Research paper
Mediator or moderator? The role of mindfulness in the association between child behavior problems and parental stress

https://doi.org/10.1016/j.ridd.2017.08.007Get rights and content

Abstract

Background

Raising a child with intellectual disability (ID) may be stressful for parents. Previous studies have suggested the mediating role of mindfulness in the association between child behavior problems and parental stress.

Aims

The present study examined whether this mediating role is a result of parents’ self-report bias. It also explored whether mindfulness has a moderating role instead when child behavior problems are reported by teachers.

Methods

In a questionnaire survey, 271 Chinese parents of children with ID in 6 Hong Kong special schools reported their levels of stress and mindfulness, as well as their children’s behavior problems. The latter was also reported by teachers.

Results

When child behavior problems were reported by parents, parental mindfulness was a mediator between child behavior problems and parental stress. In contrast, when child behavior problems were reported by teachers, parental mindfulness was a moderator between child behavior problems and parental stress.

Conclusion

The mediation role of mindfulness maybe an artifact of measurement. The findings provide an encouraging message that parenting a child with ID and behavior problems does not necessarily mean more stress among all parents. Parents with a high level of mindfulness may experience less stress than those with a low level of mindfulness.

What this paper adds

Parents of children with intellectual disability (ID) tend to report high psychological stress. Previous self-report studies have identified mindfulness as a mediator in the association between child behavior problems and parental stress. The present study differs from previous studies by including third-party’s reports. It has contributed to the existing body of knowledge in two respects. First, it examined whether the mediation effect resulted from parent self-report bias. Second, it tested an alternative hypothesis of the moderation effect by using teachers’ reports to measure child behavior problems. The results showed that when child behavior problems were measured by parents’ reports, parental mindfulness was a mediator between child behavior problems and parental stress. The more the parents reported that their children had behavior problems, the less they reported being mindful, which in turn the more stressful they were. However, when child behavior problems were measured by teachers’ reports, parental mindfulness was a moderator instead, moderating the association between child behavior problems and parental stress. The association was ameliorated when parents reported high levels of mindfulness. These findings reveal another possible role of mindfulness and shed light on the support for parents of children with ID.

Introduction

Parents of children with intellectual disability (ID) often report more psychological distress than parents of typically developing children (Baker et al., 2003; Dabrowska & Pisula, 2010; Dyson, 1997; Eisenhower, Baker, & Blacher, 2005; Roach, Orsmond, & Barratt, 1999). A recent review documented that child behavior problems are one of the major factors associated with higher stress in parents of children with ID (Biswas, Moghaddam, & Tickle, 2015). Child behavior problems, in addition to the difficulties pertaining to the core impairments of ID, have become an important stressor in parents’ psychological well-being (Hastings, 2002).

Researchers have been exploring what psychological processes affect the stress level of parents of children with ID. In recent years, there has been an emerging trend to study mindfulness as one of these key psychological processes (Beer, Ward, & Moar, 2013; Jones, Hastings, Totsika, Keane, & Rhule, 2014). According to Kabat-Zinn (2003), mindfulness refers to “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” (p. 145). Lloyd and Hastings (2008) conducted a pioneering study that explored the association between mindfulness and psychological distress in parents of children with ID. Since then, a growing number of researchers have been studying how mindfulness-based interventions could help parents of children with disabilities (e.g., Cachia, Anderson, & Moore, 2016; Neece, 2014; Singh et al., 2007; Van der Oord, Bogels, & Peijnenburg, 2012; Whittingham, 2014). Their studies indicated that mindfulness-based intervention could reduce psychological stress and depressive symptoms in parents of children with developmental disabilities. However, the mechanism of how mindfulness functions in the association between child behavior problems and parental stress still needs further investigation.

Some studies have investigated whether parental mindfulness was the mediator in the association between child behavior problems and stress in parents of children with Autism Spectrum Disorder (ASD) (Beer et al., 2013, Jones et al., 2014). These studies proposed that the more children had behavior problems, the less likely their parents would be mindful, which in turn predicted higher parental stress. However, their findings are inconsistent. While Jones et al. (2014) found a mediator role of parental mindfulness, Beer et al. (2013) did not.

Regardless of their inconsistent findings, these studies of mediation model (Beer et al., 2013, Jones et al., 2014) share the same limitations. They used parents’ self-reports to measure all variables, including child behavior problems, parental mindfulness, and parental stress. When measures of predictor and criterion variables are obtained from the same rater, there may be self-report bias (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003; Schmitt, 1994). According to studies on cognitive consistency theories (e.g., McGuire, 1966), people tend to maintain consistency between their cognitions and attitudes. Thus, it is possible that parents may respond to measures of different constructs in consistent ways. As a result, a higher level of child behavior problems is significantly associated with lower levels of parental mindfulness and higher levels of parental stress when they were all reported by parents. The observed association between constructs measured by same rater reports may be spurious and may not fully reflect the actual covariation that exists in real-life situations (Podsakoff et al., 2003). A solution to this methodological limitation is to adopt third-party’s reports, such as teachers’ reports. Unlike parents’ reports, teachers’ reports on children’s behavior problems are not tainted by the levels of parental stress and mindfulness.

Another limitation shared by previous studies of mediation model was their assumption of causal relations between child behavior problems and parental mindfulness. In their mediation model, child behavior problems are assumed to have an impact on parental mindfulness, which in turn is assumed to have an impact on parental stress. However, the relations among these constructs may be bi-directional. It is equally possible that parents whose stress level is high tend to be less mindful. When they are less mindful and more judgmental, they may in turn tend to perceive more behavior problems in their children, even when the behavior problems are relatively infrequent or mild.

Previous studies on parents’ sense of coherence may provide support to this possibility. According to Antonovsky (1987), a sense of coherence relates to one’s psychological processes in the appraisal of stress. People with a higher sense of coherence tend to perceive a possible stressor as more comprehensible, manageable, and meaningful. Past studies have found that parents of children with ID reported higher levels of distress when they had a lower sense of coherence (Oelofsen & Richardson, 2006; Olsson & Hwang, 2002). These findings imply that if parents have a lower level of mindfulness, which relates to one’s lower psychological capacity to attend or accept present experiences, they may tend to perceive their children’s behavior problems as less manageable, and thus report higher levels of their children’s behavior problems.

Similarly, a lower level of child behavior problems does not necessarily lead to a higher level of parental mindfulness and a lower level of parental stress. This may possibly be explained with the above rationale that parents with higher levels of mindfulness may tend to perceive their children to have fewer behavior problems because they may possess a higher mental capacity to cope, even when the behavior problems of their children are in fact serious. A recent study by Neece (2014) may lend support to this inference as it found that parents of children with developmental delays reported their children to have fewer behavior problems after a mindfulness-based intervention. Therefore, it is reasonable to argue that parental mindfulness may not function as a mediator in the association between child behavior problems and parental stress. Teachers’ reports of child behavior problems can serve as an independent way of measuring whether child behavior problems are still negatively associated with the levels of mindfulness reported by parents. If this relation no longer exists, then the mediation effect suggested by previous studies (Beer et al., 2013, Jones et al., 2014) may be an artifact produced by parents’ self-report bias.

In light of the above inference, child behavior problems and parental mindfulness may be two independent variables. Indeed there have been studies showing that despite the fact that parenting children with behavior problems is very stressful to most parents, it does not affect every parent in the same way and to the same extent. A recent review suggested that although child behavior problems are one of the major factors that significantly predicted higher stress in parents of children with ID (Biswas et al., 2015), the effect sizes reported for this association ranged from small (0.13) to large (0.5). The heterogeneity of effect sizes for this association indicated that it is important to identify third variables that may affect the strength of association between child behavior problems and parental stress. A possible moderating mechanism of mindfulness can be inferred: Parents who are more mindful (i.e., less reactive, less judgmental, and more aware of present experiences), may be less likely to experience stress than those who are less mindful. It is their own level of mindfulness that can buffer them against the adverse effect of their children’s problem behaviors on their psychological well-being. The present study thus explores whether parental mindfulness functions as a potential moderator in the association between child behavior problems and parental stress.

The study has two objectives: 1) to examine whether the mediating role of parental mindfulness in the association between child behavior problems and parental stress is an artifact of self-report bias; and 2) to examine whether parental mindfulness has instead a moderating role in the association between child behavior problems and parental stress. Two hypotheses were formulated with reference to these two objectives. Hypothesis 1: Mindfulness mediates the association between child behavior problems and parental stress if child behavior problems are reported by parents, but this mediation effect is absent if child behavior problems are reported by teachers. Hypothesis 2: Mindfulness moderates the association between child behavior problems and parental stress if child behavior problems are reported by teachers, but this moderation effect is absent if child behavior problems are reported by parents.

Section snippets

Participants

Participants were recruited from six special schools for children with ID in Hong Kong. The children in these schools had been diagnosed with ID by psychologists before they were admitted. Parent questionnaires were distributed to the parents of these children (N = 627) and teacher questionnaires to their homeroom teachers (N = 100). The sample of teachers was smaller than that of parents because one teacher usually reported on more than one child. The response rate of the parents was 46.73%, as

Data analysis strategies

Preliminary associations between demographic variables and parental stress were explored to identify confounding variables for statistical control before the main analyses. Pearson’s correlations were used for continuous demographic variables (e.g., child age) and t-tests or ANOVA were used for dichotomous demographic variables (e.g., child’s intellectual grading). These analyses revealed parental stress was not related with child age (r = .07, p = .28) but was associated significantly with three

Discussion

The present study examined the role of mindfulness in the association between child behavior problems and stress in parents of children with ID. It tested whether the mediating role of mindfulness in such association was found only when child behavior problems were reported by parents. It also investigated whether mindfulness functions as a moderator in such association when child behavior problems were reported by teachers. Consistent with the hypotheses, the results of the present study

Conclusion

The current study reveals that parental mindfulness acts as a moderator of the association between child behavior problems and stress in parents of children with ID. The mediation effect of mindfulness suggested by previous studies may be the result of parents’ self-report bias. Teachers’ reports on children’s behavior provide an alternative measure to examine the potentially moderating role of mindfulness on such an association. The findings provide the encouraging message that parenting a

Source of funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors declare no actual or potential conflicts of interest that influenced the conduct of the study or the contents of the manuscript.

Acknowledgements

The authors would like to express their appreciation to the school principals, teachers and parents who participated in this research. Special thanks go to Lance Wong for his advice with the statistical analyses and the translators for their help in back-translating the measures.

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    This manuscript was based on the Master’s Thesis of Tim Oi Chan at the University of Hong Kong under the supervision of Shui-fong Lam.

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