Parental Stress

Parental stress can come in many forms such as financial troubles, lack of social
support, or it can stem from problems within the marriage.

From: Encyclopedia of Infant and Early Childhood Development, 2008

Related terms:

Postpartum Depression, Pervasive Developmental Disorder, Coping Strategies, De-

pression, Problem Behavior, Mental Health, Child Parent Relation

View all Topics

Parenting, Stress of
K.D. Jennings, L.J. Dietz, in Encyclopedia of Stress (Second Edition), 2007

Parental Mood and Emotional Well-Being

Parenting stress is associated with lower emotional well-being in parents. That is,
parents who report more daily hassles in parenting and/or more major life events
describe themselves as having less life satisfaction and more negative mood and
emotional distress. There is some evidence that stress from daily hassles relates
more strongly than does stress from major life events, but stress from each of
these sources contributes to lower emotional well-being. In addition to the negative
impact on their own emotional well-being, parents with high stress also report a less
positive outlook on parenting and less satisfaction in the parental role. Furthermore,
they tend to experience less pleasure in and enjoyment of their children. Not
surprisingly, they report lower feelings of self-efficacy in the parenting role; that
is, they feel less competent in carrying out their parental responsibilities and less
confident that their efforts will have a positive impact on their children. For some
parents, high levels of parenting stress contribute to psychological disorders, such
as depression and anxiety. For example, mothers with higher parenting stress from
low-birth-weight or medically ill infants are at higher risk for developing postpartum
depression.
A bidirectional relationship exists between parenting stress and negative parental
mood. Parenting stress can increase negative parental mood, but, conversely, neg-
ative mood may also increase perceptions of parenting stress. Parents with negative
mood are more likely to attend to their children's negative behaviors, attribute
negative intent to ambiguous behaviors, and have a decreased threshold for aversive
behaviors.

> Read full chapter

Families of Children with Intellectu-

al Disabilities in Vietnam: Emerging
Themes
Emily D’Antonio, Jin Y. Shin, in International Review of Research in Mental Retarda-
tion, 2009

3.5 Comparison between mothers and fathers of children with

intellectual disabilities
Parental stress appears to affect mothers and fathers to different degrees and
through different mediating variables. Some studies suggest that mothers report
higher levels of parental stress compared to fathers (Shin & McDonaugh, 2008;
Timko, Stovel, & Moos, 1992); other studies suggest similar levels of parental stress
in mothers and fathers, but differences in sources of stress (Dyson, 1997; Flaherty
& Glidden, 2000; Hastings, 2003; Krauss, 1993; Rousey, Best, & Blancher, 1992).
Krauss (1993), for example, found that in the United States, mothers of children
with intellectual disabilities report more stress related to their personal support
networks, while fathers note stress related to their relationship with their child. In
a population of Finnish families of children with disabilities, Saloviita, Italinna, and
Leinonen (2003) found that stress in mothers of children with intellectual disabilities
was related to maladaptive behaviors in their child, while fathers reported stress
associated with perceived social acceptance of their child.

Shin et al. (2006) explored social support and parental stress in Vietnamese mothers
and fathers of children with intellectual disabilities. The Vietnamese version of the
SSSPCDD (Shin & Crittenden, 2003) was again utilized to assess the availability
of several types of social support. Furthermore, an individual’s perceived level of
social support, as compared to an objective measure of available social support (such
as number of supportive individuals), may be a more robust predictor of physical
and mental health (Brissette, Scheier, & Carver, 2002; George, Blazer, Hughes, &
Fowler, 1989). Shin et al. (2006) therefore assessed perceived social support with the
Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet,
& Farley, 1988), a 12-item self-report questionnaire assessing three sources of
perceived social support: family, friends, and significant others. Parental stress was
again assessed with the PSI. Finally, the impact of stigma on families of children
with intellectual disabilities was assessed with The Social Life Scale (SLS). The SLS
specifically focuses on the degree to which stigma limits the social life of these
families.

Shin et al. (2006) found both similarities and differences between mothers and fa-
thers of children with intellectual disabilities. When compared to parents of typically
developing children, both mothers and fathers of children with disabilities reported
smaller networks of social support. Regarding parental stress, mothers of children
with lower intellectual functioning reported higher levels of stress compared to
mothers of typically developing children. In contrast, there was no difference in
reported stress level between fathers of children with intellectual disabilities and
fathers of typically developing children. Overall, mothers of children with intellectual
disabilities reported more parental stress than fathers of children with intellectual
disabilities, consistent with traditional Vietnamese family roles in which mothers
assume the majority of the responsibility for child care. Similar patterns have been
found in Western populations. Hastings (2003), for example, found that among
parents of children with autism, mothers’ stress levels were correlated with child
problem behaviors, but fathers’ stress levels were not. Fathers may be less involved
in caregiving activities in families of children with disabilities, and their level of stress
may be affected more by other factors.

Regarding perceived stigma, differences between mothers and fathers of children

with intellectual disabilities emerged. There was no difference in perceived stigma
between mothers of children with intellectual disabilities and mothers of typically
developing children. The two groups of fathers differed, with fathers of children with
disabilities reporting significantly more perceived stigma. These results suggest
that traditional Vietnamese gender roles impact the types of stress experienced by
mothers and fathers of these children. As the primary caregiver, mothers experience
stress as a result of problems within the immediate family. Fathers, with the re-
sponsibility of integrating the family within the larger community, experience stress
related to the acceptance of his family within the community. For both mothers
and fathers, those with more stigma experienced more stress. This is consistent
with literature regarding Chinese and Korean families of children with intellectual
disabilities (Chen & Tang, 1997; Lam & Mackenzie, 2002). In a Western population,
Krauss (1993) found that mothers of children with disabilities experienced stress
related to their personal support networks, while fathers did not. Mothers of chil-
dren with intellectual disabilities may be more concerned with maintaining their
social network, while fathers are more concerned about maintaining the connection
between their families and the larger community.

Further analysis revealed other sources of the different experiences of mothers and
fathers of children with disabilities. Child gender had a direct impact on mother’s
reported stress level, with mothers of female children with intellectual disabilities
reporting the most stress. In many Asian cultures, male children are more valued
than female children (Lam & Mackenzie, 2002). Due to inadequate health care,
a significant proportion of the fathers studied had a health condition. Mothers
with a spouse with a health problem also reported significantly more stress.
Again, maternal stress was associated with problems within the immediate family.
Paternal stress was directly related to socioeconomic status (SES) and the number
of individuals available for support, with more stress associated with lower SES and
fewer sources of support. Vietnamese fathers appeared to experience more stress
when their ability to provide for their family, and their family’s connection with the
larger community was compromised.

Interestingly, when other factors that could cause stress were taken into account,
such as child’s level of intellectual functioning or SES, perceived stigma was not
related to parental stress. This was true for both mothers and fathers. Both perceived
stigma and parental stress are explained by these demographic variables, rather than
a causal relationship between stigma and stress.

Overall, when compared to previous findings regarding Korean families, Vietnamese

families reported less professional support (Shin, 2002). This is not surprising, con-
sidering that Vietnam has fewer established training programs for special education
teachers and a less-developed special education system. Both Vietnamese mothers
and fathers reported less availability of support from informal and professional
sources when their child’s level of intellectual functioning was lower. Mothers who
reported a larger network of informal and professional support perceived higher
levels of social support and somewhat less parental stress. For fathers, larger support
networks were associated with higher levels of perceived support and significantly
less parental stress.

No differences were found between mothers and fathers in amount or type of

informal and professional support or perceived social support, but some gender
differences did emerge. Mothers reported more parental stress when immediate
family members, such as a spouse or other children, were less available for support.
Fathers, however, noted more parental stress with less availability of friends and
neighbors for support. This suggests that mothers, as the primary caregivers, receive
a great deal of direct support from immediate family members and feel stress
without that support. As the head of the family in traditional Vietnamese culture,
fathers value their family’s acceptance into the community of friends and neighbors
and experience stress without that acceptance.

> Read full chapter

Parenting Styles and their Effects

M.H. Bornstein, D. Zlotnik, in Encyclopedia of Infant and Early Childhood Develop-
ment, 2008

Parental Stress, Marital Problems, and Divorce

Parental stress can have potentially damaging effects on parents’ attitudes and
behaviors toward children. Parental stress can come in many forms such as financial
troubles, lack of social support, or it can stem from problems within the marriage.
Stressors adversely affect the general well-being and health of parents and demand
attention and emotional energy from them. Parental stress can reduce parental
participation, attentiveness, patience, and tolerance toward children and increase
the use of punitive practices. This disruption in family functioning can negatively
impact children’s social competence. Social support can improve parenting satis-
faction, affecting the availability of mothers to their infants as well as the quality of
mother–infant interactions. Well-supported mothers are less restrictive and punitive
with their infants than are less well-supported mothers, and frequency of contacts
with significant others improves the quality of parent–infant relationships as well
as parents’ sense of their own effectance and competence.

Marital problems affect more than just the individual’s own relationship; they can
also compromise a person’s ability to be a good parent. For example, parents in
unhappy marriages can become preoccupied with their marital problems leading
them to detach emotionally from their children and become less engaged in their
upbringing. Due to this preoccupation, parents may act overly lax and permissive,
engendering a sense of rejection in children. Mothers and fathers who are dissat-
isfied with their marriages are more likely to exhibit authoritarian parenting styles.
Also, parents who are depressed are more prone to have marital problems, and as
a result, are less likely to be authoritative. The negative consequences of parental
stress influence a parents’ well-being in addition to the well-being of a marriage
and the parent–child relationship.

Divorce changes a family dynamic in many ways including effects on parenting

styles. Studies show that divorced parents are similar in parenting style based on
their SES and level of education. For example, a divorced mother or father is more
likely to be authoritative if she or he has higher levels of education and is mid-
dle-class. In many families of divorce, a child usually resides with only one parent.
Having a noncustodial father can be difficult for children. However, research shows
that the amount of time noncustodial fathers spend with their children is generally
unrelated to child adjustment. Instead, the important factor is the quality of the
father–child relationship. Having a close relationship with an authoritative nonresi-
dent father leads to better outcomes for the child than having a distant relationship
with a nonauthoritative nonresident father. For example, children who have a close
relationship with a nonresidential authoritative father have greater academic success
and exhibit fewer externalizing and internalizing behaviors. However, having a father
who is intermittently involved or infrequently visits the child can lead to a different
type of father–child relationship. These fathers are often more permissive and take
on a role as a recreational companion instead of that of teacher or disciplinarian.

> Read full chapter

Applications in Diverse Populations

Abram Rosenblatt, Jennifer A. Rosenblatt, in Comprehensive Clinical Psychology,
1998

9.26.4.2.3 Parenting Stress Index

The Parenting Stress Index (PSI; Abidin, 1990) is used to measure child- and paren-
trelated stress in physically abusive parents and those parents at risk for physical
abuse, although the measure was not specifically designed for this purpose (Milner
& Murphy, 1995). The PSI consists of 120 items that assess parent-related stress,
child-related stress, and general life stress. PSI scores, specifically the “parent
domain stress” scores, have been correlated with child abuse potential (Milner,
1986). Data suggest that parents at risk for physical abuse as well as parents who are
physically abusive score higher on the PSI than comparison parents (Abidin, 1990;
Mash, Johnston, & Kovitz, 1983).

> Read full chapter

Challenging Behavior
Laura Lee McIntyre, in International Review of Research in Developmental Disabil-
ities, 2013
2.5.4 Parenting Stress and Depression
Eight studies measured parenting stress (Bagner et al., 2010; Hudson et al., 2003,
2008; McIntyre, 2008a,b; Plant & Sanders, 2007; Singh et al., 2007) with mixed
results. Bagner et al., Hudson et al. (2003, 2008), and Singh et al. (2007) reported
significant reductions in parenting stress from pre- to posttreatment. In contrast,
McIntyre (2008a,b) and Plant and Sanders (2007) reported null findings on the effects
of parent training on parenting stress. Six studies measured parental depression
(Hudson et al., 2003, 2008; McIntyre, 2008a; Nicholson et al., 2008; Plant & Sanders,
2007; Williams et al., 2012) with all but two (McIntyre, 2008a; Plant & Sanders, 2007)
reporting significant decreases in parental depression postintervention.

> Read full chapter

Marital Quality and Families of Chil-

dren with Developmental Disabilities
Sigan L. Hartley, ... Jan S. Greenberg, in International Review of Research in Devel-
opmental Disabilities, 2011

3.1 Child diagnosis

Some of the variation in parenting stress and well-being may be attributed to the
nature of the child's disability. Previous research has found marked differences in the
psychological and physical well-being of parents of children with DD based on the
nature of their child's diagnosis (e.g., Abbeduto et al., 2004; Hartley, Seltzer, Head,
& Abbeduto, in press). These differences in parenting experiences and well-being by
child diagnosis likely contribute to differences in risk of marital discord and divorce.
The nature of some DDs may take a heavier toll on marriages than other DDs. In
support of the notion that risk of marital discord varies as a function of the nature
of the child's DD, within their investigation of families of children with various DDs,
Joesch and Smith (1997) found that parents of children with intellectual disability had
a lower rate of divorce than parents of children with medical or physical conditions
such as congenital heart disease and cerebral palsy.

Similarly, when looking across studies, there is evidence of diagnostic differences

in parental marital quality. For instance, families of children with Down syndrome
are often found to fare better than parents of children with other types of DD.
Mothers of children with Down syndrome report a lower level of parenting stress
and view caretaking more positively than mothers of children with other types of
DD (Hodapp, Ly, Fidler, & Ricci, 2001; Hodapp, Ricci, Ly, & Fidler, 2003; Sellinger
& Hodapp, 2005). This “Down syndrome advantage” continues during mothers’
midlife, when their son or daughter is an adolescent or adult (e.g., Abbeduto et
al., 2004; Esbensen, Bishop, Seltzer, Greenberg, & Taylor, 2010) and is also evident
in fathers (Hartley et al., in press). The “Down syndrome advantage” is purported
to be related to a variety of factors including the certainty (i.e., genetic testing)
and early timing of diagnosis, profile of less negative and more positive behaviors
displayed by individuals with Down syndrome compared to children with other DDs,
and possibly parent resources (e.g., older and more educated mothers), although
recent evidence suggests that maternal age and education do not contribute to this
advantage (Esbensen & Seltzer, 2011).

In line with the “Down syndrome advantage,” in a study of medical records of over
372,000 families living in Tennessee, the risk of divorce in parents of children with
Down syndrome was equal to and even slightly less than that of families of children
without an identified disability and families of children with other congenital disabil-
ities (Urbano & Hodapp, 2007). The certainty and early timing of diagnosis of Down
syndrome, relatively low levels of parenting stress, positive views on caretaking, and
overall positive psychological well-being experienced by parents of children with
Down syndrome may help promote positive marital interactions.

By contrast, the nature of other disorders appears to be more taxing on families and
may take a toll on parents’ marriages. For instance, the behaviors associated with
attention deficit/hyperactivity disorder (ADHD) have been found to be stressful for
parents and may result in added strain to marriages (Wymbs et al., 2008). The rate
of divorce in a sample of 282 parents of children with ADHD was found to be twice
as high as the divorce rate in a comparison group of parents of children without
ADHD (Wymbs et al., 2008). Individuals with DD often have comorbid ADHD and
inattentive and hyperactive behaviors (e.g., Emerson, 2003; Simonoff, Pickles, Wood,
Gringras, & Chadwick, 2007) and the presence of these symptoms may result in
increased risk of marital strain for these families as well.

Few DDs appear to be more stressful for parents than ASDs (Seltzer et al., 2001).
Mothers of children with an ASD report higher levels of stress (Sanders & Morgan,
1997; Herring et al., 2006) and more depressive symptoms (Dumas, Wolf, Fishman,
& Culligan, 1991; Olsson & Hwang, 2001) than do comparison groups of mothers
of children with other types of DDs. Moreover, this profile of heightened parental
stress and poor psychological well-being is not limited to early parenting years
or to mothers; studies have found elevated levels of parenting stress and poor
psychological well-being in mothers of adolescents and adults with an ASD as
compared to normative comparison groups (Smith et al., 2009), and in fathers of
adolescents and adults with an ASD as compared to fathers of adolescents and adults
with Down syndrome and fragile X syndrome (Hartley et al., in press).
Several factors are theorized to contribute to the poorer well-being of parents of
young and grown children with an ASD, including the uncertainty surrounding
ASD diagnosis and often long diagnostic odyssey to reach a diagnosis of ASD
(Wiggins, Baio, & Rice, 2006), the stressful profile of symptoms and associated
behavior problems including inattention and hyperactivity seen in individuals with
an ASD, and public misunderstanding of and low tolerance for the symptoms and
behaviors seen in individuals with an ASD (Abbeduto et al., 2004; Gray & Holden,
1992). In addition, family members of individuals with an ASD may themselves show
symptoms of the broader autism phenotype (BAP), which involves mild and subtle
ASD-like impairments in social interactions, communication and restricted/repeti-
tive interests and behaviors (Bolton et al., 1994; Piven, 2001; Piven et al., 1990), and
other psychiatric conditions (Smalley, McCracken, & Tanguay, 1995; Szatmari et al.,
1995). Thus, parents of children with an ASD may often be caring for an additional
child with a disability or special care needs and parents themselves may evidence
problems that limit their resources to cope with the demands of caring for a child
with an ASD.

Recent evidence suggests that parents of children with an ASD may also be at risk
for experiencing marital discord. However, in terms of divorce, this risk may only be
apparent during the later parenting years. In the first published study on divorce
in parents of children with an ASD, we examined the prevalence and timing of
divorce in a sample of 391 families of adolescents and adults with an ASD (Hartley
et al., 2010). We found that parents of children with an ASD had a similar risk of
divorce as did a matched comparison group of parents of children without a mental
health condition or DD when the son or daughter was young. However, in late
childhood (aged 8 years) and beyond, the divorce rate declined among parents of
children without disabilities, but this decline in the divorce rate was not evident
among parents of older children with an ASD. The high level of parenting stress and
caregiving demands that continue into the child's adolescence and beyond coupled
with the poor psychological and physical health of parents of sons and daughters
with an ASD may foster an extended period of risk of negative marital interactions
and reduced resources for promoting positive spousal interactions for parents of
individuals with an ASD, and hence a higher rate of divorce. However, in this study,
the majority (75%) of families remained married to the biological or longstanding
adoptive fathers of the child with an ASD through the son or daughter's adolescence
and adulthood. Thus, although the risk of divorce was higher for parents of children
with an ASD during the later parenting years as compared to parents of children
without a DD or mental health condition, the majority of marriages remained intact
through parents’ mid to late life.

Findings from a second recent study on parental relationship status in 913 children
with an ASD also suggest that rates of marital disruption for parents who have a child
with an ASD are similar to that of a normative comparison group during the early
parenting years (Freedman et al., 2011). This study examined the current relationship
status (i.e., whether biological or adoptive parents were living together) of children
using data from the 2007 National Survey of Children's Health, a population-based
survey of children in the United States aged 3–17 years. Children reported to have an
ASD by parents were equally likely to live with both parents (biological or adoptive)
as were children reported who did not have an ASD according to parent report.

The mean age of children in the Freedman et al. study was 10 years (SD = 4 years),
ranging from 3 to 17 years. In the Hartley et al. (2010) study, the increased risk of
divorce between parents of children with an ASD and the comparison group first
began in the son or daughter's older childhood and became more prominent during
their adolescence and adulthood. The mean age of children in the Hartley et al.
study was 27 years (SD = 9 years), ranging from 14 to 56 years. Thus, the lack of
an overall difference in the parental relationship status of children with an ASD as
compared to the normative comparison group in the Freedman et al. study may be
due to the younger age of the sample. It is also possible that historical changes in
public awareness of ASD and increases in services and supports over the past decade
lessened the negative effect of having a child with an ASD on parents’ marriages.
Thus, the marital relationship of parents of current children with an ASD may be
less negatively impacted than the marital relationship of parents of current adults
with an ASD.

> Read full chapter

Persevering in the Face of Hardship:

Families of Individuals with Develop-
mental Disabilities in the People’s Re-
public of China
Peishi Wang, in International Review of Research in Mental Retardation, 2009

4.3.5 Family education

Two studies examined the effect of family-focused education on parental stress
and parenting competency. Wong, Lai, Martinson, and Wong (2006) found that
family-focused education was effective in enhancing parental skills, knowledge,
and competency among 40 parents of children with developmental disabilities
from Guangzhou, China. Specifically after the education program, parents in the
experimental group scored higher in the knowledge domain and overall parental
attitude, and reported a decrease in stress level. Parents also learned from each other
and shared with each other during the training sessions.

Wang (2008) evaluated the effects of a parent-training program on the interactive

skills of parents of children with autism in a Northeastern city of China. Both Wong
et al. and Wang (2008) found that, after training, parents in the experimental group
demonstrated a more affectionate attitude toward the child, were more responsive,
had more parent–child interactions, and used praise more often during parent–child
interactions.

> Read full chapter

Social Relationships
Judith Wiener, Victoria Timmermanis, in Learning About Learning Disabilities
(Fourth Edition), 2012

Parenting Interventions
Parents of children and adolescents with LD experience difficulties in their
parenting role including parenting stress and anxiety. Some of these challenges
are similar to those experienced by parents of children with other learning and
behavioral problems (e.g., ADHD) (Johnston & Mash, 2001). As such, some of the
intervention work for parents of children with LD has been conducted in mixed
samples with parents of children with other disabilities or learning difficulties (e.g.,
Margalit & Raskind, 2009; Shechtman & Gilat, 2005). Group counseling and online
communities are two strategies that have been used to enhance social support and
parenting strategies for parents of children with learning difficulties. Both enhance
social support by providing parents with the opportunity to share and discuss
difficulties related to their children, explore thoughts, feelings, and behaviors in
difficult situations, and receive guidance by discussing effective and ineffective
solutions to the problems they encounter. Additionally, such programs typically
provide psychoeducational information to increase parents’ understanding of LD
and enhance parent–child interaction. This information usually includes symptoms,
diagnosis, etiology, and management of learning disorders, and teaching of effective
communication and problem solving skills (Uslu, Erden, & Kapci, 2006).

Gains associated with participation in counseling and psychoeducational groups

include improved parent–child interaction (i.e., decrease in criticism and increase
in warmth and positive remarks) and parent–child relationship, lower levels of
parenting stress, and increased parenting self-efficacy and control (Shechtman
& Gilat, 2005; Uslu et al., 2006). Online communities also provide parents with valid
and reliable information and strategies for parenting and educating their children,
as well as emotional support. Parents who participated in an online community
valued receiving information, empathy, companionship, and emotional support
from others in similar circumstances (Margalit & Raskind, 2009). Additionally, the
confidential nature of online communities provides an opportunity for parents to
disclose emotions in a setting perceived as private and safe.

Innovative methods are being developed to enhance parents’ knowledge and aware-
ness of learning disabilities. Virtual reality has been effectively used to simulate the
reading errors, cognitive perceptions and personal experiences such as helpless-
ness and frustration associated with dyslexia. Parents who participated in a virtual
reality simulation increased their knowledge of reading disabilities and reported a
greater understanding of the way their children experienced reading (Passig, Eden,
& Rosenbaum, 2008).

> Read full chapter

Family-Centered Care in the Pediatric

Intensive Care Unit
Debra Ann Ridling, ... Daphne Lindsey, in Pediatric Critical Care (Fourth Edition),
2011

Communication
The highly technical nature of the PICU environment and its multiple caregivers,
paired with parental stress, creates a complex situation with a great potential for
miscommunication. It is important to establish clear lines of communication both
among the various members of the health care team and between the team and
the family.26 Because the stressed family is less able to take in, comprehend, and
retain information,21,31-33 explanations must be clear, concise, and repeated. Special
attention must be focused on avoiding medical jargon and abbreviations. Routine
care conferences should be held because they are an important avenue to provide
information, share opinions, and reach consensus. These care conferences may be
held to provide medical updates or make treatment decisions.26 It may be helpful
to advise parents to maintain a bedside journal or log in which they can note
information given and list questions to be addressed later. Placing a board in the
child’s room that lists the names of the care providers, the daily plan, and goals
and that is updated daily is helpful to families. Collaborative care planning will help
reduce stress for all persons involved in the care of the patient and may resolve or
defuse conflicts between the family and the medical team or within the team itself.26
 > Read full chapter

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