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Assessment of Parenting Stress and the PSI-4 SF

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1 Assessment of Parenting Stress and the PSI-4 SF

2 Parenting Stress A set of processes that lead to aversive psychological and physiological reactions arising from attempts to adapt to the demands of parenthood Stress in the parenting role is distinct from the stress arising from other roles and experiences such as the workplace, unfortunate events, and interpersonal relationships with other family members and friends and it is likely that parenting stress more strongly affects parenting bx and children’s development than does stresss in other domains of life. 2 major studies exemplify this: *one study (Goldberg et al., 1997) followed development of a group of children (some who had chronic illnesses), parenting stress was the strongest predictor of children’s emotional and behavioral problems at 4 years of age *another studied a group of homeless families who were at risk for problems in mental and physical health due to the many sources of stress that they faced in their daily lives and it was those parents with the highest levels of parenting stress that had children with the highest leveles of problems in their cognitive and social development. *A core feature in any theory of parenting stress is the idea of a balancing act between the parent’s perceptions of of the demands of the role and access to available resources fro meeting those demands. Parenting stress arises when the parent’s expectations about the resources needed to meet the demands of parenting are not matched by available resources. *Demands: The demands of parenting are many and vaired and involve adapting to the child’s uniqu attributes as welll as the social role of parenthood. The demands include meeting children’s needs for survival (food, shelter, protection) and psychological demainds for attention, affection, and help in controlling or regulating emotions *Resources: resources for parents are similarly diverse and include a host of mental and physical factors such as adequate protections for survival, knowledge, feelings of competence, and instrumental and emotional support from others. *Much of the research has focused on families seeking help from mental health professionals for such problems as parental depression or child attendtion deficits, but all parents experience parenting stress to some degree. *This definition is simple but encompasses that parenting stress involves a broad set of complex, dynamic processes linking the child and their behavior, perceived demands of parenting, parenting resources, physiological reaction to the demands of parenting, qualities of the parent’s relationships with the child and other family members, and links with other people and institutions outside of the home.

3 Theories of Parenting Stress
Causes and Effects: Theories of Parenting Stress There are 2 predominant approaches to assissing and testing the causes and effects of parenting stress. They are what Deater-Deckard calls the parent-child-relationship theory and the daily hassles theory. They are not opposing or competing theories, but instead are alternative and complementary perspectives about the nature of parenting stress.

4 Parent-Child-Relationship (P-C-R) Stress
P=those aspects of parenting stress that arise from within the parent C=those aspects of parenting stress that arise from the child’s behavior R=those aspects of parenting stress that arise within the parent-child relationship The most widely tested throry of parenting stress consists of 3 separate components… These 3 domains of parenting stress cause deteriorations in many aspects fo the quality and effectiveness of parenting bx and can include decreases in expressions of warmth and affection, increases in harsh methods of discipline and expressions of hostility toward the child, less consistency in parenting bx, or complete withdrawal from the parenting role. In extreme cases this can be defined as child maltreatment, abuse, and/or neglect) and this in turn increases emotional and bx problems in the children. PCR theory predicts that there are bi-directional parent effects on the child and child effects on the parent. In a positive sense, as parenting stress decreases, parenting will improve and so will the child’s social-emotional well-being

5 Daily Hassles (DH) Theory
Complements and extends P-C-R Theory Cumulative effect of daily stressors Effects are serious in more extreme forms Creates potential threat to parent’s identity or role Understanding how parenting stress develops over time, how it influences parenting and child development, and how is affects the parent’s psychological and physical health requires consideration of the the typical stress that arises for most parents on a daily or weekly basis. Parents must learn to cope with the day-to-day stressors of child rearing. Adaptation is key. For most parents, the stress is relatively easy to manage, however, when coping is ineffective, the effects of minor daily stressors on the parent and child can become persistent and powerful. *Daily parenting hassles are not major stressors such as divorce or losing a job. Their effects, however, build over time and include things like dealing with a child’s minor misbehavior or problems, mundane tasks of childcare and dealing with the conflicting schedules of work and family life. Parenting stress, however, must be distinguished from daily annoyances experienced by all parents. IN order for daily hassles to truly be a part of parenting stress their effects must be serious and create a potential threat to parent’s identity or role. The differentiation is complex when considering the effect that daily hassles have on different parents. For example, consider the common situation of a child’s unwillingness to wear what her mother wants her to. To one mother, this bx may be seen as a sign of her daughter’s stubbornness and strongly held personal preferences, but is not connected to the mother’s perception of her own ability to parent. To another mother, this non-compliance may be perceived as just one of many indicators of her daughter’s lack of respect and intentional desire to undermine the mother’s parental authority.

6 Individual differences Stability vs. Change
Stability and Change External stressors Individual differences Stability vs. Change Adults differ from each other in the amount of parenting stress they experience as well as the factors that go along with those levels of stress. Theses individual differences appear to be fairly stable over time. Although several studies show moderate stability in parenting stress, the same studies show that a number of parents change over time and sometimes dramatically.

7 Perception, Cognition, Emotion, and Physiology
To understand the components of the complex systems of causes and consequences of parenting stress, a broader framework is needed that addresses human perception, emotion, thinking, and biological mechanisms. These components are interconnected and operate with bi-directional influences between the person and the environment, between the person and his or her attempts to cope with stress, and between the environment and these coping strategies.

8 External causal event or agent— stressor Cognitive appraisal
Four Components External causal event or agent— stressor Cognitive appraisal Coping mechanisms Stress reaction According to this framework, stress arises from an ongoing process involving at least 4 components. *external stressor—the original source of stress originates from outside of the individual. In the case of parenting stress, the agent is the child or children, but the events can be many and varied. *Once the individual notices this event or agent, he or she makes a cognitive appraisal to determine whether it is potentially aversive . *the individual then engages coping mechanisms in an attempt to reduce the negative experience surrounding this event *there are then consequential effects on the mind and body known simply as the stress reaction. There is feedback between these various components. For example, appraisals are involved in the initiation, maintenance, and evaluation of coping mechanisms, and emotional distress can itself become a stressor.

9 The Child and the Parenting Role as Causes of Stress
What makes parenting stress different from other types of stress? Chronic daily hassles Dependency Attributes of the parent Parenting role Societal expectations What makes parenting stress different from other types of stress? Theories about the causes and consequences of parenting stress are distinct from other theories of human stress because they assume the external causal event as “parenthood”. It is easy to take fro granted how intensely dependent children (and especially infants) are on their parents. This dependency represents an immediate, constant, and sometimes aversive set of demands on parents that they have not experiences before the arrival of the child. These demands are stress inducing—they have to be in order for the infant or child to survive. These demands work, in that they usually lead to physiological arousal in parents which in turn motivates parents to attend to and care for the child in order to eliminate the demand. These demands continue for years are occur on a daily basis. Furthermore, attributes of the parent including temperament, personality, emotions, beliefs, and physiology also contribute in powerful ways to the types and severity of stressors that are experienced. *The parenting role itself can be a source of distress which include threats to the parent’s identity, mental health, or general well-being—in addition to social constraints leading to isolation, uncertainty, interpersonal conflict, restricted choices, and deprived personal resources. Social issues such as whether or not a mother should work outside the home—childcare costs—divorce—father involvement, etc.

10 Appraisal Valence Controllability Changeability Ambiguity
There is much variation across people in how experiences are defined and evaluated In order for a stress reaction to follow from a causal agent or event, the parent not only must notice the stressor, but also must consider it to be a threatening or aversive experience . Appraisal of a stressor involves at least 6 dimensions: Valence—how aversive is it? Controllability—can I modify it or make it go away? Changeability—will it go away on its own? Ambiguity—what is going to happen? Likelihood that the stressor will reoccur Familiarity with the stressful situation or circumstance Parental attribution about the causes of a child’s difficult behaviors are a critical part of the appraisals involved in parenting stress. Parents who tend to view crying, whining, and misbehavior as arising from their children’s willful intentions are more likely to hold their children responsible for those noxious behaviors and to have a more pronounced stress reactions. In contrast, other parents may view their children's’ noxious behaviors as arising from temporary states or circumstances and in turn are less likely to hold their children responsible for these actions or to view these events a being difficult to handle. There are also cultural differences in what parents view as appropriate or aversive.

11 Coping Emotion-focused Problem-focused Perception of Control
Up to this point, I have discussed the source of stress and how the parent appraises the stressor. Once an event has been deemed to be potentially stressful, there are a number of cognitive, emotional, and behavioral strategies that parents can use to minimize the stress reaction. Parents in the same situation cope in different ways, and some cope better than others. Some coping mechanisms operate in a preventative way. That is, they work to reduce the stress reaction by minimizing the stressful events and by maximizing resources that can be used when stressful events occur. One example of this is preparation and planning for becoming a parent. Adults who report that they were prepared for becoming parents and that their pregnancies were planned show lower levels of parenting stress compared to those who report that becoming a parent was unexpected or unintentional. *other coping strategies are utilize din the heat of the moment. Emotion-focused ways of thinking about stressful experiences are those in which the person views herself or himself as a passive recipient of experiences or that focus on the denial of or preoccupation with aversive emotions such as fear or sadness are linked with symptoms of emotional problems including anxiety and depression. *problem-focused strategies, however, are more likely to promote problem solving as they do not involve attention to the negative emotions arising from the stress reaction. *The perception of control over the sources of stress for parents may well be tied to parents’ appraisals of whether particular instances of child behavior are aversive or not.

12 Information Processing Model of Coping
Gathering and Accumulation of Resources Objects (material goods) Conditions (status, social capital) Personal Attributes (personality) Energy (money, knowledge) Threats to Resources Conscious and Unconscious Approach and Avoidance Initial Appraisal Formulation Secondary Appraisal Feedback One model of coping is the information processing model. *First step involves a goal of gathering and accumulation or resources based on the conservation of resources theory which suggests that we are inherently motivated to gather and keep resources—things that we value most. The 4 basic categories are objects, conditions, personal attributes, and energy. Accordingly, stressors lead to psychological distress when these valued resources are placed in jeopardy, are lost, or are not gained when anticipated. Stress arises when a goal has been threatened and beliefs about why the goal is threatened and whether the threat persists become integral to the ways in which we approach dealing with the stressor. *Step 2 involves attention to and recognition of events that may threaten the goal of maintaining resources. Humans have a remarkable ability to monitor their environments for these potential threats; this attention to the environment involves both conscious and unconscious evaluation of perceptual information from various sensory systems. Consider 2 year old tantrums…one parent may take an approach goal such as striving to increase the amt of time the 2 year old is in a happy mood—this parent will be attending to and noticing good behavior and experience success in that manner whereas the parent who has an avoidance goal such as minimizing the tantrums means that the parent will be paying attention to the tantrums rather than the good behaviors. *Step 3: once a potential stressor has been perceived, an initial or primary appraisal is formulated and if this stressor is appraised to be an actual stressor, emotional arousal involving fear or anger ensues which motivates the individual to regulate that emotion and think and act in a way that will remove the stressor. *Step 4 is that a coping strategy is implemented which then involves a secondary appraisal *Step 5 is determining whether or not that coping method was successful and if not then modifying the coping mechanism

13 Information Processing Model (cont.)
Forethought Intentional Behavior Self-reflection These cognitive and emotional factors operate in cycles of forethought, intentional behavior, and self-reflection. *Forethought includes an analysis of the task at hand and what lies ahead (such as setting goals and planning) as well as beliefs (such as expectations about likely outcomes, value placed on desired outcome, and self-efficacy) *Intentional Behavior: includes attempts at self-control (such as self-instruction, imagining, focusing of attention) and self-observations (such as consciously attending to, noticing, and recording how the self is responding to a stressor). *Self-reflection involves judgments (evaluation yourself against some standard) and reactions (the ensuing satisfaction or dissatisfaction based on those judgments (such as shame, anger, happiness). This is then followed by adaptive inferences which involve highly effective alterations of goals or strategies of self-control or defensive inferences involving focusing on the avoidance of future dissatisfaction or aversive emotions. These inferences then feed back into forethoughts.

14 Social cognitions (attitudes about and feelings toward the child)
The Stress Reaction Parenting behaviors (e.g., parental discipline, maltreatment, and abuse) Social cognitions (attitudes about and feelings toward the child) Psychopathology (e.g., depression, anxiety) Biological mechanisms of stress Now that I have described stressors, appraisals, and attempts at coping, I will discuss the stress reaction itself. *The stress reaction includes a large set of physiological and psychological events and experiences that arise following a stressor. This stress reaction can be observed readily in parenting behaviors, cognitions, and emotions and we will talk further about this as the presentation progresses. Let’s talk just a little bit about the psychophysiology of the stress reaction. We continue, as a species, to be neurologically wired to attend to our environment, to detect potential sources of risk to our own survival and the survival of our offspring, and to react when those risks become critical. Example of losing child in grocery store...heart skips a beat and then began firing rapidly as panic sets in motivating you to stop whatever you are doing and find your child. This is not a presentation on biology, however, it is important to understand that there are biological mechanisms at work in the body that contribute to and complicate the stress reaction. To summarize, the individual components of the stress process are best thought of as parts of a whole mechanism that operate in real time, are dynamic in nature, and connect experiences, sensations, cognitions, and emotion

15 Parenting Stress and the Parent
Becoming a parent thrusts you into a new world of great responsibility, many challenges, and fantastic potential for personal growth. It brings with it a mixture of rewards and difficulties that can be extraordinary at times. For some, parenthood is a rocky road that involves concerns about their children, changes in relationships with partners, and declines and improvements in physical and mental health that affect functioning at home and work.

16 Parenting Stress and the Parent
Transition to Parenthood Age of Parent Gender of Parent Individual Differences Depression and Psychopathology Temperament and Personality Self-referent Social Cognitions Transition: can be joyful, exciting, and stressful. The child arrives and is dependent on parents for survival and well-being and throughout childhood presents an ever changing bundle of demands for attention and care which can result in stress to the parent. In addition, the sense of responsibility itself can be a stressor particularly for those who do not wish to be parents before or after the child is born. Parents that report that pregnancy was unplanned or unwanted are more likely to be harsh and negative in their parenting of that child. The transition to parenthood, however, is stressful for nearly every parent regardless of whether or not the pregnancy was planned and involves dramatic shifts in feelings and thinking, behavior, relationships, and lifestyle. Fortunately for most parents, this transition is fulfilling and a positive experience overall but can lead to marked distress in some parents. This is particularly true for parent are greater risk such as teenage mothers or adult victims of child abuse. Also—postpartum depression contributes to stress reactions. *Age of parents: young or old *Even within our changing society and roles, in the vast majority of 2-parent households where both parents work outside the home, the mother continues to be the primary caregiver who is responsible for the majority of daily child rearing . However, there are very small if any gender differences. For mothers and fathers alike, distress in the parenting role was more sever for those who had less income and education, less social support from their spouses, unhappier marriages, more stressful life events, harsher styles of child discipline, more traditional child-rearing attitudes that emphasized child obedience to authority, and children with more bx problems. *Connections with depression and substance abuse groups *huge range of individual variation in people’s reactivity to stressful events and how well they are able to control those reactions. *self-referent social cognitions—our way of thinking about ourselves and others related to self-efficacy and self-esteem. Ex. Parents who set and try to meet unattainably high standards in their personal lives (i.e. perfectionism) cannot possibly do so. The result is less self-efficacy and more parenting stress.

17 Parenting Stress and the Child
Some children are more difficult to care for than others, and the “child effect” on parents and their parenting stress can be equally strong.

18 Parenting Stress and the Child
Prematurity and Low Birth Weight Child Illness Developmental Disabilities and Disorders Behavioral and Emotional Problems Externalizing Problems Internalizing Problems Diagnosis, Stigma, and Blame Temperament Gender and Age *Premature and LBW—generally follow difficult pregnancies and show lasting effects in their development, ranging from mild impairments to severe and chronic disabilities.—medically at risk infants who live with distressed parents and who are in a family environment filed with conflict, rejection, and turmoil are more likely to show larger and longer lasting negative effects in their social-emotional and cognitive development. *Learning to cope as a parent of an ill or dying child is unlike any other stressful experience. It not only disrupts that daily lives of family members but threatens the most basic foundation of adults’ beliefs about their children and families—that they can protect their children from harm, that their family relationships will have years to grow and flourish, and that they will not outlive their own children. *externalizing—distractibility and attention difficulties, aggression, conduct problems, and delinquency *Internalizing—depression, anxiety *acceptance vs. denial of diagnosis *age and gender effects are very minimal

19 Parenting Behavior and the Parent-Child Relationship
Parenting stress becomes a critical public health issue when it is severe enough to put the child at risk of being harmed. Humans have a basic need to feel accepted by their caregivers, and to feel safe and protected. If the child feels rejected by his or her parents, that child is more likely to show problems in development and signs of maladjustment.

20 The Parent-Child Relationship
Parent-Child “Co-regulation” Child-rearing Practices Parenting Style Discipline Practices Child Abuse Physical Abuse Psychological Abuse Sexual Abuse The co-regulation (or shared control) of emotional states between parent and child is a critical part of the parent-child relationship and the child’s social-emotional development. *The clearest example of co-regulation in the family is the parent-cihld attachment system. Attachment promotes survival through the establishment and maintenance of an enduring emotional bond between the child and the parent. Although nearly all children develop attachment relationships, the security of those attachments varies widely *Parents who are themselves distressed and who report greater stress in the parenting role are more likely to be punitive, hostile, harsh, and rejecting in their behavior toward their children *Parenting style—research has consistently shown that children and adolescents who are more socially competent and well-adjusted live in homes in which their parents are involved, supportive, consistent, and not harsh and reactive. Authoritative parenting is defined as supportive behavior coupled with firm and consistent establishment and enforcement of rules and standards of behavior and is linked to the most positive outcomes.—Authoritarian parenting on the other hand is reactive and overly harsh. *of the many methods of child discipline, physical punishment has received the greatest attention because of its links with parental distress, child abuse potential, and child adjustment problems. *It is when beliefs about he appropriateness of harsh parenting practices are coupled with reactive anger and parenting stress that the likelihood of abuse is maximized. Thus, reducing the incidence of child abuse is not only a matter of reducing parental distress. It also requires changes in parental attitudes and beliefs, and education about alternative methods of discipline.

21 The Parent-Child Relationship
Parents’ Social Cognitions Schematic Event-dependent Knowledge, Goals, Attributions Biological Factors Psychophysiology The parents perceptions, attitudes, and appraisals of possible responses to stressors are just as important as the link between parenting stress and behavior. Much of the research on parents’ social cognitions emphasizes 2 related levels of thinking… *schematic—implicit cognition which operates outside of conscious awareness *event-dependent—explicit cognition which works at the level of conscious awareness and involves reflection and manipulation of thoughts. *In parenting, knowledge is power. Effective parenting that meets the needs of the child and leads to optimal developmental outcomes is most likely to occur when the parent has detailed knowledge and understanding of his or her child’s attributes. Parents form goals that may emphasize their own needs, the child’s needs, or the need of maintaining a positive relationship with the child—the goal that is formed can strongly determine how it is that a parent responds to a child’s behavior. *If parents believe that a child’s misbehavior is caused by a willful intention to misbehave, they are more likely to get angry and to use more reactive and harsh discipline strategies. *biological components of psychophysiology and genetics also play a role in the link between parenting stress and the parent-child relationship. Depression, for example, is implicated in parenting stress as we have discussed and leads to impaired interactions. Additionally, maternal depression and distress during pregnancy may have influences on the developing infant and thereby increase the baby’s vulnerability to stress after birth.

22 Parent and Child Effects

23 Parent and Child Effects
Bi-directionality and Causality Longitudinal Studies Experiments Quasi-experimental Designs There are indeed associations between parenting stress, parenting behavior, and children’s developmental outcomes. Most of the research in this area, however, is correlational in nature vs. demonstrative of a causal relationship. There are some studies that have attempted to determine causality… *Longitudinal studies involve repeated assessments of the same factors for the same individuals over time. Longitudinal research has provided evidence that prior levcels of parenting stress predict subsequent increases in children’s behavioral and emotional problems. They also have indicated that children’s attributes assessed at a particular point int itme, influence subsequent increases in parenting stress.

24 Family, Culture, Community

25 Family Parents as Partners Parent Gender Family Structures and Types
Single Parents Step-parent Families Gay or Lesbian Parent Families Adoptive and Foster Families Grandparents as Parents The family exists within an every-changing social, political, economic, and cultural milieu, all of which influence child rearing and it is important to consider these other influences when studying parenting and child development. *the quality of a parent’s relationship with her or his partner is a key aspect of parenting stress and coping. For most parents, this relationship serves as a primary source of comfort and support in facing the daily challenges of child rearing. Lower levels of pareinting stress are found for men and women who report greater satisfaction in their marriages. On the other hand, a marital or cohabitating relationship also serves as a major source of distress if there is conflict or disengagement in the relationship. *Men tend to be more likely to withdrew from family relationships or to become more reactive and negative when faced with parenting or family stess aresing from serious child illness or marital difficulties. In contrast, women may be more liekly to try to compensate in their parenting when their marriages are distressed in an effort to minimize the effects of marital discord on their children.

26 Community as Culture Collectivism vs. Individualism
Cultural Differences Community as Workplace Demands and Resources Community as Nation Socioeconomic Resources Family Leave and Child Care Cultural influences can operate in a number of ways in the stress process. Socialized values and conventional norms for child-rearing beliefs and behaviors can affect the kinds of stressful circumstances that parents face, the appraisals that parents make about stressors, and the resources that parents bring to bear in their attempts to cope. *collectivism: orientation of the individual toward the needs of the family and community *individualism: orientation of the individual toward self-maximization and autonomy from others *There have been a variety of theoretical approaches used to answers the question of how balancing the demands of parenthood and work influences the health and functioning of the family, the individual parent and child, and colleagues in the workplace. The demand and resource framework incorporates various factors, including individual and family background characteristics (education level), the specific demands of work and family (time required, stressors experienced), specific resources in the workplace and home (social support, control over an flexibility of works) and accommodations made by the parent to strike the work-family balance (missing work, spending less time with family).

27 Coping and Intervention

28 Coping Strategies Problem-Focused Coping Emotion-Focused Coping
Approach Coping Avoidance Coping Relationship-Focused Coping Emotional Support Normalizing Instrumental Support Empathy The most common definition of coping strategies involves a distinction between emotion and problem focused approaches and between approach toward or avoidance of the problem or stressor. They are not exclusive of one another and parents often apply multiple coping strategies simultaneously. Emotion focused strategies are effective because they alter the emotional experience of stress rather than altering or eliminating the source of the stress. They are more likely to be used if the individual believes that the stressor is out his or her control. *problem focused strategies are more likely to be used if the stressor is thought to be under some degree of personal control. One of the most important factors in successful adaptation in parenting is the availability and accessibility of instrumental (practical) and emotional support from others. *those who believe that social supports accessible and who have intimate relationships within close and supportive families show better adaptation to stress.

29 Coping Strategies Goals, Planning, Assessment, and Evaluation Individual Differences Preemptive Coping Ongoing Process

30 Intervening to Reduce Parenting Stress
Expanding repertoire of child-rearing behaviors Clinical interventions Counseling Teaching Individual Family Targets Family situation Parental functioning Child behavior To create long-term effects of reduced distress and increased satisfaction in parenting, the interventino must lead to new ways of thinking that create a lasting change in the parents’ self-efficacy and use of effective coping strategies. Also, intervnetins that address the needs and concerns of the family as a unit are more liekly to be successful.

31 Community Resources


33 Parenting Stress Model
Social Eco-Environment Parental Characteristics Child Characteristics Parenting Stress Dysfunctional Parenting Child Outcomes

34 Parenting Stress Model
Social Eco-Environment Social Isolation Relatives/Spouse Parental Characteristics Depression Sense of Competence Perceived Role Restrictions Parental Attachment Physical Health Child Characteristics Adaptability Acceptability Demandingness Mood Hyper/Distract Reinforces Parent Parenting Stress Dysfunctional Parenting Child Outcomes

35 Domain and Subscales (101 items)
Child Characteristics Parent Characteristics Adaptability Demandingness Mood Distractibility/Hyperact ivity Acceptability – Child to parent Child’s reinforcement of parent Depression/Guilt Attachment to child Social Isolation Sense competence as a parent Relationship spouse/partner Role restrictions Parental health

36 Domains and Sub scales

37 PSI – Short Form Total Score (36 items) Parental Distress (12)
Parent-Child Dysfunctional Interaction (12) Difficult Child (12)

38 Total Stress Score Designed to provide an indication of the overall level of parenting stress that an individual is experiencing It is important to remember that the Total Stress score does not take into account stresses associated with other life roles and life events and, thus, should never be interpreted as anything more than an indication of the stress level experienced within the role of parent. A parent’s Total Stress score reflects stresses reported in the area of personal parental distress, stresses derived from the parent’s interaction with the child, and stresses that result from the child’s behavioral characteristics. Parents who obtain a Total Stress score in the 91st percentile or higher are experiencing clinically significant levels of stress. These individuals should be referred for closer diagnostic study and for professional assistance.

39 Parental Distress (PD) Subscale
Determines the level of distress a parent is experiencing in his or her role as a parent as a function of personal factors that are directly related to parenting. The component stresses associated with the Parental Distress subscale are an impaired sense of parenting competence, stresses associated with the restrictions placed on other life roles, conflict with the child’s other parent, lack of social support, and depression—a known correlate of dysfunctional parenting. When the Parental Distress subscale score is the most elevated of the three subscale scores, it is recommended that the examiner further explore the parent’s personal adjustment. When a parent earns a Parental Distress subscale score above the 90th percentile and a Difficult Child subscale score below the 75th percentile, it is likely that the parent is experiencing personal adjustment problems that are at least partially independent of the parent-child relationship. The focus of professional services should be on interventions designed to assist the parent in his or her personal adjustment. Thera - peutic services designed to improve the parent’s selfesteem and sense of parental competence may prove to be most helpful in strengthening the parent-child dyad

40 Parent-Child Dysfunctional Interaction (P-CDI) Subscale
Focuses on the parent’s perception that the child does not meet his or her expectations and that his or her interactions with the child are not reinforcing to him or her as a parent. The parent projects the feeling that the child is a negative element in his or her life. Commonly, the parent’s description of the parent-child relationship reveals that the parent either sees him- or herself as abused or rejected by the child or is disappointed in and feels alienated from the child. High scores suggest that the parent-child bond either is threatened or has never been adequately established. Along with rapid intervention, further diagnostic investigation is needed. Scores in the 96th percentile or higher suggest the potential for child abuse in the form of neglect, rejection, or episodes of physical abuse triggered by frustration (DiLauro, 2004; Lacharite et al., 1999; McPherson, Lewis, Lynn, Haskett, & Behrend, 2009). When considering the risk for child abuse, the examiner should review the Total Stress and subscale scores of the PSI-4-SF. If all three subscale scores are in the 91st percentile or higher, this interpretation has greater credibility. On the other hand, if the Parental Distress subscale score is in the 75th percentile or lower, parental loss of control is not likely. If both the Parent-Child Dysfunctional Interaction and the Difficult Child subscale scores are in the 91st percentile or higher and the Parental Distress subscale score is in the 75th percentile or lower, it is likely that the parent is coping with exceptionally difficult behavior or personality characteristics in his or her child.

41 Difficult Child (DC) Subscale
Focuses on some of the basic behavioral characteristics of children that make them either easy or difficult to manage. These characteristics are often rooted in the temperament of the child, but they also may be learned patterns of defiant,noncompliant, and demanding behavior (Breen & Barkley, 1988; Goldberg et al., 1990; Johnson et al., 1984; Webster-Stratton, 1988). High Difficult Child subscale scores produced by parents of children younger than 18 months suggest that the child may have significant problems with his or her self-regulatory processes. In most instances, these difficulties are considered to be temperamentally or physiologically related. Colic or allergic reactions are typical physiological problems. High scores produced by parents of children ages 2 years and older are related to child-behavioral adjustment and to behavioral symptoms (Beg, Casey, & Saunders, 2007; De Bruyne etal., 2009; Mantymaa, Puura, Luoma, Salmelin, & Tamminen, 2006). In these families, parents are typically experiencing difficulty in managing the child’s behavior in terms of setting limits and gaining the child’s cooperation. In extreme cases (i.e., scores in the 96th percentile or higher), further diagnostic investigations are needed to rule out the presence of significant psychopathology. Regardless of the cause of the problem, parents who produce high scores on the Difficult Child subscale usually need professional assistance. If the Difficult Child subscale score is in the 90th percentile or higher and the other two subscales scores are in the 75th percentile or lower, then intervention in the form of short-term parental consultation or a parent education class focused on management strategies should be sufficient to improve the situation. If, on the other hand, the Parental Distress subscale score is in the 75th percentile or lower but the other two subscale scores are in the 91st percentile or higher, a more intensive child-oriented intervention program, which should include careful diagnostic assessment of the child’s behavioral adjustment and functioning, is required (Barkley et al., 1988).

42 Defensive Responding Scale
Assesses the extent to which the respondent approaches the questionnaire with a strong bias to present the most favorable impression of himself or herself or to minimize indications of problems or stress in the parent-child relationship. An extremely low Defensive Responding score—a raw score of 10 or lower—suggests one of three hypotheses. 1. The parent is trying to portray him- or herself as a very competent individual who is free of the emotional stresses normally associated with parenting. 2. The parent is not invested in the role of parent and, therefore, is not experiencing the usual stresses associated with caring for a child. 3. The parent is, in fact, a very competent individual who handles the responsibilities of parenting well and has excellent relationships with others, including his or her spouse. The Defensive Responding score by itself does not indicate which of these working hypotheses is most likely to be true. However, when the score is examined in relation to other information obtained about the individual, the examiner can usually pinpoint the most likely explanation. The first hypothesis is the likely explanation when the parent is unable to acknowledge the frustrations, annoyances, and pressures of parenting. The parent may be an overcontrolled individual who denies the reality that parenting is difficult work. The second hypothesis is the likely explanation whenthe parent is not involved with the routine care of the child and is unaware of the child’s illness history, food preferences, and fears and likes. Parents who fit the third hypothesis are often those in helping or education professions who also have sufficient economic resources to make parenting and life easier. Typically, they have had significant experience working with children and consider child care a primary family value. These parents are in families with a strong parenting alliance and child focus; they are mentally well adjusted, with good self-esteem, and they project comfort in the role of parent.

43 Validity Long form: manual refers to >250 studies documented on the PAR website Short form: manual uses the correlations between PSI-4 and PSI-4 SF to support validity Validity of the PSI-4-SF The correlations between the PSI-4-SF and the fulllength PSI-4 for the PSI-4 normative sample are presented in Table 21. The correlation between the Total Stress scale of the full-length PSI-4 and the Total Stress scale of the PSI-4-SF was .98, which is exceptionally high. The pattern of correlations suggests that the Parental Distress subscale score was highly correlated with the Parent Domain score of the full-length PSI-4 (r = .94), an expected result, as the Parental Distress subscale consists of items derived from the Parent Domain subscales. Likewise, the Difficult Child subscale score was highly correlated with the Child Domain score of the full-length PSI-4 (r = .95), as the Difficult Child subscale was derived from the Child Domain subscales. The correlations between the Parent-Child Dysfunc tional Interaction subscale and the Child Domain and Parent Domain scores of the full-length PSI-4 were .91 and .82, respectively. These slightly lower correlations were also expected, because the Parent-Child Dysfunc tional Interaction subscale contains items from both the Child Domain and the Parent Domain. Given its brevity, the PSI-SF has gained popularity with clinicians and researchers alike. Because it is a direct derivative of the full-length PSI, it likely will match the full-length PSI in validity. See chapter 5 for a summary of the validity research performed with the full-length PSI.

44 Uses of the PSI Screening/Triage Assessment Planning/Focus
Treatment Planning and Evaluation Research

45 Interpretation Literal Clinical cutoff (90% ile)
Profiles – Relative elevations Computer generated interpretive reports

46 Validity With Different Cultures
Translated into 42 languages Normed and published 10 countries Multiple replications of factor structure Replications of predictive studies

47 Prediction and Association to Observed Behavior and Objective Criteria
Warmth and sensitivity Parental intrusiveness Parental negativity, hostility, rejection Child development, child behavior objective criteria

48 Intervention Studies Early termination of treatment Treatment outcomes
Non-adherence to medical treatments

49 Topically Arranged PSI References (1983 – 2011)

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