Parenting and the parent–child relationship in families of children with mild to borderline intellectual disabilities and externalizing behavior

https://doi.org/10.1016/j.ridd.2014.08.018Get rights and content

Highlights

  • Parenting is related to externalizing behavior in children with MBID.

  • Parent–child relationship is related to externalizing behavior in children with MBID.

  • The importance of parent–child relationship for children with MBID is emphasized.

Abstract

This cross-sectional study examined the association between parenting behavior, the parent–child relationship, and externalizing child behavior in families of children with mild to borderline intellectual disabilities (MBID). The families of a child with MBID and accompanying externalizing behavior problems (n = 113) reported more positive discipline and physical punishment but less involvement, less positive parenting, less monitoring, a lower sense of parenting competence, less acceptance of the child, and less closeness to the child than the families of a child with MBID and no accompanying externalizing behavior problems (n = 71). The parent–child relationship was most strongly associated with externalizing child behavior, over and above parenting behaviors. In addition, the parent–child relationship was found to be associated with parenting behavior, over and above the child's externalizing behavior. Our results highlight the importance of both the parent–child relationship and parenting behavior in connection with the occurrence of externalizing behavior problems on the part of children with MBID. Parenting behavior and the parent–child relationship may thus be promising targets for interventions with this group of children.

Introduction

Many children in child welfare and the justice system have mild to borderline intellectual disabilities (MBID), i.e., an IQ between 55 and 85 with problems in their adaptive functioning (Kaal, 2010, Konijn et al., 2004, Kroll et al., 2002). Children with MBID are three to four times more likely to develop externalizing behavior problems than their peers with average intelligence (defined here as an IQ over 85) (Baker et al., 2002, Dekker et al., 2002). Children and adolescents with MBID have also been found to have an increased risk of displaying aggressive behavior and social skills deficits (Guralnick & Groom, 1987). In addition, the externalizing behavior problems of children with MBID have recently been shown to persist longer than the externalizing behavior problems of children with average intelligence (Emerson, Einfeld, & Stancliffe, 2011).

Externalizing behavior problems are not only problematic for the children and adolescents themselves but also for the social environment. The societal costs of such problems have been documented to be large (Orobio de Castro, 2004), and to include the costs of crime, extra educational services, and treatment services (Scott, Knapp, Henderson, & Maughan, 2001). The costs of externalizing behavior problems can be assumed to be larger for children with MBID, as their MBID is more often accompanied by other disorders that need attention. This comorbidity might entail impaired functioning in daily life and thus require more intensive care than children with conduct disorders with no MBID (Dekker and Koot, 2003, Emerson et al., 2011). Effective interventions to prevent or reduce the occurrence of externalizing behavior problems among children with MBID are thus needed but lacking to date.

In children with average intelligence, externalizing behavior problems have been shown to be associated with several aspects of parenting. Interventions aimed at improved parenting behavior have been shown to be the most effective treatment for externalizing behavior problems (McCart, Priester, Davies, & Azen, 2006). However, little is known about the associations between parenting behavior and the externalizing behavior problems of children with MBID. Given the recognized importance of parenting in the general population, knowledge of the associations between parenting behavior, the parent–child relationship, and externalizing behavior problems in children with MBID seems important. To be able to intervene, however, greater insight into the factors underlying the externalizing behavior problems of children with MBID is needed.

In the present study we therefore first examined the characteristics of parenting behavior and the parent–child relationship in families of children with MBID and either externalizing behavior problems or no such externalizing behavior problems; we then analyzed the specific associations between parenting behavior, the parent–child relationship, and externalizing child behavior in the families of children with MBID.

Parenting behavior is one of the main environmental factors associated with the occurrence of externalizing behavior problems among children with average intelligence (Dodge & Pettit, 2003). Ineffective parenting behaviors such as physical discipline, inconsistency, and lack of warmth, have been shown to be associated with the development of externalizing behavior problems in children with average intelligence (Dodge and Pettit, 2003, Lansford et al., 2004, Patterson, 1982). Even though using physical punishment might be thought to lead to desirable behavior in the short term, it has been shown to be associated with increased deviant behavior, aggressiveness, and delinquency in the long term (Straus & Donnelly, 2001). The more coercive the control that parents exert, including physical punishment, the more deviant the behavior displayed by their children, and vice versa (Barnes and Farell, 1992, Parent et al., 2011, Rothbaum and Weisz, 1994, Weiss et al., 1992). Positive parenting and especially higher levels of involvement, warmth, and monitoring have been shown – in contrast – to be associated with lower levels of externalizing behavior problems among children with average intelligence (Amato and Rivera, 1999, Barnes and Farell, 1992, Hoeve et al., 2009). Warmth has even been reported to provide a buffer against the negative effects of harsh punishment (McKee et al., 2007). Perhaps more importantly, the associations between parenting behavior and child behavior have been found to be bidirectional, which means that a vicious circle can emerge, in which inadequate parenting fosters externalizing behavior problems, which then foster further parenting problems and externalizing behavior problems (Bell, 1968, Laird et al., 2003, Reitz et al., 2006, Sameroff and MacKenzie, 2003).

Parenting interventions can break a negative vicious circle between parenting behavior and externalizing child behavior. For instance, parent management training programs have been shown to effectively alter parenting behaviors, with direct, lasting, and positive effects on the behavior of children with average intelligence as a result (McCart et al., 2006). The association between parenting behavior and child behavior may be different in the families of children with MBID than in the families of children with average intelligence. Other factors may also come into play in the families of children with MBID including inadequate parenting behavior arising from children's disabilities and parents’ lack of acceptance of their child's disabilities. Whether or not the atypical behavior of a child with MBID evokes inadequate parental responding may depend on the extent to which the parents accept or understand the child's behavior as possibly being a consequence of the child's disabilities.

Parenting children with MBID involves several challenges due to the children's lower cognitive abilities (Baker et al., 2002). For example, when children need to be repeatedly instructed, the patience of the parents may be tested. However, surprisingly little is known about actual parenting of children with MBID, or the associations between parenting behavior and the occurrence of externalizing behavior problems among this population of children. The focus of most research concerned with the parenting of children with MBID has been primarily on the impact of having such a child on parental well being and levels of stress (e.g., Baker et al., 2002, Baker et al., 2003, Hill and Rose, 2009); child behavior is of little or no concern. Parenting a child with MBID has indeed been shown to be more frequently associated with more high levels of parental stress than parenting a child of average intelligence (Baker et al., 2003). And when a child with MBID develops externalizing behavior problems as well, the parental level of stress will increase (Baker et al., 2002, Baker et al., 2003, Hill and Rose, 2009). In other words, having a child with MBID and externalizing behavior problems tends to be taxing for parents.

Mothers of young children with MBID, regardless of the presence or absence of child behavior problems, have been shown to display less positive parenting, less positive affect, more negative affect, and less involvement than mothers of young children without MBID (Beck et al., 2004, Fenning et al., 2007, Green and Baker, 2011). In another study with a group of young children who had cognitive delays, moreover, inconsistent and angry parenting was found to predict the persistence of conduct problems (Emerson et al., 2011). Taken together, these findings indicate that children with MBID are at a heightened risk for poor parenting.

Research has shown that not only child behavior, but also parental perceptions of the parent–child relationship – including parental sense of competence, closeness to the child, and acceptance of the child – are significantly associated with not only parenting in children with average intelligence (Abidin, 1992, Bosmans et al., 2006, Deković et al., 2003), but also with child externalizing behavior problems (Bosmans et al., 2006, Deković et al., 2003). Three aspects of the perceived parent–child relationship seem particularly important. Parents’ sense of competence is the parents’ confidence in his or her ability to perform parenting tasks (Bandura, 1977), and has been found to be indirectly linked to the occurrence of externalizing child behavior via parenting behaviors (Jones & Prinz, 2005). Closeness represents the strength of the affective parent–child bond. Both parental sense of competence and closeness with the child have been shown to be linked to the occurrence of positive parenting behaviors (Coleman and Karraker, 1997, Sanders and Woolley, 2004, Vieno et al., 2009) and the occurrence of less externalizing behavior problems in children (Coleman and Karraker, 1997, Vieno et al., 2009). Finally, parental acceptance of the child has been found to be associated with fewer externalizing behavior problems on the part of children and less dysfunctional parenting in children of average intelligence (Rohner & Britner, 2002).

The parent–child relationship can be stressed by the challenges of parenting a child with MBID. Parents of children with MBID more often perceive their parenting behavior as flawed, which suggests that the parental sense of competence among these parents may be lower than in other parents (Didden, 2005). In addition, families with a child with MBID might be more likely to be less close because of the increased likelihood of externalizing behavior problems on the part of children with MBID (Collot d’Escury, 2007). The parents of children with MBID face many parenting challenges, which makes acceptance of the child's disability particularly important in families of children with MBID (Baker, Blacher, Kopp, & Kraemer, 1997). Accepting that a child may have special needs and display deviant or inappropriate behaviors at times due to his or her disability may therefore be crucial for preventing inadequate responding on part of the parents to child behavior. It is nevertheless unknown whether a positive parent–child relationship (that thus entails acceptance, closeness, and self-efficacy) is associated with significantly fewer externalizing behavior problems and thus appears to provide a buffer for the less than optimal parenting that might sometimes occur in families of children with MBID and externalizing behavior problems.

In the present study, we compared the parenting behavior and quality of the parent–child relationship in the families of children with MBID and either externalizing behavior problems or no such problems. In addition, we analyzed the associations between parenting, the parent–child relationship, and externalizing behavior problems on the part of the child in the families of the children with MBID. Three hypotheses were tested during the course of doing this. First, we expected the parenting behavior and parent–child relationship in the families of children with MBID and accompanying externalizing behavior problems to differ from the parenting behavior and parent–child relationship in the families of children with MBID and no such externalizing behavior problems. Second, we expected both parenting behavior and the parent–child relationship to be uniquely associated with the externalizing behavior of children with MBID. Third, we expected parenting of children with MBID to be associated with the parent–child relationship over and above externalizing behavior in children with MBID. This hypothesis was based on the idea that parenting responses do not depend on the actual child behavior alone, but more so on parental interpretations of a child's behavior and acceptance of the child's behavior.

Section snippets

Participants

The families of 184 children with MBID and an age of 9–16 years participated in this cross-sectional study. The participating children's mean age was 12.4 years (SD = 2.07). The mean intelligence score was 71 (SD = 7.98). Sixty-one percent of the children was male. And 50% of the mothers and 40% of the fathers had finished second stage of primary education or lower secondary education at most. The sample of children with MBID further consisted of two groups: a problem behavior group (n = 113) and a

Preliminary analyses

The demographic characteristics of the problem behavior and comparison groups are summarized in Table 1. There were no significant differences between groups with regard to age or IQ. However, the groups differed with regard to SES and gender, with 83 boys and 30 girls in the problem behavior group, but only 31 boys and 40 girls in the comparison group (χ2 = 17.12, p < .001). In addition, the families in the problem behavior group had a significantly lower SES than the families in the comparison

Discussion

The first aim of the study was to examine differences in parenting behaviors and the parent–child relationship between families with children with MBID and externalizing behavior problems, and families with children with MBID and no such externalizing behavior problems. Both parenting behavior and the parent–child relationship were found to differ for the families of children with MBID and externalizing behavior problems versus the families of children with MBID and no such problems. When the

Acknowledgements

This research was funded by The Netherlands Organisation for Health Research and Development (Zon Mw 57000004) and The Association of Orthopedagogical Treatment Centres (VOBC-LVG).

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