Warfield M E, Krauss M W, Hauser-Cram P, Upshur C C, Shonkoff J P
Department of Pediatrics, University of Massachusetts Medical Center, Worcester 01655, USA.
J Dev Behav Pediatr. 1999 Feb;20(1):9-16. doi: 10.1097/00004703-199902000-00002.
This study documents the extent to which child-related and parenting stress vary during the early childhood period among mothers of children with developmental disabilities. The degree to which specific aspects of the family environment predict stress levels measured at age 3 years and 5 years, after controlling for child characteristics and family income, is also investigated. The Parenting Stress Index was completed by 79 mothers of children with developmental disabilities at three time points: (1) within 1 month of the child's entry into an early intervention program (T1); (2) within 1 month of the child's third birthday (T3); and (3) within 1 month of the child's fifth birthday (T5). Data on child characteristics and family income as well as measures of the family environment (i.e., negative life events, cohesion, and family support) were gathered at both T1 and T3. Repeated measures analysis of variance was used to assess whether there was significant change in the child-related and parenting stress scores across the three time points. Two sets of hierarchical regression equations were also analyzed. The first examined which child, family, and family environment characteristics assessed at T1 predicted stress at T3. The second identified the predictors of T5 stress based on independent variables measured at T3. Child-related stress increased significantly across the three time points, whereas parenting stress remained fairly stable. By age 5 years, one-third of the mothers had child-related stress scores above the clinical cutoff point. Regression analyses revealed the importance of the family environment in predicting both stress outcomes. The only statistically significant predictor of child-related stress at T3 was family cohesion, whereas parenting stress at T3 was predicted by income, cohesion, and family support. The predictors of both child-related and parenting stress at T5 were the same. Greater family cohesion and fewer negative life events predicted lower stress scores at T5. The significant increase in child-related stress during the early childhood period warrants attention by pediatricians, educators, and other professionals who must evaluate the needs of families of children with disabilities for supportive services. Aspects of the family environment were shown to be critical and consistent determinants of both child-related and parenting stress throughout the early childhood period. This finding suggests that pediatricians, in particular, must assess more than simply the diagnosis or the cognitive impairment of the child with a disability to make informed decisions about the frequency with which they should see particular families and whether referral to other services is necessary.
本研究记录了发育障碍儿童母亲在幼儿期与孩子相关的压力和育儿压力的变化程度。在控制孩子特征和家庭收入后，还研究了家庭环境的特定方面对3岁和5岁时测量的压力水平的预测程度。79位发育障碍儿童的母亲在三个时间点完成了育儿压力指数：（1）孩子进入早期干预项目后1个月内（T1）；（2）孩子三岁生日后1个月内（T3）；（3）孩子五岁生日后1个月内（T5）。在T1和T3收集了孩子特征、家庭收入以及家庭环境的测量数据（即负面生活事件、凝聚力和家庭支持）。采用重复测量方差分析来评估在这三个时间点与孩子相关的压力和育儿压力得分是否有显著变化。还分析了两组分层回归方程。第一组考察在T1评估的哪些孩子、家庭和家庭环境特征可预测T3时的压力。第二组根据在T3测量的自变量确定T5压力的预测因素。在这三个时间点，与孩子相关的压力显著增加，而育儿压力保持相当稳定。到5岁时，三分之一的母亲与孩子相关的压力得分高于临床临界值。回归分析揭示了家庭环境在预测两种压力结果方面的重要性。在T3时，与孩子相关压力的唯一具有统计学意义的预测因素是家庭凝聚力，而T3时的育儿压力则由收入、凝聚力和家庭支持来预测。T5时与孩子相关的压力和育儿压力的预测因素相同。更高的家庭凝聚力和更少的负面生活事件预测T5时压力得分更低。幼儿期与孩子相关的压力显著增加值得儿科医生、教育工作者和其他必须评估残疾儿童家庭对支持性服务需求的专业人员关注。家庭环境的各个方面被证明是整个幼儿期与孩子相关的压力和育儿压力的关键且一致的决定因素。这一发现表明，特别是儿科医生，在就应看望特定家庭的频率以及是否需要转介到其他服务做出明智决策时，必须不仅仅简单评估残疾儿童的诊断或认知障碍。
