Disorders
(1997) - et al.
The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories
Behaviour Research and Therapy
(1995) - et al.
Interrater reliability of the anxiety disorders interview schedule for DSM-IV: child and parent version
Journal of the American Academy of Child and Adolescent Psychiatry
(2007) - et al.
Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children
Journal of the American Academy of Child and Adolescent Psychiatry
(2005) - et al.
Examining the association between parenting and childhood anxiety: a meta-analysis
Clinical Psychology Review
(2007)
A brief method for assessing expressed emotion in relatives of psychiatric patients
Psychiatry Research
The development of childhood anxiety disorders: toward an integrated model
Journal of Applied Developmental Psychology
A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample
Behaviour Research and Therapy
The potential role of childrearing practices in the development of anxiety and depression
Clinical Psychology Review
A measure of anxiety symptoms among children
Behaviour Research and Therapy
The structure of anxiety symptoms among preschoolers
Behaviour Research and Therapy
Parenting behaviors in parents with anxiety disorders
Behaviour Research and Therapy
Diagnostic and statistical manual of mental disorders
Psychometric properties of the 42-item and 21-item version of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample
Psychological Assessment
Parental control in the etiology of anxiety
Clinical Child and Family Psychology Review
Family cognitive behavioral therapy for children and adolescents with clinical anxiety disorders
Journal of the American Academy of Child and Adolescent Psychiatry
Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV)
Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders
Journal of Abnormal Psychology
The development of anxiety: the role of control in the early environment
Psychological Bulletin
The case for involving the family in the treatment of childhood anxiety
Behaviour Change
Observational measures of parenting in anxious and nonanxious mothers: does type of task matter?
Journal of Clinical Child and Adolescent Psychology
Parenting behaviors among anxious and non-anxious mothers: relation with concurrent and long-term child outcomes
Child and Family Behavior Therapy
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