Prenatal Assessment for Childhood Discipline Experiences

Prenatal Assessment for Childhood Discipline n

t; xperzences

Kathleen Flynn Gaffney, Pamela Holley-Wilcox, and Graciella Jones

PURPOSE. To explore relationships between pregnant wornens’ childhood experiences with discipline and 1 ) prenatal plans for disciplining own child and 2 ) later maternal-infant in teract ions DESIGN. Prospective correlational study SETTING. Prenatal clinics and home visits PARTICIPANTS. Low-income pregnant women (N =

205) with a mean educational level of 12 years MAIN OUTCOME MEASURES. Adapted Ways of Handling Irritating Behaviors (Mother and You) Scales, NCAST Teaching Scale, Home Observation for Measurement of the Environment Scale RESULTS. Correlations between childhood experiences with discipline and 1 ) plans for later discipline strategies with own child and 2 ) infant components of maternal-in fan t in teract ions, including clarity of cues and responsiveness to the mother CONCLUSIONS. Prenatal assessment for childhood experiences with discipline may uncover factors associated with a break in the trajectory for optimal maternal-child interactions described by Barnard’s theoretical framework. Key words: Child discipline, maternal-infant interaction, prenatal assessment

Kathleen Flynn Gaffney, PhD, RN, is Associate Professor, George Mason University, College of Nursing and Health Science, Fairfax, VA. Pamela Holley- Wilcox, PhD, is Director of Information, Technology Support, University of Nebraska. Graciella Jones is Research Grant Coordinator, George Mason University, College of Nursing and Health Science.

T h e overall well-being of the nation’s children has declined during the past two decades (Children’s Defense Fund, 1995). Evidence of this is the increased incidence of child abuse nearly every year since 1970 (Miringoff, 1992).

Studies of family abuse patterns have demonstrated that abusive parents differ from non-abusive parents in the way they interact with their children (Starr, 1987; Wolfe, 1985). Bee, Disbrow, Johnson-Crowley, and Bamard (1981) found that parents who had abused their children were less sensitive to their child’s cues and provided less social-emotional and cognitive growth-fostering experiences. Their children also tended to demon- strate less clear cues and were less responsive to the parent. These findings concur with Starr’s review of research on the causes and correlates of child abuse. He concluded that interactional differences between abusive parents and matched control parents are found consis- tently, and that optimal strateges for predicting and pre- venting child abuse must address those factors associated with problems in parent-child interaction patterns.

Two studies have examined prenatal factors that may be associated with later problems in maternal-infant interaction. Adler, Hayes, Nolan, Lewin, and Raphael (1991) found that a woman’s perception of the mothering she received as a child was not predictive of matemal- infant interactive outcomes in the first year. Conversely, a mother’s nurturing during childhood was found to be an important predictor for later abusive interactions with her own child in a study by Altemeier, OConnor, Vietze, Sandler, and Sherrod (1984). A key difference in the two studies is that Altemeier et al. measured more specific aspects of the subjects‘ childhood parenting experiences

JSPN Vol. 1, No. 2, July-September, 1996 57

Prenatal Assessment for Childhood Discipline Experiences

than Adler et al. For example, disturbances in the childhood nurturing of the mothers who later abused their children were evidenced by several specific factors including the perception that they were punished unfairly and severely as children. Further specificity about the nature of the relationship between childhood experiences with discipline and later maternal-infant interactions is required to provide an empirical base for prenatal clinical interventions to prevent and reduce the incidence of abuse.

Theoretical Framework

Barnard and the Nursing Child Assessment Project team at the University of Washington developed a theoretical framework for the study of caregiver-child interactions (Barnard, Spietz, Snyder, Douglas, Eyres, & Hill, 1977). Foundational to the framework was the notion that poor child health and developmental outcomes were tied in complex ways to physical, emotional, intel- lectual, and social dimensions. A deficit or dysfunction in one or more of these areas resulted in consequences to overall child well-being. Children depend on caregivers to shape their environment if optimal health and development are to be achieved. A major assumption of the Barnard theoretical framework is that early assessment of potential problems in caregiver-child interactions and effective intervention provide the most substantial and beneficial effect upon later development.

The Barnard theoretical framework (Barnard et al., 1977) is based on two sequential conceptual models. The first, the Barnard Model, is based on the assumption that both caregivers and infants have critical roles in affecting the quality of their interaction with each other. Further, the capacity of each partner in the dyad to fulfill his or her role is influenced by individual characteristics that may be modified to meet system needs. In optimal interactions, the infant supplies clear cues, shows responsiveness to parent, and demonstrates behaviors contingent with parent behaviors. The caregiver provides sensitivity to cues, takes appropriate action to relieve child distress, provides growth-fostering situations, and demonstrates

behaviors contingent with child behaviors. Each partner in the dyad must have the physical and psychosocial resources to fulfill these role demands. Any deficiency will hamper optimal interaction.

The second conceptual model, the Child Health Assessment Model (Bamard et al., 1977), places the caregiver-child interaction within the context of the child’s environment. The environmental contributions to the interactive process include the availability of animate and inanimate resources within the family home that support the child’s cognitive, social, and emotional growth.

Research has provided support for Bamards theoretical notion that specific maternal psychological factors influence the “waltz” or synchrony of the interaction process. A number of studies have used Barnard’s work as a basis for selection of variables to study the impact of maternal psychosocial factors on the quality of maternal- infant interaction. For example, a mother’s mood state has been associated with the quality of the interactive process (Thomas & Barnard, 1985), as has maternal depression (Barnard, Bee, & Hammond, 1984) and maternal education (Barnard, Booth, Mitchell, & Telzrow, 1988; Barnard & Eyres, 1979). A mother’s knowledge about the tasks and issues of parenthood also has been associated with the quality of mother-infant interactions (Kang, 1985). While significant correlations have been found between maternal factors and the maternal-child interactive process, most associations are low, suggesting that additional maternal factors may be influencing the interactive process.

Abusive behavior toward a child represents an extreme interference with the interactive system described by Barnard. Using the Barnard theoretical framework as a basis for studying the maternal-infant interactions, the present study was an examination of the relationship between one prenatal maternal psychosocial factor that has been empirically associated with abuse and later maternal-infant interactions.

The specific purpose of the study was to examine the relationship between a woman’s prenatal perception of her own childhood experiences with discipline and her

58 JSPN Vol. 1, No. 2, July-September, 1996

prenatal plans for disciplining her child as well as later maternal and infant interactive behaviors.

Methods

Sample

The sample consisted of 205 women. Four women who met selection criteria refused to participate. One gave no reason; three indicated they would be moving out of the area and, therefore, would be unable to com- plete the study. The sample was restricted to women who were at least 18 years of age, had completed the sixth grade, had the ability to read and speak English, and were in the second half of their pregnancy. The mean age of the participants was 22.0 ( S D = 3.78). The average number of years of education was 12.3 ( S D = 1.70). Twenty-five percent (N = 51) identified themselves as single without a partner, while 37% (N = 76) were single with a partner. Thrty-five percent (N = 72) were mamed, while the remaining women (N = 6) idenhfied themselves as mamed but separated. Two thirds of the sample had family incomes under $15,00O/year. Distribution of race or ethnic origin was 55% (N = 113) White, 22% (N = 45) Black, 12% (N = 25) Hispanic, and 11% (N = 22) Asian/Pacific Islander. Of the 205 original women, 167 (81%) completed the Cmonth home visit with the nurse.

Measures

Instrumentation for this study consisted of three measures. The first was an adaptation of Disbrow’s instrument, Ways of Handling Irritating Behaviors of Childhood (WHIB) Scale (Disbrow, Doerr, & Caulfield, 1977). In the original instrument, the respondents completed a pencil-and-paper scale consisting of 11 childhood behaviors typical of 4- and 5-year-old children, including ”bite or hit someone” and “breaks something of yours,” which were to be matched with one or more of 16 parenting behaviors, including the range from ”pick up and hug” to ”tell him you don’t love him.” The scale had demonstrated the ability to discriminate

between a group of parents who had been identified for child abuse and a control group with no history of abuse (Disbrow & Doerr, 1982). With Disbrow‘s permission, the instrument was adapted for use in the present study.

The adapted version retained the original list of 11 typical childhood behaviors and the capacity for the respondent to provide more than one response to a single childhood behavior. The instrument was modified for use in this study in three ways. First, the closed- ended format was changed to an open-ended format so respondents could i d e n q their own ideas of appropriate maternal responses without the influence of suggested responses. This was done to deal with a potential bias of social desirability identified in the original instrument. Second, the pencil-and-paper format was changed to an interview format allowing for richer, fuller qualitative descriptions of maternal responses to childhood behaviors. Using Disbrow’s coding and scoring methods (Disbrow & Doerr, 1982) as a basis, harsh, punitive, and derogatory maternal behaviors were counted and total negative behavior scores were assigned by a panel of experts in pediatric nursing.

The third modification of the instrument allowed for the development of two forms of the instrument: percep tions of past experiences and plans for future experiences. The mothers were asked to approach their consid- eration of the 11 childhood behaviors in two ways: 1. “When you were a young child, how do you think your mother would have handled these behaviors if they occurred?” 2. “How do you think you will handle these behaviors if they occur with your child?” Use of the adapted versions of Disbrow‘s WHIB scale was intended to tap one aspect of a mother’s psychosocial history that may contribute to the quality of maternal-infant interactions (Swnner & Spietz, 1994).

In addition to the adapted version of Disbrow’s instrument, this study used two other measures to examine aspects of the maternal-infant interaction. These were the NCAST Teaching Scale (NCATS) and the Home Observation for Measurement of the Environment (HOME). The NCATS (Barnard et al., 7977) was developed within the conceptual orientation of the Child



Health Assessment Model to assess the unique contributions of both parent and child to their interactive pro- cesses. The NCATS is a dichotomous scale, consisting of 73 observations made in the home environment. A reliable NCAST-trained observer rates each of the items based on an interaction in which the mother is asked to teach her child (age birth to 3 years) an age-appropriate skill. Disturbance in the interaction is suggested by positive responses to fewer than 43 items. Cronbach’s alpha reliabilities for both Parent and Child Subscales were reported to be .83 (Barnard et al., 1989). Cronbach’s alpha for the same subscales in the present study sample were .86 and .90, respectively.

The HOME scale (Caldwell & Bradley, 1984) is an assessment of the maternal-infant dyad during a home visit in which they interact naturally, without a specific task. Similar to the NCATS, the HOME is a dichotomous measure, scored by a reliable observer. A positive response to 32 or fewer of the 45 items suggests potential problems in the interactive process. Cronbachs alpha reliability for the HOME has been reported to be .81 (Bradley & Caldwell, 1988). Cronbach‘s alpha for the HOME in the present study was .83. Together, the NCATS and the HOME provide a ”window“ into maternal-infant interactions based on a combination of both strudured and spontaneous scenarios.

Procedure

The procedure consisted of prenatal interviews conducted during the second half of pregnancy in maternity clinics for low-income women in the northern Virginia area. These interviews lasted approximately one- half hour. Subsequently, when the infant was 4 months old, a nurse home visit was conducted to assess maternal- infant interactions. These visits vaned in length from 30 minutes to one hour.

Results

The measure of a woman’s perception of how she was disciplined as a child by her mother (hereafter referred to

as WHIB-Mother) yielded a mean score of 7.58 (SD = 2.29, N = 205). Since the measure was a count of harsh, punitive, or derogatory responses to childhood behaviors with a possible range from 0 to 11, this finding reflects quite negative perceptions of childhood discipline experiences. The respondents’ scores on the measure of how they planned to handle the same childhood behaviors when their child was 4 or 5 years old (hereafter referred to as WHIB-You) yielded a mean score of 5.22 (SD = 2.37, N = 205). Although this mean score also is rather negative, it is sigruficantly lower than the mean for perception of mothers’ own childhood discipline experiences involving the same behaviors, t (205) = 13.46,

To examine the relationship between a woman’s prenatal perception of her own childhood discipline experiences and her prenatal plans for disciplining her child, scores of the two forms of the adapted Disbrow instrument (WHIB-Mother and WHIB-You) were analyzed and found to be sigruficantly correlated, Y = .47, p < .001. This moderate correlation suggests that perception of childhood discipline experiences is only one of a complex of factors that account for the variance in respondents’ prenatal plans for disciplining their own child at age 4 or 5. On the other hand, it is noteworthy that despite all the factors that potentially influence a woman’s prenatal plans for disciplining her child, a single measure of perception of childhood discipline experiences accounts for 22% of the variance in plans.

While a woman’s perceptions alone are of interest, it is important to relate these perceptions to maternal and infant behavior when the dyad interads within the home environment. Correlating the measures of prenatal perceptions about discipline (WHIB-Mother and WHIB- You) with scores from the NCAST Teaching scale revealed several interesting findings (Table 1). First, what a mother can report to a nurse during a prenatal assessment interview about child discipline is significantly related to components of maternal-infant interaction at infant age of 4 months. Second, the significant associations are primarily with the infant contributions to the interaction. Specifically, both the WHIB-Mother and

p < .001.

60 JSPN Vol. 1, No. 2, July-September, 1996

Table 1. Correlations of Maternal Prenatal Perceptions About Child Discipline With NCAST Teaching Scale Scores ( n = 167)

Scale Prenatal Measure

WHIB - Mother WHIB - You

Parent contribution subscales Sensitivity to cues Response to distress Social-emotional growth

Cognitive growth fostering Parent contingency

fostering

Parent total scale

Infant contribution subscales Clarity of cues Responsiveness to parent Infant contingency

Infant total scale

Total Scale

* p < .05.

-.09 -.06 -.08

-.12 -.16* -.12

-.15* -.16* -.17* -.16*

-.16*

-.05 -.06 -.08

-.&I -.lo -.07

-.13* -.16* -.16* -.16*

-.13

WHIB-You scores were sigruhcantly correlated with the infant subscales (”Clarity of cues” and “Responsiveness to parent”), the infant contingency score, and the total infant score of the Teaching scale. However, neither the WHIB-Mother nor WHIB-You scores were correlated with the parent subscales or the total parent score of the same instrument.

Correlations of the measures of prenatal perceptions about discipline (WHIB-Mother and WHIB-You) with scores from the HOME scale (Table 2) suggest that maternal perceptions about discipline are related to some aspects of maternal behavior. Specifically, both the WHIB-Mother and WHIB-You scores were sigruficantiy correlated with the Maternal Involvement With Child subscale of the HOME.

In summary, women’s perceptions of their own childhood discipline experiences were sigruhcantly associated with plans for disciplining their children. Women’s prenatal perceptions about child discipline were related to

Table 2. Correlations of Maternal Prenatal Perceptions About Child Discipline With HOME Scale Scores (n = 167)

Scale Prenatal Measure

WHIB - Mother WHIB - You

Home subscales Emotional & verbal -.08 -.15*

Avoidance of restriction and -.13* -.08

Organization of environment -.08 -.G9

responsivity of mother

punishment

Provision of appropriate play -.I1 -.05

Maternal involvement with -.13* -. 13* material

child

daily stimulation Opportunities for variety in -.03 -.11

Total Home Scale -.14* -.11

*p < .05.

selected aspects of their children’s behavior when maternal-infant interactions were observed. Women’s prenatal perceptions about child discipline were weakly related to certain aspects of their own behavior when maternal- infant interactions were observed.

Discussion

Three findings of this study may be interpreted in light of Barnard’s theoretical framework. First, the association found between a mother’s childhood experiences with discipline and her anticipated plans for disciplining her own child concur with the theoretical assumption that maternal psychosocial assets and deficits affect what the mother is able to bring to the interactive process with her infant. In this case, harsh or punitive, non-nurturing forms of discipline experiences in the mother’s childhood were associated with plans for similarly sub-optimal discipline strategies when interacting with her own child.

Second, the study finding that an association exists between infant contributions to the maternal-infant



interaction process and the mother’s childhood discipline experiences supports the Barnard assumption that the interactive process is an adaptive one. That is, as a mother is more available and active in nurturing, the infant responds with more clarity of cues, responsiveness, and contingent behavior. Conversely, as the mother is less available, the child receives less energy and stimulation for his or her own contributions, causing a break in the trajectory from infant to mother in their interactive process. The infant begins to ”shut down,” contributing less-organized behaviors in response to the mother’s contributions to the interaction. The demonstration of less-clear cues from the child and less responsiveness to the parent found in the present study is similar to what Bee and her coworkers (1981) found in their observations of abusing and non-abusing parents and their children. Third, the study’s findings also provide limited support for the notion that the maternal psychosocial characteristics under investigation influence the trajectory of behavior from mother to infant. This support was found in the significant inverse relationship between the Mother’s Involvement With Child on the HOME scale and both WHIB scales (Mother and You).

Recommendations

Three recommendations for future study are made. The first relates to sample size. In the absence of compa- rable studies of chldhood discipline experiences in the literature, sample size was determined using power analysis calculations that included a medium (.30) effect size, following the convention suggested by Cohen and Cohen (1983). Post hoc inspection and analyses suggest that future studies calculate sample size using a smaller estimated effect size. While low power in the present study did not call into question any of the significant findings, larger sample sizes may unveil other sigruficant relationships that were not detected in the present investigation.

Second, future studies may extend this study’s longi- tudinal design by observing the study variables at multiple data points during the first year. The Child Health

Assessment Model asserts that the adaptive, interactive process between a mother and her infant evolves over time. To see the long-term influence of the study variables, changes in the adaptations of the mother-infant dyad throughout infancy must be tracked.

Third, multivariate studies of the causes and correlates of suboptimal matemal-infant interactions might include assessment of mothers’ childhood experiences with discipline. While this study’s findings demonstrated only small to moderate correlations, they contribute another piece to understanding the constellation of maternal factors associated with the “waltz” between a mother and her infant. Specifically, a mother’s childhood experiences with discipline may be considered in combination with mood state, depression, age, and education, which also have demonstrated small to moderate correlations with the quality of maternal-infant interactions (Barnard et al., 1984,1988; Thomas & Barnard, 1986).

Understanding the influence of maternal psychosocial characteristics upon maternal-infant interactions has important nursing implications. For instance, the finding that prenatal assessment of a woman’s childhood experiences with discipline may reveal “red flags” for both harsh plans for child discipline and maternal-infant interactive problems is useful in identdymg dyads at risk for negative outcomes. As knowledge about factors that influence the mother-infant dyad grows, so does the capacity to plan and implement empirically based clinical preventive services that reduce the likelihood of the poor outcomes of maladaptive interactions, including abuse.

Acknowledgement. This research was funded by grant No. K07-NR00014 from the National Institute of Nursing Research, National Institutes of Health. The authors extend thanks to Rita Ailinger, PhD, for her contributions to the planning of the project and her critical review of this manuscript.

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Author contact: Kathleen F. Gaffney 3205 History Drive Oakton, VA 22124 E-mail: [email protected]

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Prenatal Assessment for Childhood Discipline Experiences