Critique of a Quantitative Research

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The title is self explanatory and therefore appropriate. “Maternal Factors associated with Child Behavior”. The key variables are suggested as being maternal factors and child behaviors. The abstract clearly and concisely summarizes the main features of the study report. The problem statement is not seen as such. However the study aims at identifying the maternal predictors of young children’s behaviors and thereafter selecting appropriate interventions to prevent child behavior problems.

Implications for nursing practice

Negative thinking is a variable which is amenable to intervention. Decreasing this may help to decrease depressive symptoms thereby resulting in improving the maternal perception of the behavior of her child. This may result in her child developing lesser behavior problems. The nurses working in primary care settings and community based centers may be the people who are in a position to recognize and be able to intervene appropriately. They could address the maternal mental health problems and help improve these, following the concept of decreasing the negative thinking of the mothers and in effect reducing the behavior problems of the child. The problem selected for study is thereby greatly significant for nursing practice.

Frame of reference

The influence of the mother on the child is a fact. Child behavior problems obviously point to problems related to the mother or mother figure. Children have internalizing and externalizing behaviors which can be directly and indirectly related to maternal health factors. Single mothers of the low income group happen to be a prone group for depressive symptoms. The depression coupled with a negative thinking leads to altered perceptions of their childrens’ behaviors. This in turn induces internalizing and externalizing symptoms in the child which lead to similar behavioral problems in adolescence and adulthood. Anxiety, depression, withdrawal, and somatic complaints are the internalized behaviors while impulsivity, disruptiveness, and aggression characterize externalized behavior. The problems behaviors which are triggered by maternal mental health predictors could be reduced by changing the maternal behaviors. Interventions which influence the maternal predictors would produce a good outcome in child behaviors.

Research Purpose

The research purpose has been expressed very explicitly. The purpose of this cross-sectional study was to ‘identify the maternal predictors of children’s internalizing and externalizing behaviors’ in a volunteer sample of 205 low-income, single mothers with children between 2 and 6 years of age. The maternal predictors like ‘self-esteem, negative thinking, and depressive symptoms and chronic stressors’ were found related to her assessment of child behavior. Interventions that could help to improve those behaviors of mothers which would elicit good child behaviors were to be designed. The study examined multiple risk factors of mother influencing the child’s behaviors making it unique in that all studies till then had worked with single variables. The maternal variables were depression, negative thinking, self-esteem and chronic stressors. The child variables were internalizing and externalizing behaviors. The sample population numbered 205 and had single mothers with children between 2 and 6 years of age. Interviews were conducted at their homes.

Similar Studies

Williford (2006) studied maternal parenting stress in children aged 2, 4 and 5. Stability of parenting stress was examined early childhood and changes in stress with time. ‘Single parenthood, maternal psychopathology, child anger proneness, and child emotion dysregulation’ predicted parenting stress at 2 years. The stability of stress depended on the externalizing behaviors. It was indicated that the parenting stress influenced the development of externalizing behaviors (Williford, 2006). The results showed that relationship between the parenting stress and externalizing behaviors of the child was strong. The same idea is investigated in a modified manner in Hall’s study. Effective and easily available interventions could change the behavior of a child and prevent later psychological problems. Strategic training of the parent could help them produce a more emotionally favorable environment for interactions with their child (Williford, 2006).

There was a study on examining the mother –child conflict behavior in the toddler age (Huang, 2006). The conflict was more likely to be triggered off by the mother. The conflict interactions were influenced by interaction, family, maternal, and child temperamental factors. The understanding between a mother and a toddler is indicated in this study. The context of interaction, family, maternal, and child temperamental factors all influence the mother-child interactions (Huang, 2006). Mother’s and the child’s conflict behaviors were inter-related. Many maternal, familial and child factors were involved.

‘Maternal expressed emotion (EE), attributions, depression and parenting stress in mothers of children with behaviour problems referred for therapy were tested for associations with entry to therapy’ ( Calam, 2002). EE predicts treatment outcome in children with behavior disorders (Vostanis and Nichols, 1995). The mothers selected were examined using the LACs, Beck Depression Inventory, and parenting stress index.

Father alcoholism has risk factors which have been compared in a study: ‘parental depression, family conflict, infant temperament, and parent–infant attachment’. Maternal depression mediated the association between alcoholic fathers and infant attachment securities (Eden, 2002).

Literature Review

A good flow is evident from the literature review. The influence of the mother on the child had been investigated with single variables in most of the studies quoted. The references cited within the literature review focused on the period between 1994 and 2007. A minimal number of only relevant literature indicating the current status of knowledge on the subject has been mentioned.

The statistics quoted are authentic and recent sources: for the number of the children in female headed households of single mothers (US Census Bureau in 2006) and the number of depressed people in the US (World Health Organization, 2007).

The relevant concepts reviewed are highlighted here. Economic hardship and single parent family structure had been studied for association with externalizing behaviors. Single mothers caused some behavioral problems in their children according to a study where income was controlled. It was found that maternal depression and hostile parenting accounted for the psychiatric and social problems of their children. Then there was the comparison for maternal depression between single and married mothers where the single mothers were found twice as likely to lead to child behavioral problems. There was a study which compared the child problems in depressed and non depressed mothers where the former reported more behavioral problems in their children. Another study found that the children of single depressed mothers contributed to three times the risk of psychiatric problems than the married ones. The depressed were also found to report a poor mental status for their children in the last month 10 times more than the non-depressed mothers. Another study found that externalizing and internalizing behaviors of children were associated with depressed mothers. Externalizing problems were found to be more frequent than internalizing problems. Pre-school age children were prone to externalizing behaviors. A later study found that the externalizing behaviors progressed to behavior problems in school age and adolescence. The next study found that prevention and early interventions for externalizing behaviors had a favorable effect in the long-term behavioral pattern. Depression negatively affected mothers in their interaction with children and their perceptions of child behavior. They extended their own negative perceptions to their children. Depressed low-income mothers sang less, interacted less while they read, or hardly read to their children when compared to low-income non-depressed mothers. Another study found that depressed mothers made more negative statements about their children than non-depressed mothers. Adverse outcomes, of poor cognitive and motor development, lower vocabulary and greater behavioral problems have been reported. Children of depressed parents make use of more health care utilization. There was a wide extent of research which supported the idea that the mother’s psychological status affected the reports she made on her child and her distress could actually be due to the child’s problems. The mother’s depression could produce a perceptual bias when accumulating reports from her. Mothers’ irritability and the tendency to punish could be arising from her mental status. Another study spoke about the depression-distortion theory where once again it was said that mother’s depression could influence her perception of child behavior.

This researcher has illustrated from the literature review the role of the single mother, how her approach to her child was different from two-parent families, about her depression and how it could influence her perceptions, how depression made her different from normal mothers, that low income did not change the picture, that children of problem mothers exhibited more externalizing behaviors, that these behaviors in the pre-school age progressed to further behavioral problems in school and adolescence and (probably implying that this may go on forever) and finally reached the depression-distortion theory. The present study was raised from the perspective that a person’s psychological state affected appraisal, decision making and cognition. This researcher has opted to study several maternal risk factors together in relationship to the problems in the children of pre-school age which had not been done before. The aim was to identify the maternal mental health predictors of the children’ externalizing and internalizing behaviors, in low income single mothers with children between 2 and 6 years.

The flow of literature from a general introduction to the specific research problem was ably demonstrated in this well worded paper.

Hypothesis

The hypothesis talks about testing direct and indirect health variables of the mother on the child’s externalizing and internalizing problem behaviors. The derivation of hypothesis has naturally evolved from the research purpose, literature review and the theoretical frame of reference. The research hypothesis clearly defines the maternal mental health predictor variables which have been termed chronic stressors. They were ‘self-esteem, negative thinking, and depressive symptoms’. Their influence on the child’s externalizing and internalizing behaviors were tested. The hypothesis does indicate a relationship between the variables of chronic stressors and externalizing behaviors of children. ‘Mothers’ negative thinking was hypothesized to mediate the effects of chronic stressors and self-esteem on their level of depressive symptoms which, in turn, was expected to have a direct effect on children’s internalizing and externalizing behaviors’.

Definition of terms

The conceptual definitions have not been highlighted in a single area of the paper. However the definitions of externalizing behaviors, internalizing behaviors, chronic stressors and maternal mental health predictors have been found in the body of the text. They are reflective of the conceptual frame of reference for the study. Operational definitions do reflect the conceptual definitions.

Limitations

Independent ratings on child behavior were not obtained. The perceptions of child behavior recorded were the maternal observations. However the mother’s observations were substantiated by the teachers’ reports and observation.

The cross –sectional data did not give us a correct view of the real causes and the direction of relationships in question.

How long the mothers had been in chronic stress or exhibiting depression was not considered here. The duration of the child behavior problems also had not been thought about.

These limitations could be remembered when another experiment is planned.

Sample and setting

A volunteer sample of 205 single low income (below the 185% of the poverty level) mothers with at least one child of between 2 and 6 years living with them participated in the randomized control trial. The income criterion permitted the women to avail of Health Department Services (WIC program). Post partum depression was avoided by selecting the age group from 2 years so that confusion did not arise as to the cause of depression. Pre-school age group produced maximum depression symptoms in the mothers, hence the selection of this age group of children for the study. If the mothers had 2 children, one was randomly selected. The ladies should not be taking psychiatric treatment, counseling, receiving, being suicidal, being pregnant or having any children less than one year of age. The recruitment sites were WIC offices, health departments and food stamp offices. 311 women fitted the criteria. Of these 205 volunteered.

The age of the mothers ranged from 18 to 45, the average being 27. Half were Caucasian and half African Americans. 62% or the majority were not married. More than 800% mothers had high school education. Half had college education. 35 % were full time employees, 23 % were part-time employees. More than 80% had an income of $15000 or less to fit in the low income group. 36% of the children were 2 years, 20% were 3 years old, 25% were 4, 13% were 5 and the balance of 6% were 6 years old. The average age was 3.3 years. 53% were boys.

Results

Maternal predictors of children’s internalizing and externalizing behaviors were to be identified in this cross-sectional study. The mothers’ reports did not differ because of the sex or race factors. Chronic stressors and depressive symptoms with control variables accounted for 27% of the variability in internalization and for 21% of the externalization. The biggest total effects for both were shown by the chronic stressors. Self esteem and negative thinking only had an indirect effect. The negative thinking had a stronger indirect effect through the causing of depression. Self esteem was linked indirectly through both negative thinking and depressive symptoms.

Specific requisites for the eligibility enabled correct participant selection. The participants were interviewed at their homes. The sample size, eligibility criteria, and sampling procedures all appear adequate. However a larger sample would give more room for improvement in reliability.

Research Design

The research design was a randomized controlled trial and consistent with the theoretical frame of reference, literature review, research purpose, and hypothesis. Path analysis models were used to test the direct and indirect effects of chronic stressors, self esteem, negative thinking and depressive symptoms on mothers’ perception of child behavior. Multiple regression method was used to find path coefficients and standardized beta weights corresponding to the models. Maternal age, employment status (employed vs. not employed), ethnicity (Caucasian vs. minority), education (high school or less vs. some post secondary) and annual income were the control variables. The control variables were also consistent with the study.

Insignificant predictors were eliminated in a backward stepwise fashion. Any predictor with a p value of 0.05 remained inside the model. Multicollinearity was assessed for each linear model. Statistical analyses were done using SAS Windows. The alpha level used was 0.05.

Methods and procedures

Validity and reliability of data collection methods were addressed. Cronbach’s alpha was used for all the measurements of maternal predictors and child behaviors. Internal validity was good and valuable conclusions could be drawn from the study. External validity was equally good in that the population sample was representative of the general population and the results interpreted would be similarly representative and could be applied.

The psychometric measures used were the 21-item Beck Depression Inventory (BDI), the 45-item Crandell’s Cognition Inventory for negativity of thoughts, the 10-item.

Rosenberg Self esteem scale, the 20-item Everyday Stressors Index (ESI) for chronic stressors, the 99 item Child Behavior Checklist (parent version of CBCL) for children of 2-3years of age and the 118 item CBCL for children of ages 4-18 (for measuring internalizing and externalizing behaviors).

Data analysis

This was done using the SAS Windows. The age of the mother and race had no influence on the internalizing scale or the externalizing subscales of the CBCL. Mother’s assessment of child behaviors was not influenced by marital status, education, employment status or annual income.

735 had mild depression by the BDI scale. 54 % had moderate to severe depression. Depressive symptoms, negative thinking, and chronic stress had positive correlations with mothers perceptions of child behavior self esteem had a negative relationship. Self esteem and negative thinking were found to have an indirect relationship with internalizing and externalizing behaviors. For both child behaviors together, chronic stressors had the largest total score.

Findings

The findings could be linked to the hypothesis and frame of reference. The study aimed at identifying the maternal predictors of problematic child behaviors so that future interventions for reducing the problem could be designed. The results indicated that mother’s perceptions were positively influenced by chronic stress and depressive symptoms. The negative thinking had an indirect relationship with the child behaviors. It caused depression which influenced child behaviors in turn. Depression affected the mothers who became less responsive. It caused the second largest total effect after chronic stress. Interventions designed to improve mental health could benefit the mothers and child behaviors. Antidepressants and cognitive behavioral therapy could lead to positive results in the children within 3 months.

Ethical issues

The rights of the participants were duly recognized as the research was essentially a voluntary participation.

Interpretation of findings

The conclusions, limitations, implementations, and recommendations for future research were discussed in relation to the research purposes, hypotheses, frame of reference, findings and limitations of the study.

References

Calam, Rachel, Bolton, Catherine and Roberts, Janine; (2002), “Maternal expressed emotion, attributions and depression and entry into therapy for children with behaviour problems”, British Journal of Clinical Psychology (2002), 41, 213–216.

Eiden, Rina Das; Edwards, Ellen, Peterson and Leonard, Kenneth E., Development and Psychopathology, 14 (2002), 253–278.

Huang, Keng-Yen; Teti, Douglas M.; Caughy, Margaret O’Brien; Feldstein, Stanley and Genevro, Janice, (2006), “Mother-Child Conflict Interaction in the Toddler Years: Behavior Patterns and Correlates, Journal of Child Family Studies (2007) 16:219–241, DOI 10.1007/s10826-006-9081-6.

Vostanis, P., &Nicholls, J. (1995).Nine month changes in maternal expressed emotion in conduct and emotional disorders of childhood: A follow-up study. Journal of Child Psychology and Psychiatry, 36, 833–846.

Williford, Amanda P.; Calkins, Susan D. and Keane, Susan P.; “Predicting Change in Parenting Stress Across Early Childhood: Child and Maternal Factors”, Journal of Abnormal Child Psychology (2007) 35:251–263.

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