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Journal of Abnormal Child Psychology, VoL 21, No. 2, 1993

The Impact of Young Children with Externalizing Behaviors on Their Families Geri D o n e n b e r g 1 and B r u c e L. B a k e r 1,2

Compared the impact on families of young children with externalizing behaviors (e.g., hyperactive, aggressive; n = 22), autism (n = 20), or no significant problem behaviors (n = 22) on several measures of family functioning. Previous studies have found heightened stress and parental maladjustment in families with externalizing children. The present study expanded upon that literature by (1) including a clinical control group to determine the specific impact of externalizing problems, (2) focusing on preschool aged children, and (3) using a new measure to directly ascertain parents' perception of impact. Compared to parents with normally developing children, parents with externalizing children reported more negative impact on social life, more negative and less positive feelings about parenting, and higher child-related stress. Moreover, parents of externalizing children reported levels of impact and stress as high as those reported by parents of children with autism. On broader measures of parental and marital well-being, however, the three groups of families of preschoolers did not differ. The implications of these findings for intervention are discussed. C h i l d r e n w h o e v i d e n c e e x t e r n a l i z i n g b e h a v i o r p r o b l e m s - - - e . g . , hyperactivity, n o n c o m p l i a n c e , p o o r r u l e - g o v e r n e d activity, a g g r e s s i o n - - - c o n s t i t u t e t h e m a j o r i t y o f s c h o o l - a g e d r e f e r r a l s for m e n t a l h e a l t h e v a l u a t i o n a n d t r e a t m e n t ( R o s s & R o s s , 1982) a n d a r e i n c r e a s i n g l y o f c o n c e r n in t h e p r e s c h o o l years. Manuscript received in final form September 3, 1992. This research was conducted at the Fernald Child Study Center, University of California at Los Angeles. We wish to thank Jan Blacher, Doug Granger, Stephen Hinshaw, and Karen Rudolph for comments on an earlier version of this article, and Kenny Smith and Doug Granger for computer help. We also appreciate the assistance of our colleagues on the Preschool Project, Drew Erhardt, Tracy Heller, Barbara Henker, Alice Huber, Blair Paley, Karen Rudolph, and Jennifer Treuting. 1Department of Psychology, University of California at Los Angeles, Los Angeles, California 90024. 2Address all correspondence to Dr. Bruce L. Baker, Department of Psychology, University of California at Los Angeles, Los Angeles, California 90024. 179 0091~627/93/0400~)179507.00/0

9 1993 Plenum Publishing Corporation

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It is now well recognized that a bidirectional process directs socialization, whereby children are both influenced by and shape parental behavior (Bell & Harper, 1977, Belsky, 1984). Thus we would expect these numerous externalizing children to have a significant impact on their families. Coping with these children is difficult for parents and teachers alike, as they require close supervision and control and often do not respond to typical child management strategies (Barkley, 1990). Heightened stress may negatively bias parents' perceptions of their children (Forehand, Wells, & Griest, 1980; Webster-Stratton, 1988), impair the quality of parent-child interactions, and interfere with parent-focused interventions (Baker, Landen, & Kashima, 1991). Yet relatively few studies have addressed the impact of externalizing children on their families (Fischer, 1990). In the present study, we compared the impact on families of preschoolers with externalizing behavior problems, no significant behavior problems, or autism. Several investigators have studied two dimensions of adjustment in families of externalizing children diagnosed with hyperactivity or attention deficit hyperactivity disorder (ADHD) (American Psychiatric Association, 1987): (a) stress related to child behavior and (b) parental dysfunction not directly related to the child (e.g., parental psychopathology and marital discord). Compared to parents with normally developing children, parents of school-aged externalizing children reported higher levels of difficulties on both dimensions (Breen & Barkley, 1988; Mash & Johnston, 1983). Mothers of children with ADHD, for example, evidenced more negative interactions with their children (Campbell, 1975; Cunningham & Barkley, 1979; Mash & Johnston, 1982), less efficacy and satisfaction in the parenting role (Johnston & Mash, 1989), and higher rates of parental psychopathology (Brody & Forehand, 1986; Morrison, 1980), social isolation (Wahler, 1980), and marital discord (Befera & Barkley, 1985; Johnson & Lobitz, 1974) compared to parents of normally developing children. The evidence for higher levels of marital discord in these families, however, is mixed (c.f. Cunningham, Benness, & Siegel, 1988; Mash & Johnston, 1983, 1990). Some direct evidence for child-directed effects is found in the series of investigations of mother-child interactions by Barkley and colleagues. Hyperactive children's medication status was manipulated and maternal behavior was shown to improve significantly in response to changes in the children's behavior (Barkley, 1984, 1990; Barkley, Karlsson, & Pollard, 1985; Cunningham & Barkley, 1979; Tarver-Behring, Barkley, & Karlsson, 1985). While these investigations suggest a negative impact of the child on the family, most of the studies examined variables presumed to reflect child impact, such as levels of stress, feelings of competence in parenting, or mother-child interactions. The authors of these studies did not report analyses indicating that they directly asked parents about the effects of their

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children on the families. Impact can be conceptualized as related to stress but also different from it. For example, a child with handicaps often affects the family in major ways, by influencing important decisions such as where to live or whether the mother will work. Yet this impact may or may not be experienced as stressful by the family. Moreover, stress has a negative connotation, whereas impact can be both positive and negative. Thus, stress might be thought of as one component of impact. This study expands the literature relating externalizing problems to family factors by addressing three critical gaps. First, we avoided the inferences in previous studies by directly asking parents about the impact of their children on their families. Toward this end, we employed a new measure, the Family Impact Questionnaire (FIQ) in which parents evaluate the impact of their child along several dimensions of family functioning. In developing the FIQ, we identified dimensions of potential child impact by drawing on studies of the impact of children with handicaps on their families (Blacher, 1984; Fewell, 1986) and of the familial correlates of hyperactivity and externalizing behaviors (e.g., Barkley, 1990; Hetherington & Martin, 1986; Whalen, 1987). We also included several widely used measures of stress and adjustment to assess dimensions of family life not addressed by the FIQ but conceptually important in terms of possible child impact (e.g., stress, parenting sense of efficacy, and parental psychopathology), and to evaluate the unique contributions of the FIQ to understanding family functioning. Second, families with externalizing children were compared to families with normally developing children and a clinical control group--children with pervasive developmental disorder (APA, 1987), hereafter called autism. The inclusion of a clinical control group addresses a frequent criticism of research in developmental psychopathology, that it cannot be determined whether findings are specific to a particular disorder or relate to childhood problems in general (Fischer, 1990; Hodapp, Dykens, Evans, & Merighi, 1992; Rodrigue, Morgan, & Geffken, 1990). Normally developing and autistic children seem to provide two endpoints on a continuum of potential family impact; the early onset and bizarre behavior associated with autism makes this disorder particularly upsetting for families (Bristol, 1987; Greenfeld, 1973; Rodrigue et al., 1990). Understanding where families with externalizing children fall along this continuum could provide valuable information about the relative magnitude of impact experienced by these families. Third, this study extends the literature to families of preschool-aged children. Most studies demonstrating a relationship between childhood behavior disorders and family stress or parent adjustment have focused on school-aged children. It is important to examine the magnitude and type

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of impact that externalizing children have on their families during the preschool years, a time when interventions may be most effective.

METHODS

Subjects Sixty-four families each with a target child between the ages of 3.5 and 6 years were assigned to one of three diagnostic groups. Children in Group E (externalizing, n = 22) and Group C (control, n = 22) were recruited from preschool and day care programs in Los Angeles for a larger longitudinal study. Flyers were distributed to families by school personnel and in some cases teachers specifically recommended the program to parents. Interested parents contacted the project and completed a brief phone screening to determine eligibility. Children were assigned to the externalizing group if (1) parent's referral complaint was of child externalizing problems at home and/or at school; (2) parent (primary caretaker) and/or teacher broadband Externalizing t-score was 65 or above on the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983); and (3) neither parent nor teacher broadband Internalizing t-score was 10 or more points higher than the Externalizing t-score, consistent with Achenbach and Edelbrock. Children were assigned to the control group if (1) parents reported no significant behavior problems, and (2) both broadband CBCL t-scores were below 60. None of the externalizing or control children showed developmental delays. Group A (autistic, n = 20), the clinical comparison group, was recruited from a preschool program in suburban Boston for children with developmental disabilities. All children were professionally diagnosed with autism or features of autism, and were developmentally delayed, with intellectual and social retardation ranging from mild to severe. Group A families were informed of the study by their preschool director and 87% agreed to participate. Table I shows the demographic characteristics and CBCL scores for the three groups. The mean child age was 4.9 years, and 69% were boys. Most families were Caucasian (83%), with two parents living in the home (88%). The majority of families were from the two highest of Hollingshead's (1975) five levels of socioeconomic status. The three groups were similar on a number of demographic characteristics, among them parent age, family income, socioeconomic status, and child sex, age, and ethnicity. Groups differed significantly on two highly correlated variables, number of siblings and birth order, but neither was related to the dependent measures.

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Table I. Characteristics of t h e Samples: M e a n s (Standard Deviations in P a r e n t h e s e s ) or Percentages (N = 64) a

F-ratio~z2~ Variable M o t h e r age F a t h e r age Family income (category) SES (Hollingshead) Single parent (percent) N u m b e r of siblings Child age (months) Child sex (% boys) Child race (% Caucasian) Child birthorder (category) CBCL Externalizing t-score Parent Teacher C B C L Internalizing t-score Parent Teacher

Group C 37.7 39.7 4.7 1.5 9.1 0.7 55.8 54.5 73.0 1.3

(4.2) (5.8) (1.5) (0.5) (0.6) (9.4)

(0.6)

Group E 38.6 41.7 4.7 1.5 4.5 0.9 59.8 72.7 83.3 1.5

(3.8) (6.4) (1.5) (0.7) (0.7) (10.9)

(0.6)

Group A 37.7 38.5 4.2 1.7 20.0 1.4 58.9 80.0 90.0 1.9

(4.8) (5.0) (1.2) (0.8) (0.9) (12.9)

(0.8)

t-test F = F = F = F = ~2 F = F = X2 Z2 F =

0.31 1.59 0.80 1.09 2.60 4.41 b 0.77 3.41 2.49 5.43 c

45.0 (6.5) 48.4 (4.5)

68.1 (8.4) 63.5 (6.6)

57.2 (9.5)

F = 43.52 d t = 7.90 d

49.0 (7.5) 50.7 (7.7)

61.4 (10.9) 59.0 (7.3)

61.9 (8.4)

F = 14.14d t = 3.36 c

aNote:

1. Income categories: 1 = 0-$15,000; 2 = $15,000-$30,000; 3 = $30,000-$45,000; 4 = $45,000-$60,000; 5 = $60,000-$75,000; 6 = $75,000-$90,000; 7 = >$90,000. 2. Socioeconomic status (Hollingshead, 1975, 4-factor index) categories range from 1 = major business and professional to 5 = unskilled laborer. 3. Birth order categories: 1 = only child or first born, 2 = second born, 3 = third or later born. SES = socioeconomic status; C B C L = Child Behavior Checklist. bp < .05. < .01. < .001.

~

The groups also differed significantly on parents' and teachers' Externalizing and Internalizing t-scores on the CBCL. Teachers' CBCL scores were not obtained for the autistic group. Procedures Group E and Group C families were each sent an informed consent form and two packets of questionnaires about their child, one to be completed by the child's primary caregiver and the other by the child's teacher. During two in-person assessment sessions, parents completed self-report measures assessing the impact of their children on their families, family stress and daily hassles, perceived parenting competence, marital satisfaction, and parental depression. Similarly for Group A families, some measures were mailed home and the rest were administered during an interview conducted at the preschool.

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Measures The primary caretaker, who in all but two cases was the mother, completed a Demographic Questionnaire assessing the variables shown in Table I. This parent and the child's teacher (except in Group A) completed the C B C L (Achenbach & Edelbrock, 1983). CBCL items sum to yield tscores (mean = 50; SD = 10) for the broad band dimensions of externalizing and internalizing behavior problems. The three groups were compared on seven dependent measures, as follows: Family Impact Questionnaire, The FIQ has 50 items that assess parents' perceptions of child impact on their families relative to the impact "most children his/her age have on their parents/family" (e.g., "I feel loved by my child more" or "I am more embarrassed by his/her behavior in public"). Items are endorsed in a Likert-type fashion on a 4-point scale from (0) not at all to (3) very much. A 68-item version of the FIQ was completed by 118 parents of preschool-aged children, including 64 parents from the present study. A principal-components factor analysis with varimax rotation yielded an interpretable six-factor solution. Scale reliabilities ranged from r = .83 to .92. Each item was assigned to the factor on which it loaded highest; therefore, no item appeared on more than one factor. Factors, with the number of items, are (1) impact on social life (11); (2) negative feelings toward child (9); (3) positive feelings toward child (7); (4) impact on finances (7); (5) impact on the marriage (7); and (6) impact on siblings (9). Factors 5 and 6 are completed only when there are two parents and/or siblings in the household. Parenting Events. This measure (Crnic & Greenberg, 1990) lists 20 problems that parents might experience in the daily care of their children (e.g., cleaning up after him/her). Parents indicate the extent of each problem and how much of a hassle it is, each on a 4-point scale (Not at all, some, much, very much). Total Problem and Hassles scores in this sample were correlated so highly (r = .85), that only the Hassles scores were included in analyses. Parenting Stress Index. The PSI (Abidin, 1990) is a 101-item questionnaire that assesses stress in the parent-child system. Items are endorsed in a Likert-type fashion on a 6-point scale ranging from (0) strongly agree to (5) strongly disagree. The measure yields subscale scores that sum to two domain scores, Child Domain (stress reflecting child characteristics that make it difficult to fulfill the parenting role) and Parent Domain (stress as a consequence of parental functioning). Parenting Sense of Competence Scale. The PSOC (Gibaud-Wallston & Wandersman, 1978) has 17 items, endorsed in a Likert-type fashion on a 6-point scale ranging from (0) strongly agree to (5) strongly disagree. The mea-


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sure was revised and validated by Johnston and Mash (1989) to reflect two dimensions of parenting self-esteem: Efficacy (the perceived skills/knowledge about being a parent), and Satisfaction (the value and comfort attached to the parenting role). Beck Depression Inventory. The BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) has 21 items that assess cognitive, affective, and somatic dimensions of depression and sum to a total score. Dyadic Adjustment Scale. The DAS (Spanier, 1976) has 32 items that assess marital functioning and sum to a total score.

RESULTS

Analyses Measures were grouped according to how closely they were related to the child as the primary stressor. Of the total 13, eight measured child impact or stress directly resulting from the child's behavior: Family Impact Questionnaire (factors 1-6), Parenting Events Hassles, and Parenting Stress Index Child Domain. The remaining five scales measured parents' adjustment or well being more generally: Parenting Stress Index Parent Domain, Parenting Sense of Competence (Efficacy and Satisfaction), Beck Depression Inventory, and Dyadic Adjustment Scale. Two multivariate analyses of variance (MANOVAs) were conducted across the three groups on the total scores for six of the eight child-related stress measures (excluding FIQ factors 5 and 6 which were not available for families with single parents or only children) and all five parent-related stress and well-being measures. These were followed by one-way analyses of variance (ANOVAs) across the three groups and, where appropriate, pairwise comparisons. Pearson correlations were also examined between the dependent measures and demographic variables, as well as parent and teacher CBCL scores.

Child Impact and Child-Related Stress The MANOVA across groups on the six scales that assessed child impact and stress was significant, F(12, 98) = 5.14, p < .001 (Wilks's lambda). Table II shows means and one-way ANOVA F values for the three groups on each of these six scales as well as FIQ factors 5 and 6 and PSI child subscales that were not included in the MANOVA. Group means were significantly different for FIQ factors 1 (social life), 2 (negative feelings about parenting), and 3 (positive feelings about

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parenting). Followup t-tests indicated that Group E and Group A each differed significantly from Group C, but the two clinical groups did not differ from each other. The greatest difference was on Social Life, where the clinical groups scored more than three times as high as the control group. Parents did not report impacts generalized to their marriages or to the other children in their families. On related measures, means across groups did not differ significantly for the Hassles scale but did for the PSI Child Domain. Both Groups E and A reported significantly greater stress than Group C on the PSI Child Domain, and Group A scored significantly higher than Group E. ANOVAs were conducted for each of the six PSI Child Domain subscales, and scores differed significantly across groups for each. Group E scored significantly higher than Group C on five scales; the exception was Acceptability of Child to Parent, which was also the only scale where Group A scored significantly more negatively than Group E. Group A scored significantly

T a b l e II. P a r e n t

Completed Measures of Stress, Impact, and Well-Being, by Diagnostic Group ( N = 64)

Measure I.

Child-related stress and impact Social Life FIQ: Negative Feelings--Parenting FIQ: Positive F e e l i n g s - - - P a r e n t i n g FIQ: F i n a n c e s FIQ: Marriage (n = 60) FIQ: Siblings (n = 46) Parenting events: Hassles (n = 5 7 ) FIQ:

PSI: C h i l d D o m a i n (n = 61)

Group C

Group E

Group A

ANOVA

4.5 a 8.4 a 15.4 a 4.0 4.6 4.8 46.5 a 104.0 a 25.5 a 14.1 a 20.3 a 10.2 a 24.0 a 9.7 a

15.3 b 12.5 b ll.3t, 3.9 6.5 6.9 55.4 b 130.6 b 31.8 b 16.3 a 26.4 b 12.8 b 31.1 b 12.1 b

16.0 b 10.9 b 10.2 b 5.8 5.4 6.9 52.2 143.2 c 34.7 b 21.6 b 28.2 b 14.0 b 31.8 b 12.9 b

15.56 b 8.25 b 0.91 1.94 0.85 2.61 22.340 13.28 b 17.10 b 11.21 b 9.28 b 17.37 b 4.07 d

121.3 a 21.6 29.5 a 8.4 102.3

131.0 18.7 26.1 b 8.5 96.0

136.4 b 20.4 27.0 7.5 104.2

2.85 1.67 2.21 0.14 0.95

Adaptability Acceptability to parent Demandingness Mood Distractability/hyperactivity Reinforces parent II. Parent-related stress and parental well-being PSI: P a r e n t D o m a i n (n = 61)

Parenting efficacy Parenting satisfaction B e c k D e p r e s s i o n I n v e n t o r y (n = 56) D y a d i c Adjustment Scale (n = 5 6 )

5.83 c

aNote: Means with different subscripts differ significantly a t / 4 < .05. F I Q = F a m i l y Impact

Questionnaire; PSI-Parenting Stress Index; A N O V A bp < .001.

~p

< .01. < .05.

= Analysis of variance.


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higher than G r o u p C on all six scales. Because of the consistency in these findings, we will use only the PSI Child Domain for further analyses. Table III shows correlations between FIQ factors and the other measures of stress and adjustment. The relationships between FIQ factors and the PSI were high; the FIQ Social Life scale, measuring impact, and the PSI Child Domain, measuring stress, appear to be tapping very similar dimensions. The other FIQ scales were also significantly related to PSI Child, but not as highly.

Parent General Stress and Adjustment The M A N O V A across groups on the five scales that assessed parent-related stress and well-being did not approach significance, F (10, 90) = 1.08, n.s. Despite this we conducted one-way A N O V A s for exploratory purposes; none was significant. Table II shows the means scores across the three groups for these five scales, and F values for one-way ANOVAs.

Dependent Measures and Demographics The stress and adjustment measures were not related to demographic variables. Data from the three groups were combined, and the 13 dependent measures were correlated with eight demographic variables: child age, child sex, birth position, mother age, father age, number of siblings, socioeconomic status, and income. Only six of these 104 correlations were significant at p < .05, about the number that would be expected by chance.

Table III. Correlations Between FIQ Factor Scores and O t h e r Parent and Family Me a s ure s a

1, 2. 3. 4. 5. 6.

FIQ factors

PSIC

PSIP

HASS

EFFIC

SATIS

BDI

DAS

Social life Negative feelings about parenting Positive feelings about parenting Finances Marriage Siblings

.84 b .45 b -.44 b .42 b .36 d .500

.470 .54 b -.32 c .40b .32 c .28

,45 b .32 c -.09 .31 c .27 c .28

-.07 -.12 -.12 -.02 -.05 -.22

-.31 c -.470 .36 d -.24 -.17 -.34 c

.09 .17 -.14 .33 c .16 .15

-.22 -.08 -.04 -.18 -.36 d -.29

aFIQ = Family Impact Questionnaire; PSIC = Parenting Stress Index Child D oma i n; PSIP = Parenting Stress Index Parent Domain; HASS = Hassles Score; E F F I C = efficacy; SATIS = satisfaction; BDI = Beck Depression Inventory; DAS = Dyadic A d j u s t m e n t Scale. < .001. < .05. < .01.

bp

~p

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Correlations with Parent CBCL As an alternative to analyzing by diagnostic group, we combined the three groups and examined the relationship between child behavior problems and parental adjustment by correlating broadband CBCL scores with the 13 dependent measures. As shown in Table IV, Externalizing t-scores related to a number of the child-related stress variables and, to a lesser extent, to parental well-being. However, Internalizing t-scores also related significantly to the same child-stress variables, and higher Internalizing scores also related to more parent-related stress, lower parenting satisfaction, and more signs of depression. Parents' Externalizing and Internalizing t-scores were highly correlated, r(61) = .65, p < .001. Correlations with Teacher CBCL The diagnostic groups were formed primarily based upon parent CBCL scores and the adjustment measures were completed by parents, thus introducing the potential problem of shared method variance. We therefore

Table IV. Parent and T e a c h e r C B C L Scores Correlated with A dj us t me nt Measures a Child Behavior Checklist Parent (N = 64) Measure I. Child-related stress and impact FIQ: Social FIQ: Negative feelings FIQ: Positive feelings FIQ: Finances FIQ: Marriage FIQ: Siblings Par en ting Events: Hassles PSI: Child D o m a i n II. Paren t-related stress and well-being PSI: Parent D o m a i n Paren ting Efficacy Paren ting Satisfaction Beck Dep ressio n Inventory Dyadic A d j u s t m e n t Scale

T e a c h e r ( N = 44) b

Ext.

Int.

Ext.

Int.

.57 c .38 d -.31 e .11 .32 e .23 .43 c .57 c

.45 d .28 e -.43 c .24 .18 .12 .27 e .59 c

.61 c .57 c -.36 e -.12 .25 .31 .30 .59 c

.41 e .27 -.54 c -.16 -.10 .06 .31 .53 c

.26e -.25 e -.21 .14 -.25

.44 c -.08 -.31 e .38 `/ -.23

.21 -.11 -.21 -.05 .04

.19 .06 -.13 -.14 .39 e

aCBCL = Child Behavior Checklist; Ext. = Externalizing; Int. = Internalizing; F IQ = Family I mp act Questionnaire; PSI = Parenting Stress Index. bNot available for autistic group. < .001. < .01. ep < .05.

~p


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examined the relationships between teacher CBCL scores and parent adjustment measures. Teachers' and parents' Externalizing CBCL scores were significantly correlated, r (35) = .59, p < .001, but Internalizing scores were not, r (35) = .26, n.s. Table IV indicates that the teachers' Externalizing scores correlated significantly with the same four parent-completed measures of child-related impact and stress that differentiated diagnostic groups in the ANOVAs (FIQ Social Life, Negative and Positive Feelings About Parenting, and PSI Child Domain). For teachers also, Externalizing and Internalizing scores were highly correlated, r (35) = .58, p < .001, and Internalizing scores showed a pattern of relationships with parent measures similar to the Externalizing scores.

DISCUSSION Two sets of findings are of primary interest from this study of impact and stress in families of children with externalizing behaviors, autism, and no significant behavior problems: comparisons across diagnostic groups, and comparisons among measures. First, parents of children with externalizing behaviors reported greater negative impact (on social life and feelings toward parenting) less positive feelings toward parenting, and higher childrelated stress than parents of normally developing children. Moreover, parents of externalizing children reported comparable levels of stress and impact to those reported by parents of children with autism, an objectively much more disabling condition. In studying the impact on families of young children with externalizing behaviors, we sought two control groups to anchor the continuum. For one end we selected a control group where neither parents nor teachers indicated any serious difficulties. For the other end, we chose the pervasive developmental disorder, autism. We expected impact scores for families with externalizing children to fall somewhere in between these anchors. In fact, they generally were indistinguishable from the autism group. It may be, though, that other measures would distinguish the two conditions (e.g., pessimism about the future). Directly asking parents about the perceived impact of their child on their families produced similar outcomes to a measure of child-related stress, the Parenting Stress Index. Although impact and stress are conceptually different, respondents apparently perceive negative impact and stress in much the same way. Indeed, the correlation between the 47-item PSI Child Domain and the much shorter (ll-item) FIQ factor 1 (Social Life) was quite high. Other FIQ factors, however, such as Positive Feelings Toward Parenting, Financial Impact, and Impact on Siblings, contributed useful information about additional dimensions of impact (or stress).

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One possible confound is that parents completed not only the measures of stress but also the CBCL, primarily used to classify children into the normally developing and externalizing groups. However, CBCL scores obtained from the children's teachers also related significantly to these parent stress measures, increasing our confidence in an association between actual child behavior and parent reports of stress and impact. In contrast to findings by Rodrigue et al. (1990) with families of children with Down syndrome or autism, we did not find disorder-specific impact. Families of children with externalizing behaviors or autism generally scored about the same on each measure. Moreover, within the externalizing group, parent-reported Internalizing CBCL scores had essentially the same relationship to the dependent measures as did the Externalizing scores. Although this requires further study with more diverse measures, these findings imply that, at least in the preschool years, various childhood behavior disorders may affect families in similar ways. Perhaps the stress that parents are reporting is related to their perceived coping abilities, regardless of the specific child behaviors they are coping with. The impact on families of children with externalizing behaviors may be only partly accounted for by child's behavior per se. Attributions about the child's behavior also may increase parents' levels of stress. Externalizing preschoolers rarely receive a clear diagnosis. Hence, unlike in the case of children with autism or other handicapping conditions, where the disruptive behavior is attributed t o low intelligence or the disorder ("He's autistic"), externalizing children's disruptive behavior is easily attributed--by parents themselves as well as others---to child intentions and childrearing deficiencies ("He's mean. Why don't they control him?"). An advantage to parents who join A D D associations, in addition to the mutual support offered, is that an explicit diagnosis is acknowledged. Also, recognizing similar difficulties in other children with this diagnosis may lead parents to alter their attributions about causality and consequently reduce the magnitude of stress they experience. Levels of stress or impact also may be influenced by the services available to the family. Preschool children with autism or other developmental disabilities increasingly have access to special programs, often with parent involvement and support. The autistic group in this study had been receiving special services. By contrast, our externalizing families had children enrolled in regular preschools, and in most cases were having those children formally assessed for the first time. The services available to families with autistic children may have reduced the level of stress and negative impact experienced by these parents. We should note, however, that our sample's average PSI Child Domain score (143) was above the score (139) reported


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in Abidin's manual for parents of older (mean age 9.7 years) children with autism (Abidin, 1990). A second finding of note is that the increased stress in these families with preschool children was primarily child-related. The measures of stress that were not as closely linked to the children's behavior did not differentiate the groups. This finding conflicts with studies of families that typically involved older school-aged children diagnosed with ADHD cited above; these found reports of heightened stress on the PSI Parent Domain, lower efficacy and satisfaction in the parenting role, higher levels of maternal depression, and lower marital satisfaction. Too, Abidin's families of older children with autism noted above had much higher average Parent Domain scores (159) than did our sample (136). To be sure, there is also evidence that marital conflict relates to adjustment in toddlers (Reid & Crisafulli, 1990), and that high PSI Parent Domain scores obtained in infancy predicted greater child behavior problems 41/2 years later (Abidin, Jenkins, & McGaughey, 1992). This returns us to the interactive process between child and parent behavior. A disturbed family system in the early years will likely take an early toll on the child. We speculate that in a reasonably well-adjusted family, however, there may be a cumulative process, with stress focused in the early years on difficulties posed by the child and progressively generalizing to the family system if the child's problems have not been reduced. One implication of these findings is the need for early identification and intervention for preschool children with high levels of externalizing behaviors. There is mounting evidence that these problems persist, and that the children are at heightened risk for behavior disorders in elementary school (Campbell & Ewing, 1990; Campbell, Breaux, Ewing, & Szumowski, 1986; Egeland, Kalkoske, Gottesman, & Erickson, 1990; Hinshaw, 1992). Although parent-training programs for externalizing preschoolers focusing on child behavior management strategies have demonstrated short-term effects (Erhardt & Baker, 1990; Pisterman et al., 1989), there is still scant evidence for long-term benefits. Parent-training programs in general provide some evidence for what Griest and Forehand (1982) called "family generalization," or improvement on measures of family well-being following participation in intervention programs (Baker et al., 1991; Johnston, 1989; Karoly & Rosenthal, 1977; Webster-Stratton, 1985). If parent-training programs are broadened to include an emphasis on parents' stress and coping, family well-being may be further increased (Dadds, Schwartz, & Sanders, 1987). Lowering family stress may enhance and maintain changes in child behavior following interventions, as high parental stress can interfere with carrying out a behavior m a n a g e m e n t program (Baker, et al., 1991; Maddux, Eyberg, &

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F u n d e r b u r k , 1989). F u r t h e r study is n e e d e d to d e t e r m i n e how p a r e n t a l distress develops in r e l a t i o n to child b e h a v i o r p r o b l e m s a n d how early child a n d family i n t e r v e n t i o n s m i g h t alter the process.

APPENDIX Child's N a m e : Date:

Family Impact Questionnaire-R B e i n g a p a r e n t c a n b e difficult, a n d c h i l d r e n have d i f f e r e n t effects o n the family. W e w o u l d like to k n o w what i m p a c t y o u r child has h a d o n the family c o m p a r e d to the i m p a c t o t h e r c h i l d r e n his/her age have o n t h e i r families. T h e following q u e s t i o n s a t t e m p t to u n d e r s t a n d c h i l d r e n ' s i m p a c t o n d i f f e r e n t a r e a s o f family f u n c t i o n i n g . Please check the category t h a t best describes y o u r s i t u a t i o n in t e r m s of how things have b e e n in g e n e r a l for y o u with r e f e r e n c e to the child w h o is p a r t i c i p a t i n g in the p r o g r a m . Your feeelings and attitudes about your child COMPARED TO CHILDREN AND PARENTS WITH CHILDREN THE SAME AGE AS MY CHILD . . . 1. My child is more stressful. 2. I enjoy the time I spend with my child more. 3. My child brings out feelings of frustration and anger more. 4. My child brings out feelings of happiness and pride more. 5. When I am with my child, I feel less effective and competent as a parent. 6. It is easier for me to play and have fun with my child. 7. My child's behavior bothers me more. 8. My child makes me feel more loved. 9. I feel like I am working alone in trying to deal with my child's behavior.

_

_

Somewhat

Very much

Impact of Young Externalizing Children on Their Families 10. My child m a k e s m e feel more energetic. 11. I feel like I could be a better parent with m y child. 12. My child m a k e s m e feel m o r e confident as a parent. 13. I feel like I should have better control over his/her behavior. 14. My child does what I tell him/her to do most of the time. 15. I feel like I know how to deal with my child's behavior most of the time. T h e impact of your child on your social life COMPARED TO CHILDREN AND PARENTS WITH CHILDREN THE SAME A G E AS M Y C H I L D ... 16. My child's behavior embarrasses me in public more. 17. My family avoids social outings m o r e (e.g., restaurants, public events) because of his/her behavior. 18. It is m o r e difficult to find a baby-sitter to stay with him/her. 19. My family visits relatives and friends less often than I would like to because of my child's behavior. 20. My child interferes m o r e with my opportunity to spend time with friends. 21. I feel m o r e tense when my family goes out in public, because I am worried about his/her behavior. 22. I need to explain my child's behavior to others more. 23. I participate less in c o m m u n i t y activities because of my child's behavior. 24. I have guests over to our house less often than I would like to because of my child's behavior. 25. I take my child shopping and on errands less. T h e financial impact of your child COMPARED WITH OTHER CHILDREN M Y C H I L D ' S A G E ...

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26. T h e cost of raising my child is more. 27. T h e cost of child care is more. 28, T h e cost of food, clothes and/or toys is more. ~.9. T h e cost of h o m e alterations and/or fixing and replacing items in the h o m e is more. 30. T h e cost of medication, medical care and/or medical insurance is more. 31. T h e cost of educational and psychological services is more. 32. T h e cost of recreational activities (e.g., music, swimming, gymnastics) is more. IF Y O U A R E M A R R I E D C O M P L E T E T H E F O L L O W I N G SECTION. O T H E R W I S E SKIP T O Q U E S T I O N N U M B E R 40. T h e impact of your child on your marital relationship C O M P A R E D T O P A R E N T S W I T H CHILD R E N T H E S A M E A G E AS M Y C H I L D ... 33. My spouse and I disagree m o r e about how to raise this child. 34. My spouse is m o r e supportive of the way I deal with my child's behavior. 35. This child pits my spouse and me against each other more. 36. Raising this child has brought my spouse and m e closer together. 37. My child causes m o r e disagreements between my spouse and me. 38. My spouse is less supportive of the way I deal with my child's behavior. 39. Raising this child has pushed my spouse and m e farther apart. IF Y O U H A V E O T H E R C H I L D R E N , C O M P L E T E THIS SECTION. O T H E R W I S E SKIP T O Q U E S T I O N N U M B E R 49. T h e impact of your child on his/her siblings COMPARED WITH OTHER CHILDREN M Y C H I L D ' S A G E ...


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40. The other children in the family help take care of him/her more. 41. My child prevents his/her siblings from participating in activities more. 42. The other children in the family complain about his/her behavior more. 43. The other children in the family feel more embarrassed by his/her behavior. 44. My child is more rejected by his/her siblings. 45. The other children in the family invite friends over to the house less often because of his/her behavior. 46. The other children in the family enjoy spending time with him/her more. 47. My child uses his/her siblings' toys without asking permission more. 48. My child breaks or loses his/her siblings toys more.

I

1

General Questions 49. Compared with other children my child's age, the degree of difficulty living with him/her is:

Much Easier

Easier

Slightly Easier

About the Same

Slightly More Difficult

More Difficult

Much More Difficult

50. Compared with other children my child's age, the impact of my child on our family is:

Much Less Positive

Less Positive

Slightly Less Positive

About the Same

Slightly More Positive

More Positive

Much More Positive

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