An examination of the interactions between mothers and children with anxiety disorders

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Abstract

This study examined the association between parenting styles and mother and child anxiety. Maternal overinvolvement and negativity/criticism were evaluated during a speech preparation task (N = 135 dyads) and a Five Minute Speech Sample (FMSS) from mothers (N = 155). During the speech task interaction, mothers of anxious children (aged 4–16 years), regardless of their own anxiety, were observed to be more overinvolved than mothers of nonanxious children. Similarly, the FMSS showed that mothers of anxious children (aged 4–17 years) were more overprotective, self-sacrificing, or nonobjective than mothers of nonanxious children, irrespective of maternal anxiety status. No differences in maternal negativity were found on the speech task between any of the groups. However, the FMSS showed that mothers of anxious children were more critical than mothers of nonanxious children, regardless of maternal anxiety status. These results support the relationship between overinvolved, critical parenting and child anxiety, but suggest that maternal anxiety is not associated with increased overinvolvement or criticism. Theoretical implications are discussed.

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).

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