Aspects of Mothers’ Parenting Independent and Speciﬁc INGLES

8/13/2019 Aspects of Mothers Parenting Independent and Specific INGLES

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O R I G I N A L P A P ER

Aspects of Mothers Parenting: Independent and SpecificRelations to Childrens Depression, Anxiety, and Social Anxiety

Symptoms

Natalie M. Scanlon Catherine C. Epkins

Springer Science+Business Media New York 2013

Abstract Theories on childrens depression, anxiety, and

social anxiety note aspects of parenting such as acceptance/rejection and behavioral control. Despite these theoretical

relations and high rates of comorbidity among childrens

internalizing symptoms, no studies have examined multiple

aspects of parenting and childrens symptoms of depres-

sion, anxiety, and social anxiety simultaneously. We

examined mother- and child-reported mothers parenting

behaviors (acceptance/rejection and behavioral control)

and their combined, independent, and specific relations

with childrens depression, anxiety, and social anxiety

symptoms in a community sample of 124 motherchild

dyads (children 1012 years old). Childrens report of

maternal behavioral control was related to mothers reportof childrens anxiety problems. Importantly, childrens

report of mothers acceptance/rejection was an independent

predictor of all three child-reported symptom types, and

child- and/or mother-report of maternal acceptance/rejec-

tion was an independent predictor of mothers report of

childrens anxiety and affective problems. After controlling

for anxiety, social anxiety, and both together, childrens

perceived maternal acceptance/rejection emerged as a

specific and unique predictor of childrens depression

symptoms. But, after controlling for depression, parenting

behaviors were no longer related to childrens anxiety and

social anxiety. Clinical and theoretical implications are

discussed, as well as directions for future research.

Keywords Childrens depressive symptoms

Childrens anxiety Childrens social anxiety

Maternal acceptance/rejection Maternal behavioral

control

Introduction

Depression, anxiety, and social anxiety are common psy-

chological symptoms and disorders (American Psychiatric

Association2000; Kessler and Wang2008) that often begin

in childhood (Abela and Hankin 2008; Cartwright-Hatton

et al.2006; Kessler and Wang2008; Rapee et al.2009) and

are quite impairing (Epkins and Heckler 2011; Muris and

Meesters2002). In addition, these subthreshold symptoms

have similar correlates and outcomes as clinical diagnoses(see Epkins and Heckler 2011, for a review of depression

and social anxiety symptoms; see Wood et al. (2003), for a

review of anxiety symptoms). Importantly, these symptoms

and disorders tend to co-occur (Chavira et al. 2004; Se-

ligman and Ollendick1998). This is especially true for the

comorbidity of depression and social anxiety in particular,

both for symptoms and disorders of depression and social

anxiety (see Crawley et al. 2008; Essau et al. 1999; Viana

et al.2008). In fact, children with comorbid depressive and

anxiety disorders, in comparison to anxiety-disordered

youth without depression, have been found to have more

social anxiety symptoms (ONeil et al. 2010).

Aspects of parenting have long been theorized to be

related to childrens adjustment, including their depression,

anxiety, and social anxiety (see Epkins and Heckler 2011,

for a review of depression and social anxiety; see Rapee

2012, for a review of anxiety). There is also substantial

empirical support for the relations between parenting and

childrens internalizing symptomatology, although few

studies have examined aspects of parenting and multiple

types of childrens internalizing symptoms simultaneously.

N. M. Scanlon C. C. Epkins (&)Department of Psychology, Texas Tech University, Box 42051,Lubbock, TX 79409-2051, USAe-mail: [email protected]

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J Child Fam Stud

DOI 10.1007/s10826-013-9831-1


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Given the comorbidity of depression and anxiety, and

especially between depression and social anxiety, exam-

ining relations between aspects of parenting and only one

type of internalizing symptom results in little knowledge

about whether various parenting constructs are indepen-

dently related, or specifically and uniquely related, to

depression, anxiety, and/or social anxiety.

In general, parenting behaviors may be viewed oncontinuums, one of which stems from PARTheory

(Parental Acceptance and Rejection Theory; Rohner and

Khaleque2005) and is the acceptance-rejection continuum.

Acceptance (as defined by such terms as warmth and

support) lies at the positive end of the continuum, and

rejection (as defined primarily by the lack of warmth or

support, and criticism) lies at the opposite, negative end of

the continuum. A second continuum of parenting behaviors

is that of autonomy versus control. Autonomy-granting, on

one end of the continuum, is more or less the allowance by

parents of childrens age-appropriate freedom while con-

trol, on the other end of the continuum, is broadly definedas restriction or the lack of autonomy-granting (Drake and

Ginsburg2012). Theorists have also discussed two types of

control; behavioral control and psychological control.

Barber (1996) defined both types: Psychological control

refers to control attempts that intrude into the psychologi-

cal and emotional development of the childBehavioral

control, in contrast, refers to parental behaviors that

attempt to control or manage childrens behavior (p.

3296).

Based on this definition, parents who are high in

behavioral control attempt to directly control their chil-

drens behavior by making rules and insisting that they arefollowed (Ballash et al. 2006; McLeod et al. 2007b). Par-

ents who are high in psychological control, on the other

hand, attempt to control childrens psychological devel-

opment and typically do so by means of more covert

methods than behavioral control (e.g., shaming, guilt

induction, love withdrawal; Soenens and Vansteenkiste

2010). In this way, psychological control has been likened

to criticism and a lack of emotional warmth, both of which

are more in line with the construct of parental rejection

(Settipani et al. 2013). Theoretically, parental rejection is

related to childrens internalizing symptomatology, as

Soenens and Vansteenkiste (2010) note, it seems likely

that children of internally controlling [psychologically

controlling or rejecting] parenting are more at risk for

internalizing problems. These children would experience

an inner conflict between complying with their parents

requests and pursuing their own personally endorsed goals.

This inner conflict would result in emotional distress (e.g.,

anxiety and depression) (p. 83).

More specifically, early family disruption implicated in

interpersonal models of youth depression (Rudolph et al.

2008) include parenting behaviors characterized by less

acceptance and more rejection and behavioral control,

thereby leading to negative self-evaluations on the part of

the child. Khaleque (2012), in fact, explained that all

humans need warmth, acceptance, and other positive

responses from their primary caregivers. Without these

positive responses and interactions, much can go wrong in

the childs development that pertains to emotional stability(Rohner 1986/1999). For instance, if children perceive

their caregivers to be rejecting and lacking in acceptance,

they will likely develop negative thoughts and feelings

about themselves and the future, which are symptoms of

depression.

Negative thoughts about the self are also in line with

social anxiety, which involve excessive self-consciousness

and worries about being judged harshly by others (Amer-

ican Psychiatric Association 2000). Similar to youth

depression, parental rejection and overprotection are also

implicated in models of youth social anxiety (Kearney

2005; Rapee and Spence2004). Moreover, Ollendick andBenoit (2012) have proposed a parentchild interactional

model of youth social anxiety which includes parental

rejection and overprotection (likely in the form of behav-

ioral control), in addition to less acceptance. Thus, parental

rejection and behavioral control are also implicated in

models of childrens social anxiety, due to the very self-

focused and interpersonal nature of these parenting

constructs.

As with theories of youth depression and social anxiety,

theories of general anxiety have focused on similar aspects

of parenting. Ginsburg and Schlossberg (2002), drawing

upon past models of youth anxiety, primarily focus oncertain anxiety-enhancing parenting behaviors such as

over-control (both behavioral and psychological), over-

protection, lack of warmth, criticism, and rejection.

Clearly, rejection is associated with increased conflict in

the parentchild relationship, which may lead to a lack of

self-competence and self-worth on behalf of the child and

therefore more anxiety (Ginsburg and Schlossberg 2002;

Rapee 1997). Additionally, the perception of parents as

rejecting often leads children to believe that the world is

unfriendly, hostile, or dangerous (Rohner 1986/1999),

which are symptoms of more general anxiety. Finally, lack

of parental warmth (associated with increased rejection)

may create disruption and distress in a childs development

(Chorpita and Barlow1998), as well as a lack of support or

affiliation, both of which may increase a childs level of

anxiety (Drake and Ginsburg 2012).

However, the consequences of less acceptance and more

parental rejection (i.e., lack of self-competence and self-

worth; lack of support or affiliation) are likely more so

related to childrens depression and social anxiety symp-

toms versus anxiety symptoms more generally. Thus, most

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developmental and theoretical models of youth anxiety

focus primarily on parental behavioral control, rather than

on acceptance/rejection (Chorpita and Barlow1998; Drake

and Ginsburg2012; Hudson and Rapee2009; Rapee2001).

For example, children whose parents assume control over

everything likely do not develop a strong sense of mastery

or self-efficacy, both of which are related to anxiety

(Chorpita and Barlow1998). Although parental behavioralcontrol may be well-intentioned, it often results in an

increased perception of threat and a decreased perception

of control on the part of the child. Thus, children learn that

many situations are anxiety-provoking and cannot be

handled, so their learned response is increased anxiety and

avoidance (Hudson and Rapee 2009) rather than mastery

and confidence (Drake and Ginsburg2012; Settipani et al.

2013).

The implication in many of these theoretical models of

youth depression, anxiety, and social anxiety is that it is

childrens perceptions of parenting behaviors that have the

strongest relations with their overall development (andinternalizing symptoms more specifically). For the most

part, childrens perceptions of parenting behaviors are

more salient with regard to relations to internalizing

symptoms. Thus, from both a theoretical (Rohner 1986/

1999) and empirical perspective (Fentz et al. 2011; Greco

and Morris 2002; Hale et al. 2006; Khaleque 2012;

Khaleque and Rohner 2002a), childrens perceptions of

parenting behaviors are important to consider, above and

beyond parents report of their own parenting behaviors.

Empirically, youth depression has been found to be related

to parental acceptance/rejection (Burkhouse et al. 2012;

Dallaireet al. 2006; Schwartz et al. 2012; Sheeber etal. 2007).In fact, a meta-analysis (McLeod et al. 2007a) found that the

construct of parental rejection (more specifically, aversive

behaviors and lack of warmth) was most strongly related to

childrens depression. However, none of the studies men-

tioned above controlledfor comorbid anxiety or social anxiety

symptoms. Likewise, studies have found parental acceptance/

rejection to be related to youth anxiety (Drake and Ginsburg

2011; Ginsburg et al. 2004a; Hale et al.2006; Hudson et al.

2009; Hudson and Rapee 2001; Siqueland et al. 1996) and

social anxiety (Knappe et al.2012), but none of these studies

have controlled for comorbid depression.

With regard to parental behavioral control, relations

have been found with youth anxiety (Drake and Ginsburg

2011; Ginsburg et al. 2004a; Hudson and Rapee 2001;

McLeod et al.2007b; Muris and Merckelbach1998; Wood

et al. 2003) and social anxiety (Knappe et al. 2012; Rork

and Morris2009; Rubin et al.1999). Again, however, none

of these studies controlled for comorbid depressive symp-

toms. There is some empirical support for the relation

between parental behavioral control and youth depression

(or self-criticism more specifically; Koestner et al. 1991),

in addition to behavioral control being related to childrens

internalizing problems more generally (Mills and Rubin

1998).

A few noteworthy studies have examined aspects of

parenting and multiple types of internalizing symptoms

simultaneously. These studies have had mixed results

though, owing somewhat to different methodologies aswell as to the investigation of family variables more

broadly (Johnson et al. 2005; Starr and Davila 2008) as

opposed to behavioral control and acceptance/rejection

more specifically. In terms of behavioral control, some

studies found a significant relation between childrens

anxiety (Beesdo et al. 2010) or social anxiety (Greco and

Morris 2002) symptoms and parental behavioral control,

even after controlling for comorbid youth depression.

Moreover, youth with comorbid depression and anxiety

disorders, in comparison to anxiety-disordered youth

without depression, have been found to report more family

dysfunction in general, but these two groups did not differon perceptions of parental behavioral control (ONeil et al.

2010). Thus, theoretically and empirically, parental

behavioral control seems to hold more specific relations

with childrens anxiety versus depression symptoms.

In terms of parental acceptance/rejection, some studies

have found that significant relations between acceptance/

rejection and childrens anxiety (Fentz et al. 2011), and

social anxiety (Hutcherson and Epkins2009), become non-

significant when controlling for depression symptoms. In

contrast, some studies found a significant relation between

childrens depression and parental acceptance/rejection,

even after controlling for youth anxiety (Beesdo et al.2010) and social anxiety (Hutcherson and Epkins 2009)

symptoms. Therefore, empirically (Greco and Morris2002;

Hutcherson and Epkins 2009), youth social anxiety and

general anxietyappearto have similar relations to parental

acceptance/rejection.

Thus, parental behavioral control and acceptance/rejec-

tion seem to be related to childrens depression, anxiety,

and social anxiety. However, there seem to be stronger

relations between parental acceptance/rejection and youth

depression, and between parental behavioral control and

youth anxiety. Indeed, in a recent review on youth anxiety,

Rapee (2012) stated, Although other parenting styles such

as criticism or lack of warmth may also play a role in

anxiety, their influence on anxiety specifically has been less

consistently established (p. 74). Furthermore, it is also

important to examine youth social anxiety because there is

some evidence that the parenting constructs of overpro-

tection, rejection, and low warmth are associated with

adolescents social anxiety disorder but not other anxiety

disorders (Knappe et al. 2012).

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The purpose of this study is to extend past research by

examining specific aspects of parenting (acceptance/rejec-

tion and behavioral control) and all three types of chil-

drens internalizing symptoms (depression, anxiety, and

social anxiety) simultaneously. This will allow for a test of

existing theoretical models and an examination of the

independent, as well as specific and unique, relations

between various aspects of parenting and childrensdepression, anxiety, and social anxiety which are currently

not well known (see Epkins and Heckler2011for a review;

Gere et al.2012).

We hypothesized, based on theory and past research,

that low acceptance, high rejection, and high behavioral

control would be related to increased childrens depression,

anxiety, and social anxiety symptoms. With regard to

independent relations, we hypothesized that low maternal

acceptance/high rejection would be more strongly and

independently related to childrens depressive symptoms

relative to maternal behavioral control. On the other hand,

behavioral control would be more strongly and indepen-dently related to childrens anxiety and social anxiety

symptoms relative to maternal acceptance/rejection. We

include both mother- and child-reports of parenting to

assess if childrens perceptions of parenting behaviors are

more independently related to their internalizing symptoms

(c.f., Khaleque2012).

Importantly, with regard to specific and unique relations,

after controlling for depression, we predicted that maternal

acceptance/rejection would no longer be related to chil-

drens symptoms of anxiety and social anxiety. But, after

controlling for anxiety and social anxiety symptoms, we

expected that acceptance/rejection would remain related tochildrens depression. We also predicted that maternal

behavioral control would no longer be related to childrens

depression symptoms after controlling for anxiety and

social anxiety, but that behavioral control would remain

related to anxiety and social anxiety symptoms after con-

trolling for depression.

Method

Participants

The sample consisted of 124 motherchild dyads (94.4 %

biological mothers) from the community. Seven children

were not biologically related to their mothers, but all but

one of them had lived with their mother for a period of at

least 5 years, if not for their entire life. The majority of

mothers (72 %) were married, and approximately half of

the child participants were girls (50.8 %). Children ranged

in age from 10 to 12 years (M age 10.75 years,

SD = .93 years). After Institutional Review Board

approval, mothers and children were recruited through

community events and activities such as camps, back-to-

school events, sports, various seasonal events, etc. Only

one child per household was allowed to participate,

mothers had to be legal guardians of the children, and the

participating children and their mothers were entered into a

raffle to win one of ten $15 gift cards.The majority of the children were identified by their

mothers as Caucasian (66.9 %), although a substantial

percentage (33.1 %) was identified as being of a different

ethnicity: Hispanic (17.7 %), Black (10.5 %), Asian

(1.6 %), and Other (3.2 %). Using Hollingsteads Index

(1975), the majority of families socioeconomic status

(SES) levels fell into category 4 (44.1 %) and category 5

(23.2 %), thereby reflecting a middle-upper level of SES.

According to mother-report, 10.5 % of the children had

been diagnosed with a psychological disorder in the past,

and 18.5 % had a current diagnosis. With regard to

treatment, 22 % of the children had previously been insome type of therapy/counseling (not including medica-

tion) and 9 % were at the time of the study. For the

mothers, 21 % had been diagnosed with a psychological

disorder in the past, and 17 % had a current diagnosis.

With regard to treatment, 47 % of the mothers had pre-

viously been in some type of therapy/counseling (not

including medication) and 10.5 % were at the time of the

study.

Procedure

When permission to recruit at local community events wasgranted, caregivers (primarily mothers) were approached

about participating in the study. If they were interested in

participating (or at least agreed to be contacted about

participating), mothers provided their name and contact

information. Typically, they were telephoned within

1 week of providing their contact information for the study.

If they then agreed to participate, they scheduled a time

(approximately 1 h) for themselves and their children to

complete the measures either at the laboratory or in their

home (79.8 % of the motherchild dyads completed the

measures in their homes). Procedures were identical in the

home and lab settings.

Written informed consent from the mothers and assent

from the children were obtained prior to participation in

the study. Mothers and children independently completed

two randomly-ordered packets of measures; one packet

contained measures about themselves and the other con-

tained measures about the other (the order of administra-

tion of these packets was counterbalanced across child

sex).

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Childrens Symptom Measures

Beck Depression Inventory for Youth (BDI-Y)

The BDI-Y (Beck et al. 2005) is a commonly-used and

well-validated measure that assesses depressive symptoms.

The BDI-Y contains 20 items, and responses for each item

range from 0 (Never) to 3 (Always), with a higherscore reflecting more severe depression symptoms. The

internal consistency has been found to exceed .90 in a

number of samples (Beck et al. 2005; Stapleton et al.

2007). Good testretest reliability (r = .79.92) was

demonstrated with a sample of 105 children (ages 718)

over a period of 78 days (Beck et al. 2005). Convergent

validity has been demonstrated with questionnaire mea-

sures as well as diagnostic interviews (Beck et al. 2005;

Stapleton et al. 2007). Discriminant validity has also been

demonstrated as youth diagnosed with depressive disorders

have been found to have higher BDI-Y scores than youth

with anxiety disorders, other disorders, and no disorders(Beck et al. 2005; Stapleton et al. 2007). The BDI-Y had

good internal consistency in the current sample (a =.93).

Beck Anxiety Inventory for Youth (BAI-Y)

The BAI-Y (Beck et al. 2005) consists of 20 items that

assess childrens fear, worry, and physiological aspects of

anxiety. Like the BDI-Y, items are rated on a scale from 0

(Never) to 3 (Always), with a higher score reflecting

more anxiety symptoms. Good internal consistency (a s

ranging from .89 to .91) and 1 week testretest reliabilities

(rs ranging from .77 to .93) in 7 to 14-year-old youth havebeen demonstrated (Beck et al. 2005). Convergent and

divergent validity have been demonstrated with question-

naires as well as diagnostic interviews (Beck et al. 2005).

The BAI-Y had good internal consistency in the current

sample (a = .91).

The Social Anxiety Scale for Children-Revised (SASC-R)

The SASC-R (La Greca 1999) is a 22-item self-report

measure designed for completion by preadolescent chil-

dren. It is comprised of 18 items (and 4 filler items) that are

each rated on a 5-point Likert scale ranging from 1 (not at

all) to 5 (all of the time). Adequate convergent validity has

been demonstrated between total scores on the SASC-R

and the Social Phobia and Anxiety Inventory for Children

(SPAI-C), with Pearson correlation coefficients ranging

from .63 to .81 (Epkins 2002; Morris and Masia 1998).

Divergent validity has also been demonstrated between the

two measures (Sanna et al. 2009) with the SASC-R able to

distinguish between boys and girls with and without social

phobia. Finally, predictive validity has also been

demonstrated for the SASC-R (Reijntjes et al. 2007). Good

internal consistency for the SASC-R total score (a = .91)

was demonstrated in the current sample.

Child Behavior Checklist (CBCL)

The CBCL (Achenbach and Rescorla2001) is completed by

parents and it assesses childrens behavioral problems. TheDSM-Oriented Affective Problems and Anxiety Problems

scales were used in this study. As Achenbach and Rescorla

(2001) describe, these scales comprise items that were

judged by experts as being very consistent with the

respective DSM-IV diagnostic categories. Like the empiri-

cally-derived CBCL scales, the CBCL DSM-Oriented

scales were also normed on national samples with respect to

child age and gender, and T-scores were used in the current

study. In demographically-matched referred and nonre-

ferred samples, internal consistency of the Affective and

Anxiety Problems scales has been demonstrated

(alphas = .82 and .72, respectively), as has 8-day testretestreliability (rs =.84 and .80, respectively; Achenbach and

Rescorla2001). The Affective and Anxiety Problems DSM-

Oriented scales have also been found to: (1) discriminate

between referred children and demographically-matched

nonreferred children; and (2) be related to interview

administered DSM-IV checklists (rs =.63 and .43,

respectively) and the presence or absence of professionally

assessed clinical diagnoses in each category in a clinical

sample (point biserial rs = .39 and .45, respectively;

Achenbach and Rescorla2001).

Parenting Measure

Parental Acceptance and Rejection/Control Questionnaire

(PARQ/Control)

The PARQ/Control (Rohner and Khaleque 2005) is com-

prised of the standard 60-item PARQ, in addition to a

13-item control subscale. Both the Parent PARQ/Control

and the Child PARQ/Control forms were used in this study.

The standard PARQ yields an overall Total score of

parental acceptance/rejection and includes items such as,

My mother does not really love me; my mother lets me

know I am not wanted. The control subscale yields a

separate score and includes items such as, My mother is

always telling me how I should behave; my mother

believes in having a lot of rules and sticking to them.

Each form (i.e., Parent and Child) uses a four-point Likert-

type scale, and responses to items range from Almost

always true to Almost never true. Total scores on the

standard PARQ range from 60 to 240, with lower scores

indicating an accepting parenting style, and higher scores

indicating a more rejecting style. Scores on the control

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subscale range from 13 to 52, with higher scores reflecting

more restrictive or strict behavioral control.

Meta-analyses and numerous other studies support the

reliability, validity, and factor structure of the Child and

Parent PARQ in a wide-range of diverse samples (Khale-

que and Rohner2002a,b; Rohner and Khaleque2005). The

Parent PARQ Total Score has acceptable 3-week testret-

est reliability (r = .84; McGuire and Earls 1993) andinternal consistency (alphas ranging from .78 to .90 in

diverse samples; Khaleque and Rohner 2002b). The Child

PARQ Total Score also has good internal consistency

(alphas ranging from .69 to .95) and testretest reliability

up to 10 years (Khaleque and Rohner 2002a,b). Both the

Parent and Child PARQ Total Scores had good internal

consistency in the current study (a = .92, a = .93,

respectively).

Regarding the Control subscale, adequate internal con-

sistency was demonstrated in a meta-analysis with alphas

acrossthe informant versions ranging from .49 to .91, with

a weighted mean alpha coefficient of .73 (Rohner andKhaleque2003). Rohner and Khaleque (2003) also repor-

ted alphas on the Child version ranged from .49 to .81 and

on the Parent version ranged from .62 to .74; with weighted

mean alphas for the Child and Parent versions reported to

be .71 and .69, respectively. Construct validity has also

been established across five culturally distinct samples,

with factor analyses finding two correlated yet distinct

factors: strictness and permissiveness (Rohner and Khale-

que 2003). Internal consistency for both the Parent and

Child Control subscales in the current study was as = .62

and .67, respectively.

Results

Preliminary Analyses

Table1contains the means, standard deviations, skewness,

and kurtosis values for all mother and child measures.

Childrens self-reported depression and anxietyT-scores on

the BDI-Y and BAI-Y in our sample are consistent with

those for community samples, as reported in the instrument

manual (Beck et al. 2005). Mothers reports on childrens

DSM-Oriented Affective and Anxiety problems on the

CBCL were also consistent with T-scores for non-referred

samples of boys and girls (Achenbach and Rescorla2001).

Childrens social anxiety on the SASC-R in our sample

was similar to other similar-aged school (La Greca 1999;

Reijntjes et al. 2007) and community (Epkins2002) sam-

ples. Regarding mothers and childrens overall accep-

tance/rejection scores on the PARQ, in the US, most scores

typically fall between 90 and 110 with youth having higher

scores than parents (Rohner and Khaleque2005). Thus, our

sample is similar to others. Additionally, mothers and

childrens scores on the control subscale lie in between

moderate control (2739) and firm control (4045; Rohner

and Khaleque2005).

Outliers on the measures and subscales were identified,

and these scores were set to one unit higher (or lower) than

the next highest (or lowest) score in the dataset, as rec-ommended by Tabachnick and Fidell (2007). Additionally,

the assumptions of linearity, homoscedasticity, and nor-

mality of errors were all examined. On the normal proba-

bility plot of the residuals, points fell along the diagonal

line and skewness and kurtosis values were all between -3

and 3; thus, the assumption of normality of errors was met.

Regarding linearity, scatterplots of the predicted stan-

dardized values and actual standardized residuals were

examined. This assumption too was met, as most of the

points clustered around the imaginary line drawn at zero.

Finally, with regard to homoscedasticity, variability in

scores for one variable was approximately the same at all

values of another variable, as the data met the assumption

of normality of errors. This was further supported by

examining the scatterplots of predicted standardized values

and actual standardized residuals (Tabachnick and Fidell

2007).

The correlations among the parenting scales and chil-

drens symptom measures can be found in Table 2. As seen

in Table2, neither mother- nor child-reported maternal

behavioral control was significantly related to either

Table 1 Means and standard deviations on mothers and childrensmeasures

Measure M SD Skewness Kurtosis

M-REJECTION 85.38 13.36 .64 -.07

M-CONTROL 39.81 4.01 -.30 .20

C-REJECTION 94.10 22.05 1.13 .97

C-CONTROL 37.60 5.54 .18 -.02C-DEPRESSION 11.85

(47.93)8.08

(10.41)1.06 .99

C-ANXIETY 16.30(49.90)

9.11(10.70)

.81 .64

C-SOCIALANXIETY

41.94 13.74 .63 .26

M-ANXIETY 54.04 5.84 1.66 2.02

M-AFFECTIVE 54.44 6.29 1.75 2.87

M-REJECTION = mother report of maternal acceptance/rejection;M-CONTROL =mother report of maternal control; C-REJEC-TION =child report of maternal acceptance/rejection; C-CON-TROL =child report of maternal control; C-DEPRESSION =scores

on the BDI-Y; C-ANXIETY = scores on the BAI-Y; C-SOCIALANXIETY =scores on the child-reported SASC-R; M-ANXI-ETY =scores on the Anxiety Problems subscale of the CBCL;M-AFFECTIVE =scores on the Affective Problems subscale of theCBCL

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informants report of childrens symptoms with oneimportant exception: child-reported maternal behavioral

control was significantly related to mother-reported child

anxiety problems on the CBCL. In our main analyses, we

controlled for potentially important demographic variables

that past research finds are often related to childrens

internalizing symptoms and parenting behaviors (c.f.,

Anderson and Mayes 2010; Beck et al. 2005; Deater-

Deckard et al. 2011; La Greca 1999). We controlled for

childrens race (i.e., Caucasian vs. Non-Caucasian), family

SES, childrens sex, treatment status for both children and

mothers (i.e., past or current treatment vs. none), and

mothers relationship to children (i.e., biological vs. non-biological).

Main Analyses

We examined the independent and specific relations of

both child- and mother-reported maternal acceptance/

rejection and behavioral control to each of childrens

depression, anxiety and social anxiety symptoms, both

before and after controlling for comorbid symptoms.

Hierarchical multiple regression analyses were conducted

where control variables (childrens sex, ethnicity, rela-

tionship to mother, family SES, and both child and mothertherapy status) were entered in step one. Then, the four

parenting constructs were entered simultaneously in step

two. In controlling for comorbid symptoms, the comorbid

symptoms were entered in step two and the parenting

constructs simultaneously entered in step three. We

examine statistical significance and report effect sizes

regarding the magnitude of significant unique relations;

withsr2 of .01, .09, and .25 indicating small, medium, and

large effect sizes (Cohen et al.2003).

Childrens Self-Reported Symptoms

As shown in Table3, after entering the six control variables

in step one, when considered together in step two, aspects of

mothers parenting were related to childrens depression

symptoms, and only child-reported maternal acceptance/

rejection was an independent predictor (sr2 = .14, a med-

ium effect size). Likewise, regarding childrens anxiety,

when considered together in step two, aspects of mothers

parenting were related to childrens anxiety, and only child-

reported maternal acceptance/rejection was an independent

predictor (sr2 = .11, a medium effect size; see Table3). For

the regression on social anxiety, in step 2, aspects ofmothers parenting considered simultaneously were not, as a

group, significantly related to childrens social anxiety, yet

child-reported maternal acceptance/rejection was an inde-

pendent predictor of social anxiety in the final model

(sr2 = .04, a small to medium effect size). In all three

regressions, race was a significant control variable, with

non-Caucasian children reporting more internalizing

symptoms than Caucasian children.

After considering the effects of the six control variables,

the four parenting variables collectively accounted for an

additional 17, 13, and 6 % of the variance in childrens self-

reported depression, anxiety, and social anxiety symptoms,respectively. Importantly, more child-reported maternal

rejection was significantly and independently associated

with children self-reporting more depression, anxiety, and

social anxiety symptoms, with larger effect sizes for chil-

drens depression and anxiety (sr2 = .14 and .11, respec-

tively) compared to childrens social anxiety (sr2 = .04).

Neither child-perceived nor mother-reported maternal

behavioral control emerged as a significant or independent

predictor of childrens self-reported symptoms, and these

Table 2 Correlations among parenting subscales and childrens internalizing symptoms

Measure 1. 2. 3. 4. 5. 6. 7. 8. 9.

1. M-REJECTION

2. M-CONTROL .04

3. C-REJECTION .11 -.09

4. C-CONTROL .23** .05 .28***

5. C-DEPRESSION .16* -.01 .38*** .13

6. C-ANXIETY .16* -.02 .37*** .12 .85***

7. C-SOCIAL ANXIETY .10 -.01 .27*** .14 .67*** .72***

8. M-ANXIETY .28*** .04 .21** .16* .13 .20* .12

9. M-AFFECTIVE .25** .01 .14 .08 .20* .17* .17* .58***

M-REJECTION =mother report of maternal acceptance/rejection; M-CONTROL =mother report of maternal control; C-REJEC-TION =child report of maternal acceptance/rejection; C-CONTROL =child report of maternal control; C-DEPRESSION = scores on theBDI-Y; C-ANXIETY = scores on the BAI-Y; C-SOCIAL ANXIETY = scores on the child-reported SASC-R; M-ANXIETY =scores on theAnxiety Problems subscale of the CBCL; M-AFFECTIVE =scores on the Affective Problems subscale of the CBCL

* p\ .05; ** p\ .01; *** p\ .001

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parenting constructs did not contribute much to the

regressions.

Childrens Self-Reported Symptoms, Controlling

for Comorbid Symptoms

Table4presents the above results after also controlling for

comorbid symptoms in step 2. With regard to childrensdepression, after controlling for childrens anxiety in step

2, aspects of mothers parenting considered simultaneously

were not, as a group, significantly related to childrens

depression in step 3, yet child-reported maternal accep-

tance/rejection remained a specific and unique predictor of

childrens depression in the final model (sr2 = .01, a small

effect size). After controlling for childrens social anxiety

in step 2, when considered together in step three, aspects of

mothers parenting were significantly related to childrens

depression, and only child-reported maternal acceptance/

rejection was a specific and unique predictor (sr2 = .06, a

small to medium effect size). After controlling for bothchildrens anxiety and social anxiety in step 2, child-

reported maternal rejection remained a specific and unique

predictor in the final model (sr2 = .01, a small effect size).

Thus, more child-reported maternal rejection was specifi-

cally and uniquely related to children reporting more

depressive symptoms after controlling for demographic

variables and their anxiety (sr2 = .01), their social anxiety

(sr2 = .06) and both their anxiety and social anxiety

(sr2 =.01).

As anticipated, a different pattern emerged on anxiety

and social anxiety, as seen in Table4. After controlling for

childrens depressive symptoms in step 2, the parenting

variables collectively were, as a group, not related to

childrens anxiety or to their social anxiety (both

DR2 =.00). Moreover, none of the four parenting variables

(including behavioral control) were specific or unique

predictors of childrens anxiety or social anxiety aftercontrolling for childrens depression symptoms in the final

models (see Table4).

Mother-Reported Childrens Affective and Anxiety

Problems

Similar analyses were conducted on mother-reported child

affective and anxiety problems on the CBCL. After con-

trolling for the six relevant demographic variables, the four

parenting constructs considered together were not signifi-

cantly, as a group, related to mother-reported child affective

problems in step 2, yet mother-reported maternal accep-tance/rejection was an independent predictor in the final

model (sr2 = .04, a small to medium effect; see Table5).

After controlling for mother-reported child anxiety problems

in step 2, the parenting constructs considered as a group in

step 3 were not significantly related to mother-reported child

affective problems, and no parenting variables were found to

be specific or unique predictors (see Table 5).

With regard to mother-reported child anxiety problems on

the CBCL, as seen in Table5, child treatment was a

Table 3 Hierarchical regressions examining parenting behaviors predicting childrens report of depression, anxiety, and social anxiety

Predictor Depression Anxiety Social anxiety

R2

DR2

DF b sr2

R2

DR2

DF b sr2

R2

DR2

DF b sr2

Step 1 .07 .07 1.55 .08 .08 1.65 .12 .12 2.50*

Child treatment .06 -.01 -.12

Mother treatment -.02 -.02 .04

Relationship -.07 .02 -.04

Child race .27** .05 .29** .06 .33** .08

Child sex -.05 -.05 -.14

SES .04 .02 -.01

Step 2 .24 .17 6.15*** .21 .13 4.72*** .17 .06 2.01

M-REJECTION .06 .07 .03

C-REJECTION .41*** .14 .36*** .11 .22* .04

M-CONTROL .01 -.03 -.03

C-CONTROL .05 .03 .08

Betas reported are at the step in which the variable was entered. Child/mother treatment = treatment status (past or current treatment vs. none);relationship =mothers relationship to children (biological vs. non-biological); child race = Caucasian versus non-Caucasian; SES =socio-economic status of family; M-REJECTION =mother report of maternal acceptance/rejection; C-REJECTION = child report of maternalacceptance/rejection; M-CONTROL =mother report of maternal control; C-CONTROL =child report of maternal control

* p\ .05; ** p\ .01; *** p\ .001

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significant control variable, with mothers reporting more

anxiety problems for children with past or current (vs. no)

treatment. The four parenting variables considered together

in step 2 were significantly related to childrens anxiety

problems, and both child- and mother-reported maternal

acceptance/rejection were independent predictors (sr2 = .03

and .04, respectively; both small to medium effect sizes).

Here, more child- and mother-reported maternal rejection

were significantly associated with mothers reporting more

anxiety problems in children. However, after controlling for

mother-reported child affective problems in step 2, the par-

enting constructs considered simultaneously in step 3 were

not significantly related to mother-reported child anxiety

problems, and no parenting variables were specific or unique

predictors. Finally, it is important to notethat although child-

reported maternal behavioral control was significantly cor-

related with mothers reporting more anxiety problems in

children (reported above), maternal behavioral control

(according to either mother- or child-report) did not emerge

as an independent (much less a specific or unique) predictor

Table 4 Hierarchical regression analyses examining parenting behaviors predicting childrens report of depression, anxiety, and social anxiety(controlling for comorbid symptoms)

Predictor Depression (controlling for anxiety) Predictor Anxiety (controlling for depression)

R2

DR2

DF b sr2 R2 DR2 DF b sr2

Step 1 .07 .07 1.55 Step 1 .08 .08 1.65

Child treatment .06 Child treatment -.01

Mother treatment -.02 Mother treatment -.02

Relationship -.07 Relationship .02

Child race .27** .05 Child race .29** .06

Child sex -.05 Child sex -.05

SES .04 SES .02

Step 2 .69 .61 225.79*** Step 2 .69 .61 225.79***

Anxiety .82*** .61 Depression .81*** .61

Step 3 .70 .02 1.49 Step 3 .69 .00 .26

M-REJECTION .00 M-REJECTION .03

C-REJECTION .14* .01 C-REJECTION .03

M-CONTROL .03 M-CONTROL -.04

C-CONTROL .03 C-CONTROL -.01

Predictor Depression (controlling for social anxiety) Predictor Social anxiety (controlling for depression)

R2

DR2


Step 1 .07 .07 1.55 Step 1 .12 .12 2.50*

Child treatment .06 Child treatment -.12

Mother treatment -.02 Mother treatment .04

Relationship -.07 Relationship -.04

Child race .27** .05 Child race .33** .08

Child sex -.05 Child sex -.14

SES .04 SES .01

Step 2 .48 .40 88.27*** Step 2 .50 .38 88.27***

Social anxiety .67*** .40 Depression .64*** .38Step 3 .54 .07 4.09** Step 3 .50 .00 .23

M-REJECTION .04 M-REJECTION .00

C-REJECTION .28*** .06 C-REJECTION -.06

M-CONTROL .03 M-CONTROL -.04

C-CONTROL .00 C-CONTROL .05

Betas reported are at the step in which the variable was entered. Child/mother treatment = treatment status (past or current treatment vs. none);relationship =mothers relationship to children (biological vs. non-biological); child race = Caucasian versus non-Caucasian; SES =socio-economic status of family; M-REJECTION =mother report of maternal acceptance/rejection; C-REJECTION = child report of maternalacceptance/rejection; M-CONTROL =mother report of maternal control; C-CONTROL =child report of maternal control

* p\ .05; ** p\ .01; *** p\ .001

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of childrens anxiety problems in the regression analyses,

and behavioral control did not contribute much to the

regressions.

Discussion

Although aspects of parenting have long been theoretically

and empirically linked to childrens internalizing symp-toms (Epkins and Heckler2011; Rapee2012), few studies

have examined multiple types of internalizing symptoms or

multiple aspects of parenting in the same study. No studies

have examined multiple aspects of parenting and childrens

symptoms of depression, anxiety, and social anxiety in the

same study, despite similar parenting constructs noted in

theoretical models for all three of these symptoms and high

rates of comorbidity (Chavira et al. 2004; Seligman and

Ollendick 1998), especially among depression and social

anxiety (Crawley et al. 2008; Essau et al. 1999; ONeil

et al. 2010; Viana et al. 2008). This results in little

knowledge about the specificity of various aspects of par-

enting to depression, anxiety, and social anxiety. We

extended past research by examining the independent, as

well as specific and unique, relations among aspects of

mothers parenting behaviors (as assessed by both mother-

and child-report) and all three types of childrens inter-

nalizing symptoms.Consistent with theories of depression (Rudolph et al.

2008), anxiety (Ginsburg and Schlossberg 2002), and

social anxiety (Ollendick and Benoit2012), we found that

childrens perceived maternal acceptance/rejection was

related to each of childrens self-reported symptoms of

depression, anxiety, and social anxiety; and mother-repor-

ted acceptance/rejection was related to childrens self-

reported depression and anxiety. Additionally, mothers

report of acceptance/rejection was related to mothers

Table 5 Hierarchical regression analyses examining parenting behaviors predicting mothers report of childrens affective and anxiety problems(including controlling for comorbid symptoms)

Predictor Affective problems Anxiety problems

R2

DR2


Step 1 .05 .05 1.05 .13 .13 2.80*

Child treatment .17 .24* .05

Mother treatment .08 .17

Relationship .02 .02

Child race -.01 .04

Child sex .04 .03

SES -.06 -.02

Step 2 .11 .06 1.81 .20 .08 2.67*

M-REJECTION .23* .04 .21* .04

C-REJECTION .13 .19* .03

M-CONTROL .02 .06

C-CONTROL -.04 .03

Predictor Affective problems (controlling for anxiety problems) Anxiety problems (controlling for affective problems)

R2 DR2 DF b sr2 R2 DR2 DF b sr2

Step 1 .05 .05 1.05 .13 .13 2.80*

Step 2 .33 .28 48.56*** .39 .26 48.56***

Comorbid problems .57*** .28 .52*** .26

Step 3 .35 .01 .51 .41 .03 1.33

M-REJECTION .12 .10

C-REJECTION .03 .12

M-CONTROL -.01 .05

C-CONTROL -.05 .05

Betas reported are at the step in which the variable was entered. Child/mother treatment =treatment status (past or current treatment versusnone); relationship =mothers relationship to children (biological vs. non-biological); child race = Caucasian versus non-Caucasian;

SES = socioeconomic status of family; M-REJECTION = mother report of maternal acceptance/rejection; C-REJECTION =child report ofmaternal acceptance/rejection; M-CONTROL = mother report of maternal control; C-CONTROL =child report of maternal control

* p\ .05; ** p\ .01; *** p\ .001

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report of childrens affective problems, and both mothers

and childrens report of acceptance/rejection was related to

mothers report of childrens anxiety problems. Further-

more, childrens report of behavioral control was related to

mothers report of childrens anxiety problems, although

behavioral control was neither an independent nor a spe-

cific predictor of childrens depression, anxiety, or social

anxiety symptoms.In some respects, our findings on behavioral control are

inconsistent with previous research (Chorpita and Barlow

1998; Drake and Ginsburg2012; Ginsburg and Schlossberg

2002; Hudson and Rapee2009; Rapee2001) that includes

parental behavioral control in models of childrens anxiety.

However, it is also important to consider that there was only

one measure of this construct. Although the control subscale

of the PARQ/Control has demonstrated good reliability and

validity, recent studies (Settipani et al. 2013; Soenens and

Vansteenkiste2010) have pointed to the difficulty of mea-

suring this construct and differentiating it from psycholog-

ical control (which is more akin to parental rejection). Arecent study that looked at both behavioral and psycholog-

ical control actually found a stronger relation between

childrens anxiety symptoms and parental psychological

control versus behavioral control (Wijsbroek et al. 2011).

Future studies would therefore benefit from incorporating

other measures of behavioral control, including other self-

report measures as well as observations and interviews.

Finally, it is also possible that parental behavioral control

simply is not an independent or specific predictor of chil-

drens anxiety (Gere et al. 2012), but future studies on

anxiety and other comorbid symptoms are needed regarding

behavioral control and childrens internalizing symptoms.In line with the few empirical studies that have inves-

tigated various parenting constructs in relation to multiple

youth internalizing symptoms (Beesdo et al. 2010;

Hutcherson and Epkins 2009), we found support for the

construct of maternal acceptance/rejection being indepen-

dently, as well as specifically and uniquely, related to

childrens depression symptoms. We even extended past

work by controlling for comorbid symptoms of anxiety,

social anxiety, and both anxiety and social anxiety symp-

toms together, and childrens perceived maternal rejection

remained significantly related to childrens self-reported

depression symptoms. Also in line with past studies (Fentz

et al. 2011; Hutcherson and Epkins 2009), the relations

between childrens perceived maternal rejection and chil-

drens self-reported symptoms of anxiety and social anxi-

ety became non-significant when controlling for childrens

comorbid depression symptoms.

Additional theoretical implications may be gleaned from

the current study. For example, the construct of maternal

rejection (akin to maternal psychological control; Soenens

and Vansteenkiste 2010) was related to all three types of

internalizing symptoms in children but more so to

depression and anxiety, rather than social anxiety. Thus,

relations between parental acceptance/rejection and chil-

drens social anxiety may only emerge when children also

have comorbid depression. Similarly, aspects of parenting

(as a group) did show relations with childrens self-repor-

ted depression and anxiety, as well as mothers report of

childrens anxiety problems, but those relations may onlybe implicated in models of childrens social anxiety if there

are comorbid depression symptoms. It is important to note

here that although child-reported maternal behavioral

control was related to mothers report of childrens anxiety

problems, behavioral control did not contribute much to

parenting in the regression analyses.

Important clinical implications may also be gleaned

from the current study. An improved understanding of the

independent, as well as specific and unique relations,

between various aspects of parenting and childrens

depression, anxiety, and social anxiety symptoms would

help inform childrens treatment. A recent review of elevenrandomized controlled trials found mixed results for the

efficacy of parenting components in treatments for chil-

drens anxiety (Breinholst et al. 2012). However, the

authors note that one explanation for these mixed results is

that treatments are not including the parenting constructs

most relevant to childrens symptoms (e.g., acceptance/

rejection as demonstrated in the current study), so more

research is needed to identify the specific aspects of par-

enting that should be targeted.

Furthermore, even if various aspects of parenting are not

strongly related to childrens internalizing symptoms

(McLeod et al. 2007a, b), they may still be relevant tochildrens treatment outcome and eventual symptom

reduction. For example, Festen et al. (2013) sought to

examine the parenting constructs that might predict treat-

ment outcome for anxiety-disordered youth. They found

that less perceived maternal warmth (assessed pre-treat-

ment) was related to a less favorable treatment outcome for

anxious youth. Therefore, even if certain parenting con-

structs (e.g., behavioral control) do not seem to be directly

related to childrens internalizing symptoms, they may play

a key role in childrens treatment outcomes.

We must recognize the potential limitations of the cur-

rent study. As mentioned above with regard to the construct

of behavioral control, we relied solely on self-report

measures for all of the symptoms and parenting constructs,

and we found that childrens report of aspects of parenting

were primarily related to their self-reported symptoms. On

the one hand, this is an important finding as it indicates that

childrens perceptions of parenting behaviors (particularly

acceptance/rejection) are more independently related to

their internalizing symptoms, relative to mothers report of

parenting behaviors (Fentz et al. 2011; Festen et al. 2013;

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Greco and Morris2002; Hale et al. 2006; Khaleque2012;

Khaleque and Rohner 2002a). However, by not including

other methods of measurement (e.g., observations, inter-

views, etc.), we may have had inaccurate self-reports of

negative parenting behaviors (which can often happen,

particularly with mothers; Rohner and Khaleque2005) and

of childrens symptoms. Thus, future studies should

include more observational measures in addition to othersreports such as those of fathers and other primary care-

givers whose parenting behaviors have a substantial impact

on children (Bogels and Perotti 2011; Greco and Morris

2002).

The oversimplified classification of childrens race

(Caucasian vs. all others) is also a limitation of the current

study. Different racial and ethnic groups might experience

and display symptoms and parenting behaviors differently

(Deater-Deckard et al. 2011; Stewart et al. 2012), so by

including race as merely Caucasian versus all others,

these important differences are collapsed and minimized.

Additionally, although we controlled for current and pasttreatment status for both mothers and children, we failed to

control for mothers psychopathology. This is an important

variable to consider when examining childrens internal-

izing symptomatology, as it is implicated in theoretical

models of depression, anxiety, and social anxiety and has

been found to be directly related to childrens symptoms

or, at the very least, interacting with other environmental

factors (such as parenting) related to childrens symptoms

(see Drake and Ginsburg2012; Epkins and Heckler 2011,

for a review). Our sample size also precluded analysis of

any gender differences, though we recognized child sex as

an important demographic variable and controlled for it inthe main analyses. Thus, the examination of racial/ethnic

differences, sex differences, and the inclusion of parental

psychopathology are all important avenues for future

research in this area.

Community children were sampled, and future studies

might examine similar questions in clinical samples where

stronger relations between parenting constructs and chil-

drens internalizing symptoms might emerge. Finally,

long-term prospective studies (ideally with more observa-

tional measures) are needed to assess the relations among

various aspects of parenting (i.e., acceptance/rejection,

behavioral control, and others) and childrens symptoms of

depression, anxiety and social anxiety over time. Indeed,

stemming from interpersonal and self-determination theo-

ries (Rudolph et al.2008; Soenens and Vansteenkiste2010)

as well as Rapees (2001) developmental model of anxiety,

there is some empirical support for reciprocal or bidirec-

tional relations between aspects of parenting and childrens

depression (Branje et al. 2010; Hipwell et al. 2008), anx-

iety (Ginsburg et al. 2004b; Hudson et al. 2009; Settipani

et al.2013; Silverman et al.2009; Wijsbroek et al. 2011),

and social anxiety (Van Zalk and Kerr 2011). Thus, future

longitudinal studies would allow for the elucidation of

parenting constructs as antecedents, correlates, or conse-

quences of childrens symptoms.

In addition to parenting constructs, theoretical models of

childrens internalizing symptoms have also implicated

certain biological vulnerabilities such as genetics or tem-

peramental factors, in addition to other psychosocial vul-nerabilities such as various learning experiences and peer

victimization. Some studies have found these to be mod-

erators of the relation between parenting constructs and

childrens internalizing symptoms (see Epkins and Heckler

2011, for a review; Kiff et al. 2011).

Our results, nonetheless, indicate that perceived maternal

rejection is related to childrens self-reported depression,

anxiety, and social anxiety symptoms (more so to depression

and anxiety). Furthermore, mothers report of rejection was

related to mothers report of childrens affective problems,

and both mothers and childrens report of rejection was

related to mothers report of childrens anxiety problems.Importantly, childrens perceived maternal rejection

remained a specific and unique predictor of childrens self-

reported depressive symptoms after controlling for comor-

bid symptoms. Thus, the construct of perceived parental

acceptance/rejection is an important one to consider in

treatments for childrens depression. Finally, although

childrens report of maternal behavioral control was related

to mothers report of childrens anxiety problems, behav-

ioral control was neither an independent nor a specific

predictor of childrens internalizing symptoms. Behavioral

control may possibly be an important aspect of parenting to

consider, particularly in treatments for childrens anxiety,but more research employing different methods and meth-

odologies should be conducted in order to fully elucidate

this construct with respect to childrens internalizing

symptoms.

Acknowledgments This paper is based, in part, on the masters-levelresearch project of the first author, directed by the second author. Wethank David Heckler, Matt Carroll, Shannon Kelly, and Jessica Clarkfor assistance with data collection and data management.

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