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Behavior Problems and Parenting Stress in Families of Three-Year-Old Children

With and Without Developmental Delays

Article  in  American journal of mental retardation: AJMR · December 2002

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VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002 AMERICAN JOURNAL ON MENTAL RETARDATION

Behavior Problems and Parenting Stress in Families

of Three-Year-Old Children With and Without
Developmental Delays
Bruce L. Baker
University of California, Los Angeles
Jan Blacher
University of California, Riverside
Keith A. Crnic and Craig Edelbrock
The Pennsylvania State University

Abstract
Children and adolescents with mental retardation are at heightened risk for mental disor-
der. We examined early evidence of behavior problems in 225 three-year-old children with
or without developmental delays and the relative impact of cognitive delays and problem
behaviors on their parents. Staff-completed Bayley Behavior Scales and parent-completed
Child Behavior Checklists (CBCLs) showed greater problems in children with delays than
in those without delays. Children with delays were 3 to 4 times as likely to have a total
CBCL score within the clinical range. Parenting stress was higher in delayed condition
families. Regression analyses revealed that the extent of child behavior problems was a
much stronger contributor to parenting stress than was the child’s cognitive delay.

Adults with mental retardation are at height-
ened risk for mental disorder, a phenomenon
termed dual diagnosis. The limited literature on
dual diagnosis in children, derived mainly from
the study of adolescents with mental retardation,
indicates a higher incidence as well (Gillberg, Pers-
son, Grufman, & Themner, 1986; Jacobson,
1990). Two recent population-based studies ex-
tended the age limit downward. Stromme and
Diseth (2000), examining all children ages 8 to 13
years born during a 5-year period in a county in
Norway, found that 37% of those with mental
retardation met International Classification of Dis-
eases–10th ed. (ICD-10) criteria for psychiatric dis-
order. Steffenburg, Gillberg, and Steffenburg
(1996) found that 59% of children 8 to 16 years
of age who had mental retardation and epilepsy
had at least one psychiatric disorder. We do not
know yet, however, whether even younger chil-
dren with delays are at the same heightened risk
as these older children and adolescents.
Despite high prevalence rates, dually diag-
nosed children have been among the least under-
stood and most underserved of any group with
disabilities (M. Campbell & Malone, 1991; Pfeif-
fer & Baker, 1994; Reiss, Levitan, & McNally,
1982). Dual diagnosis presents unique diagnostic
and treatment challenges and leaves children at
particular risk for unfavorable long-term life out-
comes. Placement is more likely when children
with mental retardation have serious maladaptive
behaviors that challenge the family’s capacity to
manage the child or adolescent effectively (Blach-
er, 1994; Borthwick-Duffy & Eyman, 1990; Brom-
ley & Blacher, 1989; McIntyre, Blacher, & Baker,
2001). Beyond placement considerations, serious
maladaptive behavior among persons with mental
retardation predicts academic problems, failure in

q American Association on Mental Retardation 433

VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002
Behavior problems and parenting stress
community living arrangements, frequent moves,
social isolation and rejection, and reduced em-
ployment prospects (Borthwick-Duffy & Eyman,
1990; Bruininks, Hill, & Morreau, 1988; Pearson
et al., 2000). Clearly, dual diagnosis is of serious
concern.
The overall aim of our research program is to
derive a better understanding of this heightened
risk in children with developmental delays. To
track problem development, we have begun as-
sessment of problem behaviors when children are
3 years old. Our focus in this paper is on mothers’
and fathers’ reports of problem behaviors exhib-
ited by young children with and those without
delays. Moreover, we have considered the impact
that child problem behaviors have on parents’ ex-
perience of stress.
We would not expect to find much diagnos-
able mental disorder per se during the preschool
years. However, longitudinal studies of typically
developing children have found high continuity
for behavior problems across the childhood years;
this is especially true for externalizing problems,
such as aggression, noncompliance, conduct prob-
lems, and hyperactivity (S. Campbell, 1994; S.
Campbell, Breaux, Ewing, & Szumowski, 1984;
Egeland, Kalkoske, Gottesman, & Farrell-Erickson,
1990; Heller, Baker, Henker, & Hinshaw, 1996).
Thus, our primary question is: What, if any, prob-
lem behaviors already differentiate young children
with and without cognitive delays?
There is little known about how early in life
children with delays evidence heightened problem
behaviors. Studies of typically developing pre-
schoolers have found a modest negative relation-
ship between child cognitive ability and behavior
problems. Hay and coworkers (1997), studying a
sample of 93 typically developing 4-year-olds in
South London, reported negative correlations be-
tween child IQ and mothers’ and fathers’ Child
Behavior Checklist (CBCL) behavior problem
scores. Similarly, Dietz, Lavigne, Arend, and Ro-
senbaum (1997), studying typically developing
children ages 2 to 5, found that lower verbal or
performance IQ predicted higher externalizing
and internalizing CBCL scores. On the other
hand, Feldman, Hancock, Reilly, Minnes, and
Cairns (2000a) in their study of 2-year-olds with
intellectual delays did not find elevated problems
on this measure relative to published norms, al-
though the delays were mild and in some cases
questionable.
Researchers comparing preschoolers with and
434
AMERICAN JOURNAL ON MENTAL RETARDATION
B. L. Baker et al.
without delays have found more problem behav-
iors in those with delays. Kopp, Baker, and Brown
(1992) reported social deficits in 15 children with
delays who were 4 years old (range 5 3 to 5),
contrasted with 15 playmates without delays. Play
was observed in triads of 1 child with delays and
2 without delays; the child without delays closest
in age to the child who had delays was chosen for
comparison. Observations showed significantly
more ‘‘no-play’’ intervals for children with delays.
Within intervals where play took place, delay
group children engaged in solitary play (rather
than parallel or social play) 33% of the time versus
12% for children without delays. Moreover, chil-
dren with delays showed much disruptive entry
(53% vs. 0%), and only 53% of children with de-
lays at some time smiled and/or laughed to their
peers in contrast to 93% of children without de-
lays.
On the Behavioral Screening Questionnaire
(Richman, Stevenson, & Graham, 1982), parents
of children with delays reported significantly high-
er behavior problem scores. Merrell and Holland
(1997) found similar differences in a large survey
study of 398 children ages 3 to 5 years. Half of
these children were categorized by teachers as de-
layed, although no criteria were reported; mea-
sures were completed by ‘‘parents or teachers,’’
without further specification. Social skills deficit
and behavioral–emotional problem excesses were
each 4 to 5 times as likely in those children with
delays. The greatest differences were in the social
domain: social interaction and independence
skills and socially withdrawn behavior patterns.
There is some evidence, then, of increased prob-
lem behaviors in children with delays by age 3,
although there is a need for further study with
better defined assessment procedures and child
delay status.
There has been considerable study of families
raising a child with mental retardation (Baker,
Blacher, Kopp, & Kraemer, 1997). At a practical
level, these families experience excessive caretak-
ing demands, financial burden, and restrictions on
leisure activities and social lives as well as disrup-
tions of family plans (Gunn & Berry, 1987; Rod-
rique, Morgan, & Geffken, 1992). Not surprising-
ly, parents experience increased stress, especially
in domains related to childrearing (Baker et al.,
1997; Crnic, Friedrich, & Greenberg, 1983; Fidler,
Hodapp, & Dykens, 2000; Orr, Cameron, Dob-
son, & Day, 1993; Minnes, 1988), Parental stress,
in turn, is one domain of family risk and protec-
q American Association on Mental Retardation
VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002
Behavior problems and parenting stress
tive factors that may be relevant to the emergence
of psychiatric problems in children with mental
retardation (Crnic & Greenberg, 1987; Margalit,
Shulman, & Stuchiner, 1989). A lingering ques-
tion is whether the heightened stress represents a
chronic reaction to intellectual disability per se or
a reaction to the often associated behavioral chal-
lenges that families face. Our second question,
then, is: Do parents of 3-year-olds with delays al-
ready experience heightened child-related stress,
and, if so, what are the relative contributions of
cognitive delay versus problem behaviors to pa-
rental stress levels?
Although negative impact has garnered the
largest share of research attention, there has been
a recent trend to also consider the more positive
or growth-promoting effect that a child with men-
tal retardation can have on the family. The poten-
tially positive impact on families may operate
through specific positive contributions of disabil-
ity on family members (Turnbull et al., 1993) as
well as through promoting positive coping strat-
egies and adaptation (Crnic et al., 1983; Hawkins,
Singer, & Nixon, 1993). We also examined the
influence of child behavior problems on parents’
positive views of childrearing.
Assessment of child behavior problems relies
heavily on informants’ opinions, usually through
checklists. Most studies of young children have
relied on mothers as informants. Yet, mothers and
fathers have different relationships with their
child and different opportunities to observe their
child’s behavior; moreover, any informants’ re-
sponses are to some degree influenced by his or
her own personality (Achenbach, McConaughy,
& Howell, 1987; Hay et al., 1999; Phares, 1996).
Studies in which mothers and fathers have both
completed CBCLs have reported significant but
modest correlations (Baker & Heller, 1996; Hay
et al., 1999). For example, in the Hay and col-
leagues study just noted, although the mean
scores for mothers and fathers did not differ on
any scale, the correlation between mothers and
fathers was .32 for Total score and .42 for Exter-
nalizing; the correlation for Internalizing prob-
lems did not reach significance. There has been
little study of how fathers of children with delays
perceive problem behaviors or of how these be-
haviors affect their experience of parenting stress.
Our third questions, then, is: Do fathers and
mothers differ in their perception of problem be-
haviors in children with and without delays and/
or in their experience of parenting stress?
q American Association on Mental Retardation
AMERICAN JOURNAL ON MENTAL RETARDATION
B. L. Baker et al.
Method
Participants
Participants were 225 families with a 3-year-
old child. These families had been recruited to
participate in a 2-year longitudinal study of young
children from ages 3 to 5 years, with samples
drawn from Central Pennsylvania and Southern
California. The children were classified as having
delays (n 5 92) or not having delays (n 5 133).
Delayed condition families were recruited primar-
ily through community agencies that serve per-
sons with developmental disabilities. The selec-
tion criteria were that the child (a) be between 30
and 39 months of age; (b) receive a score on the
Bayley Scales of Infant Development II (see be-
low) between 30 and 85; (c) be ambulatory, and
(d) not be diagnosed with autism. Nondelayed
condition families were recruited primarily
through preschools and daycare programs. The se-
lection criteria were that the child (a) be between
30 and 39 months of age; (b) receive a score on
the Bayley Scales of 85 or above; (c) not be born
prematurely or have a developmental disability.
Table 1 shows the demographic characteristics
of this sample by group status (delayed, nonde-
layed). The intake assessment was conducted, on
average, just before the child’s third birthday (35.2
months; standard deviation [SD] 5 3.0). In the
combined sample, there were more boys than girls
(57%), and 61% of the children were Caucasian.
Recruitment initially focused on intact families, so
most participants (86%) were married (defined
here as legally married or living together at least
6 months). The socioeconomic status (SES) was
generally high, with 51% of mothers and 51% of
fathers having graduated from college, and 53%
of families having an annual income of $50,000
or more.
The two conditions did not differ on the
child attributes shown in Table 1. The conditions
differed on the parent and family attributes that
indicated SES; these were significantly higher in
the nondelayed families, with a greater percentage
of mothers and fathers graduating from college
and more families with incomes at $50,000 or
more. We covaried SES indicators in subsequent
analyses where these correlated significantly with
the dependent variable.
Assessments
The data considered in this study were ob-
tained in two ways. The measures of child’s de-
435
VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002 AMERICAN JOURNAL ON MENTAL RETARDATION

Behavior problems and parenting stress B. L. Baker et al.

Table 1. Demographics by Group

Delayed Nondelayed
Variable (n 5 92) (n 5 133) t or chi squared
Child
Age at testing (months) 35.6 35.0 1.59
Gender (% boys) 64.1 51.9 2.85
Race (% Caucasian) 60.9 60.9 0.00
Siblings (% only children) 30.4 29.3 0.00
Bayley Scales: MDIa 57.9 104.6 29.58***
Parent and family
Marital status (% married) 80.4 89.5 2.94
Mother educ. (% college degree) 31.5 61.7 18.57***
Mother employment (%) 52.2 61.7 1.63
Father education (% college degree)b 34.6 58.4 9.94**
Family income (% $50K1)c 43.5 59.8 5.20*
a
Mental Development Index. bN 5 203. cN 5 224. d
The ts are in boldface.
*p , .05. **p , .01. ***p , .001.

velopmental level and problem behaviors were
obtained at the home intake assessment session,
conducted when the child was between 30 and 39
months of age. Prior to this session, parents had
completed a telephone intake interview with our
staff and had received project descriptions and the
informed consent form. Two trained researcher as-
sistants visited the family for a 2-hour assessment
session. After reviewing procedures, answering
questions, and obtaining informed consent, the
staff administered the Bayley Scales of Infant De-
velopment to the child. During this testing, moth-
er, and father if present, completed a demographic
questionnaire and the CBCL (see below). Mea-
sures that were not completed during the assess-
ment session were mailed to us soon thereafter.
Immediately following the home assessment ses-
sion, the two staff members completed the Bayley
Behavior Problems Scales together. The measure
of the child’s impact on the family was part of a
measure packet completed prior to a home obser-
vation, conducted at 36 months or soon after the
intake, if the intake was later than 36 months.
Measures
Bayley Scales of Infant Development II (Bayley,
1993). The Bayley Scales are a widely used assess-
ment of mental and motor development of chil-
dren ages 1 to 42 months. This instrument was
administered in the child’s home, with the mother
present. In most cases, there was a primary ex-
aminer and an assistant. Only mental develop-
ment items were administered; the Mental Devel-
opment Index (MDI) is normed with a mean of
100 and an SD of 15. Bayley (1993) reported high
short-term test–retest reliability for the MDI, r 5
.91. Also, with children ages 36 to 42 months, the
MDI related to the Full-Scale IQ of the Wechsler
Preschool and Primary Scale of Intelligence–Re-
vised (WPPSI–R), r 5 .73 (Bayley, 1993).
Behavior Rating Scale. The examiner completes
this checklist following the testing session. The
scale has three dimensions: Orientation/Engage-
ment (12 items), Emotion Regulation (10 items),
and Motor Quality (8 items). We only included
the first two dimensions in the present study. Ex-
aminers scored collaboratively, discussing any dis-
agreements and arriving at a joint rating. To de-
termine interjudge reliability, for a subsample of
25 protocols, the two examiners completed the
scale separately and then arrived at consensus rat-
ings. For each pair, the examiner with the most
experience using Bayley Scales was designated as
the standard. There was very high agreement be-
tween raters, r (23) 5 .96, p , .001.
CBCL for Ages 1.5–5 (Achenbach & Rescorla,
2001). This is a new version of the widely used
CBCL (Achenbach, 1991), aimed at the preschool
years. It has 99 items that indicate child problems,
listed in alphabetical order (from ‘‘aches and pains
without medical cause’’ to ‘‘worries’’). The respon-
dent indicates, for each item, whether it is not true

436 q American Association on Mental Retardation

VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002 AMERICAN JOURNAL ON MENTAL RETARDATION

Behavior problems and parenting stress B. L. Baker et al.

(0), somewhat or sometimes true (1), or very true or Table 2. Correlations of Mother and Father
often true (2), now or within the past 2 months. Child Behavior Checklist Scores by Group
This CBCL yields a Total problem score, broad-
Non-
band Externalizing and Internalizing scores, and
Score Delayeda delayedb
narrow-band scales (Emotionally Reactive, De-
pressed/Anxious, Withdrawn, Somatic, Sleep Total Score .75 .57c
Problems, Attention, and Aggression). Scale sum Internalizing .75 .57c
scores were used in analyses. Alphas for the pres- Externalizing .71 .63
ent sample were rs of .94 for both mothers and Emotional Reactivity .61 .38c
fathers. The CBCL also yields T scores, with the Anxious/Depressed .52 .47
mean set at 50 and an SD of 10. We report these
Somatic .73 .58
for the Total scale, where the mean is set at 50
Withdrawal .67 .57
and SD is 10; T scores for the narrow-band scales
are truncated at 50 and, thus, are not as valid for Sleep .71 .61
correlational analyses. Attention .71 .59
Family Impact Questionnaire (Donenberg & Aggression .68 .58
Baker, 1993). This instrument is a 50-item ques- Note. All correlations were significant at the .001 level.
tionnaire that is used to measure the ‘‘child’s im- a
N 5 75. bN 5 126. cDifference between delay and non-
pact on the family compared to the impact other delay correlations significant at p , .05.
children his/her age have on their families’’ (e.g.,
Item 1: ‘‘My child is more stressful’’). Parents en- Internalizing, and Emotionally Reactive scores. In
dorse items on a 4-point scale, ranging from not the delayed condition, mothers’ and fathers’ mean
at all to very much. Five scales are used to measure scores did not differ on any scale. In the nonde-
negative impact on Feelings About Parenting (9 layed condition mothers’ reported significantly
items), Social Relationships (11), Finances (7), higher Attention and lower Aggression scores
and, if applicable, Siblings (9) and Marriage (7). than fathers did, p , .05.
One scale measures impact on positive feelings Child Behavior Scores by Delay Status. We con-
about Parenting (7). A combined score (negative trasted the two status group (delayed and nonde-
impact) is the sum of the first two negative impact layed) on the CBCL and the Bayley Behavior
scales. Alphas in the present sample for negative Scale scores. Analyses were conducted as 2 (status)
impact were .92 for mothers and .90 for fathers; 3 2 (gender) analyses of variance (ANOVAs). Ed-
for positive impact, both alphas were .81. ucation and family income, on which the delay
status groups differed, were related to some of the
Results dependent variables for mothers and fathers and,
thus, were covaried for all analyses. Mothers’
Child Behavior Problems CBCL scores and Bayley Behavior scores are
Mother and Father CBCL scores. In the com- shown in Table 3. On mothers’ CBCL scales, chil-
bined sample there was high agreement between dren in the delayed condition were reported to
mothers’ and fathers’ CBCL scores. Pearson cor- have significantly higher Total and Internalizing
relations for Total, Internalizing, and Externaliz- scores as well as higher scores on Attention and
ing problem scores were .68, .68, and .67, respec- Withdrawal problems. There were several signifi-
tively. Agreement on the narrow-band scales cant gender effects; boys scored higher than did
ranged from .50 (Anxious/Depressed) to .68 (At- girls on problems with Emotional Reactivity and
tention Problems). All correlations were signifi- Aggression as well as the Externalizing and Total
cant at the .001 level. Moreover, mothers’ and fa- scores. Boys with delays scored highest on every
thers’ mean scores were highly similar; mean dif- scale (except Sleep Problems), resulting in several
ferences did not approach significance for any significant Delay 3 Gender interactions. Children
broad-band or narrow-band scale. with delays were scored significantly lower on the
Table 2 shows parents’ agreement by delay Bayley Behavior Scales of Emotional Regulation
status; parents in the delayed condition had high- and Orientation/Engagement; there were no gen-
er agreement on every scale than did parents in der or status by gender effects on the Bayley Be-
the nondelayed condition. The differences be- havior Scales.
tween correlations were significant for the Total, Fathers’ CBCL scores are also shown in Table

q American Association on Mental Retardation 437

VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002 AMERICAN JOURNAL ON MENTAL RETARDATION

Behavior problems and parenting stress B. L. Baker et al.

Table 3. Child Behavior Scores by Group, Gender, and Parent Scores

Delayeda Nondelayedb F
Test score Boys Girls Boys Girls Status Gender S 3 Gc
Mothers’ CBCL
Total Score 50.3 39.6 34.1 34.1 6.73** 5.18* 5.59*
Internalizing 13.2 10.1 7.7 8.4 5.82* 2.63 6.25*
Externalizing 18.5 14.3 13.7 12.6 3.53 7.27** 2.77
Emotional Reactivity 3.6 2.3 2.3 2.3 0.70 5.13* 5.74*
Anxious/Depressed 3.1 2.9 2.2 2.6 0.38 0.67 0.15
Somatic 2.9 1.8 1.5 1.9 1.90 2.11 9.36**
Withdrawal 3.5 3.1 1.6 1.6 23.12*** 0.75 0.90
Sleep 3.7 2.8 3.4 4.1 2.03 0.23 4.60*
Attention 4.4 3.8 2.4 2.1 28.88*** 2.51 0.21
Aggression 14.2 10.5 11.3 10.5 0.31 7.23** 3.55
Bayley Behavior Scales
Emotional Regulation 32.9 34.6 41.9 42.6 59.90*** 1.09 0.07
Orient./Engagement 32.6 31.2 37.7 36.6 27.80*** 1.51 0.06
Fathers’ CBCL
Total Score 45.8 40.7 29.7 34.9 9.43** 0.06 4.39*
Internalizing 11.3 10.5 6.1 9.2 8.80** 0.93 6.04*
Externalizing 17.4 14.4 12.1 12.5 6.28* 1.57 2.84
Emotional Reactivity 2.9 2.5 1.5 2.2 4.80* 0.06 3.67
Anxious/Depressed 2.8 2.9 2.0 2.9 0.52 2.09 3.10
Somatic 2.3 2.0 1.2 2.2 1.65 0.82 8.61**
Withdrawal 3.2 3.2 1.4 1.8 21.69*** 0.35 0.66
Sleep 3.0 3.5 3.1 4.0 0.76 2.43 0.44
Attention 4.0 3.6 2.6 2.6 11.33*** 0.88 0.76
Aggression 13.3 10.8 9.5 9.9 4.02* 1.52 3.15
Note. Analyses were run as 2 (group) 3 2 (gender) ANOVAs, covarying for mother education and family income.
a
Ns 5 59 and 33 for boys and girls, respectively. bNs 5 69 for boys and 63 for girls, respectively. cStatus 3 Gender.
d
Child Behavior Checklist.
*p , .05. **p , .01. ***p , .001.

3. Fathers reported the same status group differ-
ences as mothers did, but in addition reported sig-
nificantly higher scores for children with delays
on Externalizing, Aggression, and Emotional Re-
activity scales. Fathers did not report gender dif-
ferences, but reported status by gender effects sim-
ilar to mothers.
Children meeting criteria for clinical range. We
determined the number of children in each status
group who were at or above the clinical cut-off, T
score 5 64, on the Total CBCL (Achenbach &
Rescorla, 2001). For mothers, the CBCL Total T
score was in the clinical range for 8.3% of children
without delays and 26.1% of children with delays,
a ratio of 1:3.1, continuity corrected x2(1, N 5
225) 5 11.82, p , .01. For fathers, the CBCL
Total T score was in the clinical range for 5.6%
of children without delays and 24% of children
with delays, a ratio of 1:4.3, continuity corrected
x2(1, N 5 201) 5 13.04, p , .001.
Family Impact
For the combined sample, Family Impact
Questionnaire scores were similar for mothers and
fathers. On the Negative Impact Scale, parental
agreement was r 5 .66; mothers’ mean score was
13.9 and fathers, 12.8 The only significant differ-
ence was on positive impact, where fathers scored
higher (M 5 16.7) than did mothers (15.7), t 5
2.54, p , .05.
Family impact and child status groups. We con-
trasted the two status group (delayed and nonde-

438 q American Association on Mental Retardation

VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002
Behavior problems and parenting stress
Table 4. Correlations of IQ and Behavior Problems With Parents’ Stress (FIQ Negative Impact)
Test
Bayley Mental Development Index
Emotional Regulation
Orientation-Engagement
Child Behavior Checklist
Externalizing scale
Internalizing scale
Total
Note. FIQ 5 Family Impact Questionnaire. All correlations were significant at the .001 level.
a
N 5 225 mothers and 198 fathers.
layed) on the Family Impact Questionnaire scales.
Analyses were conducted as 2 (status) 3 2 (gender)
ANOVAs, with education covaried. Parents of de-
layed group children reported higher negative
child impact than did parents of nondelayed
group children. Delayed group mothers scored
higher than did nondelayed group mothers on the
combined negative impact variable, F(1, 220) 5
13.76, p , .001, as well as negative impact on
finances, F(1, 220) 5 21.70, p , .001. There was
no status group effect for negative impact on sib-
lings or marriage or for positive impact on feelings
about parenting. Mothers of delayed boys reported
the greatest negative impact. There was a signifi-
cant gender effect for negative impact, F(1, 220)
5 10.99, p 5 .001, and Status 3 Gender inter-
actions for negative impact, F(1,220) 5 7.66, p ,
.01, and impact on siblings, F(1,148) 5 6.19, p ,
.05. Fathers’ scores showed a similar pattern, al-
though differences were not as strong. Delayed
group fathers scored higher on negative impact
than did nondelayed group fathers, F(1,188) 5
4.76, p , .05, as well as on negative impact on
finances, F(1, 189) 5 18.08, p , .001. Fathers of
delayed boys also reported the greatest negative im-
pact; there was a significant Status 3 Gender in-
teraction for negative impact, F(1,188) 5 6.10, p
, .05. No other comparison reached significance.
Parenting stress, child delay, and behavior prob-
lems. Table 4 shows the correlations between
mother and father Negative Impact (stress) scores
and two domains of child functioning: cognitive
functioning (Bayley MDI) and behavior (CBCL
and Bayley Behavior Scales). Although stress
scores related significantly to the child’s cognitive
functioning, the relationships with behavior prob-
lems were considerably higher. To examine this
q American Association on Mental Retardation
AMERICAN JOURNAL ON MENTAL RETARDATION
B. L. Baker et al.
Stressa
Mothers’ Fathers’
2.34 2.29
2.41 2.37
2.23 2.29
.70 .65
.51 .54
.69 .65
relationship another way, we divided CBCL total
scores into thirds, yielding a high, medium, and
low behavior problem group. We conducted a 2
(status) 3 3 (behavior problem group) ANOVA
on mother’s combined Family Impact Question-
naire Negative Impact score, with mother’s edu-
cation as a covariate. Figure 1 shows mothers’
Negative Impact scores by status group and be-
havior problem group. Status group was signifi-
cant, F(1, 218) 5 11.67, p , .01, but behavior
problems group had a considerably stronger ef-
fect, F(2, 218) 5 43.62, p , .001. For the variables
positive impact, negative impact on marriage, and
negative impact on siblings, status group was not
significant, but there were significant behavior
problem group effects. For negative impact on fi-
nances, there were significant main effects for sta-
tus and behavior problems as well as the only sig-
nificant interaction, with delayed group high be-
havior problems associated with highest stress by
far. We repeated these analyses for fathers’ Family
Impact Questionnaire scores. The behavior prob-
lem group variable was significant for every Fam-
ily Impact Questionnaire scale for our primary
measure of stress, Negative Impact, F(2, 189) 5
Figure 1. Mothers stress by delay status and be-
havior problems (BP) group.
439
VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002 AMERICAN JOURNAL ON MENTAL RETARDATION

Behavior problems and parenting stress B. L. Baker et al.

42.62, p ,.001. Delay status was associated sig-
nificantly only with Negative Impact on Finances.
We examined the relationship between child
characteristics and parent stress further, using hi-
erarchical multiple regression. We considered the
relative contributions of child cognitive function-
ing (Bayley MDI) and behavior problems (CBCL
Total score; Bayley Behavior Scales of Emotional
Regulation and Orientation/Engagement). The
CBCL total score was modestly related to the Bay-
ley Behavior Scale scores for mothers and fathers,
rs 5 .27 to .34. We also entered the status variable
(delayed, nondelayed) to detect variance in stress
attributable to having a child with delays over and
above the actual level of cognitive functioning. In
the first analysis, we entered MDI (Step 1), status
(Step 2), and behavior problems (Step 3). As
shown in Table 5, these variables explained 52%
of the variance in mothers’ stress, with behavior
problems accounting for an additional 40% of the
variance after the MDI score was accounted for;
status per se did not account for variance. Each
of the three behavior problem indicators was sig-
nificant in the final model. To examine the extent
to which cognitive functioning predicted stress af-
ter accounting for behavior problems, we con-
ducted a further regression analysis with behavior
problems entered first (Step 1), followed by MDI
(Step 2), and status (Step 3). Behavior problems
accounted for 52% of the variance, with MDI and
status not accounting for significant variance.
Each of the three behavior problem indicators was
significant in the final model.
Regressions on father negative impact pro-
duced similar results, with the variables combined
accounting for 46% of the variance. With MDI
entered first, it accounted for 8% and behavior
problems accounted for an additional 38%; the
CBCL score and the Bayley Emotional Regula-
tion score were each significant in the final model.
When variables were entered in the reverse order,
behavior problems accounted for 46%, with MDI
and status not accounting for significant variance.
Here too, the CBCL score and the Bayley Emo-
tion Regulation score were each significant in the
final model. The thrust of all of the above anal-
yses is that child behavior problems contributed
to parental stress far more than did the level of
cognitive functioning.
Discussion
We examined the extent of behavior prob-
lems in 3-year-old children with and without de-
lays and the relative impact on their parents of
cognitive delays and problem behaviors. Our first

Table 5. Hierarchical Multiple Regression, Predicting Parental Stress From Child’s Mental Development
and Behavior Problems
Sig F
Negative impact R R3
R change
2
F change change
Mother (n 5 224)
Bayley MDIa .34 .12 .12 29.28 .000
Delay status .34 .12 .00 0.80 .371
Behavior problems .72 .52 .40 61.49 .000
Behavior problems .72 .52 .52 78.42 .000
Bayley MDI .72 .52 .00 2.87 .092
Delay status .72 .52 .00 0.38 .846
Father (n 5 193)
Bayley MDI .28 .08 .08 17.17 .000
Delay Status .30 .09 .01 1.31 .254
Behavior problems .68 .46 .38 44.75 .000
Behavior problems .68 .46 .46 54.12 .000
Bayley MDI .68 .46 .00 0.08 .782
Delay status .68 .46 .01 2.44 .120
Note. Behavior problems variables were: (a) CBCL total score, (b) Bayley Behavior Scales Emotional Regulation score,
and (c) Bayley Behavior Scales Orientation/Engagement score.
a
Mental Development Index.

440 q American Association on Mental Retardation

VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002
Behavior problems and parenting stress
question was, Do children with and without de-
lays already show differential extent of problem
behaviors by age 3? Parents of children with de-
lays reported higher Total CBCL scores and high-
er broad-band Internalizing Problem scores than
did parents of children without delays; indeed,
children with delays were 3 to 4 times as likely to
have a Total score within the clinical range. On
the narrow-band scales, children with delays were
most different from their peers without delays on
Social Withdrawal and Attention Problems. Al-
though fathers’ scores were higher for children
with delays on Aggression and Emotional Reac-
tivity problems, mothers’ scores were not. The
groups did not differ on either parents’ scores on
Anxious/Depressed, Somatic, or Sleep Problems.
The strong difference in social behavior is
consistent with the behavioral observations of
Kopp et al. (1992) and the survey findings of Mer-
rell and Holland (1997), discussed earlier. As chil-
dren with delays grow older, this social domain
may take on added importance as a moderator of
other types of problems. Children with poor so-
cial interaction skills may be particularly at risk
for problems with anxiety, depression, or aggres-
sion because social demands become more com-
plex as children with delays become more aware
of their differences and as peers become more re-
jecting. Kopp et al. (1992) found that 3-year-olds
without delays were already demonstrating a high-
er rate of rejecting responses (80% of children)
than their playmates with delays. Lang, Baker, and
Henker (2001) found that among nonaggressive
preschoolers, poor social skills predicted those
children who subsequently became aggressive by
third grade. Thus, although CBCL scores for typ-
ically developing children have been found to be
reasonably stable across several early school years
(Achenbach, 1991; Heller et al., 1996), we antici-
pated that for children with delays, there may be
a tendency for behavior problems, especially ex-
ternalizing ones, to increase over time with in-
creasing cognitive and social demands, resulting
in an even greater differentiation of the two
groups.
Our second question was, Do parents of 3-
year-olds with delays experience heightened stress
relative to parents of children without delays, and,
if so, is this stress primarily related to the chil-
dren’s cognitive delay or behavioral challenges?
Both mothers and fathers of children with delays
reported greater negative impact of the child on
the family (the variable we refer to as stress) as well
q American Association on Mental Retardation
AMERICAN JOURNAL ON MENTAL RETARDATION
B. L. Baker et al.
as greater negative impact on family finances. Pos-
itive impact did not differ by delay status. Thus,
parents of children with delays expressed positive
feelings similar to those of parents with nondelay-
ed children, while at the same time acknowledging
more negative ones. Although many researchers
have found heightened stress in families of chil-
dren with disabilities, the measures commonly
used to assess parental stress have a number of
items tapping the child’s limitations, and these
items are included in the summary score purport-
ing to measure the parent’s stress. It is a given,
therefore, that stress will appear to increase with
increasing disability. The measure employed here,
the Family Impact Questionnaire (Donenberg &
Baker, 1993), does not ask about child function-
ing and then make inferences about parental
stress. Rather, it was designed to avoid this prob-
lem by directly asking parents about their child’s
impact on the family, relative to the impact they
perceive other children having on their families.
Yet the association of child delay and parental
stress was still found.
The experience of child-related stress, how-
ever, was related much more strongly to the pres-
ence of behavior problems than to intellectual de-
lay. In regression analyses, for mothers and fa-
thers, child behavior problems explained most of
the variance in reports of negative impact. These
analyses support the conclusion that problem be-
haviors, much more than the fact or extent of in-
tellectual delay, account for the parents’ stress lev-
el. We realize, however, that two alternative ex-
planations, where the direction of influence goes
from parent to child, must be entertained. The
first is that very stressed parents misperceive and
misreport their children as having more behavior
problems, thus creating the apparent relationship
between these domains. The second is that very
stressed parents, through their parenting, actually
create more problem behaviors in their children.
We can address the first hypothesis within
our data set, as the Bayley Behavior Scales were
completed not by parents but by staff members,
following the in-home cognitive assessment. Al-
though the Bayley Behavior Scales does not mea-
sure the same constructs as does the CBCL, there
is a conceptual and modest statistical relationship
between these scores. In the regression analyses,
although the CBCL scores accounted for consid-
erably more variance, the Bayley Behavior Scale
scores also entered significantly. When we ran
these same regressions with CBCL scores omitted,
441
VOLUME 107, NUMBER 6: 433–444 z NOVEMBER 2002
Behavior problems and parenting stress
the pattern of findings was similar, albeit attenu-
ated; the Behavior Scales, even without the
CBCL, explained more variance in parent stress
than did the MDI. Thus, we are reasonably con-
fident that the relationship between child prob-
lems and parent stress is not spurious, based on
stressed parents misreporting their child’s difficul-
ties because we found it with variables reported
by others. The second hypothesis, that stressed
parents create greater problems in their children,
cannot be ruled out in this data set and must
await repeated assessment of these variables over
time. Even if parental stress has an effect on chil-
dren’s behavior and there is evidence that it does
(Heller et al., 1996) it is not likely that this ac-
counts in full for the relationships found here.
Mothers and fathers appeared to be viewing
their child’s behavior problems in similar ways.
Their CBCL scores were highly correlated, and
neither parent scored consistently higher on any
scale. Moreover, mothers and fathers reported
similar degrees of child-related stress, and their
CBCL scores related in a similar way to their
stress. The parent agreements found here were
high, especially for parents of children with de-
lays. Achenbach (1991) reported mother and fa-
ther agreement on CBCL Externalizing and Inter-
nalizing scores for boys 4 to 11 to be .86 and .71,
respectively; and for girls, .70 and .57. Researchers
focusing on 4-year-olds with no delays, however,
have reported considerably lower agreements, for
example, .42 and .18, respectively (Hay et al.,
1999) and .55 and .12 (Baker & Heller, 1996). Our
agreements between parents of children with de-
lays, .71 and .75, were similar to Achenbach’s cor-
relations with children who were, on average, old-
er. It is possible that the scales on this new 1.5-
to 5-year version of the CBCL will reflect better
parent agreements and/or that parents of delayed
children are especially attuned to their children’s
behavior and more likely to communicate about
it.
It appears that the roots of dual diagnosis are
taking hold at least by age 3. This finding has two
clear implications for early intervention programs.
First, developers of child programs should make
social skill development and behavior problem
management a central focus of the curriculum.
Second, parent program personnel should share
this focus on ameliorating child problem behav-
iors, but also work with families on strategies for
coping with stress. Successful child behavior prob-
lem reduction may result in reduced parenting
442
AMERICAN JOURNAL ON MENTAL RETARDATION
B. L. Baker et al.
stress as well as in reduced child risk for later men-
tal disorder.
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Received 5/7/01, accepted 8/14/01.
This article is based on activities of the Collab-
orative Family Study, supported by National In-
stitute of Child Health and Human Develop-
ment Grant 34879-1459 (K. A. Crnic, principal
investigator, B. L. Baker, J. Blacher, & C. Edel-
brock, co-principal investigators). The Collabo-
rative Family Study is conducted at three sites:
The Pennsylvania State University, University of
California, Los Angeles, and University of Cal-
ifornia, Riverside. We are indebted to our staff
members at these settings and very much ap-
preciate the assistance of Carolyn Christensen,
Kelly Dulan, Catherine Gaze, Juan Gomez, Cas-
ey Hoffman, Christine Low, Christopher Macau-
ley, Laura Lee McIntyre, Sandra Minassian, Mi-
chael Rothman, and Araksia Trmrian. We es-
pecially acknowledge Lesley Keeler’s early con-
tributions to this paper. Requests for reprints
should be sent to Bruce L. Baker, Department
of Psychology, UCLA, Los Angeles, CA 90095.
E-mail: Baker@psych.ucla.edu
q American Association on Mental Retardation